There is a strange idea that it’s “cynical” and “dishonest” to be skeptical of the claim that (a) a new entitlement will be created (b) that will lead to more medical services being consumed by more people and (c) that this regime will save costs as promised without rationing, particularly rationing aimed at reducing care for the elderly. The last piece is the only way. Otherwise we’ll have more healthcare spending even than we do today. Some have called the bureaucrats who will make this decision “death panels,” which means many things, but includes the promotion of best practices that show little regard for the elderly and their welfare and also paying doctors for suggestive counseling to the elderly for “nonresuscitation” and other death-accelerating measures.
But consider Obama’s own statement to the NY Times in an April 28 issue.
THE PRESIDENT: Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —
INTERVIEWER: Yes, where it’s $20,000 for an extra week of life.
THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.
So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.
And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.
I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.
INTERVIEWER: And it’s going to be hard for people who don’t have the option of paying for it.
THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
INTERVIEWER: So how do you — how do we deal with it?
THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.*
Let’s parse this out. First, it’s a “democratic conversation,” which is another way of saying this will be a matter for law and bureaucrats and politicians. But that’s not enough, there also must be “some independent group.” Typically this means a blue-ribbon panel that does the things politicians can’t or won’t do. Hmm, a panel deciding on difficult issues of “end of life care” with an eye to social utility and saving costs. It is perfectly reasonable to call them Death Panels. Sure, it’s rhetoric. But it’s useful, evocative rhetoric. Their goal is to save money by making people die before they cost too much and also to tie us all collectively to the mast not to treat them through a combination of best practices recommendations and high pressure tactics to get people to sign limitations on future care. The whole thing is downright pagan in its apotheosis of the society and disregard for the individual and his welfare.
Now, I don’t disagree that people getting health care from the public should not be able to spend extravagantly to take each and every heroic measure there to prolong life. It’s not morally required for them, nor for the doctors or for the broader society. That said, it is a dangerous thing for society to throw away it’s weakest, and more dangerous still to corrupt those in the caring professions to undertake this task. Consider that the “end of life” care has become a bit of a business. There are already financial incentives for hospices to accelerate death, and many do, essentially starving and dehydrating patients to death before the limited compensation from Medicare runs out. It would be worse to bring this perverse ethic to the entire medical establishment.
It’s perhaps understandable that younger and uninsured patients would like the idea of government health care, as the current regime of high nominal prices, anxiety, and untreated minor problems is extremely inconvenient and stressful for them. But what is Obama offering seniors–one of the most powerful lobbies with one of the most gold-plated and expensive entitlements there is–to support his plan? It’s they who seem the most pissed off at these town meetings, and understandably so, because Obama’s plans would create a wedge of distrust between provider and patient. Socialized medicine does this by rendering a doctor more concerned for saving costs for the “system” than he is for patient welfare. And while medicine includes many worthy and caring people, I’ve not known too many doctors that work for free, nor those that will fight the system if it means going broke. Over time, especially the newer ones, will be coopted and corrupted.
Some distrust already exists on financial matters through the Byzantine and insulting medical billing practices. We all think, “Oh crap, how much is this gonna cost me,” even when we’re insured. How much worse, though, will it be when the distrust relates not to bills and paperwork but to your health. The doctor today get paid more when he tries to fix you; if anything, you have to spend some time each visit fending off his overly cautious suggestions that also happen to earn him fees. “OK. OK. Doc, I’ll get it done, next time.”
It will be one more major destructive event in the history of liberalism if the medical profession too is ruined by destroying its essential character of doctor-patient trust by creating financial and legal mandates for doctors to harm their patients.
* Man, this guy really is always looking to throw Grandma in front of the bus, huh? First, he was pissed she was scared of black criminals in his teens and brought it up to defend the nutty Reverend Wright. Now he thinks she should have waited in agony to die with a broken hip. Oh yeah, I would have paid to help her, sure I would have.
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Well said, Mr. Roach. In my view, however, there is a bigger picture that the public needs to digest. America has fallen into the clutches of Statists, i.e., those who see the State as the Supreme Being and who see the Ruling Elite as its only legitimate representative. The Statist holds that the U.S. Declaration of Independence and the U.S. Constitution are subordinate to the State and thus must be interpreted to mean whatever the ruling elite says they mean. The Statist believes that personal freedom, personal choice, and personal rights all flow from the State, and that there simply is no such thing as a God-given, inherent, or inalienable right. In the Statist’s mind, all rights, all power, and all authority reside in the State, and all of the inhabitants of the land must yield to such rights, power and authority. For more on this, I would urge you and your readers to visit: http://socalviewpoint.wordpress.com/.
–Mr. Narrator.
This is one of the most important elements of choice lost in the socialization of health care. In the current system, you don’t necessarily have an either/or choice. You can save both Granny and Junior, and the aggregate result is a higher percentage of national GDP devoted to health care.
Tie health care spending directly to tax revenues, however, and suddenly you have a much more finite resource. Whereas before you had three choices, a) save Granny and sacrifice Junior to keep costs within budget, b) save Junior and sacrifice Granny to keep costs within budget, or c) save both of them and spend more on health care, now you are limited to only choices A or B.
I think we’ll save both for a time, since neither party has shown any will to control the budget. Costs and spending will skyrocket. Care will stay about the same, but more people will get it. Then one day the Chinese will tell us: save both, and your lifeline is cut. That’s when we really really lose our national independence and personal independence. It will be like Egypt under British receivership
due to a debt crisis in the late 19th Century
My only hope for the Obama presidency is that it whips the GOP and the American people back into a small government/deficit cutting mentality.
Kinda pathetic, I know…but it’s the only way I can see a positive com ing out of St. Barry’s tenure.
Who ARE these “death panel” people? Nincompoops and lamebrains ??? Its obviously a scare tactic used by the republicans…insurance companies, hospitals and HMOs already use terms like “End of Life” to describe this consultation…Blue Cross, Humana, Catholic Healthcare West, Kaiser Permanente, they all use it!!! It’s as if these halfwit GOP sheep just started looking into healthcare for the first time in their lives….of course they could be just flamin’ hypocrites like Sarah Palin, who now hysterically cries out “death panels” despite the fact that she declared a “Healthcare Decisions Day” in Alaska just a little over a year ago.
“WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. WHEREAS, in Alaska, Alaska Statute 13.52 provides the specifics of the advance directives law and offers a model form for patient use.
WHEREAS, it is estimated that only about 20 percent of people in Alaska have executed an advance directive. Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive.
WHEREAS, it is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about Advance Directives.
WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaska’s citizens with advance directives.
WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives.
WHEREAS, as a result of April 16, 2008, being recognized as Healthcare Decisions Day in Alaska, more citizens will have conversations about their healthcare decisions; more citizens will execute advance directives to make their wishes known; and fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient.
NOW, THEREFORE, I, Sarah Palin, Governor of the state of Alaska, do hereby proclaim April 16, 2008, as: Healthcare Decisions Day in Alaska, and I call this observance to the attention of all our citizens.”
Dated: April 16, 2008
Mr. Garagehero, I would invite you to consider the logic of the argument here to see if there might be something in it you can acknowledge:
http://socalviewpoint.wordpress.com/2009/08/14/death-panels-articulating-the-issue/
There is always some kind of rationing. Organ transplants are rationed. Who gets treated first when there are multiple serious cases in an ER is a form of rationing. How much research money goes to which diseases–another kind of rationing. Not to mention the most obvious case–insurance companies refusing to cover certain people. If we had National Health Care, the choices that were being made would be far more transparent and easier for voters to influence.
Hi Margaret, I see that I put my reply in the wrong spot below. I hope I’m not just making matters worse by repeating here in reply to your comment:
* * *
Margaret, I have to disagree that if we had National Health Care, “the choices that were being made would be far more transparent and easier for voters to influence.” Obama promised transparency, but he has not kept that promises, especially on the health care issue. (See, e.g., http://socalviewpoint.wordpress.com/2009/08/15/obamacare-deceit-as-strategy/.) Also, I, for one, do not trust a bureaucrat to make my health care choices for me, and I have NO confidence that we voters could truly influence the choices being made. Have you had any luck influencing the Social Security Administration, the Postal Service, or any other federal agency? Do you know anyone who has?
I don’t know why the above link does not work, but you can go there and click on the recent posting called ObamaCare: Deceit as Strategy, or you can try this link (and I hope it works):
http://socalviewpoint.wordpress.com/2009/08/15/obamacare-deceit-as-strategy/
But they’d not have any escape valve, they’d be subject to political as opposed to market pressure, they’d be taken out of the hands of doctors to a greater extent, and our health would be put at the mercy of the political process. Not good.
Margaret, I have to disagree that if we had National Health Care, “the choices that were being made would be far more transparent and easier for voters to influence.” Obama promised transparency, but he has not kept that promises, especially on the health care issue. (See, e.g., http://socalviewpoint.wordpress.com/2009/08/15/obamacare-deceit-as-strategy/.) Also, I, for one, do not trust a bureaucrat to make my health care choices for me, and I have NO confidence that we voters could truly influence the choices being made. Have you had any luck influencing the Social Security Administration, the Postal Service, or any other federal agency? Do you know anyone who has?
I don’t really see how “Healthcare Decisions Day” goal of getting “more citizens” to “execute advance directives to make their wishes known” for end of life care is equivalent to empowering a government panel to make these decisions for them based on what they feel is the best allocation of limited healthcare resources. Not to mention that these panels would be operating under the directives of some federal level panel which would have already worked out some general rules on whose lives were worth saving. But of course federal panels always know best, right?