Federal health brokerage
While the president is out talking about his administration’s health care plans, it’s timely to re-visit some of his recent comments relating to health, that were barely noticed first time around.
Specifically, what he said to the New York Times the day he appearaed at Georgetown on April 14. Dr. Mark Mostert noticed.
I was especially interested in the section of the interview dealing with health care, and to learn of the President’s perceptions of end-of-life issues. It’s not pretty…
Pay attention to Obama’s wording:
I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because . . . when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. [emphasis added]
To which Mostert responds:
What if the doctor says, “Well, you’ve got two weeks to live, and your quality of life is very poor, and all the expensive care we can give you will not help a bit, but assisted suicide is legal, quick, and very inexpensive?’ Should I then accept this pronouncement because he’s “the guy with the medical degree?â€
And by the way, this did happen to a woman in Oregon, when her insurance company wouldn’t pay for cancer treatment but would cover the drugs to end her life. It raised public outrage, but by the time they relented, she had died.
Back to Obama’s remarks on health care as he sees it:
And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control. And right now we’re footing the bill for a lot of things that don’t make people healthier.
Mostert breaks down the rhetoric and follows the logic:
Now we’ll get the government saying, “OK, seeing that we pay for your medical care, we’re going to decide what care you get and what care you can’t have.â€
And, more darkly, the specter of futile care emerges, because what the President was saying was, “If we’re paying for stuff that doesn’t make you healthier, we need to reconsider whether we want to pay for this treatment.â€
Note the phrase is “to make you healthier†– not to alleviate your symptoms, or provide you with comfort care because you’re never going to get healthier.
Simple: If treatment makes you healthy again, you get it. If it can’t, you can’t have it, because we need it for people who can get healthy again.
Pure, unadulterated futile care.
This is not far-fetched. Dr. Mostert is an expert on issues of bioethics. Where he and others who have been on ‘America’s Lifeline’ worry this nation is heading is suddenly getting more imminent.
The government already knows that medical care in the last weeks of life is where most medical dollars get spent. Same goes for money spent on people with significant, although not necessarily terminal disabilities. Marry that to the President’s commitment to cut health care costs, a society that increasingly thinks helping people die is just dandy, and a medical profession that is increasingly utilitarian, and you have the perfect plan to make people with severe medical problems, including those with disabilities, into Useless Eaters.
Obama continued:
So when . . . I talk about the importance of using comparative-effectiveness studies as a way of reining in costs [which] . . . is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.
Mostert translates:
Ah, “comparative-effectiveness,†“objective studies. Allow me to paraphrase my President:
Doctor to patient: “You know, what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that there’s no point in treating you any further. We’ve concluded that the blue pill, which will keep you comfortable until you die, is very expensive. The red pill, that costs a tiny fraction of the blue pill, can end your suffering quietly, effectively, and with dignity.â€
Obama paves the way for what’s to come, soon:
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.
Here’s what Mostert makes of these arrangements:
Have “conversations†with the public under the guise of measured reasonable argument. Subtly (and not so subtly) use doctors, scientists and ethicists who are pro-death to lead the way. Shape public opinion to utilitarianism, futile care, people as pure economic entities, and then the resistance to assisted suicide, and, eventually, euthanasia, will crumble.
Obama just finished holding a press conference this morning on the push to pass his health care bill. “We don’t have any excuses,” he said. “The stars are aligned.”
What they portend is another matter.
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The only people in the U.S. who are not currently affected by rationing or third-party decision making are people who are self-insured, i.e., pay all or most of their health care costs out of pocket. Most anyone who has insurance is affected in some degree by managed care, in which a gatekeeper, usually a primary care physician, decides whether to approve you for care by a specialist. Not everyone gets approved, so they don;t get the care. If you are uninsured you can always get emergency care, but this only helps in acute situations — not for anything chronic. If you are on Medicaid, you are subject to the limitations placed by the system and the limited number of doctors that will even see Medicaid patients.
And I can’t figure out why conservative commentators are so down on health care effectiveness research. Just because a company creates a new pill or a new form of medical technology doesn’t mean that everybody who says they want that bill or that technology should get it.
The U.S. spends more per capita on health care — by a large margin — and still 16 percent of the population is uninsured and health outcomes for U.S. citizens are worse than almost any other industrialized country in the world. If you are VERY sick, i.e., with an unusual form of canver, for instance, U.S. care is excellent compared to other countries. But if you are just a run-of-the-mill citizen, you pay a lot more for worst outcomes than citizens of other countries.
Let me get this straight. To ensure our “right to life” we must allow others, who have no healthcare, to die prematurely. Isn’t that what people against some kind of national healthcare system are saying? Seeking to provide healthcare to all Americans somehow subverts my opportunity to the healthcare I want. What’s more by turning our backs on the millions who do not have healthcare, we are maintaining the freedoms for which our founding fathers fought and died! We may even be giving dignity to those without healthcare since they give their lives prematurely to preserve our “American way of life!” To quote John Kenneth Galbraith, “The modern conservative is engaged in one of man’s oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.”
Fact is this is simply not true and Medicare is a prime example. The healthcare for the rich who die is still better than for the poor. This is for sure. However, Medicare ensures that their is a minimum standard of care which allows for every senior citizen to life in the later stages and death in the final stage with dignity. There is still freedom to choose the healthcare you want if you can pay for it, but there is a minimum quality of life for those who can’t. Yes, there are pitfalls, but there are pitfalls in all legislation. If this were Communism and Obama were head of the government, it would matter how he felt about assisted suicide. We, on the otherhand, have direct election of the people who write our laws.