Friday, August 14, 2009

More on "death panels"

For a change, this time I am serious. This opinion of two experts looks quite convincing to me. But I have the following question: is it true that the "Death panels" scare is indeed entirely based on this particular provision, or there is something else to this point in the bill, that the authors failed to mention? I would truly appreciate if the comments (if any) will stay focused on this specific issue.

50 comments:

Anonymous said...

It is true. They REFUSE to define "end of life counseling" before the bill is approved. Why? They also refuse to allow private health insurance companies from covering what the govt won't cover. Why? They refuse to include an amendment that would prevent taxpayers from having to pay for assisted suicide. Why, if they don't intend to implement all these things.

johnrj08 said...

The scare tactics being used by those who are against health care reform are shameful. They are blatant liars who routinely pick up on every rumor there is about the bills in Congress, never bothering to get the real facts about any of them and conveniently ignoring key passages which don't suit their opportunistic agendas.

These people are so angry that the country has a black president that they are willing to say just about anything, no matter how false, to get illiterate rubes up in arms. Before anybody listens to a word any of these people has to say about any subject, especially health care reform, you should visit PolitiFact.com or FactCheck.org. There, you will see how many "Pants-On-Fire" awards these so-called pundits have been awarded for telling outright lies that have been designed to incite uninformed, gullible people.

The fact is, the status quo of medical care in this country is unacceptable. The United States is now 37th in the world in health care quality, despite spending nearly twice as much on it than the next largest spender. It's even lower on the list in life expectancy. Slovenia has a better health care system that we do. Health care costs are spiraling higher, while wages remain stagnant, and insurance companies, who are funding people like Palin and Malkin, make billions in profits each year.

The flip side is that millions of hard-working Americans will go bankrupt every year because they couldn't afford medical coverage. Nearly 50 million people in this country do not have medical insurance. Just whom do you people think pays for their care when they visit an emergency room? The Tooth Fairy? Who picks up the tab when people go bankrupt? The Easter Bunny?

The fact is, the more people who are covered by medical insurance, the more people are paying premiums. The more people who are paying premiums means lower premiums for everybody because of the enlarged pool being covered. When the government offers the "public option", it will provide an incentive to insurance companies to be more competitive and reduce costs. That is capitalism at work, not socialism.

Right now, we have a form of corporate socialism, which dictates which doctors you can see and which conditions can be treated. Insurance companies already have their own "death panels", which are administered by non-physician actuaries. Under the reform bills now being considered, no doctor, nurse, technician or therapist would be on the government payroll, and no citizen would be told which doctor to use. "End of life" counseling is only made available on request and it is entirely optional. If you doubt the importance of this kind of counseling, speak to any medical doctor about it. He or she will tell you that it can provide valuable support and much needed information on a subject that most people do not want to talk about.

The morons who are against health care reform are either blithering idiots or ideological zombies who can't stand the idea of this administration succeeding at anything, even when it could benefit them. Politics of the self-destructive. But don't take my word for it. Visit PolitiFact.com. This is a non-partisan, Pulitzer prize-winning website that separates fact from rumor. If you're not afraid of the truth, go there. If you are afraid of the truth, maybe it's time to re-examine your motives.

avzel said...

Thanks, Anon (it would be nice if you could introduce yourself, at least partially).

> They REFUSE to define "end of life counseling" before the bill is approved.

For me this term is perfectly well defined, has been around for a while and is pretty widely used, so that even such a layman as I met it many times. I understand it as follows: when a person and/or his/her close relatives feel that death may be close, they ask the doctors' advice on their options (e.g., what kind of hospice care is available, pros and cons of stopping certain treatment, etc.; yes, I guess assisted suicide may be also discussed at these meetings). I think being able to discuss these very difficult issues with trusted professionals is hugely helpful, and I have no problem at all (in fact am glad) if the bill suggests to cover this kind of expenses (once every 5 years if I understand correctly).

There is a huge distance between "counseling" on certain options and "implementing" them (that is, forcing people to do something, if I understand what you mean). It is your right to try to figure out what "they" intend to do. But if some measure is not specifically written into the bill, one would be able to fight its implementation as much as in the present situation.

avzel said...

johnrj08: although it is somewhat refreshing to read your kind of rhetoric (normally I am exposed to rhetoric of opposite kind), it is completely beside the point that I raise here. I am trying to figure out for myself a rather specific issue, and your "party line" comment has not been helpful.

Anonymous said...

Its based on history of the Socialist movements. Where were you last century?

Anonymous said...

This is NOT something that should be controlled by governments. You are giving people who do not know you quite the license to your life.
Haven't we already seen enough waste and stupidity to prove that this is a very bad idea? I just do not understand the mind that can rationalize anything away. The idealogues on both sides of the isle will always say that there pet program just needed more time or money for it to have been successful. When will we believe what history teaches and start turning away from the idea of a nanny-state?

avzel said...

Anon #2 (or are you the same one?): sorry, I'm not interested in this kind of a comment.

Anonymous said...

Sorry Avzel. I too seem to be caught in the chaos. Which inherently leads to frustration.

Put simply. I consider the endeavor mathematically impossible. The nature of capitalism is to seek equilibrium. There are too many boundary conditions in flux for equilibrium to be reached. And I believe this to be by design.

avzel said...

Anon #3:

> This is NOT something that should be controlled by governments. You are giving people who do not know you quite the license to your life.

Can you be more specific please and show me what do you mean by "government control" or "license to life" in the provision I asked about?

johnrj08 said...

The Hyde bill expressly forbids any government subsidization of abortion, and euthanasia is illegal in most states. Despite the noise made by anti-reformists, nothing in the health care reform bills may conflict with these pre-existing legal realities. If, after counseling, a family decides that it wants their loved one's suffering to end, they would still have to go to a state that won't prosecute them for doing it, such as Oregon. Obviously, no panel is going to tell a family that they must travel to another state and have their loved one euthanized, yet that is the preposterous claim being made my Sarah Palin and Michelle Malkin. The "death panel" argument is a Big Lie being spread by those who oppose anything the current administration wants to do, even if they would benefit from it.

avzel said...

Anon #4: I have no idea what you are talking about.

An aside thought: I intended to be serious, but it is hard to refrain from laughing as this discussion turns more and more into an absurdist play with every new anonymous comment.

avzel said...

johnrj08: thanks, I see your point. But I've already said in the post that I find the arguments of two doctors convincing, so I would be more interested if somebody can show me some flaw in their commentary that I missed.

Matter said...

I do not mean to be absurd. I will try to be specific. My thoughts are as follows:

1. There are no provisions for forced euthenasia. That is absurd.

2. My fear is that the American people are willingly giving their federal government more and more control of their lives in exchange for promises of "something better". This leads to greater dependence. This becomes a spiraling process towards complete dependence.


3. I am not trying to imply that there is some great government conspiracy to control every aspect of our lives. I have worked in government. It is filled with well-intentioned people who are just trying to do more. Unfortunately, the same people who recognize that there must be difficult decisions made in healthcare, have a scotoma to the fact that the same paradigm exists for government "care". And that IS absurd.

avzel said...

Matter: 1. I see it the same way.

2 and 3. In such general terms, I do not disagree with you at all.

However, in my personal approach to the issue of health care (and to many other issues, but not all!) I prefer specifics to general principles (not to mention slogans). The modest aim of this post is to try to separate fact from fiction in this particular provision of the bill that (fairly or not) has become the focus of criticisms.

leblon said...

I think one of the main topics of end-of-life counseling is the so-called "advance directive". This is a document which instructs doctors on what to do if the patient is permanently incapacitated, is in a vegetative state, and cannot make decisions for themselves. In the absence of such directives, medical decisions are made by relatives, whose interests are often at odds with those of the patient. For example, they may be interested in keeping the patient in a vegetative state just to be able to collect the patient's Social Security benefits a bit longer. (I know what I am talking about: some of my relatives are in the medical field and deal with these issues every day.)

Matters said...

I think we've established that forced euthenasia is not a desired ability of the governments plan.

I guess my question is "What is the role that the governemnt should play in making decisions in such difficult cases?

avzel said...

leblon: Many thanks! Comments like yours is what I hoped for.

As I understand, you are describing the current practice, right? I am not sure I get the whole picture. Is it true that the patient's living will beats everything else when deciding on the "advance directive"? And in the absence of such a will and if a patient is incapable of making a decision, then it is made by relatives? And the health professionals have only an advisory role in making these decisions? This would be my understanding. Or can the patient himself or his relatives be overruled under some special circumstances, and if yes, then who could do this?

Turning to the provision in question, do you know in what way (if any) it is supposed to change the procedures that are already in place?

avzel said...

Matters:

> What is the role that the government should play in making decisions in such difficult cases?

Are you asking my personal opinion on this issue, or what the provision in question is saying about it? The latter is precisely what I am trying to figure out in this post. As for my personal views, I surely believe that the government should interfere as little as possible into people's private lives. But some interference is inevitable in a civilized society, so the meaning of "as little as possible" in this and other complicated situations should be carefully discussed and decided in a democratic way on a case-by-case basis.

Anonymous said...

From what I have read, the health care reform bill seeks to do something sensible about Health costs, namely offer a new OPTION (meaning you can take it or leave it) to current health insurance than only the corporations (i.e. CIGNA, Blue Cross etc.)control.

That new option would be provided by the government at prices determined by the government and similar to what all senators and representatives have available to them. It is OPTIONAL, not forced.

As it is now, if you want health insurance, you HAVE NO CHOICE! You either have to work in a job where an employer offers a plan you opt into, or you must try and buy it privately. In either case, the costs are very high. If you are unemployed or self employed, it is harder to get health coverage, and the costs are outrageous when you finally do get it.

From what I have read and seen about the proposed bills (there are 4 of them under consideration), all that health care reform wants to do is provide a NEW OPTION, one that gets around the corporate insurance companies for those people WHO CHOOSE IT OR NEED IT.

It is all about CHOICE.

Of course, the insurance companies do not want this choice because it will mean competition and erode their profits.

After all, if you are the only grocery store in town, wouldn't you do everything to block another grocery store from moving in? Sure, it makes sense, and it is up to the people to realize what is going on!

If people have a choice and find a better deal than a corporate insurance company provides, well, what would they go for? Usually the better deal at the lower price.

Insurance companies know this and it means they either manage costs and prices or lose to the competition. This is not socialism, it is the heart of capitalism!

So the insurance companies are spending millions of dollars and using every scare tactic they can think of to get people to tell their governmental representatives to vote down ANY bill that provides health care reform.

People who listen and do NOT research the facts but instead follow the lead of the corporations are being puppets of the corporations themselves! They are believing the corporations that have been overcharging them over their own elected government.

Basically they are telling everyone that they WANT NO competition and WANT to pay the high and soon to be higher prices for health insurance!

If they saw it this way, they might change their minds.

Go figure, huh?

President Obama and several senators and representatives have clearly explained the reform bill and its objectives, but the news coverage of their words is remarkably low compared to the outrageous coverage of town hall meetings and sensationalism.

The media needs to focus on the facts of the matter under consideration, NOT the facts of the reaction to the matter under consideration.

Some people listen to their leaders who are working in their interest and others listen to the corporations who are working in their own interests.

The latter are the more vocal and get the most press, but in the end, the elected leaders will make the choice, and they will choose (we hope) what is in the best interests of the American People, not the Corporations.

As for death camps and death lists and all that other nonsense, that is exactly what it is. Nonsense.

Thanks for allowing this comment.

Anonymous said...

Obamacare seeks to drive private insurers out of business. When Obama was a state senator, he made no secret of the fact that he was a fan of the single payer system which means healthcare system under total government control.

The can be no fair competition between the government insurance and private insurance. First, the government insurance can run deficits as high as it wants because it will be subsidised by our taxes. Second, the government will write the rules for private insurers telling them what policies they may and may not issue. Just imagine a competition between Microsof and Google with Microsoft telling Google what search engines it may and may not use.

All government programs are based on rationing, and so will be the government healthcare. There will be special panels which will decide, based on age and health, how much money should be spent on treatment. And if the panel decides that given the age of the patient, its treatment is too expensive, then the patient will get painkillers instead of the medicine that could have cured him.

In light of these facts, the requirement for doctors to discuss life ending options with the patient and to report to the government the content and results of the coversation look very suspicious.

Finally, the claim that our drive-by media does not spend enough time reporting on Obama's explanations concerning the healthcare plan is simply ridiculous. No amount of reporting can hide the fact that Obama is in favor of government run healthcare and americans simply do not want this.

Clovis

avzel said...

The last anonymous comment is another "sales pitch" that does not address the issue at hand. As I said before, this is not what I am interested in here.

avzel said...

Clovis: there is no need to start polemics with an anonymous commenter here. As I said, I find their long sales pitch completely beside the point of this post. The same applies to your comment. [Frankly, the comment preceding yours is so sleek and so beside the point that it doesn't even look like it's written by a real person. I presume you are a real person; then it puzzles me that you choose to use rhetoric that looks like the mirror image of the one used by your opponent.]

dimpase said...

There is nothing special about a compulsory, and government-controlled and sponsored, to an extent, medical insurance. Netherlands, the country a citizen of which I happen to be, has such a system in place. Moreover, euthanasia is basically legal in NL. Yet, right-wing politicians keep quiet about them both.

I just fail to see what the fuss could be about (unless it's a specific lobby, health insurers, for sure, that makes the fuss)

avzel said...

dimpase: here euthanasia is not even on the table at the moment.

> I just fail to see what the fuss could be about

This is exactly what I want to clarify for myself: is there any real foundation in the "death panels" scare, or is it sheer politics and demagoguery. So far, the latter seems to be true.

dimpase said...

a number of semi-anonymous commentators here seem to have no clue as to how government-administered insurance programs generally run. Even in UK, that went over the top with their NHS, there is room for private health insurance. In Netherlands, the (compulsory) health insurance is basically outsourced to private companies, that compete for customers.

avzel said...

dimpase: Netherlands? What Netherlands? You can't even see it from Alaska! :)

nieuwe_zijde said...

Это, видимо, иллюстрация к страстному призыву высказываться исключительно на заданную тему?

avzel said...

Мой призыв был обращен не к себе самому, а к комментирующим. Странно, что приходится объяснять такую очевидную вещь.

nieuwe_zijde said...

То есть, работа на контрастах, да? Я, как хозяин и властелин, буду позволять себе сколь угодно глупые шутки, а вы, презренные комментаторы, извольте to toe the line, а не то...

avzel said...

Именно так! Не нравится - не комментируй.

И, кстати, если мне чьи-то шутки кажутся глупыми, я это своё мнение держу при себе (если это человек, которого я уважаю, то не хочу его обидеть; в противном случае, не вижу смысла в общении). Безусловно, ожидаю того же от своих собеседников в данном журнале.

nieuwe_zijde said...

Понял. Буду комментировать только когда мне всё нравится.

Пока, кстати, дело вроде бы обстоит сравнительно неплохо. Презираемая Сара Пейлин (попыткой издёвки над которой, видимо, была обсуждаемая "шутка") пока явно побеждает в дискуссии с многомудрым президентом Обамой и его поклонниками. Запасёмся попкорном и подождём следующих выпусков.

avzel said...

> Буду комментировать только когда мне всё нравится.

Нижайшая просьба поступать именно так.

> ... Сара Пейлин пока явно побеждает в дискуссии с ... Обамой и его поклонниками.

Мне тоже так кажется. Именно поэтому я и позволил себе шпильку в её адрес (бить лежачего как-то некрасиво).

Более того, именно потому, что её страшилки явно работают, я и затеял это обсуждение - мне захотелось окончательно разобраться для себя, являются ли они чистой демагогией, или она в чем-то права по существу.

dimpase said...

Aan de Nieuwe Zijde:

nou ja, ze hebben een "Invasie van Den Haag Wet", ofwel "American Servicemen Protection Act"...

Zaat ze maar komen, die stomme vetzakken ;-)

dimpase said...

Avzel, мы, кстати, знакомы, пересеклись как-то в Стокгольме у Бори Ш...

я, конечно, знаю глубину идиотизма типичной американской публики, не только понаслышке...

avzel said...

dimpase: встречу в Стокгольме, честно говоря, припоминаю очень смутно - Вы, что ли, с Борей заезжали в Миттаг-Леффлера, когда я там был?

Насчет "глубины идиотизма типичной американской публики" я не согласен. По-моему, "типичной американской публики" не существует в природе - уж больно страна огромная, и очень много в ней всего намешано. Я в целом доверяю здравому смыслу большинства американцев в важных вопросах - в конце концов, на этом всё демократическое устройство общества держится уже много лет ...

dimpase said...

Со стороны виднее.
Америка за последние года настолько испортила себе репутацию, что в здравый смысл большинства (и/или в американскую демократию, и/или в здоровье системы) не верится ни капли, честное слово.

Самая толстая в мире страна, ездящая на самых больших машинах, производящая больше всех мусора, которой глубоко наплевать на все, что ее прямо не касается...

Да что там, честно говоря, от одной надписи "No Firearms Allowed" на молле где-нибудь в Техасе у здравомыслящего человека должна ехать крыша...

avzel said...

> в здравый смысл большинства (и/или в американскую демократию, и/или в здоровье системы) не верится

Мне пока верится. Поживём - увидим.

avzel said...

И с тем, что со стороны виднее, тоже не согласен. Agree to disagree?

dimpase said...

все-таки виднее. Глаз легко замыливается, да и пропаганда проникает в любую щель...
Достаточно СССР впомнить, с его "нормальностью".

avzel said...

С тем, что пропаганда проникает в любую щель, я для разнообразия согласен. Но аналогия с СССР не точна: там пропаганда СМИ носила полностью односторонний характер, а здесь и сейчас они представляют полный спектр мнений, не говоря уж об интернетских источниках. Кроме того, при всей вредоносности официальной советской пропаганды, я думаю, что многие важные реалии советской жизни были всё-таки более понятны вдумчивым людям изнутри, чем снаружи.

Предлагаю на этом закончить это отступление от темы - и так уже мой критик nieuwe_zijde имеет все основания упрекнуть меня в непоследовательности и unfair treatment.

nieuwe_zijde said...

dimpase: С Вашей аналогией касательно "Invasie van Den Haag-wet" / "American Service-Members' Protection Act" я, извините, не согласен ни в какой мере. Переводить Ваше замечание на всякий случай не буду, поскольку, немного зная хозяина журнала, несколько опасаюсь услышать ещё и его мнение по данному вопросу.

Что касается поимевшего тут место обмена мнениями по поводу "глубины идиотизма типичной американской публики", то я для разнообразия скорее согласен опять же не с Вами, а с хозяином журнала. Но, конечно, с вариациями, которые, вероятно, уведут меня ещё дальше от Вашего мнения.

Если кратко (поскольку мы действительно изрядно отклонились от заявленной темы дискуссии), то моя вера "в здравый смысл большинства (и/или в американскую демократию, и/или в здоровье системы)", бывшая до поры не менее крепкой, чем у хозяина журнала, изрядно пошатнулась в прошлом году. Критерием здоровья американской демократии для меня лично будет скорость, с которой нынешняя преступная шайка будет выброшена за калитку Белого Дома. Апокалиптического мнения, что этого не произойдёт никогда, я пока что не разделяю.

nieuwe_zijde said...

Запущу ещё вдогонку (пока хозяин отлучился) краткое замечание по поводу "лучше видно со стороны." Мне кажется, что таки-да, иногда лучше. Но, однако же, лишь в редчайших уникальных случаях - когда сторонний наблюдатель обладает поистине выдающимся интеллектом. Вроде, допустим, Орвелла. Подавляющее же большинство наблюдателей "со стороны" демонстрируют вполне ожидаемый уровень проникновения в суть дела.

Я люблю приводить пример, немного менее банальный, чем навязшие в зубах барбюсы / фейхтвангеры. Когда Billy Graham (знаменитейший в Америке человек - духовный наставник чуть ли не всех президентов второй половины 20 века) вернулся из поездки в брежневский СССР, он громогласно заявил: "Я вот не понимаю, почему все так дружно ругают Россию. Это - замечательная страна, никогда в жизни я не ел столько чёрной икры".

avzel said...

нынешняя преступная шайка будет выброшена за калитку Белого Дома.

Я поделился этими своими чувствами с Гаррисом, и он заметил, что принимает все это к сердцу даже сильнее. Он сказал, что чувствует желание не только прибить того, кто распорядился здесь эту доску повесить, но заодно перерезать всех членов его семьи, всех его друзей и родственников, а потом сжечь его дом. Такая жестокость показалась мне уже несколько чрезмерной. Я сообщил это Гаррису, но он возразил:
-- Ни капли! Вот так им и надо! А когда они все сгорят, я спою на пепелище комические куплеты.
Меня встревожило то, что Гаррис заходит в своей кровожадности так далеко. Мы не должны допускать того, чтобы наш инстинкт справедливости вырождался в примитивную мстительность. Потребовалось немало времени, чтобы убедить Гарриса принять более
христианскую точку зрения на этот вопрос, но в конце концов мне это удалось, и он пообещал мне, что друзей и родственников всё-таки
пощадит, а комических куплетов на пепелище петь не будет.

Matters said...

Again, I apologize for being off-topic. America does care deeply for it's citizens. But the old America believed that the absolute best that we could do for them is to let them be free. Freedom has it's consequences. It allows one to achieve great success or failure.

avzel said...

Matters: once again, I don't disagree with your general philosophy: yes, people are becoming more dependent on the government, and yes, too much dependence can be dangerous. But like it or not, life is much more complex now, and interdependency of people, and their relationships with the government cannot be as simple and minimal as they were in good old days. So we have to try to find the best solutions in very specific circumstances.

nieuwe_zijde said...

Гаррис - это голова (тот, который из первого абзаца, конечно).

dimpase said...

nieuwe_zijde,
пока хозяин журнала не видит, хочу заметить, что "преступная шайка" у вас, скорее всего, в голове - по крайней мере что-то вас заставляет оскорблять людей на ровном месте.

Непонятно, что вы вообще в NL забыли, такие правые, как вы, вам там и руки не подадут, поскольку вы не свой kaaskop...

ваши примеры с Барбюсом и т д просто смешны в данном контексте - естественно, очень легко заставить гостя увидеть то, что хочется показать. В СССР пропагандой все-таки не только полные идиоты занимались...

nieuwe_zijde said...

dimpase: Я тщательно ещё раз проверил все свои вещи и удостоверился, что в "NL" (откуда я действительно недавно вернулся к месту своего постоянного жительства) я вроде бы ничего не забыл. Поскольку Ваши остальные умозаключения (включая те, которыми вы сочли целесообразным поделиться выше) демонстрируют столь же сокрушительные логику и искусство анализировать прочитанное, считаю дальнейшую "дискуссию" излишней.

P.S. Хотя одно рациональное зерно из Вашей словесной продукции мне вычленить всё-таки (с большим трудом) удалось, так что, видимо, не стоит отчаиваться. Запрет на огнестрельное оружие в техасском торговом центре и у меня тоже вызывает крайнее возмущение. Мера явно попахивает антиконституционностью. The last I heard, вторую поправку к конституции США пока ещё никто не отменил.

dimpase said...

nieuwe_zijde, bedankt. Vaarwel.
Ik ben blij dat wij hiermee een gekke klootzak minder hebben...

nieuwe_zijde said...

Занимательно, что даже и совсем безмозглые леваки могут оказаться по-своему забавными. Больше всего в этой тупой попытке огрызнуться по-голландски мне понравилось слово "wij" (то есть, в данном случае, "мы, голландцы"). Слава Создателю, великая голландская нация обрела своего спасителя.