Why “bend the cost curve” with end-of-life planning?

posted at 12:15 pm on August 9, 2009 by Ed Morrissey

In any system that promises top-down control of medical care costs, the end effect will be rationing of services by artificial methods that get at least partly disconnected from the patient. The specific methods may be murky, but Charles Lane at the Washington Post has some questions about one section of the House version of ObamaCare. Section 1233 imposes a requirement for end-of-life planning sessions every five years for Medicare patients — and immediately after patient gets a terminal diagnosis. Lane wonders why that section gets dropped into a bill that purports to “bend the cost curve”:

Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they’re just trying to facilitate choice — even if patients opt for expensive life-prolonging care. I think they protest too much: If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.

What’s more, Section 1233 dictates, at some length, the content of the consultation. The doctor “shall” discuss “advanced care planning, including key questions and considerations, important steps, and suggested people to talk to”; “an explanation of . . . living wills and durable powers of attorney, and their uses” (even though these are legal, not medical, instruments); and “a list of national and State-specific resources to assist consumers and their families.” The doctor “shall” explain that Medicare pays for hospice care (hint, hint). …

Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party — the government — recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don’t have to be a right-wing wacko to question that approach.

Indeed.  While people should be able to access “end-of-life planning” when they desire, and having a living will is a good idea, it isn’t the role of government to push those ideas in a hard-sell approach.  It shouldn’t be the government’s business in any case, but this shows how getting the government involved in your health care reduces your privacy and your rights to individual choice.

These aren’t “death panels,” but they’re creepy nonetheless.   They’re sales presentations for surrender.   If HMOs required patients over 65 and with potentially life-threatening diagnoses to sit through presentations about how great hospice care and plug-pulling orders are, people would rightly scream about it from the rooftops.  And patients can change HMOs and insurers now, or opt to pay out of their own pocket; when government takes over health care, there will be nowhere to run.

And what happens when these sales presentations fail to get people to agree to die quickly for the greater good, and the projected cost savings do not appear?  How long will Section 1233 remain “voluntary,” even in name?

This is nothing other than an attempt to save money by convincing the sick and the elderly not to seek life-saving medical treatments.  In Barack Obama’s words, Section 1233 is where government says, “Maybe you’re better off not having the surgery, but taking painkillers.“  Monty Python had it just about right more than thirty years ago:

Update: Legal Insurrection in the Green Room has more on rationing care to the elderly and infirm.


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With all of us, eventually being forced into this crap…we’ll all be complicit in murder.

From abortions, to denying care to special needs people, to the elderly, and in between. I don’t know about anyone else, but I don’t like having that blood on my hands.

capejasmine on August 9, 2009 at 1:30 PM

Interesting article from MM today on those death panels today.

http://michellemalkin.com/2009/08/09/death-panels-what-death-panels-oh-those-death-panels/

kcarpenter on August 9, 2009 at 1:10 PM

That says it all! Especially the video of obummer.

Please tell me again why I can’t use the term “Death Panel”.

conservnut on August 9, 2009 at 1:32 PM

boomer on August 9, 2009 at 1:09 PM

Then couldn’t they give a “talk” that encourages the patients to stay OUT of hospice care, which would make them more money on the bottom line?

Black Yoshi on August 9, 2009 at 1:32 PM

Jeff from WI on August 9, 2009 at 1:16 PM

I know, it’s a terrible day when I can go to the specialist, pay my $30 copay, and get a $7k per treatment drug at no expense and actually improve instead of getting an end of life cousler and just suffering a miserable end.

boomer on August 9, 2009 at 1:33 PM

Imagine the wrath that will turned on the government when the Feds deny those treatments.

Techie on August 9, 2009 at 1:25 PM

Indeed. However, I think the libs think they will get net gain in voting advatage.

Killing off older voters who are normally conservative.

Getting votes from illegals, and the youth vote who will get the benefits from those who are terminated.

It really is a Soylent Green/Logan’s run scenario here.

portlandon on August 9, 2009 at 1:36 PM

That is simple. Like airline ’stand-by’ you go on the list. You can be bumped at anytime for any reason.

Limerick on August 9, 2009 at 12:34 PM

Of course we have an option with the airlines.

Johan Klaus on August 9, 2009 at 1:36 PM

Ya, when I have to have my panhematin treatments it costs nearly $7,000 a whack. Can you believe my evil, greedy insurance company pays the whole bill?

boomer on August 9, 2009 at 1:12 PM

Must be a mistake, I know cause San Fran Nan told me how these insurance bastards are killing us all. Your only hope is for the gubment to ride up on a white horse and save your ass!

conservnut on August 9, 2009 at 1:37 PM

Good Thread Ed. Thanks for the MP skit.

Geochelone on August 9, 2009 at 1:37 PM

And you know perfectly well the intent is to consul people regarding “extraordinary measures” when they are terminal, not ship off grandma to the gas chamber anytime she comes down with the sniffles.

e-pirate on August 9, 2009 at 1:06 PM

Thats ridiculous.

Obama care isn’t going to waste money on the mercy of a gas chamber.

Grandma will just not be treated with anything but things to make her comfortable and numb.

But thats just common sense from an economic point of view…oh wait..I thought basing decisions on $$$ was the evil capitalist way, and the libs were all about compassion….thats weird.

Itchee Dryback on August 9, 2009 at 1:38 PM

Black Yoshi on August 9, 2009 at 1:32 PM

Sure, under this system it can go either way. It’s the patients decision to make. The patient could say “Well, I’m 71 I’ve lived a full life and I don’t want to got throught the hell of chemo and radiation. So, when it gets bad I just want comfort measures.” Or the patient could say, “Life is worth living I’m not done. I want to fight it ’til the bitter end. Just maybe I’ll beat it anyway.” It’s the patients choice. But, Obama would rather “just give them a pill”, his words. This end of life couseling is about putting pressure on them to just give up and die. Again I ask why does a healthy elderly person need end of life cousneling every 5 years? My grandfather is 86 and still goes to work. Why would he need to go to the doctor every five years for that? He would have gone to the doctor more for end of life counseling than he would have gone for being sick.

boomer on August 9, 2009 at 1:38 PM

A point I don’t think gets made enough. The only time a product is rationed is when it’s dispersed through a controlled and legally mandated system. Health care today is not rationed, it’s sold. Only the government can ration, by denying care to people who would otherwise have access but are prohibited that access by the controlling authority. Medicare is rationed, the private sector is not. Not today anyway. Too many liberals today call free-markets “rationing by another name”. It’s not rationing, if you can pay for it you have access.

The Apologist on August 9, 2009 at 1:40 PM

Any system that values the state above the individual is obscene.

Post-natal abortion…with all the DNA and genetic testing now in common use, what happens if you have a kid, and it is found that he or she carries a genetic defect that may result in, say, ALS (Lou Gehrig’s Disease)? Will the state permit long term care for this malady? Or will the parents be compelled under penalty of fines to turn the “diseased” child over to the state?

This has happened in my lifetime and sooo many seem to have forgotten Ceauşescu’s Romania, if they have heard about it at all. Thousands and thousands of kids sent off to die a slow death in Romania…at children centers all across that country. Deprived of proper nourishment, deprived even of being held by another human being, let alone their own parents.

The reason? Economic costs to “maintain” the child were a burden on the state.

coldwarrior on August 9, 2009 at 1:41 PM

e-pirate on August 9, 2009 at 1:06 PM

What this will really end up being is what Oregon did to Barbara Wagner. They refused to pay for her chemo and instead offered to pay for comfort measures and physician assisted death. That’s right, they would’t pay for her to live but, they would pay for her to die.

boomer on August 9, 2009 at 1:42 PM

The only differenc is Hitler built his military up. Obama is tearing his down

unseen on August 9, 2009 at 12:56 PM

Don’t forget … “A Civilian National Security Force That’s Just As Powerful, Just As Strong, Just as Well-funded” as the U.S. Military”.

Johan Klaus on August 9, 2009 at 1:42 PM

Any system that values the state above the individual is obscene.

coldwarrior on August 9, 2009 at 1:41 PM

Hey, don’t you know that the needs of the many out weigh the needs of the few or the one? You sir need to go back to camp.

boomer on August 9, 2009 at 1:44 PM

People keep forgetting that the “government” is made up of people. And right now, there are a helluva lot of people who are pissed off at smokers like me and fat people.

With a public insurance option, I sure as hell want someone with terminal cancer to be forced to at least consider suicide to save me a buck.

I’d also limit their prescription refills on that, too. You know, drugs cost money. So they get a three month supply and if they haven’t offed themselves by the end of the last month they have to pay for their own pain pills from then on out. Nobody is more useless to society than the indecisive.

Jaynie59 on August 9, 2009 at 1:45 PM

“A Civilian National Security Force That’s Just As Powerful, Just As Strong, Just as Well-funded” as the U.S. Military”.

Johan Klaus on August 9, 2009 at 1:42 PM

That’d be SEIU and ACORN.

coldwarrior on August 9, 2009 at 1:45 PM

Clarifying question: I’m not sure if this has been answered earlier in the thread, but why would doctors have a profit motive to send patients to hospice or plug-pulling?
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Wouldn’t the patient make a little more money for the system alive?
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Just had to ask this – I’m not very well versed on the vagaries of end-of-life decisions.

Black Yoshi on August 9, 2009 at 1:08 PM

Profit??…Profit?? they don’t need no steenking profit.

If you’re getting a flat rate, what difference does it make.

Tick another one off your list of patients

Itchee Dryback on August 9, 2009 at 1:47 PM

I’d also limit their prescription refills on that, too. You know, drugs cost money. So they get a three month supply and if they haven’t offed themselves by the end of the last month they have to pay for their own pain pills from then on out. Nobody is more useless to society than the indecisive.

Jaynie59 on August 9, 2009 at 1:45 PM

I am going to report you.

Johan Klaus on August 9, 2009 at 1:48 PM

coldwarrior on August 9, 2009 at 1:41 PM

The joys of socialism/communism.

Johan Klaus on August 9, 2009 at 1:50 PM

If this immoral unGodly mess ever becomes law, the Life Insurance policies may not pay off due to the suicide clause. Has anyone investigated that probability?

fourdeucer on August 9, 2009 at 1:50 PM

conservnut on August 9, 2009 at 1:37 PM

The only thing san-fran nan wants to do to my butt is tax it.

boomer on August 9, 2009 at 1:51 PM

That’d be SEIU and ACORN.

coldwarrior on August 9, 2009 at 1:45 PM

Speaking of which, one of the bills has provisions to give billions of federal tax dollars to unions and groups like ACORN so that they can train their members to serve as “navigators” once the health care bill passes. Navigators will help people to understand their rights under the new health care law.

Doesn’t that give you a warm and fuzzy feeling? What could possibly go wrong?

AZCoyote on August 9, 2009 at 1:52 PM

Watch, they’re going have you talk to Hospice for the end of life care, Planned Parenthood for start of life, and directly to HMO accountants (not the agents) for everything in between.

MirCat on August 9, 2009 at 1:52 PM

If this immoral unGodly mess ever becomes law, the Life Insurance policies may not pay off due to the suicide clause. Has anyone investigated that probability?

fourdeucer on August 9, 2009 at 1:50 PM

“Yours is not to reason why, yours is just to Do or Die”.

Johan Klaus on August 9, 2009 at 1:53 PM

Doesn’t that give you a warm and fuzzy feeling? What could possibly go wrong?

AZCoyote on August 9, 2009 at 1:52 PM

Go wrong, go wrong, go wrong………..

Johan Klaus on August 9, 2009 at 1:55 PM

e-pirate on August 9, 2009 at 1:06 PM

You do a pretty good job of that all by yourself.

Proud Texan on August 9, 2009 at 1:56 PM

boomer on August 9, 2009 at 1:38 PM

I understand, but Obama isn’t going to be the one giving the counseling to each geriatric. That’s the doctor him/herself. If most doctors are indeed in opposition to many Obama goals, then why worry?

Black Yoshi on August 9, 2009 at 2:01 PM

If this immoral unGodly mess ever becomes law, the Life Insurance policies may not pay off due to the suicide clause. Has anyone investigated that probability?

fourdeucer on August 9, 2009 at 1:50 PM

“Yours is not to reason why, yours is just to Do or Die”.

Johan Klaus on August 9, 2009 at 1:53 PM

It’s NOT suicide if they kill you at the Dr. Josef Mengele Memorial Democratic Party Medical Center.

Jeff from WI on August 9, 2009 at 2:01 PM

Black Yoshi: “Wouldn’t the patient make a little more money for the system alive?”

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In general I’d think the bureaucrats running this won’t have that level of insight. They’ll be looking at bottom lines and death eliminates costs (the fact that healthier non-smoking, fit, long-living people ultimately cost more to pay for should throw a monkey wrench in the whole thing too)
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BUT the elderly, unemployed, underemployed, mentally and physically disabled will not be paying as much in taxes, thus the cost-benefits of allowing them to die will be that much higher. Hopenchange yall!

Simona on August 9, 2009 at 2:03 PM

AZCoyote on August 9, 2009 at 1:52 PM

Yep…saw that the first time. Really ticks me off.

coldwarrior on August 9, 2009 at 2:07 PM

Black Yoshi – and if this is ever in place just wait and see how liberalized the field of medicine will become. Its percentages will rival Academia in terms of liberals/conservatives. Liberals will be happy to just follow orders and the level of care (regardless of political affiliation) is going to fall exponentially b/c no super intelligent, hard-working undergrads are going to want to become part of this monstrosity.

Simona on August 9, 2009 at 2:08 PM

These aren’t “death panels,” but they’re creepy nonetheless. They’re sales presentations for surrender.

These are death panels, many experts have made good points that they are. The government has proven that when given the chance (See Oregon) they will opt to end life that is sustainable. Under a single payer government controlled system the dicisions will be absolute. People who believe otherwise are delusional. Why do you think the only people exempt from the state run health care system are the government and their lackies?

Euthanasia and eugenics are the goal of the Democrat Party.

Rode Werk on August 9, 2009 at 2:08 PM

Democrats have voted down an amendment to the healthcare bill from Rep. Dean Heller (R-Nv.) that would have required all Members of Congress to get insurance through the government-run plan

and again, I keep asking. If this plan is so damned good, that it needs to be put in place, the bill not read, and just rushed thru….why for heavens sake, wouldn’t the Democrats want to put themselves in it? They wrote it, but won’t join it? Why?????

capejasmine on August 9, 2009 at 2:08 PM

fourdeucer on August 9, 2009 at 1:50 PM

All of my life insurance policies cover suicide after the policy is in effect for 12 months. My agent tells me that most do.

boomer on August 9, 2009 at 2:11 PM

Rode Werk “Why do you think the only people exempt from the state run health care system are the government and their lackies” – really really good point.

Simona on August 9, 2009 at 2:12 PM

fourdeucer on August 9, 2009 at 1:50 PM

The devil is in the details. And we are headed to hell in a hand basket because Congress and too many people refuse to even look at the details, and others, such as Obama and the ACORN and SEIU thuggery (and all those who support them) refuse to allow access to those details for the general public. You supposition is correct. Either policies will have to be re-written and a hell of a lot of them at that, or life insurance become the next casualty in The War on America.

coldwarrior on August 9, 2009 at 2:12 PM

boomer on August 9, 2009 at 2:11 PM
coldwarrior on August 9, 2009 at 2:12 PM

Thank-you, I think this whole debate is fascinating, scary, and mostly way out of my league.

fourdeucer on August 9, 2009 at 2:23 PM

The United Sates of America is dead and it has been replaced by an omnipotent, ghoulish socialist monster. Thank you enlightened voters you really stuck it to us this time.

rplat on August 9, 2009 at 2:25 PM

fourdeucer on August 9, 2009 at 2:23 PM

Not at all…keep on keepin’ on. :-)

coldwarrior on August 9, 2009 at 2:28 PM

In general I’d think the bureaucrats running this won’t have that level of insight.

Simona on August 9, 2009 at 2:03 PM

Bureaucrats =/= doctors.

Black Yoshi – and if this is ever in place just wait and see how liberalized the field of medicine will become. Its percentages will rival Academia in terms of liberals/conservatives. Liberals will be happy to just follow orders and the level of care (regardless of political affiliation) is going to fall exponentially b/c no super intelligent, hard-working undergrads are going to want to become part of this monstrosity.

Simona on August 9, 2009 at 2:08 PM

I disagree. The field of medicine is somewhat nonpartisan in that those who go into it, whether liberal or conservative, are going after either 1) the satisfaction of preserving life and treating sickness or 2) money. Maybe both.

Black Yoshi on August 9, 2009 at 2:37 PM

Black Yoshi on August 9, 2009 at 2:37 PM

In hospitals all across America who is the most importantperson in the hospital staff?

Chief of medical services? No.

Head of surgical services? No.

Head of the medical college program? No.

If you thought hospital administrator, you are correct.

Why are we adding more bureaucrats to the decision-making process? One is bad enough.

coldwarrior on August 9, 2009 at 2:43 PM

A question that I have yet to see asked is this:
A military member can not sue the military for malpractice no matter how bad. At what point do the lawyers turn against themselves and pass a similar law for public healthcare to cut costs?

cobrakai99 on August 9, 2009 at 2:44 PM

Now – absolutely, probably all of the above i.e. the pleasures of healing, intellectual challenge that’s suitable for their skill/intelligence level, appropriate monetary compensation for their labor, prestige, etc. Now that is. Once it becomes a government industry with government set pay, government dictates on how much care they can provide (which will be much greater and more intrusive than under the HMOs), government mandates to do things like give an end of life lecture, this isn’t going to be the field where the kids willing to study all night in the library their entire undergrad career are going to go. No way.

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The people implementing Obama care will not be doctors, they will be employees of the executive branch. Even if they were, they can still be bureaucrats in the worst way possible.

Simona on August 9, 2009 at 2:50 PM

coldwarrior on August 9, 2009 at 2:43 PM

I don’t disagree with your point about bureaucrats – my father is a doctor, and he’s had quite the experience. But I have seen no conclusive proof that the incentive for doctors – or, indeed, for hospital administrators – is to take more patients out of their payrolls.

The local hospital in my hometown is on the verge of closing. I don’t think they’d be recommending many people to jump ship.

Black Yoshi on August 9, 2009 at 2:52 PM

cobrakai99 — ahh sovereign immunity! I don’t think lawyers and legislators will be on the same page on this one. The removal of the terror of malpractice suits which most doctor’s currently operate under is yet another reason the quality of care is bound to plummet. But have hope – if they do waive it, us taxpayers get to foot that bill too. Hopenchange.

Simona on August 9, 2009 at 2:54 PM

I wonder if the RNC could license this clip from Monty Python and use it in an advertisement, especially the “I don’t want to go on the cart!” line?

The damn AARP just started sending me letters asking me to join, heralding the advent of my Golden Years. Well, after looking at ObamaCare, I don’t want to go on the Gummint Cart.

BTW – Monty Python’s corporation’s name here in the States? It’s the Evado Tax Corporation. Not kidding.

CatchAll on August 9, 2009 at 2:56 PM

Simona on August 9, 2009 at 2:50 PM

A number of the things you speak of are already here – and, perhaps, even worse than you think. Medicare/Medicaid does a great job of dictating payments. Nosy bureaucrats without an ounce of training over a doctor get to decide whether to ruin your life or not (hint: it makes them look better if they gun for the quota). They also require doctors to take useless CME/records courses and psych evaluations, just to make their life miserable. To top it off, malpractice insurance makes it prohibitively expensive to practice.
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And people are STILL putting in the hours by the truckload.
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I don’t necessarily think there will be a shortage of smart, informed people in the medical industry. I think there will be a shortage of people, period.

Black Yoshi on August 9, 2009 at 2:57 PM

Excuse me, by medical industry I meant the doctor workforce.

Black Yoshi on August 9, 2009 at 2:58 PM

My step-father, who has been in and out of the hospital for 15 years, been on his death bed many times, was back at the emergency room about a year ago. The doctor told my mom that he would not do anything unless she signs a Do Not Resuscitate, she refused. They transfered him 30 miles away to another emergency room. Tell me it will be better under Obamacare. He has great insurance from Disney.

By the way, he plays online poker, orders trains in auctions online, plays Pogo online. This is someone they wanted to let die.

WoosterOh on August 9, 2009 at 3:05 PM

Black Yoshi – I’m not sure we are talking about the same thing, I have the utmost respect for Doctor’s, Nurse’s, and all medical professionals including pre-med students who have the brains and the drive to get into med school. I was making the point that if Medicine becomes a politicized field, with greater burdens and fewer rewards (in the future after the passage of Obamacare) the quality of applicants to medical schools is bound to drastically decrease b/c there will be greater burdens, fewer rewards, and conservatives will feel unwelcome just as they feel unwelcome in academia (to put it lightly). Thus the level of care will drastically decrease, and many hard working doctor’s in America — those who possess exceptional intelligence and work ethics — may opt for the private sector where they will be better rewarded and less constrained. Their departure will also contribute to a grave decrease in the quality of medical care.

Simona on August 9, 2009 at 3:06 PM

Black Yoshi on August 9, 2009 at 2:52 PM

Vicious circle, to be sure. Wages and services make up the bulk of hospital costs. And those payrolls have to be met, lest professional staffs leave and the hospital is de-certified, as has happened to a hospital in this area.

The other aspect, as a hospital approaches the closing point, medical professional staff’s tend to look for a more stable place to work, even if it means a pay cut. Once the doctors and nurses in Bloody Hands Memorial find out that they may not have a hospital in which to apply their healing skills in a year or so…the applications, interviews and lobbying starts at other hospitals all across the nation begin almost immediately.

Put artificial limits on how many doctors and how much they are to be paid, and you will find fewer not more doctors available. Same with the nursing field. Right now, according to my daughter, who is in the middle of her BSN program, geriatric nursing in a nursing/continual care facility is the biggest growth area for nurses. She does not want to be a geriatric nurse, says she has been taking care of the old man, me, for too many years already…

The whole point being, medicine is one of those fields that was once patient driven, and the doctor-patient relationship was close and immediate. Now it appears to be more cost-cutting oriented and that once-intimate doctor-patient relationship has expanded to many doctors…and these costs deprive patients from having access that is close and immediate.

A look at the Canadian nightmare, or the UK model, and any other country where government controls the strings of medical care, might want to go back to Cold War era Russia and eastern Europe, and see that there was a very small segment of high quality health care provided, to a select few. The rest of the nation, the workers and peasants, were afforded the most rudimentary care for the most rudimentary of ailments.

Even the leaders of the most despotic or socialist nations in the world sent themselves or family members to Mayo or Cleveland Clinic rather than risk being treated at home.

On that note, unless Obama and Congress sign “comply or resign” affidavits and sign up for Obamacare and drop any and all coverage they and their family members may presently have…there is no way on God’s green earth that I will attach myself to any part of Obamacare.

coldwarrior on August 9, 2009 at 3:06 PM

Black Yoshi – my understanding of Obamacare is that taxpayers are going to be paying ‘x’ amount for healthcare regardless (depending on what Obama/congress/that executive office sets it at) so having more patients there for more days with more procedures won’t generate more income. I could be wrong, I should probably read the bill but I’m not looking forward to either the eye strain or the cost of the printer cartridge.

Simona on August 9, 2009 at 3:15 PM

WoosterOh on August 9, 2009 at 3:05 PM

I can tell you what that doctor did was not legal. Patients cannot be refused care in emergency rooms by law.

boomer on August 9, 2009 at 3:19 PM

Black Yoshi on August 9, 2009 at 2:57 PM

Malpractice insurance…yeah, that’s is a biggee.

In this small county of 150,00 there are no obstetricians…none. One neurosurgeon. 14 years ago when I first moved here, there were at least a dozen OB’s and four neurosurgeons, and a slew of specialty physicians. In the meantime, the hospitals tried to import doctors from roving traveling medical teams, made up mostly of South Asians who recently graduated school, and that did not work out well at all. AThe primary reason cited by the doctors themselves was they could no longer afford to work here and pay their malpractice insurance and still feed their families. And the local hospitals could not afford to raise their salaries. And the independent physicians, the guys with the offices in those small medical malls? Once had a lot of them. In one such medical mall the former doctors offices are being used as for a tattoo parlor, an herbal medicine store, a cellular phone dealer, and the rest as well having nothnig to do with providing health care…maybe the herbal place migfht be an exception, but that is a stretch. But, we have this summer added a 150 bed expansion of the hospital…for geriatric and obesity care.

The system is broken…that I will agree.

But why replace all four tires, the engine and transmission of on the car when all you drove in to the dealer to get was a windshield wiper?

The “system” needs tweaking and a little adjustment…not wholesale destruction and reorganization at a cost we will be paying until the end of the century, if that.

coldwarrior on August 9, 2009 at 3:20 PM

coldwarrior – very interesting. I think it’d behoove conservatives not to go too crazy with the we love our healthcare line of reasoning. There is a desire for improvement in the healthcare system. The reason so many people are so opposed to Obamacare is because it takes all the worst current problems with healthcare and amplifies, multiplies, exponentially increases them. The other side of the coin is all these somewhat hidden factors which will lead to a decrease in the quality of care. Bigger problems, worse care. It could be a beer commercial.

Simona on August 9, 2009 at 3:23 PM

boomer on August 9, 2009 at 3:19 PM

Appears to be a violation of the EMTALA.

But here is the catch:

To establish a violation of EMTALA, “a plaintiff must demonstrate that (1) the hospital is a Medicare-participating hospital covered by EMTALA that operates an emergency department (or an equivalent treatment facility); (2) the patient arrived at the facility seeking treatment; and (3) the hospital either (a) did not afford the patient an appropriate screening to determine whether he or she had an emergency medical condition, or (b) bade farewell to the patient (whether by turning away, discharging, or improvidently transferring him or her) without first stabilizing the emergency medical condition”

Out here in flyover country, there are still a lot of hospitals that are not “covered” under EMTALA. Medicare not being a factor. And, the “plantiff” needs attorneys to establish a violation. Out here in flyover country, as is Wooster, Ohio, gonna take a lot of money to go after a hospital. Local attorneys around here are not up to the task, so the fall back is seeking out one of those nationally advertised law firms specializing in medical malpractice…and as a general rule, in any settlement, when the actual cash hits the table, the “plaintiff”/patient gets about 30%-40% of any settlement once all the law firm’s billing for services and such are paid.

Black Yoshi raised the issue of malpractice insurance…and this is indeed about a lot more than ambulance chasers and trial lawyers. It is serving to gut our medical system of its best asset…the doctors, nurses, and medical professionals.

coldwarrior on August 9, 2009 at 3:32 PM

Simona on August 9, 2009 at 3:06 PM

Simona on August 9, 2009 at 3:06 PM

I understand what you mean. However, I believe medicine is already a politicized field when you factor in the egregious bureaucratic abuse that goes on in the name of “patient safety.” The current system has a lot of liberal shades, especially if you live in New York.

To make myself clear, though, I don’t totally disagree with your projection. I could easily see a number of ambitious premeds dropping out of the doctor’s career path due to government hobbling. However, when I look at the current climate and still see so many students going into it – for nonpartisan reasons – I believe that there will always be a cadre of competent medical personnel. There may not be many of them, but they will be there.

As for the medical professional community at large…I believe there will also be a shrinkage overall in the future, at least in terms of doctors. Liberals know where the money is, too.

Black Yoshi on August 9, 2009 at 3:33 PM

Interesting, I didn’t know it already had liberal shades. These are good points — but a shortage of Doctor’s combined with an increase in patient numbers could be just as bad, no? Maybe the premeds burning the midnight oil are betting Obamacare won’t pass and hopefully they’re right.

Simona on August 9, 2009 at 3:38 PM

coldwarrior on August 9, 2009 at 3:06 PM

coldwarrior on August 9, 2009 at 3:20 PM

Absolutely. Obamacare looks like it will amplify the bureaucratic end of the system in the name of the uninsured. On the face of it, a public option looks to be okay…until the reality of the Medicare/Medicaid overcharges, abuse, and general incompetence sets in. In my eye, something has to be done about the state of the medical profession. But that seems to be ignored.

Simona, in regards to your post at 3:15, the current Obamacare plan isn’t a single-payer – yet. Hospitals will still be competing for patients regardless.

Black Yoshi on August 9, 2009 at 3:41 PM

Simona on August 9, 2009 at 3:38 PM

Yep, that could only be bad. I’m hoping for the best.

Black Yoshi on August 9, 2009 at 3:46 PM

End of life purely voluntary. The doctors get paid to do it. So if we use the President’s own words…. “taking out your child’s tonsils to earn some extra money” Won’t all of the doctors start scheduling their “counseling sessions” right away??

kringeesmom on August 9, 2009 at 3:57 PM

If some kid was thinking of being a doctor, but factoring in the time and expense of the schooling needed, then the government telling him/her what kind of doctor to be, then limiting their income, and finally allow the DEM friend and bloodsuckers, trial lawyers, continue to sue them for every minor thing, the kid figures out they’d be better off becoming a plumber.

Jeff from WI on August 9, 2009 at 4:28 PM

I have absolutely no doubt that in time, the elderly, those caring for the disabled, and parents of infants born with disabilities will be coerced by government paid doctors that it’s their patriotic duty to “let go.” You know, just like it’s patriotic to pay taxes.

This has been happening in Holland for years.

Please take a look at this report and read it through (don’t just stop at the physician assisted suicide rules – read about what is actually happening). This report is actually from 1994 so it pre-dates the whole Groningen Protocol.

http://www.internationaltaskforce.org/fctholl.htm

Candy Slice on August 9, 2009 at 4:40 PM

Any system that values the state above the individual is obscene.

coldwarrior on August 9, 2009 at 1:41 PM

Exactly. That is the nutshell of it. Our system of rule of law was designed to protect the individual. This is the proper role.

anuts on August 9, 2009 at 4:43 PM

Monty Python had it just about right more than thirty years ago:

Hey Ed, I posted a video of that weeks ago :(

Well it is a good metaphor :)

FontanaConservative on August 9, 2009 at 4:44 PM

And now for something completely different (on youtube) my friend’s little brother: http://www.youtube.com/watch?v=5RSLi62InJY

Simona on August 9, 2009 at 4:50 PM

coldwarrior on August 9, 2009 at 3:32 PM

I didn’t realize there were hospitals that didn’t participate. Both hospitals in our aread do. As far as having a doctor shortage in our area it’s not too bad. Our county has fewer that 40k for a poplulation and we have access to a number of specialists that travel here once or twice a month to see patients. We have however lost a few doctors to rising malpractice insurance rates. One was an OB who went back to school and is now an RN. Another became a hospitalist in a large city. It was the only way he could get the malpractice insurance coverage he could afford. He wasn’t a bad doctor. I don’t know of any claims against him and I would because he worked at the same small hospital as my wife. We heard that because he ended up being a cancer patient the insurance company viewed him as high risk and upped his premium.

boomer on August 9, 2009 at 5:02 PM

The only thing san-fran nan wants to do to my butt is tax it.

boomer on August 9, 2009 at 1:51 PM

Hey. Always consider, it could be worse. She could want (wink, wink) your butt. Does that make your skin crawl?

Yoop on August 9, 2009 at 5:19 PM

Beck raised an even uglier word than rationing, psst, shhh ‘eugenics’ hush, quiet. It was in response to Rahm’s brother Zeke’s graph representing who was valuable to society and who was not. And a few choice comments of Zekes about productiviy within society. This is one of O’s advisers on this medical mess! O’s two bookends? Rahm and Zeke!

jeanie on August 9, 2009 at 5:24 PM

Beck raised an even uglier word than rationing, psst, shhh ‘eugenics’ hush, quiet. It was in response to Rahm’s brother Zeke’s graph representing who was valuable to society and who was not. And a few choice comments of Zekes about productiviy within society. This is one of O’s advisers on this medical mess! O’s two bookends? Rahm and Zeke!

jeanie on August 9, 2009 at 5:24 PM

The problem will likely be the opposite of rationing. Determining benefits via the political process will cause politicians to outbid each other in their ability to deliver give aways to the voters (as was recently done with Medicare Part D).

If there is a government plan (and it looks like there won’t be) it is best if it is bare-bones, designed to provide only the fundamental care needed to keep people out of the emergency room. Anything beyond that should be handled by a competitive private insurance system, where individuals decide how much premium they want to pay.

dedalus on August 9, 2009 at 5:33 PM

(as was recently done with Medicare Part D).

On Medicare but not Part D. Had not heard of this. Can you give some examples? and, since the drug companies seem to be supporting O, what’s in it for them?

jeanie on August 9, 2009 at 5:38 PM

Once it becomes a government industry with government set pay, government dictates on how much care they can provide …

The people implementing Obama care will not be doctors, they will be employees of the executive branch. Even if they were, they can still be bureaucrats in the worst way possible.

Simona on August 9, 2009 at 2:50 PM

The German-speaking world has a term for one of these doctors with divided loyalties: Amtsarzt.

RD on August 9, 2009 at 6:05 PM

Can somebody put up the bat signal for AllahP so he can read this.

considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had a few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern the disproportionately large amounts of resources will be directed to young people with poor prognoses. When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable….

This is insane Marxist-Nazi sh!t! Sorry for cursing, but these are the insane people that Obama surrounds himself with. Death Panel Voodoo Nazi Humanist Cultist! These people are the most dangerous threat this nation has ever known. What god do they worship? Their god treats humans like cattle. We are to be allocated only that which contributes to the society as a whole, if the allocation is seen to not be equally productive in relation to another, meaning someone younger or someone without long term health problems, then we get crap!

Hellooooo MSM, when are you going to start reporting on these insane people that your candidate surrounds himself with?

AllahP owes Sarah an apology.

True_King on August 9, 2009 at 6:11 PM

All we need is for Peter Singer to get in on this government panel – I think he’s campaigning for it http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html

Candy Slice on August 9, 2009 at 6:52 PM

You only have to realize the Social Security and Medicare are going to cost the Government about $1 trillion per year in the very near future. Then you know exactly why it’s a rush to get this government health control legislation through so they can begin counseling seniors.

katablog.com on August 9, 2009 at 7:21 PM

Killing off older voters who are normally conservative. Getting votes from illegals, and the youth vote who will get the benefits from those who are terminated. It really is a Soylent Green/Logan’s run scenario here.

portlandon on August 9, 2009 at 1:36 PM

With the elderly as the new Untermenschen, whose wealth is to be ex-propriated and redistributed to the young. Except that the aged have to be dehumanized in the eyes of their younger family members to make this remotely palatable. Look for Hollywood and the shapers of popular culture to be enlisted in the effort to dehumanize the aged and make them look ridiculous, silly for ‘clinging to life’, beneath contempt, etc. Ultimately hopeless, but it’ll be enlightening to watch them go through the tortures of the damned in order to try.

Beck raised an even uglier word than rationing, psst, shhh ‘eugenics’ hush, quiet. It was in response to Rahm’s brother Zeke’s graph representing who was valuable to society and who was not. And a few choice comments of Zekes about productiviy within society. This is one of O’s advisers on this medical mess! O’s two bookends? Rahm and Zeke!

jeanie on August 9, 2009 at 5:24 PM

The problem we face is that the new super-state now has *two* (if not three) reasons to end life prematurely, amplify solvable health crises and make them appear hopeless, etc. Assuming a person could have lived to age Y with the current medical state of the art (e.g., 95 years), but who will now live to age X (e.g., 85 years), there are multiple incentives for them to sell us out:

One is the direct savings in medical costs though elimination of any future medical interventions between ages X and Y, which could be significant. This is the one everyone’s talking about.

The second is the savings recouped in other government payouts such as Social Security between the ages of X and Y. (Though a spouse may receive those benefits, the medical system applies to both equally, so in this example the net effect is the same.) I’ve heard this mentioned here & there as well.

The third, and potentially most interesting, is the backloading of taxable events from the date at age Y to the date at age X, caused by the person’s early demise. If premature death is brought about consistently and comprehensively enough, the increase in the yearly government take through the (re-appearing) estate tax and other taxes could be substantial — at least while the ‘supply’ of seniors lasts and their propensity to save for retirement remains consistent.

Assuming the U.S. lifespan is eventually shortened to X/Y years (a big assumption that is not necessarily realistic), that would translate to an enhanced collection rate per year of Y/X inheritances. At the 95 years/85 years ratio suggested above that equates to +11.76% per year above current levels.

That’s only part of the ‘good’ news. The other part is that, by not having incurred Y-X years’ worth of living expenses, there’s more money left over to tax. If on average a person would have spent Z percent of their remaining nest-egg (e.g., 40%) between years X and Y, then the true % increase in the yearly take by government could be [(1 + (Z / 1-Z)) * (Y - X)]. In my example, that would mean (1 + (40%/60%)) * (Y – X), or 2/3 more money available to tax, which would translate to a whopping +86.3% per year.

And, instead of converting this nest-egg slowly from IRA to taxable income in small amounts every year, and thus in smaller tax brackets, it would all be converted at once in a lump sum and ‘tacked onto’ a beneficiary’s income, where it is likely to be taxed at higher rates/brackets, thus enhancing the government take even further.

Presto – an instant tax on you, the middle class, without breaking his promise not to raise taxes on you, the middle class. Not to mention, one h-ll of a conflict of interest.

(Caveat: My crude attempt at stating the problem doesn’t employ the solid math needed to draw solid conclusions, but the gist of it is there. Also, the Y/X ratio wouldn’t be reached immediately as we still have a residual population of 85- to 95-year-old seniors that have been treated to good medical care, so the full brutal impact of the Y/X rate would not be felt for a while. On the other hand we would see an immediate spike in deaths as seniors from multiple age groups hit the ‘wall’ at the same time, so there might be an initial boost of revenue to ‘compensate’.)

RD on August 9, 2009 at 7:35 PM

RD on August 9, 2009 at 7:35 PM

The true evil as I see it is the ability of the State to link two things which are not naturally linked, such as estate taxation and medical decisions. With the State in charge of both issues, there is no longer a firewall keeping the two separate. Now, decisions that are not even strictly medical cost-related (such as, “does the patient have a big nest-egg that the State can confiscate if we kill him now?”), can enter the calculus.

This is as evil as it is inevitable, once the State assumes reponsibility for both estate taxation and medical care. The conflict of interest is unavoidable, and plain for all to see.

RD on August 9, 2009 at 7:43 PM

RD on August 9, 2009 at 7:35 PM

An unavoidable part of the death-tax calculus is that it is in the interest of the State to maximize the difference between mandated age of death X, and natural age of death Y, in order to preserve as much of the person’s nest-egg as possible, for inheritance tax purposes.

This goes beyond the incentive everyone is talking about, which is to deny coverage for expensive medical procedures based on productive value to society. The real problem is when a person becomes more valuable to the State as a cash cow than a work horse. Doubly so when their value as a cash cow is constantly declining. Their value two years from now will be less than their current value, most of the time.

What is there to restrain the impulse of the State to exaggerate a health problem, slip with the needle accidentally, or otherwise jeapordize the health of a patient needlessly when the cash cow clock is ticking, so to speak?

RD on August 9, 2009 at 7:52 PM

RD: Whew!! I think I’ll give it all away now in small increments not noticed by the IRS or spend it on travel(really would like to go on the QEII) and go live in subsidized housing with Auntie Zetuni and get all my medical care and meds free. But….Medicaid recipients get terrible medical care and have long waits and see all kinds of different Docs many of whom are not qualified in the particular field. Welcome to OCare, but as it’s coming anyway, there’s nothing to lose and much to gain with my plan.

jeanie on August 9, 2009 at 8:00 PM

Heck, jeanie, nothin’ to worry about aside from a few insignificant details… say, how’s that life insurance policy looking? ;-)

RD on August 9, 2009 at 8:12 PM

RD – the logic of your tax math gave me shivers
-
True King – “what God do they worship” they all claim to be atheists but really they worship Obama, which is why they get so angry when anyone says anything non-worshipful of him, his administration or his plans (see the worst interview ever post’s clip for a good example of the unhingedness)

Simona on August 9, 2009 at 9:29 PM

These aren’t “death panels,” but they’re creepy nonetheless. They’re sales presentations for surrender.

The elderly are often the #1 group targeted by scams. The bill calls for a half $TRILLION in cuts to medicare (to pay for ObamaCare), so they wouldn’t hesitate to make further cuts if they choose.

TN Mom on August 9, 2009 at 9:48 PM

It’s so simple.

One shot of morphine and you feeeeel greeeaaat.

Two shots and you’re goooone.

ALL PRAISES TO THE STATE.

ALL HAIL SAINT UTILITY, THE GUIDING LIGHT.

The Lord of Lies couldn’t come up with a better plan if he tried.

CPT. Charles on August 9, 2009 at 10:48 PM

Call me crazy, but I thought most people did all this stuff anyway. They do not need any type of government “insistence”.

xax on August 10, 2009 at 1:22 AM

Jeff from WI on August 9, 2009 at 1:16 PM

I know, it’s a terrible day when I can go to the specialist, pay my $30 copay, and get a $7k per treatment drug at no expense and actually improve instead of getting an end of life cousler and just suffering a miserable end.

boomer on August 9, 2009 at 1:33 PM

Don’t let the Obama gang know that.They’ll shut that down right away.

Jeff from WI on August 10, 2009 at 8:02 AM

Assuming the U.S. lifespan is eventually shortened to X/Y years (a big assumption that is not necessarily realistic), that would translate to an enhanced collection rate per year of Y/X inheritances.

BTW, a big disclaimer here that the coupling of shortened life spans to a % increase in the death rate is dynamic, not necessarily permanent, and more complicated than I let on so the following ratio/claim shouldn’t be taken too literally, nor as an indefinite phenomenon:

At the 95 years/85 years ratio suggested above that equates to +11.76% per year above current levels.

The meaningful number here is the % increase in the death rate of seniors over the current nominal death rate. That +% is dynamic and will fluctuate over time, spiking early in the process and tapering back off toward the nominal death rate in the long run. The cluster of accelerated deaths can be counted & measured, as can the revenue they generate for the State. Once the death rate has re-stabilized, the other term in the equation (i.e., the larger nest egg produced by an earlier death) will predominate.

And this term, too, will shrink over the long run as seniors adjust their saving / spending (and earning) patterns to the new, lower life expectancy. Thus the money taken by the State will face diminishing returns, like most of their other interventions (though a windfall profit is likely no matter what, it seems to me).

RD on August 10, 2009 at 10:30 AM

Question for Ed Morrissey: Do you actually bother to read the articles to which you link before you post them?

You said:

Section 1233 imposes a requirement for end-of-life planning sessions every five years for Medicare patients

(my emphasis)

However the article clearly states that the end-of-life planning is:

not mandatory, as some on the right have claimed

This couldnt be more clear. Yet you’re still lying to your readers. Why is that?

orange on August 10, 2009 at 12:55 PM

Why pay a doctor to explain all this, including legal documents? Just put a website up called EndOfLifeChoices.gov and provide all relevant information there. Problem solved.

Then citizens can take a look in an easily accessible and non-pressured setting, and we can all review it to make sure everything’s on the level.

willamettevalley on August 10, 2009 at 2:12 PM

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