Mitch Daniels on Medicare: We can’t afford every form of end-of-life care for everyone
posted at 9:49 pm on February 14, 2011 by Allahpundit
He said it a few days ago but it’s best contemplated today, through the lens of the fiscal apocalypse that is Obama’s budget. All along, I’ve been thinking that the Romneyites want this guy to stay out of the race lest the moderate/managerial wing of the primary grow too crowded. But now? Mitt would inevitably use Daniels as a foil to frame himself as the voice of reason on health-care reform, hammering Mitch the Knife as a de facto rationer. Then Daniels would turn around and bludgeon him for the sins of RomneyCare. And the Palinistas would watch it unfold, rubbing their hands with glee and chuckling all the while.
I hope he does get in just because I’d love to see a serious debate about entitlements in the primary. Medicare is a 10,000 lb. anchor dragging the feds beneath the fiscal waves. How are we going to float?
“We all want to live forever, we want everything done for us to live forever,” the Indiana governor told a small group of health reporters. “We cannot afford, no one can, to do absolutely everything that modern technology makes possible to absolutely the very last day of the very last resort.”…
Daniels advocated for a more patient-centered approach, where families tackle the tough decisions of limiting care. “Someone will have to be making the decisions. I prefer it not to be the government,” he said.
“Look at it this way. It’s the most human thing in the world, when a loved one is in a desperately ill state and the question is, we can try this thing that has almost no chance of working, and it’s going to cost an incredible amount? Any person of course says, ‘Try it.’….It’s the hardest of all the questions. I don’t think there’s a more humane way than the re-involvement of patients and loved ones, to a greater extent.”
A reporter asked him about Medicare reimbursement for end-of-life consultations with doctors (which was part of the “death panels” outcry), but he dodged it. This sort of rhetoric isn’t new for him, really: Last summer he knocked congressional Republicans for using Medicare as a weapon against ObamaCare, knowing that the more lip service we pay to the sanctity of socialized medicine now, the more difficult it’ll be later to explain to voters that the program’s been unsustainable for years and must change soon. It sounds like he’s advocating some form of “soft rationing” here, where Medicare patients and their families would choose among various options for deathbed treatment rather than the feds dictating any particular course of action. He’ll take a beating for it in the primaries, but as I said up top, merely forcing the discussion of how to pay for Medicare will be a productive use of primary time. And then of course it’ll all be forgotten in the general election, when Obama and the Democrats inevitably accuse the Republican nominee of wanting to take away granny’s medicine and he/she quickly backs down.
In other “Daniels controversy” news, here’s a clip dedicated to the alleged scandal of a would-be president having once been busted for pot. Given that our current president cops to having experimented with coke, I thought we were waaaay past this sort of thing. Guess not.
Blowback
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We can’t and this country will be turned into a 3rd world nightmare for our Grand Children.
chemman on February 14, 2011 at 11:44 PM
You invoke the constitution, which says nothing about medical care for citizens provided at the federal level, and accept no new enrollees — and phase out medicare taxes for anyone not already in the system.
Or is that a little pie-in-the-sky?
gryphon202 on February 14, 2011 at 11:59 PM
He used excess Social Security funds to provide for his surplus. No debt was paid off. There-in lies the whole problem. The government uses income taxes, social security taxes and medicare taxes as if they come from the same pot. Rather than investing for a rainy day when they had surpluses they spent it on other vote buying activity and now the so called entitlement programs will bankrupt us and condemn future generations to serfdom.
chemman on February 15, 2011 at 12:03 AM
Fact: Most of the cost of medical care is dished out at end-of-life.
The same people that want to slash entitlements get pissy when we talk of denying care to those that likely will die anyway. They rationalize BS about ending Medicare so they don’t have to tackle such a difficult issue logically.
We’re headed towards the government equivalent of bankruptcy. Cuts will have to be made over time, including the military and entitlements, like Medicare. Pull your hypocritical heads out of your asses and deal with it.
I use the word hypocritical because of the arguments many of us used to fight 0bamacare. It was easy to see that such talk would come back to bite us on the ass.
toliver on February 15, 2011 at 12:27 AM
Sarah Palin did such a disservice to the country by introducing the term “death panels.” I am thoroughly opposed to last year’s health insurance legislation, but we need to be able to have adult conversations about it. We do have a healthcare crisis in this country, both in terms of entitlement spending and overall percentage of GDP devoted to healthcare. One (relatively minor) way to address this problem is to try to figure out how to provide responsible care to people in their last stages of life. Does it really make sense to perform expensive (and painful) surgeries, joint replacements and organ transplants on very sick or elderly individuals with only a few days to live? Even life-extending treatments may not always be in the patients’ best interest. For people in the last stages of cancer, we can treat them with expensive rounds of nightmarish chemotherapy that makes life a living hell and may only extend life by a few days or weeks, or we could take a palliative care approach to make their final days less painful. These are serious decisions that patients need to be making with their families and their doctors. No one should or ever would be forced into an early death. But we need to be able to talk about wise, responsible approaches to end of life care, both to promote the best interests of patients and as part of a multi-front fight for health spending sustainability.
By shouting “death panels,” the ability to have a serious conversation is severely limited, and it becomes much more difficult for responsible, conservative voices to be taken seriously.
IU_Conservative on February 15, 2011 at 12:41 AM
You’re making end of life decisions sound much colder and inhumane than is actually the case.
Death panels are the only answer. Of course, that’s a terrible term for what should happen when families make health care decisions at the end of their love ones’ lives. (Thank you, Sarah, for twisting a legitimate and previously respected practice into a superficial controversy.)
My brother is a doctor who often sees patients in their final days. You have to understand that when someone’s 80 year old mother or father is knocking on heaven’s door, family members break down, become hysterical, and in their grief, often demand that anything and everything imaginable be done to extend life. We’re talking about medical technology designed to save a 20 or 30 year old from a traumatic accident. Yes, it can be applied to extend the life of a dying 80 year old for a few days or even a few weeks. But that very brief, extended lifespan is often spent in pain or in a largely unconscious state.
The doctors caring for these patients often realize the irrationality of a family member’s decision, made under severe grief and duress, but of course the doctors are morally obligated to apply any life-extending care that’s known to modern medicine- no matter how hopeless the case. That’s why it’s so important for families and doctors to sit down and discuss options. When I’m on the way out, the last thing I personally want is a hysterical relative extending my life with 2 weeks of agony (not even accounting for the cost).
So when you talk about end of live medical care, it’s not about pulling the plug on someone who might have a chance of returning to a normal life. In the vast majority of cases, it’s simply about people failing to make rational decisions, and a health care system that fails to help families deal with death.
bayam on February 15, 2011 at 12:49 AM
Not only that, government funding is completely appropriate for helping families deal with these end of life situations. It not only will result in more humane treatment of dying patients, but significantly cut medical care costs in this country.
bayam on February 15, 2011 at 12:53 AM
It is very important for all involved to have those kind of discussions. The issue that Palin raises is that these crucial discussions will be regulated by government officials rather than being the outcome of a lifetime of work and savings on the part of the patient or family.
pedestrian on February 15, 2011 at 1:55 AM
Complex treatments can cost in the millions, much more than an individual will ever pay in medical insurance or even income taxes, thus the country cannot afford to give everyone the top level of care that is available. Reality is that only those who have saved (or paid really high premiums all their life) will be able to afford expensive treatments. Those who do not save do not have the right to have others subsidize their treatment.
Canuckistan on February 15, 2011 at 2:21 AM
Equating a person’s life, no matter how short, with $ signs is one way to look at their life. General statements about medical treatments costing too much money, causing too much pain, resulting in too litte improvement and too little return on the dollar — in terms of length of life — indicates a bean counter approach to life. Life isn’t measured in beans.
As for Palin’s “death panel” remark, it caused the general public to focus more of their attention on obamacare and for that reason alone the comment was a successful…
Gohawgs on February 15, 2011 at 2:50 AM
But not very helpful in the current budget cutting debate that is essential for the health of our republic.
toliver on February 15, 2011 at 2:59 AM
My wife’s mother spent her last 4 weeks in an unconscious ICU setting. I went with my wife once early on, as support, but walked out after 10 minutes. Three of the 4 children wanted it to end, but there was one holdout. Thus it continued, with no response from the afflicted.
With costs of $4000+ per day, I guess there was ample time for the children to adjust to the fact that their mom was already dead. Everyone still got all their inheritances, so no harm done right?
BS. Decisions have consequences. Unless the government insulates you from them. Or unless there is now a total disconnect from cause and effect.
This I doubt. Unless you are of that ‘faith’ that all life is so precious that any means of extending life must be extended to all that might die, regardless of cost. For you, I expect to find you out front of every hospital, devoting you entire life earnings to that prolonging of life, no matter what harm it might do to your family.
If not, I think I have just found another hypocrite.
GnuBreed on February 15, 2011 at 4:11 AM
Mitch is RIGHT!
NRA Lifer on February 15, 2011 at 8:18 AM
Yes, for families and doctors to do it. Nobody ever said differently. What we object to, and will continue to object to, is the gov’t being involved. The gov’t making the decisions based on gov’t budgets and electoral politics. Nameless beauracrats who don’t have what it takes to work in the private sector (and yes, I am saying that most gov’t employees are less capable, competent, and intelligent than people in the private sector) making end of life decisions for my family.
You want that. The rest of america doesn’t. Your “doctor” brother probably loves the idea of joe blow in Washington, D.C. telling him who he can provide care for and who he can’t based no their budgets (by the way, b/c teh gov’t is so inefficient, the amount of potential care for each individual will be dramatically reduced, so more people will be left without care for budgetary reasons under you socialist utopian scheme).
It was a good straw-man you created though – family and doctors discussing end of life care is what was meant by “death panels”. You really are good at arguing with points that don’t exist. That must be because you have no argument as to the real issues.
Monkeytoe on February 15, 2011 at 8:20 AM
The funny thing about all this is that these decisions were always made financially, based on who could afford what care.
The libs did nto like that b/c it was “unfair”, so tehy want everyone to face teh same cost restrictions. The decisions will still be made financially, they just won’b be based on an individual person’s ability to pay (which includes the ability to afford better insurance), but instead some arbitrary decision out of washington.
So, they haven’t changed anything except taking away choice from the people who earned that choice. But somehow, this is “fairer”. And, as I said earlier, b/c the gov’t is so ineffeciant, the choices it will make will actually leave everyone a little worse off then under our current system.
It’s pathetic. these people are incapable of learning or understanding basic economics or human nature.
Somehow they will make a perfect world where unicorns and rainbows are ever-present and nobody has to pay for anything and everyone is happy (as long as they purchase the various products the gov’t orders them to).
Monkeytoe on February 15, 2011 at 8:29 AM
If you have medicare, they take the premium for it out of your SS check before it is sent. If the feds would like to get out of MC, fine, I’ll be glad to pay a premium to a real insurance company and get the coverage I need not something that needs a doc fix to make sure my doctor will still see me. If they want to get out of the SS business, fine, cut my taxes on the savings I have and use to keep food on the table and pay the electric bill.
Kissmygrits on February 15, 2011 at 8:45 AM
I’m pretty sure most people faced with an end of life situation would rather go with dignity and peacefully and not be in a hospital setting undergoing all kinds of last ditch efforts to treat them. I would have loved to have my mother around a lot longer than she was but I had to refuse treatment for her because she was terminal and nothing was going to change that. It was the worst situation imaginable but it was what I thought she would want.
scalleywag on February 15, 2011 at 9:04 AM
Medicare, at this moment in time because it will most certainly go up, is $115.40 cents per month(this statistic came from the bulletin board in the SS office). That is considerably cheaper than effective private insurance. But, if you then add in, say a conservative $300 a month(out of pocket or employer funded), for supplementary insurance, it all comes out to about 5K a year that many if not most seniors pay each year…unless they depend only Medicare. Anything over and above are out of pocket costs and these can be quite large. The difference between this and O’s plan as I see it, is that the supplementary insurance is voluntary. You don’t have to have it and the rates and plans are fairly competitive. So, it’s not all free, far from it. The only ones with free care are on MedicAid, these pay nothing at all. If you are looking for a drain on society, perhaps one should look there.(sorry for length)
jeanie on February 15, 2011 at 9:14 AM
The last two days of my father’s life cost Medicare over $150,000. He was 89 years old. He contracted pneumonia in a rehab center he was about to be released from, was rushed to big expensive regional hospital instead of the smaller local one he was used to, they threw him in ICU, sedated him, and pumped him full of antibiotics. He had a DNR order, but when his heart stopped half of our family were on the way, and my mom told the doctors to try to save him so we could all get there to say goodbye. They couldn’t. He didn’t even know what was happening and never would have wanted to go that way. I knew he was a goner the day before, the minute I heard he had pneumonia – it is what kills a lot of people in hospitals, especially old people.
These stories are repeated hundreds of times every day in America, and 15 years from now it is going to go up to thousands a day. We simply cannot afford to chew up all of our resources keeping old people alive for another day, or week.
People with aging parents need to prepare themselves and their families to make these decisions together while the parent is lucid and understands what is going on. And of ccourse, doctors should be reimbursed by Medicare for these discussions. My father was a doctor so we didn’t need one. But most people really don’t understand what is ggoing to happen, and once it starts happening they are too traumatized to make the decision. They need guidance from a doctor, but doctors who are already losing money on Meciare patients are not going to go that extra mile for free.
Hopsitals are businesses and they will not encourage you to take your loved one home. They make a lot of money on this end-of-life stuff. Everyone should have a living will that spells out what they want at the end.
rockmom on February 15, 2011 at 9:36 AM
“Death Panels” Daniels does have a nice ring to it.
steebo77 on February 15, 2011 at 9:36 AM
I found the opposite. We were encouraged to take my aunt out of the hospital for either home care or a nursing home(the latter nearly as expensive as the hospital). We opted for the home care and were very pleased with it overall. It was a drain on time and emotions, but it proved to be the best option on hindsight. Perhaps the approach varies with area of the country and the hospital involved?
jeanie on February 15, 2011 at 9:48 AM
We save every premature baby born regardless of quality of life issues being considered, even when the parents want extraordinary means discontinued because they understand their child may live a near vegetative state. It is an emotional issue, but we need an adult conversation about this. The child, who is severly disabled, oftens lives a greatly shortened life of pain and suffering usually at the expense of the states due to Medicaid waivers (child gets medicaid and supportive home services regardless of parental income).
bopbottle on February 15, 2011 at 9:49 AM
I didn’t know this about this negation of parental choice in when to pull the plug on a severly damaged infant. One has to wonder how/if this fits with the abortion arguments.
jeanie on February 15, 2011 at 9:59 AM
I must say I am very surprised and encouraged by all the rational posts, and from some very prominent people on HA.
Between the subject at hand and Daniel’s true-but-very-blunt statement, I expected the thread to be one giant “OMG DEATH PANELZ!” flamewar.
Dark-Star on February 15, 2011 at 10:36 AM
Where are you getting your information about premies? I know several parents with premies. My 2nd daughter was a premie (2 1/2 months premature… 2 lbs 1 3/4 oz). NONE of them have the issues you describe!
We homeschooled our daughter after the public schools wouldn’t slow down for her. (She is not retarded, but has problems with reading comprehension… having to read the same paragraph 3 times before understanding it kept her from completing tests in a timely fashion.) She graduated, and was an avid reader. She is now 20, works a full time job, is married, and had our first grandchild (a boy) a few months ago.
The vast majority of premies live very productive lives. The only ones in the NICU that had major issues were those born to parents on crack. It was heartbreaking to watch them go through withdrawal, and no parents coming to visit them…
dominigan on February 15, 2011 at 11:30 AM
No, they are not. I think you misunderstand the application of the term. “Death Panels” referred to committee decisions on what medical care would be allowed to be performed by doctors, regardless of a families wishes or ability to pay.
So, why do you believe a government board, interested only in cost cutting (the original makeup of the panel included only ONE doctor position), should be the sole decider in what should be allowed? If a family is well off, why should they not be allowed to make that decision?
In every case where government has controlled medical care decisions, it has resulted in poor care. I for one would prefer NOT to be forced into a system that can only furnish poor care.
dominigan on February 15, 2011 at 11:35 AM
I’ve been called many things in my day but fiscal apocalypse? That’s going over the line. Oh yeah that reminds me, be prepared for the real apocalypse described in Revelation 6:3-8 where one-quarter of the world’s population is destroyed and whole nations are likely wiped out. That’s the apocalypse to get ready for, the real one, sort of like that old commercial from Coca Cola – “The Real Thing.” Fortunately for me, I became a Christian a few years ago, this means that I won’t be here to see all that. Btw, it took me a long time, OK. I was certainly not raised that way. And, uh, so I was dragged slowly kicking and screaming, but I finally committed my life to the Lord Jesus Christ, and, well, just as the Bible says about being born again, I was a totally different person and it was the best thing that ever happened to me. So thank God I won’t be here to see all hell break loose when Antichrist deceives the masses and brings about the darkest time in world history. I will be raptured (taken out) out of this world by Jesus Christ before all this goes down.
“Then we which are alive and remain (Christian’s alive and living today) shall be caught up together with them IN THE CLOUDS, to meet the Lord in the air: and so shall we ever be with the Lord.” I Thessalonians 4:17
Friends, one thing’s for sure, it IS coming, and I wonder how many of you have had the warning this world is gonna be destroyed? God hates sin. He’s gonna judge sin. Get ready for it. Get saved. Get in Christ. That’s the only safe way out.
(Then, as suddenly as apacalyps came, he turns around and walks away. Fading into the crowd.)
apacalyps on February 15, 2011 at 12:35 PM
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