Free Markets, Free People

Death Panels


But there will be no death panels

That’s what we’ve been assured would never exist if government is in charge of your health care and paying all costs.

That, of course, in the face of a promise to lower health care costs as well as the fact that the vast majority of health care spending takes place at the end of life.  Forget those conflicting points, death panels will never happen because, well because the left says so. 

Incentive?  Well that’s sort of a foreign word to the left so forgive them if they don’t understand that those two dueling points above provide incentive to end lives whether or not they’re willing to call it the result of death panels or not.

The example?

Well the good old British NHS of course

Shocking news from England today has top NHS officials indicating doctors acting in the UK government-run health program annually kill as many as 130,000 patients prematurely because of overcrowding at hospitals, medical clinics and nursing homes.

In fact they even have a name for doing that – the Liverpool Care Pathway.

Sounds so … benign.

He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country. It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

It can include withdrawal of treatment – including the provision of water and nourishment by tube – and on average brings a patient to death in 33 hours. There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP.

Or, in other words, the government and doctors playing God.  And, naturally, it has devolved into something done often just for the medical caregiver’s convenience:

Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’. He cited ‘pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients’ as factors.

Nice.  LCP’d because they put what must be considered excess demands on the staff.  But look at the bright side – costs are cut, an less expensive patient can take the bed and everyone is happy.

Except the dead bloke and his family.   But, it’s not a “death panel”:

In the example he revealed a 71-year-old who was admitted to hospital suffering from pneumonia and epilepsy was put on the LCP by a covering doctor on a weekend shift.

Professor Pullicino said he had returned to work after a weekend to find the patient unresponsive and his family upset because they had not agreed to place him on the LCP.

‘I removed the patient from the LCP despite significant resistance,’ he said.

‘His seizures came under control and four weeks later he was discharged home to his family,’ he said.

Instead it’s just a “death pathway” protocol.  So nothing to see here, citizen, move along.

~McQ

Twitter: @McQandO


David Brooks: austerity, “death panels” and spending exemptions

David Brooks helps demonstrate the problem we face in doing anything meaningful about the fiscal mess our government has gotten itself in.  To give him his due, he is trying, at some level, to address the problems facing the country. But he manages to end up putting himself in precisely the position which seems  prevalent today among those not really serious about doing what is necessary to put the fiscal house in order (but like to pretend they are)  – that is “we want budget cuts but don’t touch my favorite programs”.

Let me give you an example from his column today entitled “The New Normal”.

He begins by acknowledging that there is going to be (needs to be?) a whole lot of deficit cutting over the next few years.  And, his first principle of austerity, as he calls it, is that lawmakers must, as he inartfully but correctly puts it, “make everybody hurt”.  He’s right – no exemptions.  Every program, department, echelon, you name it, associated with government (yeah, that means you public sector unions) are going to have to sacrifice something.  Fine to that point.  When you’re looking at 1.3 trillion in a single year deficit, everyone does have to “hurt” if you hold any hope of eliminating it.

However, in this column  he launches into his second principle of austerity and loses me immediately.

A second austerity principle is this: Trim from the old to invest in the young. We should adjust pension promises and reduce the amount of money spent on health care during the last months of life so we can preserve programs for those who are growing and learning the most.

This “principle”  is based in a very nasty premise that “we” are in control of all the money “spent on health care” during the last months and should use that power to help balance the budget (and the fact is, with Medicare, that premise is true).  In other words, “we” will decide to pull the plug on the treatment for oldsters in favor of treatment/”investment” in youngsters.  Not the old folks themselves, mind you.  They’ll have no say in it. He’s talking about the collective “we”.  But don’t you dare say “death panels” you hear me?  And note, he immediately violates his first principle of making “everyone hurt” by claiming that if we throw the oldsters under the bus, we can “preserve programs” for the young.  Where’s the cut in spending when we’re “preserving”?

Oh, it’s not “spending” … we’ll call it “investing”, shall we?

Brooks then expands his “for the children” campaign with this bit of nonsense where he takes a shot at House GOP members:

In Washington, the Republicans who designed the cuts for this fiscal year seemed to have done no serious policy evaluation. They excused the elderly and directed cuts at anything else they could easily reach. Under their budget, financing for early-childhood programs would fall off a cliff. Tens of thousands of kids, maybe hundreds of thousands, would have their slots eliminated midyear.

You’d think Brooks, someone the NYT pays to be informed about how government works, would understand that the legislation he questions isn’t a budget, but a continuing resolution (CR) to fund government in the current fiscal year.   That’s not where you make “serious policy evaluations”.  You do that in budget legislation, something which the Democrats in the House failed to pass last year.   The government has been running on a series of CRs all year.  That doesn’t remove the crying need for cuts in spending, but the only spending under their control in a CR is discretionary spending.  And that’s where they’re cutting.

Brooks prefers to ignore those facts in favor of the emotional argument that they’re going after children in favor of old folks.

What is instructive about the Brooks argument is this is precisely the type arguments that you’re going to see from now on.  Arguments like the one Brooks puts forward here are going to begin with statements like “we must make cuts” and then spend the entire rest of the time arguing against making them.   And 90% of those arguments are going to be based in emotion, not facts or sound reasoning.

Mr. “Make Everyone Hurt” then advances his third austerity principle:

Which leads to the third austerity principle: Never cut without an evaluation process. Before legislators and governors chop a section of the budget, they should make a list of all the relevant programs. They should grade each option and then start paying for them from the top down.

I don’t necessarily disagree with the point, but it is again inconsistent with his first principle, isn’t it?  If everyone has to “hurt”, then something must come from every spending point – to include children’s programs and education.  What Brooks wants is some sort of arbitrary “evaluation” which will – wait for it – justify or rationalize exempting certain programs, policies, departments from spending cuts.

Any guess as to which programs he wants exempted?  Certainly not those effecting older Americans.

Brooks isn’t really serious about cutting spending.   Like many politicians and pundits, he mouths the words and makes the point about all of us sacrificing something, but he really doesn’t mean it. When pressed, he falls right into the “cut everything else but don’t cut my favorite program” group in which you find much of the populace today.  That’s not “shared sacrifice”.

Its hard to take someone seriously who doesn’t seriously address the fact that we have massive debt, massive deficits staring us in the face, a huge new entitlement program on the books and and conclude there’s an urgent need to cut spending in all areas, period.   Brooks should have stopped with his first principle, if he actually wanted to be taken serious.  That is the “new normal”.

~McQ


Canadian court rules baby must die as it decides, not as the parents request

This is sure to revive talk of death panels.  And I’m afraid I simply don’t understand the reasoning here.  But it is a stark example of the state making decisions that should be left to the people involved – in a free country, that is.

Anyway, the story:

A Windsor, Ont. couple’s fight to bring their gravely ill baby home to die ended in bitter tears Thursday when a Superior Court judge dismissed their appeal to stop doctors from removing the infant’s breathing tube at the hospital.

The father and relatives of one-year-old Joseph Maraachli wept outside a London courthouse after an emotional Justice Helen Rady upheld the earlier decision of an independent provincial tribunal forcing the baby’s parents to comply with doctors’ orders.

With all of their legal avenues exhausted, the family will have to say goodbye to Joseph Monday morning — on Family Day — when his breathing tube will be removed.

Apparently the baby has a rare neurological disease which has put him in a “severe and deteriorating neurological condition that has left him in a persistent vegetative state, according to specialists in London, Ont., who’ve examined him. “

Bottom line, the child is dying. It is now to the point where the baby can’t swallow or breath on his own. The parents know and understand that. They know the child will die. They’re not asking the state to try and save their baby. Instead, what they are asking – what they have to ask, apparently – is permission of the state to take their child home and let the baby die among "friends and loved ones".

Pretty outrageous request, isn’t it?  And yet they don’t have the final say.

The parents had petitioned the regional medical board for a tracheotomy to be performed on the child to facilitate their ability to take him home with them.  That would have opened up a direct airway which would have made it possible to take the baby home and let it die there.

Oh, too much to ask apparently.  Remember, the baby is dying.   It’s going to die.   There’s no question about that –  everyone involved knows it will be dead in a matter of hours if not days.  The parents are not asking for heroic or extended (and expensive) treatment be continued.  Just a tracheotomy.

The reason given for the refusal?

But doctors refused to perform the procedure, citing serious risks of infection, pneumonia and other possible complications.

It’s a bit like refusing a lung cancer patient with stage 4 cancer a final cigarette because it might kill them.  The reason is absurd on its face. But apparently enough that a judge decided for the state and not the parents.  So instead of risking infection or pneumonia and letting the parents take their child home to die, the state insists on removing the breathing tube in the hospital and letting the child smother to death there.

Maraachli and Nader went before the Consent and Capacity Board of Ontario, an independent body that deals with matters under the Health Care Consent Act, which sided with the doctors in late January and agreed that it was in Joseph’s best interest to have the breathing tube removed.

Don’t you love it when something called the “Consent and Capacity Board” has the final say on what is in the “best interest” of a child, rather than the parents?

Given the structure and effect of this monstrosity called ObamaCare, that is the probable end state  we’ll eventually see here – an insurance industry which will collapse and in answer to the “problem” which government created, a single-payer system will be implemented.  And you can bet that something along the line of the “Consent and Capacity Board” will eventually take all such decisions out of your hands and make them exclusively the decision of the state.

(HT: All American Blogger)

~McQ


Death Panels? What death panels?

Rationing?  Never.  “Death panels?”  No such thing! When government runs your health care they won’t act like those evil insurance companies that deny you treatment.  Wasn’t that the promise?

A controversial new policy by the Arizona Health Care Cost Containment System depriving hepatitis C patients coverage for liver transplants is effectively a death sentence that, left unchecked, could have far-reaching consequences for millions of Americans afflicted with chronic viral hepatitis, the National Viral Hepatitis Roundtable (NVHR) said today.  

The new coverage exclusion governing liver transplants took effect Friday as part of broader Medicaid coverage changes made by the state of Arizona in response to budgetary pressures.

I’m not here to call for unlimited spending or every procedure to be okayed. I understand budget constraints.

However, critics have said that the sort of rationing and denial of care that is demonstrated above was an inevitable outcome of government taking over health care.  Those that referred to this type rationing as “death panels” were denigrated and demonized. 

Now I understand that while Medicaid is a government run program, it is a state run program that is subsidized by the Federal government to some extent.

But ObamaCare has pushed new mandates down on the states by expanding coverage and the states are faced with making literal life and death decisions concerning the affordability of care for those in their system.  This is only one of many “death panel” decisions that are going to eventually effect the lives of millions.

All foretold and inevitable. 

In other ObamaCare news more of the foretold and inevitable:

3M Co., citing new federal health laws, said Monday it won’t cover retirees with its corporate health-insurance plan starting in 2013.

Instead, the company will direct retirees to Medicare-backed insurance programs, and will provide reimbursement for that coverage. It’ll also reimburse retirees who are too young for Medicare; the company didn’t provide further details.

Apparently after reviewing the law 3M concluded that even with a subsidy offered in the legislation, it was more costly to keep the coverage than abandon it:

Maplewood-based 3M (NYSE: MMM) is one of the first large companies to indicate that it won’t tap a large federal-government reimbursement program created by Congress as part of the health insurance reform package, The Wall Street Journal reported. The rebate program was meant to encourage employers to keep in place their health-insurance plans for retirees.

Obviously, by 3M’s reading of the law, the “federal-government reimbursement program” didn’t offset the cost of keeping retirees in the system.  As you see more and more of these stories pop up – and you will – you have to begin to wonder if this isn’t a deficiency by ignorance or design – a bug or a feature.

As this goes on, you can’t help but feel it is more the latter than the former as such actions by companies move us closer and closer to a single payer system.  And when that inevitably happens, it will be characterized as the fault of greedy corporations and, of course, “market failure”.

Fair warning.

(HT: Rod F)

~McQ


So are we in “death panel” territory here?

David Leonhardt spends about a 1,000 words in the New York Times banging around the edges of what has to be done by government to cut health care costs. Or, as he calls it “In Medicine, the Power of No”. He wonders if we can every really learn to say “no”. And, of course, he’s talking about saying no to sick people, to patients – denying them care.

From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing, and Medicare’s long-term budget deficit will grow.

So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform. “Being able to say no,” Dr. Alan Garber of Stanford says, “is the heart of the issue.”

Maybe I’m reading to much into this, but what is being said here is “the new agencies” which will be “in charge of carrying out reform” need to learn to “say no”.

Huh? I thought all this reform was about leaving such decisions about treatment between your doctor and yourself and not those evil, mean insurance companies. Who are these agencies – these “new” agencies – and why are they in they charged with “saying no?” If they’re “new” they’re a creation of the HCR monstrosity and if they have the ability to say “no” aren’t they strangely like the supposed mythical “death panels” Sarah Palin commented on?

Of course any sane person reviewing the claims of those pushing this piece of garbage known as health care reform knew that to drive down costs, rationing and the denial of care was not only possible but absolutely necessary. And, like so many other aspects of this bill, what was promised to gain support is almost the opposite of what was passed in the legislation.

Leonhardt knows where he’s going with his piece, but he is loath to actually say it. So he dances all around it, but if you read carefully you understand that despite all the rigmarole about bringing patients in on the decision and his belief that if they’re informed they’ll choose the least costly methods, he understands that as he says in his title that someone in authority is going to ultimately have to say “no” to make this work. And that pretty much means, much to the chagrin of the left, that Sarah Palin was right.

~McQ


Congress: Making A Bad Idea Permanent

You have to hand to Harry Reid. His lack of respect for the Constitution is rather pedestrian by Democrat standards these days, but he is positively the Thomas Alva Edison of inventive ways to flout it:

If ever the people of the United States rise up and fight over passage of Obamacare, Harry Reid must be remembered as the man who sacrificed the dignity of his office for a few pieces of silver. The rules of fair play that have kept the basic integrity of the Republic alive have died with Harry Reid. Reid has slipped in a provision into the health care legislation prohibiting future Congresses from changing any regulations imposed on Americans by the Independent Medicare [note: originally referred to as "medical"] Advisory Boards, which are commonly called the “Death Panels.”

It was Reid leading the Democrats who ignored 200 years of Senate precedents to rule that Senator Sanders could withdraw his amendment while it was being read.

[...]

Section 3403 of Senator Harry Reid’s amendment requires that “it shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report that would repeal or otherwise change this subsection.” The good news is that this only applies to one section of the Obamacare legislation. The bad news is that it applies to regulations imposed on doctors and patients by the Independent Medicare Advisory Boards a/k/a the Death Panels.

Section 3403 of Senator Reid’s legislation also states, “Notwithstanding rule XV of the Standing Rules of the Senate, a committee amendment described in subparagraph (A) may include matter not within the jurisdiction of the Committee on Finance if that matter is relevant to a proposal contained in the bill submitted under subsection (c)(3).” In short, it sets up a rule to ignore another Senate rule.

These provisions were pointed by Sen. Jim DeMint on the Senate floor last night:

Meh. It’s an old Constitution anyways, and it’s not like we’ve really been using it. Heck, I’ll bet most people don’t even know what’s in that old rag, and those are just ones in Congress.