8.12.2009

The Obama Death Panel: An Autopsy

I was writing this post when I found out about the death of Les Paul.

He wasn't a rock star, but rock and roll couldn't exist without him. He's credited with inventing the solid-body electric guitar and multi-track recording, both invaluable staples of modern music. The notes that he gave to Gibson Guitar Company resulted in my favorite guitar, the Les Paul. He was a master technician in both his guitar work and his endless tinkering.

And until June, he played weekly shows at the Iridium Jazz Lounge in New York. Which I regret to never have made the trip to see.

In any case, I give you a clip from one of those performances. This is Les Paul at 91 with his trio. Enjoy



Rest in peace, dude. I'm proud to own an instrument with your name on it.


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It started with Terry Schiavo.

A woman was in a permanent vegetative state, and the right wing decided to use her as a football. One pro-life Republican remembered how fucked up that was and proposed an amendment to fund (opt-in) counseling for the continuum of end of life care, including drafting living wills. It was Republican Senator Johnny Isakson of Georgia acting on his better judgment.

There was something someone once said about good intentions and paving something. I forget.

Former New York Lieutenant Governor Betsy McCaughey (and bestselling author of The Truth: Bend it Like Betsy), saw an opportunity to scare a lot of old white people.

he health care reform bill "would make it mandatory — absolutely require — that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner."


And this, ladies and gentlemen, is how political discourse is conducted in the most successful democratic republic in the history of the human race. Not only was this Orwellian contortion from a former elected official, but it was quickly-- eagerly repeated by current elected officials



We should be able to remove people from office for this. A binding clause in the oaths that we make elected officials take wherein they agree to abdicate office if they're caught knowingly distorting the truth to get their constituents to shit their pants.

Eventually, the lie lost some its steam, what with it taking all of five seconds on Google to sort it out. It wasn't in the bill. At all. Which as a sensationalist, put her on tricky ground. Only unlike Geraldo, she never had to stand in front of Capone's empty vault while live cameras were rolling and explain this, somehow, was the real story. However, she did continue on with what she'd been doing as if nothing had happened. There was no mention that she'd taken a big swing and a miss the last time around, and yet what she was doing was clearly an attempt to backfill for this idea that there was going to be some form of euthanasia within Obamacare.

I could link you to the article (ok, I will, if you insist), but Michelle Bachman was kind enough to read it aloud to the House.



Sarah Palin's ears almost certainly pricked up at the line "Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy." Whether it was because she found a new and exciting way to exploit her son Trig for political gain, or because she was genuinely offended and scared as a mother for the well-being of people like her son. Neither reflects well on her, because she's certainly had the time to figure out the facts since then, but whatever the case, she included the Bachman video in a facebook post in which she said

The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil.



Clearly cobbled together from the Virginia Foxx claim (which was based on the McCaughey falsehood) and the Deadly Doctors piece, it marked the rock bottom of the healthcare debate in tis country. Which is fortunate, actually, as it was going to get there anyway. We can only go up from there.

So, this second article. What's the deal?

McCaughey selectively quotes Dr. Ezekiel J Emanuel, Obama healthcare advisor and brother of White House cheif of staff Rahm Emanuel. She references

an article he wrote in February 2008 for Health Affairs He said:

Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change


I couldn't find that particular article, but I was able to dig up the full text of the article she quotes next.


Doctors take the Hippocratic Oath too seriously, "as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008)


The title of that article, which for obvious reasons McCaughey chose to ignore, was The Perfect Storm of Overutilization, the opening paragraph of which reads

A perfect storm" occurs when a confluence of many factors or events—no one of which alone is particularly devastating—creates a catastrophic force. Such confluence is rare and devastating. Over time and through disconnected events, US health care has evolved into a "perfect storm" that drives overutilization and increases the cost of health care.


In it he speaks to the current paradigm of the American healthcare system, which incentivizes the overutilization of resources. What is overutilization? It's doctors prescribing antibiotics for an ear infection that'll clear up in three days with or without them. It's prescribing those same antibiotics for viral infections. Millions of dollars wasted on unneeded tests. Which is what Dr. Emmanuel was referring to when he said

At least 7 factors drive overuse, 4 related to physicians and 3 related to patients. First, there is the matter of physician culture. Medical school education and postgraduate training emphasize thoroughness. When evaluating a patient, students, interns, and residents are trained to identify and praised for and graded on enumerating all possible diagnoses and tests that would confirm or exclude them. The thought is that the more thorough the evaluation, the more intelligent the student or house officer. Trainees who ignore the improbable "zebra" diagnoses are not deemed insightful. In medical training, meticulousness, not effectiveness, is rewarded.

This mentality carries over into practice. Peer recognition goes to the most thorough and aggressive physicians. The prudent physician is not deemed particularly competent, but rather inadequate. This culture is further reinforced by a unique understanding of professional obligations, specifically, the Hippocratic Oath's admonition to "use my power to help the sick to the best of my ability and judgment" as an imperative to do everything for the patient regardless of cost or effect on others.

Second, fee-for-service payment misaligns incentives; it creates a big incentive for overutilization. Although most physicians are not income maximizers, they know that it is better to be paid to do something, and the higher the payment the better. Paying for doing more adds a strong financial motivation to what is often a slim clinical rationale for an intervention. Furthermore, the current system's bias toward paying significantly more for procedures rather than for evaluation and management reduces physicians' inclination to watch, wait, and communicate and increases their propensity to order a test.
(Bolded portion is what Betsy McCaughey quoted in her piece for the New York Post)

And we arrive now at the source of Palin's claim

Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).


and

He explicitly defends discrimination against older patients: "Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years (Lancet, Jan. 31)


In both articles, Emanuel is speaking to solutions for problems regarding scarcity of care in cases of global pandemic and organ donation, advocating what he refers to as a a "Complete Life Model" of healthcare resource allocation, wherin scarce resources are first allocated to those with the best prognosis to live a "full life." This is similar to allocation protocolls already in effect, especially when it comes to scarce supplies of donated organs, tissue, and blood. The latter involves a specific accusation of ageism. He further defends his proposed system

We consider several important objections to the complete lives system.
The complete lives system discriminates against older people. Age-based allocation is ageism. Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.

Age, like income, is a “non-medical criterion” inappropriate for allocation of medical resources: In contrast to income, a complete life is a health outcome. Long-term survival and life expectancy at birth are key health-care outcome variables. Delaying the age at onset of a disease is desirable.


Doctor Emanuel has very recently come out to defend himself in Time magazine.

Now this isn't to say that I necessarily agree with Dr Emanuel's conclusions. But the fact of the matter is, when certain resources are insufficient for the number of patients in cases of a pandemic, or when there are more people on the transplant list than there are donated organs, there must be a means of choosing who has resources directed towards them and who doesn't. And Betsy McCaughey should know that, working as she does for a multi million-dollar company in the healthcare industry when she's not consulting for a multi-million dollar conservative think tank.

What's clear is, Betsy McCaughey, Sarah Palin, Virginia Foxx, and now Chuck Grassley don't have a fucking leg to stand on, and they know it. They've been eagerly stoking the fear amongst their constituents, and to what end? As you can tell from the above link, funding for end of life counselling has been dropped from the bill in the Senate Finance Committee.

Great fucking job guys. You've just denied countless seniors the ability to control what happens in their last days. Enjoy the poll numbers, assholes.

Logically, now that the "offending" passage is being removed, it would follow that we've reached the end of the Death Eater conspiracy, hence the title. But it wouldn't surprise me if this one woke up on the table.

5 comments:

  1. It's crazy. Of course we already have death panel and they are called insurance companies.

    ReplyDelete
  2. Don't be silly. Those are good, honest, free market death panels. Why would we have a problem with those?

    ReplyDelete
  3. You're right, my bad. And you too can have your ruptured appendix paid for - we currently have a high standard for our veterinarians, so don't let the less expensive fee fool ya.

    ReplyDelete
  4. Love the Les Paul vid. You know how I feel on everything else

    ReplyDelete
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