Posted on 09/09/2009 8:40:13 PM PDT by mojitojoe
One of the key ideas under consideration—which can be read as expressing sympathy for limitations on end-of-life care—is morally revolting. And it’s helping to kill the plan itself.
Make no mistake about it. Determining which treatments are “cost effective” at the end of a person’s life and which are not is one of Obama’s priorities. It’s one of the principal ways he counts on saving money and making universal healthcare affordable.
(Excerpt) Read more at thedailybeast.com ...
You cannot expand coverage while cutting costs without somehow rationing health care. Logic dictates that it is the elderly who will bear the burden of this rationing.
It reminds me of Ross Perot’s statement that we spend too much money educating the mentally retarded and other special education programs. He said we ought be be putting most of our education resources into the best and brightest because they are the ones who will be paying back into the system via tax dollars and their creative contributions to society.
Perhaps true from a cold economic perspective, but it didn’t go over well with what Bill O’Reilly calls “the folks”.
I cannot believe 4 Reoublicans crossed over and voted yes to Cass Sunstein! W.....T.....H is going on?
It was a vote for cloture, not a vote on the monster Sunstein. Yet.
A Death Panel of One:
- Ezekiel Emmanuel, Rahm's brother, key Administration Official on Health Care.
Gee. Kill elderly people who are going to die anyway and make sure they Will all their remaining assets to the government. Works for Obama. /sarc
great graphic. What’s the source on this? I want to use it to share with my brainwashed friends.
My father was hospitalized in November with heart failure. Immediately his pleasant and smiling doctors and nurses began “nudging” him regarding end of life issues. Surprise! This tough old WWII vet wanted to live, no matter what. His quality of life was seeing his lady friend, his children and their families. Their lame attempts to persuade him that his various IV tubes were “nasty” failed. They actually slipped DNR orders into his file twice without his consent. Unfortunately the quality of his remaining life (he died in February) was diminished by the constant fight to have his wishes respected. They were in writing, and we had to turn to lawyers twice. The ghouls are already out there, and they aren’t wearing “Death Panel” labels on their jackets.
Soylent Green,
coming soon to a grocery store near you.
Rahm’s brother Dr. “Death” Ezekiel Emmanuel used it in a peer reviewed publication, “The Lancet.”
OPINION
AUGUST 27, 2009, 12:52 P.M. ET.
Obama's Health Rationer-in-Chief
Graphic from: "Principles for Allocation of Scarce Medical Interventions" The Lancet, January 31, 2009
White House health-care adviser Ezekiel Emanuel blames the Hippocratic Oath for the 'overuse' of medical care.
Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.
The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.
The Reaper Curve: Ezekiel Emanuel used the above chart in a Lancet article to illustrate the ages on which health spending should be focused. .Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely 'lipstick' cost control, more for show and public relations than for true change."
True reform, he argues, must include redefining doctors' ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care: "Medical school education and post graduate education emphasize thoroughness," he writes. "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." In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007). Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible." (JAMA, June 18, 2008).
"In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations," he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.
"You can't avoid these questions," Dr. Emanuel said in an Aug. 16 Washington Post interview. "We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a 'God committee' to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions."
Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: "Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia." (Hastings Center Report, November-December, 1996)
In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. "One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.
"However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear." In fact, Dr. Emanuel makes a clear choice: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated (see Dr. Emanuel's chart nearby).
Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: "Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . 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."
The youngest are also put at the back of the line: "Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . . As the legal philosopher Ronald Dworkin argues, 'It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,' this argument is supported by empirical surveys." (thelancet.com, Jan. 31, 2009).
To reduce health-insurance costs, Dr. Emanuel argues that insurance companies should pay for new treatments only when the evidence demonstrates that the drug will work for most patients. He says the "major contributor" to rapid increases in health spending is "the constant introduction of new medical technologies, including new drugs, devices, and procedures. . . . With very few exceptions, both public and private insurers in the United States cover and pay for any beneficial new technology without considering its cost. . . ." He writes that one drug "used to treat metastatic colon cancer, extends medial survival for an additional two to five months, at a cost of approximately $50,000 for an average course of therapy." (JAMA, June 13, 2007).
Medians, of course, obscure the individual cases where the drug significantly extended or saved a life. Dr. Emanuel says the United States should erect a decision-making body similar to the United Kingdom's rationing body—the National Institute for Health and Clinical Excellence (NICE)—to slow the adoption of new medications and set limits on how much will be paid to lengthen a life.
Dr. Emanuel's assessment of American medical care is summed up in a Nov. 23, 2008, Washington Post op-ed he co-authored: "The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed nations on virtually every health statistic you can name."
This is untrue, though sadly it's parroted at town-hall meetings across the country. Moreover, it's an odd factual error coming from an oncologist. According to an August 2009 report from the National Bureau of Economic Research, patients diagnosed with cancer in the U.S. have a better chance of surviving the disease than anywhere else. The World Health Organization also rates the U.S. No. 1 out of 191 countries for responsiveness to the needs and choices of the individual patient. That attention to the individual is imperiled by Dr. Emanuel's views.
Dr. Emanuel has fought for a government takeover of health care for over a decade. In 1993, he urged that President Bill Clinton impose a wage and price freeze on health care to force parties to the table. "The desire to be rid of the freeze will do much to concentrate the mind," he wrote with another author in a Feb. 8, 1993, Washington Post op-ed. Now he recommends arm-twisting Chicago style. "Every favor to a constituency should be linked to support for the health-care reform agenda," he wrote last Nov. 16 in the Health Care Watch Blog. "If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."
Is this what Americans want?
Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York state.
Oh, I know. They did the same thing with my grandmother. They wanted to put her in hospice and give her morphine and stop fluids, etc. She didn’t have cancer, was not terminal, but she was 82 and had been hospitalized several times in the past 6 months. Basically, she became too expensive. We refused but they attempted it and suggested it.
Which is why Obama only talks about the "death panels" being about giving end-of-life advice, not about deciding that a treatment is too costly for one who is too old for it.
-PJ
Win - win for the monster government.
Exactly, he simple twists the words around so the sheeple believe what he says.
What a horrible experience for you ntnychik. Ping to you, chickensoup. See what I mean?
At 87, you have nearly 100% chance of dying within 5 years - you're definitely not going to get any government heath care more than an aspirin or a morphine drip.
Of course over time, the actuarial tables will be adjusted downward accordingly.
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