The levee’s beginning to break. Public dissent has grown loud enough to actually have an effect on policy: today, an “end-of-life provision” was cut from the bill, what critics like Sarah Palin have bemoaned as “death panels.”
What? Death Panels? Couldn’t be! The New York Times and CNN, the very definition of Mainstream Media, have both denounced the idea as “false.” (They couldn’t perhaps be motivated by other factors, like a media bailout, could they?) Democrats and the media began to bash Palin, calling her comments “disgusting” and “outrageous.” One is lead to ask, then: what, pray tell, just got cut from the bill?
That would be Section 1233 of H.R. 3200, entitled “Advance Care Planning Consultation,” a proposal to pay doctors to counsel their Medicare patients every five years on end-of-life planning. With the incentive of monetary gain, doctors would be motivated to hedge emotional and ethical decisions with their own fiscal concerns. Representative Earl Blumenauer (D-OR), the author of this legislation, is denying that’s the intent of the language. The citizenry he wishes to abuse does not believe him.
(Then-Multnomah County Commission Chairman Blumenauer, circa 1979)
While Section 1233 would have stymied proper care for seniors, it wouldn’t necessarily establish death panels, right? Since it’s gone now, the threat of rationing end-of-life care should have disappeared as well; there would have to be some other mechanisms in the bill to actually set up ”death panels,” right?? Read on…
Reading Tea Leaves
Well, there are four bills floating around, but the House bill, H.R. 32oo, would establish a “Health Benefits Advisory Committee” (Section 123) to essentially make health care decisions for those on the public option, as its given authority over “benefit standards,” ”including categories of covered treatments, items and services within benefit classes, and cost-sharing.” This committee, chaired by the Surgeon General, would convene as necessary to set the minimum standards required in a benefits package.
The current bill also has provisions to establish specific methods for “Reducing Potentially Preventable Hospital Readmissions” (Section 1151 of H.R. 3200), giving government the power to determine what constitutes an “applicable condition” for care by using a formula, complete with nifty ratios and “floor adjustment factors,” to determine whether or not an individual is being readmitted to the hospital excessively. The proposal ultimately aims to draw down aggregate costs by denying readmissions.
Furthermore, the bill establishes a “Health Insurance Exchange” (to manage health insurance across the nation), the heavily-discussed ”Public Option” to private health insurance (the dangers of which I discussed on a previous post), and establishes a Health Choices Administration, with its own Commissioner (Section 141) to run the whole thing, without judicial review. It’s no wonder support for the bill is waning. The bill modifies Medicare, cutting its budget by $361.9 billion over 10 years. The results of this are directly evident in new polling data, with Rasmussen reporting that Americans over 65 are against Obamacare by 56 percent to 39 percent. Rasmussen polls also reflect the toll health care is taking on the President’s job approval rating, now at 48%, down five points in the past month.
A few weeks ago, House Republican Leader John Boehner said that the Democrats who support “government-run” health care would be in for “a very, very hot summer.” His prediction has indeed come true. Some representatives, however, seem tone-deaf to their constituency. To persuade their out-of-touch public officials not to sign the bill, town hall meetings have deteriorated into chaotic screaming matches.
As a free country, however, this is how America works. Alexis de Tocqueville observed as much in 1835, that town halls and municipalities embody the essence of freedom saying, “Nevertheless, local assemblies of citizens constitute the strength of free nations,” and although “composed of coarser materials,” they are “so perfectly natural” they stand as the strongest opposition to despotism:
“Local assemblies of citizens constitute the strength of free nations. Town-meetings are to liberty what primary schools are to science; they bring it within the people’s reach, they teach men how to use and how to enjoy it. A nation may establish a system of free government, but without the spirit of municipal institutions it cannot have the spirit of liberty. The transient passions and the interests of an hour, or the chance of circumstances, may have created the external forms of independence; but the despotic tendency which has been repelled will, sooner or later, inevitably reappear on the surface.”
Trust me, I’m a doctor.
When any business (or government program) is over-budget, planners must find ways to innovate, reduce overhead costs, or, in the case of government programs, print more money. If government has to reduce costs, there is one surefire way to do it, and it’s called “rationing.”
This is what most countries with state-run health care resort to. This position is described most accurately in a startling admission from Peter Singer, bioethics professor at Princeton, in an article entitled, “Why We Must Ration Health Care” in the New York Times in July 2009. Singer sums up the idea of “Quality-Adjusted Life Years,” a system used to assign a sliding scale to judge the worth of humans; check it out:
“As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds. These are, of course, generic teenagers and generic 85-year-olds. It’s easy to say, “What if the teenager is a violent criminal and the 85-year-old is still working productively?” But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.” (emphasis added)
Do you understand this? This is a chilling blueprint for health care cost-saving. I thought when the New York Times said that the “false ‘death panel’ rumors had some familiar roots,” they were talking about their own Opinion Editorials. Not so. By assigning value to human life based solely on age, Dr. Singer gives an eerie ”how-to” on rationing health care to seniors. The President, though, has tried to discredit any concerns about such rationing, stating:
“There are some things I’ve been hearing lately that we need to dispose of. The rumor that’s been circulating around lately is, the House of Representatives somehow voted for death panels that will basically pull the plug on Grandma ’cause we’ve decided it’s too expensive to let her live anymore. This arose out of a provision in one of the House bills that allows Medicare to reimburse people for consultations for end-of-life care. The irony is, that actually one of the chief sponsors of the bill [Republican Sen. Johnny Isakson] … very sensibly thought this is something that would expand people’s options, that got spun into this idea of death panels. I am not in favor of that. I want to clear the air here.”
And alas, at one of those raucous “Astroturf” town halls, Senator Arlen Specter also tried to debunk these “rumors” as myth, responding, “You are just not right. Nobody 74 with cancer will be written off. That is a vicious, malicious, untrue rumor.”
Is it now? So, why did Republican Senator Chuck Grassley (and key negotiator for the health care bill) insist that Section 1233 get cut? Senator Grassley lamented with his constituents, saying, “You have every right to fear: We should not have a government program that determines if you’re going to pull the plug on grandma.”
And if these are only rumors, where did they come from? Maybe from the bill itself? Or from Opinion Editorials in the New York Times? These are simply ideas, from Congressmen like Blumenauer, or from academia, from doctors, bioethicists, you know, smart people. So what ideas do you think might be floating around the Oval Office?
Enter Ezekiel Emmanuel, M.D. and Political Philosophy Ph.D. from Harvard, a National Institute of Health bioethicist, a White House “Special Advisor for Health Policy” at the Office of Management and Budget, and the brother of White House Chief of Staff, Rahm. Our friend Zeke wrote in 1996 on the ethics of medical rationing in a Hastings Report, and suggested a classification of health care needs, to be determined by a “communitarian” “deliberative body.”
Zeke also said the following:
“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. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.”
Woe to those with dementia! That’s a proverbial death sentence, but not entirely out of sync with Singer’s opinion. In January 2009, Ezekiel Emanuel along with two other Doctors, set forth in an article entitled “Principles for Allocation of Scarce Medical Interventions,” to “evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness.” In this article, Ezekiel and friends analyzed three separate systems: “the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years.” The doctors then propose their own system for rationing: “We recommend an alternative system — the complete lives system — which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.”
The systems (that Organ Sharing points system, quality-adjusted life years, and disability adjusted life-years) they evaluate herein are scary in their own right, but instead of rejecting these systems, they instead serve as a template for their complete lives system: “When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” This takes Singer’s opinion in the New York Times one step further, sliding that scale backwards for those younger than 15. Note: Peter Singer has propagated this sickness before, stating, “Killing a newborn baby is never equivalent to killing a person, that is, a being who wants to go on living.”
Gloves Off
Remember our President, as an Illinois state senator, supported infanticide twice – that is, whether leaving a botched aborted baby, in his words, “that fetus, or child — however way you want to describe it” – to die during the “Born Alive” debate in Illinois during 2001 and 2002.
So, this ideology is not new to the White House, or even the President himself. I would encourage you to watch the full video of President Obama’s response to citizen Jane Sturm, regarding her 105 year old mother. (Note that this was at CBS’ BS news conference, in which the questions were pre-determined.) When Jane asked if her mother would have been denied the pacemaker she received at 99 years under Obama’s health care plan, he rambles on and on, and ends on quite a sour note, telling her, “Maybe you’re better off not having the surgery, but taking the painkiller.” Watch it for yourself; just as I included the full quote from Ezekiel Emanuel’s article, I linked to the whole video so you can decide for yourself. It’s startling to me.
Obama once said that the people he surrounded himself with would shape his strategy. This explains why he would respond thusly in a New York Times interview, this past April, about those who can’t afford rising health care costs:
THE PRESIDENT: “So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
“I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.”
DAVID LEONHARDT: “So how do you — how do we deal with it?”
THE PRESIDENT: “Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.”
So we’ll have a conversation about these moral issues, driven by the great ethicists, you know, those smart people we covered above; there’s no need for patients or their loved ones to be involved in the decision-making process. But you said we won’t “pull the plug on grandma,” will we, sir? Sir??
As heartless as all this seems, though, at least the President is consistent; he questioned his own 86-year old grandmother’s hip replacement near the end of her life, saying they bring up tough moral decisions. You would think that he would at least get her some pain pills, but he said, “I would have paid out of pocket for that hip replacement just because she’s my grandmother.” Of course he would. But we’re not talking about the President’s family, or even particular people. We’re talking about 300+ million Americans. It’s easier to make decisions about “the people” than it is about individuals, isn’t it?
Although Congress and the White House are determined to dismiss the outcry over rationing as some fringe, right-wing extremist misinformation, is it wrong to ask whether rationing, as is the case in other countries with similar health care systems, could be possible if the bill didn’t cost out the way we think it might?
I don’t know. Looking at what other countries with state-run health care have done…. it could be. The ultimate end for a rationed health care system is something referred to as eugenics, and it’s been done before, just not here. Some will say, “Well, rationing already happens with private insurance.” You may even hear it from some pretty top-ranking characters, like HHS Secretary Kathleen Sebelius. Maybe you missed Jane Sturm’s point. Her mother went to another doctor, sought another opinion, and got the care she needed. Under the current proposal, this would not be an option; at least, that’s what I understand would happen when the “Limitations on Changes in Terms or Conditions” were statutorily implemented, outlawing a change in private insurance after the first year. (see page 16). What would happen if you moved to another state? Are you forced into the public option? As you can see, unanswered questions abound. (If you would like a breakdown of the bill from someone reputable, I suggest the summary by Duke University professor of classics, John David Lewis.)
Someone once said, “Our nation can achieve permanent health only from within on the basis of the principle: The common interest before self-interest.” Someone else said, “It is true that liberty is precious – so precious that it must be rationed.” (You can Google the authors). I, however, reject those notions. A free market, carefully regulated with the utmost constraint on the regulators themselves, sets the best price and provides the best services, based on public opinion, wants, and needs. Here, both common interests and self-interests are served.
The President has the choice, now. It’s his ballgame. He may simply choose inaction, but I don’t see that as likely. If he wants to act, he has three basic options: take the reins now and demand that the bill be toned down, take a stand and veto a partisan bill when it passes Congress, or sign it into law. If the majority is willing to accept the consequences, they have enough votes in Congress to push it through.
What can we do about this? Well, Ronald Reagan asked the same question in 1961 when campaigning against Medicare in 1961. During the “Operation Coffee Cup” Campaign, he said, “We can write to our congressmen and to our senators. We can say right now that we want no further encroachment on these individual liberties and freedoms. And at the moment the key issue is: We do not want socialized medicine.”
We have some options, too, and the public is utilizing them. The noisy town halls driving the Democrats batty embody, in De Tocqueville’s language, “The spirit of liberty.” Right now, emails to the House of Representatives are overloading its servers. Americans can act, and they will. I’ve offered suggestions for action. As I’ve pointed out in this series, so has the Congressional Budget Office. So have successful business-owners. Congress is swaying as well. Yes, Mr. President, America wants change. Just not what you’re selling.
“You and I can do this. The only way we can do it is by writing to our congressman even if we believe he’s on our side to begin with. Write to strengthen his hand. Give him the ability to stand before his colleagues in Congress and say, I heard from my constituents and this is what they want. If you don’t, this program, I promise you, will pass just as surely as the sun comes up tomorrow. And behind it will come other Federal programs that will invade every area of freedom as we have known it in this country. Until one day, as Norman Thomas said, we will awake to find that we have socialism.
“And if you don’t do this and if I don’t do it, one of these days you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”
- Ronald Reagan, 1961 Operation Coffee Cup Campaign
