Wednesday, July 29, 2009

Wingnut Lies

This pisses me off. I have a few right wingers in my family who like to forward me the latest FoxNews/Sean Hannity/Rush Limnaugh spewage via email. Making the rounds right now is the meme that page 425 of HR 3200 (Obamacare) contains a provision that will "lead to government encouraged euthanasia of the elderly". First of all it's a false accusation. Second, what sort of sick twisted world do we live in where honest dialogue between opposing political ideologies is not only rejected, but proscribed as a source of weakness? Why does the truth always have to be manipulated to meet a political agenda?

Here's the truth. There is a provision in the bill that would require Medicare to cover an end-of-life consultation between a palliative care specialist and an elderly individual. In other words, if you are in the twilight of life, but still of sound mind, you have the option of consulting with your geriatrician or palliative care specialist about things such as living wills, DNR status, and asserting your durable power of attorney. This a good thing. Any hospital-based physician who works in this country would welcome reform that better prepares patients mentally and legally for their inevitable decline. I can't tell you how many times a month I find myself seeing a demented patient in the ICU on pressors, intubated, gorked out, sustained solely by machines and no one knows what to do, no one in the family is prepared to "make the big decision" because no one ever thought to ask the patient when she was lucent: what do you want us to do when you're deathly ill and are unable to make decisions for yourself?

Close to 30% of Medicare spending on the elderly occurs in the last six months of life. And it's all wasted. These are futile cases, invariably. But it goes beyond the pure cost. The suffering and emotional angst of family members is immeasurable, as they watch a loved one transformed into something unrecognizable.

This bill is not about euthanasia. It rather represents an initial attempt to confront our mortality on our own terms, while we still have the intellectual capacity to articulate what it is we want done prior to the onset of the inexorable decline of our minds and bodies. Death is not something to run from. We ought to stop ignoring it, putting it off until it's too late. If anything, I think the language in the bill is not strong enough. We need to mandate the legal documentation of our end-of-life wishes. As soon as one contracts a terminal illness, or hits age 65, then make it law to file official DNR, durable power of attorney, and living will documents. It's the socially responsible and humane thing to do....


WarmSocks said...

Why should this be covered by medicare? You are talking about legal documents that ought to be prepared by people in their early 20's. 65-70 is decades late to be thinking about this stuff. Maybe that's another hoop people should be required to jump through when they sign up for medicare.

shadowfax said...

I wrote about this last week. It seems that this article in the WSJ by the most dishonest health-journalist hack out there is the source of the "OBAMA WILL SMOTHER YOUR GRANNY" meme.

Nurse K said...

Social workers hand out the fill-in-the-blank forms in the hospital without Medicare's help. Nurses are required to ask everyone who is admitted if they'd like more information about a living will or health care directive if they don't already have one made up. Most people say "no", even the very elderly. So...paying for this isn't going to change anything. It's free now and people still don't do it even when asked specifically if they'd like help doing it or more information.

Nurse K said...

PS You're an articulate fella, maybe stay away from DailyKos terms like "wingnut?" Your patients probably read this!

Anonymous said...

You need to blame Bama.

He is the one failing to articulate the details of his plan.

In the deafening vacuum, it is left to others to speculate what may or may not happen in the overhaul.

My prediction is that the plan is going down in flames
as Seniors question how Medicare will be cut by
half a trillion with no rationing of legitimate care, despite continuing to be run by the govt.

There is a fundamental disconnect between Obama,
who wants to cut costs, and the Public, who can't be told the truth or they would never support the radical change.

If I were dictator, I would make two changes:

1. Cap malpractice claims to actual damages based on criteria of gross negligence.

2. Anyone off the street is eligible for group plan insurance rates offered to congress or full time employees of Walmart.

Costs would go down, and damn near everyone could buy insurance regardless of pre-existing condition

Jeffrey Parks MD FACS said...

There are a gazillion things to criticize about the 1000+ page bill (lack of concrete plan for cost control, no mention of med mal reform, its overall inpenetrability, etc). So why does the nation's only opposition party choose to highlight something false and ridiculous like the alleged "kill granny clause"? It just makes them look absurd and they forfeit any remaining legitimacy...

BTW the dailykos is terrible. Almost unreadable...

Anonymous said...

As someone who has had the opportunity (misfortune) to have:

- had employer based insurance
- bought my own insurance (business owner)
- successfully fought a major insurance company (you have to know who can pressure them, there is a story behind that)
- dealt with difficult patient/physician insurance issues for a private practice

...I know this is a huge snake pit. It always has been and always will be. Easy to use public scare tactics, what with all the talk of rationing going on, thank you to HH. Most people don't understand any of it, never have. So you go for the fear of the unknown, in which anything goes.

Hey, I'd love to torture insurance companies. I am so locked and loaded. But everybody is on their payroll...


Anonymous said...

to be fair to the President, there's no mention of Malpractice Tort Reform, because there's not gonna be any. Thats what he told those fellaters from the AMA...Probably's gonna get worse to be honest. And how did "Wingnut" become a perjorative term? I use them all the time. It's like calling someone a "Dipstick"... try checking your oil without one,


Anonymous said...

According to a 2000 WHO report, America ranked the FIRST in health care spending per capita and 37th*/191 in efficiency. Naturally, we vehemently protested and questioned the validity of WHO's survey. Wonder how much we have improved over the past nine years.

Still NO on reform, [GOP]?

* 37th in overall performance and 72nd by overall level of health, out of 191 countries in the survey.

Anonymous said...

"Health Bill Clears Hurdle, and Hints at Consensus" (NYT)

The 31-to-28 vote occurred at 9:05 p.m. Friday, at the end of a session that began at 10 a.m. Five Democrats joined ALL 23 Republicans on the panel in voting no.

Dangerously close.

Majority of American acknowledge that a healthcare reform is needed yet another lump of American majority would rather stick with the status quo.

Anonymous said...

The reform is not meant to upset a perfectly balanced, fair and efficient system; it's more like a desperate attempt to repair a broken Chevrolet that for some miraculous reasons, still on the road.

Anonymous said...

Perhaps the health care reform could be paid for by re-channeling the industry's spending on lobbying.

According to figures in this website, the industry (medical industrial complex: from insurance co to pharmo to hospitals to AMA) spent more than $50 billion on lobbying so far in 2009. >$80 billion in 2008.

Anonymous said...

Oops, millions, not billions - my mistake.

Anonymous said...


I stumbled upon your blog after following an NHSblogdoctor link about 2 years ago. I have enjoyed your writing very much. I am a conservative but share in your dislike for Hannity, Rush, and some other conservative commentators. I hope that you read some others, however, that provide much more substance than the aforementioned: Dalrymple, Mickey Kaus, Steve Sailer, and Mark Steyn to name a few.

Thank you for being such a hard worker. If the circumstances were to warrant, I would be proud to call you my doctor.

Anonymous said...

40% of Medicare dollars are spent on the last thirty days of life. That's from last year's numbers.

Anonymous said...

The Lobby IS the snake pit.

"It leads everywhere. Get out your notebook. There's more..."


Risa Denenberg said...

Your post is featured in this month's palliative care Grand Rounds!