Tag Archives: health care rationing

Soylent Greenbacks: David Brooks Wants Some People to Die for Debt Reduction

To help solve the debt crisis, the best thing I can do is die. Maybe not right now, but certainly before I put too much strain on the public purse—and since I’m 74, that means pretty soon. If I should be lucky enough to contract a fatal disease, I can do the right thing by eschewing expensive medical care that might extend my life. If that doesn’t happen, and I enter a slow and costly decline, then in the interests of the greater good I should take the Hemingway solution.

That’s pretty much the message of David Brooks’s column in today’s New York Times. “This fiscal crisis is about many things,” he writes, “but one of them is our
inability to face death — our willingness to spend our nation into bankruptcy
to extend life for a few more sickly months.”

Here’s how Brooks comes by his position: To begin with, he says: “The fiscal crisis is driven largely by health care costs.” Never mind two futile wars and ten years of tax relief for millionaires—it’s primarily health care that’s driving us into national penury.

Furthermore, Brooks argues, the reason for these soaring health care costs is that very old and very sick people insist on clinging on to their miserable lives, when they ought to be civic-minded enough to kick off. It’s not the insurance companies, which reap huge profits by serving as useless, greed-driven middlemen. It’s not the drug companies, which are making out like bandits with virtually no government regulation. It’s not the whole corrupt, overpriced system of medicine-for-profit, which delivers the 37th best health care in the world, according to the WHO, at more than twice the cost of the best system (France). No. It’s all about us greedy geezers. We’re the ones who are placing an untenable burden on the younger, heartier citizenry, with our selfish desire to live a little longer.

Brooks cites the usual figures: “A large share of our health care spending is devoted to ill patients in the last phases of life,” he writes, and Alzheimer’s patients will soon cost us hundreds of billions. He continues: “Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside.” (Thanks, Dave.) “We are never coercively going to give up on the old and ailing.” Nonetheless, Brooks hopes than many “old and ailing” people will make the choice made by Dudley Clendinen, a man suffering from A.L.S., who wrote a moving essay in the Times about his decision to end his life before the disease takes its full course and renders him “a conscious but motionless, mute, withered, incontinent mummy of my former self.”

I have great respect for Clendinen’s decision. As I’ve written before in Mother Jones, I am a big supporter of what these days is called “choice in dying” or “death with dignity”—each person’s right to decide when and where and in what
circumstances they will die. But I don’t want anyone else making those decisions for me, or telling me when the time is right—not an insurance company or a Medicare bureaucrat, not Barack Obama or John Boehner, and certainly not
David Brooks. I have every intention of being my own one-man death panel. But I won’t be persuaded to die a moment sooner than I want to just because it might
save some money–money that could easily be saved by far more equitable and less draconian means.

Brooks writes that “it is hard to see us reducing health care inflation seriously unless people and their families are willing to do what Clendinen is doing —confront death and their obligations to the living.” But why is it “hard to see us reducing health care inflation” any other way? Because conservatives like Brooks don’t believe in challenging the profit-driven health care system, and the people who pass these days for liberals lack the moxie to stand up to them.

Based on models from countries like France and Canada, we could bring about whopping savings in health care expenditures through a single payer system without rationing or compromising the quality of care. Short of this, we could opt for much more regulation and still save more money than we could by pulling the plug on every geezer in the land.

If I have any “obligation to the living,” it’s to leave them with a better health care system than we have now—a health care system that values all human life above profits. But I know that’s not likely to happen before my death—which, if I listen to Brooks, could be right around the corner.

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How to Become Your Own One-Member Death Panel

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Meet the Real Death Panels: The Truth About Age-Based Health Care Rationing

The latest issue of Mother Jones includes an article by me about the controversy over age-based health care rationing, which got transformed by the right into government “death panels.” Unfortunately, liberals have fallen into a different trap, because they refuse to take on the real enemies of affordable health care for all: the insurance companies, drug manufacturers, and other profiteers of our private health care system.

As a result, old people are being asked if we would be willing to give up some expensive, life-sustaining treatment so that our grandchildren can have health care. This is a bogus question, and a bogus “choice.” The real question, as I say in the article, is whether we should give up the treatment “so some WellPoint executive can take another expensive vacation, so Pfizer can book $3 billion in annual profits instead of $2 billion, or so private hospitals can make another campaign contribution to some gutless politician.”

It’s a long article, and I’m including just the opening here, with a link at the end to continue reading at the Mother Jones web site. Or you can read the whole thing at MotherJones.com by clicking here. And if you’re one of those geezers who still likes reading print and turning pages, the July/August issue is on newsstands now.

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From Mother Jones, July/August 2010

There’s a certain age at which you cease to regard your own death as a distant hypothetical and start to view it as a coming event. For me, it was 67—the age at which my father died. For many Americans, I suspect it’s 70—the age that puts you within striking distance of our average national life expectancy of 78.1 years. Even if you still feel pretty spry, you suddenly find that your roster of doctor’s appointments has expanded, along with your collection of daily medications. You grow accustomed to hearing that yet another person you once knew has dropped off the twig. And you feel more and more like a walking ghost yourself, invisible to the younger people who push past you on the subway escalator. Like it or not, death becomes something you think about, often on a daily basis.

Actually, you don’t think about death, per se, as much as you do about dying—about when and where and especially how you’re going to die. Will you have to deal with a long illness? With pain, immobility, or dementia? Will you be able to get the care you need, and will you have enough money to pay for it? Most of all, will you lose control over what life you have left, as well as over the circumstances of your death?

These are precisely the preoccupations that the right so cynically exploited in the debate over health care reform, with that ominous talk of Washington bean counters deciding who lives and dies. It was all nonsense, of course—the worst kind of political scare tactic. But at the same time, supporters of health care reform seemed to me too quick to dismiss old people’s fears as just so much paranoid foolishness. There are reasons why the death-panel myth found fertile ground—and those reasons go beyond the gullibility of half-senile old farts.

While politicians of all stripes shun the idea of health care rationing as the political third rail that it is, most of them accept a premise that leads, one way or another, to that end. Here’s what I mean: Nearly every other industrialized country recognizes health care as a human right, whose costs and benefits are shared among all citizens. But in the United States, the leaders of both political parties along with most of the “experts” persist in treating health care as a commodity that is purchased, in one way or another, by those who can afford it. Conservatives embrace this notion as the perfect expression of the all-powerful market; though they make a great show of recoiling from the term, in practice they are endorsing rationing on the basis of wealth. Liberals, including supporters of President Obama’s health care reform, advocate subsidies, regulation, and other modest measures to give the less fortunate a little more buying power. But as long as health care is viewed as a product to be bought and sold, even the most well-intentioned reformers will someday soon have to come to grips with health care rationing, if not by wealth then by some other criteria.

In a country that already spends more than 16 percent of each GDP dollar on health care (PDF), it’s easy to see why so many people believe there’s simply not enough of it to go around. But keep in mind that the rest of the industrialized world manages to spend between 20 and 90 percent less per capita and still rank higher than the US in overall health care performance. In 2004, a team of researchers including Princeton’s Uwe Reinhardt, one of the nation’s best known experts on health economics, found that while the US spends 134 percent more than the median of the world’s most developed nations, we get less for our money—fewer physician visits and hospital days per capita, for example—than our counterparts in countries like Germany, Canada, and Australia. (We do, however, have more MRI machines and more cesarean sections.)

Where does the money go instead? By some estimates, administration and insurance profits alone eat up at least 30 percent of our total health care bill (and most of that is in the private sector—Medicare’s overhead is around 2 percent). In other words, we don’t have too little to go around—we overpay for what we get, and we don’t allocate our spending where it does us the most good. “In most [medical] resources we have a surplus,” says Dr. David Himmelstein, cofounder of Physicians for a National Health Program. “People get large amounts of care that don’t do them any good and might cause them harm [while] others don’t get the necessary amount.”

Looking at the numbers, it’s pretty safe to say that with an efficient health care system, we could spend a little less than we do now and provide all Americans with the most spectacular care the world has ever known. But in the absence of any serious challenge to the health-care-as-commodity system, we are doomed to a battlefield scenario where Americans must fight to secure their share of a “scarce” resource in a life-and-death struggle that pits the rich against the poor, the insured against the uninsured—and increasingly, the old against the young.

For years, any push to improve the nation’s finances—balance the budget, pay for the bailout, or help stimulate the economy—has been accompanied by rumblings about the greedy geezers who resist entitlement “reforms” (read: cuts) with their unconscionable demands for basic health care and a hedge against destitution. So, too, today: Already, President Obama’s newly convened deficit commission looks to be blaming the nation’s fiscal woes not on tax cuts, wars, or bank bailouts, but on the burden of Social Security and Medicare. (The commission’s co-chair, former Republican senator Alan Simpson, has declared, “This country is gonna go to the bow-wows unless we deal with entitlements.”)

Old people’s anxiety in the face of such hostile attitudes has provided fertile ground for Republican disinformation and fearmongering. But so has the vacuum left by Democratic reformers. Too often, in their zeal to prove themselves tough on “waste,” they’ve allowed connections to be drawn between two things that, to my mind, should never be spoken of in the same breath: death and cost.

Click here to the rest at MotherJones.com.

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Time for Hell’s Grannies to Ride Again

This is not a good time to be old in America. In addition to dealing with the usual burdens of aging–our aches and pains, and our worries about senility and death–we now have to contend with a backlash against the supposedly greedy geezers who insist upon clinging to life in definance of the public good.

On one side, we have pundits like David Brooks babbling on about old people stealing the nation’s wealth, and billionaire geezer-basher Pete Peterson bankrolling a campaign for an “entitlement commission” to cut Medicare and Social Security. Why should we expect a government handout just because we’ve worked and paid taxes all our lives? (Never mind that Wall Street has already decimated our retirement savings and home values.)

On the other side we have the champions of age-based health care rationing, led by “ethicists” like Daniel Callaghan, trying to convince us to go gently into that good night, while our corrupt system of medicine for profit goes on unrestrained. How would you like to be denied a kidney transplant or even a new hip, on the grounds of enlightened “cost-benefit analysis,” while the drug and insurance companies continue to rake in their profits?

It’s no wonder elders around the world are taking matters into their own hands. The only thing that’s surprising about the German geezer gang described in yesterday’s post is that it doesn’t happen more often. You hear about other incidents every now and then: an oldsters’ crime wave in Japan, or an octogenarian bank robber with an oxygen tank in San Diego. Maybe soon we’ll be seeing more elderly sapper gangs in action.

In the meantime, a reader dropped me a line last night with a reminder that there is indeed a precedent for all this, deftly portrayed by Monty Python. Seems to me that it might be time for Hell’s Grannies to ride again.

Ten Questions on Health Care to Ask at a Town Meeting

This from a buzzflash.com guest blog by Dave Lindorff, based on an idea from one of his readers. Should you go to one of the town hall meetings on health care reform, here are 10 good questions to ask. The questions about Medicare, which I’ve highlighted in boldface, are especially good ones for older people to ask. This is especially important because the media seems to be full of tales of loony geezers claiming the government is going to mess up their Medicare–if it doesn’t euthanize them first.

1. If Canada’s single-payer system is so god-awful, why have repeated Conservative governments at the provincial and national level in Canada never touched it? Canada is a democracy. If Canadians don’t like their health care system, why haven’t they gotten rid of it in 35 years? Since the system there is run by the separate provinces, many of which are very politically conservative, why has not one province ever tried to get rid of single-payer?
2. Why is rationing by income, as we do it here, better than rationing by need, as they do it in Canada?
3. Wouldn’t single-payer mean that companies could no longer threaten working people with the loss of their health insurance? Why is this a bad idea?
4. The bigger the insurance pool, the better. So doesn’t having a national pool, as with single-payer, make the most sense?
5. Why should we be allowing politicians who are taking money from the medical industry to write the new health care legislation?
6. How can the Congress be developing a health system reform scheme and not even invite experts from Canada down to explain their successful system?
7. If Medicare–a single-payer system here in America–is so popular with the elderly, how come it’s no good for the rest of us?
8. Isn’t it true that Medicare currently finances the most costly patient group–the elderly and infirm–so that extending it to the rest of the population–most of whom are young and healthy–would be much cheaper, per person?
9. The AMA, the Pharmaceutical Industry, and the Insurance Industry all bitterly opposed Medicare in 1964-5 when it was being debated in Congress and passed into law, with the right, led by Ronald Reagan, calling it creeping socialism. It became a life-saver for the elderly and didn’t turn the US into a soviet republic. Why should we give a tinker’s damn what those same three industry groups and the Republican right think of expanding single-payer now?
10. The executives of Canadian subsidiaries of US companies all support Canada’s single-payer system, and even lobby collectively to have it expanded and better funded. Why does Congress listen to the executives of the parent companies here at home, and not invite those Canadian execs down to explain why they like single-payer?

Randall Terry: Obama Wants to Kill Granny with Death Care

As I recently predicted, right wingers are rolling out scare tactics to turn people against health care reform. The creepiest of the lot is the myth that Obama’s socialist government is planning to create the setting for euthanasia. This has special resonance with Catholic and fundamentalist protestant groups, which the Republican right always want to assuage. Drawing in more and more Catholics is especially important to keeping this base alive and festering. The phony euthanasia scare could also give new energy (and new funding sources) to the right-to-lifers, who are caught between a pro-choice federal government on one side, and on the other a radical fringe that thinks shooting doctors outside their churches is heroic act.

Art by Colin S from the animation and art blog.

Art by Colin S from the animation and art blog.

Former Operation Rescue head Randall Terry, forever trying to resuscitate himself, is a leader in the drive to stop the President’s “death care.” The Washington Post on Saturday reported how Betsy McCaughey, the whacko former New York pol and health care reform assassin, told former senator and flopped GOP presidential candidate Fred Thompson on talk radio that the health reform bill contained mandatory counseling sessions for seniors how to “to end their life sooner”‘–by showing them how to “decline nutrition..and cut your life short.”

What is all this about? According to the Post:

The controversy stems from a proposal to pay physicians who counsel elderly or terminally ill patients about what medical interventions they would prefer near the end of life and how to prepare instructions such as living wills. Under the plan, Medicare would reimburse doctors for one session every five years to confer with a patient about his or her wishes and how to ensure those preferences are followed. The counseling sessions would be voluntary.

But on right-leaning radio programs, religious e-mail lists and Internet blogs, the proposal has been described as “guiding you in how to die,” “an ORDER from the Government to end your life,” promoting “death care” and, in the words of antiabortion leader Randall Terry, an attempt to “kill Granny.”…

In the past two weeks, AARP has fielded a few thousand calls from people who mistakenly think the legislation would require every Medicare recipient to “choose how they want to die,” said James Dau, a spokesman for the organization.

At a recent AARP session on healthcare reform, Obama was asked about “rumors” his reforms would include the so-called death care initiative. The President answered the question by discussing living wills, which both he and and his wife have.

That makes sense, right? Getting a living will to kill yourself?

Ted Kennedy and Peter Singer on Health Care

Conservatives are now moving to block Obama’s modest health reform (miniscule to many of us) by charging his socialist government is out to ration health care, deciding who is to live and who is to die through bureaucratic decision-making.

William Kristol in a Weekly Standard blog post yesterday seizes upon a paragraph in Ted Kennedy’s powerful, emotional plea for health care reform–including a modest public option–in the current Newsweek to claim he’s into rationing. Here is a key excerpt from Kennedy:

We will bring health-care reform to the Senate and House floors soon, and there will be a vote. A century-long struggle will reach its climax. We’re almost there. In the meantime, I will continue what I’ve been doing—making calls, urging progress. I’ve had dinner twice recently at my home in Hyannis Port with Senator Dodd, and when President Obama called me during his Rome trip after meeting with the Pope, much of our discussion was about health care. I believe the bill will pass, and we will end the disgrace of America as the only major industrialized nation in the world that doesn’t guarantee health care for all of its people. … In the last year, I’ve often relied on that Congressional insurance. My wife, Vicki, and I have worried about many things, but not whether we could afford my care and treatment. Each time I’ve made a phone call or held a meeting about the health bill—or even when I’ve had the opportunity to get out for a sail along the Massachusetts coast—I’ve thought in an even more powerful way than before about what this will mean to others. And I am resolved to see to it this year that we create a system to ensure that someday, when there is a cure for the disease I now have, no American who needs it will be denied.

Kennedy’s piece is worth reading in full. I can’t find an argument for rationing health care anywhere in it, but if you can, please drop me a line and tell me where.

We all know the U.S. already rations health care, by denying insurance coverage to the poor and lower middle classes, by forcing people without insurance to wait hours in emergency rooms, limiting treatment for anyone who doesn’t have the kind of Cadillac insurance that comes mostly with high-paying jobs, allowing pharmaceutical companies to charge exorbitant prices for drugs—so high in many cases people just stop taking them. And in the current debate, politicians want to add to that rationing by cutting back Medicare, which the only thing close to a fair, classless, single-payer system the United States has ever seen.

The subject of rationing is a tricky one, but if you want to get into it, you might start with Peter Singer’s article in Sunday’s New York Times Magazine. I know Singer from his work on animal rights. As I’ve written before, as an old person I’m not keen on the implications of things like QALYs–which stands for “Quality Adjusted Life Years”–might have in the wrong hands.  (Advacates for the disabled have criticized Singer on the same grounds.) But Singer’s piece is valuable for pointing out that even the most bureaucratic and “socialistic” government-run system manages better, fairer delivery of health care than we do. His ideas also bring the plain fact of income-based health care rationing out of the shadows, which is where opponents of reform would like to keep them. Here is an excerpt from Singer’s conclusion:

Rationing public health care limits free choice if private health insurance is prohibited. But many countries combine free national health insurance with optional private insurance. Australia, where I’ve spent most of my life and raised a family, is one. The U.S. could do something similar. This would mean extending Medicare to the entire population, irrespective of age, but without Medicare’s current policy that allows doctors wide latitude in prescribing treatments for eligible patients. Instead, Medicare for All, as we might call it, should refuse to pay where the cost per QALY [a method of assessing cost benefit] is extremely high. (On the other hand, Medicare for All would not require more than a token copayment for drugs that are cost-effective.) The extension of Medicare could be financed by a small income-tax levy, for those who pay income tax — in Australia the levy is 1.5 percent of taxable income. (There’s an extra 1 percent surcharge for those with high incomes and no private insurance. Those who earn too little to pay income tax would be carried at no cost to themselves.) Those who want to be sure of receiving every treatment that their own privately chosen physicians recommend, regardless of cost, would be free to opt out of Medicare for All as long as they can demonstrate that they have sufficient private health insurance to avoid becoming a burden on the community if they fall ill. Alternatively, they might remain in Medicare for All but take out supplementary insurance for health care that Medicare for All does not cover. Every American will have a right to a good standard of health care, but no one will have a right to unrationed health care. Those who opt for unrationed health care will know exactly how much it costs them.

It is common for opponents of health care rationing to point to Canada and Britain as examples of where we might end up if we get “socialized medicine.” On a blog on Fox News earlier this year, the conservative writer John Lott wrote, “Americans should ask Canadians and Brits — people who have long suffered from rationing — how happy they are with central government decisions on eliminating ‘unnecessary’ health care.” There is no particular reason that the United States should copy the British or Canadian forms of universal coverage, rather than one of the different arrangements that have developed in other industrialized nations, some of which may be better. But as it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country. In Canada, 73 percent answered this question affirmatively. Coincidentally, an identical percentage of Britons gave the same answer. In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.