Patterico's Pontifications

7/9/2015

Death Panels!

Filed under: General — Patterico @ 7:40 am



New York Times:

Medicare, the federal program that insures 55 million older and disabled Americans, announced plans on Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.

The proposal would settle a debate that raged before the passage of the Affordable Care Act, when Sarah Palin labeled a similar plan as tantamount to setting up “death panels” that could cut off care for the sick. The new plan is expected to be approved and to take effect in January, although it will be open to public comment for 60 days.

The cost of end-of-life care is a growing problem. In a true market economy, health insurance would address this. Health insurance would not be tied to your workplace or limited to one state. It would be like life insurance: a choice you could make. (I know: choice! what a concept!) Young people could decide early on whether they wanted to pay for unlimited care when they hit old age — and if they did, their premiums would reflect it. The premiums for such care would be very, very high, and most would probably choose to forego the coverage. Those who declined to get health insurance at all would get charity care.

It would not be a perfect system. No system is perfect. There are no solutions. Only trade-offs.

But instead we have a view that the poor and rich should not be treated differently with respect to health care. “Why should the rich receive better quality health care in their old age just because they’re rich and could afford health insurance?” Increasingly we have this attitude about everything. Why should the rich be able to afford life insurance? Why should the rich be able to afford nicer cars? Why should the rich be able to afford houses in nice areas? Vacations? Yachts.

What is lost in such discussions is the critical question of incentives, and the fact that goods and services must be produced. They don’t sit in a pile, waiting to be grabbed.

In a society where you earn according to the value you provide society, value is provided and everyone benefits. The pool of available goods and services grows. In short, the pie gets larger and there is more to go around.

In a society where you are given stuff even though you provide zero value, no value is provided and everyone suffers.

The economic theories of a socialist idiot like Bernie Sanders are the theories of people who want to sound like they care and don’t think things through to the next step.

The next step, in a society where the huge cost of medical care for the old is taken over by the government, is to ration those services. Because the demand for end of life services is not connected to any choice made by the individual, that demand will be unlimited, and cannot possibly be met by the government. Government begins by providing incentives to health care professionals to get old people to end their lives. The final step is rationing.

Death panels, in other words.

We are finally taking that first step. Sarah Palin saw it years ago, and was vilified by our “betters” for saying so. She was, in fact, the “liar of the year.”

She never said she could see Russia from her house. But she did say she saw this coming.

57 Responses to “Death Panels!”

  1. Ding.

    Patterico (3cc0c1)

  2. We’ll have no more of this reason and logic, young man!

    alanstorm (cb237b)

  3. And the leftists still don’t understand that Death Panels only pertain to us, not the rich and most likely not politicians or even bureaucrats. The former will hire what ever doctors their money can buy and the latter will continue to suck at the teat of “public service” and taxpayers money (remember, they’re “exempt”). You and I will run out of OPM and be (hopefully) quietly put to death. Soylent Green! #AllPeopleAreFood.

    Rev. Barack Hussein Hoagie (f4eb27)

  4. is that really what the Palin lady meant by death panels? … conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves?

    something seems off here

    happyfeetie (a037ad)

  5. here is the original death panel post from that Palin lady

    happyfeetie (a037ad)

  6. ” There are no solutions. Only trade-offs. ”

    ==========

    Thomas Sowell for the win!!

    If only more people *understood* that in our hugely-complex system (meaning: The Real World, whether we’re addressing medical care, foreign policy, the welfare system, … ANYTHING) whatever-you-do has consequences, and those consequences lead other independent actors to pursue benefits/avoid damages, and all THOSE independent choices have still other consequences, good and bad.

    But I guess it’s hard for Imperial Government to acknowledge they can’t control everything. So they fix a perceived “problem”, and then they fix their fixes, and after that they fix what happens after the fix-of-the-fix goes sideways, … and soon everything is tied in knots. And then they have to find a scapegoat, because by golly, everything they did was good, proper, reasonable, and necessary. That leads to: “FIND THE SABOTEUR! *THEN* we’ll have Utopia.” (And of course, THAT leads to: “Who knew we had ten million saboteurs? Keep the boxcars coming.”)

    A_Nonny_Mouse (c69e3d)

  7. the princess of populist pablum is clearly talking specifically about the kinds of rationing one would expect from an ineptly managed state-run health care system, not about “conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves”

    “And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. 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.”

    i do not understand there seems to be some miscommunication here

    happyfeetie (a037ad)

  8. Of course we all expected this.

    I always look to England to see what life in the socialist paradise will be like; they are 30 years ahead of us and offer a glimpse into our sad future.

    Patricia (5fc097)

  9. oh and also I’m transitioning back to being a guy pikachu again

    pls to support me on my courageous journey

    happyfeet (a037ad)

  10. in England they call it NICE, worthy of CS Lewis, it keys into Zeke Emmanuel’s ‘complete lives’ system

    narciso (ee1f88)

  11. The actual death panel will be something innocuously named liked the Utilization
    Review Board or the Resource Allocation Subcommitee. This is just a baby step to hector the patients into accepting a DNR label early.

    mysterian (f109e3)

  12. ugh, not a good start to my day – i have to agree with happyfeet. Well, at least to the extent that SP was referring to rationing and not to conversations. The point Patterico is well and good on its own (maybe not correct, but still well done) and should not bring in SP’s concerns about “death panels” with ObamaCare bureaucrats.

    seeRpea (5d7dd6)

  13. As said above. Once upon a time, though far from perfect, people had doctors and doctors primarily had to worry about taking care of their patients, who they learned to know over time as the population of their insurance panels did not keep changing. Part of being a doctor was knowing your patient and learning things like this.
    Now everything is supposed to be fool-proof relying on some form that nobody understood that cannot be found when it is needed.
    I bet if not already mandated, if you want to bill for that code, the discussion must have the elements as decided by the medicare review board.

    MD in Philly (f9371b)

  14. The conversation, to be reimbursed by medicare, will have to be done according to medicare guidelines, which are subject to the whim of the bureaucrat of the moment.
    And even if you spend twice the allotted time with the patient, if the discussion did not include what medicare says it should, you can be charged with fraud if you bill.

    MD in Philly (f9371b)

  15. feets @7, you have a habit of deliberately misunderstanding other people’s statements. Pat is not saying that end of life conversations constitute death panels. He makes it clear that it’s the inevitable next step, when you have an unaccountable, unelected board rationing care because not enough of the elderly take the hint and voluntarily end their worthless lives, that you have death panels.

    As is the case in Britain.

    http://www.telegraph.co.uk/news/health/elder/11637179/Elderly-face-NHS-discrimination-under-new-UN-death-targets.html

    We can also look at cases in Belgium, Switzerland, and particularly Holland, and see what those end of life conversations will consist of. Pressuring the elderly to, as candidate Obama put it, to forego the life saving heart surgery and just take a pain pill. In other words, just go home and die.

    You can not say that the elderly in countries where their consent is technically required give it freely. Because often family members eager to inherit or just simply tired of the bother join in and help the doctors pressure their relative to just die already.

    GPs in Holland are often distressed when they try to get their elderly patients admitted to hospitals for conditions that they can’t treat on an outpatient basis at their clinics. Because the hospitals don’t want to waste a valuable bed on a worthless elderly mouth. And they bluntly tell the GP he should convince the patient to “just take the pill.” I.E. go home and die.

    But the elderly are usually even more distressed when they are admitted to the hospital as they know the staff at the hospital can kill them even without their consent. Which is why I said technically required. Their consent is a mere technicality as medical professionals in Holland know they will never suffer any consequences for their actions. Which is why Dutch doctors freely admit to engaging in the practice.

    Steve57 (4c9797)

  16. sorry Patterico, it wasn’t you who bought in SP, it was the NYT. They are wrong (again).

    seeRpea (5d7dd6)

  17. Mr. 57 my disagreement is with the NYT’s framing not Mr. P’s

    and also I have a lot of salubrious habits for example flossing

    happyfeet (a037ad)

  18. “But the elderly are usually even more distressed when they are admitted to the hospital as they know the staff at the hospital can kill them even without their consent. Which is why I said technically required. Their consent is a mere technicality as medical professionals in Holland know they will never suffer any consequences for their actions. Which is why Dutch doctors freely admit to engaging in the practice.”

    – Steve57

    Link?

    Leviticus (f9a067)

  19. 12. ugh, not a good start to my day – i have to agree with happyfeet. Well, at least to the extent that SP was referring to rationing and not to conversations. The point Patterico is well and good on its own (maybe not correct, but still well done) and should not bring in SP’s concerns about “death panels” with ObamaCare bureaucrats.

    seeRpea (5d7dd6) — 7/9/2015 @ 8:39 am

    No, bringing in Palin’s concerns is entirely valid as we are on a road that leads only to one place. Death panels. How can you pretend that each step along the road is unrelated to reaching the final destination. Literally final, in this case.

    Here is how the end of life conversation is eventually going to go, per Obamacare architect Dr. Ezekiel Emmanuel:

    http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/

    Why I Hope to Die at 75

    An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly

    At first, it will just be a discussion of options. Later, as has been the case in Europe, the emphasis will be on how the elderly can’t look forward to a quality of life anyone could enjoy. Still further it will become, “What’s wrong with you, you selfish old fart? Everybody including you would be better off if you hurried up and died. No decent human being would want to keep burdening society and their families the way you are by being so stubborn about sticking around.”

    I honestly don’t understand the short-sightedness of some conservatives or at least some who appear to be right leaning. The left is playing a long game. And they can map out each incremental step to get to the end point. And they can hold semi-public training seminars on how to boil the frogs slowly.

    And the frogs in the pot keep insisting as the water gets hotter and hotter that it’s silly to think they’ll ever be cooked.

    Sarah Palin, and Pat, are telling you the recipe for boiled frog. Why don’t you understand this?

    Steve57 (4c9797)

  20. It’s taqqiya. It’s like how Obama, Hillary Clinton, and John Kerry all claimed to oppose gay marriage. Progressives voted for them anyway on the assumption that they were lying to the American people at large. Progressives don’t think there is anything wrong with progressives lying about what they believe in order to get people to vote for them.

    So when Palin talked about death panels, they said how awful, what a slander, no one’s talking about death panels, and all the while they are working toward that end, pointing out how much of the healthcare budget goes to the elderly and end-of-life care and “encouraging” physicians to discuss it with their older patients.

    “Encouraging” in quotes because it starts that way. First it’s encouraged, then voluntary, then mandatory.

    Gabriel Hanna (64d4e1)

  21. http://www.hospicepatients.org/euth-experts-speak.html

    For those who advocate euthanasia as a solution providing a death with dignity [which I strongly challenge as completely unfounded], I provide some expert opinion by physicians who have studied the subject in depth:

    Carlos Gomez, MD, Ph.D., wrote in his book, Regulating Death – Euthanasia and the case of the Netherlands, the following:

    p. 138: “…I remain unconvinced that under current regulations the practice [of euthanasia] is not abused. those in the United States who point to the Netherlands as a public policy model for assistance with suicide have not, I would suggest, looked carefully enough. If the Netherlands – with its generous social services and universal health coverage – has problems controlling euthansasia, it takes little effort to imagine what would happen in the United States, with a medical system groaning under the strain of too many demands on too few resources.”

    Herbert Hendin, MD, Executive Director of the American Suicide Foundation and Professor of Psychiatry at New York Medical College has written the following in his authoritative analysis of euthanasia in the Netherlands: Seduced By Death – Doctors, Patients and the Dutch Cure:

    The doctors who help set Dutch euthanasia policies are aware that euthanasia is basically out of control in the Netherlands. They admitted this to me privately. Yet in their public statements and articles they maintain there are no serious problems….” p. 14…

    There is a ton of information on this, Leviticus. You shouldn’t need to ask me for links.

    Santorum got savaged by the “fact checkers” in the 2012 campaign for his statements on euthanasia in Holland. As per usual for the criteria for handing out Pinocchios to Republicans, he only had a few minor details wrong.

    …In short, since lethal injections became lawful in certain circumstances in the Netherlands in 1984 (not 2001 as Kessler writes), Dutch doctors have violated a cardinal legal requirement — an explicit request from the patient — in thousands of cases, and with virtual impunity. Turning to Santorum’s claim that some elderly Dutch wear “do not euthanize me” bracelets, Kessler describes this as a “strange misrepresentation.” However, Kessler himself quotes a Dutch euthanasia specialist that the Christian Dutch Patients Association issues a “living will” in which people can state that active life termination is not an acceptable option. What, then, is the “strange misrepresentation?” That opposition is written on a card rather than on a bracelet? It would not be remotely surprising if some elderly Dutch, fearing a lethal injection without request, were to express their opposition in advance. Indeed, it would be prudent for them to do so. The majority of Dutch doctors told the survey authors that they either had given or would give a lethal injection without request. And the survey authors have written, in the light of the persistent practice of euthanasia without request, that it is now the responsibility of patients to make it clear in advance what their wishes are. Kessler comments that each euthanasia case is verified by “a commission” (which in fact comprises three part-timers). But this “commission” decides on the basis of a written report filed, after the event, by the very doctor in question. As a leading supporter of Dutch euthanasia once put it, this is like enforcing the speed limit by asking drivers to report when they have exceeded it…

    Read more at: http://www.nationalreview.com/corner/293857/santorum-and-dutch-euthanasia-fact-checking-fact-checkers-john-keown

    Steve57 (4c9797)

  22. Santorum more right than wrong about Dutch euthanasia

    …The Dutch media pounced, mocking Santorum for charging their doctors with “murdering” the elderly on “a grand scale.” Alas, he asked for it because he got the details wrong. When decrying the culture of death, one must be as accurate as possible. Otherwise, the fish wiggles off the hook.

    …But even that number is far too low. Repeated studies have shown that Dutch doctors fail to report at least 20% (or more) of actual euthanasia deaths, which means that hundreds of euthanasias aren’t included in the official statistical count. Moreover, about 1% of all Dutch deaths come as a result, to use Dutch parlance, of being “terminated without request or consent” — e.g. non-voluntary euthanasia. Such deaths are also not technically part of the official euthanasia count. That gets us up to about 6% of all deaths involving medical treatment at the time of death. Add in a few hundred assisted suicides each year where the patient takes the final death action rather than being lethally injected, and suddenly, Santorum’s 10% claim becomes far less problematic.

    Wait, there’s more: Dutch doctors also kill patients by intentionally overdosing them with pain killers. I am not referring here to death caused as a side effect of legitimate pain control, but overdosing with the intent of causing death. The exact number of these deaths isn’t known, but the authoritative 1990 government study known as the Remmelink Report found that there were 8,100 deaths from intentional opioid overdose, of which 61% were done without the request or consent of patients. Now, add in, say, half of the nearly 10% of deaths that occur after Dutch doctors place patients into artificial comas and deny them food and water — that is, those cases in which palliative sedation is not medically necessary to control otherwise irremediable suffering — and we see that Santorum’s claim of a 10% euthanasia rate isn’t materially overstated at all.

    Read more: http://dailycaller.com/2012/02/21/santorum-more-right-than-wrong-about-dutch-euthanasia/#ixzz3fPh1RqMv

    Steve57 (4c9797)

  23. We’ve already seen this happen here. The VA hospital scandal was exactly what the single-payer systems in Canada and the UK do: delaying care to save money. If the patient who should see the doctor four times a year gets his appointments stretched out to only thrice a year, the VA saved the cost of that fourth appointment in the current fiscal year; if they can do it over time, they’ll wind up saving even more, and if the patient is good enough to die a bit earlier because his care was stretched out, well, heck, even more is saved!

    This is what happens when the government which (supposedly) guarantees your rights is also the body which has to pay for your health care.

    Death panels will never consist of physicians; they will be made up of accountants and bureaucrats.

    The non-physician Dana (f6a568)

  24. I suppose that I can’t persuade anyone here that the idea of “death panels” is a bogeyman. It is true, however, that like all goods or services, health care has been, is and will continue to be rationed when the supply can’t or won’t meet the demand.

    My very personal experience with this sort of thing is that advanced directives are a critical source of information for very difficult situations. In my experience, I was being encouraged by doctors to issue a DNR order for a close relative who had experienced a sudden medical catastrophe and who was on life support. That relative’s advanced directive was my bible as I resisted those doctors, who had already written her off and were unwilling to perform procedures that they felt had almost no chance of succeeding.

    In short, communications about end-of-life decisions can be useful to resist arguments to stop care. They’re not a slippery slope to government-run death panels.

    Jonny Scrum-half (95b419)

  25. yes yes if you tether your health cares to a declining hyper-indebted whorestate like failmerica, you have to expect hard choices will need to be made

    happyfeet (a037ad)

  26. Prof. Theo Boer formerly supported euthanasia in Holland. In fact, he used to be a member of a regional review committee (dutch law technically requires all cases of euthanasia to be reported to a medical review board). Precisely because of his intimate experience with how euthanasia actually operates in fact, which is nowhere near how it is supposed to operate per the law, he now opposes euthanasia.

    Doctors simply report they comply with the law. Unless a doctor reports in his or her own words that they violated the law it is impossible to prove any wrongdoing. Dutch doctors know these committees have to rely entirely on what they report about themselves.

    He testified last July before the British House of Lords when it was considering a doctor-assisted suicide law.

    Don’t make our mistake: As assisted suicide bill goes to Lords, Dutch watchdog who once backed euthanasia warns UK of ‘slippery slope’ to mass deaths

    …Professor Boer, who is an academic in the field of ethics, had argued seven years ago that a ‘good euthanasia law’ would produce relatively low numbers of deaths.

    …But, speaking in a personal capacity yesterday, he said he now believed that the very existence of a euthanasia law turns assisted suicide from a last resort into a normal procedure.

    A ‘slippery slope’ for assisted dying in Britain would mean that euthanasia would follow the same path as abortion, which was legalised in 1967.

    There are now nearly 200,000 terminations a year. Anti-euthanasia campaigners and disability activists called on politicians to listen to the professor’s warning.

    The Paralympian, Baroness Tanni Grey-Thompson, said: ‘What Dr Boer says comes as no surprise.
    ‘An assisted dying law is playing with fire, especially when there are no safeguards in place. Lord Falconer’s bill just isn’t fit for purpose.’

    Baroness Jane Campbell, who is a disability rights campaigner, said: ‘As happens in Holland, Lord Falconer’s bill could end up encompassing significant numbers of seriously ill people.’

    Euthanasia is now becoming so prevalent in the Netherlands, Professor Boer said, that it is ‘on the way to becoming a default mode of dying for cancer patients’.

    He said assisted deaths have increased by about 15 per cent every year since 2008 and the number could hit a record 6,000 this year.

    He said he was concerned at the extension of killing to new classes of people, including the demented and the depressed, and the establishment of mobile death units of ‘travelling euthanasing doctors’.

    …The Utrecht University academic has been a member since 2005 of a review committee charged with monitoring euthanasia deaths. Its role includes a duty to ‘tell doctors how their actions in particular cases are likely to stand up to legal, medical and ethical scrutiny’.

    Professor Boer admitted he was ‘wrong – terribly wrong, in fact’ to have believed regulated euthanasia would work.

    ‘I used to be a supporter of the Dutch law. But now, with 12 years of experience, I take a very different view…

    Read more: http://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html#ixzz3fPmi5Mrt
    Follow us: @MailOnline on Twitter | DailyMail on Facebook

    Steve57 (4c9797)

  27. Sorry to hear about your relative, Jonny however, you must remember you were up against American doctors of whom a great deal cringe at euthanasia. But more than that, as Dana mentioned under the government plan the accountants, actuaries and bureaucrats are the decision makers, the doctors are only the executioners.

    I know I’m old fashion but giving doctors the power to kill a patient bothers me. I am still of the mind that doctors are there to save life not take it.

    Rev. Barack Hussein Hoagie (f4eb27)

  28. 25.yes yes if you tether your health cares to a declining hyper-indebted whorestate like failmerica, you have to expect hard choices will need to be made

    Aw common, feets. You know there are thousands of situations every year in which “hard choices will need to be made” regardless of who or what runs the health care industry. But right there is why I get mad. The left keeps interchanging “health care” with “health insurance”. They are two different things.

    Rev. Barack Hussein Hoagie (f4eb27)

  29. nevertheless Reverend Hoagie

    you can’t get blood out of a turnip you know why?

    cause of turnips are bloodless creatures, and cunning

    happyfeet (a037ad)

  30. 24. I suppose that I can’t persuade anyone here that the idea of “death panels” is a bogeyman.

    My very personal experience with this sort of thing …

    …In short, communications about end-of-life decisions can be useful to resist arguments to stop care. They’re not a slippery slope to government-run death panels.

    Jonny Scrum-half (95b419) — 7/9/2015 @ 9:54 am

    Yes, you’ll have a very difficult time persuading anyone since once again your personal experience does not conform to reality. In fact, you have no personal experience with this sort of thing. Those who do, who live in countries where government panels rationing health care can attest that it doesn’t matter whether or not you’d like to resist arguments to stop care. It doesn’t matter what the patient’s or family’s wishes are.

    The government will stop care regardless.

    As you will read if you follow the link @15 (which you clearly have not) the UN has established what NHS doctors in the UK are calling death targets. And they explain how grandma just ain’t going to be treated for her heart condition or cancer.

    The NHS will be forced to discriminate against the over 70s to meet ‘highly unethical’ UN health targets which seek to reduce premature deaths in younger people, senior medics have warned.

    Under the proposed Sustainable Development Goals, UN member states must cut the number of deaths from diseases like cancer, stroke, diabetes and dementia by one third by 2030.

    However because many are age-related illnesses people who succumb to those diseases from the age of 70 are not deemed to have died prematurely and so are not included in the target.

    In an open letter published in The Lancet, an international group of ageing specialists say the new guideline sends out the message that health provision for younger groups must be prioritised at the expense of older people…

    Meeting the death targets will be the job of the death panels, no matter what hallucinations you have to the contrary.

    Steve57 (4c9797)

  31. Reality says you’re wrong about death panels, Jonny Scrum-half, and Sarah Palin is right.

    Prof Peter
    Lloyd-Sherlock, professor of social policy and international development
    at the University of East Anglia, and lead author of the letter, said:
    “This premature mortality target is highly unethical, since it
    unjustifiably discriminates against older people.

    “We already
    know that there is age discrimination in cancer care and surgery and
    these targets give that the stamp of approval.

    “The targets are
    not quite set in stone yet, so we have a final opportunity to impress
    upon the UN the need to alter this explicitly ageist health target.

    “If this doesn’t happen, people aged 70 and over will become second-class citizens as far as health policy is concerned.”

    …“Put simply, it tells policy makers, particularly in poorer countries that older people do not matter,” the signatories warn.

    Others who have signed include ageing experts from The London School of
    Hygiene and Tropical Medicine, Institute for Ageing and Health at
    Newcastle University as well as representatives of The Alzheimer’s
    Society, Age UK, and HelpAge International.

    …Data released for the first time showed that across large areas of the
    country, almost no patients above the age of 75 are receiving surgery
    for breast cancer or routine operations such as gall bladder removal and
    knee replacements.

    This is why Obamacare architect Emmanuel wrote that article in The Atlantic about how 75 years is long enough to live. He didn’t pick the number out of thin air. Obamacare architects were never shy about proclaiming their love and admiration from Britain’s NHS. And 75 being an age limit is the de facto rule with NICE, Britain’s death panel.

    So at first choosing to die at 75 will be a suggestion, followed by what those in the Obama administration like to call “nudges,” which will become increasingly more like hard shoves. Then it will be an enforceable rule, as it is in the UK.

    The National Institute for Health and Care
    Excellence (Nice), was also criticised for attempting to change its
    funding criteria to take into account “wider societal benefits” when
    deciding on whether to fund drugs.

    So, withholding life saving drugs from the unproductive elderly and reserving those drugs for the productive clearly has “wider social benefits,” just like withholding surgical treatment.

    Steve57 (4c9797)

  32. Steve57 – I already agreed that rationing of health care is likely to occur. It’s occurring now, and always has occurred. My story described a type of rationing, albeit not the sort that your links discussed.

    My point was that communication about end-of-life circumstances is not what the scare-mongers are insisting. In fact, such communications can be helpful in resisting efforts to “ration” health care, as I described.

    Jonny Scrum-half (95b419)

  33. End of life decisions and death panels/rationing are two different things. Everyone needs to have end of life decisions made known to family members so that your wishes can be carried out and to relieve family members of second guessing what you would have wanted. I know that having this in writing for my own father helped me make decisions on his behalf when he was passing away.

    Denver Todd (7163dd)

  34. Jonny, you can resist rationing now since you have recourse when it’s a private insurance company doing the rationing.

    You have no recourse when it’s a government panel rationing health care. That is simply a fact of life.

    The Independent Payment Advisory Board (IPAB) was created by the Obamacare law and made unaccountable, secretive, and its decisions legally binding precisely because Congress knew these unpopular rationing decisions will have to be made, and Congress didn’t want to take the blame.

    So, no, these end of life conversations will provide no one with the ability to resist efforts to ration health care under Obamacare. And your past experiences have no bearing on what will happen when you are dealing with IPAB, since it didn’t exist then.

    Steve57 (4c9797)

  35. Steve57 – It’s difficult for me to argue with your hypotheticals about what might happen in the future. You’ll argue that it’s going to be bad. I’m going to point out that things can be bad now, too. And I’m going to continue to believe that your position is completely determined by the fact that the ACA was signed into law by Obama.

    Jonny Scrum-half (95b419)

  36. And I’m going to continue to believe that your position is completely determined by the fact that the ACA was signed into law by Obama.

    If that’s an honest statement you fail in understanding the conservative mind. We judge things by outcome or apparent outcome not by who wrote it or passed it nor by who is for or against it. It wouldn’t matter if George Washington signed the ACA, the law is bad, un-American and oppressive. The only proof one needs is Pelosi’s statement: “We have to pass it to see what’s in it”. You do realize how horrible a statement like that is to Free people, don’t you?

    Rev. Barack Hussein Hoagie (f4eb27)

  37. “Why should the rich be able to afford life insurance? Why should the rich be able to afford nicer cars? Why should the rich be able to afford houses in nice areas? Vacations? Yachts.”

    Because that is what it MEANS to be rich; you have more options. now, the Liberal Intellectual Radical Progressives HATE that. And they hate it not because it denies these things to the poor, but because it affords these things to people opt whom the LIRPs disapprove. In a perfect LIRP world, people with the right politics would get the good health insurance,m the nicer cars, the better houses, and the yachts. And, more importantly, boors like Donald Trump WOULDN”T.

    The LIRPs are no different from the fading Aristocracy of the Victorian age; trying desperately to hall back the rise of Those Awful People in Trade (and crippling their own country thereby).

    LIRP, Guillotine. Some disassembly required.

    C. S. P. Schofield (a196fd)

  38. Rev. Barack Hussein Hoagie – I hope that you realize that the Pelosi quote you use is very out-of-context.

    Jonny Scrum-half (95b419)

  39. “announced plans on Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves”

    That’s a great conversation that people should have… with their lawyer and their health care proxy. Those wishes then get communicated to a physician when the time comes.

    One of the problems I have with the ACA, which pales in comparison to this, is how our betters want doctors to do EVERYTHING. Talk about guns in the house? Questions of gender identity? Discussions about end of life issues?

    Apparently, these brain trusts have never heard of comparative advantage. We only train a certain number of doctors per year, only have a certain number of residencies, and they are trained at a great expenditure of time and money, and represent the smartest and hardest working Americans. Why the hell would you have them waste their time doing crap that is best done with a social worker or a lawyer (who are, respectively, less expensive and in more abundant supply)?

    bridget (606c39)

  40. The study reveals that Belgian doctors deliberately “hasten the death” of patients “without an explicit request” at a rate of 1.7% of all deaths in the country. There were 61,621 deaths in Belgium during the last year for which there is comprehensive data (2013), which means that doctors are now euthanizing more than 1,000 patients a year without their having requested it.The study reveals that Belgian doctors deliberately “hasten the death” of patients “without an explicit request” at a rate of 1.7% of all deaths in the country. There were 61,621 deaths in Belgium during the last year for which there is comprehensive data (2013), which means that doctors are now euthanizing more than 1,000 patients a year without their having requested it.

    http://www.breitbart.com/national-security/2015/04/12/euthanasia-in-belgium-doctors-hasten-the-death-of-1000-non-consenting-patients-a-year/

    Lest anyone forget Obama’s medical policy adviser in 2009-2010 was Rahm Emanuel’s brother Dr. Ezekial Emanuel. He famously trotted out a bell curve in an article and described how those at either end (as I recall 65) should just receive palliative care when seriously ill. The young because not too much has been invested in them by the government so their loss – especially those with a chronic illness – would be an economic gain for society. Likewise, the elderly have shifted from being revenue generators for the tax machine to being net takers of government services and cash. The sooner they kick off, the better so medical aid offered to the 16-64 crowd would be denied them.

    My, how very progressive of those medical specialists.

    in_awe (7c859a)

  41. The age scale used was under 15 years old, and over 65 years old as I recall (the text editor didn’t like less than and greater than symbols – oops!)

    in_awe (7c859a)

  42. I don’t have a better alternative, but the scheme you outlined in your post would engender the deepest resentment in the younger generations. They would understand the free ride their elders gave themselves, and worse, they would well understand that the promised care would not be there for them after years of paying into the system – just as Social Security won’t deliver.

    More and more, the Star Trek:TNG ep with Charles Winchester of MASH (David Ogden Stiers) looks to be more and more a realistic option in our fading republic. He was a leader in a society when absolutely everybody who reached a certain birthday (~70?), killed themselves on that birthday to avoid becoming a burden to society. No discrimination of any kind! Yay!

    Ed from SFV (3400a5)

  43. Any context is adequate context for the Pelosi quote.

    Any rational thinking person, including liberals, should have been against the bill on that statement alone, had they heard it.

    Can you imagine what the MSM would do if Boehner said the same thing with a Repub president????

    MD in Philly (f9371b)

  44. http://tinyurl.com/mt2eb9t

    “Vaccinating children against deadly diseases in Third World countries costs very little per child and saves many lives, including decades of life per child. Meanwhile, a heart transplant for an eighty-year-old man is enormously expensive and can yield only a limited amount of additional life, even if it is completely successful, since the life expectancy of an octogenarian is not great in any case.”

    Michael Ejercito (d9a893)

  45. You can already have this conversation with your doctor. Now it just means you don’t have to pay for it. You can always pay for more care if you want.

    nbf (4aae12)

  46. 45.You can already have this conversation with your doctor. Now it just means you don’t have to pay for it.

    What do you mean you don’t have to pay for it? Do you see your doctor by the word or by the visit? And if there is a charge who do you expect to pay for you to talk to your doctor? Are you really under the impression that doctors, unlike yourself, go to work expecting not to be paid? Or are you under the impression it is my job or Danas job of ropelights job to pay your doctor?

    Rev. Barack Hussein Hoagie (f4eb27)

  47. Rev. Barack Hussein Hoagie – I hope that you realize that the Pelosi quote you use is very out-of-context.

    Is there a context that doesn’t mean she is saying they have to pass the bill first before the audience can learn what is in it? (Hint: no.)

    Generally, as a citizen, I like to know what is in major controversial legislation before it’s passed. Not after. Having read the full context, it appears Pelosi was not on board for that concept.

    Patterico (3cc0c1)

  48. You can already have this conversation with your doctor. Now it just means you don’t have to pay for it. You can always pay for more care if you want.

    Yeahbutcept the system makes it unaffordable to do that. Government subsidies have caused the prices to skyrocket, so it’s not like you can just save up, unless you’re Bill Gates.

    Patterico (3cc0c1)

  49. 47.Rev. Barack Hussein Hoagie – I hope that you realize that the Pelosi quote you use is very out-of-context.

    I don’t think you know what the term “out of context” means. I saw her on the news at least 20 times make that statement she’s got her teleprompters going and she’s right at home in her element. How the hell is that b!tch out of context? Exactly what is the context? Was she lying? Didn’t she mean it? Was she just joking to see what we’d say? Here’s your context pal, one party voted for and passed a secret law that we couldn’t see of 2500 pages without one vote from the opposition. Kinda like a communist one party state, no?

    Rev. Barack Hussein Hoagie (f4eb27)

  50. The “…demand will be unlimited, and cannot possibly be met by the government.” Yeah, as if private insurance was unlimited. I call jiggery-pokery!

    Tillman (a95660)

  51. Good Allah, mendoucheity squared – first half-sack, now serial troll Tillman.

    JD (3a9424)

  52. 35. …And I’m going to continue to believe that your position is completely determined by the fact that the ACA was signed into law by Obama.

    Jonny Scrum-half (95b419) — 7/9/2015 @ 12:06 pm

    And you’d be wrong. It isn’t that he signed it into law, it’s what he signed into law.

    I don’t normally use Wikipedia as a source, but for convenience sake I will.

    https://en.wikipedia.org/wiki/Independent_Payment_Advisory_Board

    Lobbying groups

    The Pharmaceutical Research and Manufacturers of America has said that elimination of the payment board is its top priority in the 2011 Congress.[31] The American Hospital Association and the American Medical Association (AMA) have spoken out against the board.[31][32] The AMA wants to change the IPAB requirement that members have no outside employment so working physicians can be considered.[33] The AMA also opposes any independent commission which could cut physician payment rates.[34]

    Dr. J. Fred Ralston Jr., president of the American College of Physicians (ACP), expressed support for the idea behind the IPAB, saying “making complex Medicare payment and budgetary decisions is very difficult within a political process with substantial lobbying pressures”, but the group would like to see significant changes. The ACP supports creating a position for a primary care physician on IPAB, additional protections that ensure cost reductions do not lead to lower quality of care, authority for Congress to reject proposals made by IPAB via a simple majority vote, and equal treatment of all healthcare providers.[35]

    Dr. Elaine C. Jones, government relations committee cochair of the American Academy of Neurology stated, “We are also very concerned about the power of the IPAB to cut payments to physicians. The sole function of the IPAB is to cut spending with little guarantee of maintaining quality, access, and scientifically proven care. There may be no physician representation on the board either. These elements are concerning and unacceptable.”[36]

    Ron Pollack, the founding executive director of the health care advocacy group Families USA, advised Democrats against being divided and conquered by supporting repeal of specific portions of the health care reform, such as IPAB.[37]

    Two major nursing home associations, the American Health Care Association and the American Association of Homes and Services for the Aging, along with seventy two other healthcare groups, urged Congress to reject IPAB. They argued that the board would have too much control over Medicare and would affect the ability of healthcare providers to lobby for changes in how they are reimbursed. The groups also argued that IPAB would only be accountable to the president.[38]

    The American Academy of Orthopedic Surgeons has made IPAB a focus of their advocacy work. Hospital exemptions from 2015 to 2020 as well as the lack of practicing physicians on the board itself are major concerns. Recent lobbying efforts in April 2011 have focused on making these modifications if not fully eliminating this board.[citation needed]

    Medical specialty groups have spearheaded efforts to repeal IPAB. Specifically, the American Society of Anesthesiologists and American Association of Neurological Surgeons co-lead a coalition of 26 medical specialties and patient organizations representing more than 350,000 physicians and their patients dedicated to repealing IPAB.[39][40] The coalition recently endorsed efforts in the 113th Congress to repeal IPAB.[41]

    Howard Dean, a consultant for Washington, D.C.-based lobbying firm McKenna, Long and Aldridge and former Democratic Governor of Vermont, believes the IPAB will fail to control costs and should be abolished. He opposes the premise of the board, writing in the Wall Street Journal that it is “a health-care rationing body” and that “rate setting—the essential mechanism of the IPAB—has a 40-year track record of failure.”[42]

    Sorry if the math escapes you, but this can only go one way. Despite paying lip service to IPAB not being a rationing board, that is precisely what it is.

    Oh, and Bernie Sanders is promising to deliver Greece. Hence the enthusiastic response to his seductive words. That’s exactly how the Greeks got Greece. The Greeks listened to the words, and ignored the math.

    But the math always wins in the end.

    Steve57 (4c9797)

  53. 35. … And I’m going to continue to believe that your position is completely determined by the fact that the ACA was signed into law by Obama.

    Jonny Scrum-half (95b419) — 7/9/2015 @ 12:06 pm

    Yes, my position always depends on who signs something into law. That’s why I was so thoroughly behind the Comprehensive Immigration Reform Act of 2007. The GOP backed it, and George W. Bush was going to sign it into law. So I remember lobbying my Congressional delegation to get on board with the program and help pass that…

    No. Wait a sec. No, I didn’t. I called my rep and my Senators and asked if they had gone completely off their nut, even thinking about passing that garbage.

    Steve57 (4c9797)

  54. 35. … And I’m going to continue to believe that your position is completely determined by the fact that the ACA was signed into law by Obama.

    Jonny Scrum-half (95b419) — 7/9/2015 @ 12:06 pm

    I’m curious, do you think that’s also why I oppose the new HUD regulation in which the feds have decided they have the power to socially reengineer suburbs from sea to shining sea?

    If that regulation was issued under a GOP President I’d be totally down with that?

    Steve57 (4c9797)

  55. The real problem with most of the OWS idiots is that their internal visualization of “The Rich” was basically formed watching Duck Tales.

    They all think the Rich are Scrooge McDuck with his Money Bin, and, if they could just be more successful than the Beagle Boys at draining that bin, then everything would be more fair and right in the world.

    No, the fact that the Beagle Boys ALWAYS lose does not impinge on their tiny widdle libtard bwains.

    IGotBupkis, "Si tacuisses, philosophus mansisses." (225d0d)

  56. In a very real sense the wealthy and “phylthy rich” are society’s guinea pigs for new and very expensive medical drugs and procedures. The successful drugs and procedures do eventually become cheap and part of the rising water that raises all boats. In a way this is a very “progressive” system in as much as the “poor” benefit disproportionately to the very wealthy by getting formerly expensive heart surgery for reasonable prices at the expense of many very wealthy patients who died while open heart surgery was being developed and perfected on their unfortunate bodies.

    They are rich. They wish to stick their neck out in hopes of prolonging their lives. Why should they be denied? And why should I gripe unless the procedure or drug stays ruinously expensive after it has been well proven to work for the very wealthy? I don’t see a whole lot of that going on. That cuts the drug companies’ profits.

    {^_^}

    JDow (c4e4c5)

  57. “What do you mean you don’t have to pay for it? ”

    Did you read the quote in the post? Medicare will reimburse this now.

    “Government subsidies have caused the prices to skyrocket, so it’s not like you can just save up, unless you’re Bill Gates.”

    There’s other economies were medical care prices have not skyrocketed as here. We should look into how they achieve that.

    nbf (4aae12)


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