Despite all the problems of our healthcare system, as described yesterday, I still prefer it to the British system where the government decides when you’ve had enough healthcare and ought to just die. Since I’m leaving for England tomorrow, I hope I don’t come down with a light case of persistent vegetative state in the next three weeks.

As was earlier reported:

21st CENTURY BRITISH HEALTHCARE
(Monty Python and the Holy Grail, Scene 2)
CART MASTER: Bring out your dead!
CUSTOMER: Here’s one.
CART MASTER: Ninepence.
DEAD PERSON: I’m not dead!
CART MASTER: What?
CUSTOMER: Nothing. Here’s your ninepence.
DEAD PERSON: I’m not dead!

Terminally Ill Can Be Starved to Death, UK Court Rules
By Nicola Brent, CNSNews.com Correspondent, August 02, 2005(CNSNews.com) – An appeal court has denied a terminally ill British man the assurance that his wish not to be starved to death once he becomes incapacitated will be respected to the end.

Former mailman Leslie Burke, 45, has a progressively degenerative disease that although leaving him fully conscious, will eventually rob him of the ability to swallow and communicate.

He petitioned the High Court last year to ensure that he would not be denied food and water once he was no longer able to articulate his wishes.

CART MASTER: ‘Ere. He says he’s not dead!
CUSTOMER: Yes, he is.
DEAD PERSON: I’m not!
CART MASTER: He isn’t?
CUSTOMER: Well, he will be soon. He’s very ill.
DEAD PERSON: I’m getting better!
CUSTOMER: No, you’re not. You’ll be stone dead in a moment.

Burke won that right when judge James Munby ruled that if a patient was mentally competent — or if incapacitated, had made an advance request for treatment — then doctors were bound to provide artificial nutrition or hydration (ANH).

But last May, the General Medical Council (GMC) — the medical licensing authority — took the case to the Appeal Court, arguing that doctors had been placed “in an impossibly difficult position.”

The appeal judges have now agreed, overturning the High Court judgment and upholding GMC guidelines on how to treat incapacitated patients.

CART MASTER: Oh, I can’t take him like that. It’s against regulations.
DEAD PERSON: I don’t want to go on the cart!
CUSTOMER: Oh, don’t be such a baby.
CART MASTER: I can’t take him.
DEAD PERSON: I feel fine!

Those guidelines give doctors the final say in whether a patient should be given life-sustaining “treatment,” a term legally defined to include artificial feeding or hydration.

The latest ruling obliges doctors to provide life-prolonging treatment if a terminally ill and mentally competent patient asks for it.

However, once a patient is no longer able to express his or her wishes or is mentally incapacitated, doctors can withdraw treatment, including ANH, if they consider it to be causing suffering or “overly burdensome.”

Ultimately, the court said, a patient cannot demand treatment the doctor considers to be “adverse to the patient’s clinical needs.”

CUSTOMER: Well, do us a favour.
CART MASTER: I can’t.
CUSTOMER: Well, can you hang around a couple of minutes? He won’t be long.
CART MASTER: No, I’ve got to go to the Robinsons’. They’ve lost nine today.
CUSTOMER: Well, when’s your next round?
CART MASTER: Thursday.
DEAD PERSON: I think I’ll go for a walk.

Anti-euthanasia campaigner and author Wesley Smith told Cybercast News Service it was important Burke had taken the case to court because “it is now clear that a patient who can communicate desires cannot have food and water withdrawn.

“That is a line in the sand that is helpful.”

However, he added, the judgment had “cast aside” those who were mentally incompetent or unable to communicate their wishes — “those who bioethicists call non-persons because of incompetence or incommunicability.

“I believe that the judgment clearly implies that the lives of the competent are worth more than the lives of the incompetent since doctors can decide to end life-sustaining medical care, including ANH,” said Smith, a senior fellow at the Discovery Institute and author of Culture of Death: The Assault on Medical Ethics in America.

Burke was quoted as saying in reaction to the ruling that it held “no good news at all” for people who shared his concerns.

In the light of public health service cuts and underfunding, Burke said he was worried about “the decisions that will have to be made” by doctors in the future.

“I have come to realize that there are quite a few people who feel the same way I do,” the Yorkshire Post quoted him as saying. “Not everyone wants to be put down. Not everyone wants their life to be ended prematurely.”

CUSTOMER: You’re not fooling anyone, you know. (To the Cart Master:)Look. Isn’t there something you can do?
DEAD PERSON: [singing] I feel happy. I feel happy.
[Cart Master hits him in the head.]

Responding to the court’s ruling, the GMC said it should reassure patients.

The council’s guidelines made it clear “that patients should never be discriminated against on the grounds of disability,” said GMC President Prof. Graeme Catto in a statement.

“We have always said that causing patients to die from starvation and dehydration is absolutely unacceptable practice and unlawful.”

A professor of palliative medicine at Cardiff University, Baroness Ilora Finlay, supported the court ruling. “Stopping futile interventions allows natural death to occur peacefully,” she argued in a British daily newspaper. “This is not euthanasia by the back door.”

But the Disability Rights Commission (DRC) took a different view.

The commission was one of several campaigners, including right-to-life activists and patients’ groups, which had strongly supported Munby’s earlier ruling.

DRC Chairman Bert Massie expressed the group’s dismay at the Appeal Court decision, saying it did nothing to dispel the fears of many disabled people that “some doctors make negative, stereotypical assumptions about their quality of life.”

It had also “totally ignored” the rights of those who were unable to express their wishes, he added.

CUSTOMER: Ah, thanks very much.
CART MASTER: Not at all. See you on Thursday.

The Night Writer’s vote for the funniest line: “Ultimately, the court said, a patient cannot demand treatment the doctor considers to be ‘adverse to the patient’s clinical needs.'” You mean, such as, “Please don’t starve me to death?”

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Tuesday I was shuttling around the Garden State with the complimentary copy of USA Today from my hotel to fill the time between Oldwick and Hoboken. I was thinking something like, “Hmmm, news printed on paper – what a concept!” when I saw an article describing the challenges of trying to introduce competitive, market-driven shopping to our current health care system. I thought it was a particularly profound and insightful article, especially since I had covered the same thing here eight months ago:

Seen any coupons for cardiologists?

“Hello, this is ABC Cardiology. How may I help you?”

“Yeah, I’m looking to have a little work done, and I’m calling around to find out what it costs to see one of your doctors and have a couple of tests?”

“What kind of tests?”

“Oh, you know, EKG, stress test, enzyme test, whatever it is you folks do to figure out if something’s wrong with the old ticker.”

“Um, I don’t know what that costs. Let me transfer you.”

“Ok.”

“Hello, Coding Department.”

“Yeah, could you please tell me how much a visit with one of your cardiologists costs, and what kind of tests I might expect and how much they cost?”

“Well, I’m not sure I can tell you…”

“Look, it’s like this. I’m thinking it might be a good idea to have someone take a look at me, but I have a high deductible health plan so that means I’m paying for most, if not all, of any visit out of my own pocket and I’m just calling around trying to get some prices for a comparison.”

“Well, let’s see…a consultation is $334 to $432, depending on the amount of time spent.”

“Yow! Is there anyone in town who charges less?”

“No, that’s pretty much the standard Usual, Customary and Reasonable cost accepted by the health plans.”

“So, uh, do you have any coupons or specials this week?”

(Read the rest…)

The above is a composite of the discussions I’ve had recently as I try to follow up after my ultimately innocuous visit to the ER recently. I’m taking this approach for two reasons.

One is that my wife and I opted for a high deductible health plan through my employer this year because the increase in premiums for our family’s coverage through an HMO was too high. My employer was offering for the first time a plan with lower premiums but with much higher out of pocket costs; the plan is ideally suited to be used in conjunction with a Health Savings Account (HSA), which is similar to an IRA for health costs.

The second reason is that I have more than a passing familiarity with the U.S. healthcare industry as a result of my job and I believe the current third-party payer model, like that found in your employee benefits, is the fundamental reason for the virtually uncontrolled costs of our current environment. The only efficient way to control costs and provide greater access to all consumers is to return to a direct pay of health insurance that puts the individual or family back in charge of determining how the money gets spent – just like they do for everything else that is bought and sold in this country from deodorant to houses. As King or Phil would say, “markets work.”

The approach my wife and opted for is a step in this direction because, in exchange for monthly premiums a couple hundred dollars less than the HMO plan, we’re responsible for the first few thousand dollars or so of our care before the insurance kicks in (a tax-deferred HSA is an important part of this program because this is where you can accumulate and hold the funds to cover your out-of-pocket costs). Theoretically this means I can “shop” for the healthcare that fits my needs and/or budget, just as I might shop for an oil change or new home entertainment system.

The problem is that the U.S. healthcare system is still so indoctrinated into the third-party format that it is hard to bring market forces to bear individually as my vignette above illustrates. It is not presently set up to compete on price, and the suggestion that doctors or clinics might have to do so is greeted by the same slack-jawed incredulity that certain Minnesota judges have expressed now that they actually have to campaign for positions. The world is changing and the healthcare system – and the judges – will learn to adjust.

Some might argue that, as inefficient as our current system might be, it has allowed some very high-tech, life-saving technology to be created and that introducing price competition might diminish this. It seems to me, however, that price competition hasn’t kept the computer industry from leaping ahead with ever-faster, ever-smaller computers and accessories such as iPods, or slowed the development of market-driven, market-demanded goods such as high definition televisions or computer game consoles with more computational power than the Apollo spacecraft.

Switching to a direct-pay health insurance model will be dramatically different than what we’ve become used to over the last 70 years. That doesn’t mean it will be unfamiliar though.

To better illustrate, in an amusing way, how downright stupid and impractical our current model is I highly recommend you read this article from Joseph Bast at the Heartland Institute, entitled “What Hunger Insurance Could Teach Us About Health Insurance.” Here’s an excerpt:

To understand what lies at the heart of the failure of our current health-care financing system, imagine, if you can, what the world would be like if we tried to buy food the same way we buy health-care services.

You could go to work tomorrow morning and hear your boss tell you the following: The company has decided to offer a new benefit: hunger insurance. The company will purchase a hunger insurance policy for you that covers about 95 percent of your food costs whenever you enter a grocery store or restaurant, and a smaller share of the miscellaneous snacks and condiments you purchase from street vendors and the corner drugstore. To pay for the new benefit, the company will withhold some of your pay—about $100 a week or so.

Effect on Consumers
What effect would hunger insurance have on you, a consumer of food? If you’re like me, you will probably start to eat more . . . and eat better, more expensive foods. Why eat hamburger when you can have tenderloin? Why settle for beer when the finest wines cost you just as little? Why eat at McDonald’s when you can eat, for nearly the same price, at Chez Paul?

If there were such a thing as hunger insurance, some of us would stop checking prices before we ordered food, just as we don’t check prices when we ask for medical treatment. Some of us would order fancy and expensive foods that we wouldn’t order if we really had to balance the price against the improved taste . . . just as we order unnecessary and expensive tests to get just a little more peace of mind.

And if there were hunger insurance, some of us would overeat until we were so round and fat that our health was endangered, just as we see millions of people in America asking for and receiving unnecessary surgery and medication that actually endangers their health.

Effect on Providers
What effect would hunger insurance have on the providers of food? Put yourself in the shoes of a grocery store manager. You would start stocking more caviar and less Cheese Whiz, wouldn’t you? Rather than lose customers to fancier (and more expensive) establishments, you would carpet your aisles, hang chandeliers in the lobbies, and have distinguished-looking fellows with white gloves push people’s carts down the aisles!

Every grocery store would offer an impressive array of products, from the very finest meat department to the best stocked liquor counter (providing state law allowed it). That the store next door has the same expensive freezers and wine cellar matters not at all: Cost, you understand, is no object. “Overinvesting in new technology,” you ask? Hey, the insurance company pays for it all! And if we don’t offer it, customers will cross the street and shop there.. You know you would.

What if you were a lousy grocery store manager who just couldn’t keep costs down and quality up? Before hunger insurance came along, you would be forced out of the market by stores managed by sharper people able to cut costs without sacrificing quality. Customers wouldn’t patronize your establishment, and you’d be out of business. But with hunger insurance, you can pass along your higher costs to the insurer, so the customer never knows how inefficient you are! So you get to stay in business despite your inefficiencies. Out of gratitude, you may even spend a little money lobbying to make sure hunger insurance is always available!

If there were such a thing as hunger insurance, the price of food would begin to soar, just as the price of health services has steadily risen faster than the price of other goods and services. Financed by hunger insurance companies, grocers and restaurateurs would sell more food and of a fancier variety than if they faced customers who paid with their own money, just as health-care practitioners today are free to overtreat and overprescribe. Food sellers would over-invest in expensive and under-utilized equipment and pass the cost along to the insurers, just as hospital administrators today buy too many MRIs and CAT scanners and pass along the expense to health insurers. And inefficient, low-quality providers of food would stay in business rather than be forced out by better competitors, just as high-cost providers of health care are tolerated in today’s health-care marketplace.

Effect on Insurers
What would happen to insurers if hunger insurance were provided? The premiums they charged at first were based on past levels of food consumption and prices. As consumption expands and prices rise, insurers have to raise their premiums again and again. The exploding number of insurance claims buries them in paperwork. The businesses that pay the insurance premiums will, of course, be outraged by all this. “Find a way to control these rising costs !” they will demand. “The rising cost of hunger insurance is making us less competitive with businesses in other countries!”

The insurers will hire an army of “managed-eating” experts who will search the grocery bags of the insured for signs of unnecessary products, just as today’s health insurers have hired experts in “managed care” to review health services utilization. People will resent this intrusion into their personal dietary habits, just as they resent the managed care experts second-guessing their health concerns. People with hunger insurance will find ingenious ways to avoid the managed-eating experts, and the eventual results will be higher, not lower spending . . . just as businesses with managed-care programs today are discovering.

Effect on the Uninsured
Some people in our imaginary world will be uninsured: They won’t have hunger insurance because their employers are too small to afford to offer this new benefit, or because they are self- employed or unemployed. Or, in their effort to control costs and make money, some hunger insurers will refuse to cover people who are high food-risks—the hoarders, the people with exceptionally delicate palates, and the bulimics. They will offer cheaper rates to others: beer-drinking football fans, people who can’t smell, and anorexics.

The uninsured will be hurt the most by hunger insurance because they will see the price of food bid up and out of reach by those lucky enough to have hunger insurance. The foods that were once plentiful and inexpensive will now be unavailable or high-priced, just as health insurance has replaced inexpensive general practitioners with expensive specialists, and inexpensive but slow-working therapies with expensive but quick surgical procedures.

Those who lack hunger insurance will be seen standing with their noses pressed to the windows of our beautifully carpeted and chandelier-lit grocery stores and restaurants, just as millions of Americans today crowd the emergency rooms of state-of-the-art hospitals whose beds are between one-third and one-quarter empty.

Effect on Elected Officials
What would happen to our elected officials if hunger insurance existed? Civil rights activists and well-meaning people without much understanding of economics would campaign against for-profit hunger insurers, denouncing them for being heartless in their discrimination against people with eating disorders. They would condemn them for profiting from the provision of something so fundamental to human life as food. “Food is a right, not a privilege,” they would say. “The high administrative costs of the hunger insurers are what is causing the problem. We should abolish private hunger insurance companies and replace them with a single provider of food.”

And since experience will have so convincingly shown that the current hunger insurance system is inefficient and unjust, our enlightened elected officials would eventually yield to the public’s demands and pass “play or pay,” forcing businesses to buy hunger insurance for all their employees, or “national hunger insurance,” where government acts as the single payer of all hunger insurance claims.

The nation will face a difficult choice: Either abandon the idea that all food should be paid for by hunger insurance, or impose draconian rationing measures, price controls, and restrictions on new investments in food processing and delivery technologies. If we can judge by what is happening today in the health-care arena, the advocates of rationing will dominate the debate.

Commissions will spring up everywhere to determine whether a carrot is more valuable to the community’s welfare than a grape, and a grape more valuable than a banana; just as commissions are being created at this very moment to decide whether capping 1,000 teeth is “worth more” than extending a person’s life for one week by kidney dialysis. The issue will be addressed as if justice and virtue, rather than economics and incentives, were at the heart of the issue.

(hide)

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I wish I could catch Barry Bonds’ 715th homerun … so I could THROW IT BACK!

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The countdown to leaving the country is winding down and things are being steadily crossed off my list. But first, I have to get out of New Jersey, where I’m currently on a business trip. Things can sure get complicated at times. It almost makes me wish for those simpler, carefree days of high school (right kids?).

Actually, life was plenty complicated for me back then, too. That said, I think things are even tougher for kids today — a point the following post examined last August:

A hard lesson

“This is the beginning of a much more in-depth education program, in which we tell our members why and what Wal-Mart does — not just to small towns, but to workers,” said Louise Sundin, president of the Minneapolis Federation of Teachers. (Strib: Twin Cities teachers unions push Wal-Mart boycott)

Honest, Mom, I wasn’t doing anything. I was sitting in my American History class and Ms. Wolverton was talking about the founding fathers, and when she got through telling us about the first president — Samuel Gompers of the American Federation of Labor, that is, so you know I was paying attention — she told us to take out our Diversity Journals and write about what it would feel like to be beat up by cops employed by fatcat capitalists and to not have health insurance besides.

So I was opening up my backpack when it slipped – honest! – and everything spilled out on the floor. Well, not everything, because I was able to catch my iPod, you know, and then the Wolf, I mean, Ms. Wolverton points at the floor next to me and says, really mean-like, “What’s that?”

Well, I look down and I say, “Nothing Ms. Wolverton, that’s just the condoms they gave us in third period today.”

“No,” she says, “What’s that?”

Then I say, “You mean this flyer about what time Tuesday morning we’re to catch the school bus to take us to the state capital to protest for higher education spending?”

“No!” she says, and now she’s really mad. “That looks like one of the new Trapper Keepers that Wal-Mart is advertising in the newspaper! How dare you bring something like that to school?”

“Hey, it’s not mine,” I said. “Someone must have stuck that in there just to get me in trouble, probably during Conflict-Resolution class!” Really, Mom, that Billy Swedberg is sooo passive-aggressive.

So anyway, now Ms. Wolverton is all, “shopping at Wal-Mart is the first step to economic servitude, and how buying a Trapper Keeper seems innocent enough now but, like, the next thing you know I’ll be listening to talk radio and voting Republican,” you know? Then she says something like, “someday when you’re working 70 hours a week for $1 you’ll wish you’d paid more attention in class.” Well, I didn’t really know what to say to that, but she gave me the idea, so I said, “I’m sorry, my ADD is acting up – what was the question again?”

Well, that seemed to calm her down and I thought it was all going to blow over when she says, “I don’t know what people are looking for when they go into a den of iniquity and social injustice like Wal-Mart.”

OK, Mom, I knooow I should have kept my mouth shut, but I wasn’t really thinking because I was still so nervous, so I said, “Good values?” And that’s when she went ballistic and told me I knew I wasn’t allowed to use that kind of language in school and that I had to go to the principal’s office and they were going to call you to come and get me.

So, am I in trouble?

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Regular readers know that my wife and I take a dim view of dating, which is a topic that’s been addressed here several times. It’s nothing personal we have against any young men in particular who are in the vicinity or who might even arrive on the scene, but a belief that there is a better way and a desire for our daughters to approach things in ways that will lead to greater happiness.

Of course, if a guy shows up without an appreciation for the things we hold dear (especially our daughters), well, it could get personal real quick. Our philosophy isn’t all that complicated, but it does take some explaining, as illustrated by the medley of posts below.

While I haven’t kept a hard count, the first “best of” post below is without a doubt the most read and linked to post I’ve ever had. A year after it appeared I still get half a dozen visitors a week who have Googled their way to it, many from as far away as the Philippines, South America and even Saudi Arabia.

For a more light-hearted look at the situation, check out the following application I discovered (but didn’t write):

So how is this working? Well, despite my best efforts, a conspiracy was hatched and my oldest daughter ended up going to the Prom last spring. It’s quite a story of passion, betrayal, boys — and me wielding a bloody butcher knife:

Finally, let it be known that Faith, aka The Mall Diva, and I went to a gun show at the State Fairgrounds a couple of weeks ago. It was amazing – a huge room full of thousands of guns and hundreds of people and NO ONE GOT KILLED! Hard to believe, but not a single gun leapt up off of the table and attacked someone. Anyway, the always fashion-conscious Diva found a special edition Taurus .22 caliber with pearlescent handgrips that matched her purse.

I know what you’re thinking, punk. Did she really buy it? Well, considering everything else that’s been written here, I guess you really ought to be asking yourself one question: “Do I feel lucky?”

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My daughters are an important part of this blog, not only as sources of inspiration but also as writing sources themselves (check out the Mall Diva and Tiger Lilly categories on the right). They’ve changed a lot since the time the photo described below was taken, and even since I wrote this essay.

A lot of things are still the same, though.

Dad to the Bone
Every parent either knows – or feels – by heart the words to the “Sunrise, Sunset” song in “Fiddler on the Roof”:

Is this the little girl I carried,
is this the little boy at play?

When I hear this the memory that flashes in my mind is not that of carrying either of my two daughters up to bed, or of piggyback rides. Instead I think of a family photo a few years ago. In it my girls – then about 10 and 5 – and I have been wrestling. I am standing and in each hand I’ve got an ankle of one of the girls and I’m holding them both upside down and off the ground, not unlike a proud poulterer holding up a couple of prizewinners at the State Fair. Imagining the picture now I can still hear the shrieks and giggles.

At this point in their lives – and for this moment now permanently frozen on film – I am Dad the Undefeated and, in their eyes, larger than life. Meanwhile, in the moments that I write this, the next line from that song is passing through my mind: “I don’t remember getting older, when did they?” If asked to reenact the scene today my response would have to be, “One at a time.”

As I flip through my mental photo album the girls seem to grow suddenly in a series of jerks and jumps. Of course I know they are really changing everyday, judging by the continuous trips to the shoe store and cries of, “But I just bought you those pants!” I also can’t help noticing in this album that as they are getting bigger, I seem to be getting – perhaps ever-so-slightly – smaller.

Once when my oldest was very little and concerned that we might be imminently attacked by bears in our own front yard, she was greatly comforted when I assured her that if any bears came near her I’d grab them and twist their noses. Today the same promise still stands regarding boys, not bears, but it’s clear that my powers are coming more into perspective. While there are times when it may seem, in my daughters’ eyes, that I can still rise up and blot out the sun, I cannot stop it from moving across the sky. I am shade, however, standing between them and the heat of the world. I will continue to do so as long as I can stand.

Of course, brute force has always been of limited application. To be a proper protector my defenses have had to be – and must remain – more subtle. Jesus once told his disciples that it was better for them that he go away. His meaning was that his power both in their lives and in the world would ultimately be much greater by his living in them rather than with them. I don’t construe this to mean my girls are better off without me, but rather that I must devote my time with them to preparing them to live on fruitfully, just as Jesus did in his three years with the disciples. The time together already seems all too short.

When they were little, their well-being depended on instant obedience to my authority and that of their mother. It was not expected or accepted of them to ponder whether or not we meant what we said or whether our instructions supported their personhood or hurt their self-esteem. “No,” “stop” and “don’t” could keep them from a boiling pot, a busy street or a strange dog. As they get older they are still at risk from natural forces, careless strangers and unpredictable human animals interested only in their own gratification. “No,” “stop” and “don’t” might still have an effect, but it’s better to teach them the underlying reasons and standards for moral conduct so they can also work out the “Yeses,” “do’s” and “go-for-its.” In that way my influence can carry on a lot further than my authority will ever be able to.

For my influence to be effective, however, I have to keep learning and examining myself both for my own benefit as well as theirs. Like it or not, my life will be a standard that my daughters will use to judge men on in the future and I want to set the bar pretty high with no apologies to the young fellas coming along. Perfect or not, it is mine to carry. On one level my girls may see me as “Dad of Dads, Keeper of the Remote and King of Rude Noises,” but they should also know at a deeper level that I have laid and will lay down my life for them. As they grow older I hope that they will not settle for any man who will not do the same, even though the kind interested only in the “lay down” part may be all too common.

If you have daughters I think you know what I mean, and I hope you, too, are preparing yourself and them to live by your influence and that of Jesus while submitting to the authority of God. If you have sons, I pray that you are preparing them to a similar standard and helping them grow into their own responsibilities.

And if you have sons that may be hanging around my daughters, you might want to warn them about that nose thing.

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