Oh, yummy

by the Night Writer

Debate Comes Down to Public Option

I know that people’s thoughts are beginning to turn toward the Thanksgiving table and that there is a temptation to refer to this healthcare bill as a “turkey.” Debating the public option is a stupefying misdirection. The idea that this reform can be made acceptable by simply eliminating the public option is disingenous and dangerous. This legislation is ptomaine with or without the public option.

Removing the public option from the healthcare “reform” bill is the equivalent of removing a fetid piece of lettuce from a crap sandwich.

And then telling us the crap sandwich is yams.

At least Mary Landrieu got some Cool Whip.

I STILL don’t want to go on the cart

by the Night Writer

Okay, I’ve done this I Don’t Want to Go On The Cart post before and received some pretty interesting responses (and about 90% of the spam captured by my Akismet plug-in is aimed at that post). Now, via James Taranto and the Lumberjack, more tales of the “undead” just in time for Halloween:

Daughter saves mother, 80, left by doctors to starve
AN 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened.

   Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

   Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

   Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.

   Ball, 42, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

   Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.

   Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

   On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

   Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

   Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

   A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

   In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients.

   Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said: “When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed.

   “It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

   Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered. !

Three percent of patients placed on the plan recovered…but they were very hungry!

Doctor, Doctor, give me the news

by the Night Writer

Congressional and other townhall defenders of the nationalized healthcare proposals — collectively lumped as “Obamacare” — are quick to deny that rationing of healthcare is intrinsic in the proposals, or that the old and the very young are at risk from a sliding scale prioritizing who receives care. While no politician is likely to put his or her name on such a specific plan, in practice the implementation of such a bill will be up to the political appointees and advisors who will create the regulations that set the directives and protocols. People such as Dr. Ezekiel Emanuel, health adviser to President Barack Obama, health-policy adviser at the Office of Management and Budget, member of the Federal Council on Comparative Effectiveness Research and brother of WH Chief of Staff Rahm Emanuel.

In an opinion piece in today’s Wall Street Journal, Betsy McCaughey describes Dr. Emanuel as President Obama’s Health Rationer-in-Chief and, rather than putting words into the good doctor’s mouth, uses his own copious writings (with citations) to demonstrate his disdain for the bothersome Hippocratic Oath and his stated views on properly prioritizing care for those of most use to the “polity”:

True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care: “Medical school education and post graduate education emphasize thoroughness,” he writes. “This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath’s admonition to ‘use my power to help the sick to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of cost or effect on others.”

… the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: “Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.” (Hastings Center Report, November-December, 1996)

So, “Citizen”, as long as you are lucid, or still have a chance to contribute, you’ve got a chance. Start drooling, however, and the tax dollars you’ve paid in over the years might get your sheets changed on a regular basis. (Say, I wonder if one’s active – but politically incorrect – participation in public deliberations could be judged by government experts as a form of dementia?) But never fear, Dr. Emanuel wants to save the maximum number of lives, as long as they’re the right lives…

In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a “complete lives system” for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. “One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

“However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear.” In fact, Dr. Emanuel makes a clear choice: “When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated …

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: “Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.”

The youngest are also put at the back of the line: “Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . .

Oh those poor, under-capitalized infants. Actually, that reminds me of a case in Great Britain I once wrote about: Charlotte’s Web: When the State Decides if Your Baby Shall Live or Die.

Of course, the “20-year-old that might live another 60 years” would then be 80-years-old, assuming he didn’t lose his ability to participate in public discourse when he was 70 and the national health service didn’t decide to write-off it’s “investment” at that point. And let’s not overlook this contribution to the public discourse from Dr. Emanuel:

Dr. Emanuel’s assessment of American medical care is summed up in a Nov. 23, 2008, Washington Post op-ed he co-authored: “The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed nations on virtually every health statistic you can name.”

This is untrue, though sadly it’s parroted at town-hall meetings across the country. Moreover, it’s an odd factual error coming from an oncologist. According to an August 2009 report from the National Bureau of Economic Research, patients diagnosed with cancer in the U.S. have a better chance of surviving the disease than anywhere else. The World Health Organization also rates the U.S. No. 1 out of 191 countries for responsiveness to the needs and choices of the individual patient. That attention to the individual is imperiled by Dr. Emanuel’s views.

There’s a lot more so read the whole thing, especially if you want to have the direct quotes and citations handy.

HT: Amy Ridenour’s National Center blog.

I wish we could all be “so Mayo”

by the Night Writer

Tuesday I spent a chunk of the day down in Rochester at the Mayo Clinic (actually, St. Mary’s Hospital, part of the Mayo complex) while my father’s brother was undergoing an aortic-valve replacement, the same operation my father had in 2005.

It was my first visit to the Mayo campus and the time spent waiting with my aunt and cousins for word on the results of the operation allowed me to ruminate on being in one of the foremost medical centers in the world, the current debate on healthcare “reform” and, of course, on family ties.

One, I’ve never been in a hospital as pleasant as Mayo-St. Mary’s, at least in the parts where I went. The halls were quiet, the waiting room was comfortable, we even had free wi-fi … and nowhere did I encounter that institutional, disinfectant smell that had been such a part of my life a couple of years ago. Even parking was easy; I pulled into an underground lot in front of the hospital, took the elevator to the lobby and a second elevator to the fifth floor and walked to the family waiting room as easily as going to my office. Actually, it was even easier because I didn’t have to go through two security doors, nor did I dodge gurneys and masked orderlies in the halls, or have to work my way around the vortex of a nurses station as I commonly did when my father had his valve replacement or later when he was fighting lymphoma. He had had great care from one of the top guys in the business with his heart surgery at Barnes Hospital in St. Louis, but we were never entirely confident that he was getting the best or most appropriate treatment with his cancer, first at the regional hospital and later in St. Louis. Now, however, I was at the Mayo and my uncle was getting first class care in a setting where we were being treated as customers, almost as if my uncle was someone rich and important like the sheiks that fly into Rochester and the Mayo for their care.

My uncle is important to us, but maybe not so much to the rest of the world, however. He’s a retired rural mail carrier and, hence, a retired federal employee so he has great insurance that apparently covers him traveling 550 miles to get his surgery at the Mayo. Even though he’s well into his 70s and had triple-bypass surgery several years ago after a heart-attack, he didn’t have to go in front of a review board to determine if his quality of life was justified.

To tell you the truth, I have strong but mixed emotions about the healthcare debate that is raging in the U.S. right now (as regular readers already know). I believe very strongly that our current system desperately needs reform, but I believe even more strongly that the plans that are being proposed – in one form of single-payer, nationalized health insurance or another – is the exact opposite way that we should be going. I feel that the chances are good that this will be turned away (this time, anyway) but I’m discouraged that the result will be status quo, which is still unacceptable, and that there will be no stomach left for the good fight to bring about real, market-based reform. Neither the current system or “Obamacare” would affect my uncle: his union and federal coverage would likely still be affect under “Obamacare”, just as it is now. Whether I and other non-federal, non-union folks should be so fortunate is another matter that’s part of the debate.

As I sat with this part of my extended family there was talk of the “Stewart Curse”: my grandfather had died after a series of heart attacks, my father’s oldest brother had died of a heart attack, both of his other brothers had had heart attacks, and there were now two valve replacements in the family history. In addition, my younger brother will need a similar operation, likely in the next two years, and one of my cousins has already had two stents put in. I’m not too concerned for myself, as the risk factors aren’t present in me: my blood pressure is low, my “bad” cholesterol is very low and my “good” cholesterol is, well, “good” and we know my valves are in fine shape, thanks to a little scare a few years back that turned out to be nothing (except a confirmation of market principles). I do have a bit of stress in my life, but I also have resources for dealing with this.

It should be noted that the Mayo is doing very well under the present system, but it is a credible (if so far largely ignored by the administration) voice for reforming this system. In fact, they have long-since used their experience to make a series of proposals on how to go about doing this, including bringing the market incentives back into the insurance equation — not as a way to increase profits, but to improve healthy outcomes. Right now the only way a health plan or a hospital can improve its bottom line is to “save” money by denying care; a nationalized program would further degrade the system into a lowest-common-denominator approach that rations care. In a fair system, such as the Mayo advocates, where insurers and providers compete for the public’s dollars and confidence (the real “public option” in my opinion) there are rewards for innovation, successful outcomes and a culture of excellence. I hope we all live to see it.

(P.S. My uncle came through his surgery in fine fashion, complete with a new aortic valve that is an advanced hybrid that wasn’t available just four years ago when my father had his surgery. Let’s hear it for progress and innovation — and great skill!)