June 15, 2009

"You'd think the case for 'choice' at the end of life might be stronger..."

"... since the life at stake is likely to be able to participate in making that choice."

Writes Mickey Kaus, fretting about the end-of-life decisions the government may very well take over for us under ObamaCare.

Now, as you may know, the Supreme Court denied the existence of a federal constitutional right to physician-assisted suicide, but the opinion (by Chief Justice Rehnquist) shows deep concern for the interests of the individual who might suffer from untreated depression or who might be vulnerable to "abuse, neglect, and mistakes." The Court worried that family and medical personnel might subtly pressure someone to choose death to save money, and that, even uncoerced, some people might think it is the decent, honorable choice to spare their families the cost of medical care.

But all of that supports Kaus's point. It's one thing to deny the choice to die, quite another to deny the choice to live. The individual may not have a right to get killed, because the state's interest in protecting people from coercion and abuse is a good one. But Kaus is concerned about a government that wants you dead — perhaps not by actively offing you, but by maintaining full control over the medical treatments you need in order to fend off death.

106 comments:

NKVD said...

I suspect that ere long many will see death a superior alternative to living under the thumb of Obama.

DKWalser said...

Didn't a governor of some western state suggest it was the duty of the elderly to get out of the way and die (or words to that effect)? (Yes, it was the Governor of the great state of Colorado. His name, and party, eludes me at the moment.) The thought that the government might decide to enforce this "duty" by withholding health care from the elderly scares me. I think government control of health care will inevitably lead to managing costs through the "killing off" of the elderly.

Brent said...

But Kaus is concerned about a government that wants you dead — perhaps not by actively offing you, but by maintaining full control over the medical treatments you need in order to fend off death.

Is there anyone - ANYONE - who believes that such a thing will not begin to happen at some point? It's already happened in the Netherlands to 2 of my relatives.


I'm a believer in capital punishment. But I cringe at the value system of those who in their advocacy of capital punishment use the "cost benefit analysis" argument: "keeping a convicted murderer alive just costs more money."

If your value system allows to you think that, it's a short stretch to who gets to decide the cost benefit analysis for you.

AlmaGarret said...

This topic is close to my heart as my father died just one month ago. My father was like most people I know who very robustly proclaimed, when healthy, "I don't want any heroic measures to keep me alive!". Certainly my brothers and I, watching our dad waste away to less than 100 pounds, could not imagine why anyone would want to survive in that state for long.

But guess what? You just don't know how you will feel when you get to that point. Just two months ago, while visiting the kidney doctor, my father was specifically asked by the doctor, "do you want to live?" My father emphatically said yes. (This question had to do with the issue of kidney dialysis.) Why did my father want to live given his weakened condition? He wanted to take care of my mother (who has dementia).

My point is that it is easy for us baby boomers to endlessly jawbone this need to control the uncontrollable: birth (birthing plans, anyone?), the lives of our children, and death. But I'll be damned if I'm going to let the government make that decision! Are there people who are so afraid of these issues that they prefer to let Big Brother decide?

rhhardin said...

I don't see a problem provided you can get any treatment you want if you can pay for it yourself.

If you grant that, you might phase out the public system a bit at a time, until it denies every treatment for everything.

Then you'd have a functioning medical system.

Bob_R said...

Well, the law of comparative advantage says that an economic entity should stick to doing what it does best. Large governments are very good at killing people. Don't be surprised if they end up doing that in every endeavor they undertake. "Green" (and bloody red) cars today. Pull the plug health care tomorrow.

Toby said...

Am I the only one who thinks this fear might be a bit misplaced? Old people vote. They'll likely vote out politicians whose policies don't result in investments in life extension research, care of the infirm, etc. Isn't there a greater possibility that the AARP crowd will in effect steal healthcare dollars away from children, who don't vote?

We have a soft precedence for this in those Sun City retirement communities and the like, which often vote down bond measures to support the construction of new schools and libraries. There's no inter-generational pact in those places, to be sure.

Roost on the Moon said...

"I don't see a problem provided you can get any treatment you want if you can pay for it yourself."

Exactly. Weird fearmongering from Althouse.

"...by maintaining full control over the medical treatments you need in order to fend off death."

This is tin-foil hat stuff. Full control?! Are they going to send all the doctors to FEMA's concentration camps?

traditionalguy said...

The recent rise in the number of Americans now saying that they are against all government sponsored abortion on demand is connected to their realization that Protecting Life for the unwanted and weak IS a proper government role.The extermination industry active at either end of peoples birth onto the earth and a final spiritual trip elsewhere, is not a friend. Death is the enemy.

paul a'barge said...

[blockquote]...shows deep concern...[/blockquote]

arrggghhhhh .... it's the empathy case, all over again!

Jason (the commenter) said...

Toby : Am I the only one who thinks this fear might be a bit misplaced? Old people vote.

They have old people in Europe, yet their health care system favors the young. Once you start rationing healthcare (socialized medicine) it's almost impossible for bureaucrats to decide to give treatment to people who will soon die of old age.

DKWalser said...

Am I the only one who thinks this fear might be a bit misplaced? Old people vote. They'll likely vote out politicians whose policies don't result in investments in life extension research, care of the infirm, etc. Isn't there a greater possibility that the AARP crowd will in effect steal healthcare dollars away from children, who don't vote?

To some extent this will happen. However, in liberal democracies with socialized medicine, such as Canada and GB, we've seen some blanket prohibitions on certain treatments based solely on age. Say, for example, if you're over age 65 and diagnosed with breast cancer you're ineligible for radiation therapy. (I've no idea whether or not my specific example is accurate or not. I'm simply trying to convey the the flavor of the restrictions that apply in other countries.) At some point, the treatment is considered not cost effective for someone over a certain age.

Note: This is different than a prohibition of treatment based on the health of an aged person. For example, my father was recently counseled by his doctors NOT to have a hip replacement -- at age 84 they are justifiably concerned he'd not survive the surgery. That's far different from saying he CANNOT have the hip replacement because he'd not get enough benefit from the improved mobility over his few remaining years of life expectancy. I'm in favor of health-based restrictions (decided by patient/doctor). I'm not in favor of government imposed limits on care based on political considerations (no matter how the limits are dressed up as something else).

Maguro said...

Old people vote.

Exactly. And fetuses don't - Hence the disconnect with abortion policy.

Brent said...

This is tin-foil hat stuff.

Except it already happens in parts of the world, as I just told you the reality in my own family.

Idiot.

Bruce Hayden said...

"Didn't a governor of some western state suggest it was the duty of the elderly to get out of the way and die (or words to that effect)? (Yes, it was the Governor of the great state of Colorado. His name, and party, eludes me at the moment.)"

It was Democrat, Dick Lamm, aka "Governor Gloom".

I was at a funeral at our church a year or two ago, and during the services, the pastor asked if anyone wanted to speak up concerning the deceased. A couple did. Then, the guy right in front of me did, and guess who it was? The same. And, 20 years out of office, he still sounds like a politician, speechifying when we all want to get it over with.

Janis Gore said...

I ran into a weird situation last year.

My brother, one of those happy bachelors (wink, wink) reached near death from a rare form of Hodgkins disease that attacked bone marrow first.

After a year or two of misdiagnoses, and a month in the hospital without much improvement, the lead hospitalist told me to prepare for hospice. I told him to keep the transfusions up for enough days for me to bring his other five siblings in to see him.

While a group of us were waiting in a corridor waiting room, his hematologist came in. He was pleased to meet them, but when I explained the presence of siblings he nearly threw a fit. "This is treatable," he said.

Understand, my brother was privately insured on a catastrophic basis to the tune of about $500 a month.

So, my brother spent three or four days with laughing siblings, had a brief lecture on "fight", and is independent today.

Without advocates, even a privately insured patient is at risk. He was 63.

Roost on the Moon said...

"Idiot."

Rationing of medical care happens under private insurance, in the form of policy limits, copays, premiums. The "cost-benefit analysis" that you're so down on gets made every single day, right here in the good ol USA.

Furthermore, nobody is even talking about banning private insurance, let alone banning non-government medical care. Neither of those are even on the table.

This post is crazy. Glenn Beck crazy.

Robert Cook said...

Oh, for heaven's sake! There's not even any such thing as "Obamacare" and fearmongers are already asserting the government will use it to kill old people to save money! Ridiculous!

Where's the outrage over the thousands of people who die each year NOW because they have no access to health care? Where's the outrage NOW over people who become sicker and die because they are denied coverage for expensive treatments by their private insurers? Where's the outrage NOW over people bankrupted due to confiscatory medical expenses?

If more people had ready access to preventive care throughout their lives, perhaps more debilitating illnesses could be prevented or cured before they became more destructive of health and life, thus resulting in a net gain in more people living longer lives.

My beef with Obama--in this particular regard, I have others--is that he WON'T provide us with universal health care, but will preside over an abortion of a compromise that will end up making no one happy other than the parastical private health insurers, and will kill any chance for real reform for years or decades to come.

A few years ago Canadians voted Tommy Douglas the greatest Canadian ever:

http://www.cbc.ca/greatest/

Tommy Douglas is Keifer Sutherland's grandfather, but Canadians did not vote him the greatest Canadian ever because they admire his descendant's fictional brutality on 24, but because, among other things, he laid the groundwork that led to Canada's present universal health care system:

http://www.cbc.ca/greatest/top_ten/nominee/
douglas-tommy.html

http://en.wikipedia.org/wiki/
Tommy_Douglas

Jim said...

So let's recap: first Obama is a secret Muslim, then he's not really an American, then he's coming for the guns, and now...he's going to make you die!

Keep up the crazy talk. It's entertaining.

former law student said...

Writes Mickey Kaus, fretting about the end-of-life decisions the government may very well take over for us under ObamaCare.

Sure the government could reverse 40 years of policy and start rationing health care for sick old people. Probably about the same time they eliminate Social Security in favor of utilizing senior citizens as a food source. (Soylent Green... is Boomers!)

but when I explained the presence of siblings he nearly threw a fit. "This is treatable," he said.

I can't make head nor tail of this story. If I were a hematologist/oncologist presented with five siblings of my patient in this situation, I would immediately have them all tested to see if any was a match. With five full siblings, the probability one is a match is 76%.

former law student said...

Rereading I should correct my post to read "SIX full siblings". The chance that one of them is a perfect bone marrow transplant match goes up to 82%. A hematologist/oncologist should have been positively gleeful at seeing them.

Janis Gore said...

A catastrophic policy might not cover the bone marrow transpant, according to MD Anderson.

And because the patient was responsible for 20% of fees, a $150,000 outpatient expense deposit was required.

Can you lay your hands on that kind of money? I can't.

Janis Gore said...

And, FLS, as it turned out, a selective protocol of chemotherapy did the trick.

He is a Vietnam vet. An Agent Orange kind of guy.

Elliott A said...

I find it laughable that anyone thinks we can reduce costs and prolong lives with more preventive care. Most people of sound mind try to be healthy. There is a large segment of our population, however, who are never going to listen for any reason. We all pay for them. They have diabetes, but weight 450 pounds and consider a half gallon ice cream carton a snack. Did you ever see anyone on a store motorized cart that wasn't grossly overweight? Diabetics refuse to take insulin! There are so many people that have created their disease with little help from their genes. I'm not picking on diabetics, just an area I have first hand knowledge of through my wife's work. This problem extends to a much broader part of our population. People too lazy to exercise, people who smoke, people who abuse drugs, etc. A quote I heard a few weeks ago speaks well to the issue, "I have no problem paying for the helpless, but no desire to pay for the clueless."

former law student said...

And because the patient was responsible for 20% of fees, a $150,000 outpatient expense deposit was required.

Can you lay your hands on that kind of money? I can't.

This is one of the many flaws of traditional private health insurance since it began. "Major medical" traditionally paid at most 80%; more for preferred providers, and less for experimental treatments, which still include bone marrow transplants.

Janis Gore said...

i don't understand what you're trying to get at with that last comment.

First you say, "yea! a match" then, well, best to be able to afford it if you get sick.

I'm only pointing out here that private insurance is no guarantee that cost benefit analysis won't be applied to your case.

former law student said...

This problem extends to a much broader part of our population. People too lazy to exercise, people who smoke, people who abuse drugs, etc

I see Boomers dying in their 50s who have been models of healthful living. A lung cancer victim who never puffed a ciggie. A Hodgkins disease sufferer felled by her third relapse. A family practitioner -- a runner and cyclist -- who got testicular cancer when he was almost 40. The parents of all three were present at their funerals. Could boomers be more fragile than their parents?

Considering my Hodgkin's friend grew up downwind, in St. George, Utah, I'm going to blame atomic and nuclear bomb testing for some of this. I also have a hunch that the postwar spread of organic chemical manufacturing, especially pesticides and herbicides (my mom used the main component of Agent Orange to kill dandelions) accounts for a lot of Boomer health problems.

Janis Gore said...

Perhaps it was always there, FLS, but with our newer habit of measuring everything, and badly, we see more.

I'm not about to say. I'm only 52 and not a creationist.

former law student said...

I'm only pointing out here that private insurance is no guarantee that cost benefit analysis won't be applied to your case.

Private health insurance won't pay enough to make every treatment affordable, nor does the government plan we know as Medicare.

Chemotherapy is the hot setup to cure blood disorders today. Bone marrow transplants are usually saved for cases of relapse. Howevery, the five year survival rate of people over 40 with BMTs is pretty low.

Roost on the Moon said...

Janis and I are making the same point. Under the dystopian ObamaCare scenario, if you are old and dying, maybe the government won't pay for expensive treatment to keep you going.

But that's how it is now, for everybody. That's how it has always been.

The idea that the by offering a public plan, the government would be "maintaining full control over the medical treatments you need" is the craziest thing I've ever read on this blog.

Weird, weird, weird.

Bruce Hayden said...


I see Boomers dying in their 50s who have been models of healthful living. A lung cancer victim who never puffed a ciggie. A Hodgkins disease sufferer felled by her third relapse. A family practitioner -- a runner and cyclist -- who got testicular cancer when he was almost 40. The parents of all three were present at their funerals. Could boomers be more fragile than their parents
?

I seriously doubt it. Rather, you just don't remember all of those in their parents' generation who died early. But they were there. My next door neighbors growing up, both dead at about 50. Father of another friend, dead younger than that, leaving 4 boys for his widow to raise by herself. None of these died by accident, rather they all died from illness.

It is a bit scary to see parents burying their kids, but my parents buried my youngest brother, just 21 and starting his senior year at Dartmouth. And the couple on the other side growing up buried both their kids long before they died.

XWL said...

You can't tell me that all these free love hippie dippie types wouldn't embrace some sort of SOMA type narcotic in their later years.

Just have them sign a waiver, after the age of 70, you're on your own, or the government will provide five years worth of SOMA, and maybe Viagra and prostitutes upon request, and I'm sure plenty of Boomers would willingly hit the death booths at the age of 75 after five solid years of drug fueled orgiastic living (just don't open any boomer-orgy centers near me, like sewage treatment, it's something that has to be done, you just don't want to live by or downwind from it).

The cost savings would be huge, no more retirees living 30 and 40 years on Social Security into their 90s and 100s. Who says Huxley's vision has to be a 'dystopia'?

A Lawyer Mom's Musings said...

Umm, once rationalized -- I mean, socialized, medicine is here, I can only pray this opinion will be revisited. Because, as Ann seems to suggest, "no right to live" is just the other side of the "no right to die" coin.

If it's not your right, it's the government's. Kaus's concerns are well-founded.

To the invincible, young whippersnappers commenting here, so sure "it could never happen"? Many folks, much wiser than you, said a government cramdown and complete reordering of creditors could never happen, either.

It's only precedent until you're the president.

@Roost on the Moon: keep your perch. Have you got any room left for Elliot A?

traditionalguy said...

Roost on the Moon...From your cavalier attitude I have to presume that you have found the way to never become age 65. But do you plan to have children who will one day reach age 65? The game being played here is called "whose ox is getting gored?" But then the freedom to live a full life span is not in the Bill of Rights of Marxist Amerika. I wonder if Palin's care for the life of weak and inconvenient Trig Palin registered in America's subconscious and even now fires up Palin's popular support in a way that Obama's promise of a few trinket dollars more can never beat in an election booth?

Jim said...

1) A "public option" is a Trojan Horse for a single payer system. No private insurer can compete with a federal government which doesn't have to comply with 50 different state requirements and that not only doesn't have to produce a profit - it is actually subsidized by taxpayers. So insurers will inevitably be bankrupted or simply driven out of the business by simple unfair competition. So to those who are saying "no one is saying single payer" - you are either lying or mistaken.

2) Government cannot deliver health care less expensively than private insurers no matter how many tall tales and outright lies Obama and his cohorts tell you. Is the Post Office more efficient than UPS or Federal Express? More reliable? No and no. Yet these are the same people who you will be entrusting your health care to.

3) Part of the Democrats plan to "reduce costs" is digitizing medical records - putting them online. Yeah. The same people who can't keep track of PCs with national security secrets think they should be entrusted to keep your medical records private. But Leftists say we should trust them so that's the end of it, right?

4) If Obamacare is going to be so gosh darned fantastic, then why don't they fix the national health care system they have in place for Native Americans and the Medicare system first to prove it? Why do we have to take anyone's word for it when we have perfectly good samples that they can try out their theories on before doing damage to the best health care on the planet? Just today we get a story of a 5 year old Native American girl who died of terminal cancer because the government still isn't fulfilling its obligations to provide "national health care" to Native Americans. Do we even want to start on the rampant waste, fraud and abuse of the Medicare system? Fix what you've got first and prove you can do it before you get to put your hands on everyone else's healthcare too.

5) With private insurers, the profit motive ensures that they are vigilant about rooting out waste, fraud and abuse. With the supposedly endless federal tax system, what incentive is there to go after abuses aggressively? Answer: none. If there was, we wouldn't be in the situation we are with Medicare today if that were the case.

6) As other commenters have pointed out, the rationing of healthcare isn't "tin foil hat" stuff or imagined: it's already happening in the UK, Canada and other countries with national healthcare. They are already denying extraordinary end of life care because it costs too much.

Jim said...

7) The government should never, ever, ever be in the business of deciding who lives and who dies. It's a fundamental liberty which belongs in the hands of NO government anywhere, anytime. Putting the government in charge of these decisions is inherently dangerous to its citizenry.

8) For whatever flaws the private health care system has, it is still the best one in the world. People flock here from other countries (including those with national healthcare) because we offer the most advanced and innovative healthcare in the world. Cost-cutting measures in a government-controlled healthcare system would necessitate a reduction in research for new drugs (too expensive, and the drug companies would never be able to make back their R&D costs when the government is controlling prices), a reduction in innovative medicine (too expensive!), etc.

9) Obama has already said that he plans to reduce payments to doctors in order to pay for Obamacare and today told doctors that he has absolutely zero plans to limit their malpractice exposure. So let's see, we're going to reduce what we pay doctors, keep their bills the same (or higher), and then watch as fewer and fewer people enter the medical field. Why go through eight years of pain and agony if you're not going to make a whole lot of money at the end? Nobody. We already suffer from a shortage of doctors and nurses, and this is the genius plan to address that?
10) The government has already taken over GM and Chrysler after driving them into the ground with excessive regulations, do we really want to give them the chance to do that with our health?

It's hard to know where to begin or end the number of reasons why this is a terrible idea. I've given 10 reasons, and I'm sure others can come up with many more...

Elliott A said...

@ALMW Thanks for your concern.

mccullough said...

The best solution is to make elderly "pay down" their assets in Medicare, like the government does in Medicaid. (The biggest Medicaid expenditure is nursing homes, and most of those in nursing homes are the very elderly).

So a person spends down to their last $10,000 before Medicare starts paying and the government gets a lien against your house so when you die the money goes to them.

Chip Ahoy said...

AlmaGarret,

Condolences on your loss. Best of luck in caring for your mother.

Chip Ahoy said...

Ha ha ha. Why, there's Obama on TV now, on mute, of course.

In sign language I would read that as, "This is how I do needlepoint one-handedly."

* click *

Elliott A said...

One reason for some sort of a national public plan is that in many parts of the country, there is only one major private insurer. They control both premiums and reimbursements, the latter the ultimate resource in rationing care. The Philadelphia area, with its millions of peopl;e has about half a dozen endocrinologists who can operate independently of one of the areas medical schools due to the horrendous reimbursement. This extends into many other specialty areas. Many rural parts of the country are lucky to have one major insurer. Somehow, the financial incentive must be shifted from running the system at a profit to keeping people healthy and living. I clearly don't have an answer as to how, yet it is clear that any "reform" of the current system will not fix the problem. Waste, fraud and abuse are human nature and cannot be eradicated. Eventually, the resources will be strained to the point where they are insufficient to meet demand. The nonagenarians will then have few champions

Roost on the Moon said...


6) As other commenters have pointed out, the rationing of healthcare isn't "tin foil hat" stuff or imagined: it's already happening in the UK, Canada and other countries with national healthcare. They are already denying extraordinary end of life care because it costs too much.


True, if "denying" just means "not paying for". Which is what we are already doing!

It is tin-foil hat stuff to say that the government would prevent you from getting the care. Now, they may not pay for it. Just like a low-end insurance plan might not. But that's why there will still be a market for more expensive insurance.

Jim said...

In a single-payer system akin to Britain and Canada, doctors become de facto (if not actual) employees of the government. If the government says they're not going to pay, there won't be a sufficient number of doctors who are either willing or capable of providing the service. And when the government is mandating that you take all patients they send if you want to get paid for seeing any of them (as Obama has said he will do. He says he will mandate that any doctors who accept Medicaid will be forced to take his government plan whether they want to or not.), which doctors will have the time or availability to provide extraordinary services?

You think doctors are overworked now when they have the opportunity to make a couple hundred thousand dollars a year? Try paying them what they'll end up making under Obamacare and see how overworked they are when there are even fewer of them.

Roost on the Moon said...

To LawyerMom and Traditionalguy,

I'm not being callous. I'm not saying these people shouldn't be taken care of. I'm saying they aren't being taken care of now.

And if they are, they can continue on the same health plan they have right now.

Elliott A said...

In the UK it is illegal to provide any unapproved medical treatment. It is also illegal for any physician, dentist, etc. to operate outside the system.

Roost on the Moon said...

You guys are having it both ways:

The public plan will be terrible and everyone will hate it, AND, the other insurers won't be able to compete.

It seems like one problem fixes the other. It's how markets work.

Jim said...

Elliott A -

The reason there are a limited number of insurers available in some areas is because of draconian state regulations which either requires miles and miles of red tape or place extreme limits on the amount of money an insurer can make.

Do you honestly believe that there is a business opportunity in this country that a private firm won't take provided they can profit from taking it? Of course not. Try looking at the regulations that your state imposes, and you'll see that it is the state which is artificially suppressing competition not a lack of interest from companies that would otherwise be more than happy to do business with a whole new market.

The argument that this is proof that a national plan is needed is no such thing. It's an argument that voters in the region/state have done themselves no favors by electing legislators and executives that have unfairly restricted their health care options.

Janis Gore said...

The further point I'm making is that my brother didn't NEED to go to MD Anderson.

He didn't need to go through the very stringent protocol for bone marrow transplants.

He healed in Mississippi.

Jim said...

Roost -

Are you going to vote to end the public option if it gets proven to be less efficient than a private option? Will the Democrats responsible for instituting ever admit it and not try to hide it? No and no. The reality is that people like you and the Democratic Party will just decide that the public option needs even MORE taxpayers subsidies.

Eventually the public option becomes cheap enough that private insurers can't get the economies of scale necessary to compete effectively with a publicly-subsidized entity.

You say that it can't be both. I say that you and Leftist cohorts will do their best to make sure it is.

Jim said...

As an additional note, I have absolute proof that this is true:

Medicare

It is both horrible and inefficient. It has also squeezed out practically all competition for elderly healthcare.

The answer from the Left is always that Medicare would do better if only it had more money. Has it improved even one whit with the additional money? Not even a tiny bit. But this is the model you want to foist on this country.

Yeah. Thanks but no thanks.

The Mother said...

Over 70% of health care dollars are spent in the last, terminal year of life.

Controlling costs cannot be done when futile care is not only allowed, but encouraged. It's foolish and it's bankrupting the system.

Assisted suicide is a viable option. So is the right to opt out of painful, nauseating, destructive medical options.

And yes, a lot of these patients are depressed. It comes with the chronic pain and nausea. That doesn't mean that they are wrong.

MadisonMan said...

The government has already taken over GM and Chrysler after driving them into the ground with excessive regulations

GM and Chrysler were driven into the ground because their boards had crappy long-term planning. I don't think you can blame the government for dubious business plans. Well, actually you still can. But it's as sensible as blaming my cat.

Elliott A said...

The medical care and insurance system does not follow the usual economic models. The insurer cannot move into an area is currently does not operate in without recruiting a network of participating physicians. At the same time, they cannot successfully market their wares to purchasers, usually the policy holder's employers, unless they charge less than the other guy. Yet, they cannot do this and at the same time incentivize the physicians and hospitals sufficiently to sign up! To make matters worse, the physicians have little say because they are all employees of the hospital corporations. The insurer must actually deal with two competing interests at the same time in order to function. My reason for accepting the national plan is that it is the only possible competition in many places. That does not say I want one (I do NOT). A monopoly over a resource with an inelastic demand is the worst case scenario, however. The right must realize that the business model does not apply here, and the left must realize that the current system cannot withstand unfettered access. Without a major paradigm shift, the current situation is intractible and the old people will be out of luck. There is an updated version of "Logan's Run" due out in 2010. It is the perfect metaphor for this discussion.

Jeremy said...

So liberals are anti-euthanasia?

Lem said...

I like the Spanish version of Matthew 25:35-40

Respondiendo el Rey, les dirá: “De cierto os digo que en cuanto lo hicisteis a uno de estos mis hermanos más pequeños, a mí lo hicisteis”.

Cant get any more "pequeño" than a baby.

Jeremy said...

Jim said..."The reason there are a limited number of insurers available in some areas is because of draconian state regulations which either requires miles and miles of red tape or place extreme limits on the amount of money an insurer can make."

Name an area of America where there are a "limited number of insurers available."

You're out of your mind.

Elliott A said...

Jeremy- In southeastern PA, where I thankfull do not live, Independence BCBS has about 90% of the health insurance business and is the only insurer offering policies that has access to the hospitals and doctors.

Lem said...

If we can't or more to the point wont protect the most vulnerable of the vulnerable how are we expected to give a dam about people who lived a full life?

traditionalguy said...

The really interesting connundrum facing liberal politicians who specialise in buying votes with tax money in these days when all the money has disappeared, is how to find find a way to kill off a chunk of existing monetary claimants without appearing to be Callous. It is for the children's education, or for Mother Earth's CO2 load (apparently causing Global Cooling these days), or for the Murtha Memorial Airport to Nowhere; but is suddenly discovered to be a waste spending vote buying money on healing people who may die; I.e., everyone. Have you seen the latest and greatest PBS propaganda series running weekly on the coming wonderful day when all human life will have ended on earth. So tell me again who is doing all this planning for an early death for people. Did you ever see the Hitchcock movie of a John Steinbeck short story called The Lifeboat? The limited resources planners have to decide who to throw overboard. Those planners are the Socialists empowered by intentionally limiting the resources, and whom we must defeat if we intend to live out our full lifespans that God has promised to us and our children. In Darwinian terms, for an oganism to survive long it needs (1) to defend itself, and (2) to develop a secure food source, and (3) to propagate its babies. Numbers 1 & 3 are under carefully planned attack today, but we cannot afford to lose at any of these. I hope I do not sound like I am being Callous towards you Socialist Death merchants out there.

Jeremy said...

Elliott A - First of all, BCBS dominates EVERYWHERE, but are you saying there's no other insurance carrier in southeastern PA?
Of course there is, but if BCBS offers the best coverage for the best price...oh, wait...maybe...if there WAS COMPETITION...we could get it CHEAPER???

Makes you wonder why we don't have a BETTER system.

The insurance companies are sticking to us...ya think???

Jeremy said...

Blogger traditionalguy said..."The really interesting connundrum facing liberal politicians who specialise in buying votes with tax money in these days when all the money has disappeared, is how to find find a way to kill off a chunk of existing monetary claimants without appearing to be Callous."

Drunk again, huh?

What a fucking moron.

traditionalguy said...

Jeremy...That was not an arguement from either fact or law. You can do better than that. We surely need your dispassionate discourse here.

Jim said...

Elliott A -

BCBS is a business which is a prime example of an insurer which has systematically bought off legislators to limit its competition. The legislators that do its bidding in order to keep the donations coming are the ones to blame.

BCBS just recognizes what it can legally do to best grow and maintain its business. What they do isn't illegal, but it's the corrupt politicians who set up the system so that they are the power brokers that must be paid in order to do business. BCBS is just playing the game according to the rules they've been given: what is needed is a change in the system that allows legislators to profit from it.

Does further concentrating power over your healthcare in the hands of the very people who have corrupted our current system make any sense whatsoever? Only if perpetuating government power is more important to you than actually improving access to healthcare.

New York said...

But what about the next generation of Ivy league graduates? Armed with degrees in humanities, social sciences, or maybe law, they are only willing to work for do-gooder organizations or the gov't.

But those jobs aren't high paying currently. Deciding which old people get to live in a govt health plan is a great gig because it lets you feel important (playing god for millions), self-righteous ("I'm virtuous working in health rather than BigLaw), and of course gets big $$$$.

Beth said...

When I was a kid, my dad would sometimes rant about old farts that bothered him. He'd say two things (he was like that; he liked having a few good set pieces that he could rely on often): When your dance is over, get off the stage, and You know, those Eskimos have the right idea. About the time you hit 60, they put you on the ice floe and turn you loose.

That last one changed incrementaly over time: ... about the time you hit 65, they put you on the ice floe;... about the time you hit 70, they put you on the ice floe...

Janis Gore said...

It might be more interesting if you wondered who will clean your dad's or your mom's butt when they can't do what do what they taught you not to do.

Methadras said...

Does anyone remember that one Star Trek: The Next Generation episode where this alien humanoid guy was trying to save his world from their sun going supernova, but because he is 60 years old he has to commit ritual suicide because of the burden that the elderly in this planets past put on the society there. Did anyone see that episode? Here is the wiki on that episode, but basically, this is what I see happening with President ErkelCare.

http://en.wikipedia.org/wiki/Half_a_Life_(Star_Trek:_The_Next_Generation)

Methadras said...

Let me clarify my last statement. I see the eventuality that a predetermined age might end becoming a ritualized type of behavior for suicide to clear the way for families to stop caring for their elderly or the government can use it as a means to do the same in the name of savings. But I can see the beginning grains of ideas like this in socialized medicine especially the way The Incompetent in Chief is going to do it.

rhhardin said...

Well, the law of comparative advantage says that an economic entity should stick to doing what it does best.

Comparative advantage says there's something you should do, but it's not usually what you do best.

The classic example is the economist and his secretary. The economist has to send a form to the campus office, and sends his secretary out to deliver it, even though the economist has longer legs than the secretary and can walk faster.

The secretary has a comparative advantage for delivering forms.

bearbee said...

Will government imposed how-much-bang-for-the-buck treatment standards be limited to age or age-related problems, or include expensive treatment of premature babies, transplant patients in which life expectancy is limited, those with life threatening disease or diseases that are complicated, requiring prolonged hospitalization and/or protracted treatment, or to anyone permanently mentally or physically disabled or which prognosis is a shortened life expectancy?

bearbee said...

She was 84. Would O-Care (zero-care)standards require she be left there?

Woman wakes up in morgue after being declared dead by doctor

downtownlad said...

Why does the government want you to die so much? You imply that they want to save money. Since when has the government ever cared about saving money? They are a money wasting machine.

Now let's take insurance companies. Now that's an institution that has an incentive to pull the plug. . .

bearbee said...

Obama outlines $313 billion in Medicare, Medicaid spending cuts

scinfinity said...

My, how nice:

ABC is turning over its prime time programming on 6/24 to Obama to pimp his health care reform.

Their news broadcasts will originate from the WH and then there will be prime time specials promoting it.

Of course, opposing views won't be heard.

traditionalguy said...

DTL...Why is the question that needs asking over and over. It seems like we have elected a government that does not look out for Americans anymore. We have elected a "pro-choice government" and it reserves to itself the choice to protect us or not depending on our usefulness to it. But rest assured that Government plans to own us for our own good. How else can the steep rise in Global temperature be stopped?

Jim said...

The fact that there's even a question about whether or not the government would be able to influence end of life decisions for its citizenry is reason enough to do every thing in your power to stand in the way of this abomination.

"A government big enough to supply everything you need is a government big enough to take it all away."

The potential tyranny of a government with ANY say over life and death decisons of its citizenry should frighten the hell out of every citizen - Left, Right or Middle.

We've already seen what Obama has done in the name of political cronyism and to punish his political enemies, imagine what he (or even a similarly Machiavellian Republican president) would do when he has the power to decide whether to sufficiently fund Blue States and underfund Red States in a budget crisis (or vice versa when Republicans reside in the White House).

You people screaming out in support of a government-run plan either assume: a) that politics as it's playing out before your very eyes today will somehow end the moment healthcare passes, b) that your party will forever hold the pursestrings to that healthcare, and c) that you will always and forever find your beliefs completely in tune with the party who holds those pursestrings.

On their own, each and every one of these assumptions is the product of either naivete or gross stupidity. Taken together, the reverse of each of these items should scare the living hell out of even the most Lefty Leftists on this board. If it doesn't, then it's time to seek some serious mental help...

former law student said...

Elliott A said...
In the UK it is illegal to provide any unapproved medical treatment. It is also illegal for any physician, dentist, etc. to operate outside the system.

What does "unapproved" medical treatment mean? Leeches? Krebiozen? Coffee enemas?

And what does it mean to operate outside the system? Filipino psychic surgeons?

Apparently private medical insurance is thriving in the UK, covering up to 12 million people through their work, or through individually purchased policies; providing such cutting-edge and costly treatments as bone marrow transplants.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1118448

Structure of UK private healthcare sector (2000)

In 1997, over 12 million people were covered for medical expenses by insurers, friendly societies, and cash plan companies. Seven million people (12% of the population) were covered by private medical insurance. Care for this group, however, represents only 75% of acute medical and psychiatric inpatient and outpatient hospital treatment in the private sector. Some private care is self financed, and the NHS also contracts out to private providers—notably in the psychiatric services, care of elderly people, termination of pregnancy, and through waiting list initiatives

The case mix in private health care has shifted from simple elective surgery to include complex surgery such as coronary artery bypass grafts, acute and subacute care, intensive care, and cancer (including bone marrow transplantation and radiotherapy).2 The demand for health care by insured people is high. Since the mid-1950s, apart from a few exceptional years, the overall claims in the United Kingdom have been £80-£89 for every £100 of premium paid.1 Insurers manage demand by, for example, concurrent utilisation review (a system for continuing monitoring of use of a service) and case management (allocation of an experienced manager to oversee progress of a healthcare episode).


Janis, I'm sorry your brother received bad medical advice from a seemingly ignorant "hospitalist." I'm glad he survived.

Jim said...

fls conveniently leaves out of his analysis the fact that the UK strives to see emergency room patients within 4 (count them...4...) hours and is completely incapable of achieving that goal.

Ask yourself whether you would be willing, or even able, to wait a minimum of 4 hours in the emergency room to be seen by a doctor and you'll have your answer as to whether the UK system is better than the one we have.

Only by leaving out all the inconvenient actual facts about government-run healthcare make any sense whatsoever. It never ceases to amaze how little reality has to do with the political policies pushed by the "reality-based community."

former law student said...

Their news broadcasts will originate from the WH and then there will be prime time specials promoting it.

Of course, opposing views won't be heard.

Sure they will. But generally you have to analyze and understand a proposal before you can intelligently counter it. Republicans have already publicly admitted they're slow readers, in the Sotomayor case. So I don't expect them to have digested Obama's plan until August.

Or, they could just dust off these and run them:

http://www.youtube.com/watch?v=Dt31nhleeCg&feature=related

bearbee said...
She was 84. Would O-Care (zero-care)standards require she be left there?

Woman wakes up in morgue after being declared dead by doctor

This is the first suggestion I've heard that we're going to get the Polish health care system. I should have suspected it, however, after Obama named Wojciech Jaruzelski his Commissar for Health.

The fact that there's even a question about whether or not the government would be able to influence end of life decisions for its citizenry is reason enough to do every thing in your power to stand in the way of this abomination.

Ah, the Chicken Little argument: the fact that there's even a question about whether or not the Sky Is Falling is reason enough to do everything in your power to get people to flee in unreasoning panic.

scinfinity said...

Sure they will. But generally you have to analyze and understand a proposal before you can intelligently counter it.

Can you explain when the line between "analyzing and understanding a proposal" and "infomercial" is crossed? I'd love to hear it.

Republicans have already publicly admitted they're slow readers, in the Sotomayor case.

Obama clearly didn't say it, since he initially said she "misspoke" --- not that she "misspoke an awful lot over a long period of time".

And given the successful predictions our idiot-in-chief has provided us (my, those 600,000 jobs before the summer sure were amazing, weren't they? As was unemployment PEAKING at 8% if we passed their pork bill), I'd want to read every single word. Obama has lost his benefit of the doubt to date.

...perhaps if Republicans weren't left out of all negotiations, they may know more of what the bill entails.

But, I find the savings plan hilarious, given how apoplectic the Dems were when Bush proposed more modest savings than Obama is. I guess, just like every one of their supporters, their "stands" were just political gamesmanship and nothing to be taken seriously.

http://www.youtube.com/watch?v=lcVvNF3g1l4&eurl=http%3A%2F%2Fhotair.com%2Farchives%2F2009%2F06%2F15%2Fvideo-flashback-to-dems-screeching-about-medicare-cuts%2F&feature=player_embedded

Going nuclear over cuts MUCH smaller than the WH's proposed $622B cuts.

Janis Gore said...

I wouldn't call the hospitalist ignorant, FLS.

He made a reasonable call based on circumstances. My brother wasn't improving.

The hematologist was a remarkably optimistic and capable doctor -- a dedicated man.

S said...

Roost on the Moon said...
""I don't see a problem provided you can get any treatment you want if you can pay for it yourself."

Exactly. Weird fearmongering from Althouse."

The guy you quoted said it as a subversive statement (re: here is how we can introduce rot into the base of their plan). It's not fearmongering, I'm sure you and the Obama team will fight to make private care illegal if you think you can get away with it.

S said...

former law student said...
Elliott A said...

"What does "unapproved" medical treatment mean? Leeches? Krebiozen? Coffee enemas?"

Heh, I know all about it. No, its mainstream stuff that doesn't have a couple medical studies proving it works... with works being somewhat subjective / slanted to the person holding the purse (re: it might remove your symptoms and make you feel great, but the powers that be might still throw it out if it doesn't make you live longer / or save them money by keeping you out of the hospital more). Its usually rolled out as a cost saver. If some, expensive, new treatment works they can delay offering it for years until the studies are done (because the studies, by their nature, take years).

Hoosier Daddy said...

This is one of the many flaws of traditional private health insurance since it began. "Major medical" traditionally paid at most 80%; more for preferred providers, and less for experimental treatments, which still include bone marrow transplants..

Medicare only pays for 80% of covered claims which requires beneficiaries to seek out supplement policies to pick up the remaining 20%.

Most private plans have 80/20 coverage with an out of pocket maximum for the insured. For example, an 80/20 plan with a $5000out of pocket maximum means the insured is responsible for up to a total of $5000 after which the insurer pays 100%. In other words, if you have a $10K hospital bill, the insurer will pay $8K and you'll be responsible for the remaining $2K. If your bill is $30K you'll pay $5K while the insurer picks up the difference.

Hoosier Daddy said...

As I have said in other threads, people look at health insurance completely different than their homeowners or auto insurance. If you started submitting claims to your auto insurer for your oil changes, tire rotations and basic maintenance you'd find that unaffordable too.

former law student said...

If some, expensive, new treatment works they can delay offering it for years until the studies are done (because the studies, by their nature, take years).

Here if conventional treatments don't work, the patient is asked if he wants to be part of a clinical trial. Is this part of the studies you are talking about?

Republicans have already publicly admitted they're slow readers, in the Sotomayor case.

Obama clearly didn't say it, since he initially said she "misspoke" --- not that she "misspoke an awful lot over a long period of time".

No, I was referring to the Republicans' protest of Leahy's setting Sotomayor's confirmation hearing for mid-July -- they wanted it to be in September, to give them time to read and analyze all of Sotomayor's decisions.

former law student said...

It's not fearmongering, I'm sure you and the Obama team will fight to make private care illegal if you think you can get away with it.

"It's not fearmongering" [proceeds to fearmonger]

How do you keep your head from exploding?

EDH said...

I never understood why the Northeast, home of many single-payer advocates, tends to have the "best rated" private insurers.

I buy Harvard Pilgrim individually and I am content.

Janis Gore said...

Then you get into the notion of what is a predictable expense.

I'd say cataract surgery is a fairly predictable expense, and it would behoove us to have about $7000 put away for that contingency.

I'd say childbirth is a fairly predictable expense. In most cases, it's an elective procedure.

AustinTEX said...

Roost on the Moon,

The government will end up denying extroadinary health care on the grounds that not everyone will have access to it.

The left will scream "Not fair! Only the evil rich get to live longer". At that point, the government will either have to pay for all of it or begin denying it.

scinfinity said...

You mean the GOP isn't intimately familiar with every single ruling or paper every possible nominee has ever written?

Wow.

Better that than the Dems reading bills, passing them, then claiming they misunderstood them...such as with the AUMF.

scinfinity said...

"It's not fearmongering" [proceeds to fearmonger]

How do you keep your head from exploding?


He has publicly said he supports a single payer system and said he'd have to go about in incrementally.

Bruce Hayden said...

GM and Chrysler were driven into the ground because their boards had crappy long-term planning. I don't think you can blame the government for dubious business plans. Well, actually you still can. But it's as sensible as blaming my cat.

You are forgetting the union wages, benefits, and work rules. Of course, those haven't changed that much, thanks to the way the bankruptcies were run, which is why they still aren't likely to survive (and now they have the government deciding their product mix too, that should really help).

wuzzagrunt said...

"Letting Boomers Die."

As a member of the Boomer generation, even I can see the upside to that.

My contemporaries have, apparently, been unable to envision a time when "our" narcissism, petulance, attention-whoring, and self-referential nostalgia would wear thin on those we must count on to care for us in our dotage. When we become an extreme burden, we'll be lucky if the younger generations don't take up the sport of clubbing us like baby seals.

Feel free to laugh if you want to...for now.

ken in sc said...

Medicare already creates a crime out of private medical practice. If you are a Medicare patient, and Medicare does not cover the treatment you think you need. Your doctor, if he or she accepts Medicare patients, cannot provide you that treatment. It is a crime to do so.

Jim said...

ken in sc -

Don't confuse the Leftists with facts, it hurts their feelings and makes them ask you fellate them in order to ease their bruised egos.

They much prefer the time-honored practice of misdirection (i.e., fls trying to get people to talk about Sotomayor because he's been proven wrong on pretty much every comment he's made in this thread) or telling half-truths.

Pointing out that what they're saying doesn't remotely comport with reality in any way is a patently unfair way of discussing something of which they have no intention of telling the truth because they know just how damning the truth is. Just ask Obama why he's trying to bum-rush such a momentous change through the Congress and why Democrats are excluding Republicans from working out the details of the legislation: it won't stand up to the light of day and they know it.

Joe said...

Jim, you earlier highlighted a point I've made before but which needs to be made again. By treaty, the US government is obligated to provide American Indians health care. This program is called the Indian Health Service and is a disaster. On the other hand, since the government can't make it worse, they have a wonderful opportunity to try different ideas in different parts of the country with regards to health care and see what works.

Incidentally, they can do the same with the VA.

Lost in all this is why federalism is such a great idea. Rather than have a single federal health system, why not let the states experiment with different ideas? (Yeah, rhetorical question--government rarely give up power without force.)
(BTW, before someone says that the states can try ideas, the answer is yes, with one hand proverbially tied behind their backs. Federal regulation is heavy and arguably a big source of the problem.)

Eli Blake said...
This comment has been removed by the author.
Eli Blake said...

Jim (10:46):

OK, so we already have what the UK has.

My wife and I spent seven hours in a waiting room some years back, and I have a friend who spent 14 hours in a waiting room.

In fact,

In America there have been patients who have dropped dead while waiting to be seen, such as in this case from North Carolina.

Then there is also the little matter of the woman who was charged $162 for taking up space in a waiting room in a Dallas hospital for nineteen hours even though she was never seen.

So what you're really saying is that the U.K. health system is just as bad as ours. That's hardly a ringing endorsement of ours.

Jaytee said...

What's an unnecessary test anyway? You won't know a test is unnecessary until the test proves itself to be unnecessary. What about conditions in which a particular very expensive treatment cures the condition only 10 percent of the time, as recently happened with a loved one? My loved one fell within the lucky 10 percent, but I'm afraid the administration will vote for the much less expensive death-by-hospice in the future. Of course, Obama and the other politico-media-business nomenklatura will exempt themselves. To get full treatment you'll have to bribe someone or kiss some Washington aristocrat's derriere. What a system!

former law student said...

Medicare already creates a crime out of private medical practice. If you are a Medicare patient, and Medicare does not cover the treatment you think you need. Your doctor, if he or she accepts Medicare patients, cannot provide you that treatment. It is a crime to do so.

As I read the statutes, if you're on Medicare, your doctor can provide you with any treatment you want, as long as neither of you expects Medicare to pay for it.

And, other than fraud, I was unable to find any statute in Title 42 making any physician's activities a crime. Some violations make the doer subject to civil monetary penalties, but without a criminal stigma.

BJM said...

@DKWalser 6:59 PM -

The UK rations care for young Brits too, for example NHS cervical cancer screening is only available to women between ages 25-65.

How many American women wait until age 25 to have their first Pap smear or stop at age 65?

Regular diabetic retinopathy screening wasn't available until 2007. The NHS admitted that an estimated 1000 patients a year lost their eyesight before they acted (NHS began in 1948).

Should a Brit have a problem with their care this is the authority to which they must appeal, not the courts. Note under Key Facts:

-The NHSLA estimates that its total liabilities (the theoretical cost of paying all outstanding claims immediately, including those relating to incidents which have occurred but have not yet been reported to us) are £9.09 billion for clinical claims and £0.13 billion for non-clinical claims.

Who do you think paid? Yep, ratepayers (taxpayers). Twice. Once for care and again for litigation/settlements. The 2007/8 NHS budget roughly equated to a contribution of £1,500 (US$2469.48) for every man, woman and child in the UK.

Medicare will deduct $11,568.00 per SS beneficiary from their SS payments in 2009.

If you believe Obamacare will be cheaper than Medicare while maintaining the same level of care/benefits the private system currently offers then I have a very nice suspension bridge for sale. Cheap, must pick up.

Rationing of care, limited access and lower quality is inevitable in a health care system with limited financial resources.

One only needs to look to the VA system, Medicaid and Medicare as proofs that the govt cannot efficiently manage health care programs, yet we're asked to blindly hand them more of the pie to botch?

Why not provide a substantial tax credit or payment voucher for those currently uninsured and enroll those denied by medical underwriting into the govt employee system if immediate universal coverage is the reason for panic action.

Let them fix the VA, Medicaid & Medicare systems first, then we'll talk reform of the entire system.

Jamie said...

I understand that the UK's "no more than 4 hours in the ER" rule has led on more than one occasion to patients' being kept in ambulances just outside the ER until the backlog inside eases to the point where they can be seen within the required 4-hour window. Me, I'd rather wait 7 hours inside than 3 hours in an ambulance, 4 hours inside. Sounds as if the Parkland, TX, hospital has its own problems, which are not systemic even according to the article you cite, Eli.

Naturally some people have died while waiting to be seen in the ER - that's an example of a failure of triage, either a missed life-threatening condition or a "battlefield" style crisis in which so many people are in danger of death at the same time that there aren't enough medical personnel to save them all. Worse yet - some people have undoubtedly died while waiting to see their family physician. NO health care plan is going to keep people from dying suddenly; the question is why GOVERNMENT health care is presumed to be more efficient, careful, and effective than PRIVATE health care, before we actually close our eyes and jump off this cliff.

Why won't the Obama Administration commit to a "live-fire exercise" like working on the IHS or the VA, where the government already has all the jurisdiction it needs, before telling us (see also "stimulus") that this !!crisis!! can't wait another day?

Jamie said...

Gosh, fls, it's nice to know the doc won't be subject to criminal charges - only "civil monetary penalties."

Has anyone tried to donate baby/child gear to Goodwill lately? In my area, Goodwill and similar large thrift stores won't take this stuff right now because there's too much ambiguity about whether they'll have to have every item certified (lead-free? I don't remember the reg that's causing the problem, but it hit sometime early this spring, IIRC). Any possibility a doctor's office could read Medicare regs conservatively in order to avoid any possibility of those "civil monetary penalties"?

former law student said...

Any possibility a doctor's office could read Medicare regs conservatively in order to avoid any possibility of those "civil monetary penalties"?

As long as the provider is properly licensed and has performed every procedure he puts a claim in for, he should be home free. He can't have been kicked out of the system, and he can't front for someone who was. He also can't pay any patient for choosing him.

The procedures do have to be "medically necessary," i.e. you can't just do them because you have a boat payment due.

scinfinity said...

fls, you act as if they do extra tests to make money and not to cover their butts from lawsuits...which won't be addressed at all.