Here's the NYT article headlined "False 'Death Panel' Rumor Has Some Familiar Roots":
Advanced even this week by Republican stalwarts including the party’s last vice-presidential nominee, Sarah Palin, and Charles E. Grassley, the veteran Iowa senator, the nature of the assertion nonetheless seemed reminiscent of the modern-day viral Internet campaigns that dogged Mr. Obama last year, falsely calling him a Muslim and questioning his nationality."Seemed reminiscent"? To whom? "Death panels" was a characterization of a provision in a bill — an aggressive, politicized attempt at interpretation of the text of the proposed law. It was a parry in the debate about the bill, and the bill's defenders could have explained exactly why the text could not mean what Palin said it meant, or they could have rewritten the provision to make it absolutely clear that it meant whatever it was that they'd wanted it to mean when they wrote it. Rather than meet Palin's attack, the Democrats pulled the provision altogether, leaving us wondering what other provisions would have to be pulled if someone subjected them to a memorable — viral — attack.
When a big bill is dumped on us, we are challenged to read and understand the text. Usually we don't, but the text is there, and there's nothing scurrilous about trying to read it, calling attention to worrisome language, and putting our arguments in vivid words. A candidate, on the other hand, is not a text to be read, but there are facts about him that we may want to know. If someone asserts a fact about a candidate and says, for example, that Obama is a Muslim or Obama was born in Kenya, then the candidate, if he doesn't choose to ignore the assertion or simply make his own flat assertion of denial, is forced to come up with some evidence, which may be difficult and may lead to a new phase of the controversy in which the evidence is challenged.
This is completely different from a controversy about a written text that people are trying to read. If the text doesn't mean what its opponents are saying, it should be easy for the authors of the text to show how it means something good or to amend the text and make its goodness obvious. The authors of the text should trounce their opponents. If they can't, we should fear and mistrust them.
If Obama can't convincingly prove he's not a Muslim/not born in Kenya, it only means the rumors might be true, but he was not the creator of the rumor, as the Democrats were the creators of the text that lent itself to Palin's "death panels" characterization.
There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure. But over the course of the past few months, early, stated fears from anti-abortion conservatives that Mr. Obama would pursue a pro-abortion, pro-euthanasia agenda, combined with twisted accounts of actual legislative proposals that would provide financing for optional consultations with doctors about hospice care and other “end of life” services, fed the rumor to the point where it overcame the debate.Ha ha. I think that "On Thursday" paragraph had to be edited in a the last minute.
On Thursday, Mr. Grassley said in a statement that he and others in the small group of senators that was trying to negotiate a health care plan had dropped any “end of life” proposals from consideration.
A pending House bill has language authorizing Medicare to finance beneficiaries’ consultations with professionals on whether to authorize aggressive and potentially life-saving interventions later in life. Though the consultations would be voluntary, and a similar provision passed in Congress last year without such a furor, Mr. Grassley said it was being dropped in the Senate “because of the way they could be misinterpreted and implemented incorrectly.”Not just "interpreted... incorrectly" but "implemented incorrectly"! Well, there you have it! We are absolutely right to fear the way laws may be implemented. What does "incorrectly" even mean? If the language is there to be implemented a particular way, what should we care if the members of Congress preserved an out for themselves, letting them say that was not what they meant? It only makes it more underhanded!
The extent to which it and other provisions have been misinterpreted in recent days, notably by angry speakers at recent town hall meetings but also by Ms. Palin — who popularized the “death panel” phrase — has surprised longtime advocates of changes to the health care system."Misinterpreted in recent days"... and potentially misimplemented in future days, when it's too late and the law's the law.
... Former Senator Tom Daschle of South Dakota, an advocate for the health care proposals, said he was occasionally confronted with the “forced euthanasia” accusation at forums on the plans, but came to see it as an advantage. “Almost automatically you have most of the audience on your side,” Mr. Daschle said. “Any rational normal person isn’t going to believe that assertion.”Yes. Then why didn't Democrats argue their side? Why did they back down? I suspect it's because they really did hope to save money by substituting painkillers for curative treatments for the old and disabled.
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292 comments:
«Oldest ‹Older 201 – 292 of 292There are completed bills that address exactly those two things in Congress, but the Dem committee leadership won't let them out..
Yet someone upthread lamented that we could fix our health insurance problems if only the Republicans would come to the table.
I gotta get back to work. This has sort of turned into a good discussion -- I appreciate talking to Scott, Roger and others who made it that way. I tried too.
@Daniel
de nada
Big Mike-
Geez I tried reading it, and I missed all of that.
Big Mike, it's a sort of system-related necessity for anything that government does to be defined in as much detail as possible, isn't it?
When something is a *law* that actually dictates the operation of an entire business (in this case, the business of a health insurance provider) it has to spell everything out completely because being a *law* the people delivering the service can't just adjust to the circumstances and make their own decisions.
Private companies have complicated and extensive descriptions of everything their contracts offer as well.
Which seems to bother people who feel that private insurance companies are evil bastiches who twist up their contracts in an attempt to avoid paying claims.
The government as yet another insurance company (pretending that it won't all devolve into single payer) will behave the exact same way but with the additional coercive power of government behind it.
Someone has already pointed this out, I'm sure, but she's probably not referring to the end of life consultations as "death panels" -- those aren't "panels" after all. Palin was probably talking about the advisory bodies the bill is supposed to set up to determine what care is covered and where care is going to be limited -- wasn't she also talking about how her son Trig would probably not have got necessary care, under the current draft? This would be slightly misleading -- one could still, in theory, go out and get a plan that had different features than the standardised "essential benefits" package, or its two flavours of enhancement -- but it's a criticism that goes to the heart and spirit of the bill.
Daniel--I take your point on the difference between catastrophic and high risk--and I would have no problem supporting a quasi-government insurance operation like (dare I say) fannie mae
Actually, Synova, crafting these laws is an art form. On the one hand, there is a need to appear to spell out as much as possible, but to leave as many final details as possible to regulators. Then the regulators can clamp the screws down whle the lawmakers have their cover.
"The bill doesn't (or didn't) require that." Nope, it didn't. But -- wink, wink, nudge, nudge -- you knew going in that some bureaucrats selected by your side would write regulations that have the same force of law but not your fingerprints.
It's a game that I've grow tired of.
@madawaskan, I used the Thomas web site and went straight to Section 1233. The quoted material is cut and pasted straight from the text.
Daniel--thanks for the interaction--sorry I had to disappear for a bit--hate it when work interferes :)
Big Mike
Thanks I'm off to go try and read that...
Cook wrote: If you think half the country agrees with Palin, you have a worse opinion of your countrymen than I do.
It isn't about agreeing with Palin, it's about acknowledging that she isn't clueless, particularly when she makes a good point. See Big Mike's post re Section 1233 of HR 3200 at 2:59.
Left wing ideology and talking points don't translate to superior intelligence, quite the contrary. With few exceptions that's pretty much what is offered by you folks here.
Great they're using this terminology-
(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-
(1) Physician’S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:
‘(3) Physician’S QUALITY REPORTING INITIATIVE-
"Quality Reporting Initiative"
I doubt very much that HSA's would survive the crowding out that will inevitably happen
You are correct. The government plan will only allow private insurers to issue new policies that are QUALIFYING. This means that a high deductible health insurance plan where you pay for most of your ordinary expenses and the plan mostly picks up the catastrophic events will not be allowed.
Most people want this type of plan who are paying the premiums themselves because it is cheaper. Employees and Union lackeys don't give a shit how much the premiums cost, because THEY aren't paying it. Their employer does, and of course all employers are made out of gold and should pay through the nose for every itsy little desire of the employees. (sarcasm)
In order to have a HSA you must have it linked to an appropriate high deductible plan. So if you have a personal/non employer sponsered HSA/Insurance Plan, you can keep it, if you can continue to afford the premiums.
Daniel is clueless. Most people have insurance through their employer and I can tell you for a FACT that if/when we have this plan from the government, most employers will drop the private coverage and leave you to be forced onto the government program.
Why? Because the current cost of insurance premeiums is anywhere from 20% and up of payroll. If the employer is given the option of paying a mere 8% of payroll as a fee and pocketing the rest....they WILL do that. Leaving you the employee screwed. It doesn't matter if you 'get layed off'. You don't get a choice. PERIOD.
As more and more people are not using private insurance the cost will have to go up and up to cover the decreasing pool of premium payers. Gradually, the insurance companies will go out of business or ONLY the very wealthy will be able to afford private insurance.
The rest of the population will be on an inadequate, underfunded and overstressed government system. Rationing of health care is a certainty.
@Balfegor, it took a while, but eventually it clicked with me. You see, there have been plenty of studies where young women have gone into Planned Parenthood consultations pretending to be unmarried and pregnant. What these studies report is that there is a lot of pressure, and some not so subtle, to have an abortion.
This irritates liberal women, who get very upset at the studies in general and the women who cooperated with the studies in particular.
But there have also been studies, one I saw reported in the Slate's Double-X forum, where young women have gone into Christian-affiliated consulting centers and reported back that abortion is downplayed at the expense of carrying the -- should I call it "baby" or should I call it "fetus"? -- to term and putting it (him? her?) up for adoption.
This also irritates the feminists, who do not get upset with the study but with the downplaying of abortion.
Fast forward to HR 3200. Does the bill, as structured, make it possible that doctors will be coerced into pushing women carrying Downs children and the elderly and infirm into termination of life? To quote somebody that I like mostly because of who hates her, "ya betcha."
So we will slowly return to Sparta, where imperfect babies and those too old to serve in the army were pitched into the ravine.
Synova wrote: [I]t's a sort of system-related necessity for anything that government does to be defined in as much detail as possible, isn't it?
Forgive me for interjecting. It depends on your perspective. If you favor expanding governmental authority, you want just enough detail in the legislation to withstand judicial review.
If you oppose expanding government authority you include details designed to limit the authority created.
Facts of life:
1. Rationing of care is already happening in America.
2. Hopefully the rationing is mostly well-thought-out and rational in nature and people that truly need care will get it. And not see our own and our nations dollars squandered on cases where "cost is no object care" goes to futile medical intervention or simply prolongs end-stage terminal illness.
3. America cannot be competitive against other advanced nations that have 50% to 70% less of their GNP going to healthcare.
4. America must bridge the gap between proceeds taken in and the unfunded Medicare liability..now swollen to an estimated 37 trillion dollars. You cannot expect overseas lenders to float this horrendous domestic problem indefinitely. You have to drastically reform the American system, which includes less "heroic medical intervention" for the dying. Even then, paying the unfunded liability that we deferred to enjoy an artificial prosperity from the 1970s to now means that we have to go with higher taxes.
5. Even with higher taxes, we STILL DO NOT HAVE ENOUGH to pay for "sins, financial irresponsibility" of the past. Essentially, the post-WWII cohort and the Boomers did not pay enough into the system as workers to pay for their likely Medicare costs, as well as refusing to pay for the med costs of "the Greatest Generation" and earlier - preferring to defer payment for those folks by taking debt on that they HOPE future generations will accept ruinously high taxes to pay for older American's fecklessness.
That likely means a return to the "death tax" on estate and/or Medicare cost limits. Meaning if Granny paid in 80K in Medicare as her share of family taxes...and Granny has 322,000 in end-of-life expenses plus another 56,000 in Medicare before that her estate will have to put up with repaying the excess cost 298,000...meaning no house or business or Granny's remaining 51,892.oo in savings and stocks goes free and clear to her relatives. And of course, if the working Gen in 2010-2050 has a choice between higher taxes on them to pay for not just Granny, but indigent grannies and med costs of illegal's spawn - their choice will be some return of the Estate Tax.
6. Of necessity, medical care reform will mean loss of a lot of jobs in the isurance industry and an end to specialist overcharges and "less qualified" people doing what doctors and RNs were once pwemitted to do. Other countries do this and still have a higher life expectancy than Americans, with half the cost and 1/3rd of the "admin" people we have in the system
@Big Mike: Your point about counselling is well-taken, but I think Balfegor is right. Palin's reference to "panels" and to Trig imply that she was referring to the rationing inherent to public financed health care.
The Dems and their media allies seized on EOL counselling because the other issue may well doom their efforts. They simply don't want to discuss it or to debate Zeke Emanuel's policy recommendations.
Oh, goody! Cedarford and his made up "facts" again.
My dear Cedarford, your "fact" number (3) isn't a fact at all. In reality we compete quite well with Europe, Japan, China, and India. Perhaps that's because we keep our population healthier and -- who knows -- perhaps because of American exceptionalism.
As to your "fact" number (5), well I'm a Boomer and I've paid in the maximum to Social Security for over thirty years (it would have been even longer but I was drafted for the Vietnam War then went to graduate school on the GI Bill) and I've paid in tons of money into Medicare. I don't expect to use a fraction of what I paid in.
And your "fact" number (6) couldn't be more wrong. There will be no net loss of jobs; they'll merely shift to the Civil Service.
DBQ,
Won't employers that dump private policies, have to pay into the public system? I think that some employers will also realize that having private coverage may provide a recruiting / retention advantage for their people and elect to retain it on those grounds. Especially if the public option is the debacle that it is predicted to be here. My present employer provides better coverage at a lower cost to me than my prior employer did and that was a factor in my decision to switch.
@elHombre, you have forced me to refine my thinking. This is a good thing and I urge you to keep it up!
It occurs to me that there are two ways one can ration (or establish a quota system). The first is explicit -- written down somewhere and available for all to see -- and we Americans have a habit of pushing back strongly against that. The other is implicit, where the pressure is indirect and people are pressured into making the same decisions, but without those nasty explicit rules that people can debate and maybe overturn. It occurs to me that the Federal government has used "guidelines" as a way of doing implicit quotas.
So how would healthcare rationing be effected if I'm right about Section 1233? Through explicit rules that say terminate all Downs children and anybody over 80 who is a former smoker? No, I think there will be guidelines for physicians and pressure (because of the "quality reporting requirement" to counsel pregnant mothers carrying Down babies, not to mention the next of kin of the elderly and infirm, to "do the right thing."
Thanks, Hombre, your comment was helpful.
WV - glushe, the sound a toilet makes when the house is so cold that the water has turned slushy.
I hope for the sake of Senator Grassley, Sarah Palin, and Newt Gingrich, it doesn't become widely known that each of them are on record (within the last 3 years) supporting "end-of-life" counseling procedures very similar to those (republican sponsored) provisions that were removed from the insurance reform legislation.
The mental gymnastics required of Althouse readers could dangerous.
@Qwerty - Did any of them support getting the government involved?
@qwerty, what we're objecting to is not end-of-life counseling, but the likelihood -- make that strong likelihood -- that under HR 3200 as it stands that patients would be coerced into making their decisions in one direction. The one that saves Zeke, Barack, and Orszag some money.
No mental gymnastics required. (Good thing, considering the state of my knees.)
The Government grabbing for control of the money will never cease. That is what Governments are designed to do in exchange for Protection. The logical dissonance has become that our Government now wants all the supply of money in exchange for less and less protections given in return. But in America we could always fire our Government at elections, unless the news media and the movies and the TV talking heads could succeed at keep what is happening hidden behind liberal story boards. Anne Coulter was a master at seeing thru these liberal stories, but she had little traction at large until this week. Now suddenly everybody can see straight. Could that be from the Sarah Palin effect? The more they ridicule her talents, the more people admire her courage and join her in a common fight for the simple truth. There is a revolution happening as we watch.
No more than the (republic sponsored) portions of the current bill. Except perhaps for Gingrich, since his support was in the specific context of Medicare (and therefore perhaps somewhat more intrusive than the current provision).
Jesus H. Christ, Ann, are you a moron or just a self-aware (and therefore evil) provocateur?
The provision was removed because, politically, fanatics and morons (I'm talking to you, Palin) turned an innocent, Republican-authored, provision into a toxic hate-sludge.
And, being politicians, they simply 86'ed the problem. This is the FIRST TIME IN THE HISTORY OF POLITICS THAT THIS HAS HAPPENED.
(Uh, yeah. Right. Sure.)
If you've NOT been in a coma for the past 24 years, you might have seen this happen before.
Really, Ann. What the F**K is wrong with you? Are you an imbecile vis a vis politics, or do you just play one on TV?
Any school board would do exactly the same thing in the face of drooling lynchaterians.
But you knew that. Which is why this post is such a masterwork of Manichean creation.
So, is your master vacationing in Phoenix this year, or will he just economize and have a staycation in Hell?
Fine - I don't get my marching orders from Grassley, Palin, or Gingrich.
qwerty please don't tell me this was about politics. Palin and Gingrich wouldn't scare the elderly into thinking they would be terminated, if they really didn't believe it was part of the bill? That would be pretty craven.
Since we already know that end-of life care is already rationed under insurance plans offered by private insurers, I am trying to figure out how counseling offered by panels regarding end-of-life care are more dangerous when done by public employees, rather than employees of private companies.
Nobody wants to face these decisions for themselves or their loved one, but it is more than a little dishonest to pretend as if this legislation invented the problem, or that private insurers don't already do this (and under conditions which patients and families have no say at all).
@el waldo, whichever hate-mongering web site sent you over here with your mixed-up talking points should have given you some background on the blog. The real human beings who comment here know where the Professor was on her vacation and, for that matter, why she was there.
And she does not like to be called "Ann."
@Original Mike 5:03
Nice choice. Rather than risk injury, prudently refuse to participate.
@garage, you talk to me, son. Your buddy qwerty is too mixed up in the brain.
Nice talking points, though. Where'd you get them from? Daily Kos? Or some other hate-mongering web site?
@Qwerty - I don't view this as a football game (our side vs their side). It's too important for that.
big mike
I don't get where you're coming from on this issue at all. And my posts are never talking points [rude, out of left field, inflammatory yes], but not cut and paste jobs. Palin and Gingrich [and Grassley who voted for a similar provision in Congress last year] have been proven world class hypocrites on this topic. Why not take it out on them? And I thought you were a skeptical guy, yet you seem to fall for this end of life nonsense that has no real world applications.
Why would a public employee who has no stake in any money saved have more motivation to end granny's life than a private insurer who does??
WV - fixot
Not sure this is as important as football. Roll Tide!!!
more than a little dishonest to pretend as if this legislation invented the problem
I don't. But I sure don't think getting the government involved is going to help a difficult matter.
Every time I meet someone who fears government administration above all else, I want to ask: "Man, who is your private insurer? Your cable company? Your cell provider? Your bank?"
'cause I wouldn't trust any of the private companies I deal with with my health. Yet, the myth of competition improving service persists.
Every time I meet someone who fears government administration above all else, I want to ask: "Man, who is your private insurer? Your cable company? Your cell provider? Your bank?".
Well, the only relevant one there is my insurer, because my cable, cell, and even bank are not life and death matters.
And, yes, I trust my private insurer (and know that that I can sue them if need be) WAY WAY WAY more than I trust the government. Not even close.
I think that left-wingers have an inherent distrust/dislike for the private sector and trust for government.
Social Security and Medicare Tax Rates from 1937 [1966 for Medicare] through 2009
The first recipient of monthly SS checks received her first check in January 1940 (after contributing a little over $22 over the preceding 3 years) and continued to receive monthly checks for 35 years. There were, of course, many, many, many people thereafter who received checks for a great number of years after paying in a relatively small percentage of their salaries for relatively short periods of time.
I've yet to find similar information on earliest Medicare recipients, but I wouldn't be particularly surprised to find a similar phenomenon, both with regard to them and a great many others thereafter. (Interesting thing to think about: If my math's not off, only if you were born after WWII could you have paid Medicare taxes your entire working life, assuming 18 as start of working life.)
There's a lot to disagree about with Cedarford, and I do, but his point about part of the historical origin of the financial sustainability, or unsustainability, of both Social Security and Medicare has merit. Look at the demographics ... in the past ... now ... and going into the future. (And that table of tax rates to which I linked.)
Original Mike said...
And, yes, I trust my private insurer (and know that that I can sue them if need be)....
You cannot sue them in any way that would make the slightest difference. I linked to my own blog previously about this but the hell with that, don’t take my word for it. Just google ERISA and insurance and see what you find. You have no meaningful enforcement mechanism available regarding your employer-provided health insurance.
If your insurance is individually purchased and not through employment, then that’s different. But that puts you into the one-out-of-ten that applies to. Or if your employer is a governmental entity or a church. Otherwise you are SOL.
@garage, you assert that you are not cutting and pasting left-wing talking points but then where did you get your alleged facts about Grassley, Palin, and Gingrich? Probably from a site like TPM or Daily Kos. I can't imagine that you put the same effort into oppo research on those three individuals as madawaskan and I put into trying to understand the text of HR 3200, where he and I try to figure out how it could be misused and "mistakenly applied," to use the favorite liberal dodge.
And you asked why a public employee who has no stake in any money saved would have more motivation to end granny's life than a private insurer who does?? Maybe because that's how the bureaucrat can get his next promotion?
Plus keep in mind that insurance firms deny certain treatments to everybody. They don't pick and chose based on age or something akin to the UK National Health Service's Quality-Adjusted Life Year (QALY) measurement. Some of you are arguing for passage of the "health care reform" legislation based on no facts whatsoever. You have not done the basic homework to determine whether the American people will be better off or worse off if it passes as it sits. I have done my best to understand it, and I have objections. madawaskan is in the same boat. Okay with you? Not that it matters whether it is okay with you or not, because we object and we will make our objections known.
And for what its worth, I think that it is right and proper for physicians to give end-of-life counseling to patients. What I don't agree with is having the physicians directed to do annual "quality reporting" on their counseling. Does that quality reporting mean that physicians will be pressured to coax patients into termination of their lives sooner than they have to, as a money-saving measure? I'll fight that, and most people in the United States will be shoulder to shoulder with me.
In a post on an earlier thread, garage, you mentioned your frustration with insurance rules that limit their support to your diabetic daughter. I still can't get over your notion that you'd be better off if HR 3200 became the law of the land. It boggles the mind that you'd think that. If HR 3200 were the law of the land you would be more out of pocket than you are now.
Or your daughter would be dead.
For me, if HR 3200 had been the law of the land a dozen years ago it would be more stark. Absent a miracle (and me an atheist!), my son would be dead and not the upstanding, productive citizen he is today.
So I'm going to fight you. Clean if I can, dirty if you make me.
Reader:
Longtime members of Congress are to blame for the Medicare and Soc Sec shortfalls.
When Joe Biden entered the Senate in 1973, the maximum per worker tax for both programs was a total of about $1,500.
When he left the Senate 36 years later, the maximum tax had increased by about 1,000% to $16,000.
But the Congress and the presidents in those 36 years just increased and increased program benefits so that both programs gace huge future deficits.
The answer of course is not higher and higher taxes because they just will spend more than we give them.
BTW I am not picking on Biden; just using him as an example. McCain and Byrd and Specter and others are just as guilty.
wv =cyteroid (hell that describes me to a T)
Triangle Man said. Won't employers that dump private policies, have to pay into the public system?
Yes. However the amount that they will have to pay is 8% of payroll. I'm on a Board of Directors and we are changing the health insurance now to get a lesser cost. The current percentage of payroll for some employees who are older but who work less hours is as much as 60% to 75% of their particular salary!! The average cost of health premiums to payroll overall is about 38% and we hope to reduce it to about 25% By switching to a group plan with an HSA and High Deductible plan which is still legal...so far.
IF we can only pay ONLY 8% you bet your ass we will, and so will many many small businesses (under 50 people) Try to think about it from your employer's perspectve.
I think that some employers will also realize that having private coverage may provide a recruiting / retention advantage for their people and elect to retain it on those grounds.
Some will, but it will have to be on those businesses that have the economy of scale aspect to it. If you are an employer with a few people or a small business in an area where jobs are already hard to come by, the recruitment issue isn't a consideration. We advertised for a part time temporary manual labor ditch digger position and had over 20 applications. The bulk of small to mid sized businesses will opt for the government pay system and it won't hurt their ability to get employees.
Especially if the public option is the debacle that it is predicted to be here. My present employer provides better coverage at a lower cost to me than my prior employer did and that was a factor in my decision to switch.
It is nice that you have an option or a choice. Obama wants to take that away from us and squeeze out the choices and free market place competetion.
Further to what I said earlier, in the “don’t take my word for it” department, there’s this from the Washington Examiner:
“Most shocking to the conscience, however, might be the special protection big government provides for insurers covering patients through employer-sponsored plans: even if an insurance company's negligent denial of coverage causes harm or death, federal law protects insurers from legal liability.”
Big Mike
and me an atheist!)
Oh we'll get along fine! Sorry, but I will have to address your points a bit later, as I have a dinner date with the wife and daughters. I know I know cop out, but true. Pizza night at the Pizza Oven in Monona WI on Friday I'm afraid is NOT a public option. Seriously, I'd like to talk to you sometime on your son, what you went through and what you learned, to make me a better father. Sappy. Sorry!
**44 yr old eyes squinting to make out word verification**
"I am trying to figure out how counseling offered by panels regarding end-of-life care are more dangerous when done by public employees, rather than employees of private companies."
That's because you're not considering the differences between government and a private company.
Government will have all the power of the private company to define coverage if government becomes an insurance company it will BE an insurance company.
It will also STILL be the government with the power to regulate, tax, enforce compliance, and use other unrelated funding to manipulate cooperation. (Your drinking age is 19? No highway funds for you!)
What I can't figure out is how anyone can think that there *isn't* a difference.
Garage... several people keep saying that Palin voted for a similar provision. Someone linked it. I looked. Maybe you can link the real evidence because all I saw was her signing to a community education measure similar to an "eat more vegetables" or "read more books" or "always use condoms" campaign.
Not a health bill.
Why did they scuttle it?
Migawd, look for some estimate of just how much money might be left in the hands of American families, and in the Medicare trust fund, if various proportions of the many people who now don't have living wills -- remember, they must be created and witnessed while the people are indubitably competent! -- made them.
Consider most of the money spent on medical care is spent on prolonging the last year of life with extreme measures in hospitals.
Consider that families have to spend themselves broke before they can draw on medicare.
Consider the _amazing_ threat that good counseling about living wills represented to the medical industry.
That's a HUGE amount of money they were seeing at risk. Not just the money they can tap from families, either -- that's just the gateway, once it's done the industry has the big pipe into the federal money.
Imagine the musical, but put in the word "Procedures" instead of "Tradition" and sing about how important they are.
Big Mike said...
Oh, goody! Cedarford and his made up "facts" again.
My dear Cedarford, your "fact" number (3) isn't a fact at all. In reality we compete quite well with Europe, Japan, China, and India. Perhaps that's because we keep our population healthier and -- who knows -- perhaps because of American exceptionalism.
I'll leave you with the comfort of knowing just how well we compete with other nations - by your personal beliefs - not reality.
Nor trifle with you Palin Country belief that Americans are so much healthier than those of Europe, Japan...
Just please ....don't ruin your day by diminishing your faith in American exceptionalism by reading about:
1. The outsourcing of US industry to Asia.
2. America's ranking in educational attainment compared to Europe and Asia.
3. America's ranking in life expectancy, doctors and nurses per capita, cost of health insurance per capita.
I will give you one cheerful bit of news. In one area you are right about American Exceptionalism. We are undoubtedly the only nation that has a negative trade balance with every other advanced nation.
Military supremacism? Brag away about how our Army is the greatest, our forces the best. That was what Russia was doing in the 1980s...saying that their "best in the world" Red Army and Northern Fleet could easily win the battle for Europe and the N Atlantic. If it was kept conventional. They were right, according to my ROTC seniors. But that was irrelevant. As was their then-superiority in number of Nuke warheads. By the Gulf War, their inability to compete economically brought the whole show down.
Medicare's Teaching Physician Documentation Instructions
Evaluation and Management (EM) Services (Visits and Consultations)
The descriptors for the levels of E/M services recognize seven components which are
used in defining the levels of E/M services. These components are:
• history;
• examination;
• medical decision making;
• counseling;
• coordination of care;
• nature of presenting problem; and
• time.
A. DOCUMENTATION OF HISTORY
The levels of E/M services are based on four types of history (Problem Focused,
Expanded Problem Focused, Detailed, and Comprehensive). Each type of history
includes some or all of the following elements:
• Chief complaint (CC);
• History of present illness (HPI);
• Review of systems (ROS); and
• Past, family and/or social history (PFSH).
!DG: The CC, ROS and PFSH may be listed as separate elements of history,
or they may be included in the description of the history of the present
illness.
!DG: A ROS and/or a PFSH obtained during an earlier encounter does not
need to be re-recorded if there is evidence that the physician reviewed
and updated the previous information. This may occur when a
physician updates his or her own record or in an institutional setting or
group practice where many physicians use a common record. The
review and update may be documented by:
• describing any new ROS and/or PFSH information or noting
there has been no change in the information; and
• noting the date and location of the earlier ROS and/or PFSH.
!DG: The ROS and/or PFSH may be recorded by ancillary staff or on a form
completed by the patient. To document that the physician reviewed the
information, there must be a notation supplementing or confirming the
information recorded by others.
!DG: If the physician is unable to obtain a history from the patient or other
source, the record should describe the patient's condition or other
circumstance which precludes obtaining a history.
Definitions and specific documentation guidelines for each of the elements of history
are listed below.
HISTORY OF PRESENT ILLNESS (HPI)
The HPI is a chronological description of the development of the patient's present
illness from the first sign and/or symptom or from the previous encounter to the
present. It includes the following elements:
• location,
• quality,
• severity,
• duration,
• timing,
• context,
• modifying factors, and
• associated signs and symptoms.
Brief and extended HPIs are distinguished by the amount of detail needed to
accurately characterize the clinical problem(s).
A brief HPI consists of one to three elements of the HPI.
!DG: The medical record should describe one to three elements of the present
illness (HPI).
An extended HPI consists of at least four elements of the HPI or the status of at least
three chronic or inactive conditions.
!DG: The medical record should describe at least four elements of the present
illness (HPI), or the status of at least three chronic or inactive
conditions.
A ROS is an inventory of body systems obtained through a series of questions
seeking to identify signs and/or symptoms which the patient may be experiencing or
has experienced.
For purposes of ROS, the following systems are recognized:
• Constitutional symptoms (e.g., fever, weight loss)
• Eyes
• Ears, Nose, Mouth, Throat
• Cardiovascular
• Respiratory
• Gastrointestinal
• Genitourinary
• Musculoskeletal
• Integumentary (skin and/or breast)
• Neurological
• Psychiatric
• Endocrine
• Hematologic/Lymphatic
• Allergic/Immunologic
A problem pertinent ROS inquires about the system directly related to the
problem(s) identified in the HPI.
!DG: The patient's positive responses and pertinent negatives for the system
related to the problem should be documented.
An extended ROS inquires about the system directly related to the problem(s)
identified in the HPI and a limited number of additional systems.
!DG: The patient's positive responses and pertinent negatives for two to nine
systems should be documented.
A complete ROS inquires about the system(s) directly related to the problem(s)
identified in the HPI plus all additional body systems.
!DG: At least ten organ systems must be reviewed. Those systems with
positive or pertinent negative responses must be individually
documented. For the remaining systems, a notation indicating all other
systems are negative is permissible. In the absence of such a notation,
at least ten systems must be individually documented.
PAST, FAMILY AND/OR SOCIAL HISTORY (PFSH)
The PFSH consists of a review of three areas:
• past history (the patient's past experiences with illnesses, operations, injuries
and treatments);
• family history (a review of medical events in the patient's family, including
diseases which may be hereditary or place the patient at risk); and
• social history (an age appropriate review of past and current activities).
For certain categories of E/M services that include only an interval history, it is not
necessary to record information about the PFSH. Those categories are subsequent
hospital care, follow-up inpatient consultations and subsequent nursing facility care.
A pertinent PFSH is a review of the history area(s) directly related to the
problem(s) identified in the HPI.
!DG: At least one specific item from any of the three history areas must be
documented for a pertinent PFSH .
A complete PFSH is of a review of two or all three of the PFSH history areas,
depending on the category of the E/M service. A review of all three history areas is
required for services that by their nature include a comprehensive assessment or
reassessment of the patient. A review of two of the three history areas is sufficient
for other services.
!DG: At least one specific item from two of the three history areas must be
documented for a complete PFSH for the following categories of E/M
services: office or other outpatient services, established patient;
emergency department; domiciliary care, established patient; and home
care, established patient.
!DG: At least one specific item from each of the three history areas must be
documented for a complete PFSH for the following categories of E/M
services: office or other outpatient services, new patient; hospital
observation services; hospital inpatient services, initial care;
consultations; comprehensive nursing facility assessments; domiciliary
care, new patient; and home care, new patient.
Get the point?
B. DOCUMENTATION OF EXAMINATION
The levels of E/M services are based on four types of examination:
• Problem Focused -- a limited examination of the affected body area or organ
system.
• Expanded Problem Focused -- a limited examination of the affected body area
or organ system and any ther symptomatic or related body area(s) or organ
system(s).
• Detailed -- an extended examination of the affected body area(s) or organ
system(s) and any other symptomatic or related body area(s) or organ
system(s).
• Comprehensive -- a general multi-system examination, or complete
examination of a single organ system and other symptomatic or related body
area(s) or organ system(s).
These types of examinations have been defined for general multi-system and the
following single organ systems:
• Cardiovascular
• Ears, Nose, Mouth and Throat
• Eyes
• Genitourinary (Female)
• Genitourinary (Male)
• Hematologic/Lymphatic/Immunologic
• Musculoskeletal
• Neurological
• Psychiatric
• Respiratory
• Skin
A general multi-system examination or a single organ system examination may be
performed by any physician regardless of specialty. The type (general multi-system
or single organ system) and content of examination are selected by the examining
physician and are based upon clinical judgement, the patient’s history, and the
nature of the presenting problem(s).
There are about 30 more pages like that.
Message:
You're screwed.
Oh Jesus.
pogo -- it is in the nature of a bureaucracy to be bureaucratic. What is the equivalent verbiage from Blue Cross? Do any private insurers rely on Medicarese?
vw: phipso -- latin for the family of petetrum birds.
I don't think even Jesus could complete the required documentation for a 15 minute office visit 4 times an hour 8 hours a day correctly.
Guess what happens if you fill it out wrong?
You've committed 'fraud' against the US gummint.
You'll be lucky if you get 15 minutes. Even from Jesus.
Do any private insurers rely on Medicarese?
No. Only Medicare requires the constant and ever-changing use of 'secret phrases'like:
"I met face-to-face with the patient and spent more than 50% of the visit in discussion. The patient expressed comfort with verbal expression as an acceptable method of learning. No learning deficits were identified."
You have no fucking idea how many screws they can put to you, the patient, once they own your ass.
Doctors will be fine. Like in every other single payer country, in 2 years we'll strike and we'll get the price we name.
Seriously, I'd like to talk to you sometime on your son, what you went through and what you learned, to make me a better father.
garage, my friend, there's no magic formula. You do the best you can and hope it all turns out okay. There's no substitute for time with them -- quantity time is quality time.
Luck with your daughter. I think that these days raising one daughter to adulthood is a lot harder than raising two sons.
WV - sinster: A sister who's pretty naughty? An old maid who lost her ability to pee?
@Cedarford, where should I start with your foolishness.
First off, we are not losing jobs or anything else to European nations. We are indeed losing jobs to India and China, but not simply because they spend less on healthcare than we do. My understanding is that healthcare is rationed by cost in those two countries -- if you are rich or well-connected then you can get care that is unmatched. If not, you die. Are you trying to suggest that we adopt that model?
And healthcare in Europe is routinely rationed -- not just the waits for needed tests or surgeries, but also by expensive drugs being forbidden. There are drugs for treating breast cancer that are not available through the national health service -- I know this because of a family relative who is a European national. To get access to these drugs a woman has to have a friend who can procure them in North America and smuggle them in, or be wealthy enough to get to the United States and pay for the treatment out of pocket. Is this what you want? Perhaps the next time you see signs saying "Walk for the Cure" and women walking around in pink T-shirts or wearing pink ribbons you can go explain to them why expensive breast cancer drugs merely add to the cost of healthcare in the US and should be banned.
But you should have an escape route mapped out ahead of time before you take those steps.
American exceptionalism is obviously something you don't get. What it means is that America is different. We are huge, we are diverse, we are different from every place else. So pointing to tiny countries that are relatively homogeneous in population and culture as an example of how we should do things is simply insane. Which is a point that Camille Paglia was trying to make in her rant.
The inability to grasp American diversity is one source of the big headaches that federal regulators create in many parts of the country. You get somebody who grew up in a large east coast city, went to school in an urban setting, and then takes a job in Washington, DC, and the chances that they can comprehend life in rural Alabama or on a Montana ranch or a small town in the Rockies is as close to zero as you care to measure.
Right behind "I'll still respect you in the morning," "the check is in the mail," and "that feature will be in the next release of our software" comes "one size fits all." But isn't that what single payer tries to accomplish?
WV - decolize: Get rid of the e. coli bacteria on your bathroom floor.
In the C-span video I posted yesterday of the Texas rep talking about the House bill, he pointed out that there would be 31 new federal agencies, commissions, whatever in between your treatment, the insurance companies (those still left) and you. And the Health Czar (an appointed without congressional vetting position) had the power to make all the calls -- deciding who got what, when, where, why, and how.
It is clear that this bill is so far into overkill by virtue of its weasel and ambiguous language that it should be roadkill.
To trash 1/6th of the economy because the people in Washington can't figure out a way to cover 5% of the population who can't get insurance is crazy. (Who wrote this bill?)
What I want to see are true copies of Obama's transcripts and the passport he used when he went to Paahkistahn.
That's a written text I think would be worth reading, and very interesting.
Why should I trust anything about what this guy is sellng when we don't get to see his medical records, his college transcripts, his records. We have no evidence that anything he says is true.
Campaign financing anyone?
No lobbyists?
Transparency?
Bills posted online for days?
When a guy's pants are on fire, one doesn't believe a word he says.
pette
So there.
I guess that means you think that market limitations on goods and services are equivalent to government rationing.
Care is rationed, no matter who's providing it. The outcome is the same. Ignoring that is just sophistry.
Synova, your example of the Native population made me thing of a similar situation in New Orleans.
In the 1927 floods, the government did in fact blow the levees upriver from New Orleans, in the lower 9th Ward and St. Bernard parish, in order to redirect the water and save the French Quarter.
That fact remains in the memory of people whose families lived in the flooded area, and returned in the myth that during Katrina, Navy Seals loaded charges in the Industrial Canal, blew that levee and flooded the 9th Ward to save the Quarter. That just didn't happen. It's easy to understand why some people in that neighborhood would suspect it, but it's still untrue.
Newt agrees that Medicare should pay for end-of-life planning, and thinks private industry "best practices" should be adopted by government agencies.
I might be posting provocative statements and then erasing them in a fit of pique, or I might just be tangling with Word Verification and losing.
Care is rationed, no matter who's providing it.
That's reality.
The outcome is the same.
No, not necessarily, in practice. How do you define "same"? (Also, "outcome"--and, for good measure, a phrase you didn't write, I for sure and plainly acknowledge--"in practice"?)
Ignoring that is just sophistry.
There's plenty of ignoring and sophistry all the way 'round.
reader, if an insurance company bureaucrat refuses to cover a procedure, or a government hack does it, it's still refused. I have limited ability to affect my insurance company. At least I can vote for congressional reps and so can you.
I am not signed on for this amorphous plan (five versions at this point, right?) but I don't buy into many of the opposing narratives, either.
This would be slightly misleading -- one could still, in theory, go out and get a plan that had different features than the standardised "essential benefits" package, or its two flavours of enhancement -- but it's a criticism that goes to the heart and spirit of the bill.
Well, no. At least with HR 3200, the federal government will have the power to eliminate all of those non-conforming policies.
"I have limited ability to affect my insurance company. At least I can vote for congressional reps and so can you."
I'm boggling a bit at the notion that you have less influence over your private health care than you have over the US Congress.
OTOH, you work for a university, right Beth? So maybe there wouldn't be any difference for you between your influence on those who make decisions at your workplace and your influence over the government.
I can't help but think, though, that the influence my husband and his coworkers have on their boss at their reasonably small company is much greater than the influence any of them would have on our Congressperson and that, when it comes down to it, his boss probably has more ability to determine the coverage of the plan he selects than the Congressman does.
Since we already know that end-of life care is already rationed under insurance plans offered by private insurers, I am trying to figure out how counseling offered by panels regarding end-of-life care are more dangerous when done by public employees, rather than employees of private companies.
Interesting. Something that we all know, but isn't actually true. Keep stating your assumptions as accepted truths, and you won't have all that many people listening to you here.
Care is rationed, no matter who's providing it. The outcome is the same. Ignoring that is just sophistry.
Again, starting with a false assumption, and proceeding from there.
1. Rationing of care is already happening in America.
Depends on your definition of rationing. But right now, there isn't much of it, except, of course, for those who don't have insurance. But that is only rationing if you consider failing to pay for goods or services you receive to be rationing.
Indeed, as you note, the problem with Medicare is that there really isn't any rationing there - combined with those on it not paying for their care (yes, they pay a small part of its cost, but not enough to affect the market in services).
2. Hopefully the rationing is mostly well-thought-out and rational in nature and people that truly need care will get it. And not see our own and our nations dollars squandered on cases where "cost is no object care" goes to futile medical intervention or simply prolongs end-stage terminal illness.
Why do you think that it would be well thought out? Please list the areas of government (esp. at the federal level) where you think that the government thinks things through well.
6. Of necessity, medical care reform will mean loss of a lot of jobs in the insurance industry and an end to specialist overcharges and "less qualified" people doing what doctors and RNs were once permitted to do. Other countries do this and still have a higher life expectancy than Americans, with half the cost and 1/3rd of the "admin" people we have in the system.
Same bogus statistic that we keep seeing, time and time again.
Life expectancy is not a valid metric for any number of reason. For example, how many of those countries have the sorts of gang violence that we have here, where people are gunned down, esp. in the lower class areas of our country. Add to that that those gunned down tend to be fairly young, even skewing the statistic even more. Or, how about the effect of counting premies as live births, and then as infant deaths when they die shortly thereafter?
A much better metric is life expectancy after, for example, detection of one type of cancer or another. And by those metrics, we excel.
As to your suggestion that less qualified people do some of the stuff that we have more qualified people do - that is already happening to a very great extent in this country. For example, when I was growing up, we saw a pediatrician. Now, my kid almost always sees a PA, supervised by the pediatrician - I think he is up to three full time PAs now working for him.
But there is only so far that you can go there. I don't really want LPNs, etc. prescribing meds, or even diagnosing patients. Doctors, with a decade of training before entering practice screw up enough with prescriptions.
And with those PAs - it appears that three is about as many as he can handle, since they are just not trained well enough for the hard stuff.
Finally, if you want to get rid of specialist overcharging for stuff that other docs could do - the first thing you need to do is reform medical malpractice law.
You have radiologists reading X-rays because if the GP does, and anything was not caught, he is toast. I have a friend who ran an ER. They would read the X-rays hot, but always had radiologists read them cold the next day, just to CYA in case of a malpractice suit. And, of course, most of the time whatever the radiologist determined the next day was moot, because the patient was either admitted, discharged, or dead.
So, if you want your generalists doing stuff that they are decently capable of, but typically refer to specialists for CYA, then make sure that they won't get sued for it (unless they are grossly negligent).
OK, Bruce. Have it your way. In your hands I suggest we all place our care. Whatever.
I converted. The market!! The Market!!! I trust the market!!
Please save me, market!!!
I have limited ability to affect my insurance company. At least I can vote for congressional reps and so can you.
That's an unbelievable statement coming from a resident of New Orleans, Beth. Didn't you folks reelect Ray Nagin despite the mess he made of Katrina? Didn't it take two elections to get rid of Congressman "Frozen Assets" Jefferson?
In a free market you might -- I emphasize "might" because there's no guarantee in life -- be able to persuade your company to change to a better plan, or you perhaps can change jobs or you might have supplementary insurance through another source (e.g., a professional society). In the American government your representative gets to tell you that he had nothing to do with whatever regulation an anonymous bureaucrat is using to deny you coverage and it's out of his or her hands. He or she will make a show of making some phone calls that will go nowhere and then what? Still going to vote for the opponent in the next election? Even if that opponent is a Republican? Didn't think so.
At any rate, Beth, you work for a University so I imagine your plan is gold-plated and diamond-encrusted next to the rest of us. Some of us have a stake in this situation and are forced to read the bill and think through its implications. I can't afford silly platitudes like what you wrote.
@qwerty, isn't it strange? The market is far from perfect, and yet there's no way to make things better except in very specialized circumstances and for a very short while. Or by cheating.
To understand why you need to read John Nash's doctoral dissertation (it's only 28 pages typed, double-spaced) but in order to understand the dissertation you'll have to have read Theory of Games and Economic Behavior by von Neumann and Morgenstern, and that's pretty heavy going.
Bruce said
A much better metric is life expectancy after, for example, detection of one type of cancer or another. And by those metrics, we excel.
Actually, that tends to be a very misleading metric. We tend to screen for and notice cancer earlier. Thus, if cancer starts growing in a 50 year old, and we detect it when he's 51, and he dies at 57, then he counts as a 5 year survivor. In europe, they might not detect it until he's 53. If he then dies at 57, he's not a 5 year survivor. Your metric would claim a better result for the US, even though the actual result was the same.
I would think that life expentancy for people who survived until 30 would be pretty good, but would still be confounded by lifestyle choices.
WV pringlip: The funny duck-bill thing that you can do with two pringles stuck in your mouth.
Uh, Mike, no I won't. As (believe it or not) I used to have lunch with Nash every few months, I understand his claims. He wouldn't agree with your position, btw.
"Actually, that tends to be a very misleading metric. We tend to screen for and notice cancer earlier. Thus, if cancer starts growing in a 50 year old, and we detect it when he's 51, and he dies at 57, then he counts as a 5 year survivor.(etc.)"
You do realize that you just claimed that longer cancer survival rates because the US tests for and detects cancer *sooner* does not show that we have a better health system?
You seem to be claiming that "early detection" which is something that we've been told over and over is the most necessary thing to actually survive cancer, really doesn't do anything at all but let us dread our ultimate deaths for more years.
Maybe for some cancers people still die no matter what, but the stats that show survivability cover the cancers that WE expect people to survive.
But even if you're right and everyone dies right on schedule no matter what... they still get detected sooner in the US.
And availability of basic care and screenings that catch things early and thus *save money* are supposed to be why we're supposed to want a universal government system like Europe.
Right?
You seem to be claiming that "early detection" which is something that we've been told over and over is the most necessary thing to actually survive cancer, really doesn't do anything at all but let us dread our ultimate deaths for more years.
For a heck of a lot of younger people, early detection means a long happy life.
Well, qwerty, here's what wikipedia (granted, not always a reliable source) has to say about Nash's latest work:
Nash has also developed work on the role of money in society. In the context that people can be so controlled and motivated by money that they may not be able to reason rationally about it, he has criticized interest groups that promote quasi-doctrines based on Keynesian economics that permit manipulative short-term inflation and debt tactics that ultimately undermine currencies. He has suggested a global "industrial consumption price index" system that would support the development of more "ideal money" that people could trust rather than more unstable "bad money". He notes that some of his thinking parallels economist and political philosopher Friedrich Hayek's thinking regarding money and a nontypical viewpoint of the function of the authorities.
I think if he applied his thoughts to HR 3200, he'd oppose it too.
Do you know the difference between a hockey mom and a "death panel?" Dipstick!
The Senate didn't change jack. There was a leak of an agreement from a panel operating in secret. Show us the record of the vote in thomas.gov
It's all shenanigans.
Dear Sarah:
How about in honor the American "death panels," ya quit makin' stuff up?
I don't believe in the "death panels" until I see a death certificate. .
Bush "death panel" kills 4,200 healthy American adults in Iraq. No complaints. .
You do realize that you just claimed that longer cancer survival rates because the US tests for and detects cancer *sooner* does not show that we have a better health system?
Yes, I realize that.
You seem to be claiming that "early detection" which is something that we've been told over and over is the most necessary thing to actually survive cancer, really doesn't do anything at all but let us dread our ultimate deaths for more years.
No, I'm not claiming that at all. I'm quite certian that earlier detection leads to better outcomes. All I'm saying is that if you want a metric to determine who's outcomes are better, you can't go by how long people survive after the cancer has been detected.
And availability of basic care and screenings that catch things early and thus *save money* are supposed to be why we're supposed to want a universal government system like Europe.
Right?
I believe that is what we are told, but since I'm not one of the people who want's such a system, I'm really the wrong person to ask.
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