Newsweek Makes The Case For Killing Grandma

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Newsweek, in all of its wisdom, is still arguing that Sarah Palin lied about the death panel provisions in ObamaCare, but we really should have a death panel anyways. The author of the below piece, Evan Thomas, writes that his 79 year old mother wanted to die but the doctors wouldn’t let her because the assisted living facility she was staying at was sustained by Medicare. He didn’t like this and muses on how we can fix health care in this country by, you guessed it, getting people into hospice care and out of hospitals. People need to die and just get it over with you see:

The idea that we might ration health care to seniors (or anyone else) is political anathema. Politicians do not dare breathe the R word, lest they be accused—however wrongly—of trying to pull the plug on Grandma. But the need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate. Everyone sees it but no one wants to talk about it. At a more basic level, Americans are afraid not just of dying, but of talking and thinking about death. Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health-care system will remain unfixable.

Compared with other Western countries, the United States has more health care—but, generally speaking, not better health care. There is no way we can get control of costs, which have grown by nearly 50 percent in the past decade, without finding a way to stop overtreating patients.

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But how do you decide which treatments to cut out? How do you choose between the necessary and the unnecessary? There has been talk among experts and lawmakers of giving more power to a panel of government experts to decide—Britain has one, called the National Institute for Health and Clinical Excellence (known by the somewhat ironic acronym NICE). But no one wants the horror stories of denied care and long waits that are said to plague state-run national health-care systems. (The criticism is unfair: patients wait longer to see primary-care physicians in the United States than in Britain.) After the summer of angry town halls, no politician is going to get anywhere near something that could be called a “death panel.”

There’s no question that reining in the lawyers would help cut costs. Fearing medical-malpractice suits, doctors engage in defensive medicine, ordering procedures that may not be strictly necessary—but why take the risk? According to various studies, defensive medicine adds perhaps 2 percent to the overall bill—a not-insignificant number when more than $2 trillion is at stake. A number of states have managed to institute some kind of so-called tort reform, limiting the size of damage awards by juries in medical-malpractice cases. But the trial lawyers—big donors to the Democratic Party—have stopped Congress from even considering reforms. That’s why it was significant that President Obama even raised the subject in his speech last week, even if he was vague about just what he’d do. (Best idea: create medical courts run by experts to rule on malpractice claims, with no punitive damages.)

But the biggest cost booster is the way doctors are paid under most insurance systems, including Medicare. It’s called fee-for-service, and it means just that. So why not just put doctors on salary? Some medical groups that do, like the Mayo Clinic, have reduced costs while producing better results. Unfortunately, putting doctors on salary requires that they work for someone, and most American physicians are self-employed or work in small group practices. The alternative—paying them a flat rate for each patient they care for—turned out to be at least a partial bust. HMOs that paid doctors a flat fee in the 1990s faced a backlash as patients bridled at long waits and denied service.

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One place to start is to consider the psychological aspect of health care. Most people are at least minor hypochondriacs (I know I am). They use doctors to make themselves feel better, even if the doctor is not doing much to physically heal what ails them. (In ancient times, doctors often made people sicker with quack cures like bleeding.) The desire to see a physician is often pronounced in assisted-living facilities. Old people, far from their families in our mobile, atomized society, depend on their doctors for care and reassurance. I noticed that in my mother’s retirement home, the talk in the dining room was often about illness; people built their day around doctor’s visits, partly, it seemed to me, to combat loneliness.

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Other initiatives ensure that the elderly get counseling about end-of-life issues. Although demagogued as a “death panel,” a program in Wisconsin to get patients to talk to their doctors about how they want to deal with death was actually a resounding success. A study by the Archives of Internal Medicine shows that such conversations between doctors and patients can decrease costs by about 35 percent—while improving the quality of life at the end. Patients should be encouraged to draft living wills to make their end-of-life desires known. Unfortunately, such paper can be useless if there is a family member at the bedside demanding heroic measures. “A lot of the time guilt is playing a role,” says Dr. David Torchiana, a surgeon and CEO of the Massachusetts General Physicians Organization. Doctors can feel guilty, too—about overtreating patients. Torchiana recalls his unease over operating to treat a severe heart infection in a woman with two forms of metastatic cancer who was already comatose. The family insisted.

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Our medical system does everything it can to encourage hope. And American health care has been near miraculous—the envy of the world—in its capacity to develop new lifesaving and life-enhancing treatments. But death can be delayed only so long, and sometimes the wait is grim and degrading. The hospice ideal recognized that for many people, quiet and dignity—and loving care and good painkillers—are really what’s called for.

Conservatives have said for a long time that we need tort reform, as the author agrees. We also agree that many times there are way too many tests run, a byproduct of the malpractice suits against doctors. Fix one and the other will fix itself.

But then the author ventures into the real meat of his story. People just need to learn to die and get out of the way.

But the thing is we DO NOT want the government making that decision. If a person wants to die and stop treatment that should be up to them, no outside entity or bureaucrat should make that decision and NO encouragement to end their life should be given.

What should we expect with a kind of system the Newsweek author wants?

I want you to say a prayer for Jayden this morning. Who is Jayden you ask? He is the son of Sarah Capewell, a mother in Britain whose baby boy was born too early. Jayden, born 21 weeks and 5 days into Sarah’s pregnancy, was denied life-saving care by a government system which decided arbitrarily he was unsustainable; decided it was not in his ‘best interests’ to survive.

Had Jayden been born just two days later, doctors would have given him the care he deserved. Instead, based on statistics and numbers, Sarah was told there would be no oxygen administered, no treatment rendered. Doctors did not care his tiny heart was beating strong or that he was breathing on his own. It didn’t matter, because a board somewhere who had never met Sarah or Jayden decided that her baby was not worth saving, nor could the costs be justified in an already burdened public medical system. Jayden is a beautiful baby boy and his mother loved him so.

I know his mother loved him. I also know the torture and horror and hope she had. I know exactly how she felt the instant her son was born. I know the screams and begging in her head as she wondered his fate over the first few hours of his life. But there is a part of her story I don’t know: I don’t know what it would have felt like to have to doctors refuse my child care. I don’t know the heartbreak of holding my baby while no one would help, until he struggled for and took his last breath.

Michelle Moore, the writer of the above post, gives an example of a baby who was born just as prematurely as Jayden….her own.

It didn’t take long for her to become the darling of the NICU. All the nurses loved her. 18 years ago it was unbelievable a baby this early and this tiny would survive. They cared for her gently. They held her hand; they soothed her when she cried. They all pulled for her to make it thru the first 72 hours; later, the first week.

Her eyes were fused shut; she was like a puppy. She didn’t open them until more than two weeks after she was born. Thankfully the wonderful nurses documented it for me. She just couldn’t open her eyes while I was there, but during one of the few times I went home to steal a nap or a shower. I will never forget sitting there for 15-18 hours every single day … just willing her to live with my mind.

My mom always encouraged strength in me; my will is as unbending as Kelsey’s. She lived because she was born strong and willful and because I wanted it so badly.

The truth is she lived because she got the care every baby deserves. Like Jayden, Kelsey’s saving grace was her strong heartbeat and lack of any serious defects, tested for and rejected over and over in the first several hours after her birth. Like Kelsey, it is very likely Jayden only needed the opportunity to grow, to get stronger. He probably would have required oxygen for a while, but more than anything he just needed the opportunity to “finish.” I have no doubt Kelsey would not have lived for two hours, breathing on her own after birth. She had problems all the way up until she went home with keeping her oxygen right, but never did they tell me, “We give up. It’s just not in her best interests to keep going.”

And 18 years later that premature baby is graduating high school. Read the whole post, its well worth it, and gives us more then enough reasons to fight back against the kind of health care Obama and company wants us to have.

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Would vegans eat Soylent Green? Just wondering.

They wouldn’t let her?

She can leave the facility AMA and then Evan can starve her if that’s what she really wants. That would free up a bed for someone who is in need for one.

As always, Thomas is full of crap.

Conservatives have said for a long time that we need tort reform, as the author agrees. We also agree that many times there are way too many tests run, a byproduct of the malpractice suits against doctors. Fix one and the other will fix itself.

Curt, We’ve had the type of tort reform the conservatives advocate here in California for 30 years: Drastic limits on pain and suffering (only $250K). Texas passed a similar law a few years back. There isn’t one iota of evidence that this has in any way reduced “defensive medicine” tests or lowered costs of health care to patients or insurers. Any savings in malpractice premiums has just been pocketed. You can’t lower pain and suffering lower than $250K. How would you feel if you had one bad kidney and one good one and the surgeon removed the good one, condemning you to a foreshortened life hooked up to kidney machines for 5 hours 3 or 4 times a week, while you wait for a transplant, which will require you to take powerful immunosuppressant drugs for the remainder of your (foreshortened) life. You think you don’t deserve a measly $250K for your troubles?

With regard to end of life counseling (“death panels”), no one understands that the most common situation where this comes up is in patients with terminal cancer, who have already failed several forms of the “best” chemotherapy. Oncologists can easily just keep writing orders for infusion chemotherapy, which only makes the patients feel worse, but which makes the oncologists money, or they can spend an hour, having a serious discussion with patients about the realistic likelihood of benefit and the (delicate and often psychologically painful) alternatives. Thanks to Palin, the oncologists will be more likely to just keep pushing the drugs, taking the money, and running.

It’s always easier and more profitable to treat than to counsel. In everything from common viral upper respiratory infections (where antibiotics don’t do anything to help) to cancer. Palin wants to keep it that way, and it looks as if she’s succeeded. I think it’s a tragedy.

– Larry Weisenthal/Huntington Beach, CA

Curt, Newsweek’s Thomas is being more than misleading when he stated patients wait longer for primary care appointments here than in Britain and Canada under their NHS systems. He is referring to the very real complaints with our Medicaid Managed Care plans in state after state, which are as bad as the Brits. Medicaid is owned by the Federal goverment, run by the States and politically contracted out to “approved” providers; it is not the American system, but is the sociallized system. Newsweek BS’s when it makes believe Medicaid problems are not sociallized medicine at their worst.

My wife Maril;yn Morrissey died on August 18 2009 of starvation and overdosing of morphine by the orders of a hospice doctor.She had been suffering from pancreaic cnacer, but was on an experimental vaccine Telomerase peptide now in phase III clinical trials in the UK. The vaccine was working. Her tumors were regressing and her pancreas had shrunk. Unfortunately, she had continuos nausea which her doctors treated with Fentanyl a very powerful synthetic opiod, and with morphine sulfate. unknow to her family these sedatives depressed her nervous system , caused her to sleep for long periods ,slowed down paracelsus in her intestines and reduced her appetite, among other effects. Her hospice doctor announced that ehr organs were shutting down and estimated that she had 24 hours to live at most. After several days in dawned on us, her family, that her organs were fine, but by that time it was too late.She no longer could swallow or eat enough to survive.The lack of food had made it impossible to save her, even though she was about to become one of the few people in history to recover from stage 4 pancreatic cancer.Had we been a little smarter we would have told the Hospice people to get out of our sight and she would be here today.We werent smart enough to fight off the attempts to sedate her to death,a tragedy from which we will never recover.
But now try to imagine tens of thousands of these doctors with the legislative and governmental authority to command or deny care.Are they smart enough to know who can be saved and who cannot? Not on your life or on the lives of your loved ones. As one who has suffered from a very limited dose of a death panel, do not let this happen.

But now try to imagine tens of thousands of these doctors with the legislative and governmental authority to command or deny care

I am very sorry for your loss, but this is not the “fault” of the hospice system, it is an isolated failing with this particular patient. I apologize in advance for the seemingly insensitive tone of what is to follow, but you are using the case in question for the purpose of making sensational accusations, which simply have no foundation in reality.

A hospice is not a one-way ticket to death. A hospice is a place where patients are cared for and made comfortable, once they have decided to forgo further treatment. Patients may enter a hospice, change their minds and come out of the hospice, at any time of their choosing and their family’s choosing.

The first thing that I can say about this case is what in the world was the patient doing in a hospice if her tumors were regressing on treatment? No one has the power to order a patient into a hospice; not now and not in the future. Where in the world do you get the stuff about doctors with the “governmental authority to command or deny care?” That’s never going to happen. It’s scaremongering of the worst kind. What any insurance plan can do is to refuse to pay for treatment on the grounds that it’s not medically necessary, according to the provisions of the insurance, whether private or public. But this sort of thing (denying payment for treament) is much more common with private sector insurance than with Medicare, and it’s a far easier task to challenge Medicare payment denials than private insurance payment denials. And the patient would always have the option of paying for care himself/herself, either out of pocket or with supplemental catastrophic insurance.

Getting back to the patient in question: Why was she in a hospice, if she was really responding to treatment? Who made this decision? You don’t put a patient in a hospice to treat nausea, when they are responding to treatment, for goodness sake! And you certainly don’t treat nausea with Fentanyl and morphine! These drugs make nausea worse! (I suspect that the patient was receiving these drugs for pain relief — these drugs are powerful pain relievers and are NOT anti-nausea medications — which makes me also believe that she wasn’t responding to treatment, which would be consistent with the decision to enter a hospice).

Another observation: One doesn’t need to be in a hospice to have one’s death hastened by Fentanyl and morphine.

– Larry Weisenthal/Huntington Beach, CA