In a follow-up to her “Death Panels” posting, Mrs. Palin has a heavily footnoted explanation as to why they aren’t as far-fetched as TGL’s supporters would have you think.
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- August 13th, 2009 at 10:23 am
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And it’s still far-fetched.
August 13th, 2009 at 10:40 am
I like your new gravatar fuster, although I can’t imagine why you would want to risk being perceived as a nugatory newt of negativity. Did you select it or did CK assign it to you?
On a more serious note, I suspect Palin launched her sure to be attacked death panel comment with a plan in mind to release the footnoted article Bruce linked to.
August 13th, 2009 at 10:52 am
My heroes have always been gremlins.
August 13th, 2009 at 10:54 am
@Sully – An Agnew paraphrase with a Gingrich kicker.
You’re in a bad place, maaan.
August 13th, 2009 at 10:58 am
fuster, the referenced article is some 14 tiny-type paragraphs long with a dozen footnotes!
Your refutation is one anemic pass of “The Wand of Far-Fetchedness”?
What other trick of Harry Potter’s will you deploy here next? “The Cloak of Invisibility” so as to make her argument vanish altogether?
August 13th, 2009 at 11:35 am
@Joe NS – After having read those 14 paragraphs, I continue to say that Palin’s statement is far-fetched.
The entirety of her argument consists of taking something and saying that it’s a possibility, and moving immediately from there to positing it as both the intent of the provision and a likely outcome.
That she doesn’t know anything about these consultations as currently practiced seems clear. That she would posit malign intent to the people who would be responsible for providing them is reprehensible.
August 13th, 2009 at 11:44 am
There is malignity and then there is malignity. What we may reasonably expect hereinafter, on the basis of the experiences of countless hapless citizens all over the world, is the malignity of the bureaucrat, which is to say, indifference, indifference to what threatens the bureaucratic mission, which is preeminently health-care cost reduction (by the Democrats own admission), by their ominously placing language authorizing the panels in such a bill, by the remarks of the likes of Ezekiel Emanuel, by further alarming and equivocal remarks of the President. The language of 1233 does not say the consultations are voluntary; neither does it say that they are involuntary. That is artful, I will admit it. It is also, along with everything else, reasonable grounds for apprehension about future.
developments in the interests of cost-cutting.
The Federal government is designing a bill in which the Federal government, if the thing is passed as is, will likely end up with the responsibility of paying for the health care of at least a hundred-million people. To assume that these consultations will not become mandatory by something as simple as a majority vote, or to dismiss the expectation that they will as “farfetched,” is foolish, to say no more, and seems deliberately to ignore experience, common sense, and a very real menace under a pathological compulsion to provide universal health care come what may.
August 13th, 2009 at 12:16 pm
@Joe NS – Do you have any idea what happens routinely in hospitals when doctors write a consultation order?
August 13th, 2009 at 12:20 pm
What is the sense of the word “order” here?
August 13th, 2009 at 12:21 pm
@Joe NS – The physician orders that an appropriate staff member be sent to consult with a patient.
August 13th, 2009 at 12:32 pm
@fuster – rather irrelevant – or perhaps what some of the designers of the bill have in mind. As someone who has been on the other end of such consultations, I can tell you that there can already be an in-built sense of quiet coercion to “pull the plug on grandma” as our TGL so poetically put it.
The institution of a regime that by inches moves toward backdoor euthanasia and population control is something that we have every reason to resist. Moreover, the centralization of such a regime, or provision of a structure and means for centralization under the government, is something it’s our duty to resist. There is nothing that institutional man in a position of power cannot someday persuade himself is for the best.
Palin did not accuse anyone of “malign intent.” She can fairly be judged to have accused the President and All the President’s Persons of not realizing how “downright evil” the implications of their policy are. The entire problem comes down to the fact that bureaucrat, especially the bureaucrat-believer, always believes that his or her decisions serve a higher purpose or greater end – whether it’s the higher goal of purifying the race, bringing about social justice, or simply ensuring that the bureaucracy survives and that its rules are respected.
August 13th, 2009 at 1:00 pm
Question for a town hall.
The health care reform bill provides reimbursement for end of life counselling; and it provides funding for outcomes research. How will the outcomes research specialists be evaluating the end of life counselling results? Will they be evaluating them merely on how quickly they result in the government’s desired outcome or on their overall cost effectiveness in achieving the government’s desired outcome?
August 13th, 2009 at 1:06 pm
And when Dr. Emanuel’s writings are examined, some, such as those in the Lancet are troubling:
August 13th, 2009 at 1:18 pm
fuster, #10, quite so, and as I thought. The staff member is obliged to follow a doctor’s “orders,” up to a point, but the patient is ordinarily under no such obligation to cooperate.
The disagreement between us to this point, as far as I can tell, proceeds from your repeated insistence that the concerns raised in Palin’s letter are “farfetched.” At least as regards Sec. 1233 and apart from other objections to “Obamacare,” my worry is what may happen in the future, as I think should be clear by now.
Permit me an illustration from my own experience with private medical care. Some time ago I went into a hospital for what turned out to be a seriously inflamed cyst in the sigmoid colon. By and by I came to the attention of a surgeon, a very genial sort, who strongly recommended removing a portion of my colon, which entailed, he pointed out, a lengthy stay in the hospital and, with high probability, a second surgery a few months later.
I agreed to the surgery, but when a few days later they were literally wheeling me to the OR, I had a change of heart. There would be no surgery, I told the doctor, and I gave him my reasons why. He warned me that I would probably be back in the hospital within six months. I said I’d take my chances. I was acutely aware, you see, that a surgeon was recommending surgery. And I say that without in any way attributing a “malign” motive to his recommendation. At the same time it seemed to me undeniable that he was not utterly indifferent to what the course of my treatment should be. He had his interests. I had mine, and because his word was not binding on me, I prevailed. That was three years ago and, touch wood, I have had no recurrence of the symptoms that brought me to the hospital.
There is a parallel here, and by no means a far-fetched one, between my situation then and what I fear must become the case for elderly patients vis-a-vis the so-called death panels. The Federal government, like my doctor, will not be indifferent as to the outcome of such a consultation, mandatory or not. One outcome may lead to dramatically reduced costs. That outcome will seem reasonable to a government-compensated physician and far more than reasonable to the bureaucrats monitoring these exchanges. The other possible outcome, where the patient declines consultation, well, not so much. It is in the government’s clear interest, therefore, to make them mandatory sooner rather than later. Malignity, other than the usual bureaucratic tendency to indolence, inertia, and indifference, has little or nothing to do with it. At that point, the freedom to, in effect, tell the doctor, no thanks, a freedom I possessed, will be gone. The ailing elderly patient will then be exposed to a host of pressures that no one should have to bear. I don’t need to list them here.
August 13th, 2009 at 1:18 pm
@CK MacLeod -There’s a less than zero increase in coercive pressure involved in the consultations.
The whole rotten argument rests on the assumption that the people giving the consultation have an interest in the patient’s response. That’s not currently the case and wildly unlikely to be changed by the bill.
If you want to make the argument that having government bureaucrats making decisions about payment for care is different than having for-profit insurer bureaucrat so doing, that’s one thing.
If you want to make the argument that the increased concentration of government power is likely to prove insidious, that’s another.
I can appreciate that one.
But neither of these things has a damn thing to do with consultations with patients nearing death.
August 13th, 2009 at 1:27 pm
fuster, have you read this section of the bill? There’s nothing about “nearing death” in the language setting up these consultations. That they may easily become such is the whole disagreement between us.
August 13th, 2009 at 1:31 pm
@Joe NS – Joe, always a good idea to second-guess the cutters.
After consulting with the surgeon, and then refusing treatment, it seems that you were able to escape being etherized and laid out on a table. There is no power to make people opt for a specific treatment or for a DNR tag.
That ain’t gonna change until our entire system of government changes.
Even then, it won’t change until the government changes all the people in medical care.
Even then, they’re still gonna have to finish changing the very basic idea people have that they want to continue to live.
August 13th, 2009 at 1:35 pm
I do not think that “want[ing] to continue to live” is an idea or anything remotely like an idea, basic or otherwise. What would have to be changed here is considerably more complicated.
August 13th, 2009 at 1:39 pm
@Joe NS – Just as there is no language stating that soldiers going into combat are nearing death, they still get asked if they want to make out a will or write a letter home.
Take out that “easily”, Joe, because that’s unprovable. It’s more fair, IMO, to say that it’s a worrisome possibility. Even then, a whole lot of stuff has to happen for it to become much of a possibility.
August 13th, 2009 at 1:41 pm
Actually, the consultations don’t take placewhen the patient is nearing death. They take place at specified intervals (5 years I believe) and at entrance into Medicare.
August 13th, 2009 at 1:45 pm
fuster once again has no idea what he is talking about. He has zero idea how the system works, even if he is inside of it.
The current language as it exists (who knows what it will end up looking like) does not require a person to agree to die under certain circumstances.
What it does do however is pay and – by default – recruit doctors to start these discussions, and typically it will be at a time a patient is moving into some sort of medical distress. At this point the patient is most vulnerable and in general we look at doctors as gods anyway. There will be no pushback from most patients. These legal treatment decisions should be discussed with a legal representative. But that is not what reform means now. You will discuss your legal rights about treatment, with a doctor who has no legal training and whose motivation may not be in your best interest, but in what he can reasonably expect to be reimbursed for. We already see some interesting doctor behavior on medicare smoking counseling allowances. The only expectation for the placement of this provision is to allow for people to agree to lmit future treatment in order to ration care. This is consistent with what already happens with any government health system about appropriate treatment regimines as well as age/condition matrixes which determine if you will be treated at all.
fuster, you have zero idea what you are talking about.
August 13th, 2009 at 1:55 pm
Bruce – go back to the Palin piece for the details – but the consultations take place every 5 years OR if there has been a significant change in the health of the individual.
Appreciate it now in all its splendiferous implications, because you may have no or very limited choice about the matter later on.
That really is the starting point of my opposition. Even if I believed every bit of BO’s sales pitch and was convinced that the plan would radically improve health care nationwide while lowering costs and causing unicorns to sprout from my elbows etc., I’d still strongly oppose it on these grounds.
I don’t have time right now to expand on this point, but there’s safety in a patchwork hodgepodge.
August 13th, 2009 at 1:56 pm
@JEM – JEM, I guess I don’t know anything.
I actually think that any doctor discussing treatment options has a really good idea of the legal implications of the discussion.
Perhaps the people that you know look upon doctors as gods, I can guess at your meaning about the opportunity for misuse of trust by persons in an authoritative position, but anyone (except myself) might realize that the god-like impression is a fleeting one.
There’s a very human reaction to form a feeling of resentment toward anyone offering bad news and a tendency to seek another, more hopeful, opinion.
Of course, discussing treatment options with a medical professional is less wise than having the options designed by insurers or lawyers.
August 13th, 2009 at 2:22 pm
Interesting. Sec 1308 covers “Marriage and Family Counseling”. A lot of insurers offer this already (including mine) but as a REQUIREMENT?
August 13th, 2009 at 2:55 pm
Mickey Kaus has some interesting thoughts on the subject.
Key grafs:
Sounds a lot like a death panel.
August 13th, 2009 at 3:44 pm
I think the panel that decides on proper treatment for each medical condition is the real death panel here. After all, in Britain your doctor doesn’t tell you that there are these five possible cancer treatment, but you can only have this one; instead, the doctor tells you that there is just one cancer treatment appropriate for you. You the patient will never know what you missed.
August 13th, 2009 at 6:42 pm
There is an understatement if there is such a thing.
August 13th, 2009 at 6:54 pm
fuster – no, they are talking about end of life documents – living wills, where to end treatments, etc. It has very little to do with the actual issue of whether or not you should receive treatment for a condition being addressed. That is a legal discussion, not a treatment discussion. It is all about rationing care. I think you are seeing something else about this provision that isn’t its intent. I wish it were only as you suggest. The language and reimbursement scheme unfortunately suggests something else completely. It suggests please go off into the corner and die and quit using up healthcare.
August 14th, 2009 at 1:57 pm
Let’s look at the One’s own words again:
August 14th, 2009 at 6:51 pm