White Coat Underground

Lies, damned lies, and Republicans

A short while ago I wrote about a fear-mongering piece in the Wall Street Journal, written by Betsy McCaughey. It turns out that my imagination was insufficient to comprehend the scope of her audacious mendacity. McCaughey is one of the thugs pushing the lie that the health care reform bill would mandate euthanasia counseling. Her deceitful comments were picked up by Rush Limbaugh and others, and spread across the wackosphere. So what did she say?

The health care reform bill “would make it mandatory — absolutely require — that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.”

The only thing correct about that statement is the spelling. The actual bill is far less sinister. It allows physicians to be paid for counseling regarding some of the problems of aging (emphasis mine):

..the term `advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include–

`(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

I already provide my patients with counseling regarding these issues, but I can’t get paid for it. What the proposed bill would do is make it easier for me to talk to patients once in a while by actually paying me for my time and expertise. I’ve bolded some of the key points above. To think there is anything sinister about this is to be completely ignorant of the problems older people deal with every day.

As you become older, illness, infirmity, and death become more present concerns. Doctors can help guide older folks through this. For example, I encourage my patients (even before they are “old”) to have an advanced directive and to assign a health care proxy. Usually this will involve a written document that states their medical wishes and assigns a specific person to make decisions for them if they are unable to do so themselves. I also discuss various end-of-life issues, such as how to approach fatal illnesses. Hospice care is often covered by insurance, and offers great services. To get hospice care, you generally have to have a prognosis of less than six months. I’d rather refer someone and have them “flunk out” by living too long, then have them suffer and die without support.

I also talk to people about how to approach fatal illnesses in the hospital, including how to approach decisions about mechanical ventilation and CPR. These discussions are rather involved and time-consuming, but necessary for good care. I certainly wouldn’t mind being able to bill for it.

There’s a lot to be concerned about in the proposed health plan. An honest debate is good and necessary, but poisoning the waters with fear-mongering lies is anti-democratic and just plain evil.

Comments

  1. #1 Mu
    August 6, 2009

    We all know that you evil doctors only make money by by needlessly prescribing harmful treatments and painful tests to the elderly. So of course any end-of-life counseling you do will be for immediate euthanasia to maximize your profits.
    These guys need to get their conspiracy theories straightened out.

  2. #2 Rev Matt
    August 6, 2009

    I work in a federal facility. There are a lot of Reservists using Tricare, there are a lot of former military that use VA. They all are offered, as Mike Dunford notes, the option of private health insurance or government. They mostly choose government and have far fewer complaints or problems than those of us in the ‘free market’ system where our employer chooses our healthcare for us based on what’s best for them. I’m fortunate that my employer values their employees and provides us with very good coverage, a lot of the contractors I work with aren’t so lucky.

    The proposed plan as I understand it may not be perfect but I would be hard pressed to be convinced it could be worse than what we have now.

    Also, “The only thing correct about that statement is the spelling.” is definitely a keeper.

  3. #3 D. C. Sessions
    August 6, 2009

    As you become older, illness, infirmity, and death become more present concerns. Doctors can help guide older folks through this.

    And that’s not to say the young are immune. I recently lost a (very impressive) colleague to a stroke. She was 31. Her parents had to make the EOL decision.

    Don’t do that to them.

  4. #4 phishstyx
    August 6, 2009

    Also, “Audacious Mendacity” would be a good band name.

  5. #5 PalMD
    August 6, 2009

    So would “phishstyx”

  6. #6 Laura
    August 6, 2009

    This is good to know. However my mom told me that the bill also says that if an elderly person is diagnosed with a serious illness they are automatically going to be sent to end of life counseling to plan how to die in lieu of treatment. That isn’t true if the disease is treatable is it?

  7. #7 Mike
    August 6, 2009

    Mu: The Drug Companies want people to pay. The .Gov is the one changing it to euthanasia. Duh!

  8. #8 Laura
    August 6, 2009

    Oh and when I say treatable I mean it has a high probability of controlling or curing the illness. Not something like end stage liver cancer or anything. The reason I ask is because my parents fear the idea of rationing not really the end of life counseling both my parents have living wills and advanced directives and everything. Any insight is appreciated.

  9. #9 red rabbit
    August 6, 2009

    @Laura: what a horrid thing for someone to say. I haven’t seen this bill, but I imagine nobody would vote for something like that- remember, your congressfolk are likely heading for “elderly” fairly rapidly.

    I live in a place with public healthcare. I am a physician. Nobody has any control over what my patients and I discuss. They are not required to take my advice.

    My job is to spell out their options and recommend a good course of action. Their responsibility is to ask the questions they need to have answered, and make the final decisions.

  10. #10 MyaR
    August 6, 2009

    (Brain hurts from trying to figure out what Phish + Styx would sound like.)

    My father has been under hospice care for over a year. My mother discussed ending hospice care with them, but they recommended that he absolutely should stay under hospice. They’ve been my father’s best advocates at his nursing home and given my mother a tremendous amount of support. They were also lucky enough to have doctors who were willing to take the time to discuss their options and also recommend an excellent attorney that has helped my mother remain financially solvent, albeit barely. Her attorney has an RN on his staff who has also been a great advocate, particularly with the obnoxious nurse who kept wanting my mom to insist my dad’s anti-psychotic be stopped.

    This is also a timely reminder that my husband and I need our discussed wishes formal, even if we are still in our 30′s.

  11. #11 PalMD
    August 6, 2009

    Laura, anyone who told that to you is either an idiot parroting something they heard, or lying to frighten you.

  12. #12 PalMD
    August 6, 2009

    Laura, the text being twisted is probably this one, that allows for more frequent counseling if health changes:

    (B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice progr

  13. #13 Laura
    August 6, 2009

    Thanks redrabbit and Pal. I didn’t think it would come to that but my parents watch Fox and swear this is going to happen. I personally don’t see anything bad with end of life counseling and I feel that doctors should be paid for there time so I don’t see a problem with this part of the bill at all.

  14. #14 Donna B.
    August 6, 2009

    As PalMD knows, I’m one of his more conservative readers. That doesn’t necessarily translate to one of his more stupid readers…. I HOPE!!

    I’ve experienced end of life care with my mother and several step-mothers. It’s going to happen soon (within the next 10 years with my father). Frankly, it could happen that soon with my husband.

    Hospice care is the best thing since sliced bread, IMHO. It allows an individual and their family to decide how death will occur. In some cases, it will be in a nursing home or other hospice care facility, in some cases it will be at home. The wonderful thing about it is choice.

    Frankly, while I think doctors have a role in presenting evidence that leads to a particular choice, and I certainly think they should get paid for their advice (what else are they paid for??), I don’t think a doctor should have any decision-making authority (nor do I think PalMD suggests they should).

    As much as generally despise social workers (I worked with them for 10 years, so give me some slack here), they are the best qualified to determine whether someone should receive home hospice care v. an institution. It boils down to money, folks.

    No amount of insurance could cover the costs of care that one of my step-mom’s received. Yes, there were bi-weekly regular visits by nurses and, if the family requested, more often.

    What Medicare could not pay for was the 24 hour care my step-mom received by both family members and hired help. Every effort possible was made to insure that my step-mom lived in the atmosphere she had created. This meant, among other things, that a noon meal be served at 11:30. For uncountable years, she had provided this to her husband and her son. It meant a great deal to her to partake of this meal.

    Her son, and his son, frequented the table where their mother and grandmother could barely acknowledge their presence, but with a sense that she appreciated it.

    The gradual moving of my step-mom’s preparing of that meal to her participation in its continuance is one of psychological importance. It contributed to her well-being to sit among the participants in that meal.

    What I am trying to convey is that hospice and the care of a loving family — even when it’s not conducive to a lengthened life is important. I don’t doubt that my step-mom’s life could have been prolonged at least a month by extraordinary medical intervention. What I know for sure is that it would have not been worth it.

    My Mom died suddenly as a result of a blood clot from surgery for a broken ankle. For me, the opportunity to care for my step-mom for several months makes up for the time I didn’t get with my mom. My caring may have been medically meaningless… as in sharing a cup of tea when every one else decided she couldn’t hold a cup and drink from it… but they mean a lot to me, and I hope they meant something to her.

    I have another step-mom now. My Dad keeps outliving his wives. (If I were an elderly woman I wouldn’t marry him!)

    Because of my husband’s habit of having cancer, and my Dad’s habit of out-living women he marries… I have a more than normal interest in end-of-life care.

    Tomorrow, I will attend, with my father, step-mom, and brother a meeting with top hospital administrators about the care that my father and step-mom got at their facility. One purpose of this meeting (from the hospital standpoint) is to prevent a malpractice suit. Another, from my point of view is to facilitate patient care. It’s going to be an interesting meeting.

    While my brother is of the opinion that a lawsuit is the quickest way to implement reform, I am of the opinion that patient input is the best way. I honestly think that some care-givers have no idea how they come across to patients. And sometimes that is as crass and uncaring at best.

    So… am I right or is my brother right? I am certainly not a disinterested party here. I want to be right!

  15. #15 PlainRN
    August 7, 2009

    I am trying to read and understand the 1000 + pages of this bill. I support some discussion concerning living wills, etc.

    I am not certain about this portion of the bill:
    “(I) ensures such orders are standardized and uniquely identifiable throughout the State;” (p 427)
    and
    “(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and (p428)

    Appears that a standard may be set, education provided for all medical professionals for certain disease states and will be followed, regardless of patient/family desires.

    from Page 427 – 428 of bill

    “(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—

    “(I) ensures such orders are standardized and uniquely identifiable throughout the State;

    (II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;

    Page 428:

    “(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

    “(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physcians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

    Also, what is a tell me about Advance care planning clearinghouses?

  16. #16 PlainRN
    August 7, 2009

    MyaR

    I am sorry you dad is ill. Both of my parents have left this earth.

    Your hospice agency is paid $100/day to provide care for your dad.(that was the rate several years ago) They have to pay for all medicine related to his illness. They do not want your dad to come off service. $$$$

    Unfortunately, many companies have become extremely wealthy by opening hospice agencies. They are part of big business medicine. All that is necessary for a patient to be admitted to a hospice service is for a physician to say this patient could die within six months.

    Some patients do come off hospice and if that is what your family wants, it is your right. Just be sure you are making the correct decision. Other patients do not get it early enough to help the family and patient during the last days. Unless there have been changes, even if you come off you can go back on service.

  17. #17 Ranson
    August 7, 2009

    PlainRN,

    I don’t have the bill in front of me, but I’ve taken on the role of “no, it doesn’t say that” on another forum, so I’ve spent a lot of time on it.

    The first couple of statements seem to talk more about a standardization of forms that they might be recognized easily by medical professionals. For example, during my mother’s end-of-life care, she had a “Do Not Resuscitate” order posted in the house. This reads to me more like making something like that (or its opposite number) a standardized form that is easily recognizable, as they are sometimes overlooked in the heat of the moment. It reads to me like something that is done with the assistance of the patient and the patient’s goals. It also appears that such orders will be easily transferrable between facilities, etc. I see nothing disturbing here.

    It doesn’t look like a doc is going to make the decision, outside of a responsible party not being available.
    Everything there screams “counseling as to options”, which responsible doctors already do, because extreme measures to sustain life just aren’t feasible sometimes. My brother and I had to fight with some elderly aunts and uncles to end the life of my grandmother, who at 98 had a bout of pneumonia resulting in severe anoxia. Her brain was gone, and without constant intervention, she would have drowned in her own lung fluid. One uncle (as the “primary caregiver”) was more interested in continuing to collect Social Security checks for her than her actual well-being, and kept insisting that she could get better. He was steamrolling our elderly aunts into accepting long-term ventilation, constant draining of fluid, everything involved with sustaining a frail, totally nonresponsive shell. We he remarked to the doctor (who was as frustrated as my brother and I) that she “might improve”, the doc snapped and said, “Improve to what, exactly? Her brain is gone; this is the best she will ever be again.”

    That’s what counseling is for. My grandma should have had a DNR long before she ended up in the hospital, just to save her family the anguish of hovering over the bed of a breathing corpse, and having to fight to even let her go.
    It might mandate such counseling, but that’s not a bad thing to me; too many people neglect even thinking about death. To really lessen the impact on those left behind, you have to plan. If you want extreme measures to save your life, I see nothing here saying that’s not an option. I think it just guarantees that the doctor will lay out the consequences for you.

    Nothing in that bill suggests that a doctor will have the power to decide on what kind of end-of-life measures you get, excepting in a case where they’d likely already have it. The docs I’ve known wouldn’t want that authority. Good nonexistent lord, it’s a already psychotically stressful career filled with life-and-death decisions — does anyone really think that they want more potential psychological trauma on their plate? It’s conspiracy thinking; “the government and the doctors and Big Pharma are all in it together to kill off the old folks and save money”. It also runs into some of the same problems of any other conspiracy theory: it requires that all of the actors be absolutely conscienceless, it’s too large to sustain, and it’s a meme pushed by a fringe interest group, and it involves taking small amounts of information out of context.

    This bill was written by beauraucrats for politicians. It’s more likely to be stupid than evil.

  18. #18 catgirl
    August 7, 2009

    However my mom told me that the bill also says that if an elderly person is diagnosed with a serious illness they are automatically going to be sent to end of life counseling to plan how to die in lieu of treatment.

    Sorry to break it to you, but your mother lied to you. People with serious illness will receive counseling so that they can make the choice to not prolong their suffering, if that’s what they choose is right for them. The government will not make that choice for them.

    my parents fear the idea of rationing

    Well, rationing is already happening in our current system. Insurance companies want to provide as little as they possibly can. If they really fear rationing, they should be afraid of their current insurance company. I hope your parents don’t get too sick because the insurance company might decide to kick them off just because they cost too much.

  19. #19 Hospitalist Dave
    August 7, 2009

    I agree with Ranson. States have different laws regarding end of life decisions. In Oregon, where I went to medical school, there are Physician’s Orders of Life Sustaining Treatment — POLST — forms. So once a patient has a discussion(s) with his or hers primary care physician, and the patient — or decision maker — has decided that there should be some limits on resuscitation in the event of a life threatening emergency; the PCP fills out the form and this is posted in the home. It is bright red/pink and is quite conspicuous. If the patient has an arrest, the respondings EMTs are required by law to obey the POLST forms instructions unless the patient or decision maker says otherwise. In Michigan, where I practice, there is no such document. Advanced Directives have no legal standing, and unless the patient or a family member / decision maker intervenes, the paramedics and emergency department will intervene. As a resident I saw several elderly patients with very clear wishes to be DNR-DNI as admits to the medical ICU, on a ventilator. So yes, I think that standardization of these forms is a very good idea.

    In regards to a social worker deciding who is appropriate for referral to palliative care and hospice… WTF!? My social workers are completely irreplaceable parts of the medical team. They are dedicated, over worked, and underpayed. But they rely on me to tell them if someone needs hospice. You see, they went to school to become social workers. I went to school and then residency to be an internist. I know as much of social work as they know of medicine, and trust me, you do not want me to be your social worker.

  20. #20 PlainRN
    August 7, 2009

    Ranson,

    I understand about counseling, and have been involved, at times even the initiator as the nurse in the ICU settings. I was the family member who stepped forward and requested a DNR for my father, and encouraged my brother to stop with my mother.

    But, when you read this bill, there are many questions. As for evil…..I am certainly not accusing anyone of evil. I do however believe there could possibly be some underlying agendas for some. Not necessarily all.

    I understand the pharmaceutical companies support it, but in return they get 12 years on proprietary drugs in place of 8, before generics hit the market.

    The bill was copied in my post. The language is very suspicious…..does not support MD or family making end life decisions, but appears that standards will be set related to certain disease states, and that medical personnel will be educated related to such standards.

    I would like to see improvement in our healthcare system. However, I have taken care of patients from all over the world who have come to the US for their medical care. That speaks volumes to me.

    Truth of the matter is, if you are a Christian one must look at this and see we are approaching a one world order and that US has got to come in line with other nations……..Universal Health Care, and one world currency which is to come.

    This is not a conspiracy theory, but is based on the changes occurring in Israel and bible prophecies from the old testament and new testament. America is at a crossroads. We are transforming for the one world order prophesied years ago.

    Guess I should be Secure In Who I Am RN, and not Plain RN.

    Israeli changes prophesied:

    Pools of water breaking out in desert – already occured along the coast.

    The desert in bloom – already occurred currently producing more crops per acre than anywhere.
    1980 Dead Sea cost was desolate…today it blooms.

    Dead Sea is to be healed and produce fish
    Dead Sea is drying up and dividing into two sections.
    Pools of water exist along the Dead Sea Coast with minnow swimming in their waters.

    Highway out of Egypt to Assyria – Currently being constructed.

    The day when the whole world will stand against Israel is yet to come…….may occur soon.

  21. #21 JustaTech
    August 7, 2009

    PlainRN,
    You have some interesting points about generics and patents, but I must say that I have to hope that you are not ever my nurse for your statements in the second half of your post at #20 terrify me.

    I am not surprised that people come from all over the world for medical treatment in the US, we have many, many specialists for the wealthy and charity treatments for the poor. But I have never thought that we are anywhere near any kind of “one world rule”. People being people, it will take a lot of space colonization for the people of this planet to be anything like “united”.

    And for the record, the desert blooms almost every spring. It’s quite pretty and part of the normal ecosystem.

    Anyway, I will have to check in with my 93-y-o grandmother to see if she has any questions I can answer about this stuff, but as she is quite computer literate, I’m sure she’s already figured it all out. She’s also had a DNR on her nightstand for years.

  22. #22 Tsu Dho Nimh
    August 7, 2009

    C’mon Pal … you know you are just itching to euthanize us old folks. Fess up!

  23. #23 Tsu Dho Nimh, BS, MT(ASCP)
    August 7, 2009

    @15 “”am not certain about this portion of the bill:
    “(I) ensures such orders are standardized and uniquely identifiable throughout the State;” (p 427)
    and “(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and (p428)”

    PlainRN … Arizona recently did that. All EOL directives are filed with the Secretary of State, in a uniform format.

    Everyone knows where to go to get them. The terminology is uniform. The explanations are in plain, reasonably non-technical English to help discussion.

    This should prevent some idiot intern from deciding to start something that the patient’s EOL plan does not want. It should prevent a family member from pitching a hissy fit and managing to bulldoze hospital staff into hooking Granny up to a respirator for a few days that would be torture if Granny hadn’t had this kind of a consultation.

    Yes, it will save money. More importantly, it will save people from needless and futile suffering.

  24. #24 Donna B.
    August 7, 2009

    @19, Hospitalist Dave — I didn’t make myself clear about social workers. AFTER a doctor has said hospice is needed, a good idea, etc – then social workers are the best to decide what kind: in-home or institutional.

    And no, I don’t want you to be my social worker.

    btw – the meeting with the hospital administrators went very well this morning, for both sides. We all left the room on the same side, so I’d call that success.

    I did feel sorry for the nursing supervisor who started crying while apologizing for my step-mom’s fall.

    We patients learned a lot too, about how some hospital systems work. For example, we learned that when we need to call a nurse to be sure to say what we need, as they can get the message to the right person more quickly.

    The director of medical staff explained some of the problems they were having implementing a hospitalist program and contracting with a separate firm for ER physicians. It was quite honest of him to say that these two groups of physicians do not always cooperate in a timely manner and explained how the hospital was working on this problem.

    When we asked whether charges for the x-ray after the fall would be included in the bill, we were told it didn’t matter whether they were or not. Now this was upsetting at first – it seemed like the hospital was not taking responsibility for something they admitted was their fault.

    But we were oh so wrong. That’s not it at all. My step-mom in on Medicare and no matter what tests or procedures or how long she was in the hospital, they were going to paid the same, based on her problem at admission. To my way of thinking, that ain’t right.

    So now I want to know if that kind of payment system is going to be expanded with the proposed health bill.

  25. #25 PlainRN
    August 7, 2009

    JustaTech

    The people I cared for were wealthy, and some were dignitaries, Commander of Air Force, etc. from other countries. The Saudi Royal family was in the US in the late 80s/early 90s getting medical and surgical care.

    There are a lot of charity who do bring poor in for care. Hats off to them. They are true humanitarians.

    As for Israel, they are growing food in the desert.

    United, not in the sense you think. One currency, one facist, socialistic type governance.

    Don’t worry, I will not be caring for you. No longer in that type of nursing setting. But, when I was, I was most competent, compassionate, and the most prominent of patient advocates.

    I do not mean to frighten you, or anyone. Facts are facts.

    READ YOUR BIBLE – A STORM IS COMING. I DON’T KNOW WHEN, JUST THAT IT IS COMING AND THAT MORE AND MORE PROPHECIES ARE BEING FULLFILLED.

  26. #26 LanceR, JSG
    August 7, 2009

    Okay, PlainRN has degenerated from simply misunderstanding portions of the healthcare reform into pure lunacy.

    Healthcare reform leads to one world government? The destruction of Israel? Armaggedon?

    Right. Pull the other one, it’s got bells on it.

  27. #27 daedalus2u
    August 7, 2009

    I wouldn’t stand too close to PlainRN in case God decides to turn her into a pillar of salt for blasphemy and misses. People who preach an early Armageddon are saying that God lied to Abraham when God and Abraham made the founding covenant of the Abrahamic Religions.

    For those of you who don’t remember the Bible, God told Abraham to sacrifice his only son Isaac on an alter as a burnt offering. Abraham took Isaac to the mountain, sent away the others with them, cut the wood and took fire up to the place, Abraham put the wood on the alter, bound Isaac, put him on the wood and raised the knife over him to kill him (Genesis 22:10) and at the last moment an Angel came and told Abraham to stop.

    God then Promised Abraham that for being willing to kill his only son and sacrifice him as a burnt offering, that God would cause Abraham to have as many descendents as there are stars in the sky and grains of sand on the seashore. We know that both of those numbers are on the order of 10^22. So far there have only been about a hundred billion humans, or 10^11. God is no where near to having fulfilled His Promise to Abraham.

    Those who say Armageddon will happen in the near future are saying that God lied to Abraham.

  28. #28 PlainRN
    August 8, 2009

    Ha Ha. Read again. I don’t know when, just that it is coming.

    “READ YOUR BIBLE – A STORM IS COMING. I DON’T KNOW WHEN, JUST THAT IT IS COMING AND THAT MORE AND MORE PROPHECIES ARE BEING FULLFILLED.”

    So you base your coming of Christ on the numbers of chapter and verse. Interesting.

    Back to the bill…..
    I have continued to read. Some of this is good, but the government is given too much power, in my opinion, over the independent insurance companies. In the wrong hands, they could feasibly destroy independent companies.

    Why could we not do a three year trial of this plan in one state, before we totally revamp the entire industry? I am fortunate, I live in a state with a good BCBS company. Insurance of choice by most people. They interact with MDs and listen to their requests.

    Still, looks to me like the government will have too much input on what treatment patients would or would not get.

    Guess I am just a capitalist, at heart.

  29. #29 PalMD
    August 8, 2009

    Hey, I’ve got no problem with good, vigorous political debate, but delusional apocalyptic insanity isn’t useful. Don’t feed the troll.

  30. #30 Laura
    August 8, 2009

    Catgirl

    I don’t disagree. Our system does ration care and I am not against this bill. I just haven’t read it personally. I would like to but 1000 pgs of legalease seems like a daunting task and I haven’t gotten around to it yet. My parents are just very conservative and are afraid of the government controlling their care. I came here to discuss the actual bill not what Fox News and Rush say about it. I am not working and don’t have cable so I only hear what they say about the bill (Fox and Rush) and what I find on the internet. This blog is very helpful and helps put my mind at ease.

    Laura

  31. #31 MyaR
    August 8, 2009

    Just to clarify a little — I am quite sure the hospice service is NOT making money on my father. They do not provide any direct care. They do not pay for any of his medication — Medicare and his insurance do. They are an all-volunteer organization. Now, I am sure not all hospice organizations are like this. Also, if hospice were getting $100/day for his care and had to pay for his medication and medical devices, they would loosing money. Quite a lot, in fact.

    The RN who works with my father made it absolutely clear to my mother that it was entirely her choice whether or not to take him off hospice care. She recommended not because she knows that the assistance she provides can not be replaced by the average person. My mother’s attorney, a specialist in elder law, also recommended he stay under hospice care. Even though mother spends several hours at the nursing home every day, having another advocate there regularly is just another assurance that any type of abuse or neglect is detected immediately. Also, being under hospice care is about the best assurance that advance directives will actually be followed, even if they can’t immediately get in touch with my mother for some reason.

  32. #32 Inquisitive Raven
    August 10, 2009

    So, has anyone else noticed that in order to make this scare tactic fly, the wingnuts have to completely ignore the parts about medical proxies and powers of attorney?

  33. #33 Peter Thomas
    August 12, 2009

    Hi, I’m Australian. Sorry to be blunt, but the debate gripping your country is farcical.

    Farcical in an obvious way because the Republican demonisation of the proposal is so off-the-scale that it should only belong in an absurd comedy, and yet with some of your constituents it actually gains traction. And farcical in a less obvious way because if you could step outside your own mother culture for a moment you would wonder why there is even hesitation.

    At the heart of this are two dogmas: (i) that *everything* should be run by the free market, and (ii) that America has nothing to learn from any other country. ( I heard a congressman say that there is no other known system that can deliver effective health care. That can only come from a lack of looking.)

    I live in a country with a single-payer (government) health system. There are private hospitals and private health insurers. We have choice. The existence of “socialised medicine” does not mean that we salute statues of Stalin, drive tractors to work, or squabble over the communal cow. Life here is much the same as life in the US, except that we don’t worry much about our health. If you need a doctor, if you need a hospital, if you need an MRI scan, you can get it no matter who you are. The only thing we have to give up is a little bit of tax (not that much really) and a little bit of dogma. I have met only one Australian in my entire life who thinks that’s a bum deal. She thinks every road should have a separate toll charge so that only people who use that road pay for it. I guess, to be fair, once the road is fully paid for it should be ripped up, rebuilt, and re-tolled so that no-one ever gets a free ride.

    Getting back to health care, lots of western countries have good health care systems. Their communities do not face the insurance problem that grips so many Americans. They eat Big Macs, drive SUV’s, watch Hollywood movies, and buy 99 Windows PC’s for every 1 Macintosh. They don’t stress about health cover. Families don’t go bankrupt because of an illness. For some reason, American politicians get mileage by saying “we don’t want to end up like country X”. If more Americans knew what the rest of the world was like, and if fewer Americans thought they had nothing to learn from anyone else, you would cherry-pick the best from all of our systems.

    Imagine if you could do what you did back in the beginning, and lead by choosing the best ideas, instead of following an ideology.

  34. #34 Denice Walter
    August 12, 2009

    @ Peter Thomas – I think that many Americans would be interested in what you say *if* they ever actually got to hear you. You see, we have news reporting that is as factionalized as our political party system and runs parallel to it. You would *not* be interviewed on Fox News (maybe on CNN or MSNBC).Horror stories about “rationed care” in the UK, Canada, and other countries *are* reported frequently.Yesterday, Obama spoke at a town meeting to clear up some of the myths being reported about the health care bill (e.g.enforced euthanasia).Remember though, that he also had to counter vociferous oppostion in the election and very early in his presidency and did manage to win.

  35. #35 Peter Thomas
    August 12, 2009

    > some of the myths being reported about the health care bill (e.g.enforced euthanasia)

    Aside from the fact that Dems are not a party full of people waiting to slaughter their grandparents and eat their own babies, you’d presumably you have to go through a radical and phenomenally improbable process of getting all States to legalise euthanasia before the Federal Government could mandate counselling on it?

    It’s extraordinary to watch all this from afar. Hitler was right. (It’s usually attributed to Goebbels but Hitler wrote it in Mein Kampf.) The bigger the lie and the more often you tell it, the more they’ll believe it. It seemed stupid when I heard that as a kid but watching this unfold I see that it’s true. It seems that citizens can’t comprehend the audacity of politicians, so when the lie is big enough they fall for it.

  36. #36 Calli Arcale
    August 24, 2009

    PlainRN:

    I understand the pharmaceutical companies support it, but in return they get 12 years on proprietary drugs in place of 8, before generics hit the market.

    Are you sure the pharmaceutical companies support the bill? Or are they playing both sides?

    Betsy McCaughey is paid by the Hudson Institute. This think-tank gets funding from lots of corporations (Microsoft, IBM, McDonald’s, etc) but two industries are especially conspicuous, because they comprise the vast majority of its funding sources: agribusinesses and pharmaceutical companies (including PhRMA, Novartis, Merck, and so on). This may or may not be significant, but it’s a definite conflict of interest for McCaughey. It’s not clear whether pharmaceutical companies would come out ahead or not with health care reform, but their current business models definitely assume status quo, and it would therefore be in their interests to spread a little FUD (Fear, Uncertainty, Doubt) about health care reform.