I have been a speaking fool (don’t agree so fast!) for the last week and a half, and have not had a chance to post on last week’s astonishing Newsweek cover story: “The Case for Killing Granny.” (I will bet the POTUS was not please with this cover!)
Evan Thomas, one of the dying newsweekly’s most notable writers pushes the meme that the elderly should have their health care rationed. From the article:
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.
But that is precisely what health care rationing to the elderly would be–pulling the plug on Grandma. And it wouldn’t stop there. People with disabilities may be far more costly to treat, since they live longer than the frail elderly. Once you decide that saving money is the primary goal, those who need help the most will be the ones denied it–ironically, in the cause of expanding access to care
Still, the story does not at all match the cover’s hysterics. Thomas has some good suggestions in his article that are not rationing, for example, allowing nurse practitioners to be more involved in a “gate keeper” role between very sick patients and the costlier consultation with a physician:
Physicians at Massachusetts General Hospital are experimenting with innovative approaches to care for their most ill patients without necessarily sending them to the doctor. Three years ago, Massachusetts enacted universal care—just as Congress and the Obama administration are attempting to do now. The state quickly found it could not afford to meet everyone’s health-care demands, so it’s scrambling for solutions. The Mass General program assigned nurses to the hospital’s 2,600 sickest—and costliest—Medicare patients. These nurses provide basic care, making sure the patients take their medications and so forth, and act as gatekeepers—they decide if a visit to the doctor is really necessary. It’s not a perfect system—people will still demand to see their doctors when it’s unnecessary—but the Mass General program cut costs by 5 percent while providing the elderly what they want and need most: caring human contact.
Thomas also pushes hospice, which I support too–as long as it is not coerced. But changes are needed in the regulations around hospice, for example, explicitly stating that tube feeding is permitted. Today, some hospices refuse to accept patients receiving ANH in the fear that it will be deemed life-extending treatment for which they will not be paid by Medicare. That limitation, in turn, prevents some patients–who don’t want to dehydrate to death–from agreeing to the palliative approach.
Thomas’s article mostly dealth with alternatives to rationing boards and thus deserved a more substantive headline than “The Case for Killing Granny.” But Newsweek is desperate for readers, and so–ignoring their own criticisms of Sarah Palin for being alarmist with her “death panel” charge–the editors threw caution to the wind.
September 20th, 2009 | 6:26 am
POTUS was not pleaseD
Thomas’s article mostly dealth with
September 20th, 2009 | 8:05 am
Nonsense. The article is some Newsweek writer’s opinion, and has absolutely nothing to do with “Obamacare” making a case for pulling the plug on grandma. The comparison with Massachusetts’ system is also false. You and your friends on the extreme right are beginning to sound desperate.
September 20th, 2009 | 10:06 am
Wes, when is the last time you checked into emergency without insurance? Even mission run hospitals ration healthcare. As a rule only palliative care is provided until some line of reimbursement from Mecicaid can be worked out. There is an entire intermediary sector between the death panel industry – aka health insurance companies – and healthcare providers. These companies go by agreeable sounding descriptions as “revenue enhancement/augumentation service providers” etc. Their only job is to help hospitals pass the buck to the government when indigent patients in no man’s space extend the hospital’s resources – although I wonder why charitable “non-profits” are so particular about meeting profit goals! And in your righteous indignation you ignore why caring for terminally ill patients is so expensive. Terminally ill seniors as a rule – 100% of the time even – have been out of the clutches of hte deah panel business because they have graduated into Medicare at 65. So deathpanel insurance has never been an option. Medicare with growing numbers of 65+ people is composed of a growing number of care intensive people. The solution is to extend Medicare to all people – the Public Option. This will bring in millions of people of all ages under the Medicare, and decrease the cost of insurance payments by the infusion of a very large pool of lower risk and healthier people. That is how other wealthy countries and Cuba manage to deliver cheaper and better healthcare to all citizens not just the rich and elderly.
September 20th, 2009 | 10:36 am
History: IT was written in the context of the Obamacare debate and the worries about rationing.
Kaangeya: If someone goes to the ER without insurance, they have to be treated. It’s the law. The public option is a single payer plan? How come Obama denies it? Or is he really lying and doing it by stealth?
Cuba? Good grief.
September 20th, 2009 | 12:01 pm
I’m not sure how expanding Medicare will cut costs. At least according to my last paycheck, I’m currently paying for Medicare despite the fact that I won’t be eligible for more than 30 years. (This assumes that Medicare is still around in 30 years, and that the eligibility age has not been raised.)
Medicare is actually running out of money faster than Social Security, despite SS being 30+ years older. To have it paying for more people, the contribution levied from taxpayers will simply have to be increased.
Also, for those who hate insurance companies so much – are you aware that the current House bill includes an “individual mandate” that forces everyone to buy insurance or pay a fine?
September 20th, 2009 | 12:39 pm
HW: If NW is a ‘far right’ publication, than I’m donald duck.
September 20th, 2009 | 3:41 pm
Really Wes, your attempt to link this goofy article with Obama by putting them both in your headline is just a cheap propaganda technique.
We expect much better propaganda technique out of you in your future distortions of health reform, thank you.
September 20th, 2009 | 4:14 pm
I think what you say about some hospices refusing to provide ANH is a great cause of concern. But if some hospices _do_ provide it, and it _is_ paid for, why do the others worry? Is it because it varies from state to state? What percentage of hospice care programs would you say, Wesley, permit ANH as part of the care?
September 20th, 2009 | 5:14 pm
I believe that hospices get paid for each Medicare patient by the day and by their level of care (routine, general inpatient, crisis care) and not by each individual treatment/visit/medication. That is why hospices would like to have their patients on as long as possible while still abiding by the rule of being certified by a physician as terminally ill. That is also why some hospices do not want to pay for so-called “extras” like ANH. I would be curious to know the percentage that provide it as well.
Hospice is a great thing, but it is vulnerable to being corrupted by the death culture (as we saw in Terri Schiavo’s case).
September 20th, 2009 | 9:12 pm
Wes,
Cuba? You too should be horrified, as should everyone, as the world’s most important welfare economist Dr.Amartya Sen is. A poor nation that spends a tiny fraction per capita as much as the US on healthcare, makes twice as many doctors per capita as the does the US, and provides universal healthcare. You know how bad things are when the US healthcare system looks rickety ompared to Cuba. Believe me it’s that bad. Medicare is weighed down by having to treat a growing 65+ population with increasing life expectancy and stagnant incomes. So to my friend who contributes to Medicare, as do I (I am <65) the solution is to throw open Medicare to all individuals. The contortions that the many versions of the House and Senate Bills are going through is because it is the result of two different processes
A. The work of legislators who want to change the status quo but want to get out something that is good enough
B. The work of compromised legislators like Baucus who want to prevent change at any cost and ensure the the interest of their benefactors, the death panel business aka private health insurers, is protected at any cost.
There is also a third force at work – but outside Congress. These are driven by the death panel industry that has spent $150 million on running fraudulent advertising, and is fronted for by an absolutely nutty bunch of reactionaries.
A fourth group of legislators who are not involved in this sausage making process are the truly public spirited folks such as Kucinich, Sherrod Brown, Jim Clyburn, and many others who have been committed to universal healthcare for years.
More news on the misdeeds of the deathpanel industry,
http://www.chicagotribune.com/health/chi-thu-problem-briana-rice-sep17,0,807488,full.column
Quotes from the article to show what a truly venal business health insurance has become,
<>
And more
<>
So instead of getting worked up about countries like the UK that care for their citizens – remember some NHS hospitals don’t employ cashiers – let us do something about the death panels in our own land – the health insurance business. The death panel meister who dumped Brianna helpfully informs her “”The coverage you applied for would not have been issued for Brianna if we had known this medical history at the time of application.” As Congressman Kuchinich informs us – after he metaphorically fileted that Canadian shill for the US death panel business – Grazer – 80% of the medical care related bankruptcies in the US affect those with health insurance. Michael Moore’s tragic “Sicko” is about the travails of the insured.
September 20th, 2009 | 9:59 pm
Dear Mr Smith,
When I first saw the Evan Thomas article on the internet, I was unaware that it was indeed Newsweek’s cover story. The fact that Newsweek chose to put this justification for euthanasia on the cover says a lot about how far the Party of Death is now willing to go.
The triumphalism with which Thomas now openly admits that a key component of “health care reform” is the freedom to dispose of life-that-is-not-worth-living reveals how far he feels the issue has moved since the recent denials that “death panels” were ever to be considered. What will follow the freedom to kill your own granny, will be the demand that the State’s authorized representatives have the freedom and the power to kill anybody’s granny, whether she or they like it or not.
September 20th, 2009 | 10:50 pm
The thing I can’t figure out, though, Heather, is that if hospice wants people to stay on as long as possible, they should _want_ ANH patients, because obviously if they need ANH and don’t get it, they’re going to die much sooner. So the money motive would seem to argue for accepting ANH patients. It seems that the problem is what Wesley says–that they are afraid of its not being considered a “hospice type of care.” But can’t they _find out_? And if some hospices are getting paid for it, they should have no worries, right? Or is there something here I’m showing that I just don’t get.
September 21st, 2009 | 12:25 am
I think that one good lesson to take away from the article is that the problem of scarce resources and expense won’t go away even if every private insurance company was hunted down tomorrow and had a stake hammered through its heart. Health care is getting more expensive because technical innovation continues to provide new (and expensive) treatments for formerly hopeless maladies. New drugs, surgical robots, radiation projectors that can destroy brain tumors without cutting the skin, etc.
Almost every country, whether their health care systems are private, public, or some mixture of the two, is having problems with health care expenses going up and up. I don’t think that increased public funding will change this at all. People are worried that the reform will mean that they will pay more money for health care, get less care, or both.
You don’t need to be a for-profit corporation to deny treatment or restrict people’s access to health care – look at the stories Wesley has collected about the NHS on this site. They may not have cashiers in their hostpitals, but they’re capable of turning people away.
September 21st, 2009 | 6:49 am
Dear Mr Smith,
As far as the Cuban medical care system goes, I am reminded of Lincoln Steffens’s comment in 1921: “I have seen the future, and it works!”
September 21st, 2009 | 8:52 am
“Party of Death”? That’s the right name for a party that controlled the Presidency and the Congress for most of the last 10 years, and manged to almost privatize Medicare, while torpedoeing the expansion of SCHIP. The “Party of Death” is the right way to describe a party whose Senator (Inhofe) boasts that he will vote against any bill that comes to vote. “Party of Death” is the right way to describe a party whose shills (like Malkin) literally hunt down a family that testified in favor of expansion of SCHIP. “Party of Death” is the right way to describe a party that thinks it is more important to protect the profits of the death panel industry rather than provide healthcare to all.
Healthcare is more than surgery and medication. It is making available timely access to physicians and preventive care, vaccinations, prevention of premature pregnancies (which by the way is higher the redder the state).
The other rich countries have some distance to go, as they spend on average only about 50% as much per capita as us, and have sysems that are better than ours by an order of magnitude. Rising costs is our problem, because the government in any case funds 100% of the basic research, with the big drug companies spending money making copycats, aphrodisiacs and on marketing. No politician in the UK will dare touch the NHS, because it is successful and popular. Wes can spin all the yarns he can, but that is all that matters.
September 21st, 2009 | 11:51 am
Lydia,
Yes, good point. I suppose it depends on the patient. But there is perhaps a stigma out there that once you’re on hospice, ANH does no good anyway. But I don’t think we can make that sweeping generalization.
It seems like hospices should be careful about *inserting feeding tubes and starting ANH* on terminally ill people, but there should be no problem with accepting someone on hospice who already is utilizing ANH. I work with a hospice in San Diego that does not reject anyone with ANH, but it is a larger hospice and possibly more able to absorb the costs.
From what little I know of it, I do not think there is consensus on inserting feeding tubes in people with dementia when they are no longer able to swallow. On the other hand, those people with Lou Gehrig’s disease benefit greatly in terms of length of life with feeding tubes.
So I don’t understand either how a hospice could just across the board reject those with ANH, unless they think that they just don’t want to deal with the expense of it (equipment rental, formula, formula delivery, extra nursing visits to teach family, etc).
September 21st, 2009 | 4:03 pm
Granny wants me to tell the eugenicists that she has a load of double 0 buckshot waiting for them when they try to kill her!
September 21st, 2009 | 7:25 pm
Yes, the Cuban health care system is so good, that Americans make rafts out of 1950s automobiles and trucks in order to get there . . . on the other hand, the HR 3200 health plan is so bad, that the President, the Vice President, and the Congress will be exempt . . .
September 21st, 2009 | 9:35 pm
There is NO case for killing grandma outside of a totalitarian state, PERIOD.
September 21st, 2009 | 11:53 pm
There is no case for killing anyone period!
September 23rd, 2009 | 6:27 pm
The title Newsweek chose for its cover is very telling.
It wasn’t “The case for less aggressive medical care for the elderly”
It wasn’t “The case for declining heroic measures in terminally ill patients”
It wasn’t even “The case for letting Granny die”
It was “The case for killing Granny”
That’s why Evan Thomas is a cheerleader for the Party of Death, for Death’s men. He wants to make a case for active killing, and it will begin with actively killing the sick, the aged, the demented, but move on to killing the weak, the disabled, the disenfranchised . . . the world has been there, and done that . . . and not all that long ago
September 29th, 2009 | 3:35 am
“The Case For killing Granny”article should be a red warning flag to all Americans; that the death cult eugenicists are seeking to rise again from their hellish slime pit…Did they get and translate that article from an old Nazi German newspaper?
October 6th, 2009 | 4:19 am
[...] Someone I’ve heard of added an interesting post on Obamacare: The Case for Killing Granny Secondhand Smoke | A …Here’s a small excerpt [...]
Links
Blogs
Find Us
Contact