SUBSCRIBER LOGIN






Search First Things

Advanced Search

RSS

Secondhand Smoke
Archives

Categories

Monthly



Flash Forward: The Year in Bioethics 2010
Wednesday, December 9, 2009, 3:26 PM
Wesley J. Smith

Each year, the CBC asks me to predict what will happen in the coming year in bioethics.  I have done so.  From my piece:

“Flash Forward” is a new and interesting television drama presented on the ABC Television Network. The premise is brilliant – due to reasons still unknown, everyone in the world (except the bad guys) blackout for two minutes seventeen seconds. Planes crash, people collapse on the streets, swimmers drown, it is an utter catastrophe that results in the deaths of 20 million people. Being unconscious, blackout victims experience a “flash forward” – a vision of precisely what they would be doing for two minutes and seventeen seconds at the same specific time in April 2010. Some have happy futuristic visions of new loves, some unhappy of broken marriages and deaths, some terrifying such as being murdered, one hilarious – an FBI supervisor is chagrined to admit he spent his entire flash forward on the toilet. Still others have nothing but blackness, indicating that they may be dead next April. The show raises several fascinating questions; whether free will exists, can “the future” be changed , indeed, can it really be predicted.

My main focus is Obamacare.  Here is how I see it coming to pass:

I predict a health care reform bill will be signed into law in 2010. That’s the easy part. The question becomes, what will it look like? That is hard to say since many of the important details will be determined by the tens of thousands of regulations promulgated to carry out the law in over the next few years. Still, the outlines are growing clear in my crystal ball. Here is my personal Obamacare flash forward:

The Public Option. One of the biggest controversies surrounding Obamacare is whether there will be a government health care plan to compete with private insurance companies. I predict that the pure PO will not become law in 2010. Instead, there will be a hybrid alternative enacted permitting non-profit companies – and only non profit companies – to join a government authorized purchasing collective. Whether they will actually threaten the private insurance sector – which I believe is the intent – will not become clear until after the law goes into effect in 2013.

Heath Care Rationing. Obamacare doesn’t call explicitly for health care rationing, but creates its foundation with the establishment of cost/benefit/best practices boards that will be given tremendous sway over the standards of medical care and extent of coverage for both private and public plans. There is almost zero chance these boards will not be part of any law that passes. That means health care rationing will remain a looming specter and a cause for continuing societal debate for years to come.

Abortion. Companies participating in the public exchanges will be required to provide some abortion coverage, but there will not be direct public funding of most abortions. However, the law will permit regulators to require indirect public funding, for example, allowing abortion coverage to be purchased with government vouchers or tax credits.

End of Life Counseling. The provision allowing doctors to be compensated for providing end of life counseling will pass. But the law will require that it be voluntary and not directed to any particular decisions or outcomes.

Illegal Aliens. The law will not explicitly provide for coverage for people who are not legally in the country. But it will not require purchasers of government underwritten health insurance to provide proof of legal status, meaning that undocumented aliens will find ways to purchase health insurance under Obamacare.

I also discuss what I think will happen with assisted suicide, health care rationing/futile care theory, and embryonic stem cell research.  Tune in to see the future.  Or, I could be wrong.  I have been both in years past. I am also interested in your predictions.  Let’s have a little fun with this.


Obamacare: No Friend to People With Disabilities
Monday, December 7, 2009, 10:11 PM
Wesley J. Smith

I have had great sympathy with the problem Obamacare has posed for people with disabilities. On one hand, many are terribly under-served by the health care system. On the other hand, I believe Obamacare will lead to explicit rationing of expensive patients, which will one day include people with disabilities. It could also one day support assisted suicide, as I reported here.

But now, I don’t see how the disabilities community can countenance this any longer. Democrats  have supported cutting $43 billion from home health care as a way to help pay the huge Obamacare tab.  From the story:

By a vote of 53 to 41, the Senate on Saturday rejected a Republican effort to block cutbacks in payments to home health agencies that provide nursing care and therapy to homebound Medicare beneficiaries. Republicans voted against the cuts, saying they would hurt some of the nation’s most vulnerable citizens. Most Democrats supported the cutbacks, saying they would eliminate waste and inefficiency in home care. The Democrats’ health care bill would reduce projected Medicare spending on home care by $43 billion, or 13 percent, over the next 10 years. The savings would help offset the cost of subsidizing coverage for the uninsured.

This and the projected $400 billion in cuts to be made to Medicare prove that Obamacare is to be financed out of the hides, perhaps literally, of our most vulnerable citizens, most particularly people with disabilities and the eldelry. I don’t see any other way of looking at it.

Oh, right: Afterwards the senate passed a measure–as it did after refusing to delete the wider Medicare–opposing all cuts in home health care. Sorry, you can’t cut $43 billion and also maintain the same quality of services. Either the services will suffer or the cuts won’t be made, meaning this is all a sham to make it fit the CBO cost workup.  I hope it is the latter. Either way, Obamacare may be the most dishonest bill in the history of the United States.


Obamacare: Senator Reid, Stop the Hate!
Monday, December 7, 2009, 2:45 PM
Wesley J. Smith

Senator Harry Reid has stooped to a new low by comparing people who oppose Obamacare to defenders of slavery. From the story:

...Reid argued that Republicans are using the same stalling tactics employed in the pre-Civil War era. “Instead of joining us on the right side of history, all the Republicans can come up with is, ‘slow down, stop everything, let’s start over.’ If you think you’ve heard these same excuses before, you’re right,” Reid said Monday. “When this country belatedly recognized the wrongs of slavery, there were those who dug in their heels and said ‘slow down, it’s too early, things aren’t bad enough.’” He continued: “When women spoke up for the right to speak up, they wanted to vote, some insisted they simply, slow down, there will be a better day to do that, today isn’t quite right. When this body was on the verge of guaranteeing equal civil rights to everyone regardless of the color of their skin, some senators resorted to the same filibuster threats that we hear today.”

Well, the people who dug in their heels about slavery were Democrats.  Same for the most part regarding Jim Crow.  And women were given the right to vote by men because Suffragettes they had successfully made the moral case. It was a splendid example of how the system is supposed to work, because once the job was done, we never looked back.  Moreover, if a senator of a different political persuasion said something like that, it would be called hate speech.

But that’s beside the point.  These kind of alleged moral comparisons with some of the worst evils in our country’s history are pure garbage. Our health care system is flawed, to be sure. But it is not slavery. It is not denying women the vote.  It is not Jim Crow. People can disagree with the current proposal and not be malicious or supporters of oppression and tyranny. This kind of hyperbole convinces no one, changes no minds, but causes great harm by corroding what little political comity remains in this country.


Obamacare: The Emergence of Victoria’s Secret Feminism
Saturday, December 5, 2009, 1:24 PM
Wesley J. Smith

Some Obamacare supporters want to tax cosmetic surgical procedure as a way of helping pay for its costs.  I am no fan of cosmetic surgery, but oppose taxing it on principle, as I wrote here.

At the time, I had no idea feminism has devolved into what we could call “Victoria’s Secret Feminism,” which holds that “feeling good” about oneself through cosmetic alteration should be a driving principle of the sisterhood. But that seems to be the case as the National Organization for Women opposes the tax because it wants nothing to interfere with women getting those frown lines removals and tummy tucks.  From a column by New York Times columnist Judith Warner:

Yes, standing up for the rights of middle-aged women to have access to cosmetic enhancement is part of the work of contemporary feminism, [NOW president Terry] O’Neill told me this week. It’s the sorry consequence of a number of sorrier truths: The economy is terrible. Middle-aged women, many of whom reduced their working hours, limiting their earning power and ambition, when they had kids or, later, found themselves having to care for their parents, are in a particularly vulnerable spot these days, as they’re increasingly called upon to supplement or take over the lion’s share of family money-making. And any number of studies have shown that people with better (read: younger) looks have a better chance of getting a good job. Particularly women.

Oh yea? Try being a 60-year-old white member of the patriarchy. But bitterness aside, under this theory, women’s cosmetic procedures should be covered by Obamacare.  Don’t laugh, that could be coming:

“Looks are the new feminism, an activism of aesthetics,” Alex Kuczynski wrote in the introduction to her 2006 book on America’s obsession with cosmetic surgery, “Beauty Junkies.” At first glance, this seems ridiculous. And yet it says something true enough about the way many younger women understand feminism at a time when organized, real-world activism has hit wall after wall of political impossibility. Sneaker ads teach that feminism is all about taking control — of your figure. This is what happens when equal pay stalls, abortion rights wither, and attempts to improve child care and workplace flexibility die on the legislative vine year after year. Women’s empowerment becomes a matter of a tight face and a flat belly. You control what you can control. And so many middle-aged women feel particularly out of control now, as indeed they are, in these life plan-wrecking economic times.

So rather than resist the meme that female beauty begins to fade at 25, Victoria Secret Feminists promote plastic surgery as an act of female empowerment. I am woman, hear me roar: Susan B. Anthony would be so proud.


Obamacare: Nonsensical Legislating, Guaranteeing All Current Medicare Benefits While Cutting $400 billion
Friday, December 4, 2009, 2:08 PM
Wesley J. Smith

The Senate is now considering amendments to its version of Obamacare. What a travesty.  John McCain proposed to eliminate the $400 billion in Medicare cuts.  The Democrats voted it down.  (Remember when Democrats accused Republicans of wanting to cut Medicare?) But then, another amendment was proposed by a Democrat senator. From the story:

The Senate voted 100 to 0 yesterday to maintain Medicare benefits currently offered to seniors.  What they actually voted on was a hastily prepared amendment proposed by Sen. Michael Bennet (D-Colo.)  The amendment states that any Medicare benefit which is currently available will be guaranteed under the health care reform bill being debated now.

I am sorry, $400 billion can’t be cut from Medicare and not affect current benefits. But see, the $400 billion isn’t really going to be cut. Indeed, if the bill now requires all benefits to remain untouched, how can it be?

This illustrates how profoundly dishonest our legislative process generally, and Obamacare specifically, has become.  The cuts are only in the bill so the CBO will conclude that Obamacare will not increase the deficit. They will never actually be made, because once the bill is through the actual budget busting numbers won’t matter anymore, illustrating why the government programs are always more expensive than advertised (except Medicare Part D, which is fully private sector with federal support).  It’s all a big sham.


Obamacare: Swedes Say No Surgery Unless You Quit Smoking
Friday, November 27, 2009, 11:09 PM
Wesley J. Smith

Obamacare-along with radical environmentalism–are ultimately about power and government grabbing control over the way we live our personal lives. A case in point tonight out of Sweden, where the head of the Swedish Welfare Board wants doctors to make patients quit smoking as a condition of receiving surgery. From the story:

Surgeons should be able to demand that a patient refrains from smoking in the period before and after an operation, the director-general of the Swedish Welfare Board argued on Friday. The requirement should be just as natural as requiring weight loss or nil by mouth, Lars-Erik Holm argued to the Svenska Dagbladet newspaper in regard to new guidelines which the Welfare Board plans to issue next year. The director-general added that the recommendation was to be made on the proviso that anti-smoking help was made available to the patient.

Holm cited the orthopaedic clinic at Norrland University Hospital in Umeå in northern Sweden as a positive example. The hospital introduce a smoking ban as a condition for all surgery six months ago. The hospital stipulates that a patient should not smoke in the two months before and after a surgical procedure.

Sure, patients do better if they quit smoking. But refusing treatment unless the patient does as he is told? So much for freedom.  What about emergencies?

When asked how the demand for abstinence from smoking conforms with the equal rights of the patient to care, Holm responded that in emergency cases even smokers would be operated on.

Big of them. Doctors have the right and duty to recommend that we live more healthy lifestyles, whether we need treatment or not.  But they and the government should never be allowed to refuse needed care to patients because they have a bad habit.

The moral of the story is simple: Government health care equals government control over your life.  It seems undeniable to me.


Obamacare: The Magic Number For Rejection May Have Been Reached
Thursday, November 26, 2009, 11:37 AM
Wesley J. Smith

I have long thought that stopping Obamacare would require convincing 35% of the people to oppose.  That’s a hard number to hit in our society.  An idea or politician has to be really disliked to register that low–unless you have a very high number of people who express no opinion.

Well, the most recent Gallup Poll finds that support for Obamacare has plummeted to the magic number. From the story:

As the debate over a health care bill enters a critical stage, a new USA TODAY/Gallup Poll finds Americans inclined to oppose congressional passage of the legislation this year. The survey, taken Friday through Sunday, finds 42% against a bill, 35% in support of it. Despite nearly a year of presidential speeches, congressional hearings and TV ad campaigns by interest groups, more than one in five still doesn’t have a strong opinion. When pressed about how they were leaning, 49% overall said they would urge their member of Congress to vote against a bill; 44% would urge a vote for it. The findings underscore the difficult battle ahead as President Obama presses Congress to enact the legislation by the end of the year.

Remember too, the intensity of feelings about the bill are clearly running from the rejectionist camp. This doesn’t mean the Democrats won’t shove it through. But it is getting increasingly difficult to justify.  And if they do, not only could there could be a stiff political price to pay, but the intense negativity generated could kill other problematic schemes, such as the global warming bill pushed by hysteria more than science.  At some point, public opinion cannot be ignored.


Obamacare: 60 Minutes Propaganda Piece Paving the Way for Health Care Rationing
Tuesday, November 24, 2009, 2:04 PM
Wesley J. Smith

Obamacare pushers have mounted the most dishonest political campaign I think I have ever seen. They say that we will insure 30 million more people–but for less money–which is impossible.  They claimed abortion wouldn’t be funded, but that lie is now fully exposed as both the House and Senate versions would do just that. They say that there will be no rationing–and yet, attempts to amend the bill to proscribe health care rationing have all been rejected.

But the push for rationing is going full steam ahead among Obamacare’s allies.  Latest example, 60 Minutes, always as reliable an ally of this administration as it was an implacable enemy of the last, recently broadcast a story explicitly pushing rationing by focusing on the worst case scenarios and not presenting any opposing views.  From the story:

Patients, with their families’ support, want to cling to life, and it is often easier to hope for a medical miracle than to discuss how they want to die.  Charlie Haggart is 68 years old and suffering from liver and kidney failure…At a meeting with Haggart’s family and his doctors, Dr. Byock raised the awkward question of what should be done if he got worse and his heart or lungs were to give out.

He said that all of the available data showed that CPR very rarely works on someone in Haggart’s condition, and that it could lead to a drawn out death in the ICU.  “Either way you decide, we will honor your choice, and that’s the truth,” Byock reassured Haggart. “Should we do CPR if your heart were to suddenly stop?”  “Yes,” he replied. “You’d be okay with being in the ICU again?” Byock asked.  “Yes,” Haggart said.  “I know it’s an awkward conversation,” Byock said.  “It beats second place,” Haggart joked, laughing.

“You don’t think it makes any sense?” Kroft asked the doctor.  “It wouldn’t be my choice. It’s not what I advise people. At the present time, it’s their right to request it. And Medicare pays for it,” Byock said.

At the present time.  Byock–a friend of mine who I respect greatly as one of the country’s leading hospice physicians–believes that the choice he assured Mr. Haggert was available, shouldn’t be.

By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.  “I think you cannot make these decisions on a case-by-case basis,” Byock said. “It would be much easier for us to say ‘We simply do not put defibrillators into people in this condition.’ Meaning your age, your functional status, the ability to make full benefit of the defibrillator.  Now that’s going to outrage a lot of people.”

The defibrillator question is a classic misdirection. I mean, how many 93 year-old patients near death from cancer receive that level of intervention?  More realistically, note that  60 Minutes apparently thinks the extra six weeks of life provided by the chemo shouldn’t be provided–just like Ontario, Canada’s rationing board decided with regard to colon cancer earlier this year.  We do not want such centralized planning in this country.  As to the issue of choice, raised by Byock, once we stop making these decisions on a case by case basis, medicine becomes a check the boxes technocracy.  And I say this agreeing with Byock as to what I would not want (I think, we never know until we are there) if I were in a terminal situation.

And here’s a problem not specifically addressed by the 60 Minutes piece–many of the ICU admissions being complained about could go either way.  From an article in Bio Medicine:

“Even with excellent prediction models, we will still admit patients at high risk of dying because they also have a good chance of survival,” says Dr. Angus. “There will still be a large, irreducible number of patients who die in intensive care. This means we have to carefully consider providing and promoting good end-of-life care in the ICU.

In other words, if we bluntly bar certain categories of patients from the ICU, it means by definition that people who could have gone on, won’t. Death panels anyone?

This is my primary reason for opposing Obamacare. It will lead to explicit medical rationing.  Or to put my position into a soundbite: Education to help people make better end of life decisions, definitely.  Coersion either through futile care protocols or explilcit rationing, never.  That establishes a duty to die.


Obamacare: Senate Version is Assisted Suicide Friendly!
Thursday, November 19, 2009, 4:03 PM
Wesley J. Smith

Major changes in the new Senate Obamacare bill from its House counterpart, in the sections involving assisted suicide.  (The bill is actually a gutted and already passed bill from the House–HR 3590–a trick that may be designed to get around the necessity of a conference committee.  More on that in the next post.)  Recall that the House Bill prevented the promotion of assisted suicide in the end of life counseling.  It’s missing altogether from HR 3590. This is the only reference to assisted suicide in the bill, starting at page 364:

SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE.

(a) IN GENERAL.—The Federal Government, and any State or local government or health care provider that receives Federal financial assistance under this Act (or under an amendment made by this Act) or any health plan created under this Act (or under an amendment made by this Act), may not subject an individual or institutional health care entity to discrimination on the basis that the entity does not provide any health care item or service furnished for the purpose of causing, or for the purpose of assisting in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.

That’s it. In other words, it is a conscience clause protecting medical professionals who don’t commit assisted suicide. There is no prohibition on promoting it or having it paid for under the plan.

Why need a conscience clause?  Get this clause under the section 1323 of the bill creating the public option (p. 183), beginning at page 186:

(F) PROTECTING ACCESS TO END OF LIFE CARE.—A community health insurance option offered under this section shall be prohibited from limiting access to end of life care.

If assisted suicide, or even euthanasia, are legally considered forms of “end of life care” in a particular state–as it is now in Oregon, Washington, and Montana–it seems to me that the area’s community health insurance option would be required to provide “access” to it under this clause. How else can the provision be read? And because it would have been passed later in time, this clause could be construed to subsume existing federal law that prevents federal funds from being used in assisted suicide.

None of this is by accident. The next question becomes: Why might that be?  Ideology plays a part, certainly.  But considering all of the emphasis on cost control in the Obamacare debate, this has to also be about money.  Can you think of any “medical treatment” for seriously ill or disabled people than assisted suicide/euthanasia?  The cost of the drugs to kill are only about $100.  Think of the millions that could be saved if expensive treatments never have to be rendered because patients have made themselves dead.


Obamacare: Taxing Cosmetic Surgery
Thursday, November 19, 2009, 11:08 AM
Wesley J. Smith

The Senate version of Obamacare will tax elective cosmetic surgery. From the story:

The bill levies a 5 percent tax on elective cosmetic surgery. The provision raises $5 billion and was needed to make the numbers work, according to a Democratic Senate aide. The Finance Committee considered the tax but dismissed it, in part because it was a public relations battle that senators were not willing to wage.

Actually, if I believed that taxing services and products with low/negative social utility was proper, I would enthusiastically support this tax.  Cosmetic surgery sucks tremendous amounts of medical resources out of our strained medical sector for (usually) frivolous purposes–and just as harmfully, promotes a very destructive and unrealistic standard of beauty, leading to much pain and destructive behavior. But I don’t, so I oppose the tax.

« Newer Posts — Older Posts »

Links

Blogs

Find Us

Contact