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  • ilap2004 ilap2004 Aug 9, 2009 5:52 PM Flag

    Health care bill end of life counseling


    Charles Lane of the Washington Post, has taken a careful look at Section 1233 about end of life counseling. It gives doctors money to initiate a discussion with seniors "and gives them an incentive -- money -- to do so" (ending attempts to extend their life). "Indeed, that's an incentive to insist."

    "Ideally, the delicate decisions about how to manage life's end would be made in a setting that is neutral in both appearance and fact. Yes, it's good to have a doctor's perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party -- the government -- recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don't have to be a right-wing wacko to question that approach."

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    • Ilap, where do you disagree with Rush on anything?

      As far as end of life care, that is just another stupid attack on physicians. It's the Republicans attempt to be in favor of all life extending treatment like with Teri Schaivo as long as someone else is paying for it.

      And it is another rock and a hard place position for doctors. Keep people alive by all means possible (even those who are brain dead), and physicians are accused of keeping people alive to make a buck. Now if the government financially gives incentives to doctors to initiate a conversation to decide what a patient wants for his or her end of life care, idiots like yourself accuse of us wanting to kill people.

      So let me see if I have this right. Artare and Crouching posts the problem is greedy physicians. Winny posts that the government not the much more expensive private insurers are the problem. And you basically state that doctors are itching to put down the elderly, another talking point.

      One of the dumbest matters with regards to medicine is hospice care of nursing home patients. The cost to the government is around $4000 a month for that service, and Medicaid fees for the nursing home are about the same. So for one terminal elderly person alive for six months, you are paying almost $50,000 in government funds for one person who is going to die no matter what.

      And you know what group has the highest suicide rate? People over the age of 85 who are depressed because they know they aren't getting any better. They don't want to be brain dead vegetables. If asked, like three and four of the elderly do not even want feeding tubes, but if they don't specify otherwise, they HAVE to be put in.

      So giving a doctor $50 to 100 to consult with a person before they become mentally unable to decide what they want makes perfect sense if one understands it is to save $50,000 later.

      It's pretty obvious though with the attitude you all have that blaming everything on doctors is somehow the answer.

      My wife needed the iron shots I mentioned. Instead of buying them here for $450, I bought them for $9 in Mexico.

      It speaks volumes to me that people are willing to spend 50X more for drugs just for the ability to sue a drug company.

      The country cannot afford private insurers, the number of malpractice suits, and the ridiculous prices paid to drug, lab, diagnostic, and equipment companies.

      Glad to know though that you don't mind spending 21% of your health care dollars on terminally ill, mentally brain dead people suffering in pain who probably don't want to be kept alive anyway.

      Better than that paying some greedy doctor azzhole $50 to $100 to prevent said situation.

      • 4 Replies to docjoe999
      • doc, I have started to respond to a number of your posts and haven't. Can't let it go any further and I am ready to dump more words than the board would allow.

        Yes healthcare in this country is in a mess, and yes it is not all the fault of the practioners out there, but no, MDs do have their share of responsibilities in that mess.

        First to your comment: "As far as end of life care, that is just another stupid attack on physicians. It's the Republicans attempt to be in favor of all life extending treatment like with Teri Schaivo as long as someone else is paying for it."

        You are very wrong on a number of issues but first, as far as end of life care, I read some of Ezekiel Emanuel's pubs this weekend. He is hardly a republican. I suggest you read him too as he obviously is the person that educated Obama as to how physicians prescrib way too many drugs not needed and the more expensive, and how physicians perform way too many tests and procedures that are not necessary, like the pediatrician that removes tonsils when not necessary. Obama said that, not a republican. If a physician merits attack, Emanuel does though I don't think he rightly merits the title (he has an MD, PhD in Political Philosophy, was bioethicist at NIH before becoming Czar to Obama, and yes he is Raul's brother).

        You grossly minimize and distort the ideas he expouses which are expressed in that health plan. There is a BIG difference in a person facing end of life decisions, and in a doctor dealing with a person with serious death potential illness and making an assessment as to that person's worth to society in productivity versus the cost of saving their life and deeming their life not worth the dollars. He actually presents the case in comparison of such a person to a younger person in need of health care who has more productivity remaining, and recommends that the younger be treated while the older not have the money wasted on them. Ah yes, they would have death counselors besieged upon them and he has a pathetic article on that. let me just say JFC. Now either you really don't have a clue as to what is going on in that plan and the direction they are going with it, or you are being very dishonest.

        Now as far as Terri Shavo. Life support equipment that makes a heart continue to pump for example, is NOT equivalent to the basic essentials of life - food and water. No one unplugged a life support machine to Terri Shavo and let her die. They instead denied her food and water so that she dehydrated and starved to death. It would have been less cruel to take a gun and blow her brains out. Her parents begged to be allowed to take her home where there would have been no cost to any one but them. Not the same actions at all and you of all people as an MD, should know that. Shame on you and all the MDs who did not step up to the plate in that situation and clarify exactly what was really being done to that human being.

      • Mr Doctor Joe, I agree with you the government is in healthcare already but don't you agree that some agency needs to regulate this industry?

        For sure there are a lot of problems, but at the same time, I don't want a pure capitalist healthcare with no government at all. I already have fear that when I come out of a hospital, I'll likely come out worse off than before I went in. If the government is not there with some kind of standards, then I'm not even stepping foot in the door.

        btw - you mis-represented what I said. I never said greedy doctors were the problem, I just have the old fashioned view that people who want to practice healthcare should have something besides money as their top motivation.

      • Doc,
        I am a moderate Rebublican, who did not vote last year because, I did not like Obama or McCain. I thought we has slim pickings. I had an Elder Care Lawyer do a Living Will for my Mom last year. Why don´t people just do this and get it over with? Her Living will, says she can be hydrated , have oxygen,and be in no pain, but no feeding tubes or artificial means of keeping her alive etc., if the Dr says there is no hope for her outcome. I think it only cost me $60 for the Lawyer to draw this up. We pay out of the pocket for all Dr appointments, even x rays, MRI´s. We only use our insurance if someone has to be in the hospital, like when my husband was shot last Feb and there for 3 days. Or when I had my gall bladder taken out in 2003. I had lazer surgery back in 2002 to correct my vision, of course insurance would not pay that just because I did not want to wear contact lenses anymore. It was cheap, cost me $1,300 for both eyes. I think children should talk to their aging parents about Living Wills, like I did. I think almost all would get a Living Will done if confronted with it by one of their children. For me and my Mom, all it took were the memories of my Dad who had small cell lung cancer that had metastasized all through his blood stream, brain etc. The Oncologist gave him 3 months to live without radiation and chemo. He went ahead and did both of them and suffered so much ,that if he were alive today and given the same prognosis, I think he would have just kept those 3 months without treatment. But, you never know, people when given such a short time to live sometimes get frantic and hold on to HOPE.

    • iliap, I've been reading Ezekiel Emanuel this weekend, and actually working on a post to doc. Read more of what Ralph Emanuel is putting in Obama's ear and his influences on that health plan. It is not simply giving doctors incentives. It is about valuing a person's life and the cost of care when they are sick. Younger people are of more value because they have more productivity left in them than an elderly person. Therefore with limited dollars (as in controlled costs) the doctor should let the elderly person die for the sake of saving the younger ( which is really all about money - don't you love liberals and their phony pretense of being crusaders of the poor and down trodden.

      Look up and read what the man has written. There is lots more to the evil being advocated in that plan.

      • 2 Replies to btdt100
      • If Ron Paul ran against Obama, I would have voted for them. Being a Republican used to mean for less government. Now it is the party of the plutocrats. The Republican Party serves to make private corporations rich. See Medicare part D.

        I am not for national health insurance. People should pay out of pocket for all but the most catastrophic costs. That the Republicans don't support such a plan is no surprise to me. They are for the status quo, and the status quo means insurers run everything.

        When people talk about a government takeover of health care, I laugh. I want to so badly ask, what part aren't they controlling now?

        The government mandates that big companies provide insurance for their employees and gives said companies deductions on said insurance. By doing so, the government is virtually guaranteeing health insurance company profits.

        The government regulates doctors via state medical boards and Medicare reviews. It does the same with hospitals by detailing what it needs before paying any of said hospitals a cent. The same goes for lab and equipment companies. Drug companies are controlled by the FDA.

        And the CDC, NIH, and FDA put out standard of care guidelines all the time. People who claim they don't want the government in their health care are so stupid they make my head hurt. They are already in health care up to their necks.

        Now onto your issue, <Younger people are of more value because they have more productivity left in them than an elderly person.>

        No, no, no. If the elderly want to have everything done, they can. When asked, most of them don't, but no one in our society wants to talk about it. Obama wants to give doctors incentives to do so.

        The politically correct thing to do is think mom or dad is going to live forever. It is hard to sit people down and say mom or dad is not going to get any better, and we need to know how far they want us to go (ventilator, IV meds, feeding tube etc).

        Because we don't talk about living wills, there are hundreds of thousands of brain dead people lying in bed in pain being fed by feeding tubes who if asked earlier on would not want to have lived that way. I sure as hell wouldn't.

        BTDT, the real tragedy is money is being spent on the terminally ill who given the choice don't want the care that is being spent on them. That there are young people who would benefit from those health care dollars being spent on them is not political but tragic.

        This could all be avoided if people paid for their own health care. The whole problem with this issue is that the government is paying to begin with.

        With the current system, we have capitalistic expectations and a socialist system. I would prefer a capitalistic system with capitalistic expectations, but that is not even on the table.

        There have been stupid Republican plans like the Health Savings Account. The part that no one mentioned is that to get a HSA you HAVE to buy a private health insurance policy with the HSA, so it amounts to a giveaway to private insurers.

        Health insurance should be like auto insurance. It is tightly regulated, competitive, and you only use it when something really expensive happens. Routine care like oil changes ETC. are paid out of pocket, and the prices of said items are well known.

        The Republican position should be that Americans have to be responsible for their own health care, but they are too gutless to advocate said position.

        So the real Republican issue shouldn't be whether the government pays for end of life care or not. The issue should be why in the hell is the government paying for it to begin with?

        So the choices are capitalistic expectations and a socialist system or socialistic expectations with a socialist system. Given those two choices, I pick the latter.

    • The plan is to provide only Republicans, and other morons, with a serious executable exit strategy. It makes perfect sense.

    • Hi B,
      Good to see you here instead of over there with "Vermit". B, I truely understand the case of Terri, as I am a Roman Catholic. Not an arm chair Catholic like most of the Catholics we have in Congress. Who could ever forget Terri´s case. My kids were in private Catholic schools, they had Mass every day for Terri. I recall her death which came in "Holy Week" and she died on Holy Thursday March 31, 2005. I was at the beach with my family and in constant communication with my Mom who stayed at home and monitered the News. I got the call from my Mom that Thursday and announced it to all my husband´s Latin family(this was watched World wide). We all kneeled with bent knee and prayed for her. It was so sad. My Kids being brought up in Catholic school thought it was a SIN that they had taken out her feeding tube and was slowley dying of starvation. The adults all understood that she was brain dead, but also thought, "hey if her family wants to take care of her why not"? We also thought that her husband, who was already trying to do this to her as early as 1993, 1998 and again in 2001 to take out the tube, was already in a brand new relationship with another woman. Many thought her parents should have been the one to decide, since her "husband" was no longer really part of Terri´s life. But the law is the law and the spouse has the first word. Gov, Jeb Bush really tried to fight this as I recall. Bush is a Catholic. And NO I doubt/ I know the Pope was not pleased at all. Like I said her case wa sad from a religous Catholic view, but I don´t know if I would have made the same decision after her being that way for so many years. I would not want however, to play God.

    • I did not say Backward Country, read it again and get your dictionary out. I said Back Country, sometimes spelled Backcountry. Read a History book. And YOU, were so against this thread, but yet you pursue it with your debacle about Terri S. Furthermore, if you are from Brazil, you would know it is a predominately Roman Catholic country, who would not have been too happy with the outcome. Why not just end this thread right now and leave it at that? Or do you want to have a verbal spar about the USA being a backward, not "Backcountry" country? Dude don´t get your panties all twisted up, relax.

    • And that has what to do with PBR?? I don't think that 2 people in Brazil know or care who Terry Schivo was.

    • Brazil must not have CNN or Fox News and if that´s the case they are more "Back country" than Central America. Look at the title of this thread genious and ask yourself if it has anything to do with PBR, it doesn´t. but we also discuss daily political topics, even if it is OT. Me? I was the 17th person to just answer to this thread.

    • "I was the 17th person to just answer to this thread. "
      And the 8th and the 9th. Brazil is not a backward country because it neither knows nor cares about a woman who was brain dead for a long time before they could take the feeding tubes out. It could be argued that the USA is a backward country for not letting her die naturally.

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