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About those “death panels”


I was reading an article at Conservatives4Palin that points out (correctly) that when the former Alaskan governor made her infamous “death panels” post on Facebook she wasn’t referring to end of life counseling.

This is what Sarah Palin said:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

Health care by definition involves life and death decisions. Human rights and human dignity must be at the center of any health care discussion.

I know this will surprise those people who are convinced (or pretend to be convinced) that because I refuse to demonize Ms. Palin that I am infatuated with her but I disagree with the former Vice Presidential candidate.

Before I explain my disagreement I want to clarify what Sarah Palin actually said. Contrary to the assertions of Ezra Klein and others, Palin never claimed that Obamacare would euthanize anyone. She claimed that Obamacare would result in rationed health care and that bureaucrats would decide whether or not to pay for treatment based on subjective criteria like the patient’s “level of productivity in society.”

While there is a nugget or two of truth in what Palin said we’re hardly talking about exterminating “useless mouths.” What we’re talking about is the kind of cost-benefit analysis that people already have to make every day.

Despite what some people think none of us has a “right to life.” On a long enough timeline the mortality rate is 100%. As Clint Eastwood said, “We all got it coming.”

As we saw during the Terri Schiavo case, the general consensus in this country is that at some point it is acceptable to terminate life-support. The real question in cases like that is who (other than the patient) can make those decisions and when they should be made.

But “death panels” cases aren’t about whether or not to pull the plug on someone, they are about the limits, if any, on the payment for health care services.

Forget the specifics of Obamacare for the moment and assume we adopted some version of single-payer like all the other industrialized nations have done. Call it Medicare For All. As the cost goes up and the prognosis grows more grim, is there some point at which we should say “enough is enough?”

Let’s say we have a patient in his eighties who is diagnosed with cancer. Treatment will cost approximately $1 million, the chances of success are less than 10% and he has already exceeded his life expectancy so even if the cancer doesn’t kill him he isn’t gonna celebrate many more birthdays anyway.

Should we pay for his treatment? What if he had diabetes and tuberculosis too? What if he’s already in a persistent vegetative state? Is there any point at which we should draw the line?

The fact is those decisions are already being made, but the decision-makers are health insurance company bean-counters and profit-minded executives.

I think that if we are going to control health care costs one thing we need to do is set limits on how much health care we will pay for. The factors considered in setting those limits should include cost but also a number of other factors, including prognosis and quality of life.

But those limits need to be determined in an open manner by people answerable to the public. There needs to be an open process and a way to appeal the decisions that are made.

What do you think?



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Thursday: Just get it done

Just Get It Done!

Those of us who live in the corporate world by day are coming to the slow realization that getting anything done in the era of outsourcing is becoming next to impossible.  The functions we once depended on are now being performed by mysterious outside groups who offer an off the shelf service that is not tailored to our specific needs or are so hobbled by the need to keep information secret that they can’t help us without contacting an inside third party or complicated by the redirection to new training requirements that must take place before we are able to perform an operation that used to take seconds but will now take hours.  We are scolded by snippy business types who can not possibly fathom why the people in R&D have not wasted hours and hours of our time to master the arcane minutiae and non-intuitive “user” interfaces for their business units, as if there were no other task more important.  Contractors are former employees hired back at vastly reduced salaries with concomittantly vastly reduced incentive for extending themselves even one nanometer outside of the tortured definition of services to help us with our problem or are disembodied voices with southern accents (I’m guessing Georgia) who do not make the effort to contact us at home during Christmas break to tell us our credit card info in our personal profiles (that THEY entered) is incorrect and the flight we thought we booked is now $800 over budget.  (Thank you very much, Billy Bob)

So much for cost saving measures.  Look guys, we don’t have time for this crap.  Just get it done.

The same goes for Congress.  I am getting tired trying to figure out what version of Kabuki theatre we are playing today.  Are the Republicans going to spend the next two years on focus grouped cultural issues because they know their base voters are senior citizens on limited incomes who watch Fox, are not employed and grew up in an era when women’s lives were constricted, gays were still in the closet and communities were as homogenous as vanilla milkshakes or are they going to block any measure to help regular Americans get back to work so they can blame Obama for the poor economy in 2012? (I’m guessing both)  Are the Democrats going let Republicans hang themselves and concede every mean spirited measure to them so Republicans can take the blame in 2012?  Is anyone going to step up and take responsibility for anything or are they are in it together to force some shock doctrine austerity plan on us so that the small evil group without any national fealty to whom they report doesn’t have to cough up any more money of their own?

In case you weren’t paying attention to the voters in 2006, 2008, 2010, we are losing our patience.  That doesn’t mean we are all panicking.  It means we don’t have time for this crap.  It makes us peevish and unpredictable. If you panic us, you may get something you did not expect. But don’t think we aren’t paying attention to who is doing what to whom.  We see the faux drama and we see the results and we are not amused.  You congresspersons are supposed to report to US, the citizens of the United States, not Dubai or the Caymen Islands.  Quit screwing around and get it done.

In the news:

The readers of the Washington Post were paying attention yesterday when the Post put up a poll asking readers to rate issues they wanted the new Congress to tackle and “jobs” was not among them.  Nor were several other issues like bringing the financial industry to heel or fixing the mortgage crisis.  You know, stuff that the average hard working American, who does not live in the swank suburbs around the beltway, actually cares about.  Eventually, in response to the pages and pages of comments in protest, WaPo relented and added Jobs but did not reset the poll results so the numbers were skewed.  The Republican talking points continued to nest at the top.  Way to go, guys.  “Non scientific poll” indeed.

Obama is replacing Rahm Emannuel with William Daley, who is currently employed by J. P. Morgan Chase.  Because having Rahm beating up the left on a daily basis wasn’t enough?  I only ask.

{{sigh}}

Natasha Chart pointed me in the direction of this American Prospect post that in turn refers me to an article in the Atlantic about how the wealthy see the rest of us wage slaves.  (Hmmm, Global Elites should really be issued their own passports identifying them as not citizens of any country and therefore not entitled to any country’s protections.  Sounds like a fair deal to me in exchange for disenheriting American children born to illegal housekeepers and landscapers.)  This gels with the other study referenced in the New York Times titled “The Rich Lack Empathy” (and water is wet)  about how rich people are less empathic people because they don’t have to be.  In other words, if you’re a working class bloke, you have to be nicer to people to get them to do things for you.  Business units might keep that in mind next time they need the inventors to come up with some get rich quick product.

Speaking of inventorship, I sympathize with Peter Daou and James Boyce in their suit against Arianna Huffington over the genesis of the HuffingtonPost.  You have no idea how hard it is to get on a patent when a chemist who uses your ideas wants it all to himself like some spoiled child clutching his toy screaming, “MINE!, MINE!, MINE!”  Then there’s the documentation and lab notebooks and powerpoint slides and time stamps and endless meetings with lawyers.  Been there, done that.  For what it’s worth, I’m siding with Boyce and Daou on this one.  In my best, “I am not a lawyer” mode, I find argument that the pieces that were proposed and assembled were not unique or innovative to be specious.  The functional groups on a new drug entity are also not unique.  They occur in nature, er, naturally.  It is how they are put together and whether they solve a problem not previously addressed that makes them new creations.  I think we can all agree that HuffPo filled a need that did not previously exist on the left.  Well, some may argue that it *still* doesn’t serve that need but it is without a doubt a huge success and if it didn’t have this quasi libertarian Clinton Derangement Syndrome side effect, probably not intended by its creators, it would be a great addition to the left blogosphere.

But what can you expect from Arianna Huffington, whose former husband spent a king’s ransom for a senate seat he did not win?  I would have graciously cut Boyce and Daou in for a share of the immense wealth the site has generated. It must really burn their oatmeal that Breitbart is taking credit.   Even a token million or two would have been sufficient.  It’s a way to say, “Thank You”.  But then, I am an empathic working class person, not Arianna Huffington, who only kisses the asses of the people wealthier than her.

Podcast for the day: Melvyn Bragg of In Our Time has a two part series on the Industrial Revolution.  These podcasts are frequently entertaining when Bragg impatiently tells his guests to get to the point.  I think part 2, Consequences of the Industrial Revolution, is more relevant to our present day events as Bragg and his guests discuss the impact of the industrial revolution on society in general and tease out why it is so important for industrialists that religion remain the “opiate of the masses”.  Stick with it.  There’s some meaty goodness there.

And now, for something completely beautiful.  Anaheim Ballet has a youtube channel where they showcase the elegance coupled with strength of ballet.  Here’s a video of athletic loveliness.