Part One: The Consultation

You have a life-threatening illness, right? You are over 65 years old, right? I am a doctor and am being paid by the Government to give you counseling about your end-of-life decisions. This consultation is entirely voluntary on your part, and is merely to provide you with information to help you decide now how you will want to be treated in advanced stages of your illness. The information concerns living wills, health care proxies, hospice, and pain medication.

Do I have your attention? Then let’s proceed.

1. ‘Living wills.’ You sign a document that declares which treatments you do or do not want applied to you if you have a terminal illness or lapse into a permanent vegetative state. Be assured that your living will would only be used when recovery is impossible. Who will decide that it’s impossible? A couple of (Government paid) doctors would have to certify that you are in this hopeless condition. Trust them.

2. ‘Health care proxy.’ This is for when you cannot speak for yourself – because you become demented, for instance – while your physical condition is not so dire that it would justify immediate action on your living will. You name a person who will make decisions for you about what care you should be given – within the parameters of what the Government would let you have, that is. You will of course name someone you really trust. Someone who loves you. Someone you know will only act as you would want him or her to act. Okay? Good. Just one thing to bear in mind – if the Government considers his or her decision to be not the right one, it can overrule him or her. So you see, you have a sort of upper guardian who will keep an eye out for misunderstandings or misjudgments. It’s a fail-safe arrangement, you might say. Your son or daughter decides as long as he or she chooses sensibly for you. If he or she doesn’t, no worry, the Government will make the right and final decision.

3. ‘Hospice.’ Hospices are comfy places to die. They are very nice death houses. No one will hurry you to shuffle off your mortal coil. (Only you won’t be let in if you’re likely to take an unreasonable stretch of time about what you’re in there for.) Medical staff will be very kind to you. You can sit on a cushion and sew a fine seam, and you may – if your digestion allows it – eat strawberries, sugar-substitute and cream. But remember, dear, you will be there to die.

4. ‘Pain medication.’ This is what you may have instead of an operation that could save your life. No, sorry, you cannot have the operation. It is expensive and the Government cannot pay for everyone with your illness to have this surgery. Just think: say we pay for it and then you go and die of complications soon afterwards. I mean, you’re old and your powers of recovery are not what they used to be. And even if you did recover, you wouldn’t be much use to Society, now would you? Be reasonable. Be selfless. Be patriotic. The Dear Leader made it perfectly clear that this would be Government policy. He said, ‘Take the pill instead of having the operation’. You remember now? Good. That’s clear then. And by the way, it’s true that there are some drugs that might help you to recover, but they’re also very expensive and as I said we have to think about who can best use their saved life for the good of Society – you who are old, or someone else who is young and vigorous. It stands to reason, doesn’t it, when you think about it? You are – if you don’t mind my putting it this way, just for clarity’s sake – a useless old bag, and somewhere there’s a young person with the same disease as you who can still be, let’s say, a brilliant community organizer if he gets the chance to live. So the drugs are for him, not you, dear. You understand? Fine. That’s settled then.

Oh, no dear! No one’s dictating to you what to do. It’s your choice, absolutely. You don’t have to make a living will, or appoint someone to act as your proxy, or go into a hospice, or take a pill to help your pain. No one’s forcing you. All we’re saying is that we’re not going to pay for you to have surgery or expensive drugs that might cure you. But all the rest is your choice, not ours, not anybody’s but yours. Doesn’t that make you feel that you’re in control dear?

You’re really having the best of all worlds, you know. You have all this choice as a free citizen of this free country. And at the same time you can feel safe, watched over, looked after to the last breath. What more could you ask?

Who are the people who will decide whether you’re too old for the surgery or the drugs? Well, there will be general guidelines, rules.

You say some individuals are stronger and more able to work at a late age than others, so will they have their cases examined individually? Yes. By whom, do you ask? By doctors – at least two doctors who will report to the authorities that you are an exception. Or not. And yes, the authorities will make the final decision.

Yes, the very young who have disabilities and have not yet had much money spent on them would also have to forego the expensive surgery and drugs, but their parents would have the same careful consideration given to their cases by the Government-paid experts as you will have.

You ask, would they not – these doctors, these authorities, these various experts and officials – constitute a panel deciding whether you may or may not have certain life-saving treatments? Yes, in effect. You could put it that way.

Sarah Palin did? Oh, you mustn’t believe Sarah Palin. She went much too far. She actually called it a ‘DEATH PANEL’. That’s entirely wrong. That’s just hysterical. Nutty. Way out. Totally inaccurate and misleading. A wicked distortion. A dangerous lie.

Calm down, please. I’m not prepared to carry on with this argument. It’s got out of hand. You’re crazy. She’s crazy. How can you think that Barack Obama, of all people, would want to set up a ‘death panel’? Perhaps you‘re suffering from incipient dementia, dear. Would you like to have a little chat with another Government-paid doctor about preparing for when it gets worse?

Part Two: A News Item

This week, reacting to the clamor from many angry and confused people, the Senate Finance Committee dropped the idea of including ‘advance care planning consultations’ in its health care bill.

Part Three: A Democrat Meditates

Why did so many react so unreasonably to a provision that was merely designed to allow Medicare to pay doctors who counsel patients about planning for end-of-life decisions? The consultations would have been entirely voluntary and would simply provide information about living wills, health care proxies, hospice, and pain medication. It’s mystifying how such a simple service could be so misinterpreted!

Part Four: The Denial

The Obama administration has been forced to react to a ridiculous rumor launched by Sarah Palin.

It has put this up on its website (excuse the clumsy wording but the clarification had to be posted in a hurry):

It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.

Part Five: The Climb-down?

Associated Press report August 16 2009:

Bowing to Republican pressure and an uneasy public, President Barack Obama’s administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system.

Part Six: Chorus of Old People and Children

Two words have saved us – ‘DEATH PANEL’.

We need no longer fear.

The Government will not insure our care.

It cannot say ‘care granted’ or ‘denied’.

Who’ll live or die it won’t decide.

Thank you, Sarah Palin!

Jillian Becker  August 2009

Charles Krauthammer writes:

Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.

That’s a hypothetical case. What’s the real-life actuality in the United States today? A study in the journal Circulation found that for cardiovascular diseases and diabetes, “if all the recommended prevention activities were applied with 100 percent success,” the prevention would cost almost 10 times as much as the savings, increasing the country’s total medical bill by 162 percent. Elmendorf additionally cites a definitive assessment in the New England Journal of Medicine that reviewed hundreds of studies on preventive care and found that more than 80 percent of preventive measures added to medical costs.

This doesn’t mean we shouldn’t be preventing illness. Of course we should. But in medicine, as in life, there is no free lunch. The idea that prevention is somehow intrinsically economically different from treatment — that treatment increases costs and prevention lowers them — is simply nonsense.

Prevention is a wondrous good, but in the aggregate it costs society money. Nothing wrong with that. That’s the whole premise of medicine: Treating a heart attack or setting a broken leg also costs society. But we do it because it alleviates human suffering. Preventing a heart attack with statins or breast cancer with mammograms is costly. But we do it because it reduces human suffering.

However, prevention is not, as so widely advertised, healing on the cheap. It is not the magic bullet for health care costs.

You will hear some variation of that claim a hundred times in the coming health care debate. Whenever you do, remember: It’s nonsense — empirically demonstrable and CBO-certified.

Time to start spying on your friends, family, and neighbors, and reporting them to the state authorities if they show signs of dissenting from the Dear Leader’s declared orthodoxy. 

From the official White House website:

There is a lot of disinformation about health insurance reform out there, spanning from control of personal finances to end of life care.  These rumors often travel just below the surface via chain emails or through casual conversation.  Since we can’t keep track of all of them here at the White House, we’re asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to [email protected].

Hullo socialism, good-bye innovation. Socialism crushes inventiveness, as it purposefully does all private enterprise. Nothing new of any importance has come out of continental Europe since it turned socialist.

In Britain where the first Industrial Revolution took place, yes, there is still a remnant of the old inventive genius at work, though it’s slowly dying. Out of Britain has come one big new thing – the world-wide web, invented by Sir Tim Berners-Lee, blessings be upon him. (NOT by Al Gore, who claimed he invented it, but could not, we believe, invent a hand fan for a breeze.) 

To invent, men need not only their ideas but also a superfluity of time and money, even if they do it in their own garages as so many did in the Second Industrial Revolution in Silicone Valley. (I say men because women have invented sweet blow-all.) Free time and extra money, and the incentive of gaining great riches, are among the great benefits that only capitalism can bestow.  

Now that socialism is coming to the United States, incentive, opportunity and the urge to innovate will start to wither. Nationalized health care, for instance, will mean the stagnation of medical research. Will the billions needed to develop a new drug come from the state when the state is the only buyer?

The only sphere in which innovation has worked well under state control is the military. That was because American leaders have taken defense, the paramount responsibility of the state, very seriously. But now America has a president who believes that the nation is over armed – and should aim at totally giving up its nuclear defenses. Obama reckons, we are told, that if America castrates itself in this way, other nations will be so impressed by its ‘moral leadership’ that they too will give up the nuclear weapons they have, or the wish to obtain them. Either he really believes this sentimental hogwash or his motive is much darker and more sinister.

Michael Barone writes in Townhall:

Most people in the rest of the world are free riders on the productivity and ingenuity of the American military and American medicine. They get the benefits of American military protection and American medical innovation without paying, or without paying in full, for them. 

This has been the case all through the six decades after the Second World War. The American military has protected democracies from Communist expansion and today protects people all over the world from Islamist extremists. They get this service, if not free of charge, then at reduced rates. American taxpayers have been spending 4 percent of gross domestic product on our military and during the Cold War paid twice that share. NATO and most other allies spend significantly less.

American administrations of both parties have tried to get others to spend. But this is Sisyphus’s work. We are entitled to take pride in the fact that, in the spirit of “From those to whom much is given much is asked,” we are able to do so much for others.

Unfortunately, the Obama administration wants to do less. Defense has been scheduled for spending cuts. We are halting at lower than scheduled levels production of the F-22 fighter, whose brilliant advanced design is intended to assure American control of the skies for decades to come. The administration also seems to be scaling back missile defense, which could protect friends and allies from nuclear attack and over time might discourage nuclear proliferation…

We also may be at risk of squandering our high-tech advantage in medicine. As Scott Atlas of the Hoover Institution points out, the top five American hospitals conduct more clinical trials than all the hospitals in all other developed countries. America has outpointed all other countries combined in Nobel Prizes for medical and physiology since 1970.

American theoretical health research financed by the National Institutes of Health and by American market-oriented pharmaceutical companies outshines the rest of the world combined. And the rest of the world tends to get the benefits at cut rates… 

Pharmaceutical companies that produce benefits for patients and consumers get the profits that support their research disproportionately from Americans, because other countries refuse to spend much more than the cost of producing pills, which is trivial next to the huge cost of research and regulatory approval. Getting these free riders to pay more is, again, Sisyphus’s work.

The Democratic health care bills threaten to undermine innovation in pharmaceuticals and medical technologies by sending those with private insurance into a government insurance plan that would be in a position to ration treatment and delay or squelch innovation. The danger is that we will freeze medicine in place and no longer be the nation that produces innovations that do so much for us and the rest of the world.

The great essayist (and physician) Theodore Dalrymple writes in the Wall Street Journal:

If there is a right to health care, someone has the duty to provide it. Inevitably, that “someone” is the government. Concrete benefits in pursuance of abstract rights, however, can be provided by the government only by constant coercion.

People sometimes argue in favor of a universal human right to health care by saying that health care is different from all other human goods or products. It is supposedly an important precondition of life itself. This is wrong: There are several other, much more important preconditions of human existence, such as food, shelter and clothing.

Everyone agrees that hunger is a bad thing (as is overeating), but few suppose there is a right to a healthy, balanced diet, or that if there was, the federal government would be the best at providing and distributing it to each and every American.

Where does the right to health care come from? Did it exist in, say, 250 B.C., or in A.D. 1750? If it did, how was it that our ancestors, who were no less intelligent than we, failed completely to notice it?

If, on the other hand, the right to health care did not exist in those benighted days, how did it come into existence, and how did we come to recognize it once it did?

When the supposed right to health care is widely recognized, as in the United Kingdom, it tends to reduce moral imagination. Whenever I deny the existence of a right to health care to a Briton who asserts it, he replies, “So you think it is all right for people to be left to die in the street?”

When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence. He cannot think of one.

Moreover, the right to grant is also the right to deny. And in times of economic stringency, when the first call on public expenditure is the payment of the salaries and pensions of health-care staff, we can rely with absolute confidence on the capacity of government sophists to find good reasons for doing bad things.

The question of health care is not one of rights but of how best in practice to organize it. America is certainly not a perfect model in this regard. But neither is Britain, where a universal right to health care has been recognized longest in the Western world.

Not coincidentally, the U.K. is by far the most unpleasant country in which to be ill in the Western world. Even Greeks living in Britain return home for medical treatment if they are physically able to do so.

The government-run health-care system—which in the U.K. is believed to be the necessary institutional corollary to an inalienable right to health care—has pauperized the entire population. This is not to say that in every last case the treatment is bad: A pauper may be well or badly treated, according to the inclination, temperament and abilities of those providing the treatment. But a pauper must accept what he is given.

Universality is closely allied as an ideal, ideologically, to that of equality. But equality is not desirable in itself. To provide everyone with the same bad quality of care would satisfy the demand for equality. (Not coincidentally, British survival rates for cancer and heart disease are much below those of other European countries, where patients need to make at least some payment for their care.)

In any case, the universality of government health care in pursuance of the abstract right to it in Britain has not ensured equality. After 60 years of universal health care, free at the point of usage and funded by taxation, inequalities between the richest and poorest sections of the population have not been reduced. But Britain does have the dirtiest, most broken-down hospitals in Europe.

There is no right to health care—any more than there is a right to chicken Kiev every second Thursday of the month.

Getting it right and making us laugh again, here is Mark Steyn on nationalizing health care:  

Health care is a game-changer. The permanent game-changer. The pendulum will swing, and one day, despite their best efforts, the Republicans will return to power, and, in the right circumstances, the bailouts and cap-&-trade and Government Motors and much of the rest can be reversed. But the government annexation of health care will prove impossible to roll back. It alters the relationship between the citizen and the state and, once that transformation is effected, you can click your ruby slippers all you want but you’ll never get back to Kansas…

Government-directed health care is a profound assault on the concept of citizenship. It deforms national politics very quickly, and ensures that henceforth elections are always fought on the left’s terms. I find it hard to believe President Obama and his chums haven’t looked at Canada and Europe and concluded that health care is the fastest way to a permanent left-of-center political culture. He doesn’t say that, of course. He says his objective is to “control costs”. Which is the one thing that won’t happen. Even now, health care costs rise far faster under Medicare than in the private sector.

By the way, to accept that argument is to concede a lot of the turf: Why is the cost of my health care Barack Obama’s business? When he mused recently as to whether his dying grandmother had really needed her hip replacement, he gave the game away: Right now, if Gran’ma decides she doesn’t need the hip, that’s her business. Under a government system, it’s the state’s business – and they have to “allocate” “resources”, and frankly at your age your body’s not worth allocating to. Why give you a new hip when you’re getting up there and you’re gonna be kicking the bucket in a year or two or five or twenty?…

Please do yourself the favor of reading the whole thing here. 

The Obama administration believes that if you are too old to play an active part in the community they’re organizing, you should die. To help you do this, you will be denied medical treatment under their ‘health care’ plan, which will necessarily be a rationing plan.

This from  Newsmax.com 

Discrimination against the elderly when it comes to healthcare is not discrimination — at least not to a key member of the Barack Obama administration.

Ezekiel Emanuel is director of the Clinical Bioethics Department at the U.S. National Institutes of Health and an architect of Obama’s healthcare reform plan. He is also the brother of Rahm Emanuel, Obama’s White House chief of staff.

Express Riders, the blog of conservative businessman and philanthropist Foster Friess, reports that Ezekiel Emanuel has written that health services should not be guaranteed to “individuals who are irreversibly prevented from being or becoming participating citizens.”

He also stated, “An obvious example is not guaranteeing health services to patients with dementia,” according to Friess’ site.

Friess also points to an equally troubling article co-authored by Emanuel, which appeared in the medical journal The Lancet in January. It read in part: “Unlike allocation [of healthcare] by sex or race, allocation by age is not invidious discrimination. Every person lives through different life stages rather than being a single age.

“Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years.

“Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.”

Friess asks: “Are these the values we want undergirding our healthcare system?”

From Investor’s Business Daily:

It didn’t take long to run into an “uh-oh” moment when reading the House’s “health care for all Americans” bill. Right there on Page 16 is a provision making individual private medical insurance illegal.

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:

“Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

From the beginning, opponents of the public option plan have warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither. Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington’s coverage.

The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, “fizzle out altogether.”

What wasn’t known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law.

The legislation is also likely to finish off health savings accounts, a goal that Democrats have had for years. They want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs.

With HSAs out of the way, a key obstacle to the left’s expansion of the welfare state will be removed.

The public option won’t be an option for many, but rather a mandate for buying government care. A free people should be outraged at this advance of soft tyranny.

Washington does not have the constitutional or moral authority to outlaw private markets in which parties voluntarily participate. It shouldn’t be killing business opportunities, or limiting choices, or legislating major changes in Americans’ lives.

It took just 16 pages of reading to find this naked attempt by the political powers to increase their reach. It’s scary to think how many more breaches of liberty we’ll come across in the final 1,002.

Obama has appointed John Holdren as his ‘Science Czar’. (As we have said before these ‘Czars’ would be more accurately titled ‘Commissars’.)

What may we expect of him?

Forced abortions. Mass sterilization. A “Planetary Regime” with the power of life and death over American citizens.

The tyrannical fantasies of a madman? Or merely the opinions of the person now in control of science policy in the United States? Or both?

These ideas (among many other equally horrifying recommendations) were put forth by John Holdren, whom Barack Obama has recently appointed Director of the White House Office of Science and Technology Policy, Assistant to the President for Science and Technology, and Co-Chair of the President’s Council of Advisors on Science and Technology — informally known as the United States’ Science Czar. In a book Holdren co-authored in 1977, the man now firmly in control of science policy in this country wrote that:

• Women could be forced to abort their pregnancies, whether they wanted to or not;

• The population at large could be sterilized by infertility drugs intentionally put into the nation’s drinking water or in food;

• Single mothers and teen mothers should have their babies seized from them against their will and given away to other couples to raise;

• People who “contribute to social deterioration” (i.e. undesirables) “can be required by law to exercise reproductive responsibility” — in other words, be compelled to have abortions or be sterilized.

• A transnational “Planetary Regime” should assume control of the global economy and also dictate the most intimate details of Americans’ lives — using an armed international police force.

Read more here.

We draw our readers’ attention to the comment made by ‘roger in florida’ on our last posting immediately below, in which he gives a crystal-clear explanation of why a state-run health service must always necessarily be bad for the patient.

In our opinion there is no good argument for government control of health services.  

Further reinforcing our view, Investor’s Business Daily brings us this information and comment:

The Senate legislation is sponsored by the usual suspects, Democrats Ted Kennedy of Massachusetts and Chris Dodd of Connecticut. It’s modeled on Massachusetts’ plan, which also imposes a $1,000 fine [shared responsibility payment]… 

The CBO estimates the “shared responsibility payments will bring in about $36 billion over 10 years. This Senate Health Education, Labor and Pensions (HELP) bill also calls for a $750-per-worker “annual fee,” $375 for part-time workers on companies with more than 25 employees that do not offer coverage to employees.

So if you’re a small business seeking to expand beyond 25 workers, you have quite a bit to think about. That’s sure going to help job growth. In a statement released by the White House, Obama welcomed the revised legislation, saying it “reflects many of the principles I’ve laid out.”

The Kennedy-Dodd bill also provides for a government-run insurance option to compete with private plans. A competing Senate Finance Committee version does not.

According to the CBO, under its plan “the number of people who had coverage through an employer would decline by about 15 million, and coverage from other sources would fall by about 8 million.” The number of uninsured would decline by only a third.

This seems to fly in the face of the Obama promise that if you like your current coverage, nothing will change. Around 80% of Americans — 243 million of us — have indicated we like our current coverage and doctors. Too bad, for that will change.

Suppose health care reform passes and all are insured, by force or otherwise. The U.S. will be short 124,400 front-line physicians by 2025, according to the Association of Medical Colleges.

That does not include the 15,585 new primary-care providers the administration plan is estimated to require.

Put together fewer doctors, more patients and government insurance, and that spells less access to care, even rationing. HillaryCare died in 1994 when Americans realized it would force them to give up the coverage and health care providers they liked.

ObamaCare is no different.