Dignity Panel
On Morning Joe a few minutes ago, Pat Buchanan described the fear behind the death panel debate as the fear that old people without anyone around who loves them will be steered in their final years toward elective euthanasia. Surely the steering power of a government authorized to command and control the health care economy would be profound indeed. But the root issue behind the death panel debate is not federal power — it’s human dignity.
The archetypal or stereotypical conservative would say that even an old, isolated person has a reason to reject suicide that reaches to the foundations of what makes us human and what gives humans dignity. The archetypal or stereotypical progressive would say that conservatives need to abandon their romantic and/or religious fantasies that a dying person finds more dignity in enduring great suffering until their body fails than in choosing to die beforehand. Liberals, who, technically speaking, are stuck or torn between conservatism and progressivism, would be torn on this issue too. Liberalism — the political philosophy and worldview, not the ideological position — struggles to square or reconcile two competing visions of human dignity.
It’s tempting to say the first or conservative vision defines dignity in terms of the human race or species, and that the second/progressive vision does so in individualistic terms. On the question of suicide, that may seem true; but on health care more broadly, it’s obviously false. Progressives, not conservatives, are the ones most apt to think that the power of social science to help us all comes from its ability to generate valid predictions based on large-n data inputs — data in which each individual is reduced to their minimal statistical significance, and made mutually interchangeable accordingly. It turns out that conservatives and progressives also harbor an internal tension between thinking of dignity as existing in virtue of our shared human being and dignity as existing in virtue of our individual human being. It’s almost as if that tension reflects something fundamental about being human — both as a member of the human species and as a unique individual person.
But that tension today is colored deeply by our disgusted, despairing sense of nihilism over individual suffering. It’s increasingly difficult for us to conceive of the decision to soldier through a terminal illness as dignified. The problem is exacerbated by the costs of such care. If the stoic sufferer has loved ones, he or she is insensitive to what he or she is “putting them through;” if not, the stoic sufferer is wasting their — if not other people’s — money. For what? Paradoxically, perhaps, even our individualistic attitude toward the worthlessness of suffering lowers our estimation of individualistic pride.
By now it might be clear that I’ve been sliding back and forth between the assumption that enduring a terminal illness will be a natural or hands-off process versus one full of medication, treatment, and care. Possibly the final question about dignity that bears on our health care debate pertains less to choosing suicide than accepting death. But even this question is conditioned by the reality that choosing between acceptance and choice is made more human by doing so with one’s family. Unfortunately, ‘more human’ might not mean more painless or even more uplifting. Struggling with mortality can often be harder and messier with family than in isolation.
So perhaps the root moral issue behind the death panel debate actually just throws us back onto the question of whether we should choose to permit the government to influence this, one of our most difficult decisions, at one of our most vulnerable or susceptible moments. Because it appears the government at that moment would tend strongly to have greater confidence, and less at stake, than any of us.
You’re website has very good infos. I learned very a lot from reading these.
— cheap jordan shoes · Aug 25, 01:51 PM · #
We know that President Obama believes very strongly in the importance of mindsets, and sending signals; the $100 million budget cuts were supposed to send a signal that government was fiscally responsible, even despite the objective fiscal situation. He should not be incredulous when people ponder the signal sent and the mindset endorsed by end-of-life counseling.
— Aaron · Aug 25, 02:24 PM · #
There are no death panels. There aren’t going to be any death panels. At most, the government wouldn’t be doing anything that insurance companies don’t already do every day. Unless a discussion starts from those basic facts, it’s not going to be anything but wankery.
Mike
— MBunge · Aug 25, 02:48 PM · #
1) There is no “death panel debate.” On one hand, there are people who are slandering their opponents by falsely asserting that their opponents have made a ghoulish proposal. On the other hand, their opponents are pointing out that they are lying. That’s not debate, that’s something else.
2) Under our current system, the goverment pays doctors to perform medical procedures on old people; the more procedures the doctors perform, the more they get paid. What is your proposal?
— alkali · Aug 25, 02:53 PM · #
What alkali said. There’s a difference between “government permits X” and “government encourages X.” Permitting individual people with terminal illnesses to decide when and how they are going to die is the opposite of the mythical eeevil government bureaucratic death panels.
In Oregon, when they democratically passed the Death With Dignity act by referendum (and a competing referendum to repeal it was beaten back with 60% of the vote), wikipedia reports :
It’s been in place for over a decade and people who choose to die under its terms represent less than two-tenths of one percent of all deaths in the state.
— Omcrc · Aug 25, 03:31 PM · #
Now this is the Poulos straw that stirs my drink. Nice post.
Both ethea are muddled on the question of the individual.* Enter existentialism.
On dignity, consider what it is. It is a subjective phenomenon, an emotionally-accented intuition, a truth that “forces itself upon you”, as Godel would say (Fermi would call it con intuito formidable, a ‘formidable intuition’). It is a theory-laden judgment, a pre-rational observation sentence, prone to left-brain, post hoc purchase and justification. It is a natural concept and nurtured conception (to borrow Rawls on justice). The concept blooms into the conception according to the logic of socialization. The diversity of non-abelian subject-paths leads to heteroglossia, that is, it leads to an ineradicable pluralism of ‘dignity conceptions’ which have, nonetheless, facially common features.
So what do you do when you’re faced with an irreducible, human-universal like ‘dignity’? You seek spontaneous consensus, what Quine in another context calls ‘outright assent’, that is, you pursue ‘objective dignity’ by building a lattice of intersubjective agreement (Manzi refers to them as belief axioms, which is an apt way to describe them).
Of course, building the lattice is much trickier for a concept than it is for a sensory experience. However, both are percepts and both are amenable to intersubjectivity. Long story short, the trick is to control and limit context, to frame and therefore exclude. The frame is the necessary centripetal force, from which can be built the unitary language (to borrow Bakhtin). And that, my friend, is the answer.
* [I recall Rosenzweig: “Let man creep like a worm into the folds of the naked earth before the fast approaching volleys of a blind death from which there is no appeal; let him sense there, forcibly, inexorably, what he otherwise never senses: that his I would be but an It if it died; let him therefore cry his very I out with every cry that is still in his throat against Him from whom there is no appeal, from whom such unthinkable annihilation threatens — for all this dire necessity philosophy has only its vacuous smile.”
— Kristoffer V. Sargent · Aug 25, 03:49 PM · #
Oooh, great quotation from Rosenzweig, KVS.
Somehow it reminds me of this, from Bellow’s Herzog:
“I suppose, he was thinking, that we heard this tale of the Herzogs ten times a year. Sometimes Mama told it, sometimes he. So we had a great schooling in grief. I still know these cries of the soul. They lie in the breast, and in the throat. The mouth wants to open wide and let them out. But all these are antiquities — yes, Jewish antiquities originating in the Bible, in a Biblical sense of personal experience and destiny. What happened during the War abolished Father Herzog’s claim to exceptional suffering. We are on a more brutal standard now, a new terminal standard, indifferent to persons. Part of the program of human destruction into which the human spirit has poured itself with energy, even with joy. These personal histories, old tales from old times that may not be worth remembering. I remember. I must. But who else — to whom can this matter? So many millions — multitudes — go down in terrible pain. And, at that, moral suffering is denied, these days. Personalities are good only for comic relief. But I am still a slave to Papa’s pain. The way Father Herzog spoke of himself! That could make one laugh. His I had such dignity.”
— Kate Marie · Aug 25, 04:05 PM · #
Is there a Constitutional right to be treated like a child and told that you will never, ever die and that death is something you never need to think about or plan for? Is the government’s official position merely to be that Grandpa has “gone to sleep”?
— Chet · Aug 25, 04:40 PM · #
Is there a Constitutional right to be treated like a child and told that you will never, ever die and that death is something you never need to think about or plan for?
No, but last time I checked, there was no constitutional right to be told anything about death, or about how to think about and plan for death. Most people seem to sort of figure it out for themselves.
Is the government’s official position merely to be that Grandpa has “gone to sleep”?
Why should the government have an “official position” on where Grandpa has gone?
— Kate Marie · Aug 25, 04:53 PM · #
To pro-reformers, how about this. I’ll sign onto reform on one condition. I want hard assurances that, at any point in my life and for any reason whatsoever, I can utter the words, “Public Option for thee but not for me” and it will be so.* Deal?
* [i.e., there will always be a robust private market, where, in alkali’s words, the more procedures the doctors perform, the more they get paid.]
— Kristoffer V. Sargent · Aug 25, 05:12 PM · #
Orzag promises that immediately after the current expansion, the Obama administration not only will begin robust cost containment, but must, or else the government will go bankrupt. Ergo, death panels, who decide how much care, if any, young Trig Palin gets.
Obama is doing his best to sell the current health plan as all giveaway — you get all kinds of things you want, but you don’t have to give up or sacrifice anything. There’s no reason anyone should take his word for it.
As to encouraging the elderly to exit in a dignified manner and not to use so much health care in the process, well, obviously there is a strong incentive to do that, but on the other hand, the elderly are a strong political lobby. We’ll see.
— J Mann · Aug 25, 07:03 PM · #
J Mann,
You got the order wrong, first the black helicopters from the UN will be stopping by your house to pick up your guns
— eric k · Aug 25, 07:16 PM · #
Uh, sure. (In reality, I would probably except the situation where you are so poor that you can’t pay for anything, in which case I might reasonably insist that you accept Medicaid rather than die in the street, but since it’s hypothetical anyway who cares.)
— alkali · Aug 25, 07:16 PM · #
No, but there’s a significant public health interest in doing so. Much as there’s a public interest in people having wills, therefore we apply the force of law to the enforcement of people’s wills as an incentive for them to make them.
The Constitution gives the government broad authority to act in the public’s interest (the “general welfare.”) Particularly in terms of spending money to do so. And that’s all we’re talking about – the government paying for you to have a consultation with an end-of-life counselor, if you want.
If you want.
Well, no, most people don’t figure it out for themselves. Most people just die, having done no planning of any kind, and leaving their surviving family with the burden of doing what they didn’t when they had the time.
Sure. You can become a citizen of any other country, of your choice, for any reason you like, at any time.
Er, wait. We’re not talking about “death panels” who say “sorry, but it’s too expensive to keep you alive and you’re not worth it.” That’s part of the misinformation.
What we’re talking about is the fact that it’s not only cheaper not to spend big money on unecessary medical procedures that appear attractive to those facing down the death of a loved one, but it actually extends your life. Yes! Persons under properly managed hospice care actually live six months longer, on average, than the people who spend tens of thousands on ineffective, experimental procedures.
We can save money and extend the lives, and the quality of lives, of seniors – because our system is just that wasteful. There’s that much waste!
— Chet · Aug 25, 07:19 PM · #
“* [i.e., there will always be a robust private market, where, in alkali’s words, the more procedures the doctors perform, the more they get paid.]”
Do you know of a country where a private health insurance system does not exist?
Mike
— MBunge · Aug 25, 07:52 PM · #
Very literate thread. But quite weak in two respects. First, all ideas expressed in opposition to the HCReform seem to take it for granted that nothing needs to change. Very stupid. Simple fact is that the present arrangements will drive the US economy bankrupt within decades. Projection is that by 2050 the portion of the economy labeled “health care” with be 40% of GDP under current policies. Put that in your bong and smoke it for a while and then accuse ‘ObamaCare’ of driving us to the poorhouse.
Second, in the absence of LivingWill or similar AdvancedDirectives the healthcare industry has a huge gravitational pull toward “doing everything”. Compared to which the effect of the Federal Gov’t urging patients to decide what their final care should be is nothing.
I’ve been an ICU nurse for 30yrs. It is amazingly difficult to stop the process of doing procedures. Totally comatose people in their 80s have surgery all the time because there is nothing to make us stop. HealthAffairs Journal had a conference recently (C-SPAN junkies probably know this); one of their presenters said that 38% of patients spend a week or more in an ICU on a ventilator in their last 6 weeks of life. Think what that means: We sedate them to near-coma, we tie their hands, we jab them repeatedly with lines and needles, we put ‘tubes’ into every orifice (yes, even there!).
What does a discussion (very literate!!) about dignity that leaves that little fact unsaid accomplish? Absent that picture in everyone’s head this whole thread is masturbation (but literate!!).
Another little but troublesome fact: For all the wonderful heartwarming stories of families facing the death of loved ones it doesn’t always or even very often happen that way. Stroll into any Nursing Home and ask the staff how many visitors the average ‘Client’ sees in a week. You’ll find that (at least in Florida where I live) something like 1/3d of Nursing Home Patients have any regular family contact. When they do come to my ICU I am often the person who has to locate family members.
The dignity granted these folks should not start after they have a stroke.
— JohnMcC · Aug 25, 08:13 PM · #
John McC,
The “literate” nature of this thread, for which you seem to have such disdain, has to do with the “literate” nature of the post, which — unless I’m utterly misreading it — is not a wonky argument about specific health care reform policies, but a reflection on the philosophical underpinnings of the debate surrounding the government’s potential involvement in end-of-life care and counseling.
— Kate Marie · Aug 25, 08:54 PM · #
Alkali, I was cribbing from this NYTimes article.
That is something I would support. Et tu?
Chet: Sure. You can become a citizen of any other country, of your choice, for any reason you like, at any time.
That’s an ass jackal thing to say. You sound like you just plugged a handful of freedom fries.
Mike, I want my doctors to get paid more when they do more procedures. That’s a feature not a bug of a helpful heathcare system. Reformers see a bug and want to fix it.
— Kristoffer V. Sargent · Aug 25, 09:05 PM · #
Re: Surely the steering power of a government authorized to command and control the health care economy would be profound indeed.
The elderly are already subject to socialized medicine in full form. If “death panels” were the govermment policy they would already be in place. Meanwhile what about the incentives of somewhat younger people who are sick, alone— and uninsured? Seems to me our current system sends a message that they are not worth crap and they’d be better off dead.
Re: For all the wonderful heartwarming stories of families facing the death of loved ones it doesn’t always or even very often happen that way.
With one exception all of my elderly relatives lived at home, with family, until their final days. That includes my father (dead of emphysema), my step-mother (just died of a sudden and massive heart attack), one aunt who died of congestive heart failure, another dead of a massive stroke, and a third who died of cancer. My father and the aunt with cancer spent their last two weeks institutionaized (in a hospital and at hospice respectively). The exception was a rich uncle who so alienated his entire family, inclduing his children, that he had no one who gave a hoot about him at the end. (And let me add that he really did make his own bed on this and his loneliness at the end was not unjust). I really do doubt that the abandoned old person is the rule rather the exception, and in many cases those who are abandoned probably laid that fate in store by treating their families poorly over the years.
— JonF · Aug 26, 12:19 AM · #
“You’re website has very good infos. I learned very a lot from reading these.”
Yes, I see your point.
— mike farmer · Aug 26, 12:43 AM · #
KVS, I don’t understand your worry. I come from a country that has a mixed system in the sense that the private insurance is an optional add-on that costs extra money and provides better treatment. So, public health care insurance provides a decent baseline, while everything else can be purchased and often is by your employer as a part of your job offer.
Honestly, what’s all the fuss about?
As far as the living will etc. is concerned, just say no to such a meeting when offered, or say you want to be kept alive as long as possible, and that’s it.
I think the logic here is that at least some of the people would decide not to live as vegetables had they considered the possibility of such a thing happening to them in their final days, and would say: “Don’t resuscitate me.” or “Don’t keep me in a vegetative state if there is virtually no chance for improvement.”
Sure, the government (or the society, if you will) would certainly save some of the limited resources, and to some that might sound morally dubious, but I find it really hard to believe that the government would ever aggressively push anyone into making such a decision. The reason is very simple:
Even if the government would prefer to kill off the elderly to save the money (which to me seems an extremely highly improbable assumption), it is also aware of two things:
1. that if such stories came out it would represent a political disaster for the administration,
2. and that the potential savings from the whole living will and end-of-life counseling are really not going to be that big anyway.
To me the whole thing seems just like one of those ideas that was added on because the lawmakers thought it might save some money even if only a few people choose to do so. And that seems to me to explain why many Republicans have also supported similar measures in the past (for example Senator Isakson, R-Ga).
In a way, I’d say it’s similar to “cash for clunkers” – there, the gov’t says: “If you want to buy a new, more energy efficient car, here’s some money. It’ll help reduce pollution and it’ll help the automakers. But if you don’t, no problem. Case closed.”
— Marko · Aug 26, 01:16 AM · #
Let me add that, to clear any possible confusion, that in the system I’ve described one is allowed to purchase extra insurance on their own, as well.
— Marko · Aug 26, 01:28 AM · #
It’s increasingly difficult for us to conceive of the decision to soldier through a terminal illness as dignified. The problem is exacerbated by the costs of such care. If the stoic sufferer has loved ones, he or she is insensitive to what he or she is “putting them through;” if not, the stoic sufferer is wasting their — if not other people’s — money.
This does not accord with my experience, to put it mildly. Of course, I’m only one guy. Does it ring true for anyone else here?
So perhaps the root moral issue behind the death panel debate actually just throws us back onto the question of whether we should choose to permit the government to influence this, one of our most difficult decisions, at one of our most vulnerable or susceptible moments.
The choice of government influence versus no government influence is a false one. These people are on Medicare. The government already decides which procedures to pay for and how much. Right now the debate is whether or not the government should cover doctor-patient consultations on end-of-life care. At this point I’m going to quote JohnMcC because I think what he said is very important:
Second, in the absence of LivingWill or similar AdvancedDirectives the healthcare industry has a huge gravitational pull toward “doing everything”. … It is amazingly difficult to stop the process of doing procedures. Totally comatose people in their 80s have surgery all the time because there is nothing to make us stop.
Non-coverage of end-of-life consultations is itself a form of government influence. The effect is to push people along in the flow of procedure after procedure rather than encouraging them to think through what they want in advance.
I take special exception to the claim that these sessions would occur “at one of our most vulnerable or susceptible moments.” The more vulnerable and susceptible moment is after the patient has suffered more setbacks and is mentally incapable of understanding the difficult decisions to be made. At that point, the family members have to decide on their own, or the system keeps ordering procedures out of inertia.
The point of a consultation is for the patient to think about these issues while they still can, so that when their condition worsens, the people around them don’t have to guess what they would have wanted. As things stand now, thousands of people undergo treatment that they themselves wouldn’t have chosen. Sometimes it causes them pain and suffering without increasing their lifespan at all. On the other side, I bet there are patients who would make it clear in a consultation that they want everything possible done to keep them alive, but whose wishes aren’t fully heard, so their families choose not to pursue the most aggressive treatment option when the time comes. The current system fails them just as surely as the proposed system would fail the hypothetical patients buffaloed by their overbearing doctors into signing DNR directives against their will or inclination.
I make this point not as a “gotcha” but as a way of demonstrating that there is no neutral option here. Whether we do or don’t pay for these sessions, people will still have to make tough decisions, and sometimes they’ll get it wrong. We should aim for people to enter the final stage of their lives with their eyes open, cognizant of the choices ahead. We should try to avoid the situation, all too common today, when the family starts to consider the options only after the patient is too incapacitated to have a say in their own treatment.
For all these reasons, I consider the objections about “death panels” to be not just dishonest but fundamentally wrong.
— dj · Aug 26, 06:26 AM · #
Marko, your points make sense. I would indeed get behind a baseline public option so long as it’s low enough to ensure a real market for private insurance above it. I’m on record at the Scene saying as much. I do worry about feasibility, though, and bureaucratic absurdities, and decline in quality, and cascading debt, and the fucked-up priorities of do-gooder busybodies, and other nasties that might be lurking around the corner of comprehensive reform.
I also worry about the possible impact on innovation and our access to it. And I don’t think innovation-angst is illegitimate, even if it might turn out to be misplaced. I worry that the US is the mitochondrion here, and that we’re being seduced by a community of golgi apparati.
But yes, overall I bring to this table a deep distrust of government and the well laid plans of our species. I also have zero respect for the ability of my fellow citizens to vote themselves off the sauce if reform ends up being a fiscal rapist.
That doesn’t make me impervious to reason, mind, but it does set the persuasion bar a little higher for me than it clearly is for others.
— Kristoffer V. Sargent · Aug 26, 01:54 PM · #
I suspect if you thought about it, what you’d realize is that you actually want your doctors to get paid more when they make you better.
— Chet · Aug 26, 02:17 PM · #
I’d also like doctors to get paid more when the prevent terrible diseases from developing. Which, if you thought about it, means getting paid for thoroughness, which means getting paid for doing more procedures.
And what if I don’t get better? I’d still like to pay them for aggressive treatment and increased odds of survival. Which means I’d like there to be an incentive for thoroughness, for exhausting all available options. Which means I’d like them to get paid for doing more procedures.
Maybe you should think about more, nicht va?
— Kristoffer V. Sargent · Aug 26, 02:37 PM · #
“Which means I’d like them to get paid for doing more procedures.”
Who’s not going to pay them for doing more procedures? How would ANYTHING proposed under Obamacare be worse than the current insurance regime where for-profit companies look for every possible reason or excuse not to pay for treatment?
Mike
— MBunge · Aug 26, 02:45 PM · #
Kristoffer,
You don’t really want to pay them for “aggressive treatment and increased odds of survival”. You want to pay them for increased odds of survival. This may seem like nitpicking, but it’s not, because “aggressive treatment” in the sense of doing lots of procedures does not always correlate with improved outcomes and may have bad side-effects.
Also, the “paid for more procedures” phrase is a bit misleading. The issue is not just the number of procedures/treatments given, but also the cost per procedure. For example, if a hospital can give you a $30,000 procedure with some fancy equipment that it’s still trying to pay for, or a different $5,000 procedure, and the two are statistically equivalent with respect to outcomes, you don’t want them to make the decision based on how much money they get (even more so if the less-expensive procedure is actually a bit better).
— Ratufa · Aug 26, 03:57 PM · #
Ratufa, I don’t see how you can separate them. I really don’t. It’s just not practical to reward result and not effort. How do you pay a doc for preventing a disease, or for raising the odds of a cure (even if this is, yes, what I really want)? How are these things knowable?
Where the rubber meets the road is on the margin, where the doc is uncertain about the proper course. In that situation, I’d rather the doc be presented with incentives to go that extra mile. The opposite incentive structure, something like capitation, can seduce the doc into a rose-colored neglect. That’s the opposite of what I want.
To address your other points, I’m comfortable with ‘informed consent’ and the remedy of malpractice as best-mode solutions to the otherwise ineradicable problems of trust and good faith. I feel you on waste, though; it’s a problem that must be confronted.
— Kristoffer V. Sargent · Aug 26, 07:09 PM · #
How would ANYTHING proposed under Obamacare be worse than the current insurance regime where for-profit companies look for every possible reason or excuse not to pay for treatment?
Well, you can enforce an insurance contract by hiring people like me to file suit. Not so much with Uncle Sam and his Murder-Death-Kill Committees.
— Kristoffer V. Sargent · Aug 26, 07:20 PM · #
The funny thing about the death panels is they are a fiction. People haven’t simply gone and read the bill.
http://www.opencongress.org/bill/111-h3200/text
Page 432.
What are these crazies talking about? They are simply trying to scare people into opposing any healthcare reform.
— Kevin · Aug 26, 08:17 PM · #
“Not so much with Uncle Sam and his Murder-Death-Kill Committees.”
Yes, if there were only people that you could turn to when you’re not happy with the way the government is treating you. Perhaps we could call them Congressman and Senators. Ah, why should I torture myself with such ridiculous dreams.
Seriously, though, which do you think gets a better response…
1. A Congressman or Senator calling a federal agency and asking them to do something, or…
2. One person suing a multi-billion dollar corporation?
Mike
— MBunge · Aug 26, 08:48 PM · #
This makes a classic incorrect political assumption: because I am for something, the people on the opposite end of the political spectrum are against it. Broadly speaking, progressives/liberals are not enthusiastic supporters of putting oneself out of misery. Assisted suicide isn’t a plank of the Democratic policy and I would imagine where you stand on the issue has a lot more to do with personal experience than whether you voted for Obama and McCain.
Therein lies the problem: it assumes that if the pro-life right stands unequivocally against suicide, which isn’t even at issue in the healthcare debate, the left must be for it.
I’m reminded of those lists of “Top Conservative Movies” one sees now and again. Perhaps bravery is something conservatives value. Liberals, human beings who share a nation (and sometimes a household) with conservatives, agree. Of course, a conservative may see a tale of bravery in the face of long odds and take from that the notion that suffering is ennobling and spine-strengthening and that government should not try to alleviate it through social programs and the like. Conservatives may see the same movie, appreciate the bravery but take away a message that, for example, the film has exposed a great injustice against the protagonist calls out for a larger solution. One movie, one reaction, two different political solutions.
Treating people who have a different political philosophy as literal opposites provides no insights. It’s only useful for demonization and demagoguery, which may be the point of this post.
— rj · Aug 26, 10:10 PM · #
KVS, two comments:
1. US is already spending more on health-care than anyone else. And most of the countries with end-results comparable to those of US, also happen have mixed public-private health insurance AND lower costs.
2. It seems to me that you might also be setting a much higher bar for the reform i.e. public health insurance than for the status quo. Your concerns are legitimate, but perhaps if you looked as critically at the status quo or the reform without the public option, you’d find even more troublesome things.
(And regarding your comment: “Well, you can enforce an insurance contract by hiring people like me to file suit?” I have to agree with one of the comments that private suits against insurance companies are hardly the easiest or the swiftest solution to such problems in the current system. I mean how long could such a suit drag on? Who covers the costs in the meantime?)
— Marko · Aug 26, 11:05 PM · #
Oh, we spend too much on health care? That’s a problem?
Dammit man, wake up and read your Keynes!
We are in the midst of a huge crisis and you want to clamp down on people’s spending? Where have you been? Now is the time to spend our way out of this mess, with Chinese credit if we have to. There is no time for discussion!
What we need is more spending, more tests, procedures, hips for 90 year-olds on life support machines (crank em up), pull all tonsils, prescribe every pill available (no generics), x-ray the hell out of everyone then inject them with chemo and stem cells! Be a patriot and get some botox today – you look crinkled. Pay with CA IOUs if you have to, just do it.
Now is the time for all good Americans to stimulate their economy and inject money into researcher’s hands so we can sell new innovations to the stagnant, dependent, immigrant doctors in Europe.
I estimate it will take at least $5 trillion more to pull us out of the worst financial crisis ever. Maybe then, after the recovery, we can talk about forcing everyone to purchase insurance that will not cover your right to abortions, and force us to embrace the fiction that there is any dignity in death.
— Foreman · Aug 27, 06:33 AM · #
This is the best discussion of the whole ‘end of life’ and ‘dignity’ issue that I have found on the internet. And you people still do not get understand shit.
One simple thing makes life worth living and gives ‘dignity’. Love. Relationships. Human contact. As Willy Nelson says: Love’s the greatest healer to be found.
Nothing in “ObamaCare” (which like a unicorn we can all describe yet refuses to actually exist) would give love or warmth to anyone who is dying today in the places I work—or my wife an LPN in a Nursing Home here in Florida, works. No conservative has proposed any alternative that would do that. It’s the usual blah, blah, blah. Political catfights that spend huge national treasure but do not actually touch the issue they pretend to solve.
What do we all of us want in our dying weeks and hours? Freedom from pain. Clear minds. Loved ones nearby.
The issue you are discussing is the simplest of all. I remember (because I am old and have a clear mind) a remark that Ronny Reagan made about welfare. He said, If every church congregation in the country ‘adopted’ a welfare family—just one—there would be no welfare problem. Because, no one would be on welfare.
If every opinionated asshole commenting on this issue on the internet would resolve to visit one Nursing Home Patient weekly. And would advocate and accept some responsibility for that person. There would be no ‘dignity in death’ issue. Because the dignity of everyone’s dying would be assured by their human, loving connections.
It is simply what we all want for ourselves and should be willing to give to those who are dying ahead of us.
And literary? Ms Kate, this is literary:
Twelve hundred million men are spread
About this earth, and I and You
Wonder, when You and I are dead,
“What will those luckless millions do?”
…..
When leave,long overdue, none can deny,
When idleness of all Eternity
Becomes our furough and the marigold
Our thriftless, bullion-minting Treasury
Transferred to the Eternal Settlement,
Each in his strait, wood-scantled office pent,
No longer Brown reverses Smith’s appeals,
Or Brown records his Minute of Dissent.
And One, long since a pillar of the Court,
As mud between the beams thereof is wrought,
And One who wrote on ‘Phosphates for the Crops’,
Is subject matter of his own report.
These be the glorious ends whereto we pass—
Let Him Who Is go call on Him Who Was,
And he shall see the ‘mallie’ steals the slab
For Currie-grinder, and for goats, the grass.
A breath of wind, a Border bullet’s flight,
A draught of water, or a horse’s fright—
The droning of the fat Sheristidar
Ceases, the Punkah stops, and falls the night.
For you and me. Do those who live decline
The step that offers, or their work resign?
Trust me today’s most Indispensables,
Five hundred men could take your place. Or mine.
(Which unlike Beckett or Updike is available in the juvenile section of the bookstore. And being a distainful person, I take a little pride in that.)
Humph.
— JohnMcC · Aug 27, 06:35 AM · #
Because if you’re too stupid to have a living will, there is a chance the government WILL have to make an official position on whether or not you go.
See: Terri Schiavo
Is it possible to make any sort of government policy without knee jerk “you can’t make me” nonsense coming out of people’s mouths? End of life counseling is simply a way of making more people informed about their legal rights. A more informed citizenry SHOULD be the government’s goal
— Derek · Aug 27, 09:18 PM · #
Hey, Derek,
Pay attention. In the scenario I commented on, Grandpa is already dead. There’s absolutely no reason for the government to have an “official position” about his death.
As far as I know, the government doesn’t yet decide which lives are worthy of life. In the Terri Schiavo case, the government decided that Schiavo’s husband had the right to speak for her and for what she would have wanted.
If end of life counseling is “simply a way of making more people informed about their legal rights” rather than about their medical options, I prefer that a lawyer do it, instead of a doctor. For myself, I’m pretty well informed about my legal rights, thank you.
A more informed citizenry SHOULD be the government’s goal.
Listen, Derek, when government schools are “informing” their citizenry well enough for a simple majority of high school seniors to be able to tell what the three branches of government are or whether the earth revolves around the sun, then I’ll trust them to inform the citizenry about end-of-life issues.
— Kate Marie · Aug 27, 10:48 PM · #
Oops. Make that, “The courts decided that Schiavo’s husband had the right to speak for her and for what she would have wanted.”
— Kate Marie · Aug 28, 12:43 AM · #
Kevin wrote:
I bit. I went to the link you posted. There are no page numbers. There is nothing anywhere near your link that would support or refute your point.
Did you suppose no one would check? Are you being dishonest, or would you care to point us to something in your link that supports your point?
There certainly are death panels, known simply by another name: rationing. And please don’t insult our intelligence by saying that we have rationing now; there is no comparison between what happens now and what will happen if the feds take over health care.
— jd · Aug 28, 02:54 AM · #
Popped in for a few minutes. Amazed at the “death panel” idiocy. It occures to me that the modern conservative movement is probably best understood as a brain-destroying virus in the final stages of a fifty-year-long epidemic and the idiocies we are witnessing are the final demented screeches emited from the ravaged host brains just before they go dark. Soon the screaching will stop and America will experience a errie yet blessed quite. At least I hope so.
— cw · Aug 28, 03:38 AM · #
I completely agree with the assertion that euthanasia is more based on dignity than it is anything else. Much like you said, what constitutes “human dignity” varies from person to person. However, I strongly feel that the government has no business in determining whether or not a person can choose to die. Our country is based on three founding principles: life, liberty and the pursuit of happiness. Arguably, I would constitute “freedom of choice” under the pursuit of happiness. Those who get to choose and make their own decisions are generally happier, or at least in my experiences. Therefore, the government has no right to obstruct “freedom of choice” which would in turn obstruct the pursuit of happiness. Unfortunately, this debate will run around in circles and circles while many patients who may want to die are legally obstructed from doing so.
— pc · Aug 28, 05:37 AM · #
jd,
“There certainly are death panels, known simply by another name: rationing. And please don’t insult our intelligence by saying that we have rationing now; there is no comparison between what happens now and what will happen if the feds take over health care.”
What? The “rationing” we have now is that ~15% of the population is left out, and another (hard to quantify) group is underinsured. Further, even those with good health insurance do not get unlimited care (unless their wealth is limitless, or they are a member of Congress). The rationing we have now is based on personal wealth and the terms of the private insurance policies (none of which, to my knowledge, provide for limitless care). That’s w/o even addressing the common practice of recission (sp?).
You, apparently, fear governmental rationing wherein a government bureacrat decides you can’t have [insert treatment here]. I look at that and wonder if we inhabit the same country. Right now, you can be denied care by an insurance company bureacrat, and dropped from your plan b/c you are “uninsurable” due to actually being sick or having some kind of chronic condition. How is this somehow better than the (overblown, IMO) fear of a government bureacrat refusing to pay for care? It seems to me that your chances of redress are as good or better through the government than through the legal system at present (you vs. your health insurer. Best of luck!).
My greatest worry concerning the “public option” is cost, not denial of care (those two are, of course, in opposition). My second greatest worry is that eventually the GOP will get back into power and set about trying to wreck it.
— Rob in CT · Aug 28, 02:31 PM · #
“there is no comparison between what happens now and what will happen if the feds take over health care.”
There actually is a perfect comparison. It’s called Medicare and while it’s a looming fiscal armageddon, it’s wildly popular with its recipients. We have decades of evidence of what “government-run health care” would be like and NONE of it supports the paranoid, “death panel” fear-mongering being propagated by conservatives.
Mike
— MBunge · Aug 28, 03:22 PM · #
Mike’s right again.
Medicare doesn’t cut costs, but it’s popular – more popular than Britney S., pro-wrestling, and Michael J. put together. And popular = good.
But don’t be confused. Obama’s plan is not popular because people are just stupid for not supporting the new plan that expands insurance to everyone by cutting medicare supplementals, rather than taking any from doctors or lawyers.
The new plan will save money in other ways too, even though it will force those who don’t have insurance now to buy it.
Try to keep up – it isn’t April any longer – it’s August!
Yes, we needed to spend trillions (gradually) to bail out the economy – but now is the time to start saving millions.
There is no difference between the government rationing care to save money and an insurance company doing so to make money.
In fact it’s much better:
Once we the people are in charge of what is worth treating we will be able to ration according to what’s popular (i.e. good)!
It simply isn’t fair that in a country where everyone is equal some people require more resources to stay healthy. It isn’t fair how much their neighbors spend, and how much they drive up costs and eat up our resources by pursuing pleasure and risks indiscriminately.
Now we’ll have a chance to enforce our ideals of equality through the equal distribution of resources to all, no matter what their conditions are!
Finally we can have a national discussion on what kinds of lifestyles we should supplement and cut back on all these unnecessary procedures for the loose, fat, carnivorous, immoral, drunken, smoking, drug-addled whores out there!
Let’s put the wise American people (with their selected ethicists) in charge of what diseases and ages deserve high priorities. Using lotteries to ration care is for Canadians – we Americans should deliberate and apply objective econometrics to the distribution of limited resources.
I am hopeful that in less than 50 years we will not only be saving money, we’ll have cleaned up this country. True conservatives know: the Democrats are just giving us the tools we’ve been wanting to get God’s country back on track by changing people’s degenerate life choices and weeding out the weak and (immoderately) ill.
— Ethicist Ed · Aug 28, 04:55 PM · #
Ethicist Ed again demonstrates the futility of trying to argue with an unreasonable person. We’ve have government-run health care for old people in America for decades and other countries have had it for everyone for just as long or longer, and virtually NONE of the stuff he’s worried about has come to pass.
EE and his compatriots are like people arguing against space exploration because they’re afraid the rockets will always blow up. The fact that it hasn’t been a serious problem in all the decades we’ve been shooting rockets into space is something they just disappear down the memory hole.
Mike
— MBunge · Aug 28, 05:53 PM · #
Right again Mike.
It is unreasonable not to trust the government or the wisdom of the people (and especially ethicists) who have spent their whole life objectively researching and discovering the elusive definitions and formulas of social morality and the greater good.
It’s too bad the people who will be running our system don’t even seem to realize there already is govt-run health care here and in other countries and that it is stellar (which is why most Americans go there for treatment now, if they can afford it).
They must lack reason, and would have probably argued against the formation of homeland security when it was formed, as if it could cause any problems or be used to trample the rights of citizens.
NONE of these unfounded fears came true, so obviously we can trust the same people who run the post office, public pensions, CIA, FEMA, social security, and medicare so efficiently and responsibly to pass the most well written and thoughtful bill without reading it.
It’s simple logic. It is futile to try to explain it to the irrational. It is much easier and productive to call them unreasonable.
But I think you misunderstand – I think ours can be even better than the govt systems of other countries because we will work to curb costs and will have to make some tough decisions and hard choices (as Obama likes to say) about the types of unhealthy activities we will want to tax or insure.
Europe is nice but let’s face it, they really blew it by rationing care indiscriminately, probably because of their inefficient parliamentary systems and their loss of moral heritage and direction. Instead of making themselves strong their whole system is one big unionized life-support machine run by immigrants.
Besides they don’t pay their doctors nearly as much as we will continue to pay ours, and they depend on technology, staff, and private administrators from other countries to keep themselves afloat.
We can do better, I’m sure. We are Americans and Americans, like Christ, have always been more pure, ambitious, and willing to spend as much as it takes to keep strangers alive.
And now we will have all the instruments in place to truly form our national character and psychic health through physical health policies.
I look forward to making this a virtuous country again.
I don’t know why you think this is so fearful, unless you plan to be one of the unhealthy parasites on the new system who don’t know how to live properly, in which case neglect is actually the humane thing to do, rather than continuing the immoral policies of facilitating and enabling your addiction to vice like the profiteers do now.
Rockets are good analogy, but this health care bill has been designed by social-engineering geniuses who far surpass the dimwits who took so long getting rockets to fly straight and had to test them on monkeys. But who needs monkeys when you have the utopias of Europe and Canada to imitate.
— Ethicist Ed · Aug 28, 07:17 PM · #
Seriously, can anyone imagine having a reasonable discussion with EE on this subject?
Mike
— MBunge · Aug 28, 07:55 PM · #
I can’t imagine having a reasonable discussion with Schwenkler on this subject. He’d just bog the debate down in whether or not “eliminate bias” means “eliminate all bias”, etc. EE’s brand of idiocy is more entertaining, at least.
Conservatives have long since abrogated any attempts to engage intelligently on this subject.
— Chet · Aug 28, 08:00 PM · #
There is a significant delusionary component to what passes as conservative thought these days. That the government is actually filled with modern day Dr. Mengele’s and that healthcare reform is turning loose fascists who would like nothing more than killing old people, disabled people and use euthenasia to cull the herd of the sick and worthless. There seems to be an inability to call conservatives like Buchanan for what they are: bonafide right wing wackos. Out there with Glenn Beck and Mark Levin. This world view makes for great tv and/or movies but sadly has no underpinning then in their paranoid imaginations.
— mickster · Aug 29, 04:39 PM · #
Hey Mickster:
How about backing up your idiotic musings with evidence. (Don’t worry, I don’t expect you to find any.)
At least we keep our guys where they belong: on the radio. You guys promote yours to third in line to the presidency.
— jd · Aug 29, 11:28 PM · #
I’m really trying to understand the opposition to end of life counseling, frequently abbreviated to fear of “death panels”.
My father-in-law passed away a couple of years ago from complications of Parkinson’s. In his last year he had at least one consultation with his physician to learn what to expect in the terminal stages of his disease, what medical procedures could be tried, and what their likely effects would be. Armed with this knowledge, he prepared his living will, and discussed his wishes with his children. As far as I know, the consultation was covered by Medicare.
Are folks objecting to the mere fact of having such a consultation, to the consultation being covered by Medicare or equivalent government insurance program, to an incentive in the government program that would encourage physicians to initiate these consultations, or something else entirely?
— C. E. Grant · Aug 30, 12:03 AM · #
jd,
Here’s the evidence for Pelosi’s swastika statement:
http://www.youtube.com/watch?v=KFgaiCbnNQs
I suppose one could argue about whether or not Pelosi made the swastika comment because she wanted to say that the people carrying them actually had Nazi sympathies or just because she saw it as an example of irrational over-reaction. But, that sounds like a pretty pointless argument to have.
— Ratufa · Aug 30, 01:16 AM · #
I tend to agree with you. It IS a pretty pointless argument. The problem is that MOST of the media did not show what Pelosi was referring to: they simply let her insinuate that the town hall protesters had a Nazi mentality. It’s nothing new with people like her. If it isn’t Fascists, it’s racists. In fact, the link you posted did a service by showing exactly what Pelosi was referring to. However, Rick Sanchez went on to show moral outrage over the few people who went over the line with their signs—as he should. It’s just that the same moral outrage rarely occurs when it’s the other side calling Republicans Nazis. Where was this moral outrage when Bush was called Bushhitler and books were written about his assassination? That stuff was all over the news for the last five years of his presidency and somehow it just wasn’t covered like these town hall folks are.
— jd · Aug 30, 01:42 AM · #
It’s something else entirely. The worry is the rationing of health care and the need to cut costs by encouraging grandma to end her life—as our President said—by taking a pain pill. We can all argue about what he meant by that, but rationing will be a way of life for most of us if the libs get their way.
— jd · Aug 30, 02:27 AM · #
First, all ideas expressed in opposition to the HCReform seem to take it for granted that nothing needs to change.
This is not true. This statement is wackier than anything said by the wackiest town hall protester.
— The Reticulator · Aug 30, 02:51 AM · #
In the week where one of your more prominent House members famously said that Republicans need a “great white hope” for 2012, maybe you’d like to, I dunno, have the sense to shut your mouth instead of, once again, provide ample proof that it has always been being called “racist”, and never has been racism, that Republicans are most concerned about.
Don’t want to be called Nazis? Stop displaying swastikas. Seems pretty simple to me.
Drummed up, near-constantly and on demand, by the right-wing outrage machine. God, we heard about nothing else between 2002 and 2008 – “Bush derangement syndrome.” You’d have thought that lockstep control of three branches of government would have been enough to silence Republican whining, but no luck. What a titty baby you are, jd!
— Chet · Aug 30, 06:13 AM · #
“We can all argue about what he meant by that, but rationing will be a way of life for most of us if the libs get their way.”
The sort of rationing you’re afraid of ALREADY HAPPENS EVERY DAY IN AMERICA! Who do you think will work harder to deny you medical care – free spending government or insurance companies that actually profit by denying people care?
Mike
— MBunge · Aug 30, 03:55 PM · #
Care to back that up with some evidence?
I understand your point, but that doesn’t change the fact that it’s a stupid statement. Government cannot freely spend the money it doesn’t have. Only an idiot can believe that the feds will somehow make the money go farther. Your argument is self-defeating because government will necessarily spend itself into exponentially more rationing than is occurring now.
— jd · Aug 31, 12:59 AM · #
Boy, I wish someone would tell Republicans that! Why is it we can have off-the-budget trillion-dollar expenditures to fund two wars-of-adventure-turned-occupations plus a trillion dollar bank bailout – completely unfunded by any increase in tax revenue or reduced spending anywhere else – but when it comes to saving the lives of millions of Americans, suddenly conservatives balk at the cost?
Why is your wallet always open for Afghanis and Iraqis and Israelis, JD, but closed for your neighbor down the street?
— Chet · Aug 31, 01:35 AM · #
“Care to back that up with some evidence?”
I hardly think it’s fair that only one side is required to have evidence for its position, while the other side is allowed to rely on hypothesis and paranoid conjecture.
If you’d like evidence, however, go to The Google and enter the phrase “health insurance denied coverage”.
Mike
— MBunge · Aug 31, 02:58 PM · #