Pages, Costs, and Agencies Added To The Obama/Pelosi Health Care Behemoth

@mata (#160): There’s nothing tremendously wrong with IMAC, as proposed in the language of the document you linked. They are just setting broad reimbursement formulas for major classes of procedures. They are not doing detailed adjustment of individual drugs, operations, diagnostic tests, etc. They are not deciding which patients get treated and which don’t. They are a mixed panel of experts, from both political parties. They are very analogous to the Federal Reserve, only they are accountable to both President and the Senate. They are certainly nothing like a death panel. Neither is anything relating to the end of life counseling stuff, as we’ve discussed previously.

If IMAC, the President, and the Senate set reimbursements too low, providers will drop out and they’ll have to increase levels.

As I wrote, the GOP screams that Medicare is failing; George Bush only made the Medicare problem worse. Obama is trying to fix Medicare, so that it will be available for all of us, and Palin and her supporters scream “death panels.” Which is despicable scaremongering by despicable people.

I never accused you of being one of those screaming “death panels.” I do argue stridently against the people who did that and against those who defend them for screaming “death panels.”

If doctors choose “the path of least resistance” because it’s more money and less time consuming, *they*, not Palin, are the culprits. You blame her for their wallet mentality. That makes you despicable, and succumbing to the irresponsible shifting of blame, or the “it ain’t my fault” mentality. That is sheer, arrogant chutzpah.

You can moralize or you can try to fix a very big problem. You think that doctors in private practice should be paid for doing surgery and pushing poisons and directing ray guns but not paid for counseling, which is, in the situations we are discussing, far more efficacious, to say nothing of far more humane. You expect altruistic standards of doctors which are found nowhere else in capitalist society, and, when those standards are not met, you support those scaremongering with accusations of “death panels,” as opposed to those who try to come up with real world solutions to previously-intractable problems.

How do you propose to encourage more counseling and less ineffective treatment? Threaten physicians with incarceration?

It’s good legislation which was killed by “Pants on Fire,” lying scaremongering.

– Larry Weisenthal/Huntington Beach, CA

Larry, all you really keep saying is it’s for our own good.

Mata, thank you for taking the time to show how wrong larry is. Your knowledge of the proposals is very impressive.

Patvann, for once I didn’t want to needle larry. Since you did, I MUST agree. Breathtaking indeed.

Mata good luck with the Hippocratic Oath argument. Most MD’s never even take it anymore.

Between Ezechiel Emanual on record of “we take it too seriously”, to the Julie Cantor’s (MD, JD) op-ed in the NEJM advising any physician who has a problem with “anything legal” to best go into podiatry, it’s a mute point, gone the way with our moral decline.

Cantor’s rant was more focused on the Bush Conscience clause but in the end, all one in the same.

at least according to the medical elite. The New England Journal of Medicine has become the latest publication to publish an opinion piece that, in essence, tells physicians who don’t want to violate the Hippocratic Oath to get out of areas of medicine where non Hippocratic procedures are now allowed. […]

I italicized the key phrase that I think should be carefully pondered when thinking about this post: Cantor would seem to support the government legally forcing physicians who practice OB/GYN to perform abortions. That same coercive principle could also force internists, family care specialists, oncologists, hospice physicians, cardiologists, anesthesiologists, etc., to perform assisted suicide wherever that non medical act is redefined as a legal “treatment.”

@Mata:

#167,168:

BTW, Larry… I want you to ponder your statement below carefully, and let us all know how it differs from Palin’s comment that such counsel is a subtle encouragement to end your life earlier in order to save government costs:
Larry W: The “end of life counseling” had nothing to do with death panels; it was about reducing ineffective end of life treatments, improving quality of life at end of life, and also trying to control Medicare costs.

For a brief scroll refresher course, let’s compare that with what Palin quoted Eugene Robinson (o’healthcare supporter) said… where that “scaremonger”, “despicable” Palin thoroughly agreed. Again, from her testimony text:

Sarah Palin – scaremonger: Even Washington Post columnist Eugene Robinson, a strong supporter of President Obama, agreed that “if the government says it has to control health care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.”

So… this “scaremongering” differs from your statement HOW?

Here’s the difference, Mata:

Here’s what Palin said:

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.

This is scaremongering. What I wrote was factual, sensible, and not scaremongering. With respect to Mr. Robinson, what he was pointing out was the need to educate the public. Remember, the “dialogue” which was supposed to take place at those Town Hall meetings where, instead, the Senators and Representatives who came their to explain the legislation and answer questions were, instead, shouted down by citizens whipped into a frenzy by Palin’s irresponsible and dishonest scaremongering.

Regarding my quote (above): There are two huge problems, which are related to each other.

The first problem is runaway, unsustainable health care costs. 16% of GDP, headed up to 33% of GDP. Small business (“the engine of the economy”) health insurance premiums rising this year by 15%, at a time when there’s 11% unemployment and virtually no inflation in the rest of the economy. Medicare on a path to insolvency. Somewhere between 25 and 30% of Medicare expenses are for patients in the last year of life. Half of all people surveyed say that, were they to have a chronic, terminal illness, they’d prefer to die at home, rather than in the hospital.

http://content.healthaffairs.org/cgi/reprint/20/4/188.pdf

Hospice care is often the choice of patients and families, when the patients can no longer be cared for at home. Hospice isn’t a one way street for poor people who can’t afford private duty nurses at home. Art Buchwald entered a hospice, stayed there 5 months, and then left, when his kidney failure stabilized.

However, all of the financial incentives today in medicine are for performing diagnostic tests and providing active treatments, even in the frequent situations (e.g. terminal cancer) where treatments are toxic and more likely to hurt than to help.

So you’ve got a situation which cries out for reform. The reform proposed was simple and humane. Pay doctors for counseling patients, as doctors are currently paid for treating patients. The amount of money that doctors would get for counseling would still be a fraction of what they’d get for treating, but it would be at least something, and I believe that it would lead to more counseling.

I’ve explained the “rules” of the counseling previously and I’ve explained how you were not correct to claim that this counseling was ever intended to be “mandatory” or that it could ever be possibly construed to be “mandatory” by anyone familiar with Medicare reimbursement rules.

With regard to the Hippocratic OathL

You don’t understand this any better than you understood the proposed legislation regarding end of life counseling:

to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

Mata, the above quote says this:

“him who taught me this art” refers to one’s mentors and professors. One is obligated to provide all necessary care to one’s mentor (the person who was the teacher to said doctor) and to teach the offspring of one’s mentor the art of medicine, should said offspring wish to learn it. And such teaching must be provided without fee or stipulation, meaning that I am supposed to train my mentor’s children in the art of medicine without charging them tuition. Furthermore (it continues) I promise to train my own sons in the Art of medicine as well as the sons of my teachers, and to other students who agree to be bound by the law of medicine, but not to train students who do not agree to be bound by the “law of medicine.”

The above says nothing at all about providing medical services without compensation; it only says that must agree to train the sons of their own mentors “without fee or stipulation.” Would that this were true today; I’ve trained a fair number of medical students and interns and residents and fellows, who today are excellent physicians. It would be nice if they would agree to train my own offspring for free, to spare the necessity of paying $45,000 per year in tuition and fees.

Continuing:

I will give no deadly medicine to any one if asked, nor suggest any such counsel; [

Yes. Hear hear. But here’s the rub (following is a quote often cited by oncologists):

Diseases desperate grown By desparate appliance are relieved, Or not at all.

Hamlet Prince of Denmark (Claudius, King of Denmark at IV, iii)

One can almost always justify pushing more chemotherapy. Or even doing another surgery or radiation treatment. I saw an interesting study presented at the recent (October) American Society of Clinical Oncology breast cancer meetings in San Francisco. They did a survey of patients and oncologists and asked each group how long a life prolongation would be required to make chemotherapy “worth it.” It was quite interesting. The large majority of oncologists felt that a 2-4 month life prolongation was “worth it.” More than half the patients required at least a 10 month life prolongation to be “worth it.” But about 15% of patients said that even a one month life prolongation would be “worth it.”

So what needs to be done is to take the time to have a conversation with patients — telling them the facts, and, if the facts suggest that one alternative to consider is to stop receiving chemotherapy, to then be prepared to spend as much time explaining the alternatives as is necessary, and this includes considerations such as living wills and possible hospice care. Again, there will never be a net financial (or emotional) incentive to the doctor to withhold potentially beneficial treatment in any case, and counseling about living wills and advance directives is often appropriate, even when the decision is made to continue treatment.

As I have repeatedly stated, it’s legitimate to argue over language and details, but it’s a travesty to claim that this would involve death panels, and it was inaccurate of you to claim that end of life counseling would be “mandatory” and to claim that the legislation contained a coercive “use it or lose it” provision.

– Larry Weisenthal/Huntington Beach, CA

Does anyone really realize from where the word “Behemoth ” comes from? Behemah in Hebrew is a beast (untamed and wild) or a form of monster! Behemoth is actually the translation of “many beast” from Hebrew! That is exactly what we are looking at here! Thank you Curt! Good write up! Good comments as well!

J V HOFFMAN
I COME FROM THE FUTURE IN 2014 FEBRUARY, TO TELL YOU HOW TRUE YOU WHERE,YOU DEFINE THE TODAY GROWING BEAST AS WE SPEAK, SHE BEHEMOTH LIVES IN AMERICA, NOW,
BYE