There is nothing wrong with patients planning for contingencies through advance directives. There is also nothing wrong with doctors discussing those options with patients ahead of those decisions. As the spouse of a patient who has faced life-threatening circumstances on more than one occasion, I certainly understand why these conversations need to take place before the pressures of acute circumstances come into play. This new regulatory effort at least puts the conversation where it belongs, in routine wellness visits, rather than as a five-year set conversation. It also appears to make this a voluntary conversation (at least for now), one the patient can decline without any repercussions.
There is, however, something at least vaguely disturbing about a government incentivizing doctors to do so as part of an expansive regulatory program that has, as one of its primary goals, cost reduction.
Shorter Ed: Despite screaming about out-of-control spending every chance possible, this regulation that I think is a good thing, has been implemented well, is voluntary, and keeps things between a doctor and patient, is troubling because it might also have the benefit of saving money. Also, BIG GOVERNMENT BOOGAH BOOGAH BOOGAH!
I’ve just come to the conclusion that all Republicans are idiots.
Joey Maloney
all Republicans are idiots.
That’s too harsh. Some of them are crooks.
Bonnie
You’re just now realizing this?
Church Lady
What he wrote (just reading your excerpt only) seems pretty reasonable to me. If a Dr. had started talking advance directives the second they told my Dad he had lung cancer, rather than discussing all the treatment options available, I’d probably have been pretty upset. It might just sound a little like Alan Grayson’s “hurry up and die” speech.
Knocienz
This policy has been implemented well…. Maybe too well… (insert ominous music here)
Tim
You JUST came to that conclusion?
John Cole
It’s been pretty well established here what we think of your thoughts.
Nice that you still don’t understand what the “Hurry Up and Die” speech was. It wasn’t telling people to sign advanced directives the moment they learn of lung cancer. It was an attack on the Republicans, who had (and have) no plan for health care other than for people to “hurry up and die.” In fact, Republicans, up until they decided they could get some short term political gain the last two years, had a hellish hard-on for killing Medicare. But then they decided scaring grandma was more important, so the fiscal conservatism went out the window yet again.
You’d know that, if you weren’t an idiot.
Joey Maloney
…or a crook.
Mr. Furious
Any that aren’t are ignored or too afraid to step out of line.
This Christmas I desperately wanted to corner my uncle-in-law who is a GOP state Rep here in Michigan and get his unvarnished opinion on the direction of the party and the future.
Sadly, an appropriate moment eluded me.
He’s a reasonable guy. Even willing to say good things about and give credit to Bill Clinton. I suspect that shit wouldn’t play inthe Lansing cloakroom…
asiangrrlMN
@Joey Maloney: Why can’t they be both? Idiots can be crooks, too, if the people they’re swindling are even more idiotic.
I have reread the excerpt twice, and I still don’t get why he is so upset. This is a good thing. It will save money. What the fuck is the goddamn problem? Aaaaaaaaaaaaargh!
PS
“(at least for now)” … “(at least for now)” … stop me before I go all bold and blockquote and all-caps … “(at least for now)” … it’s one of those phrases (cf. “as the actress said to the bishop”) you can tag onto anything and change the perceived meaning … the technical term is “implausible deniability” …
tbogg
Having read Special Ed going back to his CQ days he’s not really an idiot so much as an opportunist who threw away any semblance of independent thought and honesty when he started taking a paycheck first from Michelle Malkin and now from Salem Communications.
He went from call center manager to “serious pundit” during this time and he’s not about to cast off his wingnut welfare feedbag and be forced to going back to resolving complaints when people’s Shaw-wows don’t show up on time.
He’s a whore. Just not a very good one.
WereBear
That’s a big IF!
Starting today, I’m referring to such idiocy as “Republicanism.” This keeps me from getting into brawls with people who, for some damn reason, still consider themselves Conservatives, and provides an umbrella term for the extraordinary blend of idiocy, propaganda, rich-people-ass-kissing, and that pinch of panic&fear that has been distilled into a Brand.
Republicanism. It’s been screwing you out of things for years!
jeffreyw
Is our kittehs learning? Sadly, no. Seems the right place for this.
Mark
I thought it was Moe Szyslak on The Simpsons who said this, but I can’t find it right now: “Organ Donor? Ain’t nobody stealing my kidneys when I die.”
fordpowers
I hope they all get terri schiavo’ed
asiangrrlMN
@jeffreyw: Yep. I see Homer doing the same thing over and over again despite the same results. However, he is much cuter than any Republican, so he is excused.
cathyx
What about cost reduction in medicare? The republicans are all over this. Cutting medicare benefits will surely kill grandma faster than talking to her about end of life decisions.
Church Lady
@John Cole: I realize that the “hurry up and die speech” was directed at Republicans. I was being somewhat facetious.
My point stands – what “Captain Ed”, or whatever the heck his name is, wrote is not unreasonable.
Insulting me, rather than addressing the point, doesn’t score points. It just demeans you.
Lesley
“I’ve just come to the conclusion that all Republicans are idiots.”
What took you so long.
OldK
John, I’m not sure you’re catching the innuendo Ed’s pitching. In this case, he’s not complaining about the end (lower costs) but the means. I think it’s well established in the formerly-conservative, but now just anti-Democrat, lexicon that “cost reduction” means “forcing Granny not to get needed care so she dies”.
MTiffany
@Joey Maloney: Some of my friends are crooks, and they resent being equated with Republicans.
Nina
@Church Lady: I am sorry to hear about your father–lung cancer really is a horrible disease. Just so you know, your choice of “reasonable repub talking point” v. “lung cancer” doesn’t actually seem so reasonable. Even if caught very early, the survival rate for lung cancer is about 5 years, and if caught later, as it usually is, the survival rate can be a year or less. It’s tragic but that’s how it is, and while it can be relieved, possibly, it can’t be cured. As Kay pointed out earlier today, advanced care planning is a long-standing part of health care, especially for those with serious illnesses.
Joey Maloney
@tbogg: Isn’t it about time to post the Malkin cheerleader thing again?
demkat620
So let me get this straight. This is what Special Ed finds objectionable.
Wtf does he think insurance companies do?
Woodrowfan
RWer: MEDICARE COSTS ARE OUT OF CONTROL!
LWer: gee, let’s see if we can find a way to control costs so it doesn’t run out of money.
RWer: YOU’RE TRYING TO KILL GRANDMA!! HANDS OFF MY MEDICARE!!!
MikeJ
@Nina: Even if the survival rate were 60 years there’s nothing wrong with starting the conversation about treatment with, “how far do you want to go?”
MTiffany
@Nina: Actually, the overall 5-year survival rate for Stage 1 lung cancers is in the 60% to 80% range.
Shade Tail
@Church Lady:
Your point stands about as well as a drunk groping for a lamp post.
How in the world could you read the except of Ed above and conclude he was talking about doctors whipping out the end-of-life directive option first thing? There is nothing in the excerpt that even brings that possibility up.
And if there had been, then that would just have been Ed lying about the program in order to score a cheap political talking point. So either way, your point remains nonsense.
John Cole
@Church Lady: What he said was completely stupid, and I’m insulting you because you’re too feeble-minded to understand it. Pretending there is something nefarious or scary about this is little more than shouting “death panel,” and only dim bulbs like yourself fall for it.
Now run along until a thread shows up in which you can talk about how unfair taxes are for you and how the poor have it so good. Because we’ve NEVER heard those comments from you…
Linda Featheringill
So, is Capt. Ed objecting to physicians having these conversations with their patients or objecting to physicians getting paid for having these conversations?
curious
isn’t there something “vaguely disturbing” about everything this administration does (or “appears” to do, “at least for now”?)
Eric U.
My father passed away recently, and it was torture deciding if he should receive each little treatment. Here we were, in the middle of grieving over his impending death, and we had to go through a series of moral decisions of the most fundamental nature. I wouldn’t want to put my family through the same thing. He had executed a do not resuscitate order, but that apparently isn’t enough. Anything that big brother can do to stop this from happening is a good thing.
I don’t see what’s wrong with each of us making decisions based partially on cost. With my father, his quality of life was very low for the last few months. I had trouble escaping the notion that keeping him alive was possibly resulting in care being withheld from someone else. Indirectly, of course.
Neil Morse
The stupid is not only burning, it’s melting my internal organs.
I had a relatively routine back surgery a year ago. I’m a healthy, young, fit guy, and for weeks before the surgery the hospital was begging me to fill out an advance directive.
Being the smart cookie that I am, though, I produced mine the first time they asked and thereafter let them know to check the file.
Planning ahead: it’s not just for lung cancer anymore.
MTiffany
@Church Lady:
So far as “Captain Ed” sounding reasonable is concerned — even a broken clock is correct twice a day. But he goes on and on (“Obama and the Demmiecraps are using the guvmint to kill granny ’cause her care is too expensive.”), and opens his closing paragraph with
Boogah-boogah! Death Panels!
JPL
Could it be that some, can’t admit that government programs work. The lack of support for the new measures in the Pell Grant are a prime example. The government gets rid of the middle man and saves money. Now that it’s finally efficient, the repubs want to defund the program because their friends aren’t milking the system.
I hate to use the word “some or some one” because it is so strawmanish but it fits.
Strawmanish might be a made-up word but maybe it will go viral and Webster’s can add it, also, too.
Brick Oven Bill
Question: Who is smarter; Sarah Palin or Balloon Juice?
Answer: Sarah.
Nina
@MTiffany: Yes, this is basically true for non small cell lung cancers diagnosed very early, but not for small cell lung cancer, regardless of stage. And most lung cancers are not diagnosed at stage 1. Most lung cancers are diagnosed later. It’s the metastasis that makes lung cancer so deadly. And even many stage 1s will have recurrences. Lung cancer is a deadly disease.
Ruckus
@Eric U.:
My dad died ten years ago after suffering from Alzheimers for about 15 years. His doctor (medicare!) explained to us what was happening and what our choices were. He and the nurses were fantastic about all the details including costs(remember medicare? we weren’t paying. but we still got all the info). It made it far, far easier to make the decision to put him in hospice, because I knew the realities. All of them.
To deny that info based on what is probably a very small cost seems like a form of torture to me. I know that it would have made the decisions I had to make much more difficult.
Dennis SGMM
Captain Ed Johnson is right about the GOP Johnson being right. Why change today’s marvelous system? The way it is now, if you have a catastrophic illness they just take all of the money that you have, then they take your house, then they tell you to go home and die. Fast, simple, effective. There’s no point in exploring end-of-life options when the patient is going to wind up dead and dead-broke anyway.
Rick Massimo
Fixt.
JCT
@Eric U.: This is the point — if this ENTIRE process was discussed throughout one’s lifetime and IF this country could grow up just a little bit regarding this basic concept of quality vs quantity of life things would be better.
Establishing one’s ideas and thoughts regarding how the end of their mortal life is to be handled is not a one-time, choose A, B, C, D sort of decision. It should be a normal part of the physician-patient dialog as people’s situations and beliefs evolve. It EMPOWERS patients, it doesn’t throw them to the whims of “death panels”.
So fucking ridiculous that all of this is being demagogued by a bunch of dishonest assholes.
jurassicpork
Some are less idiotic than others and supplant idiocy with evil. Therefore, in light of all the thousands of Chuck Norris facts that others have written, I thought it was high time that some wrote “Top 25 Facts About Dick Cheney.”
Ruckus
@JCT:
So fucking ridiculous that all of this is being demagogued by a bunch of dishonest assholes.
Isn’t this the crux of the entire conservative movement? Or am I missing something?
handy
@Brick Oven Bill:
Clean up on Aisle 38.
catpal
Advance directives are a wonderful thing – a must have discussion that saves us from what could later be an impossible decision.
Now if only We and the Medicare community – could have a rational discussion about Marketing multi-Million-dollar surgeries to those in their 80s and 90s – that really do not cure anything — and leads the patient to become even more debilitated.
You Don't Say
As someone who has witnessed several loved ones’ end of life, nothing that Sarah Palin and the right-wing has done sickens me more than the ‘death panel’ lie. For that political cravenness alone she and others like her have lost all credibility.
Skepticat
@Church Lady:
Did your father’s doctor do so?
LikeableInMyOwnWay
Really. Just now.
I don’t think so, John.
LikeableInMyOwnWay
@Brick Oven Bill:
Sure, for you. Anything odd, trollish, and absurd is smarter to you. We know you, dude.
You really need some new material.
Villago Delenda Est
If being a cretinous twit was a capital crime in this country, “Captain Ed” would be before a death panel faster than you can say Captain Jack Sparrow.
Dennis SGMM
@Villago Delenda Est:
You’ll be singing another tune when Cap’n Ed joins Erick Erick Erick Erick Erick Erick Erick Erick Erick Erick Erick Erickson on FOX news.
patrick II
@Church Lady:
I’d change doctors.
cckids
@JCT:
Amen. Currently going through this with our adult son, who has CP & 3 different “superbugs”. We could continue to treat, but the efficacy is extremely limited. It is a RELIEF to be able to talk to a nurse, physician, anyone with knowledge about what we are & will be facing. Sadly, most of them are not trained/experienced in how to address patients or their families about this.
Also, strange though it may sound, if you are the main caretaker, making the decision to end/limit treatment is the easier part. It is much tougher to stick with it as your loved one gets sicker. Though my experience may be out of the norm, because my son cannot express his own opinion on the matter.
Dan
In the “shooting fish in a barrel” department:
http://www.theatlantic.com/personal/archive/2010/12/a-little-new-years-advice/68535/
You Don't Say
@cckids: I’m sorry about your son. And I don’t think your experience is out of the norm. Making such decisions is easier than watching someone you love suffer. Nothing is harder than that.
Martha
@Skepticat: A truly responsible doctor would do both things. And if the doctor could not or would not, find another one, because they’re just looking at the revenue the patient will generate, not the patient’s quality of life. But that is the Republican modus operendi right? Show me the money? Bill early and bill often to keep all of those for profit hospitals afloat?
We just lost my father in law to Alzheimers after a long road. But we/he had had all those discussions early in the disease. It made our final months and weeks with hospice much easier because everyone knew what he wanted.
aimai
@Church Lady:
Well, why would you be upset? Do you no grasp that *even treatment options* have dangers, failures, and setbacks that need to be considered before you can actually give “informed consent?” When my lawyer, my spouse, and I drew up our wills and our advance directives did I assume that any discussion of the 101 worst case scenarios:
you divorce and your husband remarries a woman you hate
you die and your husband doesn’t remarry
you and your husband die and your choice of guardian has already predeceased you…
means that my lawyer hates me and wants me to die? No, its just her job to cover *all the contingencies.*
Similarly, if I am contemplating a course of treatments like chemo or surgery I have got to be prepared with a set of advance directives for everything that can go wrong: failure of anesthesia, side effects from the medicine. To do anything else would be folly.
aimai
Martha
@cckids: Yes, you question yourself and the second guess the decisions you made a long time ago. In our case, we just tried to think about his pain, anxiety, quality of life, and what he wanted and expected of us. We know we did the right thing. Hospice was incredibly supportive too. Angels.
joe from Lowell
It was never a five year set conversation, you idiot, and there were never any repercussions for not having it, for the doctor or for the patient.
The regulations authorized Medicare to pay for such conversations once every five years for healthy people. There was no regulation that you had to have those conversations; they just authorized Medicare to pay the doctor that often.
asiangrrlMN
@cckids: I’m so sorry for you and your son.
@Dan: Gack. Uck. Urp.
aimai
@cckids:
I just saw this. My heart goes out to you and your family. This must be incredibly difficult for you all. I can’t imagine what you are going through. May I say, as some of my more dopey but sincere friends might, that I will “hold you in the light?” and keep a good thought for you and yours that you receive all the support and love that you need while this is going on? I’ll be thinking of you.
aimai
WereBear
Not just lost credibility. Deserving of some rather barbed spikes to writhe on in a Dante version of Hell.
My husband’s grandmother, 89, collapsed at her home and was rushed to the hospital about two minutes down the road. We found out later she had essentially “died” and was revived in the ambulance. Once at the emergency room, she was asked if she wanted “help with her breathing.” As any sane person would in that situation, she nodded her agreement; was put on a breathing tube; slipped into a coma.
At this point a bunch of us arrived at the hospital, and very little changed in the next seven days. Grandma remained stubbornly under. Doctors told us to wait 24 hours. Rinse and repeat.
At the end of the seven days, she couldn’t be kept on the breathing tube any longer. Grandma’s main doctor informed us that Grandma’s bad valve, which she had dealt with her whole life and in that entire time had adamantly refused to have treated with open heart surgery & valve replacement, was now being blamed for her lack of response. Dr wanted to fly her via helicopter to a specialist in another state to have this surgery done.
Just to be clear, we were talking at least half a million dollars to force a 89 year old woman to have a surgery she had firmly refused every single time it was offered to her. At no cost to us or anyone else but the ever-loving tax payer.
Fortunately, while Grandma had filled out her proxy (though failed to sign it, watch out for that) and made her wishes clear, she had also supplemented this silly paperwork with loud, frequent, and inappropriate announcements about wanting to “die with her boots on” and “don’t you be making me one of those heads in jars” kinds of statements.
This was actually tremendously helpful as it let a large number of extremely disparate people agree that this kind of last-ditch, highly intrusive, hail-mary option would be the last thing Grandma wanted. As my blunt brother-in-law who practices a fairly primitive religion put it, “She’ll haunt us if we do that.”
Still, the mere fact that she had agreed to the breathing tube in the emergency room had apparently negated everything else. Unknowingly, this meant she had agreed to the head-in-jar option and it took seven people three hours to come up with the “right words” to allow the Dr to finally pull the plug.
Which is what she wanted.
Would I like this process to be less hellish and more sensible? Absolutely. I can’t see anyone with a drop of compassion or sense opposing it.
And, thus, Republicanism.
jrg
Yeah, ’cause that’s in the bill.
Yes it is. It’s deranged nonsense. It’s concern trolling by bringing up an imaginary scenario completely unrelated to the problem or the solution proposed. By the way, you’re not the only person who has a dad that died from Cancer.
Have you ever considered that it might be a moral imperative that you take your head out of your ass?
Ed Drone
@JPL:
Technically, we got rid of the middle-men in the Student Loan system, not the Pell Grants, which never had “middle-men,” being direct grants from the Gummint, not loans.
Ed
Linda Featheringill
@cckids:
I am sorry for the burden you are bearing now. It’s all so sad. I wish you peace.
WereBear
Short version of my comment still in moderation probably because of its length:
They wanted to spend half a million on Grandma for a procedure she had forcefully refused her entire life.
We went through three hours of Heck to ensure her wishes were fulfilled.
Anything that reduces the suffering, I’m for.
But hey, what amitalkingabout? The Republicans believe suffering is good for me. Not for them, they need lots of money and feefee stroking. But for me, suffering for something I never wanted in the first place and then can be beat over the head for… win!
MTiffany
@aimai:
What do you mean by “everything that can go wrong” ?!?!?! Don’t you know that America has THE GREATEST HEALTHCARE SYSTEM IN THE WORLD ?!?!?!?!?! Why do you hate America? Especially on the day after Christmas? Are you trying to make the Baby Jeebus cry?
cckids
@Martha: We have found, to our great disappointment, that hospice will not take our son, because he uses a respirator part time. Because he has been a quadriplegic his entire life, he has never developed normal lung capacity, and with the onset of many of his health problems 4 years ago, he needs some assistance from the vent, otherwise his carbon dioxide level builds up & he ends up “foggy”, & sleeping all the time. Not in a coma, but just unable to participate in life. When you have no meaningful use of any limbs, being able to watch movies, listen to music/books, & interact with your family IS your quality of life. Taking him off the vent takes that away. We’ve had some truly heartbreaking conversations with hospice intake directors who cannot seem to get this.
So we are on our own, with one home health care nurse who is our angel.
cckids
@aimai: Thank you, it does help. There is a certain peace in coming to a decision, difficult though it is, & being sure we’re doing it for good reasons. And we welcome all the good thoughts we can get. Peace to you.
Greg
Can I just go on the record as saying that I would gladly have my taxes doubled if it meant that not one man, woman, or family would ever have to deal with these kind of decisions alone again.?
cckids
@asiangrrlMN: Thank you, we appreciate it.
Sentient Puddle
@Dan: Yeah, that last item strikes me as so blissfully un-self-aware.
Anne Laurie
@cckids: Talk about unbearable situations… you, and your son, and your HHC ‘angel’ will be in my prayers.
JCT
@cckids: Head up and eyes forward — you’re doing a great job within the constraints of a near impossible and truly heartrending situation. Making these sorts of decisions for your child is a whole new level of stress. Thank goodness you have a wonderful home health care nurse — I use the same term (angel) when one of my patients has a good one. Sometimes they accompany my patients to an office visit and it’s like having a web cam in the home they are so attuned to what is going on. Peace be with you and your family.
It’s a huge hole in current medical education. And trust me, this idiotic “death panel” nonsense didn’t exactly help things. When folks describe Sarah Palin as some “harmless” nitwit, they are way off base.
@WereBear
I’ve mentioned this before but I went through the EXACT same thing with my FIL — and I’m a physician. I had to argue with the head of the ICU (a colleague, no less) to pull his tube and then I sat with him for hours until he finally let go. It was rough, because of course, they couldn’t give him anything to sedate him (wouldn’t want to speed the inevitable of course). I have no idea how patients deal with these situations on their own, because there is no way my husband’s family could have sat with him. He was 90, had willfully stopped eating because he wanted to die and was inappropriately intubated despite a DNI/DNR. And the staff argued with me all the way.
So wrong on so many levels.
Martha
@cckids: I am so sorry. I did not know that about the limitations of hospice’s services. My heart goes out to you.
Ruckus
@jrg:
Have you ever considered that it might be a moral imperative that you take your head out of your ass?
This just might be one of the all time greatest lines.
It’s absolutely in the running.
Comrade Kevin
Which is smarter: “change”, Brick Oven Bill, or a mildewed turnip plant?
Answer: Hard to say.
Ruckus
@JCT:
As a doc do you think this is because so much of our health care system is more about the money and less about the medicine?
BTW I think end of life care should be about what the patient or their caregivers want, even if it is to end their life. It feels to me, from experience, that the wishes of the patient are quite often the last things considered. I don’t truly understand that other than a profit motive.
Ruckus
@Comrade Kevin:
It’s a trick question. You put in the word mildewed.
cckids
Thank you, and yes, they are. I don’t claim to be any kind of expert on policy, or spokesperson for families with handicapped children, etc. , but I do have an unusual trifecta in common with La Palin: I have a special needs child, I was an single teenage mother, I come from a conservative religious family. And coming from that shared point, I can say, with feeling, “Fuck you, Sarah. Sideways with a dead saguarro cactus”. That death panel BS set off such a tidal wave of ignorance & misinformation, for which others will pay the price.
Jill
Nina @23: You’re not 100% right about lung cancer, but the only reason you’re not is my mother, who had surgery for lung cancer over 20 years ago and is still around — and still smoking. The COPD is bringing her to slow suffocation, but she beat ALL the odds. Mom is proof, such as it is, that lung cancer, if in situ and caught VERY EARLY (usually during an exam for something else; in her case it was a pre-oral surgery physical) can be “cured” to the extent that any cancer can be cured. In the cancer lexicon, “cure” = 5 year survival. I realize that mom is an outlier.
Svensker
@cckids:
My God, I can’t even imagine what you’re going through. The Quakers say “we will hold you in the Light” and we will. Peace and love to you.
Nina
@Jill: I’m glad your mother’s surgery has been successful for this long. The surgery is much more successful at a very early stage for non small cell lung cancer (~25% of lung cancers) than for small cell cancer. And as you note, her survival does make your mom an outlier–because the disease was caught so early and was one that would respond well enough to surgery. And cigarettes sure do kill, and I’m sorry about your mother’s COPD. But regardless, I would want an advanced directive in place and do discuss this early with patients.
@cckids, blessings to you and your family.
asiangrrlMN
@cckids: I’m sorry your situation with the hospice did not work out. And, since you are amenable to well-wishes and such, I will shine a white light over you and your son in this time of great difficulties. It’s heartbreaking.
@JCT: That’s just not right. That just shouldn’t happen (and I know you know that). The fact that people like Palin and this jackass would use the situation to score political points makes me furious.
Triassic Sands
@Church Lady:
You shouldn’t have been upset. You should have been embarrassed that such an important consideration hadn’t been addressed until the issue of treatment options for a potentially terminal illness became a pressing concern.
Waiting until someone faces a life-threatening illness (or accident) before taking care of this, simply means that at a time when your attention should be focused on other matters (treatment), you and/or your father are screwing around with something that should have been routinely taken care of when he was in perfect health, which is by far the best time to consider end-of-life issues.
majii
@Brick Oven Bill: In what universe, Charlie?
daveinboca
Cap’n Ed makes plenty of sense. You will gradually become anesthetized to the death panels and then you’ll accept them as natural, so when the bureaucrats tell the doc to pull the plug, you’ll think it’s okay. Pol Pot was crude, Stalin was brutal, Mao was paranoid, but Obama’s death panels will be quietly administered as ‘wellness consultations.’ Brave New World meets 1984!
Ruckus
@daveinboca:
How does it feel to be hooked like a carp, flopping around on the dock, trying to figure out why it’s so hard to read and think for yourself?
Triassic Sands
I’m curious. Are the same people who are opposed to these doctor-patient consultations also screaming about the Arizona Republicans’ decision to kill Medicaid patients who need transplants?
Oh, OK, in fairness, they aren’t really killing them, they’re just letting them die.
General Stuck
@daveinboca:
Just wait till Obama declares wingnuttery a terminal incurable disease.
xian
@joe from Lowell: thanks for hitting that point. it was the clear egregious “big lie” embedded in captard ed’s passive-aggressive polemic.
Zuzu's Petals
@Church Lady:
And exactly what part of the regulation, or even Ed’s description of it, suggests such a scenario? Or did you miss this part of his post:
Maybe people wouldn’t call you stupid if you didn’t act so you know, stupid.
Zuzu's Petals
@catpal:
You have to wonder why Ed isn’t vaguely disturbed about a Medicare system that pays doctors to put paitents in nursing homes. Or incentivizing doctors to provide expensive, useless, and often painful treatments by…well, by paying them.
Mnemosyne
@cckids:
Do you know if they have home hospice in your area? My husband works for a home infusion company and one of their biggest clients is Vitas. That might be a possible option if you think it might work for your family.
Mnemosyne
@daveinboca:
Shorter daveinboca: only for-profit insurance companies should be allowed to kill patients.
cckids
@Mnemosyne: Thank you for the suggestion, I’ll make a call this week. Two of the agencies we’ve spoken to have both home & center-based hospice. We’re committed to keeping our son here; he’d be lost without family around him.
Nathanael
@Dan:
This is disturbing, yet explains a lot.
McMegan has given some actually rather good advice on how to use dishonest argumentation to influence people. She, of course, uses said dishonest argumentation tactics all the time. I guess she’s really rather good at it.
BobS
@JCT: @<a This is consistent with my own experience. Many of the bad decisions regarding (expensive) end-of-life care are because of our inability, as a society, to have an adult conversation about the inevitability of death. As a result, one of the most significant decisions a person has to make is frequently made in a panic, often by someone other than that person.
End-of-life also seems to be the one time, as individuals and as a society, that any consideration of economics is thrown out the window. I'm an advocate of universal single-payer who is also an advocate of a humane distribution of finite resources. As it is, our system places too little financial responsibility on people chasing eternal life in their golden years while essentially shutting out 18-65 year olds. My own favorite example of the insanity of our health care system is a patient I treated several months ago (rerouted by ambulance to our ER when the one she usually visited was 'closed' due to over-crowding), a demented (unaware of date, time, or place) 88 year old woman suffering from chronic renal failure who required an ambulance three times a week to ferry her from the extended care facility where she was a permanent resident, to hemodialysis, and back again. This was the choice of her family who had power of attorney but, of course, no financial responsibility for the considerable cost of her treatment. We were seeing her because of the fever she spiked at dialysis. Sepsis is a frequent complication of renal failure patients, as well as nursing home patients in general. The standard protocol is to perform extensive 'septic' work-ups, somewhat labor-intensive and time consuming for an ER staff who frequently have 8 or more patients to care for (try to be understanding when you feel like your nurse is neglecting you and your back pain), treat with several antibiotics, admit the patient for at least several days, return them to the nursing home, and see them again in 3 or 4 weeks for the same thing. Often these patients are quite ill from their sepsis, requiring medications to support blood pressure, blood products, ventilators, and several thousand dollar a day ICU rooms. Then their stay is generally longer before we return them to the nursing home to see them again in 3 or 4 weeks. In the absence of mature discussions regarding the futility (more like foolishness) of what we we're doing, I've thought that the Medicare program would be wise to add per visit co-pays (in addition to their deductible) like many of us have with our own health insurance. Unfortunately, unless some folks are required to hand over $25 every time they access the system, they aren't going to think about these things at all.
JITC
@demkat620:
Exactly, exactly, exactly.
Every evil thing Republicans accuse “Obamacare” of doing is going on in spades in private health insurance. But their goal is increased profits, not the goal cost control or coverage expansion.
Discussing advance directives during regular doctor visits is SMART MEDICINE not the work of “death panels” or excessive government intrusion.
nitpicker
I think John Stuart Mill was actually more right about this than John (Stuart?) Cole. Mill wrote, “I never meant to say that the Conservatives are generally stupid. I meant to say that stupid people are generally Conservative. I believe that is so obviously and universally admitted a principle that I hardly think any gentleman will deny it.” I know some genuinely intelligent righties, who admit freely they are using the stupidity of their fellow travelers to get what they want.