Tuesday, August 11, 2009

Whose Death Panels are these, anyway?

In reply to: Legal Insurrection: An Inconvenient Truth About The "Death Panel" (See links below)

@ William (August 10, 2009 10:15 PM):

I think the point of that "talking point" is, what Dr. Emanuel wrote in the embedded article isn't what's in the health care bill. What Rep. Isaakson wrote, is. What Sarah Palin said about "death panels," was in reference to Isaakson's addition to the bill. The whole question of Dr. Emanuel's article or judging anyone by their "level of productivity in society" is kinda moot--except as an intellectual exercise--because nothing in the embedded article is actually in the health care bills being proposed.

@ alwaysfiredup (August 10, 2009 11:56 AM):

As regards your definition of death panels - What you describe exists in every health insurance company and most hospitals already. It's not just a part of every single-payer system; it's a part of EVERY system. Decisions are made by the providers of the actual health care (doctors & administrators), and providers of the money to pay for it (insurance company bean-counters and bureaucrats). To whatever extent the government (us) is paying for the health care, we have a right to decide under what circumstances the money starts and stops. (Personally, I trust we, the people, more than folks who're beholden to profits and shareholders.)

And again, Dr Emanuel isn't talking about every aspirin and band-aid. His article is about acute, life or death situations where "who's paying for it?" isn't the issue. There's only one heart, and more than one person who will die in the next 24 hours without one. (Except black market, I guess), one can't just run down to "hearts-r-us" and pick one up, regardless of whether they can pay for it out of their own pocket, have private health insurance, or the government is picking up the whole tab.

The way I see it, this is about creating a floor, not a ceiling. Those who can pay for it can and will always be able to get the "best" health care. These reforms are about getting adequate care for everyone else. Yeah, I suppose there will be procedures and drugs that the government won't pay for, but as someone who's had insurance companies disallow drugs that my doctor prescribed, I don't see this as a big change. Some pencil-pusher is already getting between me & my doctor and determining my care.

As for suing your insurance company, the unfortunate fact is it'll likely be your next of kin brining the lawsuit, and unless s/he's well-heeled enough to afford a team of lawyers, probably losing the case, besides. I don't know the facts about not being able to sue the government (but your claim sounds "fishy" to me--I'll read up), but I'd imagine the public outcry over denials that cause folks to die would bring about changes in a government plan quicker than in a private plan. (No non-disclosure settlements.)

Now as far as those "end-of-life" chats, I'm against any language making the chats themselves or their content mandatory. I wouldn't (at this stage, anyway) be opposed to signage and a document stating the facts about living wills and whatnot, specifying that the patient can discuss this such things with their doctor, and that if cost is an issue, the government will pay for that discussion. A take home hand out for everyone over 18--because anyone can be hit by a bus & left in a coma--and a yearly signed receipt of having received it would be fine. I wouldn't be opposed to a doctor choosing to bring it up, either. But I don't believe the government needs to be in the room mandating the conversation. (Of course, I feel the same way about abortion providers and those mandatory "counseling sessions" some states propose or have written into law.)

"Here are the facts about your options, and we'll be glad to discuss them with you ("at gov't expense," in the case of living wills & end of life care), if you so desire. Please sign & return this page stating that you received this pamphlet."

Submitted for approval August 11, 2009, 11:22 AM

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