Krauthammer on Death Panels

(It is hilarious how Republicans want to reform lawyers but not insurance companies, and Democrats vice versa.)
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It’s hilarious to how tired old columnists rely on tired old stereotypes.
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“In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.”
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http://www.nytimes.com/2009/06/15/health/policy/15health.html?_r=1&partner=rss&emc=rss

While I have no objection in considering sensible republican ideas from genuinely serious republican players, Krauthammer is not one of them. If he was really a serious person he would have been shouting from the rooftops that Palin was a nutter and all talk about death panels was a complete and utter manipulated distraction from the real debate. Now that idea has taken hold amongst the -shall we say more pliable- members of the public, it’s safe to come out with this and try to keep his “reputation” as a “serious person” but without actually changing anyone’s mind.

Joe, man I love your writing and dig your thoughts (absolute fan of Primary Colours which I thought was as poetical an ode to politics as there could be) but I think you were right yesterday: Republicans are nihilists (at the moment). On that basis, why even bother to note what Krauthammer has to say.

To put my previous comment into context and addressing the “Obama should be doing x,y,z” meme that everyone loves these days, I note no comments/posts about the forum yesterday and the radio interview that Obama gave the Smurf yesterday. I watched the forum and thought he did a fantastic job explaining where he was at in the debate and also explaining why he has taken some of the decisions he has made in terms of tactics.

That gets ignored while the has been republican shill gets a comment – IT SHOULD NOT BE NEWS THAT A REPUBLICAN ONCE IN A WHILE SAYS SOMETHING HALFWAY SENSIBLE.

Yesterday I refered to ‘the circles you travel’ in an effort to defend your gratuoitous “I criticize Liberals too” disclaimer in an otherwise refreshingly candid article. Today you reward me by ignoring the fact that Charles Krauthammer is clinically insane.

I know I’ve been sidetracked and this is seemingly off topic but when I was looking for an example of an ‘evil corporation’ for a post a few days ago, I went immediately to a Rent-To-Own Site because I know they are in the business of gouging the poor. Until I went to their site, I didn’t realize how thoroughly they do so. They offer a $180 two week loan at a flat fee of $30 dollars and hence charge and legally collect 521.43% APR. You thought that the 18-22% the credit card companies get was unconscionable? The point is simple. Corporations are not constrained by conscience. The only way to avoid shameless exploitive behavior is to either make it prohibitively expensive or illegal altogether.
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I think the debate often gets sidetracked when we talk about parasites and make it seem that we’re seeking revenge for insurance companies greed. Like the proverbial scorpion crossing the river, Insurance companies can, should and do whatever they can get away with. Our job is to make sure that ‘what they get away with’ actually serves the public.

so, i’m in a rant a minute mode today. I read Krauthammer’s column and it struck me that pretty much all of the people I have read that say, essentially, “death panels are nonsense but there is some underlying cause for concern in the bill” ALREADY HAVE A LIVING WILL! How did they know to do that? were they told to do so? They did it because it makes sense. All that is being proposed to expand that opportunity to seniors who would not otherwise have the money to get the full information. Just another case of the privileged and elite saying – well of course I understand it and no-one’s going to talk me into killing myself, but the poor people just can’t withstand it.

Now that the spineless Obama has abandoned his base a smart move by the Republicans would be to make a play for their vote, by moving left, as the Democrats move right. I don’t think it would ever happen, but the votes of progressives are certainly in play. Supporting a single-payer system would be a very smart move.

The blubbering Joe Klein attacks something that he has little to no knowledge of instead of actually reading what someone has to say about the facts.

Krauthammer, so far and above Joe Klein as a journalist, simply shows what needs to be done before Obama and his Merry band of complete idiots destroy the healthcare industry in America as we know it today.

Instead Krauthammer shows part of what I said we needed to do a few days ago with HCR.

Tort Reform: “our crazy system of casino malpractice suits results in massive and random settlements that raise everyone’s insurance premiums and creates an epidemic of defensive medicine that does no medical good, yet costs a fortune”.

The 2nd proposal from Krauthammer is to eliminate the largest tax credit in the US. Healthcare benefits paid to employees by employers. “The health-care benefit exemption is the largest tax break in the entire U.S. budget.”

I am not entirely convinced that eliminating the healthcare benefit as non-taxed income from our employers is a good thing. I do know Labor Unions will be all up in arms if this would ever be considered. But, if we do want to fund a “Public Option”, this would be one area to get tax dollars.

I am in no way a fan of Insurance Companies. I think all insurance is a big rip-off, and most people go years without any claims what-so-ever. But, if castastrophic loss is not also addressed in any type of reform bill, then most Americans will never see a benefit from any type of HCR.

This is why Krauthammer is so vile. Yes, he sends Palin out of the room, thereby establishing himself as the “adult” in the conversation. But then he reiterates the core argument (and I use the term loosely) that both Palin and Gingrich have been making.
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“It’s not an outrage. It’s surely not a death panel. But it is subtle pressure applied by society through your doctor. And when you include it in a health-care reform whose major objective is to bend the cost curve downward, you have to be a fool or a knave to deny that it’s intended to gently point the patient in a certain direction, toward the corner of the sickroom where stands a ghostly figure, scythe in hand, offering release.”
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The argument is basically that you can’t include end-of-life counseling in a bill that also seeks to reduce healthcare costs without putting “subtle pressure” on those near the end of their lives, as if there were not innumerable ways to create savings and efficiencies in the way we currently deliver health care. Joe, you should be calling Krauthammer out for propagating this logical fallacy instead of pretending it is a rational contribution to the conversation.

every time I hear someone talking about Obama being spineless I get the urge to say – run for f**king office yourself if you think you could do better.

a question: would you rather Obama be verbally tougher but fail to get a bill through or for Obama to be conciliatory but get a bill through?

IT SHOULD NOT BE NEWS THAT A REPUBLICAN ONCE IN A WHILE SAYS SOMETHING HALFWAY SENSIBLE.
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Unfortunately, for now this is a “man-bites-dog” story.

I hardly think the anti-healthcare reform crew cares much what happens to the poor. The poor could all get talked into cyanide as the latest weight loss craze for all they care. It’s the possibility that some public money might get diverted from funnel into the pockets of the insurance and drug companies and do, you know, some public good that bothers them.

It’s not the illegal things that have been done to the poor in the name of finance that appalls me, it’s what has been done that is legal and still is.

whoops – replied to the wrong comment – scroll down please, folks.

Shorter pierogielunaire: It IS subtle pressure on elderly patient’s and families at a very emotional time in their lives to choose less expensive treatments and Hospice / Palliative care by dicussing a Living Will or Advance Directive. Most patient’s and their families at death’s door do not want to discuss it. Denial is overwhelming for some people.
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Have you ever had a discussion with a patient and/or family about end of life options?

Right. When your side pushes a totally discredited late-nite joke line, say, “Well, it’s so subtle you can’t see it.”

The Constant Weader at http://www.RealityChex.com

Rusty, you are reminding me of the Monty Python sketch about wanting to buy an argument. That’s not an argument Rusty, it’s mere contradiction.

Rusty: No it’s not…

Perogie: Yes it is!

R: No it’s not…

Krauthammer and the pseudo-cons are making the argument that cost savings and end of life care are mutually exclusive in healthcare reform. They don’t even pretend to make a demonstrable connection but simply site the “context.”

And yes, Rusty, having a spouse who is a chaplain in and elder care facility has impressed on me how important it is for people to have counseling about end-of-life decisions.

“would you rather Obama be verbally tougher but fail to get a bill through or for Obama to be conciliatory but get a bill through?”
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I prefer he use the majority he was given and do what those who voted for him want him to do. He doesn’t need any Republican support and yet he persists in trying to win their approval. My guess this weak need for mass approval, even from his enemies and people who hate him, may be a result of growing up without a father.

“My guess this weak need for mass approval, even from his enemies and people who hate him, may be a result of growing up without a father.”

my guess is that amateur psychology is really not helpful to any debate.

“I prefer he use the majority he was given and do what those who voted for him want him to do. He doesn’t need any Republican support and yet he persists in trying to win their approval. ”

but how do you know what he is doing or not doing? he still supports the public option and wants to keep costs down. what has he done to make you think he’s spineless. The house has passed three bills, the senate one and only one other committee is stalled in these bipartisan negotiations.

Arguments are usually contradictory statements.

See “Basic Definitions”, pierogie…http://www.cs.pitt.edu/~kirk/cs1510/notes/greedynotes.pdf

“my guess is that amateur psychology is really not helpful to any debate.”

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I suggest that blowing up at other posters adds nothing to the conversation. Just scroll by mine if you are unable to control your temper.

“Malpractice reform and a government health care tax credit” is small-time sh!t. I have repeatedly asked those who advocate this scheme, “Where’s your math on this?” None of these “tort reform” advocates or “tax credit” proponents has demonstrated one iota how these solutions would bring us even minimally towards the goal of 1) bringing most of the uninsured into the health care system; 2) controlling health care costs such that it isn’t bankrupting families and Medicare and 3) making sure that every insured person receives quality health care when it is needed.

Indeed, “tort reform” fanatics are unable to quote the basic facts about malpractice insurance: what percentage of unnecessary health care costs are caused by “excessive” litigation payouts and what percentage of overhead costs are caused by malpractice insurance. We had “tort reform” in California to no effect in reducing health care costs. Not only did it not reduce malpractice insurance nor health care costs in the form of reducing unnecessary tests and treatment, but had the effect of adding to the taxpayer burden because payouts capped at $250,000 are often inadequate to cover the life-long medical care many times required by negligent medical injury. Here is an article to educate yourself:
LA TIMES: Justice Denied?

No one has done the math to show that “tax credits” would serve the health reform goals either. I have asked.

Gratuitous JOE-bashing: Once again Joe Klein demonstrates that he is supremely unqualified to opine on anything as complex as health care reform. You are in over your head on this, Joe, you don’t know what you are talking about, and your stenography transcribing of your Republican buddies like Hoekstra is embarrassing your. Too bad you are to vain to recognize that fact.

Meh. I didn’t finish my gratuitous JOE-bashing sentence:
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Once again Joe Klein demonstrates that he is supremely unqualified to opine on anything as complex as health care reform. You are in over your head on this, Joe; you don’t know what you are talking about, and your stenography transcribing the distortions and lies of your Republican buddies like Hoekstra is embarrassing you and your family. Too bad you are too vain to recognize that fact.

Joe Klein, perhaps you don’t realize what you have done.
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I was so heartened by your article yesterday because finally, someone is calling the GOP out on their crap. Then you turn around and you treat one of the principal megaphones in their massive disinformation campaign as if he has actually someone who has displayed human decency in his column — Charles K and redeeming qualities? sorry but not a good fit.
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Now Joe, you know I am one of the President’s most solid supporters, and I’ve even been known to champion your cause here in the swamp, but today both of you are failing to recognize one glaring fundamental fact — we can’t keep turning our cheeks, we’re getting whiplash from all of the activity and we can’t afford to go to the doctor for a neck brace.
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Maybe Oprah should call her friend the President and explain what happens when you continually force people to stuff down their frustration and provide no outlet to relieve the pressure. Right now the President is getting it from all sides and that’s mainly because he has deliberately cut off every avenue to hold the GOP accountable for breaking the country and the frustration at watching them get away with the most juvenile, craven, un-democratic activities year after year is why the pressure is building. Fighting tooth and nail for the public option is the only means left of holding on to our sanity.
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If it wasn’t the public option it would be something else. This rift between progressives and Obama isn’t really about the public option per say. It’s about the fact that he has shut down every avenue of inquiry to hold Republicans accountable for their most egregious action of the last 8 years. Whether it’s civil libertarians who feel he hasn’t done enough to remove the stench of the GOP’s assault on our constitution, the pacifist wing who feel we haven’t scratched the surface of torture and Christian death squads or the social justice wing who feel they’ve not had a chance to vent their anger about the myriad ways the GOP has dismantled our safety nets, politicized our justice department, failed to protect our food, water or the air we breath, the bottom line is that the GOP has broken the country and no one wants to make them pay for it.
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Of course, understanding why the President wants to take the high road intellectually, doesn’t change the fact that it’s hard to do with the GOP attack dogs still nipping at your heels. After 8 years of the most vindictive political machine in history, I wanted a President who could take the high road, I marveled at Nelson Mandela too. But unlike Lincoln quickly bring the south back into the American bosom, here the GOP hasn’t accepted defeat. They are still swinging at us, and the frustration is building because you seem to just stand there and take the blows. The public option is just the final straw, The one that broke the camel’s back so to speak. At least the South Africans and the Rwandans got to vent their frustrations and could expect an apology. We know that apology is not in their vocabulary.
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Now, he wants to be President to the entire country and I get that and Joe you want to present all sides and I get that. But you can’t do it by ignoring the truth just because you can’t find an equivalence or in his case something nice to say about the other side. It’s been one thing after another and personally, while I’ve tried to follow the president up his higher road, I have to get off at the intersection of death squad alley and security alert road. Please, can we just say that we’ve achieved bipartisanship on November 4th and move on. Because its clear that anyone interested in solving the country’s problems are already working under the Democratic banner and don’t worry about being this thing being about left or the right, our focus now has to be on the sane and the not!

@Krauthammer: “What do you think such a chat would be like?”

Why doesn’t Krauthammer actually ask someone who does end-of-life counseling instead of producing a column of conjecture with the intention of validating his ideological bias?

Hack.

Joe, the only thing I’m seeing as ‘close to reasonable’ with Kratuhammer is his tone…ginning up fear sotto voce instead of using Palin’s grating inflection.

Rusty, are you or are you not arguing that pressure toward euthanasia is implicit in a health care plan that includes both end-of-life counseling and seeks to create efficiencies and savings? If you are arguing that, fine. Make the argument. But guilt by association (“Say, End-of-Life Counseling, didn’t I see you at the bar the other night with Cost Control Measures?”) ain’t gonna do it. If you’re not willing to make the argument, buh-bye!

in your dreams

I know conservatives have a fetish for tort reform, but don’t expect it to move the needle on basic Health Care costs.
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“Family physicians, internists, and pediatricians all paid a median of $12,500 annually for med-mal coverage, based on the survey.”
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and
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“Malpractice premiums are expected to stabilize or continue falling through 2009 in most areas”

They’re getting it from mindbogglingly poor “reporting” like this:

A Basis Is Seen for Some Health Plan Fears Among the Elderly
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By ROBERT PEAR Published: August 20, 2009
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WASHINGTON — White House officials and Democrats in Congress say the fears of older Americans about possible rationing of health care are based on myths and falsehoods. But Medicare beneficiaries and insurance counselors say the concerns are not entirely irrational.
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Bills now in Congress would squeeze savings out of Medicare, a lifeline for the elderly, on the assumption that doctors and hospitals can be more efficient.
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The zeal for cutting health costs, combined with proposals to compare the effectiveness of various treatments and to counsel seniors on end-of-life care, may explain why some people think the legislation is about rationing, which could affect access to the most expensive services in the final months of life.

“I don’t think we will get the quality of health care with this plan that we get now,” said James T. Aronis, 79, of Wichita, Kan.
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In an interview, Mr. Aronis explained his reasons for concern. “I had prostate cancer,” he said. “My doctor removed it immediately, one day after getting the results of a biopsy. That probably would not happen under the new health plan.”

In the poll, among those 65 and older, 62 percent said they were confused by the debate in Washington, compared with 43 percent of those under 65.
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In effect, Mr. Obama says he can cut bloated Medicare payments to inefficient health care providers without adversely affecting any beneficiaries. Many doctors are dubious.
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Mr. Obama has been unable to dispel the concerns of older Americans because the health care bills in Congress are long, complex and evolving.

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I can’t even imagine the kind of thinking that believes that this level of He Said/She Said is journalism, but there it is.
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Where are facts? Where is any actual reporting of them? What possible good does this article do for anyone confused about anything?
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“A Basis Is Seen for Some Health Plan Fears“? What?
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” White House officials and Democrats in Congress say the fears of older Americans about possible rationing of health care are based on myths and falsehoods.” Oh! That’s what those people say! Fine job of reporting, Robert Pear!
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But is there another side?
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Yes!
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“But Medicare beneficiaries and insurance counselors say the concerns are not entirely irrational.” Oh, really! Some unnamed, unlinked people with an unknown agenda say something else? That death panels are “not entirely irrational”? Not entirely, did he say? Does that mean “irrational” in almost every case one can think of? Does that mean “irrational” unless certain important information about rationing not existing is withheld? Does that mean “irrational”, except on the surface of Jupiter?
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“The zeal for cutting health costs, combined with proposals to compare the effectiveness of various treatments and to counsel seniors on end-of-life care, may explain why some people think the legislation is about rationing…”
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Right.
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The proposals themselves, which have nothing to do with rationing, and everything to do with addressing the problem of the United States paying twice as much as every other developed country, combined with important information sharing and decent, noble efforts to help us prepare for the inevitable may explain why some are misinformed about those proposals.
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Apparently, Robert Pear hasn’t considered the idea that perhaps articles about non-rationing proposals entitled “A Basis Is Seen for Some Health Plan Fears Among the Elderly ” may also “explain why some people think the legislation is about rationing“.
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Perhaps he might have considered that, in reporting the entirely reasonable concerns of “Mr. Aronis”, that “[his life-saving prostate surgery] probably would not happen under the new health plan” without ever actually evaluating whether or not this is true, Mr. Pear has contributed to why “Many doctors are dubious” that proper treatment would be paid for under current proposals.
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Maybe, in addition to the complexity and length of the bills befuddling he and his colleagues so, “Mr. Obama has been unable to dispel the concerns of older Americans” precisely because of this surreally poor output of worthless, He Said-She Said reportage from our respected, elite, Serious institutions of journalism.
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Truly, it is amazing that we in this country are subject to a public policy debate in which “reporting” like this abounds –even in a supposedly elite institution of journalism like the New York Times. It explains quite a bit about the confusion that exists amongst ordinary people about how the proposals being discussed will or will not help them.
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It also explains quite a bit about how career liberals –busy as they are climbing political media ladders towards and through these elite institutions– can’t quite ever match the misinformation power of the rightists (who don’t depend on papers like the Times to exist), and then blame those strangely uninformed people out there for not being as sure of things as they are.

Actually, rustynuterrs, the definition of an [argument] can mean more than just contradiction.

Interesting that you focus on that meaning almost exclusively. You could maybe try:

a discussion involving differing points of view; debate

or

a process of reasoning; series of reasons

Just trying to help; you’re welcome…

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Last night Paul Begala stated that Obama has made 100 concessions to the Republicans without getting a single thing in return, like a vote for example. If that isn’t a sign of weakness I don’t know what is. If I were the Republicans I’d just sit there is silence and watch him fold up like an accordion, negotiating with himself.

Derek, isn’t it more likely he’s just not that into progressive policies? Why search for elaborate psycho-babble explanations when a simple one is readily available?
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He’s governing like WJC, with similar aims and ideological orientation, but trying to avoid some of his process mistakes. Which is probably because that’s the kind of person who becomes the leader of the Democratic party. Look, if HRC had won and was making exactly the same choices no one would be surprised. Disappointed maybe, but not surprised or confused. Obama is like other elite Democrats.

Joe: am surprised your taking CK seriously. I know he has a medical background. But he is a winger first and then, maybe a professional.

SZ” I wrote to the NYT about ” A Basis is Seen..” and asked them which idiot dreamed up that header.

bitterpill8:
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which idiot dreamed up that header
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Cretins. I can’t wait until they’re in bankruptcy.
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When reporters like Scherer bemoan the financial woes of corpulent swill-mongers like the Times, he should be given a link to this monstrous pile of dung.

Rustydog:

The 2nd proposal from Krauthammer is to eliminate the largest tax credit in the US. Healthcare benefits paid to employees by employers. “The health-care benefit exemption is the largest tax break in the entire U.S. budget.”
I am not entirely convinced that eliminating the healthcare benefit as non-taxed income from our employers is a good thing.

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I think that, in theory, Krauthammer (and John McCain) are right that this exemption needs abolishing, but for the wrong reasons (as usual). It’s a very, very stupid incentive with perverse outcomes. The private insurance market is wildly distorted as a result, and smaller entrepreneurs (who Democrats and liberals support and encourage) are unfairly disadvantaged.
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I’m fairly certain that this idea shouldn’t be included at this stage of the game, since there’s nothing simultaneously being proposed that could handle what would most likely be the resulting flood of uninsured. If the Democrats were talking about single-payer, that would be one thing, but they’re not.

“Derek, isn’t it more likely he’s just not that into progressive policies? Why search for elaborate psycho-babble explanations when a simple one is readily available?”
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I was under the illusion he was more liberal than Clinton. However, if he isn’t I see no reason for democrats to blow up at progressives for deserting him, in the same way he has deserted liberals. Why stay in a party where you are not welcome?

Arguments are usually contradictory statements.

Man: Oh look, this isn’t an argument.
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Mr Vibrating: Yes it is.
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Man: No it isn’t. It’s just contradiction.
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Mr Vibrating: No it isn’t.
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Man: It is!
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Mr Vibrating: It is not.
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Man: Look, you just contradicted me.
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Mr Vibrating: I did not.
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Man: Oh you did!!
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Mr Vibrating: No, no, no.
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Man: You did just then.
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Mr Vibrating: Nonsense!
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Man: Oh, this is futile!
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Mr Vibrating: No it isn’t.
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Man: I came here for a good argument.
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Mr Vibrating: No you didn’t; no, you came here for an argument.
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Man: An argument isn’t just contradiction.
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Mr Vibrating: It can be.
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Man: No it can’t. An argument is a connected series of statements intended to establish a proposition.
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Mr Vibrating: No it isn’t.
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Man: Yes it is! It’s not just contradiction.
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Mr Vibrating: Look, if I argue with you, I must take up a contrary position.
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Man: Yes, but that’s not just saying ‘No it isn’t.’
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Mr Vibrating: Yes it is!
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Man: No it isn’t!
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Man: Argument is an intellectual process. Contradiction is just the automatic gainsaying of any statement the other person makes.
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(short pause)
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Mr Vibrating: No it isn’t.
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Man: It is.
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Mr Vibrating: Not at all.
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Man: Now look.
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Mr Vibrating: (Rings bell) Good Morning.

Well, thanks for considering the other side’s ideas, Joe – even if you barb it with snark. However.

Actually, given the current fee-for-service structure, I suspect the doctor would go with the gizmo. Keep ‘em alive and you can charge them for unnecessary blood tests, urine samples and so on and so forth, ad infinitum. That is one of the crucial problems in this mess: the incentive structure for doctors is wacked.

Gee, Joe, it’s almost like you’re saying doctors are…evil. Hmmmm
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James:

what percentage of overhead costs are caused by malpractice insurance[?]

We’ve been around this before, and in this post, I’m not going to argue tort reform, but I can tell you that the malpractice burden is extraordinary. My father is a retired family physician, and one of the key elements in his decision to close his clinic was the astronomical cost of malpractice premiums. This factor, combined with the salaries for staff, inadequate Medicare/Medicaid payments, and the mortgage required for the building itself, was putting him in the red (even though his patient base was substantial).
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Premiums are a problem.

I’ve never been a big Obama supporter; of course I voted for him for lack of a better choice. Even so, I was hopeful about his presidency. At this point I have lost faith in Obama’s leadership. Sure, because of the euphoria in seeing the end of the worst President in US history, the Obama Administration was able to push some bills through, even with the inept Reid in the Senate. Those days apparently are over.

Obama’s communications team is wholly incompetent. The whole staff is inept and small time. Here’s what they COULD be doing: Daily Kos: The PolicySpeak Disaster for Health Care

I won’t even go into the disappointment with his weak-kneed fealty to Bush Administration policies in Justice and National Security. I expected this administration to purge the criminals left over from the Bush Administration — the actual criminals — and to put a leash on the operatives that Cheney left behind. Instead, they seem to still be running things at Defense, the CIA, the NSC.

We see a big drop in confidence in Obama this week by Dems and Indies, and deservedly so. Here, read and weep Daily Kos :: State of the Nation

And now this weak-kneed bowing to the recalcitrant Republicans on his *signature* issue. The Republicans are laughing behind closed doors, and Obama is knee-capping his biggest supporters. What the hell?

Gratuitous JOE-bashing: Having suffered the wrath of the public option supporters, Joe’s vanity will not allow him to address the valid points made here on Swampland or concede that they know quite a bit more about the subject than he does. Instead, he, supremely unqualified to speak on the issue, goes all drama queen on us. Didn’t you vow to cease the gratuitous Democrat-bashing a while back, Joe?

Thanks for the quote from the Python sketch, Stuart. Seems not just funny, but prophetic given the current state of discourse.

Oh, really? “EXTRAORDINARY” hunh? Wow, I’m impressed by your argument! You make a compelling case! So strong in fact that you don’t need data or numbers, because that WORD ALONE convinces me that I ought to jump aboard the “tort reform” bandwagon!

I was under the illusion he was more liberal than Clinton.
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Derek, okay. But why? He was the hedge fund managers favorite candidate. He was to the right of HRC on health care, with that transparently illogical argument that mandates were not essential for universal health care (and for doing something about costs, of course). Was it Iraq? Because WJC was right, he did backtrack on that before he embraced his initial opposition again.
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Instead of blaming his failure to meet your (unrealistic) expectations on father issues, it would be better to just face the truth.
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However, if he isn’t I see no reason for democrats to blow up at progressives for deserting him, in the same way he has deserted liberals. Why stay in a party where you are not welcome?
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Because it’s better than the alternative.

Oh, and WOW! His premiums are “A PROBLEM”!
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Well that settles it! I’m a believer now!

momentomaury

As always a half ass argument. It may be true that tort reform does not move the needle in Primary Care and Pediatrics however; it is the mother lode in OB/GYN, Surgery and Cardiology where the cost for tort insurance is over $200,000/year. As most liberals tend to do, you look at one point in isolation. Tort reform is needed in every aspect of our economy not just health care. The lack of reform has negatively impacted innovation, manufacturing and job creation.

It may not be the holy grail but the cost curve doesn’t bend very far without it.

Er, James, I’m just asking you to acknowledge the problem. Don’t get too excited.

Obama’s communications team is wholly incompetent. The whole staff is inept and small time.
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Yes, I don’t know why they changed a winning communications strategy. Did you read the NY Times article on Rahm Emanuel? It was uninteresting except for its emphasis on how Rahm is largely in charge of communications and messaging, and he’s back to a reactive, 24-hour news cycle approach. Apparently they change their message on a daily basis. Which is exactly the approach Plouffe et. al rejected during the campaign.
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It’s like Mark Penn and Bob Shrum are running communications…

We had this conversation the other night, Yoshi, wherein I presented you with my argument and a plea for a rational argument for “tort reform” from proponents. I presented you with a real life model that debunks the myth that “tort reform” might have any impact whatsoever on bringing down the cost of health care. You said you would do some serious reading and get back to me.
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And you come up with “the malpractice burden is EXTRAORDINARY” and “the premiums are a problem”? Forgive me for being wholly unimpressed.

His interview with Smerconish was another serving of political softballs. Obama continues to talk in generalities of what he wants then demurs when confronted by the utter nonsense of his statements. He will then argument “it is lies and misinformation” as none of those items are in the bill. He speaks fluent BS.

Pay attention…

We’ve been around this before, and in this post, I’m not going to argue tort reform

Is there something you do not understand about this?

Paul

Here is a concept for you. If the APR’s are too high DON’T USE THEM. No one holds a gun to someones head to use the service.

You also mention 18-22% as unconscionable. The you must really be appalled at 35-50% confiscatory tax rates for governments. With credit cards you have a choice to use them, not so much with taxes.

Oh and. Gratuitous JOE-bashing. Joe Klein has drunk so much Hoestra koolaid that he actually thinks that the “tort reform” argument has merit. Klein is so innumerate that he is unable to demonstrate where “tort reform” will significantly reduce health care costs, and he is so vain that he refuses to acknowledge it.

They also do it through their free choice and to assure the government stays out of their affairs

http://www.HULAgate.org is proud to announce our recent selection for the 2009 White House Enemies List by Rahmshtool LLC. Free Tweets all around!

http://twitter.com/HULAgate

Rose I don’t see what is so outrageous about suggesting that someone who did not have a father may try to compensate for it later in life. However, believe me I’ll never raise it again.
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To me the democrats no longer offer a better alternative that the Republicans. I don’t see a difference between them. The party is more concerned with appeasing a small band of blue dogs than satisfying the large group of activists who worked tirelessly to get them into power. It would be better for liberals to behave like the blue dogs, and then maybe they will get some attention.

Where is John Edwards when the Obama health scam needs him?

Oh, right.

Banging his former bloggers, and shopping at Baby Gap.

Move On to 2012, leftwits!

” It’s like Mark Penn and Bob Shrum are running communications…”

Bravo rose 83, couldn’t have said it better myself.

I thought you were jumping back into the “tort reform” argument to help Joe out, Yoshi. It’s rather disingenuous to back Joe up with “extraordinary” and “a problem” a claim you aren’t arguing for “tort reform”. By doing so, in effect you ARE jumping into the fray, trying to inoculate yourself from the burden of presenting a rational argument with facts and data.

Frankly, Rose, it wouldn’t surprise me in the least to discover Penn and Shrum ARE in charge behind the scenes. That poll-driven daily wavering has the stink of Clinton-era Pennism, no?

To me the democrats no longer offer a better alternative that the Republicans. I don’t see a difference between them.
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Really? Do you not remember the past 8 years? The changes in reproductive aid policies alone make his election worthwhile. And Sarah ‘Death Panel’ Palin is not a heartbeat away from having her finger on the button.
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There are a lot of reasons why it’s problematic to focus on Obama’s potential father issues, but perhaps the most important reason is that it changes the discussion from ‘What are the forces margianalizing progressivism?’ to a purely speculative and gossippy dissection of Obama’s personal life.

I’m not going to argue tort reform…
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[Good, considering that]:

As of 2006, most states had enacted some type of tort reform. In total, thirty-two states have established some type of medical malpractice award cap. The amounts and applications of these caps vary by state. Some of these damage caps are rigid, while others can be adjusted for inflation or severity of the damage.
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For example, four states (Alaska, Florida, Ohio, and Massachusetts) have caps that can be waived or increased in severe cases. The caps in Oregon and Maine apply only to wrongful death cases. Four states have a $250,000 general award cap, four states have a total damages cap, eighteen states have non-economic damages caps between $250,000 and $500,000 , and four states have damages caps that exceed $500,000.

And the results of ‘tort reform are a mixed bag, anyway.
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…the malpractice burden is extraordinary
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It is, especially in the more delicate specialties like neurosurgery. Or if the doctor has a lot of malpractice suits filed against him/her. An interesting point is that:

…although medical malpractice caps reduce the burden on insurers, they do not alleviate the growing problem of skyrocketing insurance premiums. One report reveals that limitations on medical malpractice awards produced payout averages 15.7% lower than those of states without caps between 1991 and 2002. This statistic is true despite the fact that many of the states did not institute the limitations until near the end of the reporting period. Meanwhile, the median annual premium in states with caps increased an alarming 48.2%. Surprisingly, the median annual premium in states without caps increased more slowly: by 35.9%.

Seeing how ‘tort reform’ has a) mostly been done already, and b) premiums have actually gone up instead of down, it’s useless to continue flogging this dead horse.

A few weeks ago, he proposed his own plan: malpractice reform and a government health care tax credit to replace the current tax exclusion for health care benefits–in other words, he favors a single-payer system (the government would be the payer via the tax credits),
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Joe are you really this stupid? Seriously? I mean, only a complete idiot would think that at tax credit could ever mean “single payer”.
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The above comment tells us that either you are simply too stupid or too dishonest to write on the topic of health care reform.

Chicago White Sox ask Dopie Obama for jersey back, Windy City’s best baseball team ever seeks to disassociate itself from worst POTUS ever.

Ready To e-Rumble? Add your Tweetness to the Official White House Enemies List today, with the new #OWHEL hash tag. LET’S ROLL.

Don’t really understand Obama, yet? You will, after reading BOZO TAKES BOZEMAN… http://bit.ly/kaNvB

I was wondering when you would notice that one.

Unfortunately people who really have no idea what they are talking about are a clear majority and the people who know the issues intimately all have particular agendas.

Joe is just engaging in his standard ‘navigate to the center – avoid the rocks’ strategy that he applies to almost every issue.

It’s rather disingenuous to back Joe up with “extraordinary” and “a problem” a claim you aren’t arguing for “tort reform”.

Ah, so if we identify a problem, there can be only one solution? That sounds…disingenuous.

grape_crush
August 21, 2009
at 12:23 pm

Thanks for the data. A link would be appreciated.

They also do it through their free choice and to assure the government stays out of their affairs
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By leaving living will consultation coverage out of government-run Medicare?

Oops. You did hyperlink it. Sorry.

“I’ve never taken it terribly seriously because unless I’m comatose or demented, they’re going to ask me at the time whether or not I want to be resuscitated if I go into cardiac arrest. ”

Well, that’s kind of the point, isn’t it? That and sparing your family and loved ones the pain of making those decisions for you. A very good friend of mine died a few weeks ago — at 44, of a very rare disorder that took him from brilliant to unable to communicate in a matter of a few months.

This is a condensed (stripped of legalese) version of his living will, which was given to everyone who interacted with him during his last month of life:

“Is it my desire to be comfortable. If I cannot communicate with my Doctor, family or friends, then I want my Attorney-in-fact, family and friends to know the following:
- I ask that medical treatment to alleviate pain, to provide comfort, and to mitigate suffering be provided so that I may be as free of pain and suffering as possible.
- If my temperature is above normal, I want a cool moist cloth put on my head.
- I want my mouth and lips kept moist.
- I need to be kept fresh and clean at all times.
- I desire to be massaged with or without warm oils as often as you think will help maintain my skin integrity and provide for my comfort.
- I want to have my favorite music played when possible.
- I want my personal care such as nail clipping, hair combing and teeth brushing and shaving as long as they do not cause me pain.
- I want to have religious readings read to me when I am near death.
I hope my family and friends would consider that:
- I enjoy your company and want you with me when possible. I desire that one of you stay with me when it seems that my death may be imminent.
- Please continue to talk to me about daily happenings and events even if you think I don’t understand, because I might be able to understand.”
- Please don’t be afraid to hold my hand or hug me.”

It was developed with his physician and his minister.

I don’t find this scary at all. Nor do I see it as a document to be “not taken seriously”, as Krauthammer cavalierly suggests.

Joe is just engaging in his standard ‘navigate to the center – avoid the rocks’ strategy that he applies to almost every issue.
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…Because Joe Klein is a radical centrist, which is it’s own political ideology:

The New Democrat philosophy was seen — and is still seen by die-hard, old-style lefties — as a cynical corruption of the true faith, an electoral strategy gussied up as a political philosophy. Which was rather ironic, since traditional liberals soon began to adopt many of the positions developed in the early 1990s by the Progressive Policy Institute (PPI), the think tank of the DLC.
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Indeed, a delightfully dangerous centrist radicalism was in the air. The political spectrum seemed, suddenly, an arrow — with moderates pointing the way to the future and the traditional left and right wings lagging behind, hopelessly retro.
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Joe Klein, DLC | Blueprint Magazine | May 21, 2002

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It’s not a habit; it’s not even the professional tic of Beltway Conventional Wisdom.
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Joe Klein is a committed, wildly enthusiastic centrist ideologue. That is the fact of the matter.

joyo,
thanks for weighing in. That’s a profoundly moving document. Thanks for bringing into the discussion.
…I really miss your presence here on Swampland.
-j

I know, I’ve been bad. Especially on Twitter. My sabbatical is over and they are making me go back to work.

You are teaching this semester? I hadn’t realized you have been on sabbatical.
…
I’ve long ago found twitter too pithy and superficial to be of much value for the time spent sifting through all that landfill. I guess it’s fun for quick-hit journo-bashing, but that’s about it. Sifting through all those adolescent Star Wars analogies and water cooler puns gets to be a bore….
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Again, thanks for checking in!

Thank you for posting that. What a beautiful and honest statement.
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My condolences.

True story that backs up your point, Joe, about the general inanity of end-of-life care in this country and why such counseling is a good thing:

My mother-in-law was dying of colon cancer that had metastasized in her lungs. It finally came to a point where there was no more treatment for her. So my wife called the hospice folks to come over and talk to her about end-of-life issues.

At first, my mother-in-law insisted that there were still treatments to be had. But my wife and the hospice folks gently let her know that, no, in fact, there were no more possible treatments.

So after 30 more minutes of discussion about being comfortable at the end of life, my mother-in-law agreed and signed a do-not-resuscitate form. Plans were made to move her into a hospice facility within a couple of days.

Late that same night, her breathing became incredibly labored and her doctor recommended we take her to the hospital. She was fully alert, but in great pain in her hospital bed due to the difficulty of her breathing. I asked the nurse if my mother-in-law could get something for the pain.

“We can’t give her morphine,” the nurse told me, “because her chart shows she has glaucoma and morphine can make the glaucoma worse.”

“But she only has days to live,” I replied. “Who cares about her glaucoma?”

“There’s nothing I can do unless we get a waiver from eye doctor.”

Of course, this was on a Sunday and tracking down her eye doctor was no easy task. We knew we had to get her into the hospice care, ASAP.

We moved her into hospice care later that same day. And if there is ever such a thing as a “wonderful way to die,” this was it. My mother-in-law ended up living eight more days, seven of which, she was fully alert and pain free. We had cocktails in her room every night at five o’clock (she loved Jack Daniels), and all of her friends had a chance to come by and say good-bye. It was sad and joyous all at the same time.

I don’t think we can ever fully express our gratitude to the hospice workers who made my mother-in-law’s end-of-life experience so beautiful and positive and pain-free.

And that’s why this lying and posturing and “death panel” trash is so despicable. End-of-life counseling is a great service, and anyone who gets such counseling only benefits from it. To cynically distort it for the purposes of serving corporate master to the detriment of the general public is criminal.

Yes, my first class is the 31st. (sigh) I have been enjoying the chance to just read and write and travel. I got a tattoo for my 60th birthday. I taught a couple of computer classes to people in their 80s and 90s, which kept me from getting all whiny about the 6-0.

Twitter works for quick reads, and I can follow links to all my favorite blogs (like this one). pourmecoffee and MS’s poetry posts brighten my day.Swampland is a giant bar of chocolate, Twitter is a bowl of M&Ms.

Amen. My father insisted on dying at home and resisted hospice care. The only “end of life” order he had on record was a do not resuscitate, which he decided on his own because he figured that was all he needed. His doctor refused to give him pain meds because of the chance of addiction. Oy.

freeinpa,

I hate to tell you this, but the idea of “tort reform” and “malpractice insurance reform”, is a big strawman. Insurance companies have been jacking up rates for years and it has nothing to do with claims. Insurance companies made millions investing in the stock market before the dot.com bubble burst. When they lost money, they “passed” the losses to the doctors. Doctors who have been OB/GYN and who have never had ANY claims filed against them suddenly saw their insurance rates triple. Where is the justice in that. In various states, there have been caps placed on malpractice payouts in cases, yet, the insurance rate for these doctors has not changed one bit.

The idea of “tort reform” is a joke. Ironically, the places with the worse “jackpot justice” are overly conservative and send Republicans to Washington. However, don’t look for local Republicans to change the local laws governing tort claims.

Prior to my heart surgery a few years ago, the local hospital insisted on having a signed, notarized copy of a living will on file a month prior to the operation.
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The idea was to do this at a point in time when cool heads could prevail, not in a moment of crisis. I don’t recall if the counseling was covered, but at $12K out of pocket for a $100K procedure, it would have been nice to have a public option in which it was.

stuart:
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You “agree” in theory, but do not state your opinion as to why you agree.
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I’m curious to know why you believe this employment benefit should be taxed?
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My hesitation is giving the government more money in the form of taxes to piss away on frivilous programs.

joyomama,

At one point, I asked the nurse in the hospital if they had a masseuse on staff to massage my mother-in-laws back muscles which were in spasm because of the labored breathing.

The nurse looked at me like I was high.

@FH: Now that you mention it, I seem to recall a Governor from Texas running for President in 2000 claiming that “tort reform” would be a major initiative of his, should be become president. What ever happened to that…?

Again grape_slushy, I said “usually”. Had I said “always”, then your point would be a valid one. But, as usual and typical for a liberal you simply jump to conclusions, filled with multiple delusions.
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Furthermore, “debate” and “discussions” are possible without argument.
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Ever hear of “agreeing to disagree”?

Congrats on the tattoo! Sounds like you had a great sabbatical. I think of you often joyo for your uniquely positive outlook on life. You must be a wonderful teacher, and I’ll bet those lucky 80 and 90 year olds loved the class! Anywayz happy birthday! Many more!
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Twitter: I’m basically an information gatherer, I guess. Not so good for that. Did *not* know MS was a poet….. though on some issues he *does* have a poetic soul. NOT on politics though.

The joke is your response. You clearly lack a basic understanding of how insurance companies price risk and expected losses. The investments in stocks, bonds, real estate are used to pay benefits across all lines of insurance. Yes if they are hit with a catastrophic loss they adjust premiums to the pool. Not dissimilar to how states run budgets with one small difference. If an insurance company charges excessive premiums, the insured can change policies, states just raise taxes unabated. Without these investments, the insured would pay premiums equal to whatever reimbursement they were seeking.

You are just as wrong on your tort reform tirade. In 2002, FL, MI, TX, WV had the highest malpractice premiums. In 2005 Texas put forth Proposition 12 which was tort reform. Today awards are down, premiums are down and TX has reversed the physician outflow it has suffered.

Rustydog:
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You “agree” in theory, but do not state your opinion as to why you agree.
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I’m sorry, I thought that I had made this as clear as possible (with an unusual minimum of words):
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I’m curious to know why you believe this employment benefit should be taxed?
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Because the practical effects of this big-business subsidy are pernicious in terms of the insurance market, and because larger businesses then enjoy a government-mandated double competitive advantage over individuals and entrepreneurs: both in scale of purchasing power and tax break.
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If IBM can employ their size to their competitive advantage over me as a consultant when negotiating rates with insurers, and they also get a subsidy in the form of tax advantages that I don’t enjoy as an individual, then the field is perpetually tilted to the benefit of the largest competitors, which is both unfair and bad for capitalism (we liberals care about both).

states just raise taxes unabated
Which is of course why California as drowning in red ink.

None of that in any way demonstrates that “tort reform” will have any meaningful effect on controlling health care costs overall. What is the proportion of the overall cost of health care that is litigation and insurance expense? Any sentient person can cite models, like California, who have tried “tort reform” to absolutely no effect in controlling health care costs.
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I don’t dispute that malpractice insurance is a burden on medical practices individually. What you can’t answer, because you cannot, is how further “tort reform” is going to control medical costs. What’s your math?

You know, when I wake up and eventually stumble into the Swamp, I always ask myself what does Charles Krauthammer or Sarah Palin think about the news of the day …

… and m@therf@cking presto, here it is always is, aggregated, concise, waiting for me. It really is amazing.

Matt Taibbi on Joe Klein (i.e. Kraut’s codependent doppelganger):

“Where the chief executive of any administration is on almost any issue, one can also usually find Hobbit understudy and professional White House apologist Joe Klein. Here he is on health care, licking as usual the presidential jellyring”

That should get his hackles up (the personal insult, not the substance of the criticism).

Seriously though, Greenwald and Krugman have excellent things to say about HCR today and we’re stuck in groundhog day engagement with the Kraut.

So explain how you pay for it. You want free crap to every Democrat and don’t explain where the money comes from. You want everyone to get free medical care and don’t explain who gets the bill.

Basic concept about “insurance” — it is based on percentages. The premium is based on the likelihood you will get sick. If you come in with a pre-existing condition, guess what moron — the probability is 1.0. So you walk into the insurance company and say “I’ve got terminal cancer, it will cost $1M a year to treat me, now cover me for $100 a month.” The company has 1 of 2 options under the New Messiah plan — (1) charge EVERYBODY a premium of $10,000 a month to cover every fool that comes in or (2) go bankrupt. There is no way to pay for it in the free market.

Your “public option” — that’s just a nice Obaterm for “shaft the taxpayer and it’s handouts as far as the eye can see”. Obozo charges the terminal cancer person $100 a month, and sends the balance of the $1M treatment costs to the taxpayer.

However, when the treasury runs out, guess what — only 2 options again. (1) Print money until hyperinflation renders the money worthless, or (2) ration the care and hope the guy dies before he gets up for the $1M treatment. Oh, wait, “death panels” is just a big Republican myth, right????

Stuart … “… a committed, wildly enthusiastic centrist ideologue.”
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I have to ask …. what exactly does that mean? Centrist radicalism seems about as counter intuitive as “keep government out of my Medicare”.
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You have the differing right and left, and the contention is that something in the middle of the two extremes would be the ideologue, or radical?
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Please expound.

“There are a lot of reasons why it’s problematic to focus on Obama’s potential father issues, but perhaps the most important reason is that it changes the discussion from ‘What are the forces margianalizing progressivism?’ to a purely speculative and gossippy dissection of Obama’s personal life.”
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I am simply trying to understand why he keeps trying to make friends with people who hate his guts, and who wish him nothing but ill will. It is obviously some sort of psychological defect, an overriding need to be loved and accepted. There is no rational reason why he would still be trying to cut a deal with them.

I am simply trying to understand why he keeps trying to make friends with people who hate his guts, and who wish him nothing but ill will. It is obviously some sort of psychological defect, an overriding need to be loved and accepted. There is no rational reason why he would still be trying to cut a deal with them.
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Derek, love? Acceptance? Um… maybe he just wants to maintain the support of fanatic bipartisan ideologues like Joe Klein, and maybe he doesn’t want to be beholden to progressives.
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Look, I suggest you face the obvious here: he’s happy to try and cut deals with “moderate” Republicans because he is happy to make the concessions. And he’s happy to make the concessions because he is not a progressive.
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It would be irrational for Obama to refuse to make concessions which are essential for his popularity with elites in the MSM and elsewhere and which he’s not even strongly opposed to on ideological grounds.

I don’t know if MS writes poetry, but he has excellent taste in poetry and (too) occasionally posts links to his selections. And because you’ve said such lively things about me, here’s a link to my blog so you can see my tattoo:

http://nicewhitelady.blogspot.com/

It’s a flaming chalice, b/c I am a liberal religious zealot of the worst kind.

I can sympathize w/both positions illustrated here. On a rational level, I’d have to side with Rose’s contention that psychology is purely speculative and unproductive. I think dems personally affronted by Obama’s “betrayal” (an arguable depiction to begin with) are similar to those who trust him on some nebulous gut level. Greenwald says of trust for ALL politicians:
~
“‘trust’ is appropriate for one’s friends, loved ones, family members and the like — but not for politicians.”
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But, of course, we are all human and thus seek to understand human (I know, they’re POLITICIANS!) actions in human terms. And I admit I’m guilty of this at times. Perhaps I’m just trying to salvage a reason to continue voting donkey-D after decades of disappointment (a humiliating cycle of hope and reality).
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In my less than rational moments, it’s ‘oh, Obama, really, in his heart of hearts is a progressive, his sympathies are with us,’ but as Rose says, he’s afraid to embrace those inner convictions, terrified of losing Joe Klein or Chucky Grassley. Part of me knows I’m projecting wildly when I do this, but, honestly, where would most of us summon the resolve to participate in this so-called democracy without such vain misreadings.
~
Before I head out for the day, let me just say that per GG, Krug, and espec Link！Digby that Derek’s feeling is hardly surprising or limited in scope. 9 months in, let’s be frank, Obama is poised to alienate his base and see another Naderite desertion in coming elections.

“Look, I suggest you face the obvious here: he’s happy to try and cut deals with “moderate” Republicans because he is happy to make the concessions. And he’s happy to make the concessions because he is not a progressive.”
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John Kyl said today he does not expect a single Republican to vote for health reform. Even if he gets one of them to vote for it do you think alienating your base for one lousy Republican vote is the action of a rational person? He either has some sort of pychological problem or he just isn’t very bright.

maurice2u:
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Please expound.
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First of all, I’m quoting Joe Klein directly from his book when he gurgles blissfully: “Indeed, a delightfully dangerous centrist radicalism was in the air. The political spectrum seemed, suddenly, an arrow — with moderates pointing the way to the future and the traditional left and right wings lagging behind, hopelessly retro.”
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Secondly, if you’re really interested, click on this link here to a conversation between Jay Ackroyd and myself that he told me to go write down.

[...] Krauthammer on Death Panels – Swampland – TIME.com [...]

Ever hear of trying to resolve an issue?

Anti-reformers say a bill can be interpreted to yield an evil result. Pro-reformers say they do not agree with the argued interpretation, and in any case that result is not their intent.

Is the adult approach to scream about “Death Panels” or even to take Krauthammer’s approach and merely try to justify the strained interpretation? Or is the adult approach to suggest resolution – a clarifying amendment that precludes the agreed evil interpretation without undermining general support for responsible end-of-life consideration by individuals?

If you’re not trying to improve the bill, there’s a reasonable argument you’re trying to scare people into killing it for unrelated reasons – say, preservation of profit.

I believe knowledge is power. There is no more complex topic in the healthcare debate than end-of-life care. I have been a Registered Nurse for thirty years. I deal with this every day. All of us will confront this issue eventually. When it’s your turn, I hope the medical profession will guide you to the best options for you and your family.
Often I see patients who have prepared Living wills and think a document will protect them. This is frequently not the case. Often these documents are not specific enough to guide family members. Occasionally they are completely ignored.
Imagine you’re in a nursing home. You no longer know your family. Chronic illnesses ravage your body and render you bed-bound. Your life becomes an endless series of hospitalizations that only benefit your providers. Does your living will advise your family to stop treatment? Do they step in only if you end up on life support? Would you choose to live like this for years until you finally succumb?
Perhaps this is why nearly 70% of ICU beds are filled with “Do Not Resuscitate” patients. I have seen these patients on life support, on dialysis machines and receiving chemotherapy. What are we doing? In the last 2 years I have interviewed dozens of patients for my book, “A Bitter Pill: Understanding America’s Healthcare Crisis”. Not one of them chose this course.
When you create a living will, you think that you have made your wishes known and that you are protected. Were you advised that “DNR” orders aren’t honored in operating rooms? Did you know that if a distant family member intervenes, your doctors, fearing liability, will violate your wishes?
There is much to debate on the end-of-life topic, but let’s begin with an honest discussion of how the system works. The crisis in healthcare is about money. End of life care consumes 25% of the Medicare budget, in many cases on futile care. Yet billable procedures are performed on patients that just delay the inevitable and prolong suffering. Each time a treatment is offered someone should ask: Will this procedure improve the quality of life?
Recently a 92 year old Alzheimer’s patient entered a Wisconsin Hospital with a heart attack. She had bypass surgery and a pacemaker implanted. Shortly thereafter, she died in a nursing home. If a doctor had fully counseled this family on the likely outcome and asked them for a $250,000 check to cover her care, they might have said, “Let’s keep mom comfortable”.
Because it was Medicare’s money, she endured high risk surgery. It did not improve the quality of her life, ease her suffering or comfort the family. But everyone: the hospital, the device company, the pharmaceuticals and the physician got paid. It’s not that these people are wrong, it’s that the system defaults toward treatment rather than compassion. Just because we can do a procedure, doesn’t mean we should.
The idea that government will dictate your end-of-life care is misleading. Medicare rarely denies procedures, while private insurance companies do it everyday. Physicians need greater reimbursement for their time in presenting difficult options. They need to ask themselves, what care they would offer their own parents. Medicare incentivized procedures and doctors often choose the course of least resistance. We shouldn’t blame them. We should change the system to encourage care over procedures.
I’ve seen enough suffering for a lifetime. I am grateful for the public debate. It takes real courage to counsel dying patients. I’ve done this for hundreds of Heart Failure patients and for my own father as well.
My dad suffered complications of diabetes: blindness, cardiac problems and amputations. His surgical site, covered in gangrene would never heal. His doctors continued to work on him planning more surgery, dialysis, and tube feeding. When none of the MDs presented his options, I did. When I mentioned the nursing home, he stopped me. “How long will I last?” he asked. I told him that his future would include many hospitalizations, but the quality of his life would never improve. He made an informed decision. We stopped all treatment, including antibiotics for infection. He died peacefully 6 weeks later. One of the doctors, shocked by our decision asked, ‘How could you do this to your father?” I responded, “Because I love him that much.”
These are challenging times in healthcare, but with compassion and honesty, we can lead our way out of this mess. Fear and greed in healthcare are what need reforming. Scare tactics about rationing care and having the government make your decisions do not help in educating the public on the true issues on end-of-life care.

Yoshi –

Allow me to suggest, without protracting an argument, that there’s an essential disconnect in the usual citation of “tort reform” as a requirement of health care cost control.

Between the compensation awards deemed reasonable by juries of our peers and the doctor facing a bill for malpractice premiums stands an insurance company. There’s little correlation between the trends in damage awards and the changes in premium rates, so it’s likely the responsibility lies with the controlling entity in the middle.

I haven’t seen recent figures, but for some time the trends in malpractice premiums correlated inversely with insurance company earnings from unrelated investments, and not directly with trends in jury awards. Doctors have reason to be concerned, but I’m not sure they’re putting their fire on the right target.

It seems to me that Palin was partially right about the final outcome.

It is clear that doctors would not pull the plug on grandpa. But it is equally clear that they would choose not to plug him in in the first place. Clearly one can argue that it is wrong to waste scarce common resources to prolong life by some short period of time. But the use of one’s own private resources to prolong one’s life is a personal decision that competent individuals should make on their own.

I also do not see how one can argue that companies should be forced to insure people with pre-existing conditions. If an automobile insurer is able to refuse to insure a driver that has an alcohol problem or is simply a bad driver with a long history of accidents why should a health care insurer be forced to insure people that are certain to run up very large charges that other people will have to pay for by being forced to sign up for policies at a higher price than they could get if they did not have to subsidize higher risk individuals?

“It is hilarious how Republicans want to reform lawyers but not insurance companies, and Democrats vice versa.
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But, unfortunately, neither Democrats nor Republicans have the courage to take on the docs.”
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I hope you understand the relationship here and exactly what the problem is (hint: it’s always corporatist “conservatism”). If “conservatives” allowed government to forcefully regulate the health care industry, we wouldn’t need the tort system to do it for us. As it stands, only the threat of massive jury awards keeps giant hospitals, pharmaceutical and insurance companies from killing more of us, beyond the few hundred thousand per year they do now.

Well if that’s your concern then you should be the first one in line, leading the charge for the public option. Because when it comes to automobile insurance, if you have such a bad driving history that no private insurer will take you then you have two choices:You will either secure high risk insurance from the state. It might be slightly higher than geico, but you’ll be able to swing it, or you’ll take the bus. There is not always such a counterpart in most states when it comes to health insurance.
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And frankly, I don’t care if it cost more to cover everyone. We can demand that insurance companies make less profit to keep cost down for everyone. That’s the price insurance companies should pay if they want to keep the business. Think about it, why should health be something bought and sold on the open market like a barrel of corn? We don’t allow people to buy and sell their organs for transplant because we don’t think it’s right to have rich people have an unfair advantage, yet we set up a system where overall access to health is determined by your socio-economic status. My god are we not the most blatantly inconsistent hypocrites to ever walk the earth!
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So as long as we are going to continue to allow profit to be a motive in this system, well then they have to learn to deal with a little less profit. There are just somethings that are more important than the almighty dollar. Get a grip. We don’t have private police, or fire departments for a reason. And you can see from the headlines lately that our foray into private military forces isn’t working out so well.
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At some point we need to realize that health ought to be an essential service on par with fire and safety and take it out of the private sector altogether. No chairman of any board should have a right to determine who lives and who dies based on his stock prices. And as long as the only real death panel is the one based on the Dow Jones average I suggest that you and your ilk STFU. If that makes me a socialist so be it. I’d rather be that than a heartless, inhuman slug.

“We can demand that insurance companies make less profit to keep cost down for everyone.”

Let us get rid of this anti-capitalist mentality and deal with the facts as they are rather than as they are said to be. Health insurance companies rank 86th in profitability with profit margins that are four times lower than rail-roads and eight times lower than the beverage industry. If all healthcare profits were eliminated spending would only decline by one percent.

The problem is not the insurance companies but the vast array of regulations at the federal and state levels that prevent real competition. Let insurance companies sell across state lines and you will see the efficient operators win more customers and reduce some of the overhead expenditures that now add to the overall costs. Stop forcing Catholics to buy insurance that covers procedures that violate their beliefs and Muslims to buy policies that cover alcohol rehab procedures and costs will go down. Let people buy the policies that they want and you will see more obtain the coverage that they want.

I find it ridiculous that the government is given as an example of a solution when all of the programs that the government is running are bankrupt. The Post Office is incapable of taking advantage of its monopoly on first class letter delivery and has been bleeding red ink for quite some time. It is bankrupt. Amtrak is bankrupt. Social Security and Medicare are bankrupt. Costs in all of these areas have gone up faster than in the private sector where failure leads to bankruptcy.

The US is bankrupt. It fights costly wars abroad and has stationed troops in more than 100 nations around the world. Its SS and Medicare programs have massive unfunded liabilities that are multiples of GDP. Its financial system is technically insolvent. Most of the states and quite a few of the municipalities are bankrupt. The federal government is running massive deficits and has resorted to borrowing huge amounts from countries like China, Taiwan and Japan. After throwing billions to the brokers and bankers the federal government has no money to spend on idiotic schemes such as those that are being proposed for healthcare.

The question for you is were the money comes from to pay for the millions of individuals that will require subsidies or incentives in order to be convinced to purchase insurance coverage. And why should people accept the argument of greater efficiency when government run healthcare schemes have seen greater cost increases than procedures not covered by insurance? In the private sector we saw the cost of procedures such as plastic surgery or Lazik eye correction decline even as service improved substantially. At the same time Medicare costs, which were entirely within the control of the bureaucrats increased sharply while procedures did not improve nearly as quickly, if at all.

The tort system has nothing to do with regulating the insurance companies because it is set up to transfer wealth from insurance purchasers to lawyers. While the insurance companies pay for whatever judgements go against them it is the insurance purchasers who wind up paying for those judgements.

And if you think that it is only the Republicans that are corporatists than you are not paying attention. Waxman-Markey is going to force consumers to pay much more as carbon traders, GE, First Solar, the utility companies and many companies and special interests get much richer. Both of your major parties are very corrupt and favour the growth of the sate over individual liberty.

Obamacare?

Simple enough to understand:

YOUR kids will get to pay for HIS smoking habit.

http://twitter.com/HULAgate

“I find it ridiculous that the government is given as an example of a solution when all of the programs that the government is running are bankrupt.”
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This will probably come as huge shock to you but government isn’t in the business of making money, it’s in the business of making sure that the vital needs of society are met. Health care is one of those needs and, quite obviously, for-profit business has proven unable or unwilling to meet the need, particularly for the poor, the elderly and the sick. I find it ridiculous that anyone would be comparing it to government programs which not only meet the need but do it for less money.

“This will probably come as huge shock to you but government isn’t in the business of making money, it’s in the business of making sure that the vital needs of society are met.”

Where does it say that the government is supposed to lose money running the Post Office or Amtrak? Who in his right mind believes that if the government stopped subsidizing the Post Office the mail won’t get delivered?

This will probably come as huge shock to you but the markets are quite good at providing the vital needs of society. Food is essential but we do not need government planners to make certain that Wal-Mart will have enough bread to meet consumer demand. If the market can deliver packages more efficiently and better than the government or make sure that people have all the food that they want or need at a reasonable price, what makes you so sure that government bureaucrats, who have no incentive to be pleasant, efficient or effective, will do a better job than private providers?

I do not mean to imply that the private markets will not produce inefficient players that can’t meet demand because some human beings will fail if given the opportunity. But the market has little tolerance for failure and anyone who is wasteful and cannot produce what the public needs at a good price will be punished by being forced into bankruptcy.

When was the last time govenrment bureaucrats were punished for failure? The fools that let the 9/11 hijackers on those aeroplanes or failed to follow up on intelligence that could have caught them before they could have carried on their plans kept their jobs. Many were actually rewarded with much bigger budgets, higher pay grades, and more power. How about the incompetents who could not repair the New Orleans levees even though they had years to do the job? Or the idiots at HUD who kept pushing the banks to keep lending more money to people that could not pay back their loans?

I am sorry but having been born and lived in the shadow of the Iron Curtain I have a great deal of experience about how bureaucracies and government agencies work. Sadly, when I moved to Canada I did not see much of an improvement and realized that it wasn’t the quality of people but human nature and the incentive system in the public sector that were the problem.

Since Milton Friedman said it much better than I ever could, I will use his example. Friedman pointed out that there were four ways in which we can spend money.

1. We can spend our own money on ourselves or our families. When we do that we are very prudent and try to get as much for our money as we can.

2. We can spend our own money on somebody else as we do when we buy a gift for someone. When that is the case we are more concerned about the cost than about the gift itself.

3. We can spend someone else’s money on ourselves as we do when we bill our company for a business lunch or some similar event. When we do that we care about the quality of the lunch but do not really care as much about the value because it isn’t our money.

4. We can spend somebody else’s money on somebody else. If that is the case we do not care all that much about either the value (as we did when it was our money) or about the quality (as we did when we were spending on ourselves.)

As Friedman pointed out, that was the essence of government buracracy. Since the bureaucrats do not use the services they do not care much about the quality. (Keep in mind that Congress voted to opt out of public pension plans, health care plans, etc.) And because it isn’t their money they don’t care much about value either. In fact, given the incentives, it makes sense for bureaucrats to ask for bigger budgets and spend far more than they should because their pay depend on those budgets and the number of people they have working for them.

It seems to me that there is a problem with some posters understanding basic economic concepts. Given the fact that my ten-year old son has no trouble figuring out the incentive and signalling issues I am very surprised that adults have so much trouble figuring things out. Some reading may be in order. If I may be allowed to make a few recommendations, I suggest that it is essential for any competent adult to be familiar with the following works:

The Wisdom of Henry Hazlitt

That Which Is Seen, and That Which Is Not Seen

Human Action: The Scholars Edition

Man, Economy, and State, with Power and Market

Money, Bank Credit, and Economic Cycles

Reading any one of the books referenced above should make one a better economist than 99% of the fools that are shown on CNBC, CNN or write in the NYT or other similar papers. It might be easier to loo at the first two links first. The last three books are clearly written and not very difficult but require careful reading and serious thinking.