Health Care

Debating Assisted Suicide

/ Matthew Clemente / Leave a comment

After a brief (Spring) break, the SLACE Archive has returned. The most recent episode of the BBC’s Moral Maze radio programme, lived up to its name–tackling the vexing issue of physician assisted suicide.

Here is a description of the show from the Moral Maze website:

There are few more emotive subjects than assisted dying. It captures both the hopes and the fears of the age in which we live. Advances in medical technology have been a triumph, extending our life expectancy almost exponentially. 33% of babies born today can expect to live to 100. 80 years ago the figure would have been less than 4%. But along with the undreamt of levels of longevity have come the nightmares of a lingering death; robbed of our humanity by the indignity and pain of diseases. The government has just announced that it will give MP’s a free vote on the latest legislative attempt to allow people to get help to die and campaigners believe that decision will give the bill a strong chance of becoming law. It will allow adults to ask a doctor to help them die if they’ve been given no more than six months to live. But it won’t go as far as some campaigners would like. Why is it morally acceptable to help someone to kill themselves if they’re already close to death, but not to help someone who might have many years of pain and suffering ahead of them? And if it’s right to allow adults assisted suicide, why not children? After all is it moral to expect them to endure the suffering we would not? At the heart of this issue is personal choice and moral agency – it’s my life and my death. But is the brutal truth that in almost every circumstance we already have that choice, it’s just that we want someone else to administer the coup de gras? Or is that point? Assisted dying – a very compassionate and humane answer to help people when they are at their most desperate or a law that will in reality help only a small number, but put many more vulnerable people at risk? Chaired by Michael Buerk with Claire Fox, Anne McElvoy, Matthew Taylor, Giles Fraser.

Witnesses are Graham Winyard, Colin Harte, Gerlant van Berlaer and Ruth Dudley Edwards.

Debating Assisted Suicide

/ Matthew Clemente / Leave a comment

After a brief (Spring) break, the SLACE Archive has returned. The most recent episode of the BBC’s Moral Maze radio programme, lived up to its name–tackling the vexing issue of physician assisted suicide.

Here is a description of the show from the Moral Maze website:

There are few more emotive subjects than assisted dying. It captures both the hopes and the fears of the age in which we live. Advances in medical technology have been a triumph, extending our life expectancy almost exponentially. 33% of babies born today can expect to live to 100. 80 years ago the figure would have been less than 4%. But along with the undreamt of levels of longevity have come the nightmares of a lingering death; robbed of our humanity by the indignity and pain of diseases. The government has just announced that it will give MP’s a free vote on the latest legislative attempt to allow people to get help to die and campaigners believe that decision will give the bill a strong chance of becoming law. It will allow adults to ask a doctor to help them die if they’ve been given no more than six months to live. But it won’t go as far as some campaigners would like. Why is it morally acceptable to help someone to kill themselves if they’re already close to death, but not to help someone who might have many years of pain and suffering ahead of them? And if it’s right to allow adults assisted suicide, why not children? After all is it moral to expect them to endure the suffering we would not? At the heart of this issue is personal choice and moral agency – it’s my life and my death. But is the brutal truth that in almost every circumstance we already have that choice, it’s just that we want someone else to administer the coup de gras? Or is that point? Assisted dying – a very compassionate and humane answer to help people when they are at their most desperate or a law that will in reality help only a small number, but put many more vulnerable people at risk? Chaired by Michael Buerk with Claire Fox, Anne McElvoy, Matthew Taylor, Giles Fraser.

Witnesses are Graham Winyard, Colin Harte, Gerlant van Berlaer and Ruth Dudley Edwards.

Health Insurance Reservations

/ Lorne Runge / Leave a comment

I am now a semi retired older physician who started practicing rheumatology in Syracuse in 1975. During the recent government impasse, I experienced a curious relief that universal health insurance might not happen. Although I have supported universal health insurance for decades, working within Medicare guidelines as made me suspicious of government control. I doubt most patients care about documentation requirements in order to bill for medical services through Medicare. Patients might be surprised to learn a complete review of systems encompassing 12 areas of possible complaints must be documented in order to bill for a complicated consultation. In the past, we [the physicians] could simply ask whether anything else was bothering you. Now we must go through a laborious inventory asking about menstrual problems, memory loss, extra-marital sex, etc., and whether or not you are using a seat belt and are agreeable to routine HIV testing. I have always resisted becoming the patient’s biographer as most of the data is none of my business, and the answers do not usually impact my specialty services. Medicare forces me to go way beyond my comfortable limits. The process started as an innocent attempt to ensure appropriate services were rendered, but has evolved in typical government fashion, to include a 1-2 page confusing list of mostly irrelevant issues.

I remember when everyone paid directly for services. Then, it was not unusual for some patients to decline expensive investigation. Many would refuse additional x-rays especially if there was no direct impact on treatment. With insurance, patients have already paid. They want their money’s worth, which means some want every test and treatment possibly relevant. Many expect an MRI of the affected area and feel neglected if not done.

When patients paid directly they limited their requests to attainable goals requiring expert opinion/services. Now, in a further attempt to get their money’s worth some keep adding on additional complaints many of which are impossible to solve satisfactorily. For example, being overweight and fatigued usually has a straightforward solution… eat less and exercise more. With insurance, some feel entitled to diet advice, appetite suppressants, in depth evaluation to exclude anemia, cancer, etc.. Modern medicine has not solved the problem of how to reduce fatigue and excess weight with a simple pill. Good health is not yet effortless, but insurance makes it worth a try.

Another consequence of insurance results from the natural tendency to discount advice that comes for free. Our recommendations, which used to cost real out of pocket money, is now treated as coming for free in the same way as supplement advertisements, or cheap shot advice off the Internet. Most pay directly for their lawyer’s advice and are often happy to do so. I doubt this would be the case if/when legal advice becomes a government supplied insurance benefit with little or no direct payment required.

My last reservation is that perhaps lifesaving healthcare is not affordable. We can often afford to patch things up for hours to days, but often treatments such as intensive care unit support for months, organ transplantation, or intensive genetic testing are very, very expensive. We have been willing to spend enough so that the sick and dying do not get left in the street, but are we able to pay indefinitely for costly care that could consume over 20-30% of GDP?

Nevertheless, the nagging discontent with the hidden consequences of insurance pale by comparison with the frustration that develops when simple effective treatment cannot be delivered due to lack of funds. I therefore still support the affordable care act but worry about some of the consequences.

Hopefully, these issues can be addressed to evolve a smooth running efficient medical system. But given our current collective inability to work together, I am not holding my breath.

 

 

Hostages and Health Care

/ Peter Bell / Leave a comment

Today’s (Friday, Oct. 18) N.Y. Times reported in a front-page article on the “despair, anger and disillusionment” felt by ‘conservatives’ over Congress’ bipartisan vote this past Wednesday to reopen the federal government without defunding the three-year-old health care reform law, popularly termed “Obamacare.’

The talk radio and blogosphere homes frequented by the Tea Party faithful were apparently filled with condemnation for those ‘spineless’ Republicans who abjectly surrendered, rather than proceed with the drastic measures needed to prevent the reforms of the Affordable Care Act of 2010 from taking root in American society much the way pernicious health reforms like Medicare and Medicaid have.

Essentially, what we have seen from the most conservative members of the Republican Party, most of them in the House of Representatives, is the sort of principled “no matter what the consequences” cause-based stands long asssociated with the political left: the to-the-barricades French youth celebrated in “Les Miserables;” the Freedom Riders of the Civil Rights movement, recently celebrated in the film “The Butler;” the environmentalists of the ’70s and ’80s who would chain themselves to redwoods to or lie down in front of bulldozers to block loggers or developers from despoiling what they thought was a vital environment; or the protestors who try to block access to military bases or pound on missiles, in order to stop drone use or prevent funding for nefarious military training provided to right-wing para-militaries in Central America.

The difference this time was that none of the Tea Party conservatives lay down in front of bulldozers, braved Klan members, or risked imprisonment for their cause.   Instead, they decided to take hostages to advance their ‘noble’ cause.  And the hostages were the American people.

Not all the American people, of course.  Just those who wanted to visit a national park or memorial, or those families seeking a military burial for a life sacrificed in service, or anyone who depends on the government for some key piece of his or her daily life.  Or, to boot, those who might benefit from the healthier economy that might exist in the absence of uncretainty and jitters about America’s default on its debts.

But, it was just a temporary hostage-taking — one which would end as soon as the President of the United States capitulated to their demands that he and other Democrats agree not to implement the key pieces of the health reform legislation that was enacted by Congress and the President three years ago.  Legislation which is THE signature reform of the Obama Administration.

“Defund Obamacare, and we will let the government function again,” said the conservatives — the same people who on more than 35 occasions in the past two years have attempted legislatively to repeal the law, without a bit of success.  That is why they had to take us all as hostages.

All in a good cause, right.  As the late, great Sen. Barry Goldwater — the darling of the conservative wing of the Republican party in the 1960s said: “Extremism in the defense of virtue is no vice.”

Well, not exactly.  The great cause for which we were all — to greater or lesser degree — held hostage in order to force concessions from the government was the termination of a law (the Affordable Care Act, a.k.a. ‘Obamacare’) that aims to do the following:

1. Reduce the number of Americans who do not have health insurance by about 30 million persons.

2. Provide much more affordable health insurance to millions more, through the establishment of free markets in health insurance, markets in which consumers will have a real chance of being able to compare the costs of insurance plans that provide adequate coverage.  This massive reduction in health insurance costs will be driven by competition — a distinctly Republican concept.

3. Provide incentives for innovation in both the ways health care is provided in America and the establishment of criteria to help health care providers determine what is effective care and what is ineffective care.

4. Provide incentives for both hospitals and healthcare providers to take steps which lead both themselves and their patients towards greater health at a lower cost, i.e., provide and take preventive measures which reduce sickness before it arrives.

5. Create an expert body which will step in to reform Medicare when Congress cannot itself come up with reform legislation that would slow significantly the rapid growth of health care costs that threatens the future stability of the program which assures health care to all Americans over the age of 65.  The reforms adopted or suggested by that expert body will percolate down to help control the costs of ALL healthcare provided in this country.

All these “aims” are to be achieved by a package of measures in the Affordable Care Act which were created and legislated by both Democrats and Republicans working together in 2010 in the House and Senate.  The Democrats and the President gave up a lot of what they most wanted in order to get Republican — and national — support for the legislation.  That legislation aimed to fix what Presidents and Congresses since the time of Harry Truman and Richard Nixon had recognized was a terribly flawed system for the provision of and payment for health care — a system which left 17 per cent of the population without health insurance and an even larger percentage without adequate health insurance in the event of a medical emergency.

Now, the Affordable Care Act may not end up achieving all its aims.  In many states, governors have refused to expand insurance to cover more poor people, even though the Affordable Care Act assures that the federal government will pay for all the costs associated with that expansion for the near future.  Many states have refused to set up the marketplaces in which their citizens could make better informed decisions that should lead to more affordable, adequate health insurance.

In short, the Affordable Care Act may not be implemented as successfully as the Republicans and Democrats who created and enacted the Act had intended.  Nevertheless, its aims for an America in which citizens did not have to live in fear that illness or injury would crush them financially, as well as physically, are noble.  Its aims to make the cost of health care in this country — which spends more per person BY FAR on such care than any country in the world — more affordable are sound management — efficient.

Neither description can be applied to those Republicans who this October so willingly put the American-People hostages in harm’s way to stop a bulldozer that seeks only to build a safer, fairer, more efficient health care system in America.

Tom Hanks, when you finish with those pirates in the film “Captain Phillips,” there are some others whom you should take on.

 

Sunday Funday: Obamacare vs. The Affordable Care Act

/ Matthew Clemente / Leave a comment

Jimmy Kimmel Live: Obamacare vs. The Affordable Care Act

In an effort to bring some levity to the blog, Sundays will feature  “Sunday Funday” posts, posts about the lighter side of public policy debates.  This week, we have the viral video from Jimmy Kimmel Live where people on the street are asked which they prefer: Obamacare or The Affordable Care Act.

Here is a description of the video from CBS:

As someone who covers entertainment and viral videos all day long, I am not going to pretend that I totally understand Obamacare, but I kind of hoped that the general public knew more than me (since I choose to stay out of politics as a rule), but this clip from Monday’s “Jimmy Kimmel Live” demonstrates that we really don’t know what we’re talking about when it comes to this healthcare initiative. Watch the segment titled “Six of One” above, posted on Kimmel’s YouTube page, and be prepared to be disturbed.

This clip seemed particularly timely in the midst of all this government craziness, and it just seemed to scare me more. Were you shocked that people knew so little about Obamacare? Or that Obamacare and The Affordable Care Act were the same thing? Now, I know that this “data” is not scientific in the least, and they definitely chose clueless people on purpose, but it’s still a pretty shocking indication of what most people probably know and think.

But what I do like best about Kimmel, and the way he handled this social experiment is that no matter how dumb he may make people look, he’s always a good sport. As the woman who really seemed clueless on the segment was in the audience, and the late night host joked, “Welcome stupid people, you have a home here with me.” Always keeping it light, that’s what I like to see.