Doomed to Die

When Governor Sarah Palin objected to President Obama’s health care proposal (Obamacare) as containing “death panels” she was simply expressing what should be obvious to all: demands for efficiency and cost-effectiveness lead to widespread rationing of medical care. In all the debates about whether it is right to require people to carry insurance or to require that insurance companies cover pre-existing conditions, no one looked too closely at Mitt Romney’s health care bill (Romneycare). It required the creation of a Health Care Quality and Cost Council (HCQCC), whose recommendations included:

 “The strategies proposed here are intended to reduce care that is unnecessary, duplicative, and of no or marginal benefit”[1]

Economist Thomas Sowell has put forth the idea that the question we often face is not “What is the best decision in this matter?” but “Whose decision is this to make?” Who decides what surgery is necessary or is of no benefit? A bureaucrat in Boston or Washington, DC(?!), or should that decision be made between a doctor and her patient?

The Romney panel continued:

Spending on end-of-life care in hospitals can be very expensive with little benefit; patients are often more satisfied with less costly hospice care. Medicaid and private insurers would encourage the use of hospice over hospitals…[2]

Hospice is a place where you go to die, not a place to get better; and I can tell you from experience that when money is the motivator and a third-party is the payer, patients will not be making decisions which satisfy their own needs and desires but those of the “health care system.” There will be pressure to move to the hospice for the rest of the family’s sake.

Carey’s Horror Story[3]

Carey Goldberg used to be a reporter for the New York Times. Now she writes about medicine in Massachusetts and elsewhere for NPR. She’s an expert. She knows all about end of life care, because she ended the life of her own “beloved” mother. Of course, no matter, because her mom wasn’t a person, she was just “a vegetable.” Goldberg’s biggest nightmare was that she couldn’t just poison her mother or something.  It took nine days for her mother to die – NINE DAYS! – CAN YOU BELIEVE THE AUDACITY! It would have taken much longer if poor old Carey hadn’t stopped giving her mother anything to eat or drink and finally ordered the nurse to please give her enough morphine to kill her, and put her out her misery (the last “her” being Carey, not her mother).

What does this have to do with big government and Romneycare?  Goldberg’s article was written to encourage the use of a Medical Orders for Life Sustaining Treatment Form, the brainchild of a panel created by Governor Romney called the Massachusetts Expert Panel On End-Of-Life Care (I think Sarah Palin called this a death panel), a subcommittee of Romney’s HCQCC .

If you are found on a street or brought into a hospital unconscious, this form is all health care workers need to err on the side of letting you die. Second, this same person can make the decision whether or not to resuscitate you or use life-saving measures; the form even tells somebody whether to take you to the hospital or not!

The death panel (they even admit that’s what they are) also recommends that the law require both coverage of and help in getting hospice care for those the doctor thinks need it. So, maybe the death panels aren’t made up of suits in some board room. They may be those folks in clean white jackets, and no they are not coming to take you away, they may be coming to put you away.

 

MOLST-Form-SAMPLE

 



[1]http://www.mass.gov/hqcc/docs/roadmap-to-cost-containment-nov-2009.pdf

[2]http://www.rand.org/pubs/research_briefs/RB9464-1/index1.html

[3]http://commonhealth.wbur.org/2010/11/end-of-life-menu/

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