Alibris Secondhand Books Standard

Tuesday, September 08, 2009

pulling the trigger on the public option

Robert Reich has some concerns about Senator Olympia Snowe's 'trigger' health care proposal:

Her idea (evidently encouraged by Rahm Emanuel, the President's chief of staff) is to hold off on any public option. Give the private insurance companies a period of time -- say, five years -- within which to make changes that extend coverage to more people and also drive down long-term costs. If those goals for coverage and cost aren't met by end of the five-year grace period, kaboom: the public option is triggered -- which will force such changes on the insurance companies.

In principle it sounds like a good idea. But in the reality of Washington D.C. …

The problem is twofold. First, it's impossible to design airtight goals for coverage and cost reductions that won't be picked over by five thousand lobbyists and as many lawyers and litigators even if, at the end of the grace period, it's apparent to everyone else that the goals aren't met. Washington is a vast cesspool of well-paid specialists who know how to stop anything resembling a "trigger." Believe me, they will.

Second, any controversial proposal with some powerful support behind it that gets delayed -- for five years or three years or whenever -- is politically dead.

President Obama has remained noncommittal about what the health care reform legislation should look like by the time it reaches his desk. But if Reich is right, Obama's refusal to take sides puts him firmly in the camp opposing the public option. If Obama really cares about the public option, he needs to speak up now. And if he doesn't, he should say it and be done. Health care reform is too critical an issue, and the President is too critical a player to sit on the sidelines.

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Monday, August 24, 2009

being honest about health care reform

Charles Krauthammer is concerned about the language in the health care reform bill HR 3200, and makes his concerns known in an essay titled Let’s Be Honest about Death Counseling.

Noting that the bill contains a provision in section 1233 for a Medicare-paid advance care planning consutation between the patient and the doctor, Krauthammer opines:

What do you think such a chat would be like? Do you think the doctor will go on and on about the fantastic new million-dollar high-tech gizmo that can prolong the patient’s otherwise hopeless condition for another six months? Or do you think he’s going to talk about — as the bill specifically spells out — hospice care and palliative care and other ways of letting go of life?

Yes, the bill says that the doctor must mention palliative care and hospice options. Specifically, the consultation must include, among other things:

(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

The sentence containing the words "palliative care and hospice" clearly puts them in the context of "the continuum of end-of-life services and supports". As I read it, there's nothing in the bill to prevent the physician from getting paid if he or she advocates heroic life-sustaining treatment even in the most hopeless cases, as long as the range of options is discussed in the consutation.

Now it may be the case that Krauthammer does not read it the same way, and it may be the case that he would like to see the other side of the continuum spelled out in more detail. That's a valid concern; perhaps the language is not clear enough, and this section of the bill should be modified. That's a reasonable criticism.

After a brief digression into why he thinks living wills are worthless and irrelevant, Krauthammer returns to the reform bill, concluding:

So why get Medicare to pay the doctor to do the counseling? Because we know that if this white-coated authority whose chosen vocation is curing and healing is the one opening your mind to hospice and palliative care, we’ve nudged you ever so slightly toward letting go.

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 you in a certain direction, toward the corner of the sick room where stands a ghostly figure, scythe in hand, offering release.

Were it not for this conclusion, I'd believe Krauthammer was voicing an honest concern about the bill. But his final two paragraphs make no sense whatsoever, unless we make one huge assumption: That physicians can't think for themselves; that they are incapable of doing anything unless Medicare orders it.

I worked for a medical billing agency for ten years. I can't imagine a competent physician would ever say, "Since Medicare is paying for this consultation, I should probably advise my patient to choose death." The reaction will probably be more along the lines of, "Medicare isn't paying any more than that?" Because that's the general reaction to anything Medicare pays for.

Medicare, in my experience, is actually less bureaucratic than most private insurances, but it requires physicians to take deep, deep discounts. And since Medicare patients usually need more care than patients with private insurance, doctors must take these discounts on a high percentage of their services.

As I stated above, I don't see anything in the bill requiring physicians to push their patients toward palliative care for chronic illnesses. I can't imagine any physician would read the bill that way either. I certainly can't imagine a physician would advise patients to opt out of any care that might cure their condition.

Only someone filled with disdain for the medical community would suggest otherwise.

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Tuesday, August 18, 2009

out of bounds

Henry Neufeld comments on Shane Raynor's response to Jim Wallis's cursing of Sarah Palin.

Wallis is rightly upset at Palin for her grotesque distortion of the language of the health care bill. In Palin's mind, the bill's section defining advance care planning equates to "death panels" where bureaucrats determine who lives and who dies. In the real world, advance care planning is a way of making decisions ahead of time about what kind of care you want to get in case you reach a point where you're no longer able to make those decisions for yourself. With more people living longer, it's more important than ever to have a plan in place. According to, this provision of the health care bill allows Medicare to pay for a consultation between patient and physician about end-of-life care. Palin's scaremongering is just the latest in a string of attacks by the opponents of reform.

But Wallis is not content to criticize Palin for her falsehoods. He goes a step further and invokes a curse against her:

Please don’t invoke your “Christian faith” anymore and embarrass the people of God even further. May your efforts to scare Americans during this important debate fail. May your political future also fail, and may your star fall as fast as it rose just a few months ago — because we now know who you really are.

Since I've previously written about mixing politics and religion and about cursing — and not in favor of either — I want to add my voice to those who say Wallis is out of bounds.

It's fine to disagree strongly with someone's political agenda, and to point out the dishonesty of their claims. But is cursing ever justified? Not when it's done in the name of political debate.

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Saturday, August 15, 2009

on the theology of health care reform

Marie Callahan Brown, blogging in support of health care reform, asks some pointed questions:

I was raised in a loving and respectful Christian environment. In it, I learned that Jesus wanted humanity to be generous, forgiving, supportive and loving in every aspect of life. If you come across people who are hungry, feed them. Someone who’s cold, give him your coat. To people who are down, and not “being all they can be”, give them kindness and respect, not advice and condemnation.

That said; I genuinely want to know how certain, other viewpoints are honestly justified. If this is a Christian Nation, how is it that citizens are so afraid of losing anything or everything here? Why is sharing so difficult? What about “reaping what we sow” aka “what comes around goes around”?

I find myself in an awkward position here. While I too support health care reform, I don't think it has anything to do with the question of whether the United States is, in any sense of the term, a Christian nation. So at this point, I'm already leery of where this is going. Sure enough:

Jesus shared His fish and bread without reserve, and I feel pretty safe in saying He believed in Free Healthcare with all that healing and comforting He did pro bono.

That's quite an exegetical stretch. Christian teaching has always been that genuine healing comes only from Christ, so it's very hard to see how Jesus' healings can be taken as support for "Free Healthcare," whatever that is.

And let's be honest: Even under the most radical reform of the system, health care would not be free. Medical care has a cost, and that cost must be paid by someone. It's likely that any system we put in place would lower the overall cost, but some cost will remain.

I think perhaps the only request put forward by Jesus when He healed people, was that they continue to share with others the same loving kindness He showed them. Why don’t Christians do more of this?

A good question, but one that is easily answered by opponents of health care reform. The most common reply is that charity must be voluntary, not mandated by the state.

And therein lies one major problem with attempting a theological defense of national health care reform. Jesus didn't ever explicitly give his opinion about the political issues of our day. He barely touched on the politics of his own time. Since we have no clear mandate from him, it's easy for people on both sides of the issue to read their own politics back into the gospels. In my experience, that's not a healthy way to grow as a Christian.

There are other problems with this approach, too, as Ms. Brown seems to recognize later in her blog:

Personally, I couldn’t care less whether someone is a Christian, a Muslim, a Buddhist, a Satanist or an Atheist. At healthcare reform rallies Americans have been known to drive by shouting “FU#K THE POOR!” Forget religion. That is the most UNAMERICAN thing I’ve EVER HEARD.

Now we're getting somewhere. In a nation whose founding documents speak of equality of all people, we are being untrue to our heritage if we don't want poor people to have the same opportunities as the rest of us. This is a foundational American value. On the other hand, it is not a Christian value. Jesus didn't die on the cross to give us greater opportunity for personal advancement.

It seems to me that our politics and our theology will both be healthier if we can remember which of our values belong to which sphere. There are some very good reasons why overhauling America's health care system is morally necessary, but "Jesus would have supported it" is not one of them.

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