Sunday, August 30, 2009

Pulling The Plug On Sanity

Sarah Palin, as always, epitomizes inane, irrational, uninformed, hyperbolic, stream-of-consciousness ditziness. Her characterization of a particular health reform proposal as instituting "death panels" was merely par for her crazy course.

And yet, a teeming horde of inane, irrational, uninformed masses latched on with mindless fury, outraged that government led health care reform intended to "pull the plug on Grandma." The right went ballistic, and more so than usual. Even politicians who know better, such as Chuck Grassley of Iowa, fanned the flames.

The easy answer to to the "death panels" demagoguery is that they aren't in the bill. That is, the entire notion of "death panels" and "pulling the plug" is but the figment of a willfully deranged imagination, exponentially amplified by unhinged throngs apparently happy to clamp on to any bizarre notion that comes their way. This is what passes for public discourse in America, c. 2009. It's what happens when special interest advocacy degrades into fear mongering to the uninformed and unsophisticated.

When I say death panels aren't "in the bill" I mean they aren't in any of the draft legislation that has passed through various Congressional committees, or in any proposals being discussed by legislators. Death panels, or anything like them, or any whiff of them, simply aren't anywhere to be found.

What has been proposed, and what has apparently been responsible for stirring up the hornets nest, is the suggestion that Medicare should pay for a patient's consultation with his or her doctor to discuss end of life matters. Such matters could include living wills, access to hospice and palliative care, and so forth. The point is to give patients information on the availability of services, and to make sure the patient's wishes regarding medical intervention are observed*. Patients and their families have such discussions all the time; the reform proposal simply ensures the consultation is paid for as part of the patient's medical coverage. These consultations are not required. There is no coercion. There are no "panels". Just the patient and her personal physician, when and if the patient desires it.

Interestingly, the political debate is now becoming more nuanced. It's hard to keep proclaiming "death panels" when you can't produce any actual evidence for them. So the tack of late is to assail not the specific legislation, but where (in the imagination of the assailer) the legislation will inevitably lead. To wit: death panels may not be in the bill, but government intrusion into health care will surely result in unaccountable bureaucrats denying legitimate care to achieve cost control. Even worse, there will be pressure, subtle or not, for the elderly to die and be gone for the greater good.

This is deranged ideology gone off the deep end. It's an irrational fear that "big government" will lead to all sorts of horrific evils. Such thinking seems to immunize its adherents against a sane discussion of concrete health care proposals, and perhaps that is part of its purpose. It seems impervious to evidence or logic. Can we, in fact, have a reasoned debate with individuals who hold such views? We can try.

One thing we can point out is that Medicare, the government run health insurance for the elderly, has been in existence for over four decades without any hint of sliding toward euthanasia. Government "intruded" into health care long ago, and at least in terms of health outcomes, it has been a remarkable success.

Indeed, this government run program we call Medicare has been transformative in making otherwise unattainable medical care available to individuals in the twilight of their lives. As a singularly high cost group, the vast majority of seniors simply could not afford to purchase insurance on the private market, particularly as it exists today. Before Medicare, seniors generally had dismal prospects for obtaining decent medical care. So with respect to the elderly, government has been not the problem but the solution.

We should also point out that the right wing demagogues who now warn of death panels are cut from the same ideological cloth as those who opposed the creation of Medicare in the first place. Imagine what life would be like for the elderly had the right won that fight. Had they gotten their way, most Grandmas would not have a plug to pull.

And finally, we should ask ourselves who is actually most likely to pull the plug: the government that created the benefits in the first place, or the private insurer or heath care provider who would be all too happy to jettison Grandma when she becomes unprofitable?

That one side of the health reform debate has been so successful in disparaging government and lauding private insurers is a measure of the great difficulties that lie ahead. A mindless appeal to a mindless ideology makes for an unpromising negotiating partner. What we desperately need is a return to sanity.

Update Aug 19, 2010: A new study finds that palliative care extends life in terminally ill patients, and casts doubt on the wisdom of having removed (as a political expedient) provisions for end of life counseling from the health care bill that was ultimately passed. From the article: “It shows that palliative care is the opposite of all that rhetoric about ‘death panels.’ ”

* The National Hospice And Palliative Care Organization supports end of life counseling in health reform legislation, as does AARP.

Copyright (C) 2009 James Michael Brennan, All Rights Reserved