Monday, August 10, 2009

When Emotion and False Statements Drive Policy Debates

Publicity hound Rush Limbaugh comparing Pres. Obama to Adolf Hitler, and Sarah Palin stating the health care proposals coming out of Congressional committees promote suicide, take away health care from those who need it most, and says Obama's "evil plan" has "death panels" that will control what happens to those who are close to dying, have made the headlines this past week. That was by design. The more outrageous the statement, the more press coverage. And the more you can get the masses all riled up since just about no one ever does their own research for little things called facts. Democrats trying to hold town hall meetings across the country are being forced to cancel them due to unruly crowds and, in one case, death threats against the Congressman. The millions being spent to crush any type of reform whatsoever is making some progress, it seems, even though the main claims are inherently false, particularly the wild claims by Palin.

I am putting a Comcast news article below verbatim, since it does a fact check that completely contradicts what the far right campaign of fear mongors have been spreading daily.

"WASHINGTON — Former Republican vice presidential candidate Sarah Palin says the health care overhaul bill would set up a "death panel." Federal bureaucrats would play God, ruling on whether ailing seniors are worth enough to society to deserve life-sustaining medical care. Palin and other critics are wrong.

Nothing in the legislation would carry out such a bleak vision. The provision that has caused the uproar would instead authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes. Here are some questions and answers on the controversy:

Q: Does the health care legislation bill promote "mercy killing," or euthanasia?

A: No.

Q: Then what's all the fuss about?

A: A provision in the House bill written by Rep. Earl Blumenauer, D-Ore., would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health care proxy, learning about hospice as an option for the terminally ill, and information about pain medications for people suffering chronic discomfort.

The sessions would be covered every five years, more frequently if someone is gravely ill.

Q: Is anything required?

Monsignor Charles Fahey, 76, a Catholic priest who is chairman of the board of the National Council on Aging, a nonprofit service and advocacy group, says no.

"We have to make decisions that are deliberative about our health care at every moment," Fahey said. "What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini — then let me go."

Q: Does the bill advocate assisted suicide?

A: No. It would block funds for counseling that presents suicide or assisted suicide as an option.

Q: Who supports the provision?

A: The American Medical Association, the National Hospice and Palliative Care Organization and Consumers Union are among the groups supporting the provision. AARP, the seniors' lobby, is taking out print advertisements this week that label as false the claim that the legislation will empower the government to take over life-and-death decisions from individuals.

Q: Should the federal government be getting involved with living wills and end-of-life questions — decisions that are highly personal and really difficult?

A: It already is.

The government requires hospitals to ask adult patients if they have a living will, or "advance directive." If the patient doesn't have one, and wants one, the hospital has to provide assistance. The mandate on hospitals was instituted during a Republican administration, in 1992, under President George H.W. Bush.

Q: How does a living will work, and how is it different from a health care proxy?

A: A living will — also called an advance directive — spells out a patient's wishes if he or she becomes incapacitated. Often people say they don't want to be kept alive on breathing machines if their condition is terminal and irreversible.

A health care proxy empowers another person to make medical decisions should the patient become incapacitated.

There's also a power-of-attorney, which authorizes another person to make financial decisions for someone who is incapacitated.

Such legal documents have become standard estate-planning tools in the last twenty years.

Q: Would the health overhaul legislation change the way people now deal with making end-of-life decisions?

A: It very well could.

Supporters of the provision say the main consequence would be to formally bring doctors into a discussion that now takes place mainly among family members and lawyers.

"When you execute a legal document with your lawyer, it ends up in your files and in the lawyer's files," said John Rother, a senior policy and strategy adviser for AARP. "Unless the doctor is part of this discussion, it's unlikely that your wishes will be respected. The doctor will be the one involved in any decisions."

The American Medical Association says involving doctors is simple common sense.

"There has been a lot of misinformation about the advance care planning provisions in the bill," AMA President Dr. James Rohack said in a statement. "It's plain, old-fashioned medical care."

Q: So why are some people upset?

Some social conservatives say stronger language is needed to protect seniors from being pressured into signing away their rights to medical treatment in a moment of depression or despair.

The National Right to Life Committee opposes the provision as written.

"I'm not aware of 'death panels' in the bill," said David O'Steen, executive director of the group. "I'm not aware of anything that says you will be hauled before a government bureaucrat. But we are concerned ... it doesn't take a lot to push a vulnerable person — perhaps unwittingly — to give up their right to life-sustaining treatment."

The White House says it is countering false claims with a "reality check" page on its Web site,"

Would it not be wonderful to debate issues and ideas on merit, facts, and evidence? To take testimony and advice of experts in the field and make informed decisions? Whether it comes from the right or the left, shame on those who knowingly and blatantly state lies and exaggerations, who spend more effort and creativity on what names they will call their opponents than on new, original ideas if they think the other side is so wrong.

Do we really want to keep the status quo? How has that been working? How is it working for the 50 million uninsured, who may be finaincially ruined if someone in th efamily is seriously ill? That is a national embrrassment. Are we happy spending twice as much on average as the rest of the Western, industrialized world on health care, while having lower life expecancies, higher infant mortality rates, more obesity, and higher cancer rates? Keep in mind all of the other countries in this category insure every single citizen while having results we ae striving for as far as actual health goes.

Let's try to have an honest would that be for change?


mark said...

How likely is the USG to deliver health care at the current level of quality to more people at less cost?

Not very.

Instead of loading more complexity on to an already complex system and expecting cost savings/more coverage to appear, perhaps the first step should be to simplify the inefficiencies and disincentives and no-value cost add ons ( like malpractice insurance premiums and class-action lawsuits) from the current system. That in itself is pretty hard but it would give us an idea of the real money we have to play with in extending care to more ppl. Why accept all the current irrationalities and load national health care on top of them?

For that matter, if we have national health care, why would we need separate medicare and medicaid and veteran's health programs?

These are questions our representatives should answer.

vonny said...

These are precisely the types of issues I wish could be debated and discussed at the town halls. The distractions that come in from emotionally charged groups, who are buying into absolute falsities, distortions, exaggerations of what is on the table is what drives me nuts.

Much of this comes from the leadership of the two sides in Congress. Pelosi has not done a good job at all of bringing about a real discussion with Rep. leaders, at least from what we can gather through media reports. Of course, some on the right-wing then play the revenge game and literally make things up in order to see what grabs their supporters' ire. End result, no true debate, and this will lead to a left of center bill that will pass, if indeed something passes, in September or October.

I absolutely agree that it is too complex, and the addition of another 1000+ page bill numbs the mind. Perhaps Obama made a mistake by letting Congress take the lead early on, and has lost his ability to keep the two sides from ending up where they usually do - completely split, with tit-for-tat politics taking precedence over what is best for the country.

The one promising feature of this, to me, is how the AMA, AARP, and nurses associations have all endorsed the premise from a health-care point of view. Presumably decisions are to be made from doctor-patient interactions rather than insurance bureaucrats deciding what will and will not be paid for. The money is a problem, but even this is entirely in flux since everything is at the committee stage. Very maddening, to say the least.