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View Diary: Medicare: What can we do about it? (314 comments)

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  •  Before the issue becomes a "panel", ... (0+ / 0-)

    ... I'd want to know what I was walling in and walling out.

    "Death panel" is such a loaded phrase that its very invocation reminds people of Sarah Palin, who has said many memorable things, all non-sensical or positively dangerous to political health.

    As I recall, what she was referring to, obviously unaware or uncaring of the source, was a proposal by a Republican Congressman for legislation that would compensate medical professionals for the time they spent educating patients and relatives about the time, if it comes to that, when they are terminally ill.

    What's this panel you're proposing, Doc? The truth is that the very phrase is so loaded that as you say, we're gonna have to start differently to make any progress.

    Obama and strong Democratic majorities in 2012!

    by TRPChicago on Sun Aug 21, 2011 at 09:10:46 AM PDT

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    •  I guess a board of local medical (0+ / 0-)

      and medical ethics professionals who decide, based on nationally published guidelines, which procedures will be done on a case-by-case basis.

      I'm in the I-fucking-love-this-guy wing of the Democratic Party!

      by doc2 on Sun Aug 21, 2011 at 09:29:47 AM PDT

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      •  Then I have a lot of trouble with this proposal. (2+ / 0-)
        Recommended by:
        Catte Nappe, tardis10

        With a terminally ill patient, the attending doctor(s) and other medical professionals caring for the patient may not themselves be in agreement. The relatives of the patient may not - I suggest, often are not - in agreement.

        That's why a health care power of attorney, with a clear set of declarations of the wishes the patient has expressed to meet the most likely conditions, is so very important. And why the patient's rapport with the primary care doctor is also very important.

        If "death panel" actually means empowering realistic counseling (not anything like this put up job of must-listen-to-fetal-heartbeats-and-get-counseling that anti-choice activists promote so vigorously) in advance and at the beginning of care for a terminally ill patient, right on!

        But even so, there will be cases where these do not resolve a particular case and I assume it is those situations for which you propose a formal panel. If I'm stuck in a Bible belt state with a spouse who's near death (for example, after an auto accident), I do not want a "board of local medical and ethics professionals" deciding anything. Similarly, I'm sure that if a Perry/Bachmann-like True Believer were stuck in a big city hospital (same hypothetical), I would not want to insist on such a panel for them, either.

        Obama and strong Democratic majorities in 2012!

        by TRPChicago on Sun Aug 21, 2011 at 10:04:19 AM PDT

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        •  If the public is going to pay for (2+ / 0-)
          Recommended by:
          Uncle Milty, stitchmd

          the procedure, the public deserves to be represented in the decision-making process. If it were your grandma, I understand why you wouldn't want the government involved in making the decision. But if you need the government's money for the procedure, I don't think you should have the ability to NOT allow the government to make the decision. Now, as to HOW the govt. makes the decision, I have no doubt that there are better ideas than my simplistic one.

          I'm in the I-fucking-love-this-guy wing of the Democratic Party!

          by doc2 on Sun Aug 21, 2011 at 10:13:27 AM PDT

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          •  So long as your panel is optional, then, so be it. (0+ / 0-)

            But I could not disagree with you more that every time the government funds something, it can hang on a condition like abiding by a panel of local medical and ethical experts. (I'm a Progressive Democrat who spent a 35-year career with a highly regulated company, and learned to work reasonably well with regulation even when it was not wise regulation.)

            It's one thing to fund counseling for the terminally ill patient and his or her loved ones. It is quite another to call that counseling "public representation."

            But it sounds like your proposal goes much farther than seeing to it that counseling is part of medical care. I think what you are suggesting is rationing as a condition of accepting Medicare, for example. Is that a correct reading of your idea?

            And if it is, good luck with selling that to the public. Rationing will help kill any health care reform it is a part of, however cost-cutting it may be.

            Obama and strong Democratic majorities in 2012!

            by TRPChicago on Sun Aug 21, 2011 at 10:35:23 AM PDT

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            •  Of course we are going to have to (1+ / 0-)
              Recommended by:
              stitchmd

              ration. We can't spend a million dollars to delay the death of a 90-year old by a month. If you think that the right answer is to pay for every procedure that a person wants, your policy will end up being responsible for the collapse of the entire system. People should be counseled, but those who refuse to accept the inevitability of death cannot be coddled at the expense of our entire system.

              I'm in the I-fucking-love-this-guy wing of the Democratic Party!

              by doc2 on Sun Aug 21, 2011 at 11:33:19 AM PDT

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              •  "Every procedure" and "coddling"? Ooops. (1+ / 0-)
                Recommended by:
                Catte Nappe

                If education and counseling - hopefully beginning well in advance of the event, sustained and available the time when it is called for - about the sense of continued care for the terminally ill is vital to health care reform, right on. The evolution of hospice care makes enormous sense for those in the patient's family and friends who are care-givers, aside from the cost-savings in lieu of huge end-of-life/anything-goes medical services.

                Those are sensible, even vital, aspects of HCR. I think they will care for an increasing number of terminally ill cases as time goes on and people of good will with eyes open to life's experiences understand how thoughtless it is to artificially sustain a patient's life, even though the medical profession can do it.

                But your position - as you've stated it - is beyond public acceptance right now: "People should be counseled, but those who refuse to accept the inevitability of death cannot be coddled at the expense of our entire system."

                Said that way, it sounds too much like meanly expressed cruelty, and very unlikely to persuade anyone to favor your committee approach. I'm in favor of reform, but you lose me on that one!

                Obama and strong Democratic majorities in 2012!

                by TRPChicago on Sun Aug 21, 2011 at 12:53:07 PM PDT

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                •  What I'm saying is that is where (0+ / 0-)

                  we will end up. Because as our society ages, we are not going to be able to afford all these procedures. So the public will be faced with painful decisions. And the Congress that will be in charge of making those decisions is going to cut back on end-of-life expensive procedures. It has to happen, there is no real alternative.

                  I'm in the I-fucking-love-this-guy wing of the Democratic Party!

                  by doc2 on Sun Aug 21, 2011 at 04:15:40 PM PDT

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      •  I can't get on board with that (2+ / 0-)
        Recommended by:
        tardis10, denise b

        I see two useful things that represent "rationing" of a sort - but are (have been) assuredly painted as "death panels"

        One is the payment for doctors to do end of life counseling. That takes care of some of the case by case - with the patient having more say; and both the panicked family members and the life-saving God Doc less.

        Two is the whole concept of evidence based medicine. Not that some "panel" decides that procedure x should/shouldn't be offered to Mrs. Doe; but that across the board it is recognized that procedure x should be used in situation Y but not situation Z.

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