As the discussion regarding healthcare has risen to a fever pitch (yes I’m being generous by calling it a discussion), the myths, half-truths and, sometimes, outright lies have began to take root. The most pernicious of these lies, in my opinion, is the talk of “death panels” and the killing of the elderly. There has even been talk of federal tax dollars funding abortions, even though the 1976 Hyde Amendment strictly prohibits that. For the record, I believe that healthcare reform, in its most robust sense, is a moral imperative. It is my belief that a society and a nation will be judged, ultimately, by its treatment of its most vulnerable citizens --- the least of these.
As the discussion regarding healthcare has risen to a fever pitch (yes I’m being generous by calling it a discussion), the myths, half-truths and, sometimes, outright lies have began to take root. The most pernicious of these lies, in my opinion, is the talk of “death panels” and the killing of the elderly. There has even been talk of federal tax dollars funding abortions, even though the 1976 Hyde Amendment strictly prohibits that. For the record, I believe that healthcare reform, in its most robust sense, is a moral imperative. It is my belief that a society and a nation will be judged, ultimately, by its treatment of its most vulnerable citizens --- the least of these.
Care Delayed, Is Care Denied
A recent national survey (Commonwealth Fund Biennial Health Insurance Survey, 2007) estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years. I don’t believe it would be a tremendous leap to say that amongst those who were discriminated against were the chronically and terminally ill. In fact (and the data bears this out), I’m certain of it.
When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/ her initial health status questionnaire. In most states’ individual insurance market, insurance companies can retroactively cancel the entire policy if any condition was missed – even if the medical condition is unrelated, and even if the person was not aware of the condition at the time. Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition. If the disease is serious enough, could such a decision lead to death? And if so, wouldn’t that indeed be the very definition of a death panel?
And as the justifiable-howls ascend into the atmosphere about not wanting government coming between the patient and the doctor, the fact that that is EXACTLY what insurance companies have been doing for decades is ignored and goes unchallenged.
Resuscitation is Futile
In general, futile care laws enable the following situation: Person A has a severe medical condition and/or disability. He or she desires to continue life sustaining treatment that the doctor considers futile or wasteful. The doctor brings the case to a hospital ethics committee (or panel), which, after deliberation, overrides the patient's stated desires regarding treatment. The person and his or her family then have 10 (in Texas) to 14 days (in Virginia) to find another hospital that will treat them, or the treatment will be withdrawn, resulting in death. Unfortunately, many hospitals will not treat patients whose treatment is considered futile by another hospital, which condemns these patients and their families to hospital/state imposed death, or contentious court battles, often in their last few weeks of life.
At last check, only 10 states have passed laws forbidding hospitals to withdraw treatment if family members or guardians object and require treatment to continue until the patient can be transferred.
This type of state and medically-sponsored, life and death discrimination does not need to be codified to be a threat. For example, the 2005 Haliegh Poutre case involved Massachusetts social services attempting to remove her feeding tube and ventilator against her biological mother's wishes (she had been abused by her adopted family), which was only stopped when she began showing signs of alertness after a judge gave the go-ahead to override her family's wishes. Similar cases have occurred in New Jersey, Alaska, and other states without specific futile care laws. This would be considered legislative or policy (public and business) death panels. Where has the outrage been all these years? Where were the chants of
Hitlerism and fascism?
To illustrate this hypocrisy (and in some cases cognitive dissonance), during the Terry Schiavo case what made the actions of the White House and the then Republican-led Congress (with plenty of Democrats in tow as well) even more duplicitous, is that on March 15th of 2005 at Texas Children’s Hospital, Sun Hudson (a six month-old infant) was taken off of a ventilator--- in spite of his mother’s objections--- and died in his mother’s arms. He was born on Sept. 25, 2004 with a rare and potentially fatal genetic disorder. He was placed on a ventilator because his lungs had failed. This child died without fanfare, protest or judicial review. The cruel irony is that Texas Children’s Hospital was well within its “rights” to do so because of the “Texas Futile Care Law” signed by then Gov. George W. Bush in 1999.
According to this law, a Texas hospital with the consent of a doctor and ethics committee can withdraw care they deem futile and too costly even against the wishes of the patient or legal guardian. Where were the platitudes about “erring on the side of life” as this six-month old baby took its last breaths in his grieving mother’s arms?
Cross My Heart and Hope Not To Die
The absence of health insurance creates a range of consequences, including lower quality of life, increased morbidity and mortality, and higher financial burdens. In 2002, the Institute of Medicine (IOM) estimated that 18,000 Americans died in 2000 because they were uninsured. Since then, the number of uninsured has grown. Based on the IOM’s methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.
Much subsequent research has continued to confirm the link between insurance and mortality risk described by IOM. In fact, subsequent studies and analysis suggest that, if anything, the IOM methodology may underestimate the number of deaths that result from a lack of insurance coverage.
More broadly, these estimates should be viewed as reasonable indicators of the general magnitude of excess mortality that results from lack of insurance, not as precise “body counts.” The true number of deaths resulting from being uninsured may be somewhat higher or lower than the Institute of Medicine’s estimates, but that number remains significant. Once again, is this not the very definition of death panels? Are we not already consigning people to die?
Are we supposed to get worked up about the people who, according to the myths and lies about death panels, MIGHT die and not show any concern for those who are ALREADY dead and dying?
Counting the Cost
I want to conclude this composition with some questions and an appeal. The estimates for this healthcare reform endeavor has ranged anywhere from $700 billion to 1.5 trillion (according to the numbers I’ve seen and read). A high sticker price to be sure and yet we are already footing the bill for the uninsured and under-insured: in emergency room visits, when our neighbors homes are foreclosed because of bankruptcy related to medical debt (about 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs) the property value of our homes go down, and the preventable-loss of human life to diseases and illnesses of the primary bread-winners of families comes back on us as country and society one way or another.
However, I suppose the most compelling argument I could construct against the anti-reform voices is that in the run-up to the Iraq War, by and large, we did not ask the cost of one bullet or bomb; we did not ask the cost of the care for the mangled body of one soldier; we did not ask the cost, in pain, of the families in America and Iraq who would lose their sons and daughters (another kind of death panel); we did not ask the cost of the displacement of millions of Iraqis; and we did not ask the cost for one single brick used in rebuilding a country we were misled into invading. The actual dollar amount for both wars were not even items included in our budget up until eight months ago, and we as American citizens, for the most part, didn’t ask to see the books. Now, when it comes to healthcare reform, it’s all about costs and deficits?
To my town hall-protesting friends, your preoccupation with what you believe is a government plot and plan to “pull the plug on grandma,” has caused you to miss the plugs that have been pulled and are being pulled on grandma, grandpa, dad, mom, son and daughter.
And for what? So insurance companies can enjoy a fatter bottom line and to subsidize the multi-million dollar bonuses and salaries for their executives.
So what are these protestations regarding death panels really about? If it is really about death and the sustaining of life, then why have your voices been muted up to now? If you believe so strongly in life, how can you ignore the threats to life that have been posed by our current healthcare system? Going back to the contrast concerning the dialogue before the Iraq War and our current healthcare reform discussion: what does it say about us as a nation when we are silent and malleable in our decisions to kill, but resort to fear, hate and dishonesty in our decisions to heal? How we answer that as a society will determine whether we are enablers of death or advocates and champions for life.