August 22, 2009

by Bill Levinson

Smoke is generally indicative of fire, and there is plenty of fire behind the smoke about government “death panels” that will decide when it is too expensive to keep senior citizens alive. Barack Obama’s health care advisor Ezekiel Emanuel is on record as recommending denial of health care to senior citizens (in favor of younger people) and denial of extensive care to people with dementia. Moderator-approved postings at Barackobama.com, Barack Obama’s official Web site, openly favor denial of medical care to seriously ill senior citizens for the explicit purpose of saving money.

Barack Obama cannot argue that he has no control over what individuals post on his Web site. It has been proven beyond not only a reasonable doubt but any doubt that his moderators exercise editorial control over the site by removing content with which they disagree. This makes Barack Obama responsible for the content that is allowed to remain, such as jokes about senior citizens with Alzheimer’s disease, the use of a five-letter word for a female dog and a four-letter word for the female reproductive system to refer to Hillary Clinton, extensive anti-Semitic content. and advocacy of euthanasia or withdrawal of care from senior citizens to save health care dollars.

Here are examples of moderator-vetted material that was approved for posting at my.barackobama.com and stories.barackobama.com. Note the clearcut difference between these positions and the rationale behind living wills, whose sole legitimate purpose is to refuse heroic end-of-life treatments whose sole effect is to prolong the dying process, often with pain and distress to the person involved. The cost of care is not a consideration in living wills, but each of these entries makes money a central consideration.
A Message to Secr. Designee Daschle – How to Reform our Healthcare System

The questions is do Americans now believe that health care is a right and not a privilege as I do? I don’t believe that exotic and futile health care however, is a right. Half our health care dollars (my estimate which may not be completely correct) are spent on futile health care at the end of life or the beginning of life. We need clear guidelines as to when a person at public expense will be placed under hospice care and taken out of the ICU and guidelines for other such end of life decisions. We cannot give every possible treatment to stretch out misery and suffering to the very last moment, nor keep brain dead people “alive” on ventilators at public expense instead of using that money to help those that can be saved!

http://stories.barackobama.com/healthcare/stories/165662 Can anybody say “death panels?”

work in an ICU and witness many elderly (dementia,end of life ) being kept on life support, increasing health care dollars because family members will not let go. Often because they do not want to lose financila benefits received by the patient. The health care team should have more responsibilty to determine if life support should be initiated or ended when there is no hope.

Right, Anthea, and we have just the kind of “health care team” in mind to make these decisions. “Alzheimer’s disease, to the left… broken leg, to the right… Over 65 with cancer, to the left… sore throat, to the right… Over 70 with heart problems, to the left… Democratic Senator with brain cancer, to the right… Dead Black Panther with nightstick, to the right; a few billion dollars might result in a miracle… Conservative talk show host with appendicitis, to the left…” For the record, we do not resent whatever insurance money is being used to treat Senator Kennedy’s brain cancer because that is a “There but for the grace of God go I” disease but Barack Obama and his friends would apparently deny similar heroic treatment to us commoners to “contain costs.”

Here is another moderator-approved entry at Organizing for America’s Health Care Action Center, or is that Aktion T4 Center?

I have been a nurse for 30 years. For 25 of those years, in Home Health and Hospice. We need to cut costs at end of life care. Too many doctors keep people alive too long on expensive medications and ventilators in hospital beds because they have not discussed end of life choices. The cost of chemotherapy just to keep someone alive to suffer for a few months longer is a waste of money. My own mother just died of cancer and I think they spent too much on chemo just so she could suffer a few months longer.

Make up your mind, Maureen. Is the issue cost or unnecessary suffering? From what we have seen not only from this Web page but from Barack Obama and Ezekiel Emanuel, it’s all about money. This one is purportedly from a medical doctor.

i have been a primary care physician for 25 years. I see people everyday without insurance that can not afford basic health care. I also am ethically torn when I see the dollars we spend on end of life care. Only in America do we see death as “optional” I have not seen 90 years olds survive more than 6 months on dialysis. We need to really look at how to spend less on end of life. I also work as a certified music therapist and see how compassionate healing can make a beautiful death. We can not afford the system that is in place now and need to give everyone a basic package i ho0pe there are doctors on your team that speak to these issues

Perhaps the “sleep shops” from Logan’s Run are what she had in mind; they also had nice music, as did the death room in Soylent Green. Again, we have no problems with living wills in which people voluntarily refuse heroic treatment that merely prolongs the dying process, but the Obama camp shows repeatedly that the decision should be made by others, i.e. “death panels,” in the interests of saving money. This one advocates the “quality adjusted life years” criterion for determining who should go to the left and who should go to the right in the Selektion process, a concept 100 percent consistent with Lebensunwertes Leben (“life unworthy of life”).

A caring socitey should hope to extend basic coverage to all individuals and yet also see the need to set limits on what type of measures will be covered by a national health plan (clearly demonstrating cost effectiveness given life expectancy and quality adjusted life years). Any national plan needs to pay attention to this and set limits on what will be covered – including saying no to technological advances that are not proven to extend quality of life for individuals.

Here is yet another entry in which financial considerations as opposed to the patient’s comfort is the primary consideration:

I hate to say it, but we need to seriously debate our values in this country relative to deciding how much care is appropriate. Do we use Quality Adjusted Life Years to decide on a reasonable treatment plan? Do we just always treat until we run out of money? If a minimally functioning (as in mentally mostly not there) geriatric patient goes into the hospital, how many hundreds of thousands should be spent to keep them “minimally” alive? (We’ve had to discuss it in our family since it applies to us). How much to we spend to keep a severe premature baby alive? One who will with extremely high certainty have major health issues their entire life and may have measurably poor quality of life? How should dollars be allocated? Let’s unfortunately face it — we can’t afford to treat everyone for everything in a wasteful way. We need open, heartfelt, albeit painful debate about how to spend our health care dollars. If I develop a cancer with best estimates being that I have a 2% chance with aggressive treatments of living 1 year at a cost of $500,000+ should you have to pay for it? Probably not.

We have stated previously for the record that we do not believe U.S. health care to be in such a dire situation that rationing, triage, and other “lifeboat ethics” measures are required. 30 to 60 cents of every health care dollar are currently wasted on the costs of poor quality care, inefficiencies, and medical mistakes, and removal of this waste would make health care available to everybody with no increase in costs. If, as these entries at Barack Obama’s official Web site and statements by Barack Obama and Ezekiel Emanuel suggests, we are indeed in a “lifeboat ethics” situation, then “lifeboat ethics” must indeed be applied; no one can be allowed to waste a scarce resource like food, water (note the severe fines that can be imposed on people who wash cars or water lawns in drought situations), or in this case medical care. Before medical care is denied to people with cancer, dementia, or other “there but for the grace of God go I” conditions, care and/or social services must be denied to:

(1) People with self-inflicted diseases like AIDS (other than that acquired through accidental blood contact, transfusions, and so on), other venereal diseases, and illnesses from tobacco; alternatively, tobacco taxes must cover the cost of treatment.
(2) People addicted to illegal drugs must go “to the left” as well, as society cannot afford to carry them in a “lifeboat ethics” situation.
(3) Illegal immigrants; if the ship is sinking and there are not enough life boats, stowaways go to the back of the line.
(4) Welfare recipients who keep having babies at public expense: sterilization, whether permanent or through Norplant, must be made a condition of continuing to receive welfare benefits.

We state emphatically that we would not under any circumstances deny medical treatment to AIDS patients or at least emergency care to illegal immigrants if there are more than enough health care resources to go around, and we believe there are; we are wasting no less than 30 percent of what we have. Barack Obama, Ezekiel Emanuel, and moderator-vetted entries at Barack Obama’s Web site, however, say we are indeed in a “lifeboat ethics” situation, and that we have to talk about tough decisions. If that is true, then we need to have some tough conversations about the situations described above. If there is not enough water in the lifeboats to sustain life, anybody who wastes the water has to go overboard.