Obama Administration Already Pushing Utilitarian Medical Poison
Uh, oh: Here it comes. Incoming Secretary of Health and Human Services Secretary Tom Daschle wants to create a US Agency to control costs based on the UK's Orwellian-named National Institute for Health and Clinical Excellence (NICE), which substantially controls the ethics and medical availability of care under the NHS. From a column in the Wall Street Journal:
Here in the U.S., President-elect Barack Obama and House Democrats embrace the creation of a similar "comparative effectiveness" entity [as NICE] that will do research on drugs and medical devices. They claim that they don't want this to morph into a British-style agency that restricts access to medical products based on narrow cost criteria, but provisions tucked into the fiscal stimulus bill betray their real intentions.This sounds like even if we maintain a technically private health care system, it will have to operate under federal care rules. Bring on the futile care theory!
The centerpiece of their plan is $1.1 billion of the $825 billion stimulus package for studies to compare different drugs and devices to "save money and lives." Report language accompanying the House stimulus bill says that "more expensive" medical products "will no longer be prescribed." The House bill also suggests that the new research should be used to create "guidelines" to direct doctors' treatment of difficult, high-cost medical problems.
The bill gives incoming Health Secretary Tom Daschle wide discretion to set priorities, and he's long advocated a U.S. approach modeled on the British agency, the National Institute for Health and Clinical Excellence (NICE). Mr. Daschle argues that the only way to reduce spending is by allocating medical products based on "cost effectiveness." He's also called for a "federal health board" modeled on the Federal Reserve to rate medical products and create central controls on access.
When I was in the UK in the wake of Terri Schiavo, advocating for Leslie Burke's right to have a feeding tube when the time came that he could no longer swallow--Burke has a degenerative neurological disease akin to a slow motion Lou Gehrig's and he sued to make sure he wouldn't be dehydrated--I saw the legal briefs NICE filed against Burke's position. It wanted total control by the doctors over whether he lived or died when he became totally disabled based on quality of life/resource standards. Horrible, just horrible.
In 2005, I wrote about the case for the Weekly Standard in "The English Patient," which included a quick description from official testimony about how the NICE works. From my piece:
"[Under NICE standards, an] assessment is made of the cost of the treatment per additional year of life which it brings, and per quality adjusted life year (QALY) . . . which takes into consideration the quality of life of the patient during any additional time for which their life will be prolonged. The clinical and cost effectiveness of the treatment under review is then used as the basis for a recommendation as to whether or not . . . the treatment should be provided in the NHS..." In other words, medical care is effectively rationed by the National Health Service under guidelines set by bioethicists based on their beliefs about the low quality of life of patients whom they have never met. While the views of patients and families are to be taken into account when deciding whether to provide treatment, they are not determinative.I don't think the American people will yet accept such a program here--if they know about it. But it seems that this financial fiasco through which we are careening is being used as a pretext to carve out obscure legal nooks and crannies with the potential to hide much perfidy.
Labels: Bioethics. Utilitarian Decision Making. NICE. Health Care Funding.
posted by Wesley J. Smith @ 8:29 AM
18 Comments
18 Comments:
What should we do, Wesley?
SAFEpres: In the words of the old high school football cheer: Lean to the left, lean to the right, c'mon team: fight, fight, fight! We must resist these agendas through every political means.
Well it isn't going to be easy after what just happened today. He mentioned "costs" of course. Either he has no idea what he's doing or of what the ramifications are or he's on an agenda, as a stooge or on his own, and either way, not only is he in for a rough term, but we are as well.
Isn't it bizarre that our generation has so much stuff to validate each human existance - we're more patient, more in touch with our feelings, more inclined to treat people fairly, more inclined toward sexual and racial equality - and yet there's still this wonky barrier that throws us back into the time of "Peele's Bloody Gang" in England.
Briefy history note - Robert Peele started the first police force in England. Originally it was met with hostility and refered to as above by people who didn't want any sort of police force. They were afraid police would harm their rights. Later on, when the people of England discovered that the police helped them keep order and save lives, prevent rioting, things like that, they were re-nicknamed the "Bobbies" out of affection.
I think there's something telling there, in that story. When we are in a state of chaos, we don't like to have rules laid down for us. We want our "freedoms," our "choices." But when we do come under an established rule of law that is fair and protects everyone equally, we find ourselves secure, and things go better. We're more able to trust other people. We're inclined to be part of a community.
I feel like we're seriously backsliding! Where's the sense of community? All I see are the Dollar Guys on one side, freaking out over how the aging / disabled population is costing them precious money, and the Immortailty Guys, who want to find a cure for death so they can live forever, and not care at whose expense. We're not enlightened, we're becoming endarkened.
A bow to Wesley for that particular turn of phrase.
...I have no idea how this is supposed to stimulate the economy. The proposal is to spend 1.1 Billion dollars to save, maybe, a few million dollars by denying care based on whatever the heck a QALY is (besides an ill-fated endeavor in quantifying the unquantifiable). Are we *allergic* to any of this stimulus money actually making its way to people who are in need?
T.E.: Yes "endarkened" says ot perfectly.
Doug: That reminds me of a police chief paying a "committee" hundreds of thousands of dollars of City money to "find" that it would save money to abolish police precincts, which he did, having decided to do it already and needed the "committee" to validate and to take the responsibility; then, as the city's crime rate remained unabated, he got elected mayor with the endorsement of the local paper, which editorialized that "what the city needs is a cheerleader"; then, the city had to spend $50K+ a day in police overtime while he wanted a hospital that euthanizes daily and of which his corporation counsel is chairman of the board to expand; now his "approval rating" is presented as 85 per cent and he's in the governor's favor and saying that Obama'election is a wonderful thing.
The problenm is that people just seem to have gone stupid.
Throughout history people had to spend their time and energy just trying to stay alive. Now that that is not such a pressing problem, we've got the death culture. It's just total and complete insanity.
I just reread that; people don't just seem to have gone stupid; they have gone stupid.
It's not stupidity-it's human selfishness, fallenness, etc. If the people involved were truly stupid, than we couldn't assign full responsibility for their actions, but because the people involved are not stupid, we can.
SAFEpres: You're right that it's selfishness, fallenness, etc., but stupid goes along with that. We just assume that they're not stupid because they have credentials. That doesn't mean they're not stupid, and that we were right to assume that they are not, and that people haven't gone stupid to make that assumption. We have a right to expect them not to be stupid/selfish/fallen, all of which things go together, but we've allowed ourselves to fall for the nonsense promulgated by the fallen, which makes society, which doesn't even realize that our rights have been walking away from us, stupid, too. That's what I mean about stupid.
"Fallenness"? Sounds awfully Christian to me. Ah, but I forgot: Bible-thumpers know what's good for the rest of us poor, "stupid", fallen folks. How absolutely, disgustingly condescending.
OK everybody, one last ad hominem:
Human beings are human beings. Unlike the other creatures, they are capable of great evil - and great good, but they aren't evolving into a higher order, and to think so exhibits arrogance toward our ancestors.
That out of the way . . .
So how do we deal with the issue at hand?
I think it is too late to change our healthcare system and what we need is an underground healthcare network to care for the vulnerable when the people with the money and the power want to put them in railcars to destinations where WorkMakesYouFree.
What do you think?
waterbabies
What do I think? I think you ought to stop making silly Nazi Germany comparisons, and try to have a serious discussion.
HistoryWriter, one need not be a "Bible-thumper" to have a sense of medical ethics, and it's alarming that you believe otherwise.
Waterbabies: I think you hit the nail on the head about human beings and arrogance. I don't know if it's too late to change the health care system (that it's even become called that is a bad sign reflecting that things have gone too far), but I think you've got a good idea there about the underground network.
I don't like what I see of Obama and those around him and many of those who elected him, and nothing that comes down the pike now would surprise me, but as things now stand, they don't need to put anyone on a train or send them anywhere; they do it right in the hospital and in the "health care system."
I abstain from carrying medical insurance deliberately (which alarmed both of my now-late parents, both of whom the "health care system" and its concommitant components killed) because I refuse to feed the system, and I've found that as a result, with only one exception (and in that instance the doctor, who committed malpractice and later ended up convicted of insurance fraud as the result of the way he ran his practice), I've fared well with medical treatment, and often better than I would have otherwise. The only glitch happens when the staff in the doctor's office doesn't know what to do when one goes to the desk and gives them actual money to pay the bill, except when an older office manager tells one one is doing the smart thing when one points out that just paying for it and then calculating the medical expenses when one does one's taxes instead of paying insurance premiums, and preferring to be paid for the work one does to accepting a benefits package can be more financially efficient than doing things the way "everybody" does these days.
For example, and this is just one example, when I was seriously injured in an accident, I was put in a private room lest my crying during the aftershock of the accident disturb the other patient in the double room, because there were no insurance restrictions, and it turned out the hospital had a privately endowed fund for room charges for young women with bachelor's degrees in liberal arts who did not have health insurance; when the hospital, used to bowing to restrictions imposed by insurance, wanted to send me home after two days and the doctor said I needed to be there for a week, the doctor was able to prevail because I didn't have insurance; I might not be able to walk around in possession of two legs now otherwise; clear-cut negligence had caused the accident and the award from the negligence case paid for all the medical and hospital bills. Granted, it was a very nice hospital and I was "lucky," but that's what a place of care, and what civilized medical care, is supposed to be like, and that's the kind of hospital that deserves to receive endowment, private donations, etc.
Malpractice insurance premiums have driven doctors, particularly ob-gyns, out of some states, and some doctors have adopted the policy of "going bare" (not carrying malpractice insurance at all and paying out of pocket if they lose a malpractice case, which common sense gives incentive for careful and conscientious treatment; in China, the tradition was for the doctor to pay the patient if the patient did not get well) because they are fed up with the system.
The "vast number of the uninsured" are cited constantly as a crisis, which reminds one of the Chinese character for "crisis" that also means "opportunity." They are, in fact, a great advantage in changing the "health care system" around; until the insurance companies are starved out of business we're stuck with the mess we've got and the utilitarian system and futile-care ethic that literally starves some out of life. What's so terrible about keeping a life alive, especially in a person who gives no indication of suffering thereby and is not only not asking to die, but is indicating by their very continuing to live and their very own life force that they wish to continue to live? How come Sunny von Bulow got to live and Terry Schiavo didn't? Because others were able to prevail in making the decisions, and in the case of the former, the former prevailed, just as insurance companies (another example of "others") get to make the decisions; now hospitals have, along the same lines, decided that they, as "others," can, too. The principle of care for life, regardless of what "others" say, has gone out the window.
A sane hospital would have security carry any "other" who said "pull the plug" out the door and hand them over to the police. that's what a place of care would do, and people go to hospital wanting -- and paying -- for (but when they are paying through their insurance premiums, with "others" involved, they are no longer in control). But "cost" and "resource" considerations have taken over along with the tyranny of insurance companies. Get rid of the insurance companies and "health care" would become much more efficient, much less expensive, and much more responsible.
I think that's a great idea, Waterbabies, and if Obama really wants "change" and for everyone to "pick themselves up and dust themselves off," and has as much faith in the people of this nation as he says he has, he should endorse it. Along with strenuously opposing tort reform and saying "nuclear" correctly; except for those two items, Bush being gone is terrifying.
Those without insurance may be, under the current system, at a disadvantage, but it's the insurance companies who have the most to lose if the "crisis" of "the vast numbers of the uninsured" become the majority. Wanting the government to take it over is just another version of the irresponsibility of which dependence on health insurance, credit cards, mortgages, lottery tickets, greed, sense of entitlement, etc. have become glaring symptoms that no one seems to have pointed out publicly are all part of the same syndrome. The nonsense of the insurance companies simply cannot go on if we are to survive. Women in labor wait in their cars in hospital parking lots before going in to be admitted, "co-pays" and "plans" and "managed care" and strangers making decisions about what doctor one can see, what care one can get, whether one lives or dies, are travesties bordering on and often actually consituting the criminal. Twice, at the nice hospital I just mentioned, to which I owe life and limb and to which I'll be eternally grateful, for six weeks each time, I spent an hour a day (for Lyme disease) and two hours a day (morning and afternoon, an hour each, for osteomyelitis), every day, receiving daily i.v. drips in a hospital's emergency room, where they were given to me so as not to crowd the e.r. unit, and I saw and heard many things during that time, many conversations with incoming e.r. patients at the admitting desk, etc. I'll never forget the young couple with a sick baby who were told they had to drive up the island to another hospital an hour and a half away because their "plan" dictated it. That's only one of many examples. And people ACCEPT this. Then we wonder how things got to be the way they are?
Oops, I just reread tha; I don't mean "co-pays" are travesties; I was referring at that point to the jargon and its prevalence and acceptance being part of people having become sheep... And they feel powerless against "the system," which is how "the system" has taken over and taken advantage of the vulnerability of all who require medical care. A system that wouldn't exist if people who weren't "too busy with their lives" (which would be a lot better, and less at risk, if they did think) to think, and didn't believe that a "system" is necessary, and pay into it. Obviously radical change is necessary, and it hasn't occurred to people that there's nothing wrong with looking at things from a radical point of view and challenging the system when the system is wrong. They're too concerned with their credit card debt, mortgages, buying lottery tickets, student loans, benefits packages, anxiety over not having health insurance (which is just what the insurance companies want) etc. "But what if I get sick?" Well, what if you get sick and the hospital messes up and you end up on life support and doctors claim you're in a coma or pvs and incurable when they don't even know what they're talking about or care about ethics (the "ethics committee"'s job now)and they pull the plug on you because with everything is in "others"' hands now "futile care theory" prevails is what they should be worrying about.
Every time I've said this was coming with the Obama administration, people have told me I was a crackpot.
John: Yeah well what kind of rocket scientists are they?
Post a Comment
Subscribe to Post Comments [Atom]
<< Home