The health reform lie that just won't die

The Right is desperate---desperate to derail any sort of health care reform. Notably absent from their diatribes is any debate on the merits of one plan or another. They know that the only way to convince Americans to keep the terrible system we have now is to make them think that any reform would be worse. And so they are blowing their dog whistles, talking about "culture of life" and "culture of death", and along the way encouraging ignorance about one of the most important aspects of medical care.

Any rational person knows that there are no proposed "death panels"---it's a blatant lie by the far Right designed to frighten the ignorant. And given that the "death panel" wording just isn't playing as well as they'd hoped, they're hunting for more "evidence" that government health insurance will kill you. Of course, this requires ignoring the fact that Medicare, the government health system that insures most seniors still hasn't managed to produce a single gram of Soylent Green.

We've discussed in this space many, many times the utility of discussing end-of-life care, and the importance of advanced directives (ADs). To refresh your memory, ADs allow you to in effect make decisions about your health care even when you cannot communicate. This is done using such documents as living wills, which explicitly state your wishes, and by appointing someone to make decisions during your incapacity, for example by appointing a durable power of attorney for health care (DPOA). Ideally, you would discuss your end-of-life wishes in advance with someone you trust and set the whole thing down on paper. Since our current system allows us to keep people's bodies alive far longer than the actual "person", this is pretty damned important. But even outside such extreme (but common) circumstances, ADs preserve patient autonomy and are a good thing.

But not if you're trying to scare the bejeezus out of people. Take Jim Towey (please!)---he quote-mined a VA document on ADs to make it sound like some sort of paper death panel. This was the guy in charge or Bush's ill-fated "faith-based initiatives", and apparently he's not done shoving his own version of religion down our throats.

Well, the message that they want to communicate, I think, is if you have a stroke or if you have a coma situation that somehow your life has lost a little value and it may not be worth living anymore.

My problem with the document, Chris, is that the author of it is a proponent of assisted suicide. He's way out there on that issue. And the V.A. has been using this. A new directive just came out in July, urging providers to refer patients to it. So in my view, there should be a balanced treatment. And this is a slippery slope that kind of makes people -- when you look at the document, it makes people feel like they're a burden and that they should do the decent thing and die.

Is this what the document in question does? Let's look at the actual document (gasp!)

Explaining end-of-life medical care should ideally be done in language anybody can understand.

There's only one person who is truly qualified to
tell health care providers how you feel about
different kinds of health care issues--and that's you.
But, what if you get sick, or injured so severely that
you can't communicate with your doctors or family
members? Have you thought about what kinds of
medical care you would want? Do your loved ones
and health care providers know your wishes?
Many people assume that close family members
automatically know what they want. But studies
have shown that spouses guess wrong over half the
time about what kinds of treatment their husbands
or wives would want.
You can help assure that your wishes will direct
future health care decisions through the process of
advance care planning.

The document goes on to offer guidance for how to make sure your wishes are followed:  "Think about what you want; communicate it to others; write it down".  Good advice.  It then walks you through the process.

So what's bugging Towey?

Wallace: Let's put up this page 21. It's called "What
makes your life worth living?" and it asks the veteran to check off
whether a variety of situations are difficult but acceptable, worth
living but just barely, or not worth living.
And here are some of the situations. "I can no
longer walk but get around in a wheelchair." "I live in a nursing
home." "I am a severe financial burden on my family." "I cannot seem to
shake the blues."

Mr. Towey, what's wrong with that?

TOWEY: The biggest problem is that when
you go beyond those questions to the boxes you check, the first option
you have, "it's difficult but acceptable," a lot of people with
disabilities, a lot of people who have family members with stroke, find
life beautiful. There's meaning and purpose. Sure, they're suffering,
but their life hasn't been diminished by that illness.

think there -- if you were trying to be biased and fair, you'd have a
box that starts off that says "My life is beautiful. Yes, I suffer, but
I find meaning in it."

And I think the
problem with this document, and it permeates the whole thing, is
there's a bias toward a depression. And so when you see the one that
says, for example, "I can't shake the blues," you can actually check
the box that says "My life's not worth living."

Another one said if I can't go outside on my own, so you check a box, life's not worth living.

This is idiotic.  It simply isn't the tone of the document.  The document does contain a questionnaire to help guide advanced planning, and to do this, you can't ask only the easy questions.  There are a lot more questions and examples.  It's actually a thoughtful document.

Towey also complains about the language being biased, with such words as "vegetable".  Tthis is written in a way anyone can understand.  "Vegetable" is used in the context a patient would use it in. 

Now, Arlen Spector is calling for hearings---hearings---to "look into" this thing.  This. Is. Insane.

The VA has a very well-developed tool that explains end-of-life decisions to patients and their families.  I don't know how widely used it is, but it's thoughtful, complete, and requires detailed patient participation.  The Right is, to be generous, paranoid as hell.  To be less generous, they are looking for something---anything---to justify their claims that the government wants to kill old people. 

More like this

Of course, this requires ignoring the fact that Medicare, the government health system that insures most seniors still hasn't managed to produce a single gram of Soylent Green.

There you go. Government inefficiency. Proof that socialised healthcare DOESN'T WORK.

This VA thing sounds really good to me. My 91-year-old grandpa might need to move into a nursing home soon, and he's a veteran, so I'll tell my aunt (his caretaker) to look into this option for him. I think it would really comfort him to know that he'll get to make the decisions for himself and his kids won't end up fighting over it.

"The Right is, to be generous, paranoid as hell. To be less generous, they are looking for something---anything---to justify their claims that the government wants to kill old people."

It's not like they haven't ignored the facts to make a point before (like with WMD).

no panels eh? What about Oregon's death panels?


Also, my 101 year old great grandmother was in a nursing home until she died in February of this year. OOPS! I mean she was murdered by some smartelic bitch marxist liberal nurse who worked at the nursing home.

She had a stroke after her 100th birthday. Until her 100th birthday she was in fairly good condition. My grandmother talked with the doctor and nurses as it was decided to give her some sort of insert. I do not know the name of it since I am not a doctor. She perked up after this installation of this device and began to eat on her own again. her stroke was mild.

The head asshole, I mean "nurse" there was furious that the family went over her head in getting this device for my great granmother who was now 101 and seemed to be doing okay again. A few days later we found out that she was doing poorly and was almost bedridden becuase this device was unplugged from her. We cannot prove it but we know that this murderer nurse pulled it out of her and ultimately killed her.

There were also three other deaths around the same time and this so called nurse was fired and banned from the hospital.

If we had proof of her involvment in the deaths of these people (euthanisia?) we would have her arrested and persue the death penalty for murder.

This insane marxist whore of a nurse should be stripped of her citizenship and shipped to some third world labor camp for her crimes.

There are death panels of a sort in hospitals already. these marxist freaks who call themsleves nurses and doctors and kill patients for whatever means (population control, environment ,etc.)should have the death penalty themselves.

They will burn in hell for their crimes.

If my grandparents get sick with Obamacare and are told to go home and live their life, I'll be seeking South American medicine. They are socialist marxists too, but at least they are sane marxists with compassion for people and not population control.

Under Obamacare, the elderly will be better off seeking herbal supplements if they are refused healthcare treatments. The government should stay out of health care and out of our lives. They need their power taken away and the quicker the better.

By Angry mobster (not verified) on 25 Aug 2009 #permalink

I had a look at the PDF and the disingenuous use of the "I can only get around in a wheelchair" and other tickboxes by Towey is stunning. The tickboxes are there to help people decide IF having some of these things happen to them is considered serious TO THEM...

Angry mobster, you should report that nurse to the authorities, because that's murder. At the very least, you should make a complaint to the licensing board.

It's a pretty huge leap from what your grandmother suffered to the notion that the proposed health care reform act would have anything to do with situations like that. Especially since advanced care directives ought to *reduce* the odds of that sort of bullshit. (Though a murderous medical practitioner wouldn't be constrained either way. If this nurse wasn't listening to the family or even the doctors' orders, it's pretty safe to say that nurse would do the wrong thing no matter what and ought to have her license revoked at the very least.)

By Calli Arcale (not verified) on 26 Aug 2009 #permalink

Angry mobster -

Sounds like your great-grandma had a shitty head nurse. What's the government got to do with that?

See Pal, Angry has pointed it out to us. It's the smartalec-bitch-marxist-liberal-asshole-murderer-insane-whore nurses killing the old folks. Although she does demonstrate the 'paranoid as hell' aspect of these idiots.

Angry, my condolences on the loss of your 101 year old, stroke victim mother, but you need to get real. In the great competition of life, father time is undefeated. And, well, unless you do us a favor and commit suicide, you will probably end up in the care of one of us evil nurses. Bet you'll be kissing our asses then.

@angry...yes you sound angry...and also violently misogynisitic. You need to get a grip.

Your GGM lived to be one hundred and fucking one years old. She got fucking BONUS YEARS. It's nearly impossible to murder a centenarian because 1) there aren't many, and 2) they're about to die from being fucking old.

It also sounds like you need a good advanced directive to help make sure TEH COMMIEZ don't get you.

I dunno, it retains enough anger to be non-Poe

Any Medicare or VA beneficiaries falling for this load of horse puckey who don't know teh gub'mint commiez run Medicare and the VA should be cut off before the "death panels" get to them...

Heard a commentary on NPR recently which posited that the mindless Right is courting the National Enquirer/Fox "News" market. What a surprise!

Did Arlen Spector forget he's a Democrat now? How can he not face a primary challenger from the left?

The ironic thing is that Angry Mobster demonstrates exactly how bad our current system is, implying that we need reform. S/he is basically saying "Look how bad our system is! Let's keep it exactly the same and hope that will be effective at changing things!"

I practice in Oregon and have no idea what Angry Mobster is talking about in regards to death panels. There is a physician-assisted suicide law which involves getting two doctors to agree that a patient is not depressed and has less than 6 months to live and that one of them agrees to prescribe an overdose of medication that the patient can take. There is also the Oregon Health Plan which does ration care. If the diagnosis is above the line, services will be covered. If the diagnosis is below the line, then services are not covered. Certain diagnoses are specifically excluded from coverage as are certain services. That's kind of about it.

That said, I would like the VA tool for discussing advance directives and end of life care. Mr. Towey is a fricking idjit.