"To announce that there must be no criticism of the president, or that we are to stand by the president, right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." -- Theodore Roosevelt

One of Salem Oregon's Unofficial Top 1000 Conservative Political Bloggers!!!

Wednesday, August 12, 2009

Obama's Town Hall in Portsmouth-- Health Care Theater and Deception Pt.1: Obama Dismisses "Death Panels"

I just can't get enough of these "unstaged" town hall meetings. The crowd ended the event by chanting "Yes, we can!" Huh... That's not suspicious at all, even when considering the fact that a majority of Americans are queasy about the nebulous health care reform proposals (check out the Rasmussen survey in the link-- there are some very interesting numbers in the report) and Obama's approval rating is currently at -7 also according to Rasmussen.

Despite his previous, folksy admonishment that any opposition should just shut up and let him do his work (Obama's words: "I don't want the folks who created the mess to do a lot of talkin'; I want them to get outta the way so I can clean up the mess. I don't mind cleanin' up after 'em, but don't do a lot of talkin'!"), Obama actually had the temerity to pantomime trying to find a questioner to challenge him during the town hall. Perhaps the critics were afraid they would be "punch[ed] back twice as hard," as deputy chief of staff Jim Messina told Democratic senators-- words that some SEIU staffers seem to be taking quite literally. No, the "un-American" mobs that have been villified as nazis (Pelosi's quote: "They're carrying swastikas and symbols like that to a town meeting on health care.") and "political terrorists" threatening both political stability and the American way of life, were nowhere to be seen during Obama's Portsmouth town hall.

They were there in a way. They were outside waving placards, examples of what a 13-year-old girl Obama happened to call upon described as "mean signs." [UPDATE: SURPRISE! Via the Boston Globe-- she's actually an 11-year-old girl named Julia Hall (she did an interview with the Globe and freely gave her name so I repeat here) and a her mother has political ties to Obama. From the article: "Julia's mother was an early Obama supporter in Massachusetts during the presidential election, so she had previously met First Lady Michelle Obama, the Obama daughters Sasha and Malia, and Vice President Joe Biden." Michelle Malkin has more here including a facebook picture of mother and Obama standing side by side. "Manning Hall (Julia's mother Kathleen) has donated thousands of dollars to Obama, as has her law firm." Kind of "surprising" that the girl didn't give Obama the "vigorous debate" he was "bracing" for, isn't it? Hope and Change --and a maybe a few happy "coincidences" along the way...] I have to admit that I died a little inside when this same girl intoned "How do kids know what’s true?" Obama's manipulative strategy of hiding behind frightened children in downright shameful. [Even more so now.]

If Obama really wanted "a vigorous debate" as he implied while in Mexico, all he had to do was step out of the town hall's front door. But participants who have not been pre-screened nor hand-picked by the White House can be politically dangerous. Even a softball question from a Chicago reporter can derail Obama when he's working from scripted talking points, as Gates-gate demonstrated.

No critical questions for Obama? Anyone? Anyone? Bueller?

One of my favorite moments is when Obama claimed that "nearly 56 million Americans" are uninsured. That surprised me a little because the number that's usually bandied about is the grossly exaggerated and deceptive 47 million. This is a figure that floats around in certain left-leaning circles and was famously invoked in Michael Moore's movie "Sicko." So have 9 million more Americans suddenly lost their insurance since Obama has taken office? Well, I'm sure it's Bush's fault... or something.

Yet, even the 47 million figure is actually nonsense when the numbers are broken down, as Julia A. Seymour demonstrates. "The Census Bureau's 2007 report on the uninsured found that of the 45.6 million people who are uninsured 9.7 million of them are non-citizens, 7.9 million of them are under 24 years old, and over 9 million could afford insurance because they make at least $75,000 a year. That leaves roughly 19 million uninsured, a much smaller problem than the media and some politicians admit [slightly over 6% of the population]." 19 million uninsured Americans is not "nearly 56 million Americans." And one has to ask why are they not covered by Medicaid... I mean aside from the fact, that one wouldn't want to be?

Another notable town hall moment is when Obama responded to the 13-year-old girl's [11 year-old girl's per UPDATE] question. Dismissing the idea that the house bill contains "death panels" Obama stated "The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma because we’ve decided that it’s too expensive to let her live anymore."

While it is indeed true that the House of Representatives did not vote for euthanasia, they did vote on language that includes government oversight and bureaucratic approval of costs and treatments (section 123-pg. 30, see also Senator Coburn's question #6) , as well as counseling for end-of-life care (section 1233). These are plainly contained within the House's measure There is no debate on this. The only question is what the results of such oversight and counseling will be. And the track record of other countries institutionalizing socialized medicine isn't very good.

In Great Britain, where the NHS (National Health Service) oversees the costs and runs socialized health care the results have been horrific. In a piece on health care that I posted back in April, I listed some of the results of the NHS's machinations. Such examples include the infamous "hospital of death" in which occured "between 400 and 1,200 more deaths than the national average in the three years to 2007-08" amidst appalling conditions. Another example of the NHS's draconian work is the decision that "[a]n ex-serviceman is left to go blind in one eye before the National Health Service will consider treating him for a condition affecting 250,000 people in the UK."

Britain's National Institute of Health and Clinical Excellence (NICE-- a rather misleading acronym) has refused to offer some drugs to NHS kidney cancer patients because of cost. "It concluded that the drugs - bevacizumab, sorafenib, sunitinib and temsirolimus - did not offer value for money [bang for the buck in American bailout jargon]." This prompted some of the "UK's top cancer consultants warn that NHS drug 'rationing' is forcing patients to remortgage their homes to pay for treatment."

NICE offers neither excuses nor apologies, but at least they don't bandy words. "Andrew Dillon, the NICE chief executive, and Sir Michael Rawlins, NICE's chairman, told the Sunday Times the NHS did not have unlimited funds to provide all available treatments.

"'There is a finite pot of money for the NHS, which is determined annually by parliament,' they said."'If one group of patients is provided with cost-ineffective care, other groups - lacking powerful lobbyists - will be denied cost-effective care for miserable conditions like schizophrenia, Crohn's disease or cystic fibrosis.'" Yikes.

Furthermore, NICE also has banned life prolonging cancer drugs due to cost. "Thousands of patients with terminal cancer were dealt a blow last night after a decision was made to deny them life prolonging drugs.

"The Government's rationing body said two drugs for advanced breast cancer and a rare form of stomach cancer were too expensive for the NHS."

Do you think any members of Britain's Parliament voted to "pull the plug on grandma because we’ve decided that it’s too expensive to let her live anymore?" Do you think any of them voted to let terminal cancer patients die sooner because it's too expensive to keep them alive? Those few, if any, voting MPs still alive (the NHS came into effect in 1948) can wash their hands of the matter. They never voted for anything like this... but that's what their health system is doing. The NHS is literally allowing people to die for the sake of cost effectiveness, and when its the national government, there is no possible earthly appeal.

These example of the NHS's problems are not isolated incidences, but rather are painful and tragic symptoms of a failed and ill-conceived system. More recent headlines from British papers include (h/t Michele Malkin):

Elderly left at risk by NHS bidding wars to find cheapest care with reverse auctions

Patients forced to live in agony after NHS refuses to pay for painkilling injections

Twisted priorities that let the elderly suffer

NHS neglects elderly depression a quote from this story: "Fewer than 10% of older people with clinical depression are referred to specialist mental health services compared with about 50% of younger adults with mental and emotional problems.

"In some cases, GPs are unable to refer older people on to other parts of the NHS that could help them because of discriminatory rules excluding people over the age of 65 [emphasis mine]."

Elderly suffer in care shambles: Old people living in homes are at the centre of a shameful row about benefit rules. Margaret Hughes and Phillip Inman report on the pain and who is paying the price

NHS failure on Down's screening kills healthy babies a quote from this article: "Scores of healthy foetuses die every year because most hospitals do not give ­pregnant women what the NHS says is the best test for Down's syndrome.

"In an interview with the Guardian, Dr Anne Mackie, the head of NHS screening programmes, estimated 146 babies a year in England who do not have any abnormality are lost as a result of efforts to detect children with the genetic condition.

"The death rate is higher than it should be because only one in three hospitals offer mothers-to-be the so-called combined test for Down's syndrome, Mackie said. It is the most accurate of the four methods the NHS uses to calculate a woman's chances of having a child with Down's. If every hospital provided the combined test, the total of what she called 'normal babies lost' would be around 90."

'I said to the nurse, please feed her': Pauline Pringle's mother went into hospital for a hip operation and came out close to starvation. And as Blake Morrison reports, hers is not an isolated case

The beginning of this article:
"Last year, my mother-in-law fell off her Stannah and broke a hip. If that sounds like the cue for a Les Dawson joke ('I was hoping it would be her neck'), it isn't: I'm fond of my mother-in-law and the result of her little accident, not funny in the least, was that she nearly died. After a belated but successful operation, she developed c diff (clostridium difficile, the nation's favourite hospital killer bug after MRSA), and three courses of antibiotics failed to clear the infection.

"Suddenly a robust, cheerful woman of 79, whose only mobility problem had been climbing stairs, began to talk of never leaving hospital again but of being 'laid out on a marble slab' - and when the hospital asked for our permission not to resuscitate her should she lose consciousness, we realised this was no paranoid fantasy.

"Thanks to the efforts of her five children, who travelled long distances to see her, brought food, pleaded with staff not to write her off and eventually - because the pleas were falling on deaf ears - moved her to another (I'm afraid, private) hospital, my mother-in-law is still around, less active than she used to be, but alive to see in another new year. She was lucky. We were lucky. But as I'm beginning to discover, many people with elderly relatives are not."

These are just a sampling of the sort of care administered by the tender mercies of government bureaucracy and centralized rationing. There are more. Look through some of Britain's papers such as the Telegraph, The Guardian, The Independent, etc. They're not hard to find.

The elderly, the infirm, the chronically ill, those who some say place a strain on the system are those that will actually suffer the most. Obama won't. He's constantly telling us that he's got a personal doctor and the best health care in the world-- it's not about him. (Did he think that line would be in any way reassuring?) It's a simple fact that those who need help the most are those who most acutely feel its lack, as they are denied the expensive tests for diagnosis and the costly treatments-- all in the name of social justice and the greater good.

This level of care was not the intention of the Parliament in 1948. Let me state, once again, that nobody in Parliament ever said that they voted for a system that would deny expensive medications to terminally ill cancer patients, nor deny cancer treatments because of cost-effectiveness, nor deny treatments based on special interest lobbies. Obama can derisively dismiss "death panels" (an unfortunate hyperbole-- "comparative effectiveness committees" is a less emotional phrase) and claim that nobody in the House voted to "pull the plug on grandma," but Britain's NHS is quite literally deciding who is treated and who is denied coverage, and, at times, who lives and who dies according to their governmental budgets.

Does Britain offer much hope for the quality of "universal health care" in this country? Is there any reason that Britain should be discounted? Is the US government inherently more compassionate and caring then Great Britain's? Since we're dealing with the cold realities of politics and economics, does it matter?

The difficulties and tragedies that Britain is dealing with are all but inevitable when dealing with a governmental provider. Medicaid, Medicare and veteran's hospitals attest to the US national government's inherent "compassion" and skill in handling health care. Is there any reason that that these enormous and floundering programs are not being mentioned by the House health care bill proponents?

The end-of-life counseling is just the icing on the cake. As health care costs continue to escalate (why would they not?), can one imagine what these "counseling" sessions would be like?

End-of-life care is some of the most expensive care. A government program burdened by crippling costs and looking to save money will send out someone to counsel elderly and infirm patients on their "options." To me, this is not unlike the NHS counseling women to abort their Down Syndrome children.

From the article: "Yesterday the BBC News website ran a selection of comments on this issue by members of the public. One in particular, by Heather of Livingston, Scotland, is worth reproducing in full here: “I was told that my daughter had Down’s when I was about 12 weeks pregnant and every doctor, gynaecologist I saw tried to convince me a termination was the best option. I was still offered this at 26 weeks! One reason given to me by a cold-hearted consultant was that ‘these babies put a strain on the NHS’. My daughter was stillborn and when pregnant again, I refused all tests apart from a scan. It’s not society who are looking for the ‘perfect baby’, it’s the medical profession [emphasis mine].""

Aside from such crude prodding to decide upon a most personal matter, the very structure of this counseling will very well be suspect. Wesley J. Smith wrote an excellent piece on how subtle strategies can be employed to structure counseling sessions into being more persuasive. I strongly suggest reading the short piece in its entirety.

Others have expressed misgivings about such counseling provisions. Eugene Robinson of the Washington Post has written: "If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending."

Charles Lane also of the Washington Post writes: "Patients may refuse without penalty, but many will bow to white-coated authority. Once they're in the meeting, the bill does permit 'formulation' of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would 'place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,' I don't think he's being realistic.

"What's more, Section 1233 dictates, at some length, the content of the consultation. The doctor 'shall' discuss 'advanced care planning, including key questions and considerations, important steps, and suggested people to talk to'; 'an explanation of . . . living wills and durable powers of attorney, and their uses' (even though these are legal, not medical, instruments); and 'a list of national and State-specific resources to assist consumers and their families.' The doctor 'shall' explain that Medicare pays for hospice care (hint, hint)." (h/t to Pundit & Pundette)

Will this counseling be one more Orwellian cost-saving measure? Why would it not? What forces, what checks, would stop it from becoming something out of Kafka or Joseph Heller's work?

Obama can dismiss all this unsavory talk of "death panels." The House of Representatives didn't vote for anything like that. Well, at least not exactly they're talking about "comparative effectiveness" committees. I suggest you look to Great Britain. Sixty years of socialized medicine, which began as "the envy of Europe" has resulted into this debacle where life and death decisions are made by a fiscally strapped NHS desperate to save costs, and not patients and patients' doctors. This did not happen by accident, nor did it happen by design. Yet it occured, and could very well be an inevitable consequence of socialized medicine and their "comparative effectiveness" commitees. Obama's dismissal of this, indeed his refusal to seriously address the issue, is both foolish and naive.

More in Part 2.

1 comment:

  1. Thanks for writing this, Yukio.

    The notion that withholding medical care based on third-party bureaucratic considerations will not result in wholesale needless suffering is untenable.

    For some, the root of this denial no doubt is naiveté. Acting on crossed fingers is the dangerous side of an "audacity of hope."

    But every power broker in the Obama administration cannot be naive.

    Another element in the mix, a more powerful one, I think, is the audacity of arrogance.

    Hope is a small flame, easily brought close to extinction. Arrogance, well, that's a different story.