VINDICATED! Today a New Dawn Rose for a Healthier America

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CONSTITUTIONAL!

It is a day that even I wondered would ever come.  I began Extreme Thinkover with posts on the topic of comprehensive health care for all Americans.  I wrote in September of 2008:

The typical arguments for or against universal health care always focus on what the government will have to spend, what taxes will have to be raised to finance it at any level, or providing health care to consumers, i.e., virtually the whole population, has been, from my perspective, approached from the wrong frame of reference.

I put forth the argument on numerous occasions.  The Affordable Care Act, from my perspective, is a just solution to a miserably broken health care non-system.  It is just in the sense that this law creates a new level of access to medical assistance that Americans have never enjoyed, but that virtually every other First World country (and a number of smaller nations) has offered its citizens for decades.

The Affordable Care Act is the cornerstone of an inalienable right that makes possible in a tangible manner the chance for every person in the country to be healthier, and consequently enjoy the Blessings of Liberty. Yes, I can imagine the eyes rolling over that assertion.  But though it will take a generation, maybe more, to make that difference, doing nothing, that is, to go back to the pre-ACA situation, Americans would continue to be less healthy, costing perhaps trillions of dollars in avoidable care.  Now, at least we have a law, a system, that can turn that trend around.

Having worked in a hospital for over a decade and a half with daily patient contact, I can attest to the misery and personal suffering that those who have no insurance are forced to bear.  Add to that, my hospital is Catholic, with a mission to serve the poor and uninsured, and I have seen the incredible stress this very broken way of providing medical care has placed on my organization, restricting our capacity to plan for the future because tens of millions of dollars annually are required to subsidize those with no insurance.

I fully realize that the success of this change depends on individuals taking personal responsibility for their health.  I would contend, however, based on my experience with chronically ill patients who are poor or unemployed, they are caught in a vicious circle that all too often results in their getting the short end of the stick economically, for which access to medical care for wellness simply does not exist.

I could also put it this way, with the Supreme Court’s decision today, health care in America has finally stepped into the 20th Century.  The challenge now to us living in the 21st Century is fend off those who would overturn the law and plant us firmly back into the 19th Century.

People.  Real, live people with real live medical needs.  That is what the ACA is really about.  That is why for nearly four years, I’ve objected to the argument put forth by the law’s opponents that it was all about money and government.  I rejected that argument on both moral and ethical grounds.  Those who grouse that they are only paying for others bad habits are short-sighted, and in my opinion, fundamentally selfish.  To me, that argument is both highly ironic and paradoxical, because my experience with my neighbors has uniformly been that Americans possess a natural selflessness and generosity to help anyone in need.  But somehow getting the connection tied between to the two has been an uphill battle and continues to be.

For example, I have no doubt that if Sen. Mitch McConnell, Rep. John Boehner, Rep. Michelle Bachmann, or Sarah Palin were in a setting in which total strangers were injured and needed immediate emergency medical care, that every one of them would step up and wade in to help.  But all of them today condemned this law, despite the fact it acts on their behalf as well, so that their fellow citizens will receive that care as a matter of course.  And those patients won’t be nearly as likely to end up bankrupt as a result of seeking out that care.

Simply put, I don’t get it why they don’t get it. (I’ve got a pretty good notion why they think they don’t want to get it, however). Because of that great contradiction, conservatives like those mentioned above still want to overturn it legislatively.  I will continue to write to defend it.

(Yee-haw!)

Trollish Tirades

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Trolls (Internet):

In Internet slang, a troll is someone who posts inflammatory,[2]extraneous, or off-topic messages in an online community, such as an online discussion forum, chat room, or blog, with the primary intent of provoking readers into an emotional response[3] or of otherwise disrupting normal on-topic discussion.[4] The noun troll may refer to the provocative message itself, as in: “That was an excellent troll you posted”. While the word troll and its associated verb trolling are associated with Internet discourse, media attention in recent years has made such labels subjective, with trolling describing intentionally provocative actions outside of an online context. For example, mass media uses troll to describe “a person who defaces Internet tribute sites with the aim of causing grief to families.”[5][6]  Source: Wikipedia.

Paul Krugman, (New York Times columnist, professor of economics and international affairs at Princeton University, and 2008 Nobel Prize laureate in Economics), on his NYT blog “Conscience of a Liberal” recently posted a short, curt message regarding the constant flow of comments he receives written by “trolls.” See the above definition.  Still thinking about my previous post “Hospital Food for the Mind: Benanke, Jackson Hole, and the Importance of Being Wrong,” I realized that trolls fall into the category of ignoramuses I referred to there.

Krugman’s ongoing problem with the troll attacks is that he writes as a pundit as well as an economist. His often pointed remarks and his notoriety as a Nobel Prize winner make him a high-profile target for those who do not see eye-to-eye with him.  This is not a surprise.  Trolls have often been historically portrayed as quite large.  All of us familiar with the Lord of the Rings movies, along with the Harry Potter series also know the wide range of images in which they are portrayed. The point being that by their very stature rather than character or intellectual capacity, mythological though they may be, trolls can’t see eye-to-eye with anybody.

Battle Troll from Lord of the Rings. (c) New Line Cinema. Photo: allthetests.com

Since trolls were certain to respond to Krugman’s banning them (the fact that doing so would reveal themselves probably never crossed their minds), I, too, decided to write a comment.  I know what you’re thinking, but I’m not a troll. I’ve have had numerous comments published on Krugman’s blog (22 to date) so I’m a known quantity on the positive side of the equation, even when I disagree with him. He decided, however, not to publish any comments.  I don’t blame him, really.  But I’d written what I though was a pretty good comment, so I present it here.

Reply to “Trolls:”

It seems counter-intuitive–or just odd, if you like—to comment on this particular post.

The trolls (although I fancy your use of the term “ignoramuses” in a recent post) seem to have three flaws in their character. First, they have no capacity to understand either irony or sarcasm.  Therefore, they won’t understand this comment.  Second, because they think they are completely right, they also believe they are clever enough to slip one of their tirades past your anti-troll sensors…or perhaps they are just oblivious to the fact you can read and recognize their M.O.  Finally, they think they are right, not because they have ever studied economics or whatever else you happen to be writing about, but because they can point to who is wrong.  That’s very important.  They know they are right because they know you are wrong. That’s their rule: you have to be wrong.  About everything, it would seem.

Troll from Harry Potter (c) Warner Bros. Photo: http://www.flixster.com/

That creates an interesting dilemma for the trolls (along with certain pundits, bloggers, etc.).  The problem, of course, is that here we have two diametrically opposed solutions on how to fix the economy. Everybody can’t be right.  Somebody gets to be wrong.  Somebody has to be wrong.

This probably keeps them up at night agonizing over the prospect that they aren’t the ones who are right, even though they believe they must be right, because if they get to be wrong, then you get to be right.  And based on the negative reaction to your recent comments about Texas (from not just the trolls, but pundits and certain economists clinging to failed models), it looks like that their growing sense of anxiety about getting to be wrong escalated into a full-blown panic attack.  They, of course, won’t get that either.

Afterthought: Trolls looked a lot different when I was a kid…

Troll Toy (c) RUSS

Dumbing Down the POTUS

This post is not about George W. Bush.  Really.  Although he had a role in my thesis.  This post is about our current president, Barack Obama.  I don’t want there to be any confusion about that.

It finally struck me yesterday what the GOP is up to regarding the November elections, after four events, three of which were unusual, filled the majority of my day.

They were, in this order:

  1. I watched two hours of Fox News shows at the behest of my friend, Dr. John Bogen, who is politically as conservatively moderate as I am liberally moderate.  Many of the themes I discuss below were the primary topics of those shows.  (If you are a regular reader of Extreme Thinkover, you will remember John’s very fine posts last fall on the H1N1 Pandemic, both regarding vaccinations and his advice how to understand H2N1 H1N1 (thanks, John!).
  2. I read an article about how the White House allowed President Obama’s passport–yes the President’s passport–to be photographed to counter the ongoing idiocy of the so-called “birthers” who obstinately cling to the totally false accusation that Obama was not born in the United States.  The issue of people believing the President is a Muslim is so far off the scale of absurdity it doesn’t even get its own separate number.
  3. While wandering around a big box electronics store I started experiencing chest pains and deciding to err on the side of caution and went to my hospital’s urgent care.  All my tests came out negative, fortunately, but with my family’s history of cardiac artery disease I’ve earned a ticket to be the main attraction in my second stress test.  Thinking about one’s mortality is a sobering moment for anyone.  I also have health insurance.
  4. After I got home, I got to watch my favorite NASCAR driver, Kyle Busch, set a NASCAR record at Bristol Motor Speedway in Tennessee by sweeping the three races of weekend.

It was during the race it hit me what the conservatives are doing to try to defeat the Democrats this fall and to discredit not only the president but the presidency in every way possible for their advantage. Why during the race?  Maybe it had to do with the vagaries of a car race, the strategies, and the ever-present reality that each driver and his car only has so much control over what is happening to them.  Someone else makes the smallest of mistakes and you can be out of the race with your car a pile of scrap metal in a fraction of a second.  Or maybe it was just dumb luck.

You will remember, quite painfully if you are a person with any capacity to carry on a civil conversation with someone you disagree with, the Cirque de Chaos we had to endure during the Congressional recess town hall meetings last August over the Tea Party and health care and carrying guns around in public like it was the Showdown in the O.K. Corral.  This year, there’s hardly been a whimper over this.  That’s because the new strategy is much more subtle and the Far Right learned one lesson: viewer fatigue.  By the end of August last year, the “scream at your politician” gambit had backfired; most Americans get fed up with toddler-type tantrums very quickly.  Simply put, the Far Right overplayed its hand.

The plan this summer is to make the president look dumb.  Also incompetent, if possible, but definitely dumb.

Why?  Because Barack Obama is probably one of the smartest presidents in the history of the nation in terms of sheer intellect.   So the way to attack him is to create, in this case, two exceptionally dumb fabrications about him: he wasn’t born in Hawaii, and he is Muslim, and then keep feeding those very stupid lies by constantly just hinting about them or have pundits “debate” the issue on TV and radio.

Dumbing Down the POTUS. Image Courtesy Motifake: http://www.motifake.com

http://www.motifake.com

This strategy works because there is no rational way to defend against it.  You can’t “put this one to bed” because there is no effective counter-strategy.  So the Republican leadership, now held hostage by the Far Right Wingnuts, can just keep the topic alive by continuing to feed their constituents who have bought into it.  And the way you do that is very simple: whenever the question is asked, you deny it, but ambiguously.

Last year, the Far Right tried shouting and threats of revolution.  It fell flat on its face.  This year they are trying lies and innuendo.  It’s a big gamble for the GOP because the Tea Party and other Far Right groups are much like a political multi-headed Hydra each with its own idea of who should be in control and what the outcomes should be.  But the Republicans lack a Hercules to control this beast.  Rep. John Boehner, Sen. Mitch McConnell, and RNCC Chair Michael Steele to a person lack the ability or imagination to keep these groups under control.  I suspect Rush Limbaugh and Glenn Beck are hoping they can throw meat at the monster without getting eaten themselves.

The question is can the Democrats find their equivalent of a Hercules to cut off the heads, politically speaking, of the Right’s Hydra?  President Obama, in my opinion, is more than capable, as we saw him campaign for the office, but now as Leader of the Free World, his focus should be on his job, not slaying dragons.  The same goes for Vice President Joe Biden.  Sen. Harry Reid, in addition to being in the fight of his career to keep his senate seat, is the epitome of milquetoast.  Rep. Nancy Pelosi has the fire, but in addition to being speaker of the House, is in her own campaign.  The DNC’s chair, Tom Kaine, is an excellent administrator, but has wisely kept out of the spotlight.

I’ve heard more than one pundit and politician say the Democrats are disorganized and not responding effectively to the attacks from the right.  That may or may not be true.  It may be the Democratic strategy is to let the Far Right, with all their fractures run their course, and when they begin to collapse, pounce with the equivalent with a sledge hammer against a glass window pane.  In reality it would not take much for the Republican Party to implode upon itself.  The GOP’s structure is much more precarious than they are letting on.

In the meantime they are going to attempt to make the president look dumb, out of touch, incompetent, a threat to the American Way of Life.  He is none of those things, so eventually the truth will out.  I continue to read the polls with a huge grain of salt.  Now I know what I’m looking for, I’ll be able to tell more clearly what is happening below the surface.  November 2, 2010 is still going to be a very interesting election day.

Iraq’s Future: Blood or Hope?

War in Iraq: Seven Years of U.S. Sacrifice, Image Courtesy: Nicholas P. Maurstad

Last One Out, Please Close the Gate

Last night, local time in the Middle East at a border crossing between Iraq and Kuwait, the last Stryker Brigade of American Combat troops rolled through the gates ending seven years of United States military operations.  The combat role is finished and has been turned over to the Iraqi military.  Although the Stryker Brigade is being processed for their first day in Kuwait, a substantial force of non-combat military personnel remain, some 50,000 we are told.

Is the war over?  Did we win?

Iraqi Women Grieving Killed Relatives, Photo: AFP/Getty Images

The hope is that the combat part of the war is over.  The so-called advisors will have many roles, from training to consultation, to building ongoing relations with the Iraqis as their very fragile government tries to survive just one day at a time.  What strategy will the insurgents play?  Only time will tell.

Did we win?  Now that’s an interesting question.  Can you win a war that was begun under false pretenses?  Can you win a war that was started by a president of the United States who chose to either believe pure fantasy about a huge cache of weapons that never existed to begin with, or knowing they didn’t exist, fabricated a horrible lie, colluding with the officers of his administration do give the appearance that we were in state of a clear and present danger?

Since the evidence points to the president’s lying to the nation, an act of duplicity for which he will never have to face justice and neither will the officers who assisted him in constructing this completely false rationale for going to war, how, then, can we say that we won the war?

Started on False Pretenses, Ended on…?

What we did was topple a regime. We sought out an admittedly tyrannical dictator who oppressed his people, and let his sons run amok terrorizing any one they wished, simply on a whim.  The fact that all three of them are dead was a gift to the Iraqi people.  But the fact the war we brought to them cost the lives, according to the organization, Iraq Body Count,  of between 97,267 and 106,146 civilians as well as the deaths of over 4400 military Americans.  Many of these troops were killed trying to dodge the bullets and  IEDs of a no-holds-barred civil war between rival tribal and religious sects of the same religion. This circumstance lasting years does not leave one with a sense that our goals lined up with theirs.  And on both accounts, those numbers do not include the number of those wounded, maimed, left without spouses, or orphaned.

Graph of Iraqi Casualties. Image: Iraq Body Count

The truth remains that despite the last Stryker Brigade rumbling across the border into Kuwait, the war is not over.  50,000 U.S. troops will continue on for years to come.  One Iraqi official stated: “If I were asked about the withdrawal, I would say to politicians: the U.S. army must stay until the Iraqi army is fully ready in 2020,” said the Iraqi military’s most senior officer Lt. Gen. Babakir Zebari last week.

Operation New Dawn is not the end of the war.  It is a new phase.  More Iraqis will die.  More Americans will die.  The jury of historical success or failure must remain silent for years to come.  But some facts are already self-evident, and

IED Explosion in Iraq. Photo: Wikipedia/PD

both the United States and the Iraqis have paid a terrible price for the decision of one man who out of spite, a twisted sense of revenge, incompetence, delusion, or unmitigated stupidity, started the war and conned a nation into going along with it.  While the two men and their henchmen remain free who we should have focused on like a laser beam to bring the down, to put a halt to the horrible

Bin Laden & al Zawahiri. Photo: Source Unkn

carnage they continue to spread around the world, a thousand opportunities were squandered by that administration to end the reign of terror those men and to pay for their murderous crime against the American people.  For that, George Bush, 43rd president of the United States, should be forever judged most harshly.

But What of Hope?

The old saying goes, “You can’t make a silk purse out of a sow’s ear.”  But sometimes through dogged determination, one can take the worst possible situation, and through hard work and creative thinking and planning bring some degree of good out of the bad.

This will be the paradox of the Iraqi war.  For all the wrong reasons we invaded Iraq.  The people our leaders believed would welcome us instead hated us even more.  The people freed from the masochism of Saddam Hussein instantly split from the suppressed religious and tribal fractures that Saddam had used constant brutality to hold together to control his regime.  We unleashed a monster of internecine savagery, an unintended consequence for which our leaders were totally unprepared or had any contingency to deal with.  For years we, the great liberators, were literally trapped by the rage going on around us, trying to bring order in a nation so spiritually shattered that they wanted to kill us so that they could kill each other more quickly.

Despite all that…despite all that, the soldiers of a handful of countries that came to stand beside us, and our American troops, figured out ways to bring hope to the Iraqis.  A million mistakes were undoubtedly made, but we are a people, or should I say a coalition, that don’t give up that easily.  Yes, the other countries withdrew their forces, including the British, who had been the second largest contingent, before the fighting was truly over.  But to their defense, many of their leaders saw the obvious and clear turning of events in Afghanistan, and moved their resources to that troubled land, where now they continue to fight alongside of our forces as they attempt to save Afghanistan from another Taliban regime, capable of a brutality that exceeds anything Saddam could have dreamed of many times over.

As the combat troops left last night, the question very much remains whether Iraq, is truly ready to embrace the new dawn our military has so optimistically chosen to call the next phase of the mission.  The answer may be that it ends in collapse and civil war, where millions might die this time.  It is my prayer that will not be the result, but I cannot predict the future.  It appears though that the sheer hatred the Iraqis demonstrated against the U.S. at the time of the invasion has tempered.  Though the rivers of mistrust of Americans and that the majority are Christians, runs deep, as the years have passed and the combat operations and firefights have subsided, our soldiers have had the chance to show the humanity that exists beneath the uniform.

Iraqi Child Kissing U.S. Soldier. Photo: AP/John Moore

Perhaps the chance to be human, to show kindness and even respect, after so many years of fighting has turned out to be irresistible to both the Americans and the Iraqis.

If that is true, then there is hope.

Granny’s Safe UPDATED: Rebutting the “They’re Killing Granny” Lie by Health Care Reform Opponents

Me, Uncharacteristically Pertrubed

Me, Uncharacteristically Perturbed

Now, they’ve gone and done it.  I’m perturbed!

One of the provisions in the health care reform bills being worked on in both the House and the Senate is an incentive, to be paid by Medicare, for doctors and other providers to have a conversation every five years with aging patients regarding what they want for end of life care.  That’s the true part.  I discuss that below in detail.

UPDATE:  Oregon  congressman Earl Blumenauer (D-Dist 3) is the author of this section of the legislation. He states that he has been so frustrated by the Republicans’ distortions and lies of what he wrote that he has developed a Myth versus Fact Sheet that can be read by clicking hereRep Blumenauer wrote in his blog:

Those with no solutions and no answers for how to reform our health care system are hijacking positive, bipartisan efforts that have contributed to a strong bill passed out of two House committees. Republican leadership has abandoned all efforts at passing needed health care reform — even turning their attacks to legislation that has been actively crafted and supported by both parties.

One of these outrageous examples is my Life Sustaining Treatment Preferences Act.

GOP leadership has been gravely distorting the truth and misrepresenting the facts about this bipartisan effort, and in the process throwing members of their own party under the bus — those who have reached across the aisle to do something that will help Americans across the nation.

The bill simply provides people with better care as they grapple with the hardest health care issue of all — their final chapter of life. See the Myths vs. Facts sheet on this. CNN reporter Elizabeth Landau does a great job highlighting the benefits of “doctors and family members having more conversations about end-of-life issues,” which my bill addresses.

This bill has bipartisan support (the main cosponsor is a Republican doctor) as well as support from a diverse coalition like AARP, the American College of Physicians, and Catholic health systems. It is an area where — no matter from a red or blue state — many have been able to bridge the divide.

The bottom line: this is a smart and just thing to do for families going through a tough time.

Indeed, it is a smart and just thing to do.  Americans are known to be among the greatest death-deniers in the world.  This is very well documented.  Physicians, as  a profession are generally not trained in medical school to talk about dying with their patients, and the cultural norm “I’m going to live forever!” is especially deeply held by our doctors.  This, too is very well documented. (One exception I have knowledge of is at Oregon Health and Science University in Portland, where medical residents are trained how to talk to patients about end of life issues.  I have seen their video and am well acquainted with the faculty of the Center for Ethics in Health Care.)

But those who are opposed to health care reform are using our fears about death and distorting them into a malicious fallacy about the legislation’s impact on our lives.  One provision is for providers to have a discussion about end of life care with her or his patients.  As I explain below, this conversation is taking place every day thousands of times.  But for the opponents, it’s another item on their list to distort and spread fear to preserve the status quo, mainly their profit margain.

As Charles Blow, New York Times columnist, stated in his latest piece, “Health Care Hullabaloo:”

I must say that this says more about them than it does about any forthcoming legislation. Belligerence is the currency of the intellectually bankrupt [emphasis added].

Trapped in their vacuum of ideas, too many Republicans continue to display an astounding ability to believe utter nonsense, even when faced with facts that contradict it.

This scare tactic is becoming ubiquitous, as expressed by a woman at a Raleigh, NC town hall meeting with President Obama, reported by ABC News reporter, Jake Tapper:

At the AARP town hall meeting last week, a woman named Mary told the president that “I have been told there is a clause in there that everyone that’s Medicare age will be visited and told to decide how they wish to die. This bothers me greatly and I’d like for you to promise me that this is not in this bill.”

“You know, I guarantee you, first of all, we just don’t have enough government workers to send to talk to everybody, to find out how they want to die,” the president said. “I think that the only thing that may have been proposed in some of the bills — and I actually think this is a good thing — is that it makes it easier for people to fill out a living will.”

After explaining what a living will is, and that he and his wife each have one, the president said, “I think the idea there is to simply make sure that a living will process is easier for people — it doesn’t require you to hire a lawyer or to take up a lot of time. But everything is going to be up to you. And if you don’t want to fill out a living will, you don’t have to…But, Mary, I just want to be clear: Nobody is going to be knocking on your door; nobody is going to be telling you you’ve got to fill one out. And certainly nobody is going to be forcing you to make a set of decisions on end-of-life care based on some bureaucratic law in Washington.”

Check out the AARP’s Myths vs Facts site here.

Here’s the text (authored by Rep. Blumenauer) of the proposed “Americans Health Care Choices Act of 2009”  (beginning on page 425), the House version, regarding advanced planning:

‘‘(hhh)(1) Subject to paragraphs (3) and (4), the

term ‘advance care planning consultation’ means a consultation

between the individual and a practitioner described

in paragraph (2) regarding advance care planning,

if, subject to paragraph (3), the individual involved has

not had such a consultation within the last 5 years. Such

consultation shall include the following:

‘‘(A) An explanation by the practitioner of advance

care planning, including key questions and

considerations, important steps, and suggested people to talk to.

‘‘(B) An explanation by the practitioner of advance

directives, including living wills and durable

powers of attorney, and their uses.

‘‘(C) An explanation by the practitioner of the

role and responsibilities of a health care proxy.

‘‘(D) The provision by the practitioner of a list

of national and State-specific resources to assist consumers

and their families with advance care planning, including the national

toll-free hotline, the advance

care planning clearinghouses, and State legal

service organizations (including those funded

through the Older Americans Act of 1965).

‘‘(E) An explanation by the practitioner of the

continuum of end-of-life services and supports available,

including palliative care and hospice, and benefits

for such services and supports that are available

under this title.

What got me thinking about this post was this comment by the New York Times columnist, economist Paul Krugman.  In a posting to his blog titled “Even-handedness,” he wrote:

AP: FACT CHECK: Distortions rife in health care debate:

Opponents of proposals by President Barack Obama and congressional Democrats falsely claim that government agents will force elderly people to discuss end-of-life wishes. Obama has played down the possibility that a health care overhaul would cause large numbers of people to change doctors and insurers.

So Republicans are claiming that Obama will kill old people. . .

Having just watched Bill Moyers on his PBS program interview Wendall Potter, former CIGNA executive who just testified before congress on the unconscionable tactics being regularly and deliberately used by insurance companies to deny coverage their insureds have rightfully paid for, but will dent the companies’ profits, and how they are in an all-out campaign to destroy health care reform while duplicitously endorsing it, I wrote a comment on Krugman’s blog.

Well, this time he didn’t publish it (however he had recently published my comments on 1 August 2009: “Health Reform Made Simple.“).  I, however, back up all my comments on various blogs.  Here, then, is what I wrote:

The “They’re Killing Granny” Fallacy:

For over a decade, as a hospital chaplain, I have helped hundreds of Grannies complete their Advance Directives.  Often the doctor requests this conversation take place, because Granny has a medical condition that is approaching end-stage, or is already there.  The ideal is that Granny and her physician have already had a conversation about her declining health. The Advance Directive is one tool for her to use to determine the kind of medical care she wants OR doesn’t want IF she can no longer communicate her wishes about treatment.

The purpose of the provision in the bills is to provide an incentive to medical providers to talk with Granny regarding the choice of care she wants at the end of her life.  Why?  Because Americans are the worst death-deniers in the world.  We’ll do just about anything to avoid talking about dying and death.  And physicians are just as bad as the rest of us.

Let me repeat the purpose of the provision: The Doctor talks to Granny so she has a choice to decide what she wants.  The conversation is a huge benefit not only to Granny, so she can make her wishes known, but also to remove the burden from her loved ones of having to guess about the kind of medical care she wants IF she is dying and cannot communicate by any means.

Generally, the types of extraordinary treatments being considered are:

1. Being placed on a ventilator to support breathing.

2. Being fed through a tube.

3. Being provided medications or procedures that are specifically designed to cure the disease, or to artificially prolong the person’s life.

Here are the facts (and I’m assuming most other states are very similar to mine):

1.  Any person over the age of 18 can complete an Advance Directive.  It does NOT require being notarized, it does NOT require your doctor’s signature, and it does NOT require going to an attorney and paying a fee to fill out the form.  You can download your state’s form online, or pick up a free copy at a local doctor’s office, hospital, or public health office.  Be sure to give a copy to your doctor and to take it with you to the hospital if you have a procedure (my hospital will accept a mailed Advance Directive at no charge, even if the person has never been one of our patients).

2.  The purpose of the Advance Directive is to allow Granny to decide in advance if she wants to have extraordinary medical measures should she be clinically assessed as being in the process of dying AND unable to communicate her wishes by any means.

3. Granny in her Advance Directive can choose to have everything from no extraordinary measures to all extraordinary measures.  If Granny chooses not to have extraordinary measures, she will still receive full palliative care measures to keep her comfortable, clean, and to die as peacefully as possible.  Granny, hopefully, will have access to hospice to provide this care; it is already paid for by Medicare.

4.  Granny has the choice of appointing a Health Care Representative (usually a family member or very close friend) to be her “health care power of attorney” to speak on her behalf if she is too ill to communicate (but perhaps is not in a terminal condition), or to consult with her physician if she is in the process of dying.

5. Here are some of the key rules:

a.  Granny has the  right to decline to talk about her end of life with her provider.

b.  Granny has the right to decline to fill out an Advance Directive.

c. Granny must be mentally clear (alert and oriented to time, place, and self) to fill out the Advance Directive.  If Granny is suffering from dementia, or is confused or delirious due to some medical cause, she is not considered competent (at least in my state) to fill out the Advance Directive at that time.  If she clears mentally later, she may can complete the document.  If Granny’s condition is diagnosed as permanent (such as advanced Alzheimer’s), then the family may need to consider a guardianship, but that is another topic.

d. Granny’s doctor, or if she is in a facility, a facility employee, CANNOT be her Health Care Representative, to prevent any conflict of interest in determining her treatment.

Being at the bedside of a critically ill patient, likely to die, and supporting the family through the decision-making process of what to do, when Granny never talked about it is agonizing for everyone.  One conversation would have spared all concerned the pain of indecision and second-guessing.

The AARP states,

Bottom Line: Health care reform isn’t about putting the government in charge of difficult end of life decisions. It’s about giving individuals and families the option to talk with their doctors in advance about difficult choices every family faces when loved ones near the end of their lives.

That is compassionate health care.  It is no slippery slope toward euthanasia, and it is not killing Granny.  It is, however, a provision (already in place in many places around the country), to ensure that the majority of America’s Grannies, truly die in peace and dignity.

A Caveat: Yes, I live in Oregon, which has the ignominious distinction of being the first state in the country to permit suicide with the assistance of a physician.  I personally oppose the legalization of suicide by this means (or any other, for that matter).  My hospital, being a Catholic institution,  does not encourage or participate in assisting terminal patients to commit suicide.  But that is a topic, perhaps, for another blog in the future.

The moment Sen. McConnell and Rep. Boehner realize the "They're killing Granny" distortion has seriously backfired.  Photo: Life Magazine Archives

The moment Sen. McConnell and Rep. Boehner realize the "They're killing Granny" distortion has seriously backfired. Photo: Life Magazine Archives

They Judge Themselves

This level of greed and deceit is by no means new.  The actions of insurance company executives, strategists, and lobbyists, as well as the politicians who parrot their lies are condemned in this passage from the Book of Proverbs in the Bible:

A scoundrel and a villain, who goes about with a corrupt mouth, who winks with his eye, and signals with his feet and motions with his fingers, who plots evil with deceit in his heart–he always stirs up dissension.

Therefore disaster will overtake him in an instant: he will suddenly be destroyed–without remedy.

There are six things that the LORD hates, seven that are detestable to him:

  1. haughty eyes
  2. a lying tongue
  3. hands that shed innocent blood
  4. a heart that devises wicked schemes
  5. feet that are quick to to rush into evil
  6. a false witness who pours out lies
  7. and a man who stirs up dissension among [others].

Proverbs 6:12-19, NIV

In the article about the Seven Deadly Sins, regarding greed/avarice, Wikipedia writes:

In Dante’s Purgatory, the penitents were bound and laid face down on the ground for having concentrated too much on earthly thoughts.

“Avarice” is more of a blanket term that can describe many other examples of greedy behavior. These include disloyalty, deliberate betrayal, or treason, especially for personal gain, for example through bribery .

Take a look again at the section of the bill I quoted.  Read it over several times if you like.  Do you honestly see anything that even hints that the purpose or outcome of that provision will endanger Granny?

Granny is going to be so much better cared for under the new legislation.  Those who oppose health care reform and are lying to get it defeated are the ones who need to be worried.  Very worried.

Greed & Avarice.  Dante's Fourth Level of Hell.  Wood-cut Print, 1476

Greed & Avarice. The sixth of the Seven Deadly Sins. In this depiction, the damned are being boiled in oil. This image appeared in 1496 in Le grant kalendrier des Bergiers, published by Nicolas le Rouge in Troyes, France

I should say in conclusion that both my wife and I have advance directives.  So does my mom, the best grandma in our arm of the galaxy.

The Fight of Our Lives for the Fight For Our Lives

Here it comes: the fight of our lives for the fight for our lives:  Universal health care.

Despite the incredible amount of evidence that health care in America is a disaster, a terminal disease on a social scale unprecedented in history, that annually millions of lives are ruined, physically and financially by lack of access or restricted access to health care, what I call the Hegemony of Profit Before Health is preparing to attack without mercy.

Listen carefully to the rhetoric that the Hegemony will blast at you in the coming days and weeks.  It will not be about health.  It will not be about solutions for the common good.  It will not be how to create the healthiest America possible within a generation.

No.  The rhetoric will be  about frightening you into resisting changing the status quo.  The rhetoric will be about confusing you what the real issue is:  denying your inalienable right to be as healthy as possible.  The rhetoric will be about preserving a diseased system that holds you in its grip to the enrichment of a few–and sustains a diseased population to guarantee that enrichment flows in perpetua.

This is the fight of our lives.  This is the fight for our lives.  This fight will likely determine if America remains pre-eminent among the nations: more important than the fight against terrorism, more important than saving the economy, and just as important as protecting the environment.

The fight for universal health care will determine whether or not you, your children, and your children’s children will be among the healthiest people in the world with America as its strong and sure leader, or relegated to third world status, of ever declining health, a land held hostage like cattle in a factory farm, weakened by design to sustain the Hegemony of Profit Before Health.

My life is at stake.  Your life is at stake.  I choose life.  I choose a healthy America, strong into the future, the standard for health care in the World.  I choose universal health care.

Credit Cards are Not Guns: Strip the Coburn Amendment from the Credit Card Legislation

On May 12th, the Senate passed the Credit Card reform legislation that President Obama asked for, 67-29.

Attached to this critically important bill to reign in the usurious abuses of the giant Credit Card companies, is an amendment submitted by Sen Tom Coburn (R-OK) that would authorize carrying guns in America’s National Parks.

The House bill, passed earlier, does not contain a similar amendment.

Apart from all considerations of the merits of Sen. Coburn’s amendment, it must be stripped from the final bill.

The Gun Lobby, according to the New York Times, got 66 senators to sign onto the amendment.

Again: The amendment must be stripped from the final bill before it goes to the President’s desk.

From my perspective, if the Gun Lobby believes they can get this legislation allowing the carrying of firearms in the National Parks passed, they should have the integrity of true American honesty to support it as a bill that will  stand by itself.

Anything less is an act of subterfuge and cowardice.  Evidently, this action to put one over on the American people with the credit card bill is proof you are guilty of both. And that you know you don’t have the votes to get it passed.

In doing so, you mock our Constitutional right to bear arms.

The Gun Lobby needs to take notice that this attempt at sleight of hand did not work.  Just like it’s no longer working for the financial industry and the health care industry.

America’s no longer willing to be bullied by your big money and threats of catastophe if you don’t get your way.