The Public Plan–Is Obama Capitulating or is This a Feint?

The media is all a-twitter (pun intended) over touting the demise of the Public Option in the Health Care Reform legislation, as if it were sliding toward the edge of the negotiating table ready to dribble over like a melted popcicle.  On the news I must have seen the clip where the President calls the plan just a “sliver” of the whole reform effort a dozen times.  Pundits are in full obituary mode.  Even the New York Times, a staunch supporter of the Public Option, is grief stricken.  Bob Herbert, in his column for August 18th, wrote,

The hope of a government-run insurance option is all but gone. So there will be no effective alternative for consumers in the market for health coverage, which means no competitive pressure for private insurers to rein in premiums and other charges. (Forget about the nonprofit cooperatives. That’s like sending peewee footballers up against the Super Bowl champs.)

It’s over.  The insurance companies are laughing all the way to the bank.  The clink of expensive brandy snifters raised in countless boardroom toasts is reverberating across the country.  The corporate jets are warming up on the  tarmac, ’cause it’s fiesta time for Big Medicine!

Have you heard Rep. John Boehner or Sen. Mitch McConnell whine about anything significant this week?  Have the shout-down disrupters in the Town Hall meetings gotten more strident?  Are the “experts” on Fox and CNN actually agreeing?  I even heard a PBS contributor use the term “panic” when referring to the president’s health care strategy.  Is Tom DeLay going to be on Dancing with the Stars?  I mean, if Tom DeLay “The Hammer” who almost certainly has been consulting with his Republican clients about how to kill the Public Option, has time to, well, uh, trip the light fantastic  on national TV, can there be any hope?  UPDATE: Chris Matthews, host of  “Hardball”  just named DeLay, “Twinkle Toes.”  I’m not kidding–check the transcript on MSNBC  for 8/18.

Hmm.   Well, I’m suspicious.  You see, in the days before the election (when Extreme Thinkover was still in its infancy) I posted a blog stating one of the most difficult things Americans would have to come to terms with, if Barack Obama won, would be the presence of a very smart president as president:

Make no mistake, this will be a shock to Americans if Barack Obama is elected, not because he is African-American, a Democrat, a liberal, or in the eyes of some, the Anti-Christ, but because he is smart.  That’s right, I said it plain and simple.  Barack Obama is a smart person, well educated, and has an intrinsic capacity for deep analytical thinking.

Now, I knew this would be a shock to Republicans, who had basked in George Bush’s inability to compose a coherent sentence, and Dick Cheney’s ability to snarl his victims into stone-like fear for the past eight years.  I, however, underestimated how much of a shock this would be to Democrats, who voted for Obama.  But I admit now that the Democrats in Congress are as much in shock.  They can’t seem to figure out to do with their success, AND a president that thinks complex thoughts and speaks, well, college-level English.

Back to health care reform.  I’m just thinking.  Why would a really smart politician like Barack Obama just waffle around on one of the key ideas of his health care plan?  Yes, I know, he can’t control all the political variables, and having majorities in both houses of Congress takes a while to get the kinks worked out.

So, is the dust-up over the Public Option the result of an inexperienced president, a disorganized president, a whatever president–panicked, sold out, capitulating?

Like John Stewart said, “I can’t tell if you’re a Jedi and ten steps ahead of this thing?”

Or maybe is this president well aware of this game of chess played on a shifting, multi-dimensional board, with changing rules and players, and working out his strategies many moves in advance, letting the different gambits and forays play themselves out, knowing full well what his end game will be and when to pull that trigger?

Capitulation or a calculated feint by a very smart man, who happens to hold the highest office in the land and is determined to get what he wants?

My take: Jedi Master and the Public Option: Yes.

Now is the Time: My Message to President Obama

President Obama, as part of his commitment to secure health care reform published an op-ed piece today in the New York Times, “Why We Need Health Care Reform,” laying out for the American people, and perhaps the world, the case for change.  I am a regular comment contributor to New York Times Op-Ed columns and below you will find the text of my comment.

I ended my comment with the statement: “Now is the time.”  There are times in the history of a nation, that certain reforms, regardless of the opposition, and, yes, even despite the fears of some must be overcome and guaranteed for all as part of the Common Good.  One of those times was the Emancipation Proclamation abolishing slavery.  One of those times was the ratification of the 19th Amendment of the Constitution of the United States granting women the right to vote.  One of those times was Brown v. The Board of Education decision of the United States Supreme Court that revolutionized equality in education for all U. S. citizens.  Many more could be mentioned.

Now is the time for health care to be added to those moments of sublime national change, to join those great reforms, cast as the finest, hardest steel into our Nation of Laws as an inalienable right and an eternal Blessing of Liberty.

Mr. President,

I work in health care, as a hospital chaplain, and I could give you a thousand more stories of real people whose lives have suffered and through their loss of quality of life and productivity America has suffered, simply because they could not afford health care.  I am blessed to work for a non-profit hospital system that treats every person who comes to us, but this is a burden that cannot be sustained.

I support health care reform, universal coverage, and the complete overhaul of our broken and unjust system.  I believe that health care is a constitutional right, just as freedom from slavery, women’s suffrage, and equality in education has become enshrined among the “Blessings of Liberty.”

I urge you to be courageous and strong to fight for every American’s right to medical care, as a blessing of Liberty that will build a foundation for a healthy America into the future.  Now is the time!

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 Myth of the Free Market Health Care Reform

I offer my readers two examples of why the “free market” system alone is systemically incapable of creating or sustaining any semblance of real health care reform:

  1. The free market requires that any product related to health care for real human beings actually is designed to make a profit for the owners/shareholders of that business.
  2. The free market requires that any product related to health care for real human beings actually is designed to make a profit for the owners/shareholders of that business.

That is not a typo.

“Hunter,” one of the contributors to the Daily Kos, wrote a letter to the President making his case for free market health care.  Here are his concluding paragraphs:

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company’s list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company’s claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company’s crack cost-review and retroactive cancellation and denial squads, my insurance company’s executives and board of directors, my insurance company’s profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.

Hunter didn’t make this up.  This is, indeed, the reality of health care in the free market.  I urge you to read the complete letter.  You’ll love the part about the gold-plated utensils and its vital relationship to your health care dollar.

Paul Krugman, Nobel-winning economist and New York Times columnist, however, just puts the nails in the free market myth coffin:

There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence.

I urge you to read the complete post from Dr. Krugman’s blog.

It really comes down to this.  If you are chuckling, you understand that health care reform is about real people needing real medical care when they need it, without the cost or lack of access costing them their lives or livelihoods.

If you are experiencing blustery consternation and wanting to call me a socialist, communist, or worse (none of which apply, because I am a dyed-in-the-wool capitalist), you need to make a decision.  Do you want to live in a country that is healthy and prosperous because health care is delivered through a collaboration of the government, mission-driven non-profit organizations and private enterprise, or…

Well, do you want to or not?  The myth that free market health care reform will be achieved is dead.  As Paul Krugman points out there are many things the free market can do very well.  Health care is not on that list.

I care enough about you as a person and as an American to support a portion of my taxes being spent to ensure you can get the medical care you need when you need it, because I know in the long run we will be better off–you, me, and 300 million of our fellow Americans.