Federal health brokerage

While the president is out talking about his administration’s health
care plans, it’s timely to re-visit some of his recent comments
relating to health, that were barely noticed first time around.

Specifically, what he said at Georgetown on April 14. Dr. Mark Mostert noticed.

I was especially interested in the section of the
interview dealing with health care, and to learn of the President’s
perceptions of end-of-life issues. It’s not pretty…

Pay attention to Obama’s wording:

I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be
driving treatment, because . . . when it comes to medical care; I know
how to ask good questions of my doctor. But ultimately, he’s the guy
with the medical degree. [emphasis added]

To which Mostert responds:

What if the doctor says, “Well, you’ve got two weeks to
live, and your quality of life is very poor, and all the expensive care
we can give you will not help a bit, but assisted suicide is legal,
quick, and very inexpensive?’ Should I then accept this pronouncement
because he’s “the guy with the medical degree?”

And by the way, this did happen to a woman in Oregon, when her
insurance company wouldn’t pay for cancer treatment but would cover the
drugs to end her life. It raised public outrage, but by the time they
relented, she had died.

Back to Obama’s remarks on health care as he sees it:

And part of what I think government can do effectively
is to be an honest broker in assessing and evaluating treatment
options. And certainly that’s true when it comes to Medicare and
Medicaid, where the taxpayers are footing the bill and we have an
obligation to get those costs under control. And right now we’re
footing the bill for a lot of things that don’t make people healthier.

Mostert breaks down the rhetoric and follows the logic:

Now we’ll get the government saying, “OK, seeing that we
pay for your medical care, we’re going to decide what care you get and
what care you can’t have.”

And, more darkly, the specter of futile care emerges, because what
the President was saying was, “If we’re paying for stuff that doesn’t
make you healthier, we need to reconsider whether we want to pay for
this treatment.”

Note the phrase is “to make you healthier” - not to alleviate your
symptoms, or provide you with comfort care because you’re never going
to get healthier.

Simple: If treatment makes you healthy again, you get it. If it
can’t, you can’t have it, because we need it for people who can get
healthy again.

Pure, unadulterated futile care.

This is not far-fetched. Dr. Mostert is an expert on issues of
bioethics. Where he and others who have been on ‘America’s Lifeline’
worry this nation is heading is suddenly getting more imminent.

The government already knows that medical care in the
last weeks of life is where most medical dollars get spent. Same goes
for money spent on people with significant, although not necessarily
terminal disabilities. Marry that to the President’s commitment to cut
health care costs, a society that increasingly thinks helping people
die is just dandy, and a medical profession that is increasingly
utilitarian, and you have the perfect plan to make people with severe
medical problems, including those with disabilities, into Useless Eaters.

Obama continued:

So when . . . I talk about the importance of using
comparative-effectiveness studies as a way of reining in costs [which]
. . . is an attempt to say to patients, you know what, we’ve looked at
some objective studies out here, people who know about this stuff,
concluding that the blue pill, which costs half as much as the red
pill, is just as effective, and you might want to go ahead and get the
blue one. And if a provider is pushing the red one on you, then you
should at least ask some important questions.

Mostert translates:

Ah, “comparative-effectiveness,” “objective studies.”…Allow me to paraphrase my President:

Doctor to patient: “You know, what, we’ve looked at some objective
studies out here, people who know about this stuff, concluding that
there’s no point in treating you any further. We’ve concluded that the
blue pill, which will keep you comfortable until you die, is very
expensive. The red pill, that costs a tiny fraction of the blue pill,
can end your suffering quietly, effectively, and with dignity.”

Obama paves the way for what’s to come, soon:

Well, I think that there is going to have to be a
conversation that is guided by doctors, scientists, ethicists. And then
there is going to have to be a very difficult democratic conversation
that takes place. It is very difficult to imagine the country making
those decisions just through the normal political channels. And that’s
part of why you have to have some independent group that can give you
guidance. It’s not determinative, but I think has to be able to give
you some guidance. And that’s part of what I suspect you’ll see
emerging out of the various health care conversations that are taking
place on the Hill right now.

Here’s what Mostert makes of these arrangements:

Have “conversations” with the public under the guise of
measured reasonable argument. Subtly (and not so subtly) use doctors,
scientists and ethicists who are pro-death to lead the way. Shape
public opinion to utilitarianism, futile care, people as pure economic
entities, and then the resistance to assisted suicide, and, eventually,
euthanasia, will crumble.

Obama just finished holding a press conference this morning on the
push to pass his health care bill. “We don’t have any excuses,” he
said. “The stars are aligned.”

What they portend is another matter.


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