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Post by StPetersburgHoya (Inactive) on Aug 14, 2009 6:21:47 GMT -5
Sorry but this will be long. There are about 307 million persons living in the U.S., about 46 million without health insurance, leaving about 261 million with insurance, 85%. The 46 million are without health insurance, not without health care, the law requiring anyone who shows up at an emergency room be given care. The 46 million persons living in America are composed of: - About 10 million illegal aliens (Rasmussen poll says 80% of the public are opposed to any public health care plan for illegals) - about 14 million, eligible for Medicaid or SCHIP, who would be enrolled automatically if they went to the hospital. A Georgetown University's Health Police Institute study shows that 70% of children who lack health insurance would get it if their parents enrolled in current government programs - of the remaining approximately 22 million, millions could afford insurance but choose not to get it. Census figures show 18.3 million of the uninsured were under 34 and may not see a need for insurance. In 2007, an estimated 17.6 million of the uninsured made $50,000 or more and more than 9 million made more than $75,000 a year. This leads to my estimate of between 8 and 10 million American citizens without insurance because they can't afford it, a far cry from 46 million. Instead of imposing an entirely new health system, it makes more sense first to do no harm to those 261 million with health insurance; and, then to provide health insurance for the other 8-10 million citizens. An example of how to do this. In 2007 there were 141,070,971 personal income taxes filed totaling $1,115,504,000,000. The Federal Employees Health Benefits (FEHB) program has a Blue Cross/Blue Shield Basic plan where the government pays 75% of the premium: in 2009 it pays about $3,300 per year for a single person. For 10,000 citizens without insurance if the government paid each $3,300 a year in the form of a voucher to buy insurance, it would cost $33 Billion each year. A 3% surtax on all income taxes could pay the $33 Billion to insure all American citizens. Everyone who pays income tax would be taxed at the same rate, the wealthier paying considerably more of the actual taxes. Merely an example to show we can provide "universal coverage" to all American citizens without an entirely new system. Ed - I think you're going to see a BlueCross/BlueShield plan being one of the plans offered in the marketplace. It's something that's been discussed quite favorably and I think will be included in the Senate Finance Committee version of the bill - which if I had to bet, is going to be the closest language to the final bill that gets passed out of conference. I disagree with the contention that 22 million can afford medical coverage but choose not to get it. Just going off of gross income and saying that certain people can afford medical coverage but refuse to get it is an oversimplification that ignores things like manageable debt thresholds and pre-existing conditions.
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Post by StPetersburgHoya (Inactive) on Aug 14, 2009 8:09:20 GMT -5
SIDENOTE: Ed, are you on facebook? Here's my responses to Palin's facebook post. In general, her arguments are at best self-serving and at worst show a willful aversion to being honest. Ok, so the section I quoted in the small text earlier is what we're dealing with. So Palin's critique is that Senior citizens are going to be snowed into killing themselves by their doctor's simply because ONCE every five years or when they enter a nursing home, their doctor asks them to consider getting a living will, advanced care directive, or considering the implications of hospice care? This is a pretty dim view of doctors. It pretty much assumes that: a) Doctors don't work for their patients b) A patient can't choose another doctor c) The Hippocratic Oath doesn't exist d) Medical ethics don't exist e) That 42 U.S.C. sec. 14402(a) doesn't exist (I'll discuss that later) Moreover, even if someone were coerced by their doctor into signing a medical directive or living will that stated something against their wishes, their family can go to court and challenge it because coercion and undue influence are defenses to enforcement of these agreements. So she seems to at best be on shaky ground here, and at worst looks to be fearmongering by throwing out a complete red herring. Untrue. Section 1233 begins: "Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended" What is 42 U.S.C. 1395x? It's the definitions section of the Miscellaneous Provisions of Medicare. Section 1233 does not authorize anything, it defines what the term "Advanced Care Planning Consultation" means. It doesn't require that a doctor do anything. This is a selective quote from the legislation that isn't put in context. It's actually the fifth thing included in the definition. The first 4 are: "planation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to" (i.e. "this is tough, you should talk to your spouse, kids, and pastor about this"); "explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses" (nothing scary here); "the role and responsibilities of a health care proxy" (similar to an advanced directive); and "a list of national and State-specific resources to assist consumers and their families with advance care planning" (pointing them to other resources, how terrible). Palin taking that section out of context makes it sound like the doctor is going to say "well you've lived a long life, there's a lot of ways for you to end it so you won't be a burden on your family" - that's simply untrue when you look at the other things included in the definition. Given, what she just did with context above, you know where we're going with this. For this Sara takes the remarkable step of dropping a footnote that cites to a PDF of the entire bill. Super specific footnote. However, assuming she's referring to the purpose on the face of the bill itself - the FULL purpose of the bill is: "To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes." Oh right, that's what "putting this in context" means - taking one part of the context and then leaving out the part about "quality healthcare." Given what she just did with taking the bill out of context and misstating what the section does, no, its no wonder ... First, Sara fails to mention that Charles Lane is an opinion columnist for the Post, not a reporter. In the article Lane notes how Medicare already allows your doctor to have this discussion with you(http://www.medicare.gov/health/physicalexam.asp "Starting in 2009, your doctor will also talk with you about end-of-life planning, including advance directives. Advance directives are legal documents that allow you to put in writing what kind of health care you would want if you were too ill to speak for yourself. Talking to your family, friends, and health care providers about your wishes is important, but these legal documents ensure your wishes are followed.") Charles Lane also notes: "On the far right, this is being portrayed as a plan to force everyone over 65 to sign his or her own death warrant. That's rubbish. Federal law already bars Medicare from paying for services "the purpose of which is to cause, or assist in causing," suicide, euthanasia or mercy killing. Nothing in Section 1233 would change that." So again, Sara Palin, taking things out of context to scare people. Interestingly, Palin includes the fact that the provision is not mandatory and that there is no penalty for refusing. She ignores the fact that these orders can be invalidated if they were based on coercion or undue influence. So again, taking things out of context with the intent of scaring people. This is my FAVORITE example of Palin taking things out of context. The VERY NEXT sentence after Robinson (again an opinion columnist of the Post, not a reporter) says the quoted phrase is: "It's irresponsible for politicians, such as Sarah Palin, to claim -- outlandishly and falsely -- that there's going to be some kind of "death panel" to decide when to pull the plug on Aunt Sylvia. But it's understandable why people might associate the phrase "health-care reform" with limiting their choices during Aunt Sylvia's final days." In addition, the entire article is about how Robinson wishes there was a debate on the moral obligation of providing health care, not railing against the Section 1223 as Palin would suggest. www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.htmlThey didn't say what you're attributing to them, so its kind of hard for them to be wrong. Sara Palin found a New York State Senator that wrote a letter. This has no weight. It ignores the fact that these conversations were already happening under Medicare and that they can be invalidate if they were actually coerced. Where is this in the bill? This is a complete canard. The President doesn't automatically hold the views of the people who advise him, and the Congresspersons who actually wrote the bill don't have the views of the people that don't advise them. For example, Larry Summers advises the President on the economic recovery, he also made statements once that there were inherent differences between men and women that mean that women will never be as good at math and science. I don't think this means that Obama automatically thinks that his wife and kids are automatically inferior. This is a ludicrous line of argument. Saying that "there are other provisions in the bill" that are bad, not saying what they are, and then saying that As I stated above, its ridiculous to say that someone holds the views of someone they talk to. This is the equivalent of the "palin' around with terrorists" line from the campaign. Palin has shown that she's not above the argument and like the last time she made it, it's going to foment anger that will force other Republicans to have pull back her statement or disassociate themselves from her. What evidence has she shown? Several portions of a bill that she took out of context, two Washington Post editorials she took out of context, and a letter from a State Senator ... In addition, Plain ignores the fact that 42 U.S.C. 14402(a) prevents the use of Medicare funds for assisted suicide, euthanasia, or mercy killing. www.law.cornell.edu/uscode/42/14402.htmlNotably absent from Palin's statement is an explanation of what she meant by "death panels", where you can find the death panel in the legislation, and how the death panel would work.
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Post by StPetersburgHoya (Inactive) on Aug 14, 2009 8:15:50 GMT -5
One more thing. I'm guessing since Sara Palin now believes that government-encouraged counseling regarding end-of-life decisions leads to "death panels" she should have declared April 16, 2008 "Death Panels Day" in Alaska instead. www.gov.state.ak.us/proclamations.php?id=1094What a hypocrite.
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SFHoya99
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Post by SFHoya99 on Aug 14, 2009 9:47:14 GMT -5
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EasyEd
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Post by EasyEd on Aug 14, 2009 11:09:25 GMT -5
St. Pete, a typical lawyer response, going over what Sarah Palin said and producing evidence to try to refute it. This is why I often have troubles with the lawyerly approach.
When my mother died she was 94 years old, somewhat forgetful, and very frail. Now imagine a doctor (or other) coming in, dressed in doctor garb, sitting down and telling her he'd like to discuss end-of-life issues, then telling her she does not have to have this conversation. But the doctor is now sitting there, is very nice, and so my mother (or yours or your grandfather) says, "yes, go ahead". Now this person (or doctor) calmly tells her she might consider taking measures that would reduce the cost to her family in her final days. He/she might say "do you want to have extraordinary measures to keep you alive or would you prefer not to have these measures used?" My mother (or yours) might say "I don't want extraordinary measures taken to keep me alive artificially". She has now given permission to withhold treatments, withhold fluids and nourishment, and to "pull the plug" if the attending doctor judges she is a goner anyway.
This is the realism of "end of life" discussions with an elderly person. Put down your legal books and look at the real world.
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Post by StPetersburgHoya (Inactive) on Aug 14, 2009 11:30:00 GMT -5
St. Pete, a typical lawyer response, going over what Sarah Palin said and producing evidence to try to refute it. This is why I often have troubles with the lawyerly approach. When my mother died she was 94 years old, somewhat forgetful, and very frail. Now imagine a doctor (or other) coming in, dressed in doctor garb, sitting down and telling her he'd like to discuss end-of-life issues, then telling her she does not have to have this conversation. But the doctor is now sitting there, is very nice, and so my mother (or yours or your grandfather) says, "yes, go ahead". Now this person (or doctor) calmly tells her she might consider taking measures that would reduce the cost to her family in her final days. He/she might say "do you want to have extraordinary measures to keep you alive or would you prefer not to have these measures used?" My mother (or yours) might say "I don't want extraordinary measures taken to keep me alive artificially". She has now given permission to withhold treatments, withhold fluids and nourishment, and to "pull the plug" if the attending doctor judges she is a goner anyway. This is the realism of "end of life" discussions with an elderly person. Put down your legal books and look at the real world. My response would be that stopping it because the person was susceptible to the influence of the doctor is a very real option and trying to dismiss it as a "lawyer" answer, makes it no less real.
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Post by jerseyhoya34 on Aug 14, 2009 11:32:00 GMT -5
I don't see in your example any evidence to suggest that the patient does not want the treatment requested, but, rather, evidence to suggest that you do not agree with the patient's request.
In another case (as raised last night by Rachel Maddow), I recall a similar phenomenon when a Court, after extensive and spirited briefing of the facts at issue, determined that Terri Schiavo did not wish for these kinds of end-of-life treatments. Her wishes in these regards were determined to be "credible" and "reliable." The patient's decision raised the ire of the right so much that the following events, among others, occurred:
1. President Bush cut short his vacation to sign emergency legislation.
2. Pro-life litigators petitioned the Supreme Court four times for cert and filed five federal lawsuits, among other things.
3. A congressional committee subpoenaed Schiavo with the hopes that she would then qualify for protection.
4. State legislators also got in the mix, but their efforts were struck down by the Supreme Court of Florida.
5. I suspect they hired/retained more lawyers to tackle this briefing. * * * * * My recollection was that these events took place in the real world, but, perhaps, some Republicans now wish they hadn't for the sake of consistency.
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Post by AustinHoya03 on Aug 14, 2009 12:54:01 GMT -5
When my mother died she was 94 years old, somewhat forgetful, and very frail. Now imagine a doctor (or other) coming in, dressed in doctor garb, sitting down and telling her he'd like to discuss end-of-life issues, then telling her she does not have to have this conversation. But the doctor is now sitting there, is very nice, and so my mother (or yours or your grandfather) says, "yes, go ahead". Now this person (or doctor) calmly tells her she might consider taking measures that would reduce the cost to her family in her final days. He/she might say "do you want to have extraordinary measures to keep you alive or would you prefer not to have these measures used?" My mother (or yours) might say "I don't want extraordinary measures taken to keep me alive artificially". She has now given permission to withhold treatments, withhold fluids and nourishment, and to "pull the plug" if the attending doctor judges she is a goner anyway. This is the realism of "end of life" discussions with an elderly person. Put down your legal books and look at the real world. Ed: First: this is not meant to be confrontational or a rejection of your views, just another perspective on the period at the end of a human being's life. My grandmother died in March 2008 at the age of 89. She had lived for over three decades with emphysema, and for the last five years of her life she was in and out of the hospital with pneumonia and lung conditions. In the fall of 2007 she told the doctors at her assisted living facility she no longer wished to be admitted to the hospital during these bouts of illness. She made this decision on her own, without the "consultation" of any doctor. When she got really sick in January 2008, she had to be given fluids and nourishment through a series of tubes. When her condition worsened further, the doctor had a "consultation" with her children (my aunt had some type of power of attorney/guardianship rights at this point), and stated that in his opinion, my grandmother could be kept alive for some time with this series of tubes and hospital treatment. However, in his opinion doing so would only prolong her physical pain, as she had clearly lost both the will and ability to live on her own. My point here is dual: first, not everyone wants medical treatment that will keep them alive for another day, month, or even year. Second, sometimes witholding fluids, treatment, and nourishment is medically and morally responsible. I lived a few blocks away from my grandmother in the spring of 2008, and after watching her die, I have no problem with a doctor with ethical responsibilities having a frank conversation with his/her patient regarding end of life options. If you have concerns regarding "somewhat forgetful old ladies" signing their lives away, perhaps we could overlegislate further and require that each patient be given a mental competency evaluation before signing on any dotted line.
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Post by StPetersburgHoya (Inactive) on Aug 14, 2009 15:14:51 GMT -5
Ed - I hope since you feel that government funding of counseling regarding end-of-life issues "in the real world," you'll agree with me that you should also be against the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (http://thomas.loc.gov/cgi-bin/cpquery/?&dbname=cp108&sid=cp108d60yh&refer=&r_n=hr391.108&item=&sel=TOC_2103579&) This bill stated: Which was voted for by such haters of life and killers of grandmothers like: John Boehner, Lamar Alexander, Jon Cornyn, Elizabeth Dole, Jim Inhofe, Orrin Hatch, Richard Shelby, Ted Stevens, Richard Lugar, Sam Brownback, Jeff Sessions, Thaddeus McCotter, Johnny Isakson, and Chuck Grassley, and was sponsored by people like John Sullivan and Roy Blunt. (source: www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=108&session=1&vote=00459)Or could it be that the right was for counseling before it was against it?
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EasyEd
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Post by EasyEd on Aug 14, 2009 16:00:59 GMT -5
When my mother died she was 94 years old, somewhat forgetful, and very frail. Now imagine a doctor (or other) coming in, dressed in doctor garb, sitting down and telling her he'd like to discuss end-of-life issues, then telling her she does not have to have this conversation. But the doctor is now sitting there, is very nice, and so my mother (or yours or your grandfather) says, "yes, go ahead". Now this person (or doctor) calmly tells her she might consider taking measures that would reduce the cost to her family in her final days. He/she might say "do you want to have extraordinary measures to keep you alive or would you prefer not to have these measures used?" My mother (or yours) might say "I don't want extraordinary measures taken to keep me alive artificially". She has now given permission to withhold treatments, withhold fluids and nourishment, and to "pull the plug" if the attending doctor judges she is a goner anyway. This is the realism of "end of life" discussions with an elderly person. Put down your legal books and look at the real world. Ed: First: this is not meant to be confrontational or a rejection of your views, just another perspective on the period at the end of a human being's life. My grandmother died in March 2008 at the age of 89. She had lived for over three decades with emphysema, and for the last five years of her life she was in and out of the hospital with pneumonia and lung conditions. In the fall of 2007 she told the doctors at her assisted living facility she no longer wished to be admitted to the hospital during these bouts of illness. She made this decision on her own, without the "consultation" of any doctor. When she got really sick in January 2008, she had to be given fluids and nourishment through a series of tubes. When her condition worsened further, the doctor had a "consultation" with her children (my aunt had some type of power of attorney/guardianship rights at this point), and stated that in his opinion, my grandmother could be kept alive for some time with this series of tubes and hospital treatment. However, in his opinion doing so would only prolong her physical pain, as she had clearly lost both the will and ability to live on her own. My point here is dual: first, not everyone wants medical treatment that will keep them alive for another day, month, or even year. Second, sometimes witholding fluids, treatment, and nourishment is medically and morally responsible. I lived a few blocks away from my grandmother in the spring of 2008, and after watching her die, I have no problem with a doctor with ethical responsibilities having a frank conversation with his/her patient regarding end of life options. If you have concerns regarding "somewhat forgetful old ladies" signing their lives away, perhaps we could overlegislate further and require that each patient be given a mental competency evaluation before signing on any dotted line. First off, as a Catholic it is never morally acceptable to withhold nourishment and fluids. If your grandmother had specified ahead of time that this was her specific preference I can accept that. If she had delegated via a medical power of attorney who was not a Catholic and if was a case of her being unable to make that decision herself, I can also accept that if the person with the medical power of attorney had no specific instructions from your grandmother. But, as you described it, the doctor, himself, appears to have advocated "pulling the plug" for reasons he regarded as good. This is where the problem arises and is a real life situation. Suppose that doctor was, in fact, a committee that was part of the Health Care "Reform" situation and there was a cost containment motive.......
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Post by StPetersburgHoya (Inactive) on Aug 14, 2009 16:04:37 GMT -5
Ed, you also realize that the person who first made these claims was Betsy McCaughey, a former NY lieutenant governor who is now a consultant with Manhattan Institute and Hudson Institute. She first made these claims on July 16th on the Fred Thompson show (http://www.politifact.com/truth-o-meter/statements/2009/jul/23/betsy-mccaughey/mccaughey-claims-end-life-counseling-will-be-requi/).
The Manhattan Institute's backers include Bristol-Myers Squibb, Exxon Mobil, Chase Manhattan, CIGNA, Sprint, Reliant Energy, Lincoln Financial Group Foundation, and Merill Lynch. (http://en.wikipedia.org/wiki/Manhattan_Institute)
The Hudson Institute is funded by, amongst others: Eli Lilly and Company, Monsanto Company, DuPont, Dow-Elanco, Sandoz, Ciba-Geigy, ConAgra, Cargill, and Procter & Gamble. (http://en.wikipedia.org/wiki/Hudson_Institute)
She was also on the boards of directors of Cantel Medical Group and Genta (http://www.nydailynews.com/news/2009/08/13/2009-08-13_former_lt_gov_mccaughey_leads_death_panel_charge_writing_up_talking_points_on_he.html#ixzz0O5VZS2Si)
Palin should have considered the source.
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Post by StPetersburgHoya (Inactive) on Aug 14, 2009 16:07:41 GMT -5
Ed: First: this is not meant to be confrontational or a rejection of your views, just another perspective on the period at the end of a human being's life. My grandmother died in March 2008 at the age of 89. She had lived for over three decades with emphysema, and for the last five years of her life she was in and out of the hospital with pneumonia and lung conditions. In the fall of 2007 she told the doctors at her assisted living facility she no longer wished to be admitted to the hospital during these bouts of illness. She made this decision on her own, without the "consultation" of any doctor. When she got really sick in January 2008, she had to be given fluids and nourishment through a series of tubes. When her condition worsened further, the doctor had a "consultation" with her children (my aunt had some type of power of attorney/guardianship rights at this point), and stated that in his opinion, my grandmother could be kept alive for some time with this series of tubes and hospital treatment. However, in his opinion doing so would only prolong her physical pain, as she had clearly lost both the will and ability to live on her own. My point here is dual: first, not everyone wants medical treatment that will keep them alive for another day, month, or even year. Second, sometimes witholding fluids, treatment, and nourishment is medically and morally responsible. I lived a few blocks away from my grandmother in the spring of 2008, and after watching her die, I have no problem with a doctor with ethical responsibilities having a frank conversation with his/her patient regarding end of life options. If you have concerns regarding "somewhat forgetful old ladies" signing their lives away, perhaps we could overlegislate further and require that each patient be given a mental competency evaluation before signing on any dotted line. First off, as a Catholic it is never morally acceptable to withhold nourishment and fluids. If your grandmother had specified ahead of time that this was her specific preference I can accept that. If she had delegated via a medical power of attorney who was not a Catholic and if was a case of her being unable to make that decision herself, I can also accept that if the person with the medical power of attorney had no specific instructions from your grandmother. But, as you described it, the doctor, himself, appears to have advocated "pulling the plug" for reasons he regarded as good. This is where the problem arises and is a real life situation. Suppose that doctor was, in fact, a committee that was part of the Health Care "Reform" situation and there was a cost containment motive....... Ed, in addition to passing judgment on someone else's family life, you got the bill wrong. There is no committee that sends a doctor to talk to you - its your physician who can do it if they choose to. Just like they can under the current Medicare rules and just like they could under the bill that a number of members of the Republican leadership voted for in 2003. Point to me where in the bill where the doctor is a part of a "committee."
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kchoya
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Post by kchoya on Aug 14, 2009 16:09:52 GMT -5
When my mother died she was 94 years old, somewhat forgetful, and very frail. Now imagine a doctor (or other) coming in, dressed in doctor garb, sitting down and telling her he'd like to discuss end-of-life issues, then telling her she does not have to have this conversation. But the doctor is now sitting there, is very nice, and so my mother (or yours or your grandfather) says, "yes, go ahead". Now this person (or doctor) calmly tells her she might consider taking measures that would reduce the cost to her family in her final days. He/she might say "do you want to have extraordinary measures to keep you alive or would you prefer not to have these measures used?" My mother (or yours) might say "I don't want extraordinary measures taken to keep me alive artificially". She has now given permission to withhold treatments, withhold fluids and nourishment, and to "pull the plug" if the attending doctor judges she is a goner anyway. This is the realism of "end of life" discussions with an elderly person. Put down your legal books and look at the real world. Ed: First: this is not meant to be confrontational or a rejection of your views, just another perspective on the period at the end of a human being's life. My grandmother died in March 2008 at the age of 89. She had lived for over three decades with emphysema, and for the last five years of her life she was in and out of the hospital with pneumonia and lung conditions. In the fall of 2007 she told the doctors at her assisted living facility she no longer wished to be admitted to the hospital during these bouts of illness. She made this decision on her own, without the "consultation" of any doctor. When she got really sick in January 2008, she had to be given fluids and nourishment through a series of tubes. When her condition worsened further, the doctor had a "consultation" with her children (my aunt had some type of power of attorney/guardianship rights at this point), and stated that in his opinion, my grandmother could be kept alive for some time with this series of tubes and hospital treatment. However, in his opinion doing so would only prolong her physical pain, as she had clearly lost both the will and ability to live on her own. My point here is dual: first, not everyone wants medical treatment that will keep them alive for another day, month, or even year. Second, sometimes witholding fluids, treatment, and nourishment is medically and morally responsible. I lived a few blocks away from my grandmother in the spring of 2008, and after watching her die, I have no problem with a doctor with ethical responsibilities having a frank conversation with his/her patient regarding end of life options. If you have concerns regarding "somewhat forgetful old ladies" signing their lives away, perhaps we could overlegislate further and require that each patient be given a mental competency evaluation before signing on any dotted line. You have to consider the context. I don't think anyone is arguing against doctors "having a frank conversation with his/her patient regarding end of life options." In fact, I think that's part of a doctor's responsibilities to help her patient make informed decisions about his or her health care. However, in the context of changing national health care policy and crafting legislation to help reduce the costs of health care, including legislative language for end-of-life counseling looks a lot different.
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EasyEd
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Post by EasyEd on Aug 14, 2009 16:20:43 GMT -5
Sorry but this will be long. There are about 307 million persons living in the U.S., about 46 million without health insurance, leaving about 261 million with insurance, 85%. The 46 million are without health insurance, not without health care, the law requiring anyone who shows up at an emergency room be given care. The 46 million persons living in America are composed of: - About 10 million illegal aliens (Rasmussen poll says 80% of the public are opposed to any public health care plan for illegals) - about 14 million, eligible for Medicaid or SCHIP, who would be enrolled automatically if they went to the hospital. A Georgetown University's Health Police Institute study shows that 70% of children who lack health insurance would get it if their parents enrolled in current government programs - of the remaining approximately 22 million, millions could afford insurance but choose not to get it. Census figures show 18.3 million of the uninsured were under 34 and may not see a need for insurance. In 2007, an estimated 17.6 million of the uninsured made $50,000 or more and more than 9 million made more than $75,000 a year. This leads to my estimate of between 8 and 10 million American citizens without insurance because they can't afford it, a far cry from 46 million. Instead of imposing an entirely new health system, it makes more sense first to do no harm to those 261 million with health insurance; and, then to provide health insurance for the other 8-10 million citizens. An example of how to do this. In 2007 there were 141,070,971 personal income taxes filed totaling $1,115,504,000,000. The Federal Employees Health Benefits (FEHB) program has a Blue Cross/Blue Shield Basic plan where the government pays 75% of the premium: in 2009 it pays about $3,300 per year for a single person. For 10,000 citizens without insurance if the government paid each $3,300 a year in the form of a voucher to buy insurance, it would cost $33 Billion each year. A 3% surtax on all income taxes could pay the $33 Billion to insure all American citizens. Everyone who pays income tax would be taxed at the same rate, the wealthier paying considerably more of the actual taxes. Merely an example to show we can provide "universal coverage" to all American citizens without an entirely new system. Ed - I think you're going to see a BlueCross/BlueShield plan being one of the plans offered in the marketplace. It's something that's been discussed quite favorably and I think will be included in the Senate Finance Committee version of the bill - which if I had to bet, is going to be the closest language to the final bill that gets passed out of conference. I disagree with the contention that 22 million can afford medical coverage but choose not to get it. Just going off of gross income and saying that certain people can afford medical coverage but refuse to get it is an oversimplification that ignores things like manageable debt thresholds and pre-existing conditions. First off, I estimated, repeat, estimated that there were 22 minus 8-10 million = 12-14 million who can afford insurance but choose not to get it. If you don't like the 12-14 million, choose another number. You're getting lost in the detail of my estimate rather than the concept. The concept is there are some millions of citizens who do not have insurance because they can't afford it. Let's solve that problem, along with doing no harm to the 261 million who do have insurance, rather than creating an entirely new health care insurance system. If my estimated 8-10 millions of uninsured citizens who cannot affort it is off, how about doing a poll or study to determine the real number and address that. Also, I proposed an example 3% surcharge but I'm not necessarily defending that. Instead, let's find a satisfactory solution to paying for those who can't afford the insurance. I'm proposing a concept, not a specific set of numbers. I realize this concept does not address cost containment. Seems to me, however, cost containment can be put off until later, if it's feasible. The administration and Congress are in danger of making no progress on reform because they want "universal health care" and cost containment and this appears to be too much in the current economic situation. The Blue Cross/Blue Shield was not a proposal for BC/BS insurance but merely to cite a specific example of what a basic insurance program under the FEHB program looks like. In actuality, I support competing programs, giving those uninsured a choice of programs, just like federal workers have.
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Post by HoyaSinceBirth on Aug 14, 2009 18:25:50 GMT -5
Ed: First: this is not meant to be confrontational or a rejection of your views, just another perspective on the period at the end of a human being's life. My grandmother died in March 2008 at the age of 89. She had lived for over three decades with emphysema, and for the last five years of her life she was in and out of the hospital with pneumonia and lung conditions. In the fall of 2007 she told the doctors at her assisted living facility she no longer wished to be admitted to the hospital during these bouts of illness. She made this decision on her own, without the "consultation" of any doctor. When she got really sick in January 2008, she had to be given fluids and nourishment through a series of tubes. When her condition worsened further, the doctor had a "consultation" with her children (my aunt had some type of power of attorney/guardianship rights at this point), and stated that in his opinion, my grandmother could be kept alive for some time with this series of tubes and hospital treatment. However, in his opinion doing so would only prolong her physical pain, as she had clearly lost both the will and ability to live on her own. My point here is dual: first, not everyone wants medical treatment that will keep them alive for another day, month, or even year. Second, sometimes witholding fluids, treatment, and nourishment is medically and morally responsible. I lived a few blocks away from my grandmother in the spring of 2008, and after watching her die, I have no problem with a doctor with ethical responsibilities having a frank conversation with his/her patient regarding end of life options. If you have concerns regarding "somewhat forgetful old ladies" signing their lives away, perhaps we could overlegislate further and require that each patient be given a mental competency evaluation before signing on any dotted line. First off, as a Catholic it is never morally acceptable to withhold nourishment and fluids. If your grandmother had specified ahead of time that this was her specific preference I can accept that. If she had delegated via a medical power of attorney who was not a Catholic and if was a case of her being unable to make that decision herself, I can also accept that if the person with the medical power of attorney had no specific instructions from your grandmother. But, as you described it, the doctor, himself, appears to have advocated "pulling the plug" for reasons he regarded as good. This is where the problem arises and is a real life situation. Suppose that doctor was, in fact, a committee that was part of the Health Care "Reform" situation and there was a cost containment motive....... The Churches position is a bit more complicated as I understand it than just " it is never morally acceptable to withhold nourishment and fluids." For the most part yes the church does not approve of the removal of feeding tubes once they are inserted. However it is ok to refuse them in the first place if you so choose( allowing yourself to die in a natural manner). In addition the church is ok with cessation of "extraordinary means." Unfortunately, this is one of the most poorly defined terms and is misunderstood and much debated even within the Church. In general, it's any mean that causes an unnecessary amount of harm to the patient. But again, what this means is hard to define. Another real problem for the church and for the medical community to define what death is. Is it the heart stopping? Is it loss of brain activity? All activity or just higher brain activity? Anyway these aren't clear cut issues that even the church has fully sorted out yet. There are cases when Feeding tubes can be removed even according to the church.
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EasyEd
Platinum Hoya (over 5000 posts)
Posts: 7,272
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Post by EasyEd on Aug 14, 2009 18:40:06 GMT -5
First off, as a Catholic it is never morally acceptable to withhold nourishment and fluids. If your grandmother had specified ahead of time that this was her specific preference I can accept that. If she had delegated via a medical power of attorney who was not a Catholic and if was a case of her being unable to make that decision herself, I can also accept that if the person with the medical power of attorney had no specific instructions from your grandmother. But, as you described it, the doctor, himself, appears to have advocated "pulling the plug" for reasons he regarded as good. This is where the problem arises and is a real life situation. Suppose that doctor was, in fact, a committee that was part of the Health Care "Reform" situation and there was a cost containment motive....... The Churches position is a bit more complicated as I understand it than just " it is never morally acceptable to withhold nourishment and fluids." For the most part yes the church does not approve of the removal of feeding tubes once they are inserted. However it is ok to refuse them in the first place if you so choose( allowing yourself to die in a natural manner). In addition the church is ok with cessation of "extraordinary means." Unfortunately, this is one of the most poorly defined terms and is misunderstood and much debated even within the Church. In general, it's any mean that causes an unnecessary amount of harm to the patient. But again, what this means is hard to define. Another real problem for the church and for the medical community to define what death is. Is it the heart stopping? Is it loss of brain activity? All activity or just higher brain activity? Anyway these aren't clear cut issues that even the church has fully sorted out yet. There are cases when Feeding tubes can be removed even according to the church. You are absolutely wrong on the Catholic Church's position on fluids and nourishment. It has been stated emphatically by the Vatican that food and fluids are normal, not extraordinary measures. The Diocese of Arlington makes available draft Advance Medical Directives that make this clear in an unambiguous manner. Check it out. Now back to the lawyers of the world.
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EasyEd
Platinum Hoya (over 5000 posts)
Posts: 7,272
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Post by EasyEd on Aug 14, 2009 18:57:17 GMT -5
One Vatican reference. www.usccb.org/comm/archives/2007/07-143.shtml"The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life," according to the Congregation's response. "It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented." There are a few exceptions given in the reference.
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Post by HoyaSinceBirth on Aug 14, 2009 19:47:35 GMT -5
So i'm wrong, Except you admit I'm right that there are exceptions
"Nor is the possibility excluded that, due to emerging complications, a patient may be unable to assimilate food and liquids, so that their provision becomes altogether useless. Finally, the possibility is not absolutely excluded that, in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort, for example resulting from complications in the use of the means employed."
This is exactly what I was talking about.
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Post by jerseyhoya34 on Aug 14, 2009 22:30:06 GMT -5
Some factual clean-ups of the alternative English interpretations of Dr. Emanuel's articles are offered here: tinyurl.com/lmdo58As with many philosophical/ethics texts, there are twists and turns that require some attention. I found Tapper's report to be a responsible treatment of the situation. I am not personally a fan of having Dr. Emanuel as an advisor due to my lukewarm view of his brother and disinterest in that kind of professional situation in the WH, but I think it is worthwhile to criticize Dr. Emanuel for factually accurate reasons. * * * * * I also found Paul Krugman's column this morning helpful in clarifying the misinformation about end-of-life consultations - tinyurl.com/nenh3j. I think most conservatives can appreciate that he is not in the tank for Obama and has been critical of many of his policies, particularly as they relate to the economy/stimulus. * * * * * As to the gratuitous attack on lawyers above, I think many on this board can do without it, particularly when the accusation at hand was that a poster was "going over what Sarah Palin said and producing evidence to try to refute it." It is a tall order given that Palin's writings on the subject at hand are largely in the realm of fantasy, and the poster making the accusations a few pages ago called on posters to challenge Palin/Bachmann on "the content of [their] words."
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Post by StPetersburgHoya (Inactive) on Aug 15, 2009 8:17:12 GMT -5
Since we're on the issue of religion and its relation to this healthcare plan. Since we are called to imitate Christ (1 Corinthians 11:1, John 13:15, Luke 6:40, 1 Peter 2:21, Matthew 16:24, 1 John 2:6), shouldn't a big part of doing that be caring for the "some millions of citizens who do not have insurance because they can't afford it," regardless of whether it does "harm to the 261 million who do have insurance"?
Isn't alms giving a big part of Christianity? (Matthew 6:1, Luke 11:41, Deuteronomy 15:7-11, Sirach 29:10-13, Luke 12:33, Luke 6:19-24)
Wasn't a large part of the ministry of Christ that we are called to follow caring for the sick who could not otherwise be helped by society? (Matthew 8:1-4, Matthew 8:5-13, Matthew 8:14-15, Matthew 8:16-17, Matthew 9:1-7, Matthew 9:18-22, Matthew 9:27-30, Matthew 12:9-13, Matthew 14:34-36, Matthew 15:29-31, Mark 1:29-31, Mark 1:32-34, Mark 1:40-45, Mark 2:1-12, Mark 3:1-6, Mark 6:53-56, Mark 7:31-37, Mark 8:22-26, Mark 11:46-52, Luke 4:38-39, Luke 4:40-41, Luke 5:12-16, Luke 5:17-26, Luke 7:1-10, Luke 7:12-17, Luke 13:10-17, Luke 14:1-6, Luke 17:11-19, Luke 18:35-43, John 5:1-9, John 9:1-17)
Or is it that your "concept" is more focused on giving to Ceasar what is Ceasar's and not one dollar more?
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