TheMiddleofSomewhere

Granted, saying that “Obama Care” provides for a “death panel” to make decisions about the level of one’s medical care is hyperbole. Of course there’s no mention in the frontrunning bill, H.R. 3200, of any “death panel.” I’ve read enough of that Bill, however, to see the likely genesis of that hyperbole, and it’s not particularly reassuring.

Have you wondered why President Obama hasn’t yet nominated anyone to be Surgeon General? I suggest that we keep an eye on that vacancy, because if H.R. 3200 becomes law, whoever is named Surgeon General will have enormous power.

The Surgeon General of the U.S. would chair an extensive Health Benefits Advisory Committee most of whose members would be appointed by the President. This panel would, within a year, propose standards of care for a couple of different levels of a federal health care plan to the Secretary of Health and Human Services, Kathleen Sibelius, one time executive director and chief lobbyist for the Kansas Trial Lawyers Association, who will decide whether to accept them.

Currently, we have an acting Surgeon General, a career Navy doctor, who, I am convinced, is just a place-holder. Remember that Dr. Sanjay Gupta from TV was being touted as the next S.G, but withdrew his name. I believe Dr. Gupta was mentioned to make people think that Obama was leaning toward appointing someone familiar and innocuous. This is more of Obama’s stalling. He would never appoint a left-wing Surgeon General before passage of the bill, for to do so would likely ensure its defeat. There’s much in the bill about the diversity of Advisory Committee members in the sense that they must represent labor, medical practitioners, private insurers, etc. And, oh yes, there’s a provision for collecting public input.  But knowing how all this could, in the final analysis, be manipulated, it’s still scary.

One of the President’s primary health advisors is Dr. Ezekiel Emanuel who has written that doctors “take the hypocratic oath too seriously.” Among other things, the oath says, “I (the physician) will apply … measures for the benefit of the sick according to my ability and judgment” (emphasis mine). I don’t believe Dr. Emanuel is, as some have implied, a “doctor death.” Rather he is an academician who theorizes about arcane points of medical ethics as though it would be possible to apply theory to practical decision-making with universally superior results. Would you want your doctor pausing to consider whether your care is justified in the context of the greater social good or have him/her getting on with the application of best medical practices? Care delayed could result in care denied. (–The problem, by the way, with establishing a whole new bureaucracy.)

When I imagine Dr. Ezekiel Emanuel as Surgeon General presiding over a committee made up overwhelmingly of Presidential appointees, reporting to Secretary Kathleen Sibelius who reports to the President I find it a highly unsettling scenario.

In the debate about Sarah Palin’s use of the phrase “death panels” in opposing complete overhaul of the nation’s health insurance, one point has escaped scrutiny. The highest payout for health care occurs during the last 6 months of an individual’s life. It is felt, by some, that one way to limit the overall costs of health care is to focus on reducing the costs realized during those final six months. Now, of course, this could be achieved by rationing the procedures, medications, hospitalizations, etc. provided during that period. Some describe this as “pulling the plug on grandma.” Some have even suggested that it would be an elderly person’s patriotic duty to forgo expensive medical treatment, you know, just step onto the ice-flow and sail off into oblivion.

The problem is that no one actually knows when a person’s last six months commence. True, old people do get sick, but they also recover. Often, they defy the odds; fall outside the statistical range of probability. Sometimes they experience “miracle” cures.

Some older people do remarkable things during their final days on earth,
Galileo lived to be 78. In 1640 he invented the first pendulum clock. At the time, he was within two years of his eventual death in 1642. Beethoven conducted the first performance of his 9th Symphony within 3 years of his death and had started composing a Tenth. Mozart died one day after conducting a performance of his uncompleted Requiem.

Are we expected to believe that, under Obamacare, a panel of bureaucrats, armed with actuarial tables, comparative life-expectacy statistics, and the like, will be prepared to decide when those “superfluous” last days begin?

One of the favorite arguments of proponents of Health Care reform is comparison of US life expectancy with life expectancies in other countries. The US is ranked 41st – 50th depending on the list one consults. These data are supposed to indicate (prove?) that other countries, especially those with socialized health plans, have better systems than we have. Even a cursory examination of comparisons of life expectancies reveals that it’s like comparing snakes and worms (as in “can of”). Citizens in different countries have disparate life styles, diets, histories, etc. all of which can affect life expectancy. For example, people born in the 1920’s who might have started out with a decent “from birth” life expectancy were suddenly faced with a little thing called “World War II.” When bombs start falling all bets are off.

With this in mind, I found it interesting to note that factors used to determine U.S. life expectancy include auto accidents, homicides, and military deaths. Since we drive more than just about anybody else, have a high homicide rate, and provide more of the manpower to fight wars than other countries our mortality rate goes up in comparison. As Disraeli said and Mark Twain repeated: “There are three kinds of lies: lies, damn lies, and statistics.”

Of course, auto accidents, murders, and war may point to more pressing concerns than health care. (Interestingly, more military personnel are surviving what used to be fatal battlefield wounds than ever before because of advances in medical treatment. But that’s another topic.)

The point here is that we should not accept that spurious claim that other countries have higher life expectancies than we do because they have superior (socialized) health care plans. As one list that ranked us 45th said, “This list does not directly reflect the quality of healthcare of the countries listed.”

At least that’s how it looks from here.