T Nation

The Death Panel

Fans of Obamacare decry “the death panel” panic as idiocy; critics insist it is inevitable.
I say the model for it is already in operation, silently, and beneath scrutiny. It will be the unfortunate death that informs us.


Friday at 5 pm I was called for an old man who had been hospitalized since early May. He had had an acute MI, and a difficult CABG (coronary artery bypass graft) and a series of medical misadventures. Now he was in renal failure, on dialysis, multiple organs were failing, and he was bleeding from every pore and needle stick, and anemic.

Astute clinician that I am, I elaborate a set of diagnoses, start an empiric therapy (plasmaharesis) and he stabilized. As labs return I am more and more convinced that he has a rare disorder, and by Monday, I am sure of it. He requires a unique medicine, FDA approved for this purpose, once a week: it is life-saving and (the company insists) may be life-long treatment (I happen to disagree.) Oh, btw, the drug company will charge $150,000 retail per year for the drug alone.

I am told by the hospital pharmacy that it is “off-formulary” and I will have to fill out paper work. I do so: this is an FDA=approved medicine for an FDA-approved indication. MediCare patients cannot be denied safe and effective therapy. I am told however, that I am overruled: the medicine is expensive and is “only available as an outpatient infusion.” This is not so; it should be available in any venue, and unless he gets this medicine, he will not survive to be an outpatient. “No,” I am told, and i demand to speak to the supervisor, an unnamed–and apparently ineffable–“ChargeMaster,” who won’t be available anyway for a week. I have to speak to the Chief Hospital Administrator.

Next: I speak to the Drug Company. They are forbidden by the FDA and regulation to speak about MediCare, but the inferred revelation is this: MediCare pays the hospital for a patient’s care by his “DRG” (diagnosis-related group). THe patient has exceeded his payment for heart attack DRG by over $1 million.

So…the hospital wants me to continue ineffective therapy for $10,000 per day rather than give a curative therapy for $8000 per week.
And…they send in the “palliative care specialists” to convince the family to let him die a peaceful death. The patient, incidentally, is mentally clear, can make his own choices, and can converse with me in 3 of of his seven languages (I do not know American sign language or Hungarian.)

Short story: no one will know that a curative expensive medicine is withheld from the elderly because of hospital budgeting policy, in defiance of human rights. The tracks are hidden.


Now: flash forward to Obamacare. A central feature of this mess will be something called the ACO (Accountable Care Organization) or the “Medical Home.” The Orwellian name is designed to funnel money through insurance companies to the ACO (which will inevitably be dominated by the hospitals, which will decide who gets paid for what.) The ACO will have all sorts of regulations and policies.

Can we expect Obamacare to more responsive to the dependent individual in acute need, or to budgeting constraints? There will not be the “death panel” as envisioned by Sarah Palin, but there already is a model in place: the silent euthanasia by regulation.

Thanks for sharing, and sorry to hear that

I was thinking earlier today about all this climate change shit and I finally just gave in and have decided that none of it really matters. Whether or not we can prevent/slow down/ reverse any of it is immaterial in my mind now.

PEOPLE are the problem, not what we actually do to the environment. All this bullshit about trying to save lives and all that really just isn’t that great for the planet at all. I say have at it with all the booze and cigarettes and fatty foods and all of that shit. Flu shots? Fuck 'em. Speed limits? Who needs those? Safety features in cars? Why make the companies put that much more money into their products?

It’s occurred to me that it is completely hypocritical or ignorant or short-sighted for all these liberals to push the environmental shit down our throats and then turn around and tout some healthcare program that will allegedly save lives or increase our life spans. Increasing our life span is the LAST thing this planet needs. I HOPE that Obamacare has some sort of death panel. It would be good for the whole planet to start knocking off a bunch of people left and right.

[quote]DBCooper wrote:
…I HOPE that Obamacare has some sort of death panel. It would be good for the whole planet to start knocking off a bunch of people left and right. [/quote]

I hear that there is room for you at the head of the line.


It may come as a surprise to you, but you will not be one of the deciders. You will be the unwitting object of others’ decisions. Good luck, there.

[quote]DrSkeptix wrote:

[quote]DBCooper wrote:
…I HOPE that Obamacare has some sort of death panel. It would be good for the whole planet to start knocking off a bunch of people left and right. [/quote]

I hear that there is room for you at the head of the line.


It may come as a surprise to you, but you will not be one of the deciders. You will be the unwitting object of others’ decisions. Good luck, there.

[/quote]

Yeah, I’ll save you a spot up there in front too, pal.

It’s just a fatal flaw in being a human, I suppose. We’re really the only species on the planet that turns death into such a tragedy. Animals die and the rest just sort of go on with life as if nothing ever happened after a little while. But we spend countless amounts of money trying to prolong our lives and stave off the inevitable for another few years or so. And then we turn around and lament the damage that we do to the environment. I get it. No one wants people to start dying off in large numbers and no one wants the quality of life on this planet to diminish. But the reality is that there is only so much to go around. Life is a zero-sum game in that respect.

Humans want what’s best for humanity, but what’s best for humanity is less humans. And we’re stuck in this mindset that what is best for humanity is prolonging everyone’s lives for as long as we possibly can. I mean, do you realize how much money is wasted trying to stave off death at the end of our lifetime’s for another year or six months or whatever? If we just accepted the writing on the wall when we were hit with terminal cancer or whatever instead of racking up crippling healthcare costs trying to beat those 100 to 1 odds against us, the entire nature of this country’s economy, and probably the rest of the world’s, would be radically different.

[quote]DBCooper wrote:

It’s just a fatal flaw in being a human, I suppose. We’re really the only species on the planet that turns death into such a tragedy. Animals die and the rest just sort of go on with life as if nothing ever happened after a little while. But we spend countless amounts of money trying to prolong our lives and stave off the inevitable for another few years or so.[/quote]

Maybe there are like…you know, fumdamental differences between human beings and other animals on the planet or something…you think?

This post was flagged by the community and is temporarily hidden.

This post was flagged by the community and is temporarily hidden.

I love it when progressives whip out the either-or fallacy. Either government takes total control of our lives, or we descend into utter chaos.

Let’s just completely rule out the options in the middle - you know, the ones where people are responsible for their own actions, or the ones where anyone can do a better job than a centralized federal government at just about anything.

Nope. No siree-bob. We need the government telling us how big our mythical carbon footprint can be. We need the fed telling us what kind of health insurance is acceptable, what kinds of treatment is best for us, and when it is time to take two aspirin, assume the fetal position and die.

At least animals don’t have a board of unelected, unaccountable policy-wonks making the when-to-die decision for them.

[quote]SexMachine wrote:

[quote]DBCooper wrote:

It’s just a fatal flaw in being a human, I suppose. We’re really the only species on the planet that turns death into such a tragedy. Animals die and the rest just sort of go on with life as if nothing ever happened after a little while. But we spend countless amounts of money trying to prolong our lives and stave off the inevitable for another few years or so.[/quote]

Maybe there are like…you know, fumdamental differences between human beings and other animals on the planet or something…you think?[/quote]

No shit, Sherlock. I’m just saying, what makes us human unique is also what makes us tragic figures on this planet in a certain way.

[quote]drunkpig wrote:
have a board of unelected, unaccountable policy-wonks making the when-to-die decision for them.
[/quote]

Bolded the part that irks me personally.

Seems somewhat related. I’m not making commentary on Palin here so save the strawmen, I’m judging the content of her statement, and it seems to make sense…

[quote]DBCooper wrote:

If we just accepted the writing on the wall when we were hit with terminal cancer or whatever instead of racking up crippling healthcare costs trying to beat those 100 to 1 odds against us, the entire nature of this country’s economy, and probably the rest of the world’s, would be radically different.[/quote]

As much as we’ve differed on other issues, I think we’re on the same or similar pages here. Until we get brains in pickle jars and intelligence(s) backed up in the cloud, striving for immortality is wishing in one hand while shitting in the other (or shitting in our children’s hands depending on how you think about it).

I would, however, say I’m a against a death panel as created through Obamacare (or any other executive action) though, as the past and present clearly indicate, even if you/we explicitly forbid the death panel from out and out killing people, an executive order, special exception, or rogue administration official would make it legal and use it as a tool to infringe on others’ personal freedoms.

As sad as the OP’s story is, an old man with MI and multiple organ failure is lucky to get to let alone leave whatever hospital they’re admitted to (even without the organ failure). Even if they leave, they aren’t going out in the same condition they came in (esp. w/renal failure). Lastly, even when they do ‘walk’ out, the odds are near certain that their next visit will be sooner rather than later and that it will probably be their last. There are numerous studies that indicate that healthcare professionals will recommend and perform treatments that they themselves wouldn’t undergo. The Hippocratic oath makes no consideration for differences in the idea of harm and necessitate things like DNR orders, living wills, etc.

Personally, depending on circumstances, right around 70-75, I plan on a warm coat, warm boots, a good rifle, maybe enough cash for Xmas cards, and a long hike North. I advocate dueling for similar reasons; there’s a highly political climate activist with whom I’d probably stake my future carbon footprint against his if it could somehow be seen as legitimate or at least respected.

We can’t all go out like this;

http://www.examiner.com/article/satwant-singh-kaleka-and-lt-brian-murphy-american-heroes

But there’s certainly more dignified ways of going out than lying on my/our backs consuming my/our childrens’ income.

[quote]countingbeans wrote:

[quote]drunkpig wrote:
have a board of unelected, unaccountable policy-wonks making the when-to-die decision for them.
[/quote]

Bolded the part that irks me personally.

Seems somewhat related. I’m not making commentary on Palin here so save the strawmen, I’m judging the content of her statement, and it seems to make sense…[/quote]

My wife works in Pediatric Lung Transplants. She can not speak to this child’s specific situation, but she is very angry with how the media is portraying this little girl and making the hospital look like a bunch of a@@munches. Of the 19 pediatric lung transplants done in 2011 my wife’s team did 12 of those. This girl is not even listed so she can not get a lung transplant. There is a reason why this girl is NOT listed the question is why? There is something going on that the Hospital can not talk about (HIIPA) that the mother is twisting to make everyone look bad. Also just because you get a lung transplant does not mean you will live. I think 50% of all lung transplant recipients die with in 2 years and 75% die within 5 years. Lung Transplants are very risky, and taking an adult lung, cutting it down to size to fit the chest cavity of a child is even more risky.

In this situation the government is correct.

Wait until you face death, right in the face, we will then see how eager you are for death panels.

When you are losing 3 lbs of bodyweight a day, while being NPO (no food or water by mouth, just IV fluid and this white milky-looking shit called TPN going through your vein), you will find throwing an IV pole at a world renowned doctor to be much more effective than simply whining that you do not want to die.

[quote]dmaddox wrote:

In this situation the government is correct.[/quote]

Yeah, I’m not trying to say it is or isn’t. I am not educated enough in the matter to say. What is pickles about the situation is the fact the government is involved AT ALL, and on any level, in the choice to have or not have this girl get a set of lungs.

If a group of doctors got together and decided it was best for the lungs to go to a different person on the list, so be it. I have a problem with bureaucrats and fuckign Senators involved in the conversation.

[quote]countingbeans wrote:

[quote]dmaddox wrote:

In this situation the government is correct.[/quote]

Yeah, I’m not trying to say it is or isn’t. I am not educated enough in the matter to say. What is pickles about the situation is the fact the government is involved AT ALL, and on any level, in the choice to have or not have this girl get a set of lungs.

If a group of doctors got together and decided it was best for the lungs to go to a different person on the list, so be it. I have a problem with bureaucrats and fuckign Senators involved in the conversation. [/quote]

I agree.

[quote]dmaddox wrote:

[quote]countingbeans wrote:

[quote]dmaddox wrote:

In this situation the government is correct.[/quote]

Yeah, I’m not trying to say it is or isn’t. I am not educated enough in the matter to say. What is pickles about the situation is the fact the government is involved AT ALL, and on any level, in the choice to have or not have this girl get a set of lungs.

If a group of doctors got together and decided it was best for the lungs to go to a different person on the list, so be it. I have a problem with bureaucrats and fuckign Senators involved in the conversation. [/quote]

I agree.[/quote]

In the case of a transplant there are no bureaucrats or politicians involved. There are strict criteria that must be met to be placed on the list and one of these is survivability. There are however outside aspects that do affect the decision such as what hospital you are at and if they specialize in that procedure.

[quote]Testy1 wrote:

[quote]dmaddox wrote:

[quote]countingbeans wrote:

[quote]dmaddox wrote:

In this situation the government is correct.[/quote]

Yeah, I’m not trying to say it is or isn’t. I am not educated enough in the matter to say. What is pickles about the situation is the fact the government is involved AT ALL, and on any level, in the choice to have or not have this girl get a set of lungs.

If a group of doctors got together and decided it was best for the lungs to go to a different person on the list, so be it. I have a problem with bureaucrats and fuckign Senators involved in the conversation. [/quote]

I agree.[/quote]

In the case of a transplant there are no bureaucrats or politicians involved. There are strict criteria that must be met to be placed on the list and one of these is survivability. There are however outside aspects that do affect the decision such as what hospital you are at and if they specialize in that procedure. [/quote]

I think the Hospital the girl is at is the largest issue.

[quote]dmaddox wrote:

[quote]Testy1 wrote:

[quote]dmaddox wrote:

[quote]countingbeans wrote:

[quote]dmaddox wrote:

In this situation the government is correct.[/quote]

Yeah, I’m not trying to say it is or isn’t. I am not educated enough in the matter to say. What is pickles about the situation is the fact the government is involved AT ALL, and on any level, in the choice to have or not have this girl get a set of lungs.

If a group of doctors got together and decided it was best for the lungs to go to a different person on the list, so be it. I have a problem with bureaucrats and fuckign Senators involved in the conversation. [/quote]

I agree.[/quote]

In the case of a transplant there are no bureaucrats or politicians involved. There are strict criteria that must be met to be placed on the list and one of these is survivability. There are however outside aspects that do affect the decision such as what hospital you are at and if they specialize in that procedure. [/quote]

I think the Hospital the girl is at is the largest issue.
[/quote]

Probably true, but more than that it is probably laypeople that don’t understand the process. This girl could very well be too sick to survive a transplant, hence why she is not on the list. It is heartbreaking I know, and if it was my child I’m sure I would raise holy hell, but they are not going to do a transplant just to see it thrown away. The shortage is just too critical.

With that said, sign your donor card or state registry people.

[quote]Testy1 wrote:

[quote]dmaddox wrote:

[quote]Testy1 wrote:

[quote]dmaddox wrote:

[quote]countingbeans wrote:

[quote]dmaddox wrote:

In this situation the government is correct.[/quote]

Yeah, I’m not trying to say it is or isn’t. I am not educated enough in the matter to say. What is pickles about the situation is the fact the government is involved AT ALL, and on any level, in the choice to have or not have this girl get a set of lungs.

If a group of doctors got together and decided it was best for the lungs to go to a different person on the list, so be it. I have a problem with bureaucrats and fuckign Senators involved in the conversation. [/quote]

I agree.[/quote]

In the case of a transplant there are no bureaucrats or politicians involved. There are strict criteria that must be met to be placed on the list and one of these is survivability. There are however outside aspects that do affect the decision such as what hospital you are at and if they specialize in that procedure. [/quote]

I think the Hospital the girl is at is the largest issue.
[/quote]

Probably true, but more than that it is probably laypeople that don’t understand the process. This girl could very well be too sick to survive a transplant, hence why she is not on the list. It is heartbreaking I know, and if it was my child I’m sure I would raise holy hell, but they are not going to do a transplant just to see it thrown away. The shortage is just too critical.

With that said, sign your donor card or state registry people.[/quote]

Agree 100%. I feel bad for this child because she did nothing wrong to be in this situation.

I have signed my donor registry, and all of my family knows I do not need anything if I am dead so give it to people that need it.

I had it out with my Mother-in-law on my wife’s wishes. My wife wants to give away all her organs also. My mother-in-law was like no I want to barry my daughter whole. I told her that I am her husband and I make the decisions. Also my mother-in-law’s sister and cousin both had a liver transplant, so I had to throw that at her. It was very sobering for her.