Overuse or Humane?

The following article appeared on page A - 11 of the San Francisco Chronicle

Health care reform: What is costly overuse, what is humane?
Katherine Dowling Schlaerth
Wednesday, July 29, 2009

President Obama has impressed me once again with his multifaceted talents.

Citing his grandmother's hip-replacement surgery as a personalized experience, he has made his case to deny aggressive and costly end-of-life care, and his concepts have been embodied in HR3200, "America's Affordable Health Choices Act of 2009," rocketing its way through Congress.

All of us would agree that putting a dying person through painful and useless procedures not only costs a lot, but also interferes with normal developmental tasks of the end of life, such as putting one's financial and spiritual house in order and saying goodbye to loved ones. To quote President Obama, we must correctly inform families who might otherwise approve of "additional tests or additional drugs that the evidence shows (are) not necessarily going to improve care." My problem, as a physician who has practiced medicine for decades, is that I just can't predict with certainty what is end-of-life care, nor can I determine for another individual the meaning of "quality of life."

I recall cases like that of the nonagenarian WWII veteran, comatose for days with multiple organ failure, who with the help of a loving family and dedicated ICU nurses walked out of the hospital, brain intact, to live a few more years.

I've seen "terminal" cancer patients kept alive long enough to hold a new grandbaby, and a 2-year-old's cancer-ridden body sustained for the weeks it took for his heartbroken parents to finally come to peace with his passing.

This current legislation, however, seeks to prevent such costly overuse of health resources through a program of "advance care planning consultation," wherein those on Medicare, or their families, could meet with a "practitioner of advance care planning" every five years, or sooner if illness supervened. Such an adviser need not be a physician, either.

This specialist would discuss care issues such as "the individual's desire regarding transfer to a hospital ... the use of antibiotics and the use of artificially administered nutrition and hydration." The discussion may, in fact, be triggered if "there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease."

I would be loath to talk a person on dialysis or in a wheelchair from a stroke into forgoing antibiotics for a pneumonia that may itself be treatable.

HR3200 has created tiers of administrators, who do not necessarily have medical experience. They will attempt to facilitate your end-of-life care, probably with the assistance of the electronic medical records each medical facility will shortly be required to use.

These and other provisions of the health choices act frankly scare me. As a physician, I took an oath long ago to put my patient's interests above all else, but provisions in the bill have a quality of coerciveness that make me wonder if I can fulfill my oath. Certainly they bear deeper inspection than possible during the brief monthlong look-see President Obama wants lawmakers to give this 1,000-page bill before passage.

Katherine Dowling Schlaerth is a practicing physician and associate professor emeritus of the University of Southern California School of Medicine.

This Is What It Says

Regarding healthcare reform, President Obama has said that no one will have to sacrifice. He has also said seniors should reconcile themselves to the difficulties of old-age and realize they should get less benefits.

A healthcare adviser to the President, Dr. Ezekiel Emanuel, brother to Rahm Emanuel, has written extensively on his beliefs about healthcare. In his writings he has stated that he believes no money should be spent on someone with an incurable disease.

Recently, Besty McCaughey, a health policy expert, has read the full house bill on healthcare reform. She has been reporting on what she read. In light of the Presidents statements and the beliefs of the people he surrounds himself with, we should not be surprised to see these "benefits" included in the healthcare reform bill:

• Over 10 years the Medicare budget will be cut by 500 billion dollars to pay for the healthcare reform provisions (this is roughly half of what the President has said reform will cost). [This likely means rationed care with fewer hip and knee replacements, bipass surgery and angioplasty-- all procedures that extend life and increase enjoyment and participation in activities.]
• On pages 425-430 a new benefit is found that requires mandatory counseling for seniors on end-of-life issues: how to refuse antibiotics, hydration, nutrition. After you reach a certain age a senior must receive this counseling every five years. If a senior becomes ill before the next scheduled counseling session, they must receive end-of-life counseling at that time.
• On pages 442-443 another benefit is described called "Shared Decision Making-- it will not be the patient and possibly their family who will be making healthcare decisions; doctors guided by government panels will also way in.

These are only a few the frightening provisions in the proposed healthcare reform.

There has got to be a better way to provide for those who do not have access to affordable insurance! Must we tell one group to die more quickly so that another group might have access to rationed care?

Contact Information

Below you'll find contact information for the elected officials to the federal government for SE Wisconsin. If you don't live in SE Wisconsin, use the link provided to find your officials.

http://www.congress.org/congressorg/officials/congress

Obama
The White House,
District of Columbia 20500
Phone: (202) 456-1414
Fax: (202) 456-2461

Kohl
Washington, D.C. Office:
330 Hart Senate Office Building,
District of Columbia 20510-4903
Phone: (202) 224-5653
Fax: (202) 224-9787
Committees:
*Appropriations Committee
*Committee on Banking, Housing, and Urban Affairs
*Judiciary Committee
*Special Committee on Aging: Chairman

Milwaukee Office:
310 West Wisconsin Avenue, Suite 950
Milwaukee, Wisconsin 53203
Phone: (414) 297-4451
Fax: (414) 297-4455
Milwaukee Office:
310 West Wisconsin Avenue, Suite 950
Milwaukee, Wisconsin 53203
Phone: (414) 297-4451
Fax: (414) 297-4455

Madison Office:
14 West Mifflin Street, Suite 207
Madison, Wisconsin 53703
Phone: (608) 264-5338
Fax: (608) 264-5473

Eau Claire Office:
402 Graham Avenue, Suite 206
Eau Claire, Wisconsin 54701
Phone: (715) 832-8424
Fax: (715) 832-8492

Appleton Office:
4321 West College Avenue, Suite 370
Appleton, Wisconsin 54914
Phone: (920) 738-1640
Fax: (920) 738-1643

La Crosse Office:
205 5th Avenue South, Room 216
La Crosse, Wisconsin 54601
Phone: (608) 796-0045
Fax: (608) 796-0089

Feingold
Washington, D.C. Office:
506 Hart Senate Office Building,
District of Columbia 20510-4904
Phone: (202) 224-5323
Fax: (202) 224-2725
Committees:
*Committee on Foreign Relations
*Committee on the Judiciary
*Select Committee on Intelligence
*Committee on the Budget

Middleton Office:
1600 Aspen Commons, Room 100
Middleton, Wisconsin 53562-4716
Phone: (608) 828-1200
Fax: (608) 828-1203

Ryan
Wisconsin-1st, Republican
1113 Longworth HOB
Washington, DC 20515-4901
Phone: (202) 225-3031
Committees:
* Committee on the Budget
* Committee on Ways and Means

Subcommittees:
* Health (Ways and Means)
* Oversight (Ways and Means)

The Assualt on Seniors

If you are a senior or love a senior, you need to listen to an interview and read this article: http://defendyourhealthcare.us/assaultonseniors.html

Interview can be downloaded here:http://fredthompsonshow.com/programhighlights the interview was on 8/27/09 and starts at minute 18 and goes to about minute 28.

Please pass this info on!