With charges, countercharges, information, disinformation, flat-out lies, and half truths being disseminated on all sides of the health reform debates, how is a poor citizen to learn the real story? Today begins the first in a series of occasional posts called Straight Talk that will sort out information and misinformation for readers who may feel themselves caught in the middle and not knowing who to believe. We invite you to send us examples of questionable claims on which you would like us to comment. Direct your questions to trudyal530 [at] aol.com. The entire series is archived here.
In mid-July, Betsy McCaughey, identifying herself as a former lieutenant governor of New York state and chair/founder of the Committee to Reduce Infection Deaths, penned op-eds in two editorially conservative newspapers: The Wall Street Journal and the New York Post. The first, published in the Post on July 17, rambled on about people being forced into “qualified” health plans with limited access to specialists and treatments. It sounded scary, but McCaughey didn’t tell readers that the term “qualified plans” may mean plans that will offer minimum benefits as protection against being underinsured and potentially bankrupt when illness strikes. That’s a good thing.
McCaughey then went on to mention “one troubling provision in the House bill” that, she said, “compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care.” She posited that the sessions cover “highly sensitive matters” and that the mandate “invites abuse.” Seniors, she said, “could easily be pushed to refuse care.”
The day before the Post published another of her op-eds, entitled “Deadly Doctors”, McCaughey appeared on former Sen. Fred Thompson’s radio show, saying that “Congress would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner”—an inaccurate assertion that apparently scared the bejesus out of Thompson’s listeners.
In the Journal op-ed, which was mostly about seniors being denied care, she offered more scary stuff. McCaughey claimed that the House bill:
Ensures that seniors are counseled on end-of-life options, including refusing nutrition where state law allows it (pp 425-446). In Oregon, some cancer patients are being denied care by the state that could extend their lives and instead are afforded the benefit of physician-assisted suicide instead.
To set the record straight, we checked in with Washington and Lee law professor Timothy Jost, an expert on consumer-driven health care. Jost told us that the bill allows Medicare to pay for voluntary consultations between doctors, nurse practitioners, and physician assistants about advance planning for the end of life. Medicare will pay for the service every five years, or more often if warranted by changes in a patient’s health. Consultations can cover such issues as hospice and palliative care, setting up a durable power of attorney, and advance directives which instruct medical providers about your wishes for end-of-life care. In my other writings, I have urged consumers to set these up, but according to Howard Brody, who directs the Institute for the Medical Humanities at the University of Texas, Galveston, only about one-quarter of Americans have done so.
“There is nothing new here,” Jost explained. The proposed legislation builds on the Patient Self-Determination Act of 1990, signed into law by George H.W. Bush. That law requires hospitals, nursing homes, hospices, and home health agencies to provide the same kind of information contemplated in the House bill. “Anyone who has been though the death of a parent knows the value of this service,” Jost said. “It is impossible to believe that this innocently got twisted into this ‘death panel’ legislation.”
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Please point me immediately to ANYone on the pro-reform side that has disseminated in any shape or form anything approaching the outright lies and disinformation that is being flung around from the right, or from the anti-reform sources.
That statement is one of the worst cases of "false equivalence" that I've seen in years. Your statement is in itself a flat-out lie, Ms. Lieberman. I suggest you revise it immediately. Lying about what pro-reform people are saying to obtain isn't helping matters.
Where are the statements from pro-reform side equivalent to DEATH PANELS and EUTHANASIA OF YOUR GRANDMOTHER? You want to know why "truth goes on the defensive"? Because of this kind of "false equivalence" that is perpetuated by supposedly mainstream writers like yourself.
#1 Posted by Tom, CJR on Fri 14 Aug 2009 at 06:26 AM
This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just alloca- tion of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future genera- tions, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example Is is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.
The above is not an invention of the right ... its not a manufactured quote coming out of the Palin RNC scare machine. It is a direct quotations from Dr. Ezekiel Emanuel health care advisor to President Obama.
It is people, monsters if you will, like Emanuel who were setting the both the tone of the health care debate and influencing the actually legislation as it was being crafted by congress. That people would get their noses bent out of shape about this should come as no surprise.
Like in many of these kinds of debates and issues there exists a mix of misinformation, disinformation, partially true but exaggerated, and good information coning from all sides. I am not surprised that Lieberman chooses to focus exclusively on the misinformation coming from the opponents of this monstrous cluster fuck of a bill and completely ignoring the misinformation coming from the side she is sympathetic to. After all, by doing this she doesn’t have to deal with all the lies and misinformation coning from he side.
#2 Posted by Mike H, CJR on Fri 14 Aug 2009 at 10:22 AM
Maybe part of the problem is that public health care already exists in parts of the United States. Massachusetts has public health. It is bankrupt. Hawaii set up a public health care plan that went under within seven months. And then there is Oregon. That state has a public health care plan. And Sarah Palin's predictions of Death Panel have come true. Both Fox News and ABC News have reported that seniors with tereminal illnesses are not only being denied health care treatment, but the state is sending out letters to these victims suggesting that they avoid the pain and cost of treatment by committing suicide. Furthermore, if the senior agree to choose suicide, the state is offering to pay them $50 to $100 to cover their expense!!!
Read these stories for yourselves:
Read the ABC story: http://abcnews.go.com/Health/Story?id=5517492&page=1
Read the Fox News story: http://www.foxnews.com/story/0,2933,392962,00.html
#3 Posted by Eric Munhall, CJR on Fri 14 Aug 2009 at 04:47 PM
Trying to change some people's minds will be like banging your head against a brick wall--most will never change. Last night on PBS Newshour with Jim Lehrer they had Mr. Armey from Texas giving no reasons or preferred plans. Whatever the official on the Obama staff said he either used one of the standing phrases or "I don't believe it can happen" How does he know it can't happen unless it's tried???? The business of "death panels" brings up the POSSIBILITY that a doctor or nurse can force them into giving up too soon or with no care whatsoever and charging them for it. We have laws against murder and robbery but for some funny reason we still have people thinking they can rob or steal and get away with it. There are wrong ways to doing just about anything and some one somewhere will misuse a good idea for the wrong reasons esp. if he/she can profit by that. End of life care is standard in many hospices and hospitals everywhere. This just makes it available for anyone and the Medicare fund will pay for it. A few minutes and a couple of papers per patient is not a lot of money and it saves a lot of grief if the state decides it has more of a say-so than a relative 500 miles away. There are numerous others that just need to be re-stated and re-stated hoping some will either give up or change their mind. Medical corporations are saying one thing to Obama and Congress and other things to the public usually under the auspices of a "non-profit" organization they set up. Look at the far-right Republicans?? Senator Grassley works against the bill and Obama every chance he gets- He did the same Monday or Tuesday this week at PBS Newshour starting out with many will lose their insurance to a government controlled- public option. The only way that may happen is if the employer drops his insurance and says the employee must get his/her own. He refuses to specify. Nor does he tell anyone that the employer that does that, if he has more than 25 people, will pay a fine on his taxes similar to the cost of insurance. Most union members require that of people that don't belong to the union. If they don't then they must pay the equivalent fine in their pay check to the employer. That's been with teachers' unions in Minnesota and California since the 1960's. The individual still chooses from a list of available insurance companies and pay according to what they want. Keep plowing along. But changing a lot of minds is not too feasible. Just hope you can get enough to make the Congress do as they should have 50 years ago. Tell the senators to put the counselling note back in!! Their week knees and lack of backbone have still not changed since Bush and 9/11. They are a sorry sight!!!
#4 Posted by Patricia Wilson, CJR on Fri 14 Aug 2009 at 06:27 PM
Mike H, you realize that Emanuel is writing an academic paper and is analyzing a position he doesn't necessarily agree with right?
You forgot this: "Communitarians endorse civic republicanism and a growing number of liberals endorse some version of deliberative democracy. …"
Basically, he's analyzing the position of communitarians. According to Emanuel, "services that promote the continuation of the polity-those that ensure healthy future genera- tions, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic" are substantive. On the other hand, he prefaces your bolded sentence with 'conversely' suggesting this may be what he considers the negative side of such a philosophy. Also, Emanuel has written against euthanasia and assisted-suicide in the past as well. Here's a quote from a Jan. 7, 1997, commentary written by Emanuel for the Wall Street Journal: "For the millions of others, legalizing euthanasia or physician-assisted suicide would be of no benefit. To the contrary, it would be a way of avoiding the complex and arduous efforts required of doctors and other health-care providers to ensure that dying patients receive humane, dignified care."
#5 Posted by Matt P, CJR on Sun 16 Aug 2009 at 02:02 PM
Mike H. should be angry, but not at Trudy Lieberman. First, Zeke Emanuel disavowed that quote in the NY Times withing th elast 2 days as something he said many years ago before he full understood the issue. As Lieberman writes, the legislative language being proposed has nothing to do with this. Even Sarah Palin previously in the campaign praised hospice care and said more people should be aware of the value of advance directives for end-of-life care. But Mike H. is right to be wary of lurking liberal intellectuals.
In fact, Emanuel and other "best and brightest" liberal bioethicists led Daniel Callahan of the Hasting Center, actively championed healthcare rationing, especially for the very old, despite little medical evidence that this made personal or economic sense. Callahan recommended denying high tech procedures to older people (at times he said 75 or 80), regardless of a person's individual consitutution, of technological advances, and most especially of a physician's assessment of a procedure's therapeutic value and the older person's probably post operative quality of life.
Callahan, now 79 was quoted in Saturday's NYT (Aug. 15) in Peter Steinfels' "Beliefs" column, after the elderly philosopher survived the kind of 7-hour heart surgery he'd have denied others. His nemisis for many years has been Prof. Robert H. Binstock of Case Western Reserve Univ., a genuine progressive who has well dissected Callahan's antice ovedr the years. Yet, his misbegotten scarcity thinking continues to get media interest.
Journalists need to know two things about this. One is that the public needs to be kept ever abreast of poorly considered ideas around rationing healthcare, even from the best minds. Callahan reminds me of the Rene de Carte quote, which translates rought as: "The greatest minds, as they are capable of the finest excellencies, and likewise able to render the worst aberrations." Watch for versions of the Calahan philosophy to play soon in a legislative body near you.
Most critically, though, Dr. Robert N. Butler, Pres. of the International Longevity Center (www.ilcusa.org) and first NIA director, has often said that the oft-cited factoid (by Callahan and others) that the greatest cost of care comes in the last 6 months presents a false understanding of costs in the health care system. In fact, he says, older people ARE denied life saving care every day. That's because pervasive ageism in the health professions results in elders commonly being dismissed and denied care. (Also, greater use of hospice and advance directives, although I'd agree well monitored use) would help reduce the misuse of high tech at the end of life.)
The tragic result of horrific poltiical shrikes like Sarah Palin (or, say, Jeb Bush and Sen. Bill Frist, MD, in the Terri Shiavo case) is that their hystrionics detreact from the potentila for public exposure to real dimensions of these vital debates.
#6 Posted by Paul Kleyman, CJR on Mon 17 Aug 2009 at 01:18 AM
If the "advance planning" for end-of-life provision is so troublesome to so many, then why doesn't Congress delete it? Is it really needed? What does it achieve (other than create much heat and passion), and is it vital to one's health care 24/7? Well...Ms Lieberman believes it is valuable because she says she has urged her readers to get this service, but sadly only 25% of the country has done so, according to medical experts. What's the problem: simply that many people do not share the same value system that the learned and erudite do, and, for goodness' sake, that just won't do! And, if these ill-educated, disadvantaged folks don't know what's good them, then we'll use the force and power of the state to change their minds/behavior. I suppose the world would be a better, perfect place if we all shared all the same values, but that's not going to happen. We, however, can count on the paternalistic state to try. Personally, I am "pro-choice".
#7 Posted by D. Matthews, CJR on Mon 17 Aug 2009 at 09:35 AM
D. Matthew, congress may end up deleting it as I believe one senate bill already has, but the counseling isn't required, so this widespread fear seems to be largely misplaced. There's the possibility the doctor may subtly pressure patients into it as they will get paid for providing it (not quite sure about that though), but nevertheless even if that is the case it is still voluntary since it isn't required. Also, should those in Congress really establish or continue a precedent where in they will give into an angry opposition even if that opposition is utilizing paranoia and fear mongering as their main tactics?
#8 Posted by Matt P, CJR on Mon 17 Aug 2009 at 01:33 PM
Trudy--Thank you very much for telling those three "gentlemen" off tonight on PBS and Newshour when they kept justifying the re-run re-runs of protester after protester after protester. I had hoped some of that "nonsense" they--all the channels and news outlets--would lighten up after the Comedy Hours with both Stewart and Colbert showing the ridiculousness of the statements from the voters and the humor of some of those such as Barney Frank. But no--they still think the protests are more important than analysis and explanation of certain parts of the Health bill. I had been cutting off all the news including Newshour last week just because it was too idiotic to waste time listening to. Protests are--as you said--EASY to report but they are "old hat" now. Besides if the individual wants to put them on Youtube--so be it! Don't waste our time on daily news reports. I hope they got your message. Again--THANK YOU!!!
#9 Posted by Patricia Wilson, CJR on Mon 31 Aug 2009 at 10:18 PM