Category: Money

General interest/Health/Money/Politics & Causes/USA
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Tracking Down a Rumor

by Fran Johns

Rumors come, and don’t seem to go. Jim Rutenberg and Jackie Calmes of the New York Times have weighed in again today with a few facts… just in case anyone is interested in facts:

The stubborn yet false rumor that President Obama’s health care proposals would create government-sponsored “death panels” to decide which patients were worthy of living seemed to arise from nowhere in recent weeks.

Advanced even this week by Republican stalwarts including the party’s last vice-presidential nominee, Sarah Palin, and Charles E. Grassley, the veteran Iowa senator, the nature of the assertion nonetheless seemed reminiscent of the modern-day viral Internet campaigns that dogged Mr. Obama last year, falsely calling him a Muslim and questioning his nationality.

Rutenberg and Calmes point out that the doggedly persistent rumor “was not born of anonymous e-mailers, partisan bloggers or stealthy cyberconspiracy theorists.

Rather, it has a far more mainstream provenance, openly emanating months ago from many of the same pundits and conservative media outlets that were central in defeating President Bill Clinton’s health care proposals 16 years ago, including the editorial board of The Washington Times, the American Spectator magazine and Betsy McCaughey, whose 1994 health care critique made her a star of the conservative movement (and ultimately, New York’s lieutenant governor).

This is the core of what all reasonable people know:

There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure.

But as T/S Contributor Andy Geiger points out, the real issue in health reform is that people are suffering because they don’t have health coverage. Opponents to any reform at all have found a handy way to create this smokescreen by keeping everyone riled up with an utterly false rumor.

I’ve spent much of my adult life working for better end-of-life care, including being forever on a soapbox urging everyone, not just seniors, to consider their end-of-life options, have conversations, create advance directives and then get on with living. I strongly, fully support the good provision in the health care bills that may indeed now get cut.

But we need not to lose this forest for a tree. Rational people have got to continue fighting for a decent system, a decent bill.

False ‘Death Panel’ Rumor Has Some Familiar Roots – NYTimes.com.

Health/Money/Politics & Causes/USA
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End-of-Life Care is Losing to Lies

by Fran Johns

Here is some of the current worst news on health reform:

The Senate Finance Committee’s health care plan will not include provisions dealing with end-of-life care, now one of the more controversial topics in the health care debate, the committee’s top Republican said on Wednesday.

Senator Charles E. Grassley of Iowa said in a statement that the committee “dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly.”

If anyone knows misinterpretation, it’s Senator Grassley. He’s the originator of such enlightened parting phrases as the one he tossed out at an Iowa meeting Wednesday, about not wanting a health plan “that will pull the plug on grandma.” There is, of course, no grain of truth in that phrase, but its repetition does exactly what Sen. Grassley and his ilk wish: whip the opposition to any real reform into an emotional, unthinking frenzy. And they are winning the war against reason one battle at a time.

A Senate Finance Committee aide confirmed that the panel was not discussing end-of-life measures, adding that they were “never a major focus” of the committee’s negotiations.

House committees have passed legislation that would provide Medicare coverage for optional counseling sessions on end-of-life services.

But as people like Senator Grassley, and former N.Y. Lt. Governor Betsy McCaughey who sought fame and perhaps fortune by starting this whole flap, keep the country inflamed with misinformation the chances of decent legislation rising from these ashes grow dim.

The hopeless optimists of the land continue to believe that calls and letters and e-mails of sanity will convince our legislators that the country will rally around a decent bill… but Mr. Grassley and Ms. McCaughey are making optimism difficult.

via Senate Bill Will Not Address End-of-Life Care – Prescriptions Blog – NYTimes.com.

Health/Money/Politics & Causes
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Can We Hear It for Truth-Telling?

by Fran Johns

Although the They’re going to kill the grannies! campaign continues, some heavyweight voices of sanity are being heard above the roar. Sojourners founder/author/activist Jim Wallis weighed in Friday with a few choice words of wisdom:

I have said that one important moral principle for the health care debate is truth-telling. For decades, the physical health and well-being of our country has been a proxy battle for partisan politics. Industry interests and partisan fighting are once again threatening the current opportunity for a public dialogue about what is best for our health-care system. What we need is an honest and fair debate with good information, not sabotage of reform with half-truths and misinformation.

Yet in recent weeks, conservative radio ads have claimed that health-care reform will kill the elderly (it won’t), that it will include federal funding for abortion (it doesn’t), and that it is a socialist takeover of the health-care system (it isn’t). The organizations promoting these claims, including some Religious Right groups, are either badly misinformed, or they are deliberately distorting reality.

I think it’s all of the above. But what’s particularly frightening is the number of people who, hearing these messages over and over, are passing them along as presumed truth. My Inbox is having some dark days thanks to conservative friends wanting to know if I’m aware of one untruth or another. Because I have some conservative friends I like and respect, I try to listen, understand their points of view and keep lines of communication open — but it’s getting hard. Wallis cites one reason why:

A particularly egregious example is an ad that the Family Research Council has run in selected states. It depicts an elderly man and his wife sitting at their kitchen table. He turns to his wife and says, “They won’t pay for my surgery. What are we going to do?” He continues, “and to think that Planned Parenthood is included in the government-run health care plan and spending tax dollars on abortion. They won’t pay for my surgery, but we’re forced to pay for abortion.”

These kinds of ads should be stopped. They do not contribute to the debate that is needed to ensure that all Americans have access to quality, affordable health care. It is rather exactly the kind of misinformation campaign that could destroy needed reform.

It’s going to be a long, hard August.

Jim Wallis: Truth-telling and Responsibility in Health Care.

General interest/Health/Money/Politics & Causes/USA
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Ethical dilemmas for one and all

by Fran Johns

In case you don’t have enough medical/political/ethical dilemmas on your plate, William Saletan tossed out a hefty bunch, in last Sunday’s New York Times Book Review, to chew on:

The most powerful revolutions of our age aren’t happening in Washington, the Muslim world or the global economy. They’re happening in science and technology. At a pace our ancestors couldn’t have imagined, we’re decoding, replicating and transforming the human body. These revolutions are changing how we live, what we think and who we are.

Bodies used to be unalterably separate. Yours was yours; mine was mine. That isn’t true anymore. Organ transplantation has made human parts interchangeable. Thanks to aging and obesity, global demand for kidneys and liver tissue is increasing. Meanwhile, anti-rejection drugs and other innovations have turned more and more of us into potential donors. But supply isn’t keeping up with demand, so doctors, patients and governments are becoming more aggressive. Death is being declared more quickly so organs can be harvested. Rich people are buying kidneys from poor people. Governments are trying financial inducements to encourage donation. The latest proposals, outlined in Sally Satel’s “When Altruism Isn’t Enough: The Case for Compensating Kidney Donors” (2008), include tax credits, tuition vouchers and cash. As pressure grows from the left through socialized medicine, and from the right through free markets, organs will increasingly be treated either as a commodity or as a community resource.

The one that catches my eye (see Looking at One’s Own End-of-Life Choices, 7/30; Palliative Care: Rush Limbaugh vs the Grannies, 7/24, and a slew of other recent posts) is confronted in a reasonable, head-on fashion.

Beyond transplantation and mechanization looms the broader question of longevity. Over the last half-century, the age a 65-year-old American could expect to reach has increased by one year per decade. In 1960, it was 79. Today, it’s 84. Life expectancy at birth has passed 78 in the United States and 83 in Japan. We have no idea where these trends will end. It’s been just six years since we decoded the first human genome and less than two years since we learned how to make adult cells embryonic.

The cost of caring for old people will be enormous, but that’s just the beginning. We’re fixing and replacing worn-out body parts for older and older patients. How much life do we owe them?

The long-run solution, outlined by Robert N. Butler in “The Longevity Revolution” (2008), is to treat longer life as a resource, not just a goal. That means exploiting its benefits, like wisdom and equanimity, while focusing medicine and lifestyle changes on extending health and productivity rather than dragging out the last bedridden months.

It is well past time for us to stop looking at prolongation of life, regardless of quality, as the be-all-and-end-all of health care. Religious groups, right-wing factions and assorted others are screaming that even coverage of honest conversation with one’s physician about prognosis, treatment and options is going to shove people into early graves. But conversations of such sort, and civil discourse in general, are desperately needed.

OK, according to the above statistics this writer still has eight years before my projected demise; but I am definitely one of the grannies Mr. Limbaugh and his ilk profess to be protecting. Thanks very much; rather than drawn-out bed-ridden months I will take wisdom and equanimity any day, if our health care reformists will please focus on addressing health and productivity for all ages. Problem is, the voices of “protection” are drowning out the voices of reason. Which makes this not just a dilemma but a potential national tragedy.

Crossroads – You – The Updated Owner’s Manual – NYTimes.com.

Health/Money
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Waterfront Condos: More on the housing dilemma

by Fran Johns

Waterfront esplanade, expansive views from a sunny terrace, walk to the ballpark — what’s not to love about this housing choice?

Downsizing from a large, Victorian house filled to overflowing with the accumulations of two very active lives, the Langleys of San Francisco decamped, a few months ago, to a new, easy-care, sun-filled two-bedroom condo in the city’s happening-place Mission Bay neighborhood. They love the convenience, the mix of ages and cultures, the freedom from old-house maintenance worries and some unexpected bonuses like new friends living on houseboats from another era who are within conversation range of their 4th floor deck. “We (the new condo development) block the view they used to have all those years,” Judy Langley says, “but there are a lot of  trade-offs like getting the creek (which leads into San Francisco Bay) cleaned up, and the park over there…” For the newcomers, the young dog-walkers on the esplanade below, the middle-aged Chinese couple doing tai chi on the common lawn, it is an urban idyll.

Urban condos, even those without kayaks at the door and aged houseboats for neighbors, are an increasingly popular answer to the downsizing dilemma. But the dilemma remains huge and answers are seldom easy.

On the day the Langleys were hosting an Open House in their new digs, my sister was packing the last boxes from the high-ceilinged Boston condo that’s been her family’s home for decades. She and her husband are headed for a New York retirement community to which a physician daughter will also relocate from the west coast. Elsewhere this weekend a childhood friend was finalizing plans for a move from Northern Virginia to a coastal community where her husband will be able to live in a Memory Unit while she lives independently nearby.

These choices typify the variety of factors that go into contemporary downsizing decision-making: Is it affordable? Will I (or my parents) have the care that’s needed? Can life still be good (or even get better?)

And any of these families might also have considered co-housing. Yet another option for Boomers and Beyonders as well as for younger families and individuals, co-housing in some ways harkens back to a simpler, long-ago lifestyle and in other ways could only work in the 21st century. It was the topic of an OWL-sponsored panel discussion on Saturday, and will be tomorrow’s Boomers and Beyond topic.

General interest/Health/Money/Politics & Causes
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Palliative Care: Rush Limbaugh vs the Grannies

by Fran Johns

The patient was in four-point restraint, which means his hands and feet were tied to the bed. He was shouting over and over, in Spanish, “Help me!” but no help came. Until Diane Meier happened upon the scene.

The back story, she learned, was that the man had end-stage cancer for which he had declined treatment. After he fell at home, his adult children had found him on the floor and called 911, landing him back in the hospital. There, among other interventions that were put into play, a feeding tube had been inserted through his nose. When he repeatedly pulled it out, his hands were tied. After he then pulled it out three times with his knees, his feet were tied. You could say these treatments were being performed over the patient’s not-quite-dead-body.

“Why,” Dr. Meier asked, “is it important to have the feeding tube?” The attending physicians answered, “Because if we don’t, he’ll die.”

It was at this point that Diane Meier, M.D., F.A.C.P., already honored for her work in geriatrics and for her personal and medical skills, became a crusader for palliative care. “A light bulb went off,” she told a group of physicians and other professionals in the field today in San Francisco. “I realized it was an educational problem, and thus a solvable problem.” She saw that the doctors and nurses were only doing as they had been taught, and the results were distressing also to many of them. “All I did was say ‘It’s all right to care about your patient.'”

Meier’s pioneering efforts to shift care of critically ill patients from aggressive, often futile treatment to comfort care focusing on the patient instead led to formation of the Center to Advance Palliative Care, which she currently serves as Director. They also resulted in a MacArthur Fellowship she was awarded in September, 2008.

“The MacArthur,” says the self-effacing physician, “was in recognition of the tens of thousands of people working in palliative care.” But those tens of thousands are not enough to have eliminated the tragedies of patients such as the unfortunate man cited above. Walk the halls of almost any hospital, nursing home or similar institution in the U.S. and you will hear the incessant “Help me!” cries of people being treated over their almost-dead bodies.

Helping them with comfort care rather than aggressive treatment, though, is referred to by the Rush Limbaughs of the world as “Killing off the grannies.” It is a handy sound bite, and it is tilting the balance against sanity in our lurch toward health reform. Unless Mr. Limbaugh can convince me I’d rather be 4-point-restrained with a tube inserted in my nose than gently treated with comfort care when I encounter my next critical illness, this particular grannie would appreciate his butting out of my rights. Palliative care should be a right.

It is, unfortunately, a campaign of the political right to keep palliative care out of health reform. They will prevail, Dr. Meier said, unless voices of sanity are raised, whether Democrat or Republican. She urged her audience, representative of a wide variety of compassionate groups, to help get the message out and get the calls, e-mails and letters in. Legislators behind the three bills working their way through Congress, she said, need to hear from the citizenry.

The citizenry is unquestionably in favor of comfort, and where palliative care can be understood it is welcomed. Hosting Dr. Meier’s informal talk were the California HealthCare Foundation, the California Coalition for Compassionate Care, Archstone Foundation and the University of California, San Francisco, four of many organizations committed to making palliative care understood, available and effective.

The question of whether they or Rush Limbaugh will prevail is as yet unanswered. Having Mr. Limbaugh forming our health policy, though, is almost as scary to this granny as 4-point restraint.

General interest/Health/Money/Politics & Causes
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Health Reform 101 for Seniors

by Fran Johns

At an annual reunion gathering of California Senior Leaders today at the University of California, Berkeley, AARP California Executive Council member Bob Prath (himself a CA Senior Leader) made a valiant effort at outlining key segments of the proposed Health Reform bill which are of primary concern to over-50 generations.

Those segments include, in no specific order of significance or degree of complexity: guaranteed access to affordable coverage for Americans 50 to 64; closing the Medicare Part D coverage gap (known to insiders and more than a few others by now as the “doughnut hole”); approving generic versions of biologic drugs; preventing costly hospital readmissions by creating a follow-up care benefit in Medicare to help people transition to home; increasing funding for home-and-community-based services through Medicaid to help people stay in their homes and out of institutions; and improving programs that help low income Americans in Medicare afford needed drugs.

If that list of details seems daunting, it was not so to the Senior Leaders. Word had already circulated that Prath had read the entire 3,000+ pages of the bill, and no eye was going to glaze over. Covering it all, though, despite a carefully prepared power point presentation, was somewhat of a challenge in the after-lunch time whittled down to less than 30 minutes by the irrepressible tale-sharings of the reunion attendees.

Prath was asked, afterwards, for suggestions of where and how anyone over 50 might find concise and useful information, short of undertaking his own feat of studying 3000+ pages. Much, he says, can be learned through Health Action Now, and those worried about exorbitant drug bills can get some good, practical help from a nifty AARP brochure, “Don’t Dump Dollars into the Doughnut Hole.”

More enlightenment from the time-squeezed power point will appear in this space over the next few days.

General interest/Health/Money
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Affordable Health Reform

by Fran Johns

It was actually spoken out loud on NewsHour Friday night: we could have a workable, affordable healthcare system if we would address the excessive costs that go into the last six months of life, particularly the last few days. The remark was immediately followed by the standard caveat: of course, no one is going to suggest doing this.

Good grief, why not? Everybody knows it, a few others have even said it out loud. Sure, it’s political suicide, but if someone were ever brave enough to fall on that particular sword there would be a lot of people around to pull out the sword, cleanse the wound and stand him or her back upright.

It could be done. If individual choice were encouraged and enabled. If physicians had to be honest about the quality of life (if any, usually for a few days or weeks) being bought with aggressive treatment at life’s end. If futile treatment were avoided. If protections were put in place for physicians and hospitals complying with the above, since fear of lawsuit is behind most of the mess. If all of us began to look at — and make clear — what extreme measures we would or would not want.

Big ifs. But the reward would be a workable, affordable system.

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