Death Panel

Sara Palin has a lot of followers. The Associated Press (August 8^th) noted her first “post-gubernatorial” edict: “Palin called President Barack Obama's health plan ‘downright evil’ [on August 7^th] in her first online comments since leaving office, saying in a Facebook posting that he would create a ‘death panel’ that would deny care to the neediest Americans… ‘The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care,’ the former Republican vice presidential candidate wrote.”

OK, the debate is on. The President did say that the biggest expense in our healthcare system was focused on extending the lives of the elderly, often at hideous cost (averaging $20K a day in the last year of life) with exceptionally unspectacular results and some pretty terribly painful treatments. So we should kill the old bastards, tell them they are out of luck on the care they want and kiss them off? Not exactly. OK, not even close.

Charles Lane writing in the August 8^th Washington Post: “Enter Section 1233 of the health-care bill drafted in the Democratic-led House, which would pay doctors to give Medicare patients end-of-life counseling every five years -- or sooner if the patient gets a terminal diagnosis…. On the far right, this is being portrayed as a plan to force everyone over 65 to sign his or her own death warrant. That's rubbish. Federal law already bars Medicare from paying for services ‘the purpose of which is to cause, or assist in causing,’ suicide, euthanasia or mercy killing. Nothing in Section 1233 would change that.”

The counseling that is envisioned deals with choice. Do you want extreme measures to be applied to you, when you are unable to think or speak coherently for yourself, to extend your life? Even if such procedures are painful, uncomfortable or even akin to torture? I’ve noted my own familiarity with these issues, and both my parents wanted to die rather than face the world in which they were living at the end of their lives. My mother, who died of Alzheimer’s, knew her mind was crumbling long before her death. She did not want to live without her memories or an ability to talk to those around her about who she was.

My father, frail, weak and in pain, begged me to end his life. His mind was operating at a delusional and primitive level, even though during most of his life, he could only be described as brilliant. He died in abject desolation, unable to dress himself, speak coherently or walk without wincing and shuffling. He died “of natural causes.” He was not mentally capable of making a rational decision about his own life, so doctors just “kept him alive.”

Picture yourself, barely conscious, drugged out, with an IV drip and an oxygen mask over your face attached to a constantly beeping EKG machine monitoring your existence. Feel the pain creeping in between the drug treatments. Imagine confusion and the inability to speak to those around you; the words just don’t come out. Could a living will have given you a more comfortable choice? Could counseling have given you a clearer decision?

Perhaps, we simply need to be more humane – a kind of pragmatic approach to those final months of life. If there is a “death panel,” there is no way that Americans could ever live with such a system. But that’s not on the table (and it never will be); it’s just a scare tactic paid for by those with huge economic stakes in the profitability inherent in an industry that consumes 16% of the U.S. gross domestic product: healthcare. People do not want to be separated from their money, and if it takes scare tactics to do that, well… it wouldn’t be the first time.

That said, the healthcare proposal that may wind up before Congress has yet to be ironed out. Blue dog Democrats are bucking some of the universal benefits that were in the original concept; virtually all Republicans on the Hill oppose the notion of national healthcare of any kind. Solid debate is necessary. Not death threats against those who favor the plan or screaming epithets drowning out genuine exchanges of points of view. Scare tactics hide the truth; the shape and scope of healthcare reform needs ideas. The plan has yet to take a “final form,” but making a decision based on fabrications, left or right, isn’t what this process should be all about. Let’s deal with truth. 46 million Americans are not covered by any form of health insurance, and the cost of existing healthcare plans is rising still at a multiple of the general cost of living; soon even fewer Americans will have coverage.

I’m Peter Dekom, and I approve this message.