The first story that kicked up in my health-care searching last night was this, about the GOP’s “seniors’ health care bill of rights.” Taking a page from the Contract
with on America playbook, Michael Steele has evidently found what he thinks is the key to elderly America’s heart.
I finally saw Jon Stewart’s takedown of Betsy McCaughey last week (parts one and two), although I’m sure she wouldn’t describe it as such. At the end of it, I couldn’t help but share Stewart’s frustration (and yes, I’m sure it was engineered to elicit just this response): It’s possible — maybe — to have an honest discussion about health policy reform. But it’s impossible when lying liars like McCaughey and her BFF Sarah Palin hog the spotlight with death panels and death books and SAVE MY DOWN SYNDROME BABY OH MY GAW.
The NYT has a profile today on Ezekiel Emanuel, Rahm’s brother, a physician and bioethicist, who is advising the Obama administration, or trying to:
Largely quoting his past writings out of context this summer, Betsy McCaughey, a former lieutenant governor of New York, labeled Dr. Emanuel a “deadly doctor” who believes health care should be “reserved for the nondisabled” — a false assertion that Representative Michele Bachmann, Republican of Minnesota, repeated on the House floor.
Former Gov. Sarah Palin of Alaska has asserted that Dr. Emanuel’s “Orwellian” approach to health care would “refuse to allocate medical resources to the elderly, the infirm and the disabled who have less economic potential,” accusations similarly made by the political provocateur Lyndon H. LaRouche Jr.
In fact, Dr. Emanuel has written more than a million words on health care, some of which form the philosophical underpinnings of the Obama administration plan and some of which have enough free-market elements to win grudging respect from some conservative opponents.
The debate over Dr. Emanuel shows how subtle philosophical arguments that have long bedeviled bioethicists are being condensed, oversimplified and distorted in the griddle-hot health care debate. His writings grapple with some of the most complex issues of medical ethics, like who should get the kidney transplant, the younger patient or the one who is older and sicker?
Yes, who? Because of course now every single person who needs an organ transplant gets one. No one dies or pulls the strings available to a very rich person with a private plane idling on the tarmac and unlimited resources. The system is perfect now. Let’s keep it that way. Let’s pass a constitutional amendment, in fact — call it Trig’s Law.
Have none of these gasbags heard of the QALY? The quality-adjusted life year is a means for assessing the value of health interventions in the big picture of a patient’s long-term outlook. It’s been around a long time, and it tries to analyze, more or less numerically, whether it’s smarter to give a liver transplant to Steve Jobs or a 70-year-old end-stage alcoholic. It doesn’t consider that Jobs gave us the iPod and has a lot of dough, only who is more likely to get more productive years of life out of the procedure. It is a tacit acknowledgment of what no one, including Michael Steele, seems willing to admit: Life is a terminal disease, and sometimes it makes little sense to spend a few more hundreds of thousands of dollars extending it for one more week.
I think they know this. What makes them uncomfortable is this: There are no firm answers. What works for one patient might not work for the next. It changes from year to year; I’m old enough to remember when Mickey Mantle got his liver transplant, and the debate then was whether he “deserved” it, having destroyed his factory-issued liver with a lifetime of drinking. Livers were scarcer then. In another 20 years, they may be grown in labs from your stem cells, and be the equivalent of expensive hothouse tomatoes. But more to the point: Does anyone think it — QALYs, money, how good your insurance coverage is — isn’t a factor in thousands of health-care decisions made every single day?
Even more to the point: What’s their alternative? And we’ve already heard “allow cross-state competition between insurers.” What’s the second item on the list? P.S. We’ve heard “tort reform,” too, a total red herring — malpractice costs amount to about 1 percent of total health-care expenditures, and I’d like to see the hands of those who believe drug-addicted doctors who make mistakes in surgery shouldn’t be punished. OK, then.
Sorry to start off on such a sour note, but I was still thinking about this hours after scraping the top of my skull off the ceiling. I think this graf, deep in the WSJ story, says it all:
The Republican statement highlights an irony in the health debate, as illustrated during some of the emotional town-hall meetings this month: Many Americans say they fear a government takeover of health care, even as they resist any cuts to Medicare, the federal government’s largest health program.
And now I have a meeting — best thing about meetings for hyperlocal journalism? you can get there on your bicycle — so no real bloggage today. Besides, all I want to talk about is Ann-Margret’s awful singing, and you “Mad Men” fans know what I’m talking about.