"Death panels" are real - brought on by budget pressure by Norman Ornstein

[peacebird]

During the debate over health reform, Rep. Michele Bachmann (R-Minn.), Sarah Palin and others railed against the "death panels" that would result from the bill. Government bureaucrats, critics said, would decide who would die and when. The bill passed - and indeed there are death panels. But they do not come from the Patient Protection and Affordable Care Act, a.k.a. "Obamacare." They come from Republican administrations in states such as Arizona and Indiana.

In Arizona, the government headed by Gov. Jan Brewer summarily stopped approving Medicaid payments for many organ transplants in October; one man had a liver virtually snatched away while he waited to go into the operating room. He couldn't get it unless he came up with $200,000 to pay for the procedure.

In Indiana, the state Medicaid program denied a lifesaving operation last year to a 6-month-old boy who lacked a thymus gland, which generates cells that the body uses to fight infection. The Indiana Family Social Services Administration said the procedure was "experimental" - even though it had been successful in 43 of the 60 cases in which it had been applied. The state twice denied the family's appeals, but fortunately the publicity caused by this case prodded two health-care companies to pay for the $500,000 operation.





http://www.washingtonpost.com/wp-dyn/content/article/2010/12/31/AR2010123102727.html?nav=hcmoduletmv

[FreakinDJ]

1. Insurance Company run Death Panels

[bemildred]

2. It is perfectly obvious that one ought not spend large amounts of money for miniscule benefits.

That there is a cost/benefit tradeoff in health care as any other area. We all die, how much is an extra two weeks worth when you are dying of some painful, aggressive disease?

[peacebird]

3. the liver transplant would give him a long healthy life, as would the 6 year olds treatment

[bemildred]

6. You have an interesting notion of "long, healthy life".

However, I was not suggesting anything in particular about liver transplants, I was suggesting that it is PROPER and NECESSARY to consider the tradeoffs between cost and benefit rationally. The whole subject is a taboo which may not be discussed, lest one be called names, and that creates a problem. Other countries seem to be able to manage the issue, I'm sure we could too.

[peacebird]

8. a dear friend had a liver transplant back in the late 1980's at 25 and he is still going strong

He skies, bikes, and has a lovely family.
That said - I agree we need to talk about tradeoffs - my 90 year old aunt developed thyroid cancer. She had chemo, radiation, and many hospitalizations in the next 9 months (when she passed away) - I do not think that was the wisest use of resources. I loved my aunt dearly, but wonder if keeping her comfortable might have been better than putting her through such a painful treatment regimin?
It is a serious discussion that, I agree, we as a nation need to have.

[bemildred]

10. I don't think we disagree.

I will only say that I would consider things at 25 that I would not now at 60+. I would, for example, have to be really impressed with the results of any form to chemo to consider it now. My kids are grown, I've had a long, interesting life, I'd rather leave the money for my wife to spend or my kids to use and skip the side effects.

[obxhead]

4. Yet we can spare no expense when it comes to ending life

in the Middle East.

America has become merchants in death, not life and liberty.

[jody]

5. Consider National Institute for Health and Clinical Excellence (NICE) statement.

Quality-adjusted life year (QALY) is a measure of disease burden.

http://www.nice.org.uk/newsroom/features/measuringeffectivenessandcosteffectivenesstheqaly.jsp

What about cost effectiveness?

Having used the QALY measurement to compare how much someone's life can be extended and improved, we then consider cost effectiveness - that is, how much the drug or treatment costs per QALY. This is the cost of using the drugs to provide a year of the best quality of life available - it could be one person receiving one QALY, but is more likely to be a number of people receiving a proportion of a QALY - for example 20 people receiving 0.05 of a QALY.

Cost effectiveness is expressed as ‘£ per QALY'.

Each drug is considered on a case-by-case basis. Generally, however, if a treatment costs more than £20,000-30,000 per QALY, then it would not be considered cost effective.

[bemildred]

7. A gesture in the right direction, an attempt to define a metric.

Statistical measures of long-term survival rates under different treatment regimens get too little use too, everything is done very specifically. For example, I have read articles that state that overall statistical survival rates for disease X have not changed in the last 40 years, say, the same proportion or more get the disease, and the survival profile once they get it is the same. That seems to me to call innovations in treatment during that period into question, they are not actually doing anything.

[jody]

9. Obama has asked for a billion $ to study “Comparative Effectiveness Research”, a cover name for the

same policies UK's NICE uses for QALY.

[bemildred]

11. I suppose it's just out of the question to borrow from the Brits.

We have to do our own studies, which will take decades no doubt.

[jody]

13. Agree. Fact is we can't afford every medical procedure for everyone. IMO we need some version of

QALY/cost but I don't trust politicians to solve that problem nor lobbyists for insurance and financial interests to offer moral recommendations.

A moral question that plagues me is whether society benefits more from giving open-heart surgery costing $300K+ to a 75 year old or using that money to help several preteen patients?

[bemildred]

14. Being an old fart myself, I can speak to that.

We spend something like 50% of the lifetime cost of medical care on the last few weeks or months of life. That is just stupid, and mostly it results from the taboo on discussion of oncoming death rationally, and the whole "health insurance" racket enables that waste and muddies up the discussion even more.

It is in fact criminal negligence for the government to neglect the health and welfare of the young (food, clothing, shelter, education, and positive social situation), which is cheap, necessary, effective, and creates lots of jobs too.

[CarmanK]

12. Brewer and the state legislature Denied those Medicaid Pmts!

It was the State legislature that passed the budget removing 5 million dollars from the FEDERAL dollars and directed them toward the support of their "privatized prison buddies". Brewer and the legislature condemned to death,without remorse, nearly 100 persons for being poor.
Didn't know about INdiana, but once again it was the individual state with republican governors that made the decision to withhold care from the POOR to balance the budget, even though the revenue source was from the federal govt.
The real death panels have been operating in TX since signed into law by George W. Bush in 1999. The law empowers hospital committees to withhold life support from patients once they have run out of money or cannot find another facility to accept them. So far, we know of 22 patients, the committees "executed" for budgetary purposes.

In AZ, TX and IN each person has a price tag on their backs and the value of their life is predetermined by budget allocations.

[Igel]

15. But that's comparing apples with moments of inertia.

At least apples and oranges are both edible, both are from plants, both are fruit, --for that matter, both are matter.

In fact, there are three discrete categories of "death panel" discussed.

The one "death panel" is conceived of as helping end-of-life planning when you're not immediately pre-end-of-life.

The second would decree which treatments are cost effective in general and may be applied. This goes to cost-effectiveness as a whole--as in the entire mammogram controversy from a year or so ago. "Cost-effectiveness" requires more honesty, transparency, and willingness to compromise on deeply held emotional beliefs than most are comfortable with.

The third is to decree which approved treatments will be allowed for individuals. We say "we must do everything possible" but in pretty much every case that's a huge bit of hyperbole intended to deceive the self as much as others. (Give me good old fashioned malicious lying any day, thank you.)

People assume the third kind is meant when the first is discussed, not because of what they read but because of ill-will. Or they assume that advisory panels of the second type must inevitably become dictatorial panels of the third type. Often we make these decisions not because of the text or actions of the panel as a whole, but because we don't like the particular people involved.