1.03.2011

The True Death Panels

No, I'm not talking about the reprehensible scare tactics used by the Republicans prior to last year's health care bill. I'm talking about the closed door sessions in corporate board rooms of payers, political strategy sessions, and PAC planning meetings. You know - a lot of the people who opposed health care reform. The real death panels are those that want to preserve the status quo. Hopefully, this will make sense after you read the rest of this post.

What follows are some indisputable facts. How they get used in Washington is up to us.
  1. Prevention, wellness, and early disease detection strategies are the best methods to provide both improved care and reduced costs.
  2. All of these strategies depend upon; a) ready access to care, b) profiling strategies to identify those most at risk, and c) low cost lifelong support for chronic problems.
  3. Our current system denies ready access, penalizes those identified with risk factors, and denies continuity of care caused by job changes, relocation or aging, for example.
  4. Economic disincentives to prevention and early detection exist for both patients and care providers.
  5. Disincentives include nonexistent or low reimbursement for prevention, fee increases or canceled coverage for pre-existing disease, life-long exclusions for pre-existing disease or risk factors with changes in coverage, etc. All of which make individuals reluctant to seek preventive care.
  6. These disincentives are most acute for the poor or those generally described as working class.
  7. Lack of prevention and early detection results in failure to prevent or recognize early stage disease which increases preventable mortality, particularly amongst the poor and working class families.
So, the real death panels; the ones that ultimately make decisions that cost people their lives; aren't the ones giving end of life counseling in a clinic. They are the shadow groups that oppose the reforms that can improve care and extend life for all. Those that oppose reform out of financial gain or political gamesmanship. Can one sink any lower than that?

12 comments:

Jared said...

well, yes, but we already knew the teabaggers are the ones that really think they can determine the value of a human life...

Michael Lockridge said...

Policies are made by humans. Humans tend to work in their own self-interest.

How do you move anything at all out of this paradigm? People will seek power to forward their own interests. Generally, an individual or group forwarding their own interests will do so at the expense of other individuals or groups.

Anyone have an easy answer? Maybe a nice loaded phrase like "death panel" that will swing things in a new direction?

Are there any viable models out there? You know, ones that work rather than just being screwed up in some different way?

pboyfloyd said...

Well, I obviously think that it's got to do with ideology.

There are those who are so hellbent on being free FROM government that they imagine it's simply wonderful for them to be totally immoral when it comes to their fellow man, being, in their mind a personal decision and between them and their God.

I think that these people should stick to bilking the public out of their money instead of trying to 'become' government and using the pretext of government/governing to aid them in their quest to bilk the public.

But we get the government we deserve, I suppose, which for a country that is supposedly over 90% Christian, helping the poor when they can and so on, doesn't seem to be 'coherent' at all.

Jared said...

I think Colbert did a little bit on the "Christian Nation" crap a few weeks ago.
http://www.colbertnation.com/the-colbert-report-videos/368914/december-16-2010/jesus-is-a-liberal-democrat

Michael Lockridge said...

Thank you. I like to laugh, and I certainly did.

Pliny-the-in-Between said...

Thanks for the Corbert bit. As for models that work, here's a reference that was written by the current head of CMS. Very telling.

http://content.healthaffairs.org/content/27/3/759.full

Michael Lockridge said...

Not bad. A worthy goal, and I suspect doing something is better than doing nothing.

Who would be the "integrator?" What would be their carrot, and what would be their stick?

What of individual responsibility? I have too often been my own worst enemy with regard to my health. Many others are their own enemies, as well. I have chosen my own carrots and sticks, and am doing better. ;-)

Pliny-the-in-Between said...

Some of us are working on the premise of 'what' not who is the integrator. That's my research for the last 15 years in a nutshell.

the carrot for the individual will be the topic of a coming post because its a critical question to get right.

You are very correct to assume that any rational fix will require some redistribution of responsibility for one's ow actions.

Harry C Pharisee said...

"You are very correct to assume that any rational fix will require some redistribution of responsibility for one's ow actions."

An accidental misspelling and yet still salient. How do you do that?

Pliny-the-in-Between said...

Rim shot!

mac said...

I think it's pitiful that most of the people opposing health care reform identify themselves as Christians.

What. The. Fuck?
I thought Jesus core teaching was about caring for your brothers and sisters. Why does it seem secular folks are more compassionate than many self identified christians?

GearHedEd said...

The way I see it, there are several problems, and each needs to be addressed:

1) For-Profit insurance companies.

2) For-Profit pharmaceutical companies.

3) Lack of tort reform.

There's probably more, but I think we can see the problems with trying to move corporate insurance and pharma off their stacks of easy cash. Mr. Lockridge put his finger on it already:

"Generally, an individual or group forwarding their own interests will do so at the expense of other individuals or groups."

And it's not JUST the corporate execs; the stockholders (many of whom are rich and/or politicians) will also resist moves like these.