Sarah Palin, M.D.
The former Alaskan governor, Sarah Palin, better explains today why she is concerned about President Obama's support for allowing doctors to offer living will consultations to patients with government funding. It is, I believe, a must read, if only as an exercise in logic. Palin is arguing in plain terms that doctors cannot be trusted to give advice to patients, a rather stunning turn.
The issue is the context in which that information is provided and the coercive effect these consultations will have in that context. Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program." During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services.
Palin goes on to explain that since one of the intents of the bill is to reduce costs in the health system it is logical to assume that seniors "might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care." (This situation, it can be noted, leaves wealthy people, who by contrast do not depend on Medicare to pay for their consultations with doctors, free to be manipulated by nefarious doctors with discussions about end-of-life preferences.) Let us pause a moment here to consider the import of this argument. Palin is saying that the government should not fund a service many doctors want to provide to their patients--and many patients want provided to them--because doctors might try to dupe patients into denying themselves services. She is arguing, in other words, that the government's proper role is to restrict the range of services that doctors can provide patients. Isn't this the opposite of the traditional conservative stance on health care--that the government should not get between the doctor-patient relationship?
Later in the same post, Palin returns to her case against Ezekial Emanuel, whom I wrote about yesterday. Here the problem really is context. Again, she misrepresents his academic work with selective quotes. The first quote, in a paper in which Emaneul discussed dementia, should be put in the context of a theoritical discussion of social ethics, which Marc Ambinder ably explains here. The second quote, in which she speaks about Emaunel's endorsement of age preference for certain medical treatments, should be put in the context of his paper--which was narrowly focused on those few ethical dilemmas in which there is an absolute scarcity of resources, like when there is one liver for three potential patients.
As Emanuel later makes clear in the same paper, his argument about age preference should not be applied to the broader healthcare debate, which is exactly the thing Palin is accusing him of doing. "Accepting the complete lives system for health care as a whole would be premature," Emanuel writes on page seven of the paper. "We must first reduce waste and increase spending." (Reducing waste and increasing spending is, it turns out, exactly the strategy at the heart of the Obama health care reform effort.) Luckily, Palin provides citations for her quotes, so anyone can read for themselves exactly what Emanuel was writing about.
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1
Well written, Michael. if you keep producing analysis like this, you will deserve to be taken seriously as a journalist. If you do it often enough, you might even receive email from Gene Chamblin!
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1.1
This is what drives most of us nuts about Scherer as well as other writers at Swampland. He obviously has the ability to write stuff like this when he wants to but most of the time he plays right into the he said she said drudge inspired media game. Its not even about whether he slants right or left, its about calling bs when something is bs instead of creating false equivalence.
Nice job Scherer, can you keep this kind of consistency?
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2
Barack Obama, M.D.:
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http://www.powerlineblog.com/archives/2009/08/024258.php
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And Mr. Scherer, Charles Lane made similar points in his WaPo piece. -
3
Michael, I have been, as you know, more than ready to condemn some of your more atrocious pieces of equivalency-peddling and scaremongering, but this is probably the best and most informative piece I have seen from you. Kudos, good sir. I do, however, have to point out a spelling error. In your title, you need to insert an "A" between the M and D after Sarah Palin.
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4
What does the "traditional conservative stance" have to do with today's right-wing extremists? They're perfectly happy to have the government control any aspect of our lives – other than firearms and the evident Constitutional responsibility to enrich the rich at the expense of the rest.
I'll say it again – it serves no purpose merely to point out the illogic or outright lies of the Wingers in a blog entry. The only thing that will affect their nefarious manipulation is a relentless focus on the dishonesty of specific officials as a fraud on the body politic.
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5
also:
"give advice to patients," not the verb "advise."
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6
Of course Sarah doesn't trust doctors. She already knows they can be manipulated. She certainly manipulated the Dr. who 'delivered' her youngest child. If you believe her story of the birth then she manipulated her to allow travel from Texas. If you do not believe the birth story then she manipulated her to change the hospital records! Either way it explains her disdane for Doctors in particular and life in general.
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7
Isn't this the opposite of the traditional conservative stance on healthcare--that the government should not get between the doctor-patient relationship?
Like reducing Federal defecits before it and defending personal freedom even earlier, these 'traditional conservative stances' are simply fiction. They are after the fact rationionalizations.
If you want to defend Conservative positions, they are very useful and make some kind of sense but they do not represent what Conservatives actually believe.
There's nothing todays Conservatives would like better than to insert government between doctors and patients when it comes to prenatal care and counseling. End-of-life, not so much.
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8
http://corner.nationalreview.com/post/?q=NzY2MzhjYjc0MWJhMTJiNzIyYjQ2NjhiZThmZWJlZDU=
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One would think, given all the time spent on Sarah Palin by the Swampland reporters, some time would be given to Obama's whoppers.
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But no.-
8.1
Except for the undeniable fact that Obama didn't specify that was what Medicare pays, and except for the undeniable fact that the surgeon actually bills $50k for the operation, and except for the undeniable fact that only Medicare or insurance company intervention whittles it down to something rational, and except for the undeniable fact that any poor slob without insurance would be stuck for the whole $50k, and except for the undeniable fact the surgeon will sic collection agencies on said poor slob if he does not fork over the whole $50k, you have a perfectly valid point.
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8.2
It's always useful to remember one simple fact: if spob were an honest, patriotic American, he wouldn't be spob.
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9
How about the next time a Pol starts spouting outright lies the MSM just call them a liar. Stop using words like distorition, or half-truth etc. Just say, this person is LYING.
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9.1
Really! This has become one of my pet peeves. Call a spade a spade.
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10
there is one key aspect here that you seem to be missing -- that Obama seems to be embracing the "outcome based" payment model.
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when you add that to doctors discussing "end of life" care, suddenly the "doctors counselling euthanasia" is not quite as far-fetched.
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Imagine, if you would, that you're a doctor or hospital (or insurance company) with a patient with condition X whose prognosis is terminal. The "outcome" is known, and you get paid based on the outcome -- at this point, any care that you provide beyond palliative care comes out of YOUR pocket; you have an incentive to "free up the bed" as soon as possible so it can be filled with a new revenue stream.
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For all its absurdity, the "death panel" debate reflects concerns that are very real and legitimate. They are the same concerns that medical ethicists are discussing every day. The fact that they are being exploited by demagogues doesn't make these concerns any less valid.
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Lets put it another way. Lets say that we get health care reform, and in 2012 a right-wing president and congress is elected. Do you really trust that the people they would put in charge of the system wouldn't cut appropriations aimed at providing care to the poor -- and wind up "warehousing" the poor in poorly staffed and admininstered government hospitals? Do you trust the GOP to do the right thing when it comes to health care for the poor?
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If you don't then you have to remember that a lot of people don't trust the Democrats either.-
10.1
The other issue is that the government is obviously incentivized to control costs. Given that end-of-life care is often expensive, people can easily worry that's what's going to be scrimped on.
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10.2
plukasiak -- I'm not at all surprised that you've joined this debate in a way that is so incredibly disingenuous. clearly you have such a problem with Obama that you can't resist any shot at him, regardless of how ludicrous it really is. If there is one aspect missing from this debate it is the very real possibility that not having access to this kind of counseling so your precise wishes can be known increases your chances exponentially that you might end up as some conservative's issue de jour for ginning up political support in an increasingly hostile environment. Terry Schiavo anyone.
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10.3
Hilarious, spob:
The other issue is that the government is obviously incentivized to control costs.
I can't keep your arguments straight. Is it that the government makes a mess of everything with its free=spending ways, or is it that the government is more effective at controlling costs than the private sector?
And, by the way, do insurance companies try to control costs? Do you have health insurance? Ever have to fight with your insurance company to get them to cover a needed test or procedure?
What a steaming load you dished up...
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10.4
The difference, guys, is that I can fight an insurance company. You cannot really fight a govt bureaucracy.
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10.5
Oh, really, spob? So you admit that the issues you claim will happen under a public option are already happening under the private insurers? And you also admit that the government will be cutting costs?
And why are you against this again?
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10.6
Of course, private insurers are incentivized to control costs. They also need to follow their contracts.
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With respect to the gov't, the issue is that if the gov't makes a policy choice not to fund something or to not fund enough of it, you're going to see what's happening in Canada or Britain.
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As for government, the government can at once be profiligate (e.g., V-22 Osprey) and cheap. It's called nuance, guys. -
10.7
that I can fight an insurance company.
Of course the best way to fight an insurance company is to call in the appropriate govenment agency. Without the law on your side, ya got nuthin.....
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10.8
Spob said:
"Of course, private insurers are incentivized to control costs. They also need to follow their contracts."
Gee, if that's the case, why have medical costs been rising faster than the cost of normal inflation? Insurance companies are incentivized to attain maximum profits. The profit motive and the need to provide medical care for everyone do not go well together.
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10.9
THANKS YOU! Finally the first reasoned posting I've seen from a consertive point of view. Listen, a LOT of Obama supporters have concerns and would love to see, hear, read... real and factual arguments and debate on this topic. It's extremely important that we all hash this out. Being someone who's seen the suffering our current system imposes on many less fortunate, I fully support Obama's efforts to reform healthcare. This, of course, doesn't mean that nefarious elements couldn't pervert his good intentions. WE ALL NEED TO READ, LEARN, AND DEBATE rationally amongst ourselves. Talk to your neighbors, learn about their concerns. Why do they support or oppose healthcare reform. Listen first, then, they might be in a better position to hear your concerns. I don't hate anybody because they fear this plan--they have GOOD REASON to fear it, because it's written by politicians. Make your logical, fact based concerns known to your legislators.If you don't care for your fellow american: black, white, dem, repub, lib, etc.. Then how do you call yourself a true american? Our moral center is that of human rights, equal opportunity, justice, fairness. These are not just Christian values, they are human values. If you care not if your neighbor lives or dies--you're not just un-american... you're inhuman.
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10.10
"you're going to see what's happening in Canada or Britain."
What I see happening in Canada and Britain is a bunch of their citizens getting really p*ssed at wingnuts lying about their health care systems.
The Stephen Hawking lie was especially rich.
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11
Poor Sarah - still making sh!t up.
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12
For all its absurdity, the "death panel" debate reflects concerns that are very real and legitimate. They are the same concerns that medical ethicists are discussing every day. The fact that they are being exploited by demagogues doesn't make these concerns any less valid.
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So the fact that liars and kooks rabidly distort an important subject and prey on the emotional distress and fear of others means that we should give them the time of day? Just what sort of idiot are you?-
12.1
but when you guys lump illegal aliens into the 47 million uninsured, that's just service to the cause, right.
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12.2
If by uninsured, you mean people who underutilize preventive care, overutilize ER's and end up not paying for services thus driving costs up for everyone, I don't see any particular reason NOT to refer to Illegals as uninsured.....
The problem with the current debate is that everything bad that people are afraid will happen is already happening under our current system.
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12.3
failing to address the legitimate concerns because the loudest people are "kooks and liars" is a recipe for disaster, because the "quiet" ones will not be hearing what they need to hear from you.
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Obama is taking on subjects that are much harder to deal with than expanding access to health care -- and that is his big mistake. He's taking on "entitlement reform" in the midst of the health care reform debate, because he's made deals with the health care parasites that rule out the kind of 'single payer' option that can achieve a level of cost savings sufficient to provide health care to all Americans.
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The parasites want this to be about the inefficiency of the delivery system -- about doctors ordering unncessary treatments and tests. The problem is that while the delivery system may be "inefficient", it can still be the most cost effective, because the costs associated with creating a more efficient delivery system have to be included in that system.
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And while its easy to find ways to reduce the most egregious examples of inefficiency, the costs savings available through the elimination of egregious waste are probably not sufficient. Moreover, the more money you try to save through imposition of efficiencies in non-egrious cases, the more likely you are to interfere in the doctor/patient relationship and/or engage in "rationing".
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All these considerations create massive opportunities for demagogues -- and that's why everyone always talks about forming "bipartisan commissions" to deal with these kinds of issues. Obama lack of knowledge and/or experience with health care legislation processes has lead him into an ethical swamp populated by parasites and demagogues....
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Obama may be able to get out of that swamp in one piece, but he'll have to sacrifice effective health care reform to do so. -
12.4
Interesting .. mention liars and kooks, and spob appears. It's like calling a dog.
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12.5
pluk, given your record of paranoid hatred of Obama, somehow I don't think your analysis deserves too much concern. But I am sure Sarah Palin will be delighted to sign you up as a Facebook buddy. After all, you share the same concerns, and have the same approach to discussing them. You can join spob there and peddle misinformation together.
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13
"(Reducing waste and increasing spending is, it turns out, exactly the strategy at the heart of the Obama health care reform effort.)"
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Then why isn't Obama addressing all the medicaid/medicare fraud, which is a huge problem. And, given Obama's profilgacy with respect to the "stimulus", why do you take what he has to say at face value, Mr. Scherer? -
14
I too appreciate Michael's analysis, but it runs the risk of suggesting that Palin be taken seriously because she used footnotes. The idea that end of life counseling as described in the bill represents pressure to accept euthanasia is and outright fabrication, as is the notion that Emmanuel is suggesting generalized euthanasia as a way to hold down costs. Whether or not Palin's lies are consistent with a mythical, nostalgic view of conservatism is secondary to the fact that they are lies. And not just the typical truth-twisting we expect from our politicians, but genuinely dangerous misinformation.
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14.1
The use of footnotes is just another indicator that Palin is not writing her Facebook blurbs. The only footnote she understands is made by "Naughty Monkey". She has a new ghostwriter.
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14.2
A ghost writer as ignorant as herself, apparently. Her whole "context" argument boils down to the fact that there is end of life counseling in a bill that also purports to save money, ergo euthanasia. As if one could not possibly make healthcare less expensive while providing for needed services without killing off a bunch of people.
I also love how the writer puts "Death Panel" in quotes in the post as if Palin were not the one who said "death panels" to begin with. Maybe she writes her own titles and leaves the rest to someone else. That would explain the unnecessary punctuation.
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15
The other issue is that the government is obviously incentivized to control costs
And private insurers are not?!
Missing from the discussion is the fact that anybody and everybody has the opportunity to pay for their care out-of-pocket. Why is it the Conservatives who suddenly think the government owes them money?
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16
Those (of us) who find Ms. Palin's world view and lust for higher office to be scary beyond description should take every opportunity to let her (publicly) speak her mind, and just get out of the way. Every day she paints herself as an apt successor to Rush Limbaugh on the blow-hard radio circuit, but not much more.
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17
I used to think she was simply a moron. Now, I think she's simply a complete moron.
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18
"It is, I believe, a must read, if only as an exercise in logic."
Yes, only. A time suck with zero significance. You might as well search for the end of a mobius strip.
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19
At some point covering anything Sarah Palin has no point.
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20
So the Democrats want to save money by killing off all those folks getting government socialized medicine? She's saying the Democrats are evil socialist savers? Death before deficits and the Democrats are the sponsors?
She's on a new dimensional horizon of right wingnuttery.
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20.1
spob makes a similar illogical leap, upthread.
I can't keep the conservative argument straight... Is it that Democrats are free-spending fools, or cost-control zealots?
Great humor in trying to track the inanity that flows from Palin and her loony acolytes...
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20.2
Guys, the govt can be at once profligate and penurious.
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See, e.g., California, right now.
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http://www.conservatives4palin.com/2009/08/larry-kudlow-obamas-non-denial-denial.html -
20.3
More hilarity ensues...
Guys, the govt can be at once profligate and penurious.
Only as it suits your argument, spob. Generally, under the Reagan (dead god) scenario, the government is always wrong. And your inanity makes that clear.
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21
pluk, given your record of paranoid hatred of Obama, somehow I don't think your analysis deserves too much concern.
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translation: I can't rebut you, so I'll ignore you.-
21.1
I see that The Last of the Pumohicans is still going strong. The real translation of what pluk says is:
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I used to be a crank, but now the US has dared to elect a black man, I've decided to become a kook as well.
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As for the idea that we need to refute the dishonest nonsense you spout - no, not really. The best treatment for trolls is silent contempt.
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23
While Palin is priceless you should check out an article in the Guardian:
http://www.guardian.co.uk/society/2009/aug/13/stephen-hawking-nhs-twitter-welovethenhs
Which covers an editorial in Investor's Business Daily. The main quote from IBD is:
"People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."
I couldn't stop laughing for five minutes.
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24
I refuse to believe that Sarah Palin is actually portraying doctors as nefarious tools of the government.
I choose to think that Palin is simply out of her mind and grabbing at any scenario, no matter how remote, to back up her "death panel" blurb.
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25
My reaction to reading the first line of this post was not to read it because why on earth do I care what Sarah Palin is concerned about? Will you post what Rush Limbaugh is concerned about next? Suffice to say I skipped to the first couple comments and seeing that people who have opinions I respect think it's a good piece, I guess I'll read it when I have time, sigh.
- michaelscherer Speaking of Mars, these may be the best lyrics of any non-Dylan song: http://bit.ly/4nfnz5 - 5 hours ago
- michaelscherer Mars is super cool. http://bit.ly/4b0IBH - 5 hours ago
- michaelscherer My favorite newish piece of political rhetoric in Obama's speech today: "waxing political." Sort of like waxing lyrical, except not. - 10 hours ago
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