The Conspiracies of Sarah Palin

My last guest blog post at Boing Boing: click here to read. Things will soon return to normal here.

One thought on “The Conspiracies of Sarah Palin

  1. A thoughtful comment from an old colleague, my reply, and his reply to my reply. Proof that civil debate is still a possibility:

    Arthur: I try to keep up with your blogs which I find interesting. I can share with you some experiences I’ve had with people suffering from paranoia fueled by conspiracy theories.

    I wanted to respond to your saying that Sarah Palin’s use of the term “death panel” is a canard. I actually see it as a semi-canard. She was originally referring to a version of the health care reform bill that came out of, I believe, Henry Waxman’s committee that required end of life counseling — specifically having living wills, medical powers of attorney assigned and the like. I actually agree that we all should have these things, and maybe they should even be mandatory. Note: due to the uproar last summer, the end of life counseling provisions were dropped. However, when Palin used the “death panel” term, it was not out of the bill.

    My understanding is that there was an additional provision that would deny Medicare payments under certain circumstance to people who were very near the end and had no quality of life. This understanding came via my sister, whose husband is an Internist in Ohio, who in turn received an email from a physician she knows who had read the bill. This physician maintained that indeed payment for treatment could be denied.

    My sister indicated that this denial might have hypothetically extended to treatment my Mother received in late 2007 and early 2008, when she suffered acute kidney failure. My mother, who is in assisted living, has a slowly progressing Altzheimer’s dementia, and at the time also had chronic back pain. Due to the back pain she was immobile, and was not getting water enough to drink. Through an MRI it was discovered that she had compression fractures in her spine, that she received surgery for. (Note: the X-ray missed this). She also received extensive physical therapy. As a result she’s had nearly two full years of quality living time, and she may have another 5 similar years.

    Now, obviously, my Mom’s been taken care of. Her doctor and hospital bills were paid by Medicare and with her own funds. However, might not someone in a similar situation in the future be denied coverage? From what I have heard, payments and even treatment are denied in circumstances in the UK and Canada where the end of life is imminent. When the patient or his legally designated representative in consultation with a physician cannot make the decision on life saving care, and that decision is instead made by a bureaucrat, then you have a death panel.

    I think what troubles many people is that even those of us paying attention to these proposals aren’t sure what’s in them. Provisions come, provisions go. It makes one vulnerable to provocative terms like “death panel.”

    MY REPLY:

    A question and a comment: 1) Would you like me to post this very thoughtful e mail on my blog so others can read it? 2) You don’t need to go to Canada or UK to see medical services denied–private insurance companies do it all the time and not just to the elderly or people with terminal conditions. They do it figuratively by refusing to cover “pre-existing conditions,” such as cancer, or by refusing to cover “experimental” or “unnecessary” treatments. Then there are all those people who are unemployed, work for companies that don’t supply insurance, or who simply can’t afford to purchase private insurance. Medicaid will pay for a lot of medical care for them, but only after they dispose of all their assets. Private insurance companies, which work on the profit principle, are not only entitled to refuse to pay for as many expensive services as they can, they owe it to their shareholders to do so. If people are so upset at the prospect of seeing sick people denied services, they should be looking to take both medicine and medical insurance out of the private sector, and into the public, where it can be forced to lose money.

    Whatever the specific provisions of Waxman’s bill, “death panels!” wasn’t a considered response to existing language–it was a rallying cry to promote opposition to any bill whatsoever.

    I totally agree with your last point about us not being sure what’s actually in proposals, and for that I blame Democrats, Republicans, and the press alike.

    REPLY TO MY REPLY:

    I did receive your letter via email. Thanks for sending and for your comment. I would be pleased for you to post my comments to your blog.

    In response to your comments, I’m well aware that private health insurance companies routinely deny to pay for coverage for a host of items for a variety of reasons. As I believe you are aware, their stated reason that they do so is that the said coverage was not a part of the insurance contract between the insured and the insurer. Another excuse is that the insured did not accurately disclose his/her medical condition prior to the contract being issued, thereby nullifying partially or totally the contract. (Bastards) Of course, this is often a matter of interpretation and insurance companies routinely use this excuse to deny coverage they are actually contractually required to pay.

    As an aside, if someone continually maintains their health insurance, when they transfer from one job to another, or via COBRA, or via a private plan, private health insurance companies are forbidden to exclude pre-existing conditions from coverage. This was part of the Kennedy-Kassebaum, HIPPA, legislation back in the late 1990’s. Since my wife and I both have pre-existing conditions and since I am self-employed (we now receive our coverage via her employer), we have been very aware of what must be done to see we have adequate coverage.

    Very few people like private health insurers, myself included. My sister tells me what a pain in the butt they are when her husband’s medical practice tries to get paid for services rendered. The amount of back and forth, haggling and arguing, the time and effort involved is pretty high. Still, private health insurance companies do offer an important and vital service. The price has risen dramatically in the 11 years I have owned my business, with the premium rates quadrupling for the two people I once employed. So, from a personal standpoint, a public option might seem like a good deal and a benefit to us.

    I am not 100% against the public option, maybe 85% would be more like it. The concern those who oppose the PO have, and that I share, is that it will eventually lead to the elimination of private health insurance for everyone, leading ultimately to a nationalization of the entire health care system. I’m sure you have seen the arguments. The PO could offer insurance cheaper than the private companies a) due to not needing to generate a profit, b) due to their access to cheaper capital (government insured bonds and/or government subsidies) and c) their underpaying doctors, hospitals and other medical service providers, as do Medicare and Medicaid, which in turn would cause further cost shifting to the private payer. The private insurance plans would quickly lose customers and go out of business. Doctors and hospitals would be at the mercy of a single payer, and ultimately would become owned and/or employed by it. At least that’s the theory.

    The problem we still face is people not being able to afford sufficient health care insurance due to their risk factors and/or income levels. I think there are alternatives to the bills coming out of Congress that can accomplish this, without the Federal government going into the business areas covered by private companies. My own proposal is to offer vouchers linked to a health care savings account where the Federal Government would issue voucher credits to match an individuals and/or his employers contribution based on a formula that took into account risk factors like age, gender, and pre-existing medical conditions. One exercises voucher credits once the money in the HSA is depleted. A total spending of $75 billion per annum could cover 25 million Americans with an average $250 per month voucher subsidy linked to an HSA. This is about half of what the House bill will cost. I sent this proposal to Senator Lugar, whom I have known personally for many years, and discussed it with Senator Enzi, the leading Republican on the Senate Health Committee. They indicated there was no interest on the Democratic side for anything other than a top down approach such as has been drafted in committee and last week passed by the House.

    I really think the fault for people not knowing what is in the proposed health care legislation lies with both the administration and the Democratic Congressional leadership that has produced a massive and complex package that keeps changing. The reporters in the news media, many of whom want the bill to pass, are not doing what they should just to get the basics of what’s in the legislation out. The Republican congressional leadership and the more conservative media are doing their best to get the information out, because they feel that’s the best way of getting the bill(s) defeated.

    I want to leave it there. Palin’s use of the term “death panel” was provocative and effective, although inaccurate to a degree. But both sides play the demagogue on a variety of issues.

    What I would like to see is everyone think critically and independently on the issues that face us: get the facts, think hard about what’s likely to be the outcome of proposed changes, be empathetic and compassionate about the circumstances that others face, and make the best judgment possible. If they’ll do that, I have tremendous confidence in the peoples’ ability to come to the correct conclusions, even if it differs from my own.

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