Death Panels Should Have Been Named Moral and Ethical Reasoning

  What Broke My Father’s Heart 

James Wise

Class: HCA300

 
                                                                       Introduction

            This week’s course study took us down the path of reading a true story written by Katy Butler, regarding the end of life experience of her Father who was put on a pacemaker.  The story was heart wrenching as may be expected considering the nature of our topic, death.  Her family was upper middle class, her father a retired professor.  They were known to be educated, even prepared for end of life experience with both having signed living wills.  Katy suggests that the healthcare system is profit focused and towards that end keeps a person alive as long as possible, disregarding value of life.  She explains that her father has dementia, and already he could not do all his ALD,s which was left up to her mother to perform on his behalf in changing diapers, giving baths and more.  Her research lead her to lobbyist from drug and medical equipment companies who that pay over 500 million to get policies that reward doctor as she terms it as overtreatment. 

She exclaimed that she is given more Government-mandated consumer information on a new car then medical procedure counseling, such is it a good idea to put a pacemaker in a man who barely has a mind.  Ironically, her father was not for it but because of his dementia it was left up to mom.  As well informed, as her mother was she was put in a life or death decision with the surgical team advising the pacemaker. Katy points out, that the new healthcare bill had a provision, called ”end of life counseling;” to determine value of life and if the procedure is worth the outcome of the patient.  However, this was to become known as “Death Panels” and removed from the bill, the very thing that would have stopped the pacemaker from being put in her father.  After years of grief, service in mom helping her estranged husband do to dementia, he passed away with the pacemaker still shooting electrical pulses to his now dead heart. 

All About The Money

   

         I am in complete agreement with Katy Butler concerning the money trail and underlining motivation.  She also point out that 30% of  elderly who are deathly ill wish for death or trade one good day then two more years of illness.  Comparably, she showed statistics that 30% of Medicaid/Medicare cost is from overtreatment.  Her rational is sound when she says, “if a patient says no to a procedure then there goes the money, no one is paid.”  In my support of Katy, I have, in many other courses shown that the worse disparities in health care are formed when profit is the motivating factor.    In her family’s case, it turned her joyful mother and their shared joy into a nightmare, resulting in thoughts that cause guilt because you want it all to end.

     

       We are called the sandwich generation because science has created longevity of life.  In today’s world many are raising their children and caring for their ageing mother or father as well.  The young parents are now sandwiched into taking care of two generations and often times the ailing parent is harder to care for. This puts so much more stress in life and strains family systems to point of even breaking.  Such was the case in my personal story when my mother in law moved in with our family.  She was both mentally ill and physically incapable and she stayed with us for three years.  Personally experiencing the downward spiral of my mother in law and the twenty so procedures to keep her going was the most depressing time of my life.  In the end, it was one of the factors that broke up my marriage; an experience I still shutter over to this day.   It was my first real glimpse in health care’s great machine, often playing on my ex-wife emotions they would get yet another procedure underway.  In my mother in laws case it was overtreatment with each procedure as she worsened from each and everyone. Not only were the doctors paid but also my family paid the price as well with heated discussions that our predicament created.      It was indeed a path into nightmarish madness watching a love one slowly and with no personal dignity left finely pass away. 

Common Sense or Policy

            I do not fault medical science, in fact I applaud each new breakthrough with much vigor.  Medical science continues to enhance life in many ways.  Policy drives market in the direction towards maximum profit and policy form from special interest groups or lobbyist.  Anytime a policy is not based in common sense thent I almost guarantee a lobbyist was behind its creation.  Who was behind the coinage of “Death Panels” when it was based in common sense not the automatic model that says maybe one more procedure will fix the problem.  Simply there must be transparency in our health system that does not compromise value of life when achieving longevity. 

   

         Concerning life-supporting equipment such as pacemakers they have great use and help people live, long lives that they would have been deprived of.  In contrast, I would highly question putting the device in a 81 year old man suffering from dementia in the story I summarized here.  In such decisions in life, perhaps the hardest concerning death, needs good counsel with all considerations on the table.  In my personal experience with my mother in law, it was always a hurried process when it came to a new procedure.  We should have called death panels’ moral and ethical reasoning.  In conclusion, I will order the Do Not Resuscitate bracelet and wear it from now on, because simply I do not want to trade quality of life for longevity. 

Reference:

Butler, Katy (2010)  What Broke My Father’s heart The New York Times

            Retrieved on November 27, 2010, from

                       

                        http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=3&_r=1

2014 changes our health care landscape!

Policy and Politics in Health Care
James Wise
Class: HCA303
 
Abstract

Imagine for a moment the future of health care. Upon awaking we can look at our health monitor that tracks 300 aspects of our personal wellness plan with personalized definable health goals. Then with a few clicks, we can monitor our 90-year-old mother’s health status 1000 miles away because the monitor is connect to a health information system. We can set appointments through this portal, order our medications, and access reliable literature concerning our health care issues. Furthermore, we have access to all aspects of our health record with all the ability of my health monitoring transferred to my mobile smart phone. This is just one of the policy driven directions our government is taking. Another is health insurance for all by the year 2014. Focus has been put on preventative care in the area of obesity and smoking with movements like Lets Move.gov headed by the first lady, and quit smoking central dot com that gives you a national list by organization or state that offers free nicotine gum and patches. We will highlight these policies in the effectiveness of potential effect, costs, equity, and fairness.

Health Informatics

All that was suggested in the abstract concerning health monitoring is already a reality it is just the matter of plugging it all in on a national level. HealthInfoNet is a company funded by Government mandates is doing just that. In light of new federal rules, several of the services HealthInfoNet offers will help make many health care providers and hospitals adopting and using electronic medical records (EMR), eligible to receive federal incentive payments from the Centers for Medicare and Medicaid Services (CMS). Furthermore, on July 13 this year, Health and Human Services (HHS) Secretary Kathleen Sebelius announced two long awaited "final rules" that define stage one meaningful use and certification of EMR technology outlined in the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

The stage one meaningful use criteria include fifteen "core" measures that must be demonstrated by both hospitals and physician practices. Hospitals and physician practices must also demonstrate compliance with five "other" criteria chosen by each provider organization from a "menu" of ten additional criteria. To trigger stage one meaningful use incentive payments, most providers and hospitals must demonstrate compliance with these criteria by April of 2012.

The one notable exception will be physician practices that qualify for incentive payments under Medicaid. These practices can secure meaningful use incentive payments prior to installing a certified EMR so that funds may be applied to the cost of investing in an EMR solution. Under the Act, health care providers and hospitals can qualify for Medicare and/or Medicaid incentive payments if they meet stage one meaningful use criteria. In total 17 billion in stimulus funding has been allocated in the future of information exchange and being the new reality by 2020, states HealthInfoNet (2010).

Policies Addressing the Obese

Obesity has been the new epidemic in America with 60% of our population overweight with 34% being obese. Asserts the New York Times(2010). The cost on health care is in the billions from complications and the onset of chronic diseases like diabetes or cardiac problems to name just two. The policies in this area are complicated because of the infusion of so many government programs that overlap each other. Policy is needed to unite the many agencies involved in governing the United States’ food and nutrition landscape. The U.S. Department of Agriculture (USDA), the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the Department of Health and Human Services (DHHS), and the Centers for Disease Control and Prevention (CDC) are among the numerous federal agencies overseeing the nation’s food supply. These agencies sometimes work at cross-purposes and, such as in the case of the USDA, there are clear conflicts of priorities within the agency itself. The USDA establishes national nutrition policy, but it’s more important aim is to help the agriculture industry be profitable by maximizing food sales. The following are some examples of public policy changes that could be made in government to improve nutrition.

• Move nutrition policy and programs from the USDA to the Centers for Disease Control and Prevention. The USDA is typically headed by someone from the food or agriculture industry and exists to promote the business of agriculture, which is to sell as much food as possible. This priority often conflicts with good health policy.

• Design agriculture policy (such as the Farm Bill) with health as a principal consideration.

• Change the fundamental economics of food. Create incentives that help consumers buy healthy food, instead of incentives that make the unhealthiest foods also the most affordable.

We applaud the efforts of Lets Move.org; this is Government policy at its finest. The purpose is to reduce or eradicate childhood obesity in a generation. Their scope is complex and filters into school lunch programs, and local mandates to build parks, recreation centers, bike trails and more. Government incentives to help implement these programs, as well as building a rich resource to raise awareness with parents, Chefs being trained in nutrition in culinary academes. This effort could effectively lower obesity in America and provide billions saved in our health system.

A Smoke Free America

In the last two years many have noticed the price of cigarettes inflated, in some place as much as 50%. Simply, smoking is the most irrational behavior our society engages in that lead to major morbidity factors costing our health system billions once again. Government has not only raised the tax on cigarettes which has effectively resulted in many new non-smokers but have many state level programs that administer free aids in helping the smoker quite. This program has been very effective and continues to yield favorable results Among Americans, smoking rates shrunk by nearly half in three decades (from the mid-1960s to mid-1990s), falling to 23% of adults by 1997. It remains at 23.1% but with an increasing population since 1997 asserts the (American Heart Association, 2010). We conclude this as a good policy in promoting behavioral change in our populace by approaching both sides, the negative in taxes on cigarettes and the positive help in empowering the person to quit smoking in providing support and free aids.
Health Insurance for All

The new healthcare reform bill or as many call “Obama Care” has a slow timeline as we prepare to embrace so many entering a new open system. The leveling of the playing field does not take place until 2014, but make no mistake it is a leveling, and all preparation is taking place now to make the change happen.

The primus after all, is based on the ideology that health care is a rite of passage and no one should be left out. When we talk about natural rights we, as a nation knows it come with a dear price to maintain our freedoms. In the military, it takes hard training, personal discipline, and a desire to win the day. How do you achieve this is in a civilian populace without consequences to adverse actions that are counterproductive to our health system? The simple answer is you cannot without consequences, it is law that we must have auto insurance, because of the great risk of catastrophic event accruing in an accident. This will be reality for us in 2014 concerning health insurance and fines leveled for those who choose not to have insurance and can afford it. This is on a personal, family, and business level so all are affected. Let us take a look at the bill first on a individual level.

Require all individuals to have “acceptable health coverage.” Those without coverage pay a penalty of 2.5% of modified adjusted gross income up to the cost of the average national premium for self-only or family coverage under a basic plan in the Health Insurance Exchange. Exceptions granted for dependents, religious objections, and financial hardship.

And on a business level; require employers to offer coverage to their employees and contribute at least 72.5% of the premium cost for single coverage and 65% of the premium cost for family coverage of the lowest cost plan that meets the essential benefits package requirements or pay 8% of payroll into the Health Insurance Exchange Trust Fund. E&L Committee amendment: Provide hardship exemptions for employers that would be negatively affected by job losses as a result of requirement. Eliminate or reduce the pay or play assessment for small employers with annual payroll of less than $400,000 ( KFF 2010).

Furthermore, public health care expands Expand Medicaid to all individuals (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% federal poverty level or (FPL). Newly eligible, non-traditional (childless adults) Medicaid beneficiaries may enroll in coverage through the Exchange if they were enrolled in qualified health coverage during the six months before becoming Medicaid eligible. Replace full federal financing for Medicaid coverage expansions with 100% federal financing through 2014 and 90% federal financing beginning in year 2015 (KFF 2010).

Affect on Insurance Stake Holders

Many may see this as the day of great reckoning, and the change to an open market. No longer will insurance companies deny you coverage because of a pre-existing condition, new regulations go into effect concerning premium levels, cannot drop a client from a plan or deny expensive life saving procedures. The plan creates a National Health Insurance Exchange, through which individuals and employers (phasing-in eligibility for employers starting with smallest employers) can purchase qualified insurance, including from private health plans and the public health insurance option. The public option has four plan tiers with the basic plan covering 70% of your medical encounters per year set in the context of your affordability based on income that sets the price of your premium.

Many believe this will infuse competition, a perspective we agree with in our personal vocation. Our company will be Medicaid certified next week in preparation of the new health care funding options that will happen. We work with the most disenfranchised souls in providing shelter for the homeless vets, department of correction, probation, and community release. We provide a therapeutic community and empower our clients through classes, counsel, to help them back into the main stream of society. The new Government policies will greatly increase our client base, being able to provide services for the homeless we could not reach before.

What is the Cost, Who’s Paying for it?

Universally speaking, everyone is shouldering the responsibility of a rite to health care then without the changes that are coming. Clearly, the Government is competing for the first time with for- profit insurance companies, setting the rules in their public health exchange require private insurance to comply. The Congressional Budget Office estimates the net cost of the proposal (less payments from employers and uninsured individuals) to be $1.042 trillion over ten years, of only half is pay for by new policy changes in mainly Medicare and Medicaid. So where does the 500.021 billion come from to finance our new health care bill? You may have guessed it, the redistribution of wealth.

The remaining costs are financed through a surcharge imposed on families with incomes above $350,000 and individuals with incomes above $280,000. The surcharge is equal to 1% for families with modified adjusted gross income between $350,000 and $500,000; 1.5% for families with modified adjusted gross income between $500,000 and $1,000,000; and 5.4% for families with modified adjusted gross income greater than $1,000,000. These surcharge percentages maybe adjusted if federal health reform achieves greater than expected savings. The largest source of new revenue will come from an excise tax on high cost insurance, which CBO estimates will raise $201 billion over ten years. Additional revenue provisions will generate $196 billion over the same time period CBO estimates the proposal will reduce the deficit by $81 billion over ten years (KFF 2010).

Conclusions

We have explored many areas of policy changes in health care concerns, proposed needed policies changes in our food production, and referenced clearly the policies that are soon coming. Preventative care is and needs to always be the focus point, changing behavior in a society is challenging for a Government in the context of freedom and choices. Dare we exist chained to our government even though this bill may holds aspects of this scenario? We agree in most part of the policy changes, and the simplistic but powerful approach to healthier children and obesity issues. The proven good direction in tobacco usage, simply a policy that has been holding ground for many years now. Information Health Management Systems have the most potential in lowering cost in major disparities in our current system. Efficiency is at the speed on electronics, vast databases with evident based favorable results will be accessed to determine proper cost effective procedures lowering mistakes and tort law cases. Administration cost will shrink when all information is in electronic format and storage, also eliminating many mistakes found in paper filing. Algorithms in these management information systems will find and highlight any abnormalities found in the progressing of a patient’s medical record (e.g., diagnosis does not match treatment). We cannot forget the personal empowerment spoken in our abstract and patient accessibility to their health records and monitoring your health condition. Nothing can be changed unless there is awareness to the issues; information technology continues to open the window to a broader awareness.

Without question the new health care bill opens access to everyone, makes everyone responsible to attain health insurance or pay the fine. It levels the playing field in Government competing with large insurance giants; it will break down barriers for new companies to come into this reformed market. The only issue is the redistribution of wealth in making the wealthy bear half of the cost. A better policy would have addressed this differently and not hold that aspect we mentioned earlier being a slave to government. A luxury tax placed on all non-inessential products and services, the higher the price of the product or service, the higher the percentage of tax. This does not target a particular social class; however, it will be the rich taxed the most in this policy.

Although, they will be taxed on some luxurious privilege, they want, and they will not feel the sting of being obligated to the Government to finance health care for all. It is our thought that this would generate more money because all classes are involved in a luxury tax. Here is where we see the new health care bill greatly flawed and singles out one social class from all others, and simply there is no equality in that action. It creates entitlements for many and payment for them from few. More wisdom is needed here and hopefully ratification, it strikes controversy in whether it is a violation of constitutional rights.

Reference:

Jonas, S., Kovner. A. (2008). Health Care Delivery in the United States. New York, NY.
Springer publishing company.

HealthInoNet.org (2010) HealthInfoNet Positioned to Help Providers Achieve Meaningful Use.
Retrieved on September 11, 2010, from http://www.hinfonet.org/news.html

The New York Times. (2010). Obesity Rates Hit Plateau in U.S., Data Suggest. Retrieved on
September 11, 2010, from http://www.nytimes.com/2010/01/14/health/14obese.html?_r=1

CDC.Gov. (1999) Overweight and Obesity. Retrieved on September 11, 2010, from
http://www.cdc.gov/obesity/stateprograms/index.html

Fastlane.Dot.Gov. (2010) DOT, First Lady and Childhood Obesity Task Force share Important-
Goals: Let’s Move. Retrieved on September 11, 2010, from
http://fastlane.dot.gov/2010/05/dot-first-lady-childhood-obesity-task-force-share-goal-lets-move.html

Let’s Move: America’s Move to Raise a Healthier Generation of Kids. (2010) Retrieved on
On September 11, 2010, from http://www.letsmove.gov/

American Heart Association. (2010). Cigarette smoking statistics. Retrieved on September 11,
2010, from http://www.americanstroke.com/presenter.jhtml?identifier=4559

Kaiser Family Foundation or KFF (2010) Health reform law, the patient protection and
affordability act, and health care and education reconciliation act of 2010. Retrieved on
September 11, 2010, from
http://www.kff.org/healthreform/upload/housesenatebill_final.pdf