I certainly accept that people with power (government) should always looked at suspiciously if they try to expand/retain their power. “I don’t trust ‘em” is smart thinking in my book. Sometimes though, there is some power that power-obsessed people don’t want, because it’s not worth the cost.

EOL to me is a perfect example of a power the government desperately does NOT want to wield. There has to be a default rule for “pull the plug on an incapacitated person or not” if there isn’t a directive in place. There HAS to be a default rule because its going to come up.

You said the hospital hounds everybody about having AMDs. If there isn’t one, then they have to enforce the government’s rule. They either have to leave the patient plugged in despite the sobbing relatives begging them to end the suffering, or they have to pull the plug despite the sobbing relatives calling them murderers. The hospital is doomed no matter what the rule says.

No matter what the AMD says, the hospital (as the physical manifestation of the government’s “power”) is officially not responsible. Let the sobbing relatives rip each other’s hearts out.

The Judge in case like this . . . I’m willing to bet they would rather be doing ANYTHING ELSE rather than dealing with a case like this.

At least in the current healthcare reform discussions, the closest I’ve heard the government even suggested to exerting power in this field is the proposal that the reform bills mandade getting a directive. Or put another way, forcing citizens to exercise their individual rights to make their own decisions. Demanding that the people take the power from the government. Tell us to plug your ass in, tell us to unplug your ass, we don’t care . . . we don’t want anything to do with this crap. Horrible family anguish is bad PR, amigo.

I agree that governments inherently try to expand their power, and I also agree that if the government tried to exert power in this area it would be extremely bad. I honestly can’t see the government wanting to fight the fight for this minor and unproductive powergrab. There’s money to be appropriated, districts to carve up, hookers to abuse, bribes to take, playoffs to watch in boxseats, new jobs to be patronaged away, new types of favors to do for other politicians to grease deals . . . that $h!t actually benefits me. Wading into hysterical family drama with ABSOLUTELY NO TANGIBLE BENEFIT except the smug knowledge I can piss on someone’s not-yet-corpse and get away with it? If I want to feel that powerful . . . well, that’s why I’m chasing the pages! Its less work, I still feel like I’m above the law, and I still have time to line my pockets afterwards.

Politicans may be turned on by power, but they are usually opportunistic narcissists first and formost. Screwing with EOL just seems like something even they wouldn’t want to do. Not because of any sense of morality, but becasue they are such amoral jackholes that they wouldn’t do something so self-destructive. That’s not just evil — that’s crazy-and-evil.

EOL is certainly something that shouldn’t be screwed with, but I guess I’m trying to say I don’t think its something to lose sleep over without something concrete. I don’t think Obama should mess with the military either, but I’m not worried about the next appropriations bill budgeting for mind control food additives. There are more immediate issues that need dealing with — like universal health care (I’ll just slip that in there at the end . . .).

The difficulty I see in all of this is that people simply do not believe that the US government can grow to be your worst enemy in certain domains. The old “I am from the government, and I am here to help!” says it well.

Things usually begin reasonably well in a new agency or department, with high hopes and a ferver to do something to serve the public. It goes downhill from there, some rapidly, and some more gradually, until you can’t read their “mission statement” without derisive laughter.

This isn’t merely an emotional bias with me, because I have seen this phenomena several times over first hand, and it is my government that is screwing up mightily, which is painful to witness. The more complex the issue, the more likelihood there is for a screwup, and the more layers of bureaucracy that become involved. Once it is bucked high enough it becomes politicized, and all hope is lost. We all have shudders from the Terry Schiavo experience. I could talk about quite a few more flubs in government that are equally appalling.
Don’t get me started on the Engineer Corps and New Orleans, for instance, or on the INS and State, illegals, and visas.

In the medical field, I believe the government is just about far enough into the problem. We need solutions, for sure, but most of them can be accomodated without the government crashing through, taking a heavy managerial role, and creating major opportunities for mission creep, egregious errors, and bumbelitis for the next decades. A few rules and regulation changes might be in order, but I’d keep the government bureaucrats away from the field!

The real brainpower in the field is with the doctors, and I cannot imagine how the government could match their collective talent and knowledge across the full spectrum of medical problems in a timely manner, much less for them to keep up with new developments adequately.

In another vein, I voted for Bush twice, and I believe we ended up with the better choice each time, but from the outset of his second term I was greatly disappointed with his efforts and the efforts of his party in Congress, and in what I believed to be the total mismanagement of the Iraqi situation.

But, then, I am far, far more disappointed with Obama, his czars, and his leftwing ilk, and I think I’d have been disappointed with McCain too. The nation thirsts for a leader that we can have confidence in to get us rolling again and it shore ain’t Obama. He is far too devisive.

I just couldn’t figure out how I was 100% agreeing with everything you said but kept getting to the end and going ” . . . yeah, . . . yes . . . ye-what? No. . . . nonono, wait, . . . wait, no, what happened . . .”.

If I thought there was the slightest chance they were trying to seize control of “end-of-life” decisions I’d be screaming bloody murder right next to you. Regardless of our conversations, I hope I’ve at least displayed a consistent “oppressive government sucks” belief system. We may disagree with what “oppressive” and “government” mean precisely . . . but some things aren’t “near the line”. I’d be center-of-the-Sun balistic if a US Administration tried something like that, and I CERTAINLY believe with every fiber of my being that Administrations are capable of doing something so morally obscene. You know I’d be screaming bloody murder if Bush tried anything like that, all I can do is swear I have zero “party loyalty” to Obama. He and his can absolutely go to hell if that happened.

You’ve been through it. I’ve only seen it from the distance of a desk . . . and I don’t ever want to think about how horrible what little I had to see was again. You said that things went “smoother” for you because you were designated, the painful conversations were had with loved ones and doctors. You mentioned your AMD (I’m guessing Advanced Medical Directive?). You wrote down what you wanted to happen.

Please everybody, for God’s sake, whatever State you live in:

GET A LIVING WILL, AMD, DNR, WHATEVER THE PAPERWORK FOR YOUR STATE REQUIRES. You do not (notnotnot) want to see what happens when there isn’t the proper paperwork and discussions. Even with all the proper paperwork . . . it is a very, very painful and not-nice situation. You will not like it. Without covering your ass legally . . . you will really, really not like it. If the government has to deal with it, everybody involved will suffer. Yes, there is an extremely high chance you won’t need it. But you might. And if you don’t have it then you’re going to be very sad. Really, really, God-damned sad.

Seriously people — get the paperwork.

manning — Obama dreams about hoping to attempt to maybe try to mess with EOL for one second . . . you give me the caliber, I’ll bring the cartridges. I don’t see it today, but if you show something to me in the future I’ll even give each round a spit-shine. Just imagining it is getting me pissed off.
You think I had a grudge against Bush? Hell, I always thought he was a jagoff (a nice jagoff . . . but a jagoff regardless). I actually think Obama is Not Utterly Pathetic, which is the highest ranking I’ve given a President since I was 6 (Regan’s hair rocked). If I was betrayed by a jagoff that slipped past my jagoff radar . . . that’s a cold flame of hate right there.
And my sympathy for having to grind through EOL dramas again and again. That must have sucked to a jaw-dropping extent.

Only Republicans do that, and then only if your name is Schiavo.

Jesus H. And we wonder why the conversation goes nowhere.

Yes, Mannning: the federal government is going to force you to stay on life support forever . . . forever . . . forever . . . Because, um. . . Um . . .

It’s like trying to talk to the crazy guy who pushes a shopping cart around muttering about the CIA.

We do face the possibility of a government-run, single-payer healthcare system in the future, I believe, and any legislative steps that might be perceived to be in that direction must be thoroughly examined for their long-term implications.

I am not at all convinced that, if the government was the sole operator of healthcare, they would keep hands off of all the medical decision processes–including EOL–for their own rationales, motives, and political notions, and with ever less care for the patient. I am not reacting here to any specific legislation purporting to lead in this direction, but to the basic principle of rejecting government intervention ever further into our lives.

What knits those statements together you highlighted is the opportunity that seems to be growing for government to increase its role in every direction, and EOL is a critical one. To dredge up an old saw: he who pays the bills calls the tune. If they can, they will, or at least try. My opinion. A line must be drawn somewhere.

I will leave it at that.

I deliberately ignored the intermediate problem of coverage by either the government or by insurance companies and which would be better, because the end of life problem dominated my thoughts and dictated my aversion to having the government in the decision loop.

We currently have both involved: via Medicare and Medicaid, the VA and military medical care on the government side; and private medical insurance on the other side, as supplemental to Medicare, for instance, or as primary medical care via an employer’s policy. There are a few golden policies written for the wealthy, I suppose, and for Congress, but they are not dominant in the industry.

From a practical view, I do not see how we should favor one over the other: both have their place in our society. Yet, each has its flaws and needs a tuning to become really effective. I have already shown one flaw in having the government take part in the end of life decision process, which, if taken to the extreme, would overload our systems. There are several flaws in the private insurance approach that need to be addressed also. Here is a quick list of what I see as needing to be solved satisfactorily “real soon now”, and by employing conservative principles as appropriate:

1. Ensure financial security for Medicare and Medicaid
2. Ensue financial security of Social Security
3. Reform the tort system to eliminate abuses
4. Reform the administration of Medicare and Medicaid to eliminate fraud and abuse
5. Allow health insurance to be portable across state lines and from company to company, if practicable
6. Eliminate the “doughnut hole” in prescription insurance
7. Require immigrants and visitors to take out adequate health insurance in advance of entry into the US
8. Require employers of aliens to take out health insurance on their employees and families.
9. Require proper ID and medical records for all persons resident in the nation.
10.Allow or demand that insurance companies write policies for people with preconditions whose premiums adequately reflect the insurance risks, and spreads the risks as well over the policy field.
11.Address the problems of long-term care more deeply, perhaps with a joint solution between the government and private industry.
12. Address the problem of upper limits to coverage by insurers, cutoff criteria, and the ensuing problem of probable bankrupcy of the patient.
13. Further address the problem of rapid approval of procedures and medications for use by providers for patients.
14. Retain the essential free market approach, while addressing ballooning medical costs. A big how?
15. Perhaps consider an “insurer of last resort” approach to provide coverage in hard cases by industry, and not necessarily the government in the first instance.
16. Doctor compensation is a significant problem. They spend the better part of a decade in schooling, and can incur personal debts in the hundreds of thousands to pay their way, and have a highly constrained personal life during those years; many take a decade to simply catch up.

I have not seen any detailed healthcare plan that not only addresses these problems but also provides a clear and understandable means for solving them adequately, shows how to pay for them, and at the same time preserves the essential freedoms of the marketplace.

You’ve mischaracterized MikeReynolds argument.

In Comment #20, he tried to illustrate the danger of private insurance — motivation. He tried to illustrate that private insurance had a motivation for policyholders to die before receiving expensive care. To counterbalance that, he gave the example of the government being motivated to keep people alive, ostensibly to make them happy and so they would vote for the politicians.

The issue was a motivation to provide care. Private insurance companies have an incentive NOT to provide care, whereas public insurance does have a motivation to provide care.

This presupposes something that may have been lost . . . that the patient WANTS the care. A private insurer failing to provide care is only a “negative” if the patient wants the care.

“I don’t want plastic surgery!”
“Well, we wern’t going to pay for it anyway.”
” . . . you bastards!”

What MikeReynolds was talking about is trying to get care from your insurer, and being denied. Something that is more of a threat with private insurers than with public insurers. Trying to GET care, not trying to reject care. You read that as the government forcing care on people . . . and that’s isn’t what anybody meant.

MikeReynolds is NOT advocating or suggesting that the government would tie patients down and force care on them. At all. If the goal was to gain the patient’s vote, how would torturing them get votes? Or the votes of their family and loved ones? Even if the government is evil enough to do that, it would be counterproductive.

“Please, please, let me die! I’m in agony!”
“No!! Will you vote for me?”
” . . . okay.”

???

As far as I can tell, this fundamental misunderstanding has resulted in you, me, and MikeReynolds carrying on different conversations. You are absolutely right that if MikeReynolds was/is advocating that, he’s a sumbitch. That is something we all can rally against. But he’s not advocating that.

I’m confused how you go from:

“The only thing health insurance providers are responsible for is to pay for covered items–or not. They are not responsible for life or death decisions, and I never said they did.”

and this:

“life or death decision for a patient currently resides with the patient, or his appointed relatives, with medical aspects of the decision contributed by doctors, and with no input from the government.”

to this:

“it is diabolical to bring the government into this decision if the only motivation of the government is to prolong the life of the patient so that he can vote,when it is totally against the patient’s wishes to continue to live. This is a disgusting idea unworthy of rational people.”

and this:

“With the government as provider, and as the determining member of the parties concerned—including the patient, doctors, and relatives–it is the government that has the final say whether to extend the life of the patient or not.”

Your first two statements are true. Your last two are absolute nonsense. Out of respect for you I won’t call them lies . . . but they are completely and clearly false in every possible facet.

The government is NOT being brought into the decision. At all. No one has proposed that the government have a voice in this debate. The absolute closest was the proposal that a government plan pay for the doctor if you meet with them to discuss end-of-life care (which you said is who you should be talking to). Pay for . . . not direct. You want to talk to your doctor, they will pay for it. You say that the provider only pays for care, not directs it. Then you say that if the government were to be the provider, they would direct care . . . and in the most cruel manner possible.

So if the provider is private, they don’t dictate care. If the provider is public, they do. Why the fundamental change in control? No reason. Depending on who writes the check, the entire paradigm of laws, rights, and precedent implodes instantly. Why? Because.

Wouldn’t the government just act as the private insurer, and so the “hands off decision-making” approach would apply to them as well? Nonsense, you say. Why nonsense? Because.

You provide the example of the government sadistically prolonging the suffering of a patient who begs and begs for death. You end this utterly disgusting example with the triumphant declaration “FACTS AGAIN”.

THAT IS A PARANOID FANTASY. It is NOT “facts”. Surely, you know that. You have made up a monster, then attacked it. That would be as silly as deciding not to vote Republican because they want to kill left-handed people in concentration camps. Surely you don’t support that? It is diabolical! Only a sick twisted person would support that. Have fun in your right-handed-only utopia!

Let me repeat this again. Nobody is proposing to make the government part of the decision-making process for end-of-life decisions. I agree with you wholeheartedly that would be a bad thing — but it is not a real fear. It does not exist. Nobody is trying to make it exist. You are railing against an evil that is not real.

“The bottom line for me is I do not want the government anywhere near me when I am approaching death, unless it is to provide me with no-strings cash gifts.I trust my doctors far more than any government weenie.”

This is EXACTLY what everybody is agreeing to. The government pays for your care. That’s it. Where did you get the idea that the government will get decision-making power, especially over end-of-life issues? It is NOT TRUE. I’ve cited the actual text in the House Bill before, if you would like I’ll be happy to find it again so you can read the actual source material. Haven’t read the Baccus Bill, but I’m pretty sure it’s not in there either.

No hyperbole, no snark. What you fear is certainly something to be afraid of, but is NOT in danger of being a threat. It is as legitimate a concern as being worried about a zombie invasion. Yes, a zombie invasion would be a bad thing. No, it isn’t happening, about to happen, likely to happen, or being advocated to happen.

I really can’t think of anything else to say about this.

If we remove the issue of end-of-life care from the table, does your opinion of healthcare reform change at all?

However, can the government ignore such a directive and keep me alive against my will? If I accept a bit of what busboy alluded to, they certainly can disrupt the game, deep six my AMD, keep me bubbling on the tubes, and in the agony of advanced cancer, especially if they want me to vote! Oh Michael, do you really believe in this?

A vote, you may recall, has to be executed by someone in their right mind, so no morphine or other pain-killing drugs for me either. This gets even more diabolical!

No, I do not want this scenario at my deathbed!