"'Rate shock' is the new 'death panels.'"

"They’ve chosen these words very carefully to scare people. It’s the ideal term for what is, at its core, a fear-based campaign."

"Why have Americans lost their devotion to the future?"

Asks David Brooks, observing that America was built on a "future-oriented mentality," but these days we "sacrifice the future for the sake of the present." Read the whole thing to see if you agree with that premise, which is backed up by assertions like: "The federal government is a machine that takes money from future earners and spends it on health care for retirees." Taking the premise as true, why is it happening? Brooks goes back to the big events that shaped The Greatest Generation:

The Great Depression and World War II forced Americans to live with 16 straight years of scarcity. In the years after the war, people decided they’d had enough. There was what one historian called a “renunciation of renunciation.” We’ve now had a few generations raised with this consumption mind-set. There’s less of a sense that life is a partnership among the dead, the living and the unborn, with obligations to those to come.

Interesting avoidance of the obvious generation that deserves the blame. I'm talking about my generation: The Baby Boomers. We didn't endure the Great Depression and World War II, but we were raised by parents who found it just wonderful to have a predictable quiet life home life, comforts that were perfectly normal to us, but without the prior deprivations, boring and unsatisfying.

Oh, the trouble we made, changing the culture, restructuring the politics, leveraging our numbers. Don't say we didn't look to the future! The future was us getting old.

We set up the benefits programs, and we taught the younger generations to believe in them, deeply and emotionally. We're just trying to get to the end without their noticing what we have done. It's a tricky business, because we want the money to flow into our needs as we struggle to live longer and longer, sucking more and more of the life out of the young before we die.

Wasn't it amazing the way we got you to love Obama — the last of the Baby Boomers (or did you believe him when he said he was post-Boomer?)? Under the banner "HOPE," he got you to believe in a health-care scheme that forces healthy young people to sacrifice your hope of building individual wealth.

Obviously, the story isn't over yet, but what will be left when we're gone? How long will that take? It depends on how securely we've structured this thing, how long your soppy empathy lasts, and whether the "death panels" taunt keeps working to deter you from the kind of self-serving politics from which we ourselves never refrained.

The coming scourge of Baby Boomers with Alzheimer's disease.

Get ready. We're being softened up. Pay attention... while you still can.

"Birth Control Rule Altered to Allay Religious Objections."

"Under the proposal, female employees could get free birth control coverage through a separate plan that would be provided by a health insurer."

The institution objecting to the coverage would not pay for the contraceptives. The costs would instead be paid by the insurance company, with the possibility of recouping the costs through lower health care expenses resulting in part from fewer births.

Is the system better with fewer births? You know, they are babies at first, but eventually they will be workers and therefore taxpayers, and we're especially going to need young workers to be the health care providers for the aging population that will need more and more care.

But if the social engineers are thinking about fewer births, they must also be thinking about more deaths. What better way to avoid costs than for the aging people to depart? How can they not be thinking about that too? At least they're sensitive enough not to spit it in our faces the way they celebrate the savings inherent in fewer births.

And do you really understand the new plan to accommodate religion? Do you see how the religious objectors are absolved from their connection to what they see as sin? Isn't it all sleight of hand? But what is absolution?

"If we accept the Liverpool Care Pathway we accept that euthanasia is part of the standard way of dying..."

"... as it is now associated with 29 per cent of NHS deaths."

Medical psilocybin.

Easing your way down life's off ramp.

Why not? The boomers are aging. The death panels will be handing out prescriptions.

Turn on, tune in, drop out... indeed.

Trend watch: Segregated hospital emergency rooms.

Because there's a class of persons who need different treatment.

There were no beeping machines or blinking lights or scurrying medical residents. A volunteer circulated among the patients like a flight attendant, making soothing conversation and offering reading glasses, Sudoku puzzles and hearing aids. Above them, an artificial sun shined through a skylight imprinted with a photographic rendering of a robin’s-egg-blue sky, puffy clouds and leafy trees.

Ms. Spielberger, who is in her 80s, was even getting into the spirit of the place, despite her unnerving condition. “It’s beautiful,” she said. “Everything here is wonderful.”

If you think that's beautiful, you should see the afterlife.

Or am I taking this the wrong way? The NYT is acting like this is sort of posh. But one look at the headline — "For the Elderly, Emergency Rooms of Their Own" — and my "Death Panels!" red flag went up. Let's make them very comfortable, let's palliate, but let's not save them. The heroic treatments are in that other emergency room, the one for the people who are still useful.

Romanticizing suicide. [AND: Murder!]

In the NYT.

Expect more propaganda of this kind, my friends, because in the future, it is hoped, you will be your own death panel.

"Obama Punks the GOP on Contraception."

That's the spin from Slate's Amanda Marcotte (and I think she may have it right!):

After two solid weeks of Republicans rapidly escalating attacks on contraception access under the banner of "religous [sic] freedom," Obama finally announced what the White House is proposing an accomodation [sic] of religiously affiliated employers who don't want to offer birth control coverage as part of their insurance plans. 

Yeah, rotten spelling/proofreading, but give her a chance. Normally, I can't stand Marcotte, but I think she's homing in on the truth:

In those situations, the insurance companies will have to reach out directly to employees and offer contraception coverage for free, without going through the employer. Insurance companies are down with the plan... contraception actually saves insurance companies money, since it's cheaper than abortion and far cheaper than childbirth. 

Remember the economies of the "blue pill" and the don't-call-them-death-panels for end-of-life human beings? There's lots of money to be saved at life's onset. Insurance companies (and the safety-net-providing government) stand to save lots of money through pregnancy — and child! — prevention. It makes economic sense to incentivize the use of birth control. A woman has a right to choose whether to have children or not, but the government may nudge the woman toward its preferred choice. It is good economic policy to push women to avoid having babies until they've got a stable relationship and a solid economic foundation, so clear the path to the relatively inexpensive pills and poisons and devices that keep the sperm and the egg from acquiring a will of their own.

Another point, which Marcotte doesn't make, is that many, many healthy individuals are about to be forced to spend thousands of dollars a year on health insurance, and there needs to be a decent flow of seemingly "free" things so that they don't get too upset about it. Birth control is perfect for this. It's something women use — continually — when they are perfectly healthy. Face it: Birth control is about preventing an important bodily function from working. Now, the birth control won't be free, because everyone paying into the insurance pool will be covering the cost, but the women who use the birth control will have the feeling that they're getting something. That's a special kind of palliative care that the designers of Obamacare are going to want to cover.

So did Obama "pull a fast one" on conservatives, as Marcotte surmises?

He drew this out for two weeks, letting Republicans work themselves into a frenzy of anti-contraception rhetoric, all thinly disguised as concern for religious liberty, and then created a compromise that addressed their purported concerns but without actually reducing women's access to contraception, which is what this has always been about....

Now, those who complained about the old rule have a choice whether to move on to some other traditional-values issue or to find a way to say that the problem is still there. If they do the latter — as Rush Limbaugh did a series of semi-coherent rants on his show yesterday — they're going to annoy/scare the millions of women who use contraception and the millions and millions of women and men who want other people to use contraception. (Don't forget the "Freakonomics" theory connecting the avoidance of unwanted pregnancy to a reduction in crime.)

Marcotte thinks the conservatives will give up on this issue and exults that "the damage has already been done."

[W]hat most people will remember is that Republicans picked a fight with Obama over contraception coverage and lost. This also gave Obama a chance to highlight this benefit and take full credit for it. Obama needs young female voters to turn out at the polls in November, and hijacking two weeks of the news cycle to send the message that he's going to get you your birth control for free is a big win for him in that department.

And let's not forget — Marcotte doesn't mention this — that the birth control fracas peaked precisely when a story was breaking that should have made the administration look weak on a women's rights issues: the decision limiting women in the military. As I noted yesterday, Michelle Obama was deployed on a nutrition-in-the-military mission on the very day that decision was announced. So there is good reason to think the Obama campaign is sharply focused on manipulating the minds of constituents who care about women's issues.

As Marcotte said: "It's all so perfect that I'm inclined to think this was Obama's plan all along."

"To help prevent overtesting and overtreatment of older patients — or undertreatment for those who remain robust at advanced ages..."

"... medical guidelines increasingly call for doctors to consider life expectancy as a factor in their decision-making. But clinicians, research has shown, are notoriously poor at predicting how many years their patients have left."

So, let a website figure it out: ePrognosis.

As Bette Davis once said: "I think I'll have a large order of prognosis negative!"

***

"Oh, Ann. Don't be sorry. About anything."

Things seen and unseen.

Instapundit linked my post about the morality of affirmative action:

THE MORALITY OF AFFIRMATIVE ACTION: “The students at a university are always the students who were admitted. They feel hurt or outraged if they think the message is that they shouldn’t be here. They’re here, in the room, and the individuals who did not get in are not here to cry out with corresponding outrage. . . . The policy will only affect individuals who are not in the room, who are out there, just as the students who didn’t get in this year are out there. The difficult thing — and the true moral challenge — is to visualize those who are affected who are not in the room to express pain when you hurt them.”

Another case of what is seen and what is not seen. Politicians — among whose number I certainly count university presidents — advance their careers by exploiting the difference between the two.

He links to the essay "What Is Seen and What Is Not Seen," by the 19th century political economist Frédéric Bastiat, who begins:

In the economic sphere an act, a habit, an institution, a law produces not only one effect, but a series of effects. Of these effects, the first alone is immediate; it appears simultaneously with its cause; it is seen. The other effects emerge only subsequently; they are not seen; we are fortunate if we foresee them.

There is only one difference between a bad economist and a good one: the bad economist confines himself to the visible effect; the good economist takes into account both the effect that can be seen and those effects that must be foreseen.

My son John Cohen also quoted my seen-and-unseen comments, and he associated the general principle with the specific problem of capital punishment, quoting an article by Cass Sunstein and Adrian Vermeule called "Is Capital Punishment Morally Required?" In that context, statistics indicate that capital punishment has a deterrent effect, but the people who are not killed are, of course, never identified. What we see is the convicted person, with whom we may feel challenged to empathize, and the dead person, whom it is too late to save.

The phrase "seen and unseen" calls to mind the Nicene Creed:

We believe in one God,
the Father, the Almighty,
maker of heaven and earth,
of all that is, seen and unseen.

I wonder if that was ever intended to refer to things that are unseen because they never happened, the alternate version of reality that would exist if we had made a different decision. But that is the moral problem I want to notice, and I will designate with a new tag "seen and unseen." I have 2 more things I want to talk about under that heading. One has to do with Rick Perry and the other has to do with Dan Quayle. But I'll put these in separate posts.

Beyond Obama's blue pill: folksingers!

What medical treatments will the government approve, in the future, for the aging population of America? Two years ago, President Obama let it slip that cheap painkillers would supervene more expensive cures. And here's a new, low-price palliative for the oldies:

Every week, three music therapists from MJHS Hospice and Palliative Care crisscross the city and suburbs to sing songs to the dying. With guitars strapped to their backs, a flute or tambourine and a songbook jammed in their backpacks, they play music for more than 100 patients, in housing projects, in nursing homes and even in a lavish waterfront home. The time for chemotherapy and radiation is over.

The music begins: a song to hold death at bay, a song to embrace death, or to praise God. A Vietnam veteran asks for a song in Vietnamese. One man asked only for songs with death in the lyrics, to force his family to talk to him about the future. He was ready to talk about it. They weren’t. So the therapist sang Queen’s version of “Another One Bites the Dust.” “Amazing Grace” and other spiritual songs are most often requested just before death.

It's a jobs program for sensitive young women who might feel uncomfortable busking on the city streets, waiting for cold-hearted businessmen to drop a dollar in their guitar cases. The government will drop the dollar in, and the elderly patients will be too polite (and also physically unable) to walk away.

Welcome to the hospice, where the strumming of Joan Baez wannabes will prepare you for death. They will ease your "final transition." You'll be ready to die before they're ready to leave.  If you hang out too long at the hospice, be forewarned: When you've heard "Amazing Grace" 10,000 times, you've only just begun.

Can't we please pick our own music? Recorded music played by virtuouso musicians? Maybe Beethoven's 6th Symphony.... or "The Man in the Box"....



IN THE COMMENTS: Jim said:

I was on the faculty in a music department with a music therapy program for ~25 years, and taught a couple of courses to students majoring in MT during that time.

The MT professors/practitioners have been relentlessly pursuing their dream of obtaining funding from medical insurance and the public schools. They point to a growing body of MT research - all of it advocacy, most of it incompetent, much of it just silly - to support their lobbying for the loot.

ALSO: When you get to that hospice and the folksinger arrives, remember John Belushi. (Suggestion via RLC in the email and Sixty Grit in the comments.)

Let's talk about morality.

America has a strong consensus about a lot things even as we are divided on others:



What surprises you the most here? Are you surprised that 80% of Americans say suicide is morally wrong? I've often had to struggle with commenters on this blog when I have taken the firm position that suicide is murder, but I think America mostly agrees with me. There is generally an outpouring of sympathy when someone commits suicide. Why don't we express our moral opprobrium toward the self-murderer? I think it's because that person is gone, and we feel sorry for those who are left behind. They are the victims.

Doctor-assisted suicide is an important subcategory of suicide, and the Gallup report says that it "emerges as the most controversial cultural issue in Gallup's 2011 Values and Beliefs poll." But what is notable is that support for assisted suicide has been dropping and has reached its lowest level of support in 8 years.

"Death from Dehydration Is Usually Serene."

An ABC News article, from 2005, back when people were agonizing over Terri Schiavo.

"The process of starving to death seems very barbaric but in actuality is very peaceful," said Dr. Fred Mirarchi, assistant clinical professor of emergency medicine at Drexel University College of Medicine in Philadelphia.

"The patient's experience is really pretty benign," said Dr. Joanne Lynn, a hospice physician associated with Americans for Better Care of the Dying, a group working for improved end-of-life care. "Overwhelmingly, what will happen is nothing."...

"Patients [become] uremic -- filled with bodily toxins -- and are unaware of their surroundings," Mirarchi said. "They develop electrolyte imbalances that eventually cause an abnormal beating of the heart."...

"The heart will then stop and the patient will die," said Mirarchi....

"Going without water makes it more gentle," Lynn said. "Allowing chemicals [in the blood] to cause arrhythmia is more merciful."

That came up first when I Googled "patients die of dehydration," which I did because I was trying to find this news article I'd read yesterday. Here it is: "Elderly patients dying of thirst: Doctors forced to prescribe drinking water to keep the old alive, reveals devastating report on hospital care." That's in the Daily Mail, reporting on the situation in the UK:

The snapshot study, triggered by a Mail campaign, found staff routinely ignored patients’ calls for help and forgot to check that they had had enough to eat and drink.

Dehydration contributes to the death of more than 800 hospital patients every year.

Another 300 die malnourished.

Am I wrong to suspect there is a form of euthanasia going on?

Paul Krugman notes that Obama's budget plan relies heavily on what people are going to call "death panels."

(NYT link.) And his response is: "remember: you can always buy whatever health care you want; the question is what taxpayers should pay for."

The law, in its majestic equality, permits rich and poor alike to pay for surgeries, medicine, and hospital stays.

"Illinois Workers Find That a Death Penalty Ban Abolishes Their Jobs, Too."

Says the NYT.

[S]ome of the very people who pushed and prayed most fervently to end capital punishment in the state found that the triumph came with a termination notice.

“We’ve done such good work that we’ve put ourselves out of work,” joked [Wendi ]. Liss, 37, who spent a decade as a mitigation specialist assembling information to persuade juries to spare the lives of defendants....

The "workers" in question are lawyers and others at the Office of the State Appellate Defender. (Odd to see lawyers called "workers.") The job market in the law field is rough, and it must be especially grim to have put your specialty out of business in the state where you are licensed to practice law. Grim... but ecstatic. These were people devoting their lives to fighting the death penalty.

It's a fascinating life crisis. The celebration followed by ironic job loss could be the first scene in a movie. But what would happen next? 

2 things about the impending government takeover of medicine.

These items are side-by-side at Memeorandum:

1. In the Boston Globe, a Harvard nanophysics researcher named Mike Stopa says the term "death panels" "persists... because it denotes, in a pithy way, the economic realities of scarcity inherent in nationalizing a rapidly developing, high-technology industry on which people’s lives depend in a rather immediate way."

2. The NYT reports that "The Obama administration has become so concerned about the slowing pace of new drugs coming out of the pharmaceutical industry that officials have decided to start a billion-dollar government drug development center to help create medicines."

Life and death — it's economics, and the government is here to help.

The Obama administration gets cold feet on death panels.

"The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law...."

Is it wrong to use the inflammatory rhetorical term "death panels"? It sure gets results!

The death panels are back.

Excised from the statutory text, death panels — or that thing that got wrongly called "death panels" — returns by way of regulations:

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves....

Get ready to be prompted to sign a document that will sound helpful and reasonable. The advance directive. Don't you want the autonomy and control that comes from deciding in advance that you don't want people to try to save your life?

“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” [said the office Representative Earl Blumenauer of Oregon*] in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”

Moreover, the e-mail said: “We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ — e-mails can too easily be forwarded.”

The email said email can be too easily forwarded. Ha ha ha. And now, here it is, quoted in the NYT, cut and pasted into blogs.

The e-mail continued: “Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”

In the interview, Mr. Blumenauer said, “Lies can go viral if people use them for political purposes.”

But it's not a lie. You may not like the label — no labels! — attached to the policy, but the policy itself is understood — understood and presented in an inflammatory way that precisely counterbalances the soothing, lulling tones used by people who like it.

Sarah Palin, the 2008 Republican vice-presidential candidate, and Representative John A. Boehner of Ohio, the House Republican leader, led the criticism in the summer of 2009. Ms. Palin said “Obama’s death panel” would decide who was worthy of health care. Mr. Boehner, who is in line to become speaker, said, “This provision may start us down a treacherous path toward government-encouraged euthanasia.” Forced onto the defensive, Mr. Obama said that nothing in the bill would “pull the plug on grandma.”

Well, you will pull the plug on grandma, but only after grandma has signed the document the doctor explained to her long before she got into the situation she's in now, back when it seemed like autonomy and control.

“Using unwanted procedures in terminal illness is a form of assault,” [said Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Service]. 

The question is what do patients want and how what they want will be determined. It seems to me that the effort is to get people to commit in advance to death-hastening choices, by getting everyone to sign these documents. Now, all the new regulation seems to do is to authorize Medicare reimbursements for the time health care professionals spend counseling patients about the value and importance of signing the document. It's hard to see what's wrong with that. If treatments are covered but advice about forgoing treatment is not covered, then there's an incentive to do expensive things.

In a recent study of 3,700 people near the end of life, Dr. Maria J. Silveira of the University of Michigan found that many had “treatable, life-threatening conditions” but lacked decision-making capacity in their final days. With the new Medicare coverage, doctors can learn a patient’s wishes before a crisis occurs.

Treatable? You have a condition that can be treated, but you can't think well enough anymore to decide whether you'd prefer to die? If you've signed the document, the answer is you'd rather let the condition kill you, because you allowed the doctors to "learn [your] wishes before" this "crisis" occurred. You didn't know what the crisis would be or how you would feel when it happened, but you had "wishes" then and these will be taken as your "wishes" now.

_______________________

*Oregon, the assisted suicide state.

"If geezers like me have lots of tests and treatments... there isn’t going to be enough money to spend on the other end. This health-care mess isn’t going to be fixed if we aren’t ready to get out of the way."

Said Hanna Rosin's "new hero."

IN THE COMMENTS: Martha said: "Death Panel of one."