How Obama Botched and Bungled the Health Reform Message

How Obama Botched and Bungled the Health Reform Message

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While it’s comforting to just blame the GOP for the unhappiness with health reform threatening the president’s re-election, the truth is that Barack Obama repeatedly botched, bungled and bobbled the health reform message. There were three big mistakes:

The Passionless Play

While Candidate Obama proclaimed a passionate moral commitment to fix American health care, President Obama delved into legislative details.

When a Baptist minister at a nationally televised town hall asked in mid-2009 whether reform would cause his benefits to be taxed due to “government taking over health care,” Candidate Obama might have replied that 22,000 of the minister’s neighbors die each year because they lack any benefits at all. Instead, President Obama’s three-part reply recapped his plans for tax code fairness.

While Republicans railed about mythical “death panels,” and angry Tea Party demonstrators held signs showing Obama with a Hitler moustache, the president opted to leave emotion to his opponents. The former grassroots organizer who inspired a million people of all ages and ethnicities to flock to Washington for his inauguration never once tried to mobilize ordinary Americans to demand a basic right available in all other industrialized nations. In fact, he hasn’t even mobilized the nearly 50 million uninsured, who have no more favorable opinion about the new law than those with health insurance!

When CNN captured a sobbing middle-aged woman telling Sen. Tom Coburn (R-OK) of her husband’s brain tumor, only to get the reply, “Government is not the answer,” the president might have helped all Americans feel her pain. He did nothing of the sort. The public face of “Obamacare” was never a mother, father, spouse or child, but, just as the Republicans wished, it remained…Obama.

The Friend (or Enemy) of the People

Hard as it is to recall, a New York Times-CBS News poll in mid-2009 showed nearly three-quarters of Americans supported universal coverage through a government-administered plan like Medicare. But the survey also revealed “considerable unease about the impact of heightened government involvement on…the quality of the respondents’ own medical care.”

That unease surfaced even in the heart of liberal Chicago, at a Second City show satirizing the new president. A doctor tells a woman her diagnosis gives her only three months to live. When she pleads for help, the doctor tells her the good news is that Obama’s health reform plan means she’s scheduled for her next visit just six months from now. The parking lot was packed with “Obama ’08” stickers, but the audience still broke out in laughter.

The comedy worked because it connected with real feelings. GOP consultant Frank Luntz soon urged Republicans to stress quality-of-care concerns. Obama and team remained tone deaf. Three years later, the same Times-CBS poll showed only one in five Americans thought the ACA would help them personally. A full third expected their quality of care to worsen, and just 17 percent expected it would get better.

In fact, though the individual mandate to buy insurance has received the most attention, the ACA is filled with provisions to improve care quality and individuals’ care. But for many middle-class voters, the answer to, “What’s in health reform for me?” was allowed to become, “Nothing good.”

The Caricatured Crusader.

When GOP leaders decided to just say no to Obamacare, they were honest about their political calculus. The polarization worked.

The number of Republicans saying reform would make their lives “worse off” started at only 22 percent in early 2009, according to the Kaiser Family Foundation (KFF) tracking poll, before jumping to 61 percent that summer. Just 11 percent of the critical independents began by thinking that health care reform would make them worse off, but that percentage more than tripled by summer to 36 percent.

In early 2010, the White House posted a list detailing which proposals by which Republicans had echoes in the ACA. That the mandate had originated in the conservative Heritage Foundation was nowhere to be found. Nor did the White House note that the GOP’s 2008 presidential platform had called for coordinated care and other changes almost identical to ACA provisions. In the event, none of this information was used to respond to the GOP attacks that helped sweep out Democratic candidates in the 2010 election tsunami.

It was only this past March that the administration, acting as if the Supreme Court’s ACA hearing was a political pep rally, sprang into action. It activated supporters, talked up the ACA’s Republican roots and rolled out press releases touting the law’s benefits for average Americans. It was too little, too late.

A 2009 report by the Institute of Medicine concluded that the consequences of a lack of access to medical care include “needless illness, suffering, and even death,” with the victims frequently being children. Yet health reform’s opponents have managed to switch the discussion from dead kids to the Constitution’s commerce clause. All the while, Barack Obama has flailed and failed to convince the American people that “Obamacare” is change they can believe in.

Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age. This post originally appeared in The Huffington Post.

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105 Comments on "How Obama Botched and Bungled the Health Reform Message"


Guest
R Prat
Apr 26, 2012

He totally missed the communication and engagement. Making change this big cannot be done through mandate or fiat. Sooner or later those that feel dread upon will have their day and I think that day is coming this June.

Guest
Apr 26, 2012

“[I]f this Court invalidates the minimum individual coverage provision, 26 U.S.C. § 5000A, the court of appeals’ severability judgment should be reversed and, with respect to the minimum individual coverage mandate’s operation, this Court should sever, along with Section 5000A, ACA’s guaranteed issue, preexisting conditions, health-status discrimination, and adjusted community rating provisions.”

– AHIP / BCBSA amicus brief

http://www.ahipcoverage.com/wp-content/uploads/2012/01/AHIP-BCBSA-SCOTUS-Amicus-Brief.pdf

In other words, they’re saying ‘we want all the old stuff back. Exclusions, recissions, denials, actuarial-based individual risk rating, no limits on MLR, etc.’

In other words, set the clock back to 2008.

Guest
Nate Ogden
Apr 26, 2012

2008 when we had fewer uninsured and premiums were 30% lower then today? OMG that would be terrible

Guest
MG
Apr 26, 2012

As if premiums would magically drop 30% if these were reinstated or wouldn’t have greatly outpaced CPI and wage increases in the first place.

It baffles my mind when anyone says the individual health insurance market was anything but a morass before HC reform filled with plenty of scumbag insurers and companies using all kinds of chicanery to get off the hook.

‘It’s a great market – as long as you don’t get sick!’

Guest
Nate Ogden
Apr 26, 2012

How dare those evil greedy insurance companies protect themselves from people being dishonest. They should shut up and take the loss for the good of all right?

Find me one person that has EVER had a policy recinded that didn’t lie or have “incorrect” information on their application.

It’s a great market as long as you don’t wait until your sick to try and buy insurance then lie about your health to get a cheaper policy.

Perspective…….

Guest
MG
Apr 26, 2012

You are going seriously argue that their was rampant illegal practices with rescissions in the individual health insurance market prior to HC reform? Ugh.

This is why having a discussion with you is a generally a waste of time. You bring plenty of interesting points up but border on the delusional in regards to your stance on issues.

Guest
Nate Ogden
Apr 26, 2012

that is a subjective question. How much is rampant?

If you get technical;

“Occurring without restraint and frequently, widely, or menacingly;”

Not even close, your over reacting or ignorant of the facts from listing to the MSM.

https://insurance.illinois.gov/hiric/RescissionDataCall.pdf

“The data call revealed that there were roughly 27,246 rescissions against a sampling size of about 6.7 million issued policies. This translates into a rescission rate of 3.7 rescissions for every 1,000 policies/certificates that were written over the five-year period covered by the survey (2004 to 2008). The rate of rescissions peaked in 2005 and was at its lowest in 2008.”

Oh damn is that a factual smack down. For those not good at math;

.37% as in less then 1%. On top of that it peaked in 2005 and was at its lowest in 2008. Double smack down. So know that we clearly know without doubt you were wrong how do you respond. Admit you were wrong or pull the typical lefty crap and just keep making stuff up and spreading lies.

Why is it so hard to talk to people that know the facts?

Guest
Nate Ogden
Apr 26, 2012

of the 27,000 rescissions I can find well under 1000 that were over turned, and that was after detailed review by the state. So that means for every questionable recission 27 people clearly lied and committed fraud. How many of those have been charged with a crime or suffered any penalty for fraud? And that is only people that had policies rescinded. How many more lied and got away with it?

Want to know what is honestly rampant…..applicant fraud, for some reason the left is ok with that though

Guest
Responsible_Development
Apr 26, 2012

Maybe the opposition and unease grew as people first saw the sausage making process and and then learned for themselves what was in the sausage. Politicians asked for special treatment, only some of which has since been reversed. Insurance costs rose faster (you mean prevention and covering 25 year olds isn’t actually free?!), while the pharma/device/unerned income taxes are kicking in before the bulk of the benefits. The messaging may not have been great, but it is the substance of the bill that is deeply flawed.

Guest
Nate Ogden
Apr 26, 2012

“While Republicans railed about mythical “death panels,”

Denial does not supercede reality. There is a legit concern about LCP, most liberals just aren’t educated enough to know what it is.

“the president opted to leave emotion to his opponents.”

Moe denial, I see a thread. The left has been throwing up sob stories for 40 years. Even you engage in it, just not smart enough to see it or honest enough to admit it.

“Candidate Obama might have replied that 22,000 of the minister’s neighbors die each year because they lack any benefits at all.”

Does that comment not play to emotion? Was it not Obama that said it? You contradict yourself in under 2 inches.

“never once tried to mobilize ordinary Americans to demand a basic right available in all other industrialized nations.”

great line, to bad its not true. According to the CIA China is industrialized, do you really want to compare our healthcare to their rural poor?

Your line about mobilizing ordinary Americans is a lie.

“More than a thousand pro-health care reform advocates gathered in Washington, DC Tuesday”

“HUNTSVILLE, AL – A Huntsville group that supports health care reform is planning to “protest the protestors” this afternoon”

You Tube has videos of what you claim doesn’t exist.

“Protesters gather outside Marsha Blackburn’s office to voice their support for Health Care Reform”

“On February 17, Health Care For America Now is organizing pro-health care reform protests around the U.S., ”

“Hard as it is to recall, a New York Times-CBS News poll in mid-2009 showed nearly three-quarters of Americans supported universal coverage through a government-administered plan like Medicare.”

Breaking news, people like free stuff, liberals offer everything you want for Free!!!! Majority of people don’t like 16 trillion dollar national debt. Even fewer like 40 trillion Medicare shortfalls.

“the ACA is filled with provisions to improve care quality and individuals’ care. ”

When Medicare was passed it was sustainable, your point? Bills mean nothing. Just because a liberal calls a bill the affordable care act doesn’t mean it is magically going to make care affordable. Most grown ups are smart enough to realize this.

“The number of Republicans saying reform would make their lives “worse off” started at only 22 percent in early 2009, according to the Kaiser Family Foundation (KFF) tracking poll, before jumping to 61 percent that summer. ”

Have to pass it to see what was in it!

Guest
R Prat
Apr 26, 2012

“mythical death panels”. Last weeks article in the Health Care Blog spoke to spending an arm and a leg for a month of life. No one knows the last month of life. Someone must therefore make a decision to stop treatment because they think it is not worth it. If that person is someone other than the patient and the doctor and that decision means ending life, then what do you call that? Death panel may be harsh words but they certainly caused a valuable discussion.

Guest
Nate Ogden
Apr 26, 2012

Time 1974

“Man, too, may be somewhat responsible for the cooling trend. The University of Wisconsin’s Reid A. Bryson and other climatologists suggest that dust and other particles released into the atmosphere as a result of farming and fuel burning may be blocking more and more sunlight from reaching and heating the surface of the earth.”

Today man is responsible for warming, which actually stopped over 12 years ago.

Death Panels are a myth until republicans pass any bill then death panels will be real and the fault of republicans.

You can’t have inteligent conversations with these people. They are right now matter the facts and how dare we question them. They are smart, there mommies even told them so.

Guest
Nate Ogden
Apr 26, 2012

cue BobbyG the typo super hero;

intelligent
no
their

Guest
Apr 26, 2012

Yo, Nate…
Ease up on the Kool-ade, dude.
I like you better when you’re calm, cool and collected. You have too much on the ball to let yourself show out like this. You remind me of someone I know who can’t stand to see a dust particle without grabbing the Pledge.

Guest
Nate Ogden
Apr 26, 2012

I have bad OCD when it comes to people making stuff up like Michael. Facts are readily available on the internet with 10-20 seconds of searchingm why can’t people get them right?

Guest
Apr 26, 2012

Just pretend it’s a parade — or better yet, a New Years Eve party… And all this stuff is just so much confetti.
If a few pieces hit the floor it’s really okay. In fact, it’s part of the ambiance.

Okay, I’m done. Carry on.

Guest
Apr 26, 2012

When in doubt,

http://dictionary.reference.com/

Oh, wait — “doubt” and “Nate” are mutually exclusive concepts.
__

In fairness, John, he’s been doing better lately, in the aggregate.

Guest
Joe
Apr 27, 2012

At what point will PPACA supporters realize that it is not the messaging — it is the PPACA itself that makes it unpopular.

Even far-left Dems (Barney Frank) have finally admitted the effort was misguided…

Long term, Dems are helped (not to mention patients and the country) if SCOTUS throws out the whole thing.

Guest
Peter1
Apr 27, 2012

I too have been extremely disappointed by a lack of any fire in the belly of Obama for these issues. It’s as if he expected reason and intellect would take over in the minds of Americans (not to mention congress) after he was elected. Americans always loose enthusiasm for programs when they see that long term problems cannot be solved without pain and cost.

“2008 when we had fewer uninsured and premiums were 30% lower then today?”

Unemployment bottomed out in 2007. Yes, Nate’s view from the Titanic just before the iceberg.

“How many of those have been charged with a crime or suffered any penalty for fraud?”

Guess it wasn’t fraud after all. Only people thinking insurance is the solution will agree that recessions are an important element in health care. Your health care history should only be an issue between you and your doctor.

“Today man is responsible for warming, which actually stopped over 12 years ago.”

http://www.realclimate.org/index.php/archives/2012/04/evaluating-a-1981-temperature-projection/#more-11398

“We have all heard the hoopla regarding how many years it takes to evaluate a climate projection from the denialistas who wish to make something of a short term trend. These statistically challenged clowns also often want proof that models are useful, but they usually refer to projections from current research. So, you want a 30 plus years projection validated, behold- Hansen et al., 1981.”

You’re an idiot Nate.

Guest
Nate Ogden
Apr 27, 2012

Are arguments of logic really where you want to be?

“Guess it wasn’t fraud after all.”

So if no one is tried or convicted the crime isn’t real? So that means victims of unsolved murders aren’t really dead? But by that same logic the 99% of rescission that are not overturned means they were correct. If they were correct even under the new laws they would still be allowed.

“Only people thinking insurance is the solution will agree that recessions are an important element in health care.”

In your wisdom then Peter tell us how you handle someone that can afford insurance that doesn’t buy it, then gets sick, and lies about the illness in order to get lower rates?

Is that not unfair to those that maintain insurance and do things right that others pocket the money then lie to get coverage? Why are you ok with that?

We can save the global warming pseudo science for another place.

I notice you don’t have much to say yourself, always linking to others, how much intelligence does that take?

Guest
tcoyote
Apr 27, 2012

Michael is only half right. The reality is actually worse.

The President was bleeding copiously at the end of this project, and his overmatched political advisors made a calculation that the administration had committed enough political capital to ACA and that they needed to pivot to what the public really cared about-jobs, foreclosures, massive personal cash flow problems, etc. One of them even said, ignoring the evidence of rising public doubts about “health reform” that, the ACA would “sell itself”.

In other words, the White House made a deliberate decision to change the conversation, instead of trying to explain what they’d done in comprehensible English. That’s why they didn’t defend the Berwick nomination, because they wanted to turn the page and move on to stuff the public really cared about. Health reform was a massive political loser for Obama, regardless of how many voiceless citizens it helped.

As someone who’s read the bill twice, I can tell you this was a thoroughly mediocre piece of legislation, not only poorly drafted but poorly focused. It was a massive bureaucratic project, and a huge pork barrel gift to the consulting and “policy” communities. It is crammed full of commissions and boards to be staffed by experts, and laden with lots of tired ideas that haven’t worked so far, but “let’s try ’em again”.

The public has no patience with “experts” these days, or with massive bureaucratic projects. Their patience with government in general is at an all time low, and it required not only passion, but enormous public faith in government’s ability to make constructive improvements in our lives.

The tragedy is that 30 million people, many of whom do not know they would have been helped, will lose coverage as a result. This was not a failure of passion, but a failure of political judgment and of policy.

Guest
Apr 27, 2012

Well stated.

Guest
Apr 27, 2012

I agree.

I came to terms some time ago that the main importance of the effort was the Herculean effort it took to finally get a constructive conversation underway. I’m convinced that without that abortive attempt to repair the train wreck we call health care in America, that conversation would still not be happening.

To that end, I just read a reassuring link from an oncologist reporting on a recent meeting of professionals in his specialty.

http://sunriserounds.com/?p=629

Similar professional conversations are in progress all over the place. And I know that I know that without ACA those conversations would not be where they are today.

Guest
Nate Ogden
Apr 27, 2012

from the insurance side it did get tens of thousands of employers engaged to do something about the cost. Unfortunetly tens of thousand of others still don’t care enough to make any effort.

In most states I work workers comp is a meaningful expense and employers go to great lengths to avoid claims. The cost is substantially less then health but the same employer that will hold saftey meetings and spend time every month mangaing their workers comp can’t find time for quarterly meetings or to educate their employees.

We see the same thing from individuals, many more are trying to become consumers. We get more calls in a month from members asking about cost or wanting some ideas on how to shop then we would get in years before it all started. Again this is offset by just as many who still don’t care or refuse to make the effort.

Provider community has not been nearly as responsive. While I see a couple health systems making meaningful efforts to address cost most are continuing on just like nothing is wrong. As this is where 85%+ of the money goes I think this is still the major problem. If providers main focus is still extending life every day possible and providing as much care as possible instead of making what care we have affordable its going to be a rough few years. Lots of PR fights, lots of court cases, and lots of turmoil.

Should be a gold mine for the politicians and news propogandist though.

Guest
Apr 27, 2012

Your comment confirms my suspicions. That part about “Provider community has not been nearly as responsive” jumped out at me. That reflects my long held impression that providers — from small practices to big hospital systems — may know a lot about medicine but are crippled when it comes to accounting. For too long they have leaned on TPAs and the insurance people to manage their financial affairs.

Insurance people are in the business of managing economic risks, not health care, and they have a century or more of experience that has only been improved by technology and actuarial statistics that only get better as the years go by.

Health care professionals, on the other hand, manage disease and trauma (also getting better at that mission over the years) but outsource most financial issues to insurance, government and other third party resources.

Businesses which do that don’t last long in the market. They will get eaten alive by competitors. Health care providers, though, don’t think in terms of competition. Once they have the patient that’s the end of the story. My guess is that it’s a rare patient who leaves one doctor for another (unless he’s a pain in the butt and the doctor is happy to get rid of him). (I’ve had customers like that in the food business. Happy to let a competitor try to serve him champagne at beer prices. But I digress.)

Thanks for your reply.

Guest
Nate Ogden
Apr 27, 2012

“My guess is that it’s a rare patient who leaves one doctor for another”

Actually this is pretty common, in majority of cases people will change doctors for financial or plan reasons. It’s inconvient if a doctor leaves a network but not the end of the world.

Dentist, OMFG, don’t you dare ask someone to change a dentist! We have groups that offer dental PPOs and have well under 50% utilization. Since dental usually caps at 1000 to 1500 every year I see people spend thousands out of their own pocket instead of switching to a PPO dentist.

doctors generally do make terrible businessmen. The PHO/IPO HMO mess of the 90s where they rushed to accept capitation and lost their shirts is a great example. Even today though when it comes to money matters their is a breakdown in logic.

Guest
Apr 27, 2012

I fear friend tcoyote (Jeff Goldsmith) is right about Obama’s communication strategy. They decided to cut bait — but then, when the GOP lawsuits became not a nuisance but a real threat to the entire bill, they decided to launch a two-week publicity blitz that has had zero effect on public opinion but was fun for both sides of the debate and good for television.

The bill was poorly drafted, but that’s not what got it in trouble at all. Ironically, when it was up for debate, no one mentioned the constitutionality as a reason to vote against it. What does that tell you?

Nate: None of my facts is made up, though you’re free to differ with the interpretation of the facts. You also may notice that this site, unlike many others, is pretty light on calling people names. People who say, “Liberals want everything for free” and use lots of exclamation points usually have a pretty liberal (as it were) interpretation of fact, and Nate, you are no exception.

Speaking of which: are insurance companies good or bad? I don’t know, but the Gallup Poll of late last year noted that the public’s response to whether it trust/likes various industries (car salesmen, Congressmen, health insurers) now shows a split by political affiliation. Apparently, Obama’s attacks on health insurers have prompted Republicans to respond with love for their insurance company, rating them “excellent” much more than in the past.

Oh, happy partisans!

Guest
Responsible_Development
Apr 27, 2012

Most polling shows that people are satisifed with their own insurance company, especially if employer sponsored. The demagoguery of the industry comes from some politicians and the media.

But I don’t understand the broader debate. North of 75% of health care spending is easily preventable by diet, exercise, not smoking/abusing other substances, etc. Most of the fight isn’t over the remaining 25% or less of costs, it’s over forcing those who make good lifestyle decisions to subsidize those who make bad ones. And obviously this applies to broader society as well, not just health care.

Guest
Nate Ogden
Apr 27, 2012

While it’s comforting to just blame the GOP for the unhappiness with health reform threatening the president’s re-election,

Baptist minister at a nationally televised town hall asked in mid-2009 whether reform would cause his benefits to be taxed due to “government taking over health care,”

While Republicans railed about mythical “death panels,”

angry Tea Party demonstrators held signs showing Obama with a Hitler moustache,

sobbing middle-aged woman telling Sen. Tom Coburn (R-OK) of her husband’s brain tumor, only to get the reply, “Government is not the answer,”

When GOP leaders decided to just say no to Obamacare, they were honest about their political calculus. The polarization worked.

You were saying what about people that make sweeping generalizations about GOP, Republicans, Tea party….oh that’s right you weren’t. Those rules and standards only apply to those you attack, you live by a loser set of rules.

“None of my facts is made up”

Mythical Death Panels is 100% madfe up. If you care to discuss how Americans can be certain The Liverpool Care pathways or something similar could never happen in the US I would love to educate on the matter, maybe then you will stop denying it was a real concern.

Saying supporters of the bill were not mobolized is also false as the links I gave you prove.

Gallop pool on populatory of industries has as much value as the person willing to pay to advertise next to it. Not even worth discussing.

Guest
Apr 27, 2012

Nate, you’re not even well-enough informed to be close to factual. For instance, if you were referring to comparative effectiveness research leading to “death panels,” you might be excused hyperbole. (Or not excused.) But the death panel reference was in reference to end-of-life counseling in a provision proposed by a Republican from Georgia. It was demagogued by others.

Gallup poll on industries, of course, is not paid for by any one industry — perhaps the nurses are paying all these years to be rated higher than used car salesmen? Etc., etc., etc.

And Responsible_Development leaves out the voluminous literature on health problems’ link to socioeconomic status and environmental hazards.

Gosh, I remember back when the left wing had the simple answer to everything. Now it’s the right wing. Maybe Sarah Palin and Ron Paul can meet up in Heaven with Abbie Hoffman and the far-left ideologues. It will be Heaven for all of them, right?

Guest
Nate Ogden
Apr 27, 2012

So what your saying Michael is you have no idea what LCP is and how educated people aware of how LCP came to pass see the same potential in the proposals put forth for end of life counseling.

What’s humorous for intelligent people is how you argue an end of life plan in the UK is not at all comparable to an end of life plan proposed here. What in the world would an end of life plan have to do with an end of life plan right?

If your done deflecting why don’t you answer the simple question? Let me ask it again;

What assurances were there that the end of life panel would not adopt the LCP or something very similar? LCP is a very real and functioning death panel, unless your clueless on what the word mythical means you can’t call them that. LCP is a death panel you were wrong.

Guest
Nate Ogden
Apr 27, 2012

To further educate Michael

LCP was created by non elected “experts” not accountable to the public. All of the proposals put forth by the government so far are the same set up. Non accountable bodies that have the potential to subject the public to policies they don’t agree with.

Look at the uproar when similar bodies suggested less frequent breast exams. That was preventive testing, now imagine if this panel suggested prostate cancer not be treated for anyone over 70. Over stage 4 breast cancer not be treated.

The reason the left rushes to label these mythical and mock those that ask the question is they are afraid to have the conversation. That and most lack the education and intelligence.

If only death panels where as mythical as Obama’s recovery and Liberals attempts at affordable healthcare we wouldn’t be worried.

Guest
Nate Ogden
Apr 27, 2012

Michael’s MYTHICAL death panels; makes you wonder why people like him are so insistant on lieing to us….

‘Death Panel’ Concerns in the UK with the Liverpool Care Pathway

A letter from a group of concerned doctors, including Dr. Peter Hargraeevs, a London-based palliative medicine physician, to the British Telegraph newspaper is raising concerns over the UK’s National Health Service (NHS) implementation of a protocol called the Liverpool Care Pathway. The letter asserts:

“If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death. As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients. Syringe drivers are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong. It is disturbing that in the year 2007-2008, 16.5 per cent of deaths came about after terminal sedation. Experienced doctors know that sometimes, when all but essential drugs are stopped, “dying” patients get better.”

Guest
Michael Millenson
Apr 27, 2012

Nate, I think you’re arguing past me. What panel? How does making end-of-life counseling a covered benefit involve a panel? That’s the narrow issue here. Not the UK or anything else in the US. It’s how a bipartisan bland Medicare benefit with no panel, no experts, no nothing but a benefit that would cover your local doctor became something else. So: rant away, but first, show me a real panel involved in what was really proposed. Other maybes don’t count.

Guest
Apr 27, 2012

I think Nate’s referring to the Liverpool Care Pathway, a standardized interdisciplinary protocol for managing palliative and other medical decisions after a patient is determined to be irreversibly on the way to death. I don’t know much about it other than what can be found on the Internet, but I’m not as alarmed as he and others seem to be inasmuch as well-established measures are in place in this country guarding against euthanasia.

A few years ago those constraints were so strong that doctors were fearful of NOT doing “everything possible” to prolong life, even in someone who was brain-dead. The cases of Nancy Cruzon and Terri Schiavo underscore the radioactive nature of the issue.

http://www.sptimes.com/2005/02/27/Tampabay/A_fate_unclear__a_leg.shtml

Discussions of advance directives have been characterized by many as a slippery slope leading to “death panels” the LCP reference is shorthand for that threat.

In my post-retirement work as a non-medical care-giver for the last eight years I have seen the end of life up close and personal, sometimes for younger people with terminal conditions, but mainly with the aged. It has made me something of an evangelist for advance directives, but this comment thread is not the place for that discussion.

Hope this helps.

Guest
Nate Ogden
Apr 27, 2012

John I would ask you read about the healthy people misdiagnosed then starved and dehydrated to death. The problem is not with the dying people its with all the healthy people its murdering.

Guest
Nate Ogden
Apr 27, 2012

the biggest complaint people had is the way it was created and applied. Originally family was not told and was kept in the dark. There was never a public debate or discussion about it.

That is why arguments like Michaels are so ignorant and annoying, they keep demanding to know what bill ever proposed created death panels, that is the whole point, there never is a bill debated and passed. Its done without the public’s knowledge and input.

They want to mock and redicule those that want debate becuase they lack the knowledge.

Guest
May 29, 2012

A down economy ALWAYS afeftcs sales. Generally, most sales jobs are largely commission based until you start getting further up the ranks, such as territory or regional manager. I once found a financial advisor position (mutual fund jockey) that paid 18k base to start with comissions, but you lost the base after 2 years, and you had to maintain a quota to keep the base. Sales is tough, but sales and marketing are pretty much the only people top management respects, so go figure.

Guest
Nate Ogden
Apr 27, 2012

“A report into palliative care in the NHS found that in one, unnamed hospital trust, half of families were not told that their loved one had been placed on the LCP and in a quarter of trusts, one in three families were not informed.”

“Tens of thousands of patients with terminal illnesses are being placed on a “death pathway”, almost double the number just two years ago, the Royal College of Physicians has found.

Health service guidance states that doctors should discuss with relations whether or not their loved one is placed on the scheme which allows medical staff to withdraw fluid and drugs in a patient’s final days. In many cases this is not happening, an audit has found.”

“In addition to the withdrawal of fluid and medication, patients can be placed on sedation until they pass away. This can mean they are not fed and provided with water and has led to accusations that it hastens death.”

“he Liverpool Care Pathway was intended for use in hospices but was given approval by the Department of Health in 2006 leading to widespread use in hospitals. Concerns about the pathway were raised first in The Daily Telegraph in 2009 when experts warned that in some cases patients have been put on the pathway only to recover when their families intervened, leading to questions over how people are judged to be in their “last hours and days”.”

A clear example of how an unelected panel came up with an idea intended for specific uses but then spread across the entire system without any public discussion or debate.

Guest
Nate Ogden
Apr 27, 2012

Where did LCP come from? They never passed a law to form a panel to kill old people.

Where did the questionable language in the VA handbook come from?

Where did the proposed child farm labor rules come from?

The point of the entire argument is the government is suddenly going to pay doctors to discuss end of life care. At the same time they are also proposing other regulations to ration care. Discussions to move everyone under government healthcare. Massive expansion of government regulation over existing plans.

If doctors are going to consult over end of life care who prepared the guidelines? What were they discussing and recommending and who created and approved it?

Congress has gotten in a bad habit of passing vague laws then allowing unelected bureaucrats to basically make up the laws. i.e. now apparently as a TPA I am suppose to pay for birth control for my religious clients. What bill was ever proposed or passed that even hinted I might have to buy birth control for people that don’t even work for me?

You want to argue there was never a clear cut proposal to create death panels, this is naive and ignorant argument, we are saddled with all sorts of “regulations” that were never clearly proposed , voted on, or passed. Every month HHS comes out with new regulations that disprove your argument.

I’m not talking pass you; I’m talking at a higher level you either refuse to acknowledge or are sadly unaware of. As is anyone calling death panels mythical.

http://www.webmd.com/breast-cancer/news/20091116/panel-breast-screening-should-start-50

A government appointed expert panel is calling for huge changes in breast cancer screening in the United States, but a leading cancer group is highly critical of the move.

In newly revised guidelines, the U.S. Preventive Services Task Force (USPSTF) now recommends against routine mammography screening for average-risk women in their 40s.

HHS determines what plans cover, and also can’t cover. They could easily say screenings under 50 are not covered.

They could decree treatment over 70 is not covered just as easily, now that they have been empowered to determine what is and is not covered without public say they can make such significant changes.

Arguments like yours denying death panels as a legitimate concern just show how little you know about healthcare and our current systems. No grasp on how they work and things got to be the way they are.

Guest
Apr 27, 2012

Sorry. I guess I pushed the wrong button.

My recollection of the Terri Schiavo affair is that before the dust settled on what should have been a private matter involving no one but family members and their doctors became instead a national case resulting in the US Congress being convened for a special session to address the matter. (Oddly, many of the same people who scream about individual and states rights are often the first to invoke federal authority when they want to impose blanket federal rules for issues better left private. Abortion, in vitro fertilization and assisted suicide come to mind.)

I’m not without fears of Big Brother, but those fears have more to do with privacy and economics than health care. As far as I can see, health care professionals are at the leading edge of real improvements and panic about death panels is simply that — panic. I realize that trolling for new patients is important for commerce, but I’m not convinced it is important for effective medicine.

This link to an oncologist’s blog summarizes how that group of specialists are working to standardize a specialty-wide protocol for treatment options. (Catch at word — options not mandates.)

http://sunriserounds.com/?p=629

That kind of professional leadership is finally getting started. Better late than never, I suppose. But it’s not being dictated by government bureaucrats or technocrats. It’s happening in the field, led by card-carrying successful professionals who earn a living in the healing arts.

I can’t resist leaving a link her to the Advance Directive forms for my state. I’m sure there are others, but I think Georgia has a really good one.
Twelve pages of instructions and 14 pages of the form. (pdf)

http://www.tiftregional.com/documents/Advance%20Directive/advance%20directive.pdf

And nothing there refers to the Liverpool protocols.

Guest
Apr 27, 2012

**Sigh**
I left a comment but it has two hot links and is stuck in “moderation.”
Oh, well. Sooner or later it will appear.
Meantime, Nate, your link above it three years old. Protocols have changed since then and are continuing to change, thankfully, even as we speak.

Guest
Nate Ogden
Apr 27, 2012

Which is the point, once it was brought to the publics attention and open for debate an acceptable program was created.

That is all conservatives have been asking for, lets talk through this and make sure we do it right.

People like Michael are insisting there is nothing to talk about, we should just shut up and go away.

Guest
steve
Apr 29, 2012

I have been swarmed at work, but reading over this, you have gone off the deep end. Could paying for a consultation result in docs telling people they have to die? I guess, but with about the same probability of owning guns means we will al shoot each other and be dead in a week. Just because I can get paid does not mean I am going to practice unethically.

The child labor on farms thing has been debunked. references if you want, from a libertarian writer.

Steve

Guest
Nate Ogden
Apr 29, 2012

“I guess, but with about the same probability of owning guns means we will al shoot each other and be dead in a week.”

Thank you for proving my point. We have endless debate on gun laws. Some cities outlaw them. And the left is constantly raising this issue every chance they get.

So discussing gun laws is acceptable debate but wanting to discuss end of life dictates from the funder of care who has motivation to lesson cost is just crazy talk and mythical?

And you still missing the point of the debate, its not that doctors are going to kill people, that is not how LCP started. It would be nice for any of the liberals attacking me for this to actually read the history of LCP and have a clue of what they are talking about.

I would explain LCP’s history but get in trouble for thread jacking. Its not hard to look it up and see what the concern is.

Yes please debunk the child labor laws just suggested, its been going on for years, just ask a farmer.

Guest
steve
Apr 29, 2012

Sigh. Your reading comprehension is better than that. We own guns. I own guns. I am an NRA member. I do not go out and shoot people. If you make guns easier to get, i will not go out and start shooting people. If you pay me for consulting about end of life issues I will not suddenly start telling people they should die.

Yes, I know about the LCP. No one in the US seriously advocates for a NHS type system. It works in the UK where they are concerned about costs, but would not be accepted in the US.

” Some cities outlaw them.”

Not the place to discuss it, but guns are really a federalism issue.

Steve

Guest
Nate Ogden
Apr 29, 2012

problem is not my reading I know exactly what your saying. So if all these responsible gun owners own guns with no problem can we dismiss the liberals that want to talk about gun control and the mythical issue of gun saftey?

How about all the mythical disinfranhize arguments against voter id? There are no proposals to discriminate against minorites when it comes to voting yet the left is crying like crazy about it.

How about this mythical war on women?

How can you not see how hypocritical it is to ignore legit questions on death panels then turn around and make up the three items above. And there is 100 more examples of the left making issues out of arguments far less likely then death panels.

Guest
Nate Ogden
Apr 29, 2012

“No one in the US seriously advocates for a NHS type system.”

Nice subjective argument to go with it, and who is the judge of what leftest proposals are serious and which are not?

Guest
Peter1
Apr 29, 2012

“Arguments like yours denying death panels as a legitimate concern just show how little you know about healthcare and our current systems. No grasp on how they work and things got to be the way they are.”

Just interested Nate on the policies your clients (employers) design (with your help) for their workers. Do they have limits or do they pay for everything/anything with no caps?

Guest
Nate Ogden
Apr 29, 2012

all plans have caps and limits

Guest
Peter1
Apr 29, 2012

“In newly revised guidelines, the U.S. Preventive Services Task Force (USPSTF) now recommends against routine mammography screening for average-risk women in their 40s.”

Is this a cap or a limit?

“Warren Buffett’s decision to undergo prostate cancer screening reflects the reality that nearly half of American men 75 and older continue being tested despite official recommendations against doing so, researchers reported today.

“PSA screening for more than 40 percent of men 75 or older is inappropriate,” said Dr. Scott G. Eggener, an assistant professor of surgery at University of Chicago Medical Center, whose research confirms that older men aren’t heeding 2008 guidance from the U.S. Preventive Services Task Force.”

Would this be a cap or a limit?

Guest
Nate Ogden
Apr 29, 2012

limit, it is limited to women over 40s

Cap would be screenings are covered up to $300 per year or something like that

Or you could have a cap on the number of visits in which case caps and limits are pretty much the same thing

Buffet guideline would also be a limit

Guest
Leslie M
Apr 27, 2012

Here’s what I know: I am 60 years old, self-employed, and on COBRA until September. If health care reform is turned back, there is a fairly good chance I will spend some time uninsured before I qualify for Medicare, putting my financial stability at risk — to the extent that I could end up costing other tax payers thousands of dollars in Medicaid or uncompensated care. One message Obama has failed to communicate is that health care reform is not about poor people. It’s about hard working, middle class people, more and more of whom are self-employed or working for small businesses with no benefits. We have the chance to get it right now, with or without passion.

Guest
Nate Ogden
Apr 27, 2012

How does PPACA prevent you from being uninsured?

Are you counting on the subsidies to be able to afford coverage? If so you will cost tax payers tens of thousanbds.

Are you worried about guarantee issue? You already have that with HIPAA

How does driving up the cost of healthcare help small businesses?

How does hundreds of billions added to the national debt on top of the 16 trillion we already have and 40 trillion of Medicare underfunding help?

What would help individuals and small business is the flexibility to buy policies that are right for them, not one size fit all government designed plans.

Lowering the cost 20-30% by addressing fraud and provider payments.

Guest
Apr 28, 2012

Michael–

I agree that Obama left “emotion to his opponents.”

From the beginning, his way of handling opposition is to try to make a logical argument with facts–not emotion. He assumed that if his argument is logical and reasonable, people with agree. (He even seemed to assume that he could bring the most conservative Republicans around to his way of thinking just by being patient and rational.)

Unfortuantely, most people respond to emotion, not reason. And medical care is an especially emotional topic. Thus conservative soundbites about “death panels” etc were very successful.

Fearmongering is pretty easy–you just push a button.

. Explaining how the ACA will improve health care is far more difficult–especially because it involves explaining that, at present, our hospitals are not as safe as they could and should be, and that over-treatment is a major problem which drives costs higher while putting patients at risk.

The basic message is “less is more. Higher quality and lower costs go hand in hand,”

Most Americans believe that “more is more”–especially when it comes to heatlhcare for themselves or their family. A great many Americans distrust science. Thjey are not interested in medical evidence. They believe that their own doctor knows best. (It’s too frightening to consider tthe possibility that he
might be somewhere on the lower end of the bell curve that Atul Gawande talks about).. They believe that the hospital where their children were born is top notch. They don’t want to hear about infection rates and preventable errors.
They want to feel that medicine makes them safe.

So while I agree that Obama could have and should have brought more passion to the argument, he had a very tough job.

I would point to Don Berwick as someone who is brilliant at explaining what’s wrong with our health care system with passion — but in a public debate with an articulate fear-monger who opposes reform, I’m afraid that Berwick would lose. People don’t want to hear that we don’t have the best health care system in the world.

Certainly, Berwick wasn’t able to persuade many of the Republicans in Congress.

Finally, the debate over heatlh care reform isn’t just emotionally charged, it’s about basic values. Do all Americans have a right to high quality, comprehensive care? Do we as a society have a responsibilty to ensure that they have access to care?. Many Americans would say “Not if that means I might get less care— and don’t talk to me about unncessary care!”

Health Care Reform is a tough sell.

Guest
Apr 28, 2012

Yesterday’s piece in the WaPo by two contributors (from Brookings and AEI already — not exactly Left-leaning outfits) underscores the point.

Today, thanks to the GOP, compromise has gone out the window in Washington. In the first two years of the Obama administration, nearly every presidential initiative met with vehement, rancorous and unanimous Republican opposition in the House and the Senate, followed by efforts to delegitimize the results and repeal the policies. The filibuster, once relegated to a handful of major national issues in a given Congress, became a routine weapon of obstruction, applied even to widely supported bills or presidential nominations. And Republicans in the Senate have abused the confirmation process to block any and every nominee to posts such as the head of the Consumer Financial Protection Bureau, solely to keep laws that were legitimately enacted from being implemented.

http://www.washingtonpost.com/opinions/lets-just-say-it-the-republicans-are-the-problem/2012/04/27/gIQAxCVUlT_print.html

Guest
Peter1
Apr 29, 2012

Nate Ogden says:
April 29, 2012 at 2:09 pm

“limit, it is limited to women over 40s

Cap would be screenings are covered up to $300 per year or something like that

Or you could have a cap on the number of visits in which case caps and limits are pretty much the same thing

Buffet guideline would also be a limit”

Wouldn’t they be a death panel?

Guest
Nate Ogden
Apr 29, 2012

matter of opinion.

In my opinion when a person is free to purchase a policy that does or does not cover something they are exercising their free will.

If on the other hand the government dictated what is and is not covered and requires you to buy that policy and some panel made the decision then yes it would be a death panel.

Guest
Peter1
Apr 30, 2012

A person may be free to purchase anything they want, if they can afford it. Would not being able to afford more coverage be a death panel?

A person is not free to get what they want in their employer’s policy.

If a test/procedure is not covered by Medicare is the patient not free to purchase themselves?

Guest
Nate Ogden
Apr 30, 2012

not being able to purchase something is not someone else inflicting a decision on you. If you can’t afford steak and lobster most people won’t accuse society of starving them. And those that do complain people would ignore. EMTLA provides for basic care, no one will die in the street. Do 70 and 80 year olds need transplants though? If you can afford one and choose to spend your money that way then go ahead. I personally rather pass a few hundred K on then live longer at that age.

An employer’s policy is not the end of one’s insurability. They are free to buy additional coverage just like they do know for life insurance, cancer, accident, deductible reimbursement etc. The availability of additional coverage for those that feel they need it is why we need to stop trying to make employer insurance all inclusive one size fits all.

They are free to purchase but not from their doctor they receive the rest of their care. This is also a couple steps down the slippery slope. Under NHS if you get care not approved by your doctor they will cease treating it all together. So now you need to get and personally pay for all of your cancer treatment for example. It’s not far after that to eliminate all care and kick them off coverage.

When systems are ran by government on large global budgets the cutting and planning are seldom discussed or reasonable. In Medicaid for example in numerous states and on numerous occasions when it got to expensive millions of people where just dropped. Wholly illegal in private insurance unless the carrier is getting out of the business and then those people are guaranteed coverage by the rest of the system. Their can be price shock but they are guaranteed coverage. When Medicaid eliminates your class your just done.

As government consumes would of the insurance market finding providers who can walk away from that base is going to be harder to find. When 30% of the population was public plans that left you 70% to serve if you didn’t take money from the public plans. What happens when Medicaid and Medicare enrollment hits 50% or 60%? Could doctors afford to write off that much of the market?

Guest
Peter1
Apr 30, 2012

“EMTLA provides for basic care, no one will die in the street.”

Then where’s the “death panel”?

“They are free to purchase but not from their doctor they receive the rest of their care.”

?? If a procedure is not a Medicare covered procedure then you’re saying the Medicare patient as no ability to pay for that procedure themselves?

“They are free to buy additional coverage”

Only if they can afford it. Are poorer people relegated to market cost “death panels” and richer ones not?

Nate, you say government should not be involved in deciding who can get coverage but the market can – and that is different?

“Under NHS”

This is not England and we do not have the NHS.

“In Medicaid for example in numerous states and on numerous occasions when it got to expensive millions of people where just dropped. Wholly illegal in private insurance”

Yes, they are not “dropped” in private insurance but their rates are escalated to a point where people will self drop – can you tell me the difference?. But Nate, don’t you agree that government needs to cut, and if it can’t afford Medicaid then wouldn’t the “dropping” be a good budget move in line with your principles?

Guest
Apr 29, 2012

You know, I try to treat everyone respectfully, but, Nate, you try my patience.

If you have private insurance today, there are treatments not covered. Do you think that’s a death panel? If you have government insurance, there are treatments not covered. Is that a death panel? If so, then your assertion makes sense. Of course, the only people being forced to buy insurance — or pay a fine — are the uninsured, who have NO treatments covered — which we know does lead to death.

Nate, you are so obdurate and so committed to not letting facts sway your opinion that you are making arguments that even Sarah Palin didn’t. Those who distorted the Affordable Care Act were talking about end-of-life counseling. Since the end-of-life counseling does not involve a panel — since, in fact, you were utterly wrong — you’re reduced to saying that IF there were a panel and it didn’t cover all care, it would be a death panel.

Alas, no private insurer offers 100 percent coverage for everything anyone who buys a policy wants. The only other alternative is to self-insure for 100 percent of care, which only rich people can do.

So: if the government forces a rich person to buy health insurance that doesn’t cover anything AND, at the same time, prohibits him from paying money from his own pocket for uncovered expenses, that would be a death panel. Of course, that situation doesn’t exist even in Britain, where you can pay out of pocket.

On the other hand, if you, personally, would rather die than pay for medical care your health insurance doesn’t cover, I guess you could make that choice. But that would be a death wish, not a death panel, and a completely different discussion.