Undernews is the online report of the Progressive Review, edited by Sam Smith, who covered Washington during all or part of one quarter of America's presidencies and edited alternative journals since 1964. The Review has been on the web since 1995. See main page for full contents

July 6, 2009


Charlotte Allen, LA Times - In looking for a way to fund healthcare, Obama has set his eye on the oldest and sickest. You see, according to the Centers for Medicare & Medicaid Services, about 30% of Medicare spending -- nearly $100 billion annually -- goes to care for patients during their last year of life. What if there were no "last year of life," the president seems to be asking. The Eskimos used to set their elderly and sickly adrift on the ice or otherwise abandon them during times of scarcity, and that, metaphorically speaking, is what Obama would like us all to start doing.

The scarcity of resources to pay for expensive medical procedures will only increase under a plan to extend medical benefits at federal expense to the 47 million Americans who lack health insurance. So why not save billions of dollars by killing off our own unproductive oldsters and terminal patients, or -- since we aren't likely to do that outright in this, the 21st century -- why not simply ensure that they die faster by denying them costly medical care? The savings could then subsidize care for the younger and healthier.

Sound too draconian? Enter the ghost of Obama's late maternal grandmother, Madelyn Dunham, who died of cancer at age 86 two days before her grandson's election to the presidency. Dunham's health issues first surfaced in a New York Times interview with the president on May 3. There, Obama questioned the appropriateness of a hip replacement that his grandmother had undergone after falling and breaking her hip shortly after being diagnosed with terminal cancer last year. The alternative to such surgery is typically excruciating pain and opiate dependency. Obama made it clear that he loved his granny and would have paid for the surgery out of his own pocket if he had to, but he said there ought to be a "conversation" over whether "sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model." Obama suggested that such decisions be made not by patients or their relatives but by a "group" of "doctors, scientists, ethicists" who are not part of "normal political channels."

Obama brought up his grandmother's hip replacement a second time in his June 24 town hall event on healthcare on ABC. The "question was," Obama said, "does she get hip-replacement surgery, even though she was fragile enough they were not sure how long she would last?" . . .

An audience member, Jane Sturm, told the story of her 99-year-old mother, who had initially been turned down for a pacemaker on account of her age. Sturm's mother persuaded a second physician impressed with her /joie de vivre /to perform the life-extending operation -- and she's still hale today at age 105. "Outside the medical criteria," Sturm asked, "is there a consideration that can be given for a certain spirit . . . and quality of life?"

Nope. "I don't think that we can make judgments based on people's spirit," Obama said. "That would be a pretty subjective decision to be making. I think we have to have rules that we are going to provide good, quality care for all people."

If that sounds cold, or like an interference with the traditional physician-patient relationship, in which doctors make decisions -- call them "subjective" decisions, if you like -- about the most appropriate care for their patients on an individual basis, that is the very point. Obama and those who support his healthcare reform proposals have embraced a concept called "comparative effectiveness research." The idea behind comparative effectiveness research is basically a good one: Use large-scale scientific studies to determine which medical procedures produce the best patient outcomes in the aggregate, and whether some expensive tests, drugs and surgeries might not be as effective in the aggregate as cheaper alternatives. . .

But Obama and his healthcare supporters do not want to stop there. Their implicit proposal seems to want to turn comparative effectiveness research into the "rules" that Obama was talking about on ABC: one-size-fits-all procedures that physicians would have to follow at the risk of not being paid by the government. . .


Anonymous None dare call it evil said...

Meanwhile, trillions and trillions and trillions and trillions are continuously thrown down that rathole we call the Pentagon and to a criminal cabal of banksters and kingpins-on-the-dole.

This can only be called tear-your-hair-out stupidity. Americans are completely lost, completely mad to even tolerate such talk - and only a true enemy of humanity would speak Obama's words.

July 6, 2009 11:37 PM  

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