Getting health care healthy

Full story: Chicago Tribune

Next year we'll spend $17 billion in Medicare money on an oxymoron: preventing inevitable death.

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John

Minneapolis, MN

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#1
Aug 4, 2009
 
If we are not sure if Obama is legally President, why talk about health care? Republicans are fact based. We just want to see a birth certificate. Otherwise, this talk about health care might as well stop.
Mark in Chicago

United States

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#2
Aug 4, 2009
 
John wrote:
If we are not sure if Obama is legally President, why talk about health care? Republicans are fact based. We just want to see a birth certificate. Otherwise, this talk about health care might as well stop.
“There is a lot of disinformation about health insurance reform out there, spanning from control of personal finances to end of life care. These rumors often travel just below the surface via chain emails or through casual conversation. Since we can’t keep track of all of them here at the White House, we’re asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to flag@whitehouse.gov.”

Source:http://www.whitehouse.g ov/blog/Facts-Are-Stubborn-Thi ngs/

Finally we have a venue to turn in the wing-nuts.
I hope Obama appoints a Truth Czar to help ferret out the racist deceivers who are trying to defeat Obama and the Health Care reform bill.

CHANGE is here.
You have been warned.
This is a serious discussion.
Add your hateful descent at your own peril.

“Ex New Yorker”

Since: Mar 08

Chicago

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#3
Aug 5, 2009
 
John wrote:
If we are not sure if Obama is legally President, why talk about health care? Republicans are fact based. We just want to see a birth certificate. Otherwise, this talk about health care might as well stop.
Can all you birthers just get a life. Yesterday the Worldnet Daily certificate you all swore was the truth turned out to be a fabrication of an Australian Birth Certificate posted on a family genealogy site. Don't we have more important things to do. The courts throw this out every time it gets there, he was born here, is a citizen and we as a society have important jobs to do. Like it or not he is still the president.
slats

Granger, IN

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#4
Aug 5, 2009
 
well Ann Moore has certainly climbed onto the Obama Health Care speeding train hasn't she?
What a delightful piece. Just be sure to die the least expensive way so you can get out of the way of the rest of us.
Jack

Chicago, IL

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#5
Aug 5, 2009
 
I think this shows...let them die. We waste so much money on health care and welfare, why not use that money on the people best able to contribute to society? But elderly and minorities are voting blocks, so we'll continue to bribe them with handouts for their votes.
Zara

Stratham, NH

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#6
Aug 5, 2009
 
What's next, Logan's Run type healthcare, perhaps we'll all be ordered to kill ourselves at 50?
Stella Fitzgibbons MD

AOL

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#7
Aug 5, 2009
 
As a hospital-based physician, I want to thank the Tribune for reprinting this fine piece. I have seen far too many terminally ill patients denied pain medication because it drops their blood pressure, forced into futile invasive and painful procedures, and in general denied a comfortable end by families who were unable to face facts. Ms. Moore is quite right that asking about the patient's wishes for comfort care is a neglected part of care--sometimes simply because their doctors are paid by the day of care and the services given, and there's little profit in comfort or hospice care. Though almost all hospitals offer patients an opportunity to put their wishes in writing at the beginning of their stay, if they become unable to speak for themselves the family's demands decide what will really be done. If people would talk frankly with their loved ones on this issue (and even get a power of attorney for heathcare if their next of kin won't agree to their wishes), we might see more humane treatment of the dying.

“Ex New Yorker”

Since: Mar 08

Chicago

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#9
Aug 5, 2009
 
slats wrote:
well Ann Moore has certainly climbed onto the Obama Health Care speeding train hasn't she?
What a delightful piece. Just be sure to die the least expensive way so you can get out of the way of the rest of us.
I watched both of my parents die a slow painful death. The hardest thing I ever did was sign hospice papers for my dad. He died the next afternoon, peacefully, and finally not in pain. I would not wish what happened to him the two weeks previous to that on my worst enemy. It would be fair to say that even when we signed the papers, the nursing home was none too happy over it.
paul

Chicago, IL

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#10
Aug 5, 2009
 
Excellent article -- too bad the Tribune had to reprint it from Salon, considering she's a local writer.
Chris

Bolingbrook, IL

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#11
Aug 5, 2009
 
Posters who jump on articles like this for anti Obama/anti healthcare reform show their ignorance.

This is a wonderful piece that so accurately and articulately describes the "want it all" mode we have acquired, no thanks to TV and self-indulgence.

Death is a part of life, scary as it is. I've now seen several relatives, including my mother and uncle, go thru various scenarios of in-hospital ICU (mother) and hospice (uncles, neighbors, etc.) at the end of terminal illness. Hospice makes so much more sense - of course, for so many today, it's just "too messy", "too inconvenient" because it requires more personal involvement on the part of family (as opposed to handing it off to hospital staff).

I have a father with stage six ALZ, who takes over a dozen pills each day to manage his cardiac, thyroid and dementia. Better living through chemistry: let's keep him alive only to die a cruel death. But with a wink and "I can't tell you this", many of the health practitioners (outside of the nursing homes who make money on life at all costs)confide they would understand perfectly if some of these medications didn't see their way into my dad, that his heart be allowed to fail on its own terms, hopefully prior to the ravages of ALZ.

This is why a new way of thinking about medical care at the end of life is important. Legal documents like DNR, directives etc. are fine, but where you put your loved ones and how they are cared for in their final days needs a mental and cultural reset.
Albigensian

Morristown, NJ

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#12
Aug 5, 2009
 
There's often a lot to be said for hospice care as one approaches end of life. It's also inexusable to deny a dying person adequate pain medication on the grounds that narcotics, by depressing respiration and other vital functions, may hasten death.

But having said that, do we want to slide down the whole slippery slope to "voluntary" euthanasia-- without recognizing that the pressures on the old and sick to just go gently (and quickly) into that good night may become irresistable?

In short, I do not think it irresponsible to fear handing government bureaucrats the authority to deny (or simply not pay for) life-extending treatment for those who might benefit from it.

Perhaps there won't be a "cash for corpses" program tomorrow (such as $45,000. incentives for physician-assisted suicide of those older than 65 and with a poor prognosis), but, it's far from unreasonable to avoid paths that may lead there.
Mich

Chicago, IL

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#13
Aug 5, 2009
 
My grandfather wanted to die naturally of his congenital heart condition. Despite his DNR, he couldn't get the medical establishment to follow it. If his wife said "help him" they did, instead of sending a social worker to remind her of her husband's wishes on end of life care. He died exactly how he didn't want, with tubes and intervention treatments, none of which would save or even prolong his life. That is a tragedy too.
Elderly and terminally ill patients should have full say on their care. If it is throw everything at it, fine. But many who have fought the battle for a long time, or who are elderly and simply ok with their earthly life coming to a close are ready to take palliative care. They shouldn't have to be shoved toward it, but it should be offered and family & medicine should actually listen to the patient's voice.
Clark Kent

Skokie, IL

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#14
Aug 5, 2009
 
Albigensian wrote:
There's often a lot to be said for hospice care as one approaches end of life. It's also inexusable to deny a dying person adequate pain medication on the grounds that narcotics, by depressing respiration and other vital functions, may hasten death.
But having said that, do we want to slide down the whole slippery slope to "voluntary" euthanasia-- without recognizing that the pressures on the old and sick to just go gently (and quickly) into that good night may become irresistable?
In short, I do not think it irresponsible to fear handing government bureaucrats the authority to deny (or simply not pay for) life-extending treatment for those who might benefit from it.
Perhaps there won't be a "cash for corpses" program tomorrow (such as $45,000. incentives for physician-assisted suicide of those older than 65 and with a poor prognosis), but, it's far from unreasonable to avoid paths that may lead there.
Perfect example of government health care: http://www.youtube.com/watch...
George From Outerspace

Canada

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#15
Aug 5, 2009
 
Is this the preparation for RATIONING??. Start with the old and infirm first.

But of course make all the money available for the illegal and welfare crowd FIRST.
Lynn

United States

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#16
Aug 5, 2009
 
Terrific article. People in Chicagoland should be grateful that they have Rainbow Hospice. http://www.rainbowhospice.org/ . The organization makes a tremendous difference for the better at the time of end of life.

Since: Sep 08

Elkhart, IN

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#17
Aug 5, 2009
 
Mark in Chicago
Since you want a serious discussion, this is a direct quote from Section 102 subsection (A) of House Bill 3200 (from http://www.opencongress.org/bill/111-h3200/ )

(1) LIMITATION ON NEW ENROLLMENT-

(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

(B) DEPENDENT COVERAGE PERMITTED- Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

Please explain to me how this section maintains competition in Health Care as it appears to state that existing plans cannot accept new members once this law goes into effect.
Mark in Chicago wrote:
<quoted text>
“There is a lot of disinformation about health insurance reform out there, spanning from control of personal finances to end of life care. These rumors often travel just below the surface via chain emails or through casual conversation. Since we can’t keep track of all of them here at the White House, we’re asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to flag@whitehouse.gov.”
Source:http://www.whitehouse.g ov/blog/Facts-Are-Stubborn-Thi ngs/
Finally we have a venue to turn in the wing-nuts.
I hope Obama appoints a Truth Czar to help ferret out the racist deceivers who are trying to defeat Obama and the Health Care reform bill.
CHANGE is here.
You have been warned.
This is a serious discussion.
Add your hateful descent at your own peril.

Since: Sep 08

Elkhart, IN

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#18
Aug 5, 2009
 
Chris, I feel for you. My father had advanced Parkinson's on top of severe arthritis that greatly limited his motor skills. Fortunately the nursing center that he was in was very supportive, and when his Parkinson's was getting to the point that his ability to swallow was at risk they provided our family with the options:
1 - Have a feeding tube inserted or
2 - Enroll him with a hospice organization that worked with the nursing home. He would continue to be mouth fed as long as possible, but at that point, end of life would be inevitable. He would stay in the nursing home, and our family would get extended visting hours until he passed.
As a family, based on earlier conversations with our Father we agreed that a feeding tube would not be in his best interests, and we would let nature take it's course. It is not an easy decision to make, but it is important that patients and their families be allowed to make these decisions and have the options made available to them.
Chris wrote:
Posters who jump on articles like this for anti Obama/anti healthcare reform show their ignorance.
This is a wonderful piece that so accurately and articulately describes the "want it all" mode we have acquired, no thanks to TV and self-indulgence.
Death is a part of life, scary as it is. I've now seen several relatives, including my mother and uncle, go thru various scenarios of in-hospital ICU (mother) and hospice (uncles, neighbors, etc.) at the end of terminal illness. Hospice makes so much more sense - of course, for so many today, it's just "too messy", "too inconvenient" because it requires more personal involvement on the part of family (as opposed to handing it off to hospital staff).
I have a father with stage six ALZ, who takes over a dozen pills each day to manage his cardiac, thyroid and dementia. Better living through chemistry: let's keep him alive only to die a cruel death. But with a wink and "I can't tell you this", many of the health practitioners (outside of the nursing homes who make money on life at all costs)confide they would understand perfectly if some of these medications didn't see their way into my dad, that his heart be allowed to fail on its own terms, hopefully prior to the ravages of ALZ.
This is why a new way of thinking about medical care at the end of life is important. Legal documents like DNR, directives etc. are fine, but where you put your loved ones and how they are cared for in their final days needs a mental and cultural reset.

Since: Sep 08

Elkhart, IN

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#19
Aug 5, 2009
 
If your grandfather was beyond the ability to make medical decisions, and his wife had medical power of attorney, she would have the legal ability to rescind his DNR. If that was not the case, then the medical facility seems to have acted if not illegally, but at the very least un-ethically, but every situation is clearly unique.
Mich wrote:
My grandfather wanted to die naturally of his congenital heart condition. Despite his DNR, he couldn't get the medical establishment to follow it. If his wife said "help him" they did, instead of sending a social worker to remind her of her husband's wishes on end of life care. He died exactly how he didn't want, with tubes and intervention treatments, none of which would save or even prolong his life. That is a tragedy too.
Elderly and terminally ill patients should have full say on their care. If it is throw everything at it, fine. But many who have fought the battle for a long time, or who are elderly and simply ok with their earthly life coming to a close are ready to take palliative care. They shouldn't have to be shoved toward it, but it should be offered and family & medicine should actually listen to the patient's voice.
Jack Stephens

Worcester, MA

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#20
Aug 5, 2009
 
My mom had quadruple bypass and then 3 strokes over the course of several years. She was at home, with help from the famly and a community care worker. The day she died the last thing I ever said was "I love you" and she replied the same, and I threw the newspaper into the living room like I did everyday. When I got home from class that day (I was a college student) I found her.

After everyone left that evening I looked around the living room, and remembered the TV was on when I got home, on the channel FX. I'm 99% certain she was watching MASH (which she loved), doing the crossword puzzle, and having a cup of coffee.

She did not go to the "imaginary place in the sky" that "xitans" go to. She is in my heart, everyday...both the good and bad.
Lincoln Park ER Doc

Chicago, IL

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#21
Aug 5, 2009
 
Finally, some one actually wrote an article in plain English about wasted health care dollars and how to fix the problem and placed the blame right where it belongs: the american public.

Many people want things that they cannot afford that would actually improve their lives and we have no trouble denying them; why do we insist that is is their right to have a wasteful and expensive death that they cannot and have no intension of paying for?

And this does not imply not caringe for the terminally ill; you simply do things that make sense for their comfort and do not pretend that they are not going to die. Doctors should not be engaged in encouraging death, but comforting the patient and family as nature takes it course.

Do not resuscitate does not mean Do not treat.

If we could change this culture, curb the malpractice crisis ( which wildly inflates costs of care), curb insurance abuse ( such as denying patients with pre-exiting conditions and allowing the insurance compaines to cherry pick healthy inexpensive patients), and place some limits on irresponsible behavior by the public, we could go along way toward solving the crisis without spending more money.

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