Weekly Pulse: End-of-Life Counseling Returns, But Death Panels Still Nonsense

by Lindsay Beyerstein, Media Consortium blogger

A proposed program to cover counseling sessions for seniors on end-of-life care has risen from the ashes of health care reform and found a new life in Medicare regulations, Jason Hancock of the American Independent reports.

In August, former Alaska governor Sarah Palin started a rumor via her Facebook page that the the Obama administration was backing “death panels” that would vote on whether the elderly and infirm had a right to live. In reality, the goal was to have Medicare reimburse doctors for teaching patients how to set up their own advance directives that reflect their wishes on end-of-life care.

Patients can use their advance directives to stipulate their wishes for treatment in the event that they are too sick to make decisions for themselves. They can also use those directives to demand the most aggressive lifesaving interventions.

Waste not, want not

Though end-of-life counseling was ultimately gutted from the Affordable Care Act (ACA), the legislation will eventually ensure health coverage for 32 million more Americans. However, Joanne Kenen in The American Prospect argues it will do comparatively less to curb the high costs of health care. The architects of the ACA had an opportunity to include serious cost-containment measures like a robust public health insurance option to compete with private insurers, but they declined to do so.

Kenen argues that the government should more aggressively target waste within the health care delivery system, especially Medicare and Medicaid. Unchecked and rising health care costs through Medicare and Medicaid are a significantly greater driver of the deficit than Social Security or discretionary spending:

“The waste is enormous,” says Harvard health care economist David Cutler. “You can easily convince yourself that there is 40 to 50 percent to be saved.” Squeezing out every single bit of that inefficient or unnecessary care may not be realistic. But it also isn’t necessary; eliminating even a small fraction of the current waste each year over the next decade would make a huge difference, he added. Health care would finally start acting like “a normal industry.” Productivity would grow, in the one area of the economy where it has not, and with productivity gains, prices could be expected to fall.

The new end-of-life counseling program will help reduce waste in the system, not by pressuring people to forgo treatments they want, but by giving them the tools to refuse treatments they don’t want.

Teen births down, but why?

The teen birth rate has dropped again, according to the latest CDC statistics. Births to women under the age of 20 declined by 6% in 2009 compared to 2008. One hypothesis is that the reduction is an unexpected consequence of the recession, an argument we pointed to in last week’s edition of the Pulse. John Tomasic of the Colorado Independent is skeptical of the recession hypothesis. He writes:

Emily Bridges, director of public information services at Advocates for Youth, agrees with other observers in pointing out that teens aren’t likely to include national economics as a significant factor in pondering whether or not to have unprotected sex. Peer pressure, badly mixed booze, general awkwardness, for example, are much more likely than the jobless recovery to play on the minds of horny high schoolers.

Some states with weak economies actually saw a rise in teen birth rates, Tomasic notes. However, this year’s sharp downturn in teen births parallels a drop in fertility for U.S. women of all ages, which seems best explained by economic uncertainty.

It’s true that prospective teen moms are less likely to have jobs in the first place, and so a bad job market might be less likely to sway their decisions. However, young women who aren’t working are unlikely to have significant resources of their own to draw on, which means that they are heavily dependent upon others for support. If their families and partners are already struggling to make ends meet, then the prospect of another mouth to feed may seem even less appealing than usual.

Abortion is the elephant in the room in this discussion. The CDC numbers only count live births. Logically, fewer live births must be the result of fewer conceptions and/or more terminations. Some skeptics doubt that economic factors have much to do with teens’ decisions about contraception. However, it seems plausible that decisions about abortion would be heavily influenced by the economic health of the whole extended family.

Last year’s decrease was notably sharp, but teen birth rates have been declining steadily for the last 20 years. The Guttmacher Institute, a New York-based non-profit that specializes in research on reproductive choice and health, suggests that successive generations of teens are simply getting savvier about contraception. Births to mothers between the ages of 15 and 17 are down 48% from 1991 levels, and births to mothers ages 18 to 19 are down 30%.

Stupid drug dealer tricks

Martha Rosenberg of AlterNet describes 15 classic dirty tricks deployed by Big Pharma to push drugs. These include phony grassroots patient groups organized by the drug companies to lobby for approval of dubious remedies. Another favorite money-making strategy is to overcharge Medicare and Medicaid. Pharmaceutical companies have paid nearly $15 billion in wrongdoing settlements related to Medicare and Medicaid chicanery over the last five years.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

Twitter and the Cowardice of Sarah Palin

Originally posted at Cagle.

When I joined Twitter in July 2006 I was the 3,365th person to sign up for the 140-character message streaming social network. Now, with more than 190 million users having taken the plunge, I guess you could call me an early adopter of sorts.

See, I've always believed that the Internet -- and by extension new online tools like Twitter -- have the ability to create change because it levels the political playing field tearing down walls that have traditionally separated the powerless and the powerful.

It turns out I may have been wrong -- at least when it comes to a certain half-termer from Alaska.

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The Pulse: House Passes Health Care Reform

By Lindsay Beyerstein, Media Consortium blogger

Last night, the House of Representatives passed comprehensive health care reform after more than a year of fierce debate. The sweeping legislation will extend coverage to 32 million Americans, curb the worst abuses of the private insurance industry, and attempt to contain spiraling health care costs.

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On One Health Care "Myth"

Republicans have attacked Obama's health care plan for, amongst other things, creating "death panels." Democrats, predictably, have responded by calling this a ridiculous scare tactic, something that of course will never happen.

The problem is, however, that the fundamental concept behind this idea has merit. And unfortunately, because of Republican attacks, a good idea may not be implemented.

Here is the viewpoint on "death panels." Killing old people is a bad idea. So don't do it. Case closed.

But reality is not that simple. The plain truth is that the enormous cost associated with caring for the elderly is slowly bankrupting our nation and its health care system. The last months of a person's life incur an enormous and disproportionate amount of spending relative to his or her lifespan. And sometimes - many times - those expenses are simply not justified; unnecessary operations and surgeries simply prolong the pain and delay the inevitable. Unplugging the machine may simply be the right thing to do - both for the nation at large and the person individually.

There is most definitely a chance of abuse and terrible wrong happening with this. There usually is. This idea is not perfect; few ideas are. The point is that it should not be immediately dismissed out of hand.

Today, with the health care plan losing popularity, Democrats are quickly backtracking from end-of-life planning. They have promised to delete the text concerning "death panels."

That is unfortunate. Excessive end-of-life treatment that does not help is a major part of our skyrocketing health care bill. If we ignore the problem, as Congress seems poised to do, it will not magically get better. Sadly, ignoring the problem increasingly looks like what is going to happen.

--Inoljt, http://thepolitikalblog.wordpress.com/

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Healthcare Protests Reek of Short Memories and Double Standards

Crossposted from Hillbilly Report.

All over the country right-wing folks have made a special effort to make it to various townhalls to protest- and make sure that anyone with positive things to say about the healthcare bill do not get heard. These folks are angry about many things, from what they percieve as a "government take-over" of healthcare, to the debt and deficits they see as being caused by Barack Obama, and most ridiculously to their parents and grandparents being put before Obama's "death panels" whose sole purpose they believe is to murder the elderly and sick children who are not worth the cost to keep alive.

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