The rhetoric on the US Health Care debate needs to calm down a bit on both sides. There is enough fear in the grassroots about the bill that plans to ram through a bill at this point will only result in a Republican sweep in 2010.

Let’s cut through the rhetoric and check a few facts.

One: most people, facing a life threatening problem, will find funding to pay for their care. Yes, it might mean emptying their savings first, selling their house, and going on welfare so they can get Medicaid, or maybe even going bankrupt, but they’ll get care.

Two: A lot of the hyperbole about people who “can’t get care” ignores the fact that if they go to the local Emergency room, they have to be treated, no matter what. This is very expensive care, and does little preventive medicine, but they do get care.

Three: denying medical care to those working in the US but whose employers don’t give them medical insurance is a crime that cries out to God.  The “cure” is to solve immigration, not to take over medical care.Maybe someone should consider sending the bill to the Mexican government for their care.

Four: Living Wills are naturally biased toward dying. After all, they were devised to stop technology that prolonged the dying process. Who wants to be placed on machines?

But this is not an “all or nothing” choice. The dirty little secret is that palliative care often results in a longer life than high tech care; on the other hand, the high tech care, which seems so expensive, sometimes is cheaper and more humane in the long run.

Take feeding tubes. A lot of them are put in for the convenience of the caretaker. But for patients with severe dementia, the tubes don’t really prolong life: if you can’t swallow food, you can’t swallow saliva, and will probably die of aspiration pneumonia within a year.

But in many cases, instead of a tube, you can pay someone to spoon feed a person.  The patient may not get enough nutrition, and they may die of pneumonia or bedsores, but it can be done. When I worked with the profoundly retarded thirty years ago, some of our patients too one hour of slow feeding three times a day: but they ate. Nowadays, we’d just put in a tube, and they’d be cared for with their families or in a home like setting instead of an institution.

Or how about someone with a broken hip. Instead of replacing a broken hip, you can instead treat someone with bedrest for six months until the hip heals. It’s a lot more painful, and a lot of nursing care, but it can be done.

And instead of dialysis, you could just eat a strict tasteless diet, and risk being hospitalized to remove your excess fluid on your lungs every month or two.

My point is that these are not “all or nothing” decisions.

Five: The press has used the phrase “death panels” to describe the emphasis on promoting living wills.

This is incorrect.  The phrase refers to the “quality of life” bias that is built into a lot of medical ethics. So Trig Palin, because of his retardation, would start out with an inbuilt bias against paying for his care.

Such bias is dangerous, if for no other reason that it slowly diffuses into society the idea that if you are old, or retarded, or handicapped, or otherwise a “useless eater”, why waste our hard earned taxpayer money on you.

As I pointed out, a government program need not promote this type of bias. They could do like the Indian Health Service, and limit “elective” medical care.

But what few have pointed out is that some government programs and some insurance companies already do this for experimental treatment that may not work. Indeed, states like Texas have “futile care” laws that similarly stop treatment against the wishes of patient and (more commonly) the patient’s family.

The current Act only provides a 10-day period for the patient’s family either to find another facility to accept the patient or to obtain a court injunction to extend the time period. If no other facility will accept the patient within the period of time and the family is unable to obtain a court injunction, then the hospital is legally permitted to withdraw life sustaining-treatment from the patient, and to allow the disease process(es) to bring about patient’s death.

And guess what? This was signed into law by then Governor George W Bush.

Finally, there needs to be a backup for those who lose health insurance when they change jobs or lose their job. Under the COBRA law, passed in 1986, one is allowed to continue their insurance for 18 months, if they pay the premiums.

Twice this has happened to me: I was told I could keep the insurance and would be billed, but both times, when I wasn’t billed as I had requested, and I found I had lost my insurance.

But there are other ways to get insurance: I pay for a private insurance policy, but then I am in good health.

There are programs that help you pay for your drugs, programs that offer cheap pap smears and mammograms, and often your physician or HMO will let the bill ride with an agreement to pay so much a month to show your good faith to eventually pay the whole bill.

(In the past, we docs often “lost” the bill, but ironically, if you bill Medicaid or Medicare X amount, if you don’t bill everyone the same amount, you can be indicted for fraud…and of course, nowadays, most docs work for HMO’s who do all the billing for them).

So there you have it. Lots of lies and lots of exaggerations.

But a lot of this comes down to the fact that few Americans want the government to have that much power over their lives. Hence the protests, which are more about government power than about health care per se.


Nancy Reyes is a retired physician living in the rural Philippines. She writes medical essays at Hey Doc Xanga Blog.

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