Rep. Alan Grayson's Synopsis of the Republican Healthcare Reform Plan

[coprolalia]

Yes. I'm referencing the ultra-libbo HuffPo...

Maybe I haven't been paying attention (yeah, right), but I have not heard a better talking point on healthcare, Democrats, and Republicans yet. [Alan] Grayson is being widely quoted for his two-part exposé of the Republican health care plan: (1.) Don't get sick. (2.) If you do get sick, die quickly. Now, you'd think that was a pretty succinct soundbite for the media, but you would be wrong. Their attention span is closer to three seconds, as they proved once again by cutting this even further to merely "die quickly."

The Republican response was as amusing as it was predictable. They howled. Like most bullies, they can dish it out, but they sure can't take the same medicine leveled at them. They called for all sorts of condemnations of Grayson, until it was pointed out to them that (a) no rules were broken by Grayson, and (b) the Republicans have been saying worse things for the past four months. So they'd have to condemn all of the "death panel" comments they've been making as well.

Read more at: http://www.huffingtonpost.com/chris-weigant/friday-talking-points-96_b_308418.html

Let me be the first to say that Grayson got it completely right.

This is precisely the type of healthcare reform we need in this country, but the problem is that politicians love to oversimplify into rhetorical soundbites in order to gain some political bang. The devil, however, is always in the details.

So, let's dissect it a little bit more:

DON'T GET SICK: Yes, correct. Don't get sick. Our hospital censuses are disproportionately full of patients who are morbidly obese, heavy smokers, or have otherwise put themselves there not through unexpected illness or happenstance beyond their control, but through their bad habits or poor behavioral choices. They literally suck the system dry through their completely preventable diseases, and the take the focus of our care away from patients with unfortunate circumstances clearly beyond their control that are in want of all of our resources, best help, and efforts.

IF YOU DO GET SICK, DIE QUICKLY: It is appalling how much money we waste in this country on FUTILE care. I'm not talking about spending money to improve and palliate patients who may live another 6 months to a year reasonably comfortably and lucidly with their loved ones. I'm talking about people who would otherwise be dead, have absolutely no meaningful contact with consciousness and reality, and have zero chance (not even a small chance) to recover from their illness. We keep these patients alive, sometimes, for months in this condition. Get this concept clear in your heads: WE PROLONG THEIR SUFFERING AND ONLY ARTIFICIALLY DELAY THE INEVITABILITY OF THEIR OUTCOME OF THEIR DISEASE SIMPLY BECAUSE WE HAVE THE TECHNOLOGICAL CAPABILITY TO DO SO. And, guess what? That technology costs money.

So, I applaud Rep. Grayson for so neatly and succinctly framing exactly what we need to accomplish in this country. Of course, his summarization of the Republican plan was completely lacking in detail, which I always expect from the touchy-feely, tree-hugging, Kumbaya types (on both sides of the fence) who seek more political mileage than they do actually fixing anything.

Let me, therefore, resummarize:

(1) We need to focus on making people healthier by punishing bad habits and lifestyle choices in this country.

(2) We need to stop futile care in patients with absolutely no hope of getting better that only increases their suffering and prolongs their inevitable death.

There are multiple ways to accomplish this. Clearly, hot-breathed and hollow rhetoric on the house floor is not one of them.

-copro

---

Members don't see this ad.

 

[coprolalia]

We seriously need to re-address the cost of near end-of-life care and treating terminally ill patients in this country.

Most deaths of Medicare recipients occur after an advanced or terminal phase in which symptomatic care alone without aggressive interventions (ie, hospice) should be employed. However, aggressive treatments attempting to prolong life in terminally ill people typically continue far too long. Reflecting this overaggressive end-of-life treatment, the Health Care Finance Administration reported that about 25% of Medicare funds are spent in the last 6 months of life (about $68 billion in 2003 or $42,000 per dying patient).[13] Actually, the last 6 months of a Medicare recipient's life consumes about $80,000 for medical services, since Medicare pays only 53% of the bill.[14] Dying cancer patients cost twice the average amount or about $160,000.[13]

http://www.medscape.com/viewarticle/464964_2

This simply has to stop.

-copro

 

[Surfer]

it doesn't have to stop. it should be up to the patient. however, the patient should be financially responsible for their decisions.

 

[coprolalia]

it doesn't have to stop. it should be up to the patient. however, the patient should be financially responsible for their decisions.

Fair enough. I presented CMS data. Right now, you and I are paying for it.

-copro

 

[Camel]

Fair enough. I presented CMS data. Right now, you and I are paying for it.

-copro

I tend to agree with copro on this topic. Out of curiosity, from those with some exposure to such environments, how is it done currently in places that have been cited by some as examples to be followed:

Namely, those listed by Atul Gawande in this article.

Places such as the Mayo Clinic?

 

[Prof Moriarty]

Clearly, hot-breathed and hollow rhetoric on the house floor is not one of them.

I'm on a palliative care rotation. The team gets called in on complicated cases with advanced disease. Sometimes the patient is still receiving potentially curative treatment, albeit often with a limited chance of success; more often they are past this point.

It is the consensus on the palliative care team that they are generally called in later than they should be. In addition to pain and other symptom management, we have the conversations about health care proxy and advance directives. The DNR/DNI status is routinely noted in the patient's chart as "Defer to PMD." Most doctors seem to avoid this conversation. Granted, it's a tough one, but the patient deserves to have access to information that is potentially going to make a big difference in their QOL in their final days/weeks/months. The default status is "full code" and all that comes with it and after it.

Among other things, the palliative care team answers the patient's questions, presents the options, and talks about them candidly, and even discusses the realistic outcomes of aggressive resuscitation / life-sustaining efforts on patients of a certain age and/or debility. Some decline to have this conversation, and that's their right. But many welcome it. The conversation may be difficult, but it cannot hurt the patient. It informs them of their options, and with that information, the patient and their family is better able to manage their EOL care.

So I agree with you wholeheartedly that the system's gotta change. We need to get the information about advance directives and health care proxy to patients in a timely manner. At different stages of life or in different states of health our needs in this regard will be different. There is no one-size-fits-all program. But to be most effective, EOL counseling has to occur before the beginning of the end. Otherwise, the patient's wishes can quickly become an unknown and as you know their QOL can immediately become "worse than death".

But when you talk about "hot breathed and hollow rhetoric" on this topic, I gotta ask you... did you happen to notice all the national headlines recently when certain political and media personalities were talking about "death panels" and "killing grandma" in their efforts to achieve a political victory? Playing politics with those kinds of lies was one of the most shameful, despicable things I've seen in this whole debate. Do you agree?

 

[Narcotized]

This simply has to stop.
-copro

It has to stop... when we are broke. Any rational mention of it before then will get you labelled a nazi. Ever notice how many consults a terminal vegetable gets if they have good insurance versus no insurance? It's sickening. The chart is 10 inches thick. They get seen by every specialist because every organ system is in failure, and then they get the most ridiculous laundry list of expensive tests. And other than a pulse they are already basically dead!!!! Totally insane.