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Well, it took a while, but Blair is gone and our troops are out of Iraq. Afghanistan has much more to do with al-Qaeda, the Taliban and women's rights, and has been superceded by the banking crisis in this country. The daily troop death count causes barely a ripple here at the moment.

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This Wall Street Journal article describes an interesting strategy, and seems in line with the earlier quoted New York Times report: New Rx for Health Plan: Split Bill.

And in a rather bizarre statement:

Seriously, given the influence of health industry lobbyists on the political process, how much reform can there be in a bill that has that garners that many votes?
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Question: Would full federal funding of all federal elections, or an absolute cap on campaign contributions of, say, $500, be sufficient to seriously decrease the power of lobbyists?

Just asking.
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Only the honest ones.

From an editorial in today's paper, it seems the "death panels" are not entirely fiction. The charge stems from the writings of Dr. Emanuel, special advisor to the Obama administration on health care.

Dr. Emanuel says consumption of health care in the US is similar to that everywhere else, except in two areas: end of life care and use of the most modern/most expensive treatments. These two areas account for differences in costs in the US when compared to other nations.

Understanding that not providing the best treatment regimen available is politically unacceptable, Dr. Emanuel says the alternative is an "independent body" who would make such decisions as to when the best available treatment would be cost effective and when it wouldn't be.

He didn't call them death panels, of course, but it seems obvious what function this independent body would perform --- hold down costs by rationing and/or denying care and by forcing the use of less effective alternatives because they are cheaper. At the same time, the independent body would provide plausible deniability to the politicians.

Is this not exactly what the opposition is charging... bureaucrats standing between the patient and the physician?

Doesn't the NHS have a panel that serves some similar function?

(Of course, private insurance companies have been doing the same thing for years.)

For non-approved treatments, each local council (or hospital body - I'm not sure which) gets to decide independently whether or not it is too expensive. An application for treatment is made on behalf of the patient by their GP. This has lead to the phrase "post code lottery" because the treatment you can get often depends upon where you live. It gets media traction because more affluent areas tend to place lower overall costs on the hospital budget and thus they can generally afford the more expensive treatments, hence the view that if you live in an affluent area you can get better treatment - basically a class-division issue.

Of course, the NHS is required by the government to provide certain treatments to everyone regardless, so this only applies to the 'edge case' treatments like the latest not-yet-approved cancer treatment drugs (for example).

EDIT: for a while, offering to help pay for your treatment meant that the NHS would withdraw your care (as you were then viewed as a private patient), but that has since changed. Now, the NHS-funded treatment you are entitled to can be "topped up" from your own savings/insurance policy/etc.

EDIT 2: in the UK, euthanasea is illegal, but I'm not sure what the stance on "willful witholding of life-saving care" is (which is still a conscious decision to end someone's life).

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A natural question, then, is whether or not the decision to withhold life-savingg medical treatment from someone who cannot afford to pay is to be considered euthanasia. I think it is.

And given over 18,000 cases of involuntary euthanasia in the USA every year, I am surprised hardly anyone is talking about it -- let alone calling this what it is.
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Yup, the whole question gets pretty dicey when you dig into it. Essentially, who should make these decisions if the individual cannot or is not allowed to? Is it better to leave it to the family, a body of cost conscious professionals, or the individual's medical team which is not at all divorced from the profit motive?

Profit motive being they are reimbursed for the care they provide or they may need that bed for another patient who needs even more expensive care... and on and on.

In my view, it comes down to who do we trust least for these decisions? Think that might well be insurance companies.

EatsWithFingers --- thanks for the honest assessment of NHS. Reality is our insurance companies do the same thing in our current system in that they require prior approval for most any treatment.... all the company need do is start asking for more justification that the care is necessary and/or will provide a better outcome. Once the question of reimbursement availability enters the equation, the health care providers start reconsidering what they really want to do in the way of care.... do they really want to take a loss on this patient?

When active euthanasia is discussed, as for instance in questions of whether to prosecute people who escort relatives to Switzerland to receive it, the antis always make a big do about the financial incentives to said relatives. That is, if you are chief heir of Auntie Mabel, who's old and sick and fed up, there may be a danger that you will influence her to sign up with Exit to get painlessly offed. But they don't seem to connect this with the financial incentives to hospitals and insurance companies. That is, they only seem to see individuals as the potential abusers.

It's a most difficult decision in the best of circumstances and there really are no disinterested 3rd parties who can make such decisions.

Which is why it pays to have a living will.

Won't help in all situations. There was a young Brit who got his neck broken in a rugby accident, became quadraplegic, and went the Swiss route. Now, he would not have been covered by any legal arrangement premised on a terminal situation, since he was not terminal, au contraire might have lived another 50 years, nor was he in a hospital, nor was he in pain. He just didn't want to live the 50 years like that; and his parents supported his decision. It was, of course, impossible for him to kill himself without aid, because he had no working limbs. A German (?) girl in a similar situation had unknown friends set her up with a video camera, a glass of cyanide-laced drink and a straw; she looked the future viewer in the eye and bent her head to the straw.

Those are extraordinary situations, however. I was talking about the end of a "normal" lifespan when physicians have a problem with interpreting the phrase "Above all, do no harm" (Hippocratic Oath). They too often consider that from a purely physical body perspective and will undertake heroic measures to preserve a life that the owner of that body wouldn't consider "life".

I know, I was going off on a tangent. One of my best friends is a Christian physician, and the only time I've ever been angry with him was when he was defending the refusal to countenance euthanasia -- even well-safeguarded euthanasia requested by the patient -- in terms of "the redemptive value of suffering". I considered that an unprofessional confusion of roles.

I once left a referral doctor's office very shortly after the interview began for that reason. I said to him that I wanted him to apply his full-blown medical expertise unfiltered by his religious beliefs. If that wasn't possible, I'd leave now and seek another opinion; and did.

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Here is a scathing article on the status quo. In short: today’s market is far from free. Nor are there serious proposals to make it so. Unfortunately.
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Here's a point of view from today's Wall Street Journal. Well said, in my view. Health Care and the Democratic Soul

Right on. The Democratic proposal has been so watered down that I don't even support it any more. Whole thing has been mismanaged coming out of the gate.

Obama says up front that half the funding will come from cuts to Medicare.... and you want senior citizens to support that? And those cuts won't affect what you have now? Fat chance. No wonder we hear senior citizen screaming "Leave my Medicare alone!"

The public option as outlined in the Senate bill must compete with private insurers on a level playing field.... that is, NO govt subsidy. How is a public plan going to be able to take all comers regardless of their health and pre-existing conditions for the same premiums the private insurers get who don't take all comers? Nor does the public plan address those who cannot afford insurance. THIS public plan does not solve the problems, so exactly what DO we need it for? Only one reason... once it's in place, we can throw out that level playing field nonsense and provide health care insurance to all comers using govt subsidy for those who cannot afford it (with tax increases of course).

Right now, the Canadian, British or French system looks pretty darn good to me.

For the record.... I support an overhaul of the system even though my and the family's insurance is great and extremely cheap!

That's my read as well. The President is trying to mediate instead of leading.

I'd add to that the Swiss, Swedish, Danish, and Norwegian systems. They all work too.

From afar, as it were, I support an overhaul as well. Even though two of my kids (and their families) and a nephew and his family all live in the USA and don't really need reform because they all have excellent health insurance and very stable employment (in addition to having done well in their careers).

I have a nephew in Canada though whose youngest son was born with a kidney problem and requires a lot of medical care. He's lucky to live in Canada (and that his dad is an officer in the Navy).

Something interesting, incorrect, and somewhat funny:
http://www.huffingtonpost.com/2009/0..._n_257343.html

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Just read a relatively unknown chapter of history -- new at least to me. Fascinating cooperation between Kennedy and Nixon!
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