Posted on 09/07/2009 2:45:23 PM PDT by 2ndDivisionVet
When former Alaska Gov. Sarah Palin introduced “death panels” to the health care overhaul debate vernacular via Facebook in early August, she showed herself to be a brilliant idiot.
Technically, Palin’s claim of a panel of “downright evil” government bureaucrats rationing health care based on Americans’ “level of productivity” is obviously idiotic. There is not, and never will be, some mythical jack-booted panel of government pinheads, rubber stamps in hand, deciding who shall live and who shall die. As such, Palin was deservedly roasted.
Tactically, however, Palin’s move was pure brilliance: in but a few keystrokes she synthesized the underlying suspicion at least half of Americans have about a government role in health care delivery and created a visual metaphor from which the Obama White House and congressional Democrats still haven’t fully recovered.
So would it surprise you that Palin has a legitimate point? Well, sort of.
There actually is a government-appointed panel, named MedPac, which is made up of health care experts — those pesky pinheads — who analyze and make policy decisions, including policies about death. MedPac oversees and evaluates Medicare’s costs, physician payments and quality controls. Its decisions affect health care coverage for 40 million American elderly and the medical institutions involved in end-of-life care — in this case, hospice care.
In other words, there is a government panel which makes decisions that affect when (but not how) a hospice can “pull the plug on Grandma.” So does Iowa Republican Sen. Charles E. Grassley have legitimate point too? Well, sort of.
It depends on whether you believe for-profit hospices should be tacitly encouraged to keep patients under their care for extended periods of time in order to bilk Medicare for more days of service to pad their profit margins, and at largely taxpayer expense.
While Palin’s baby son Trig, who has Down syndrome, would never be denied needed medical care and left to die by some mythical bogus death panel, there actually is some truth that changes in Medicare’s reimbursement methods for hospice care will affect how and for how long millions of senior citizens spend their final days.
First, some background on Medicare’s hospice benefit, which began in 1983 primarily for the near-death elderly, mostly cancer patients, through nonprofit hospice facilities affiliated with religious and community organizations. By 2005, hospices treated 1.2 million patients and one-third of Americans who died did so at a hospice facility. Hospice admissions continue to increase at roughly 10 percent per year.
Overall, Medicare hospice spending more than tripled between 2000 and 2007, to more than $10 billion. Total hospice care will cost roughly $46 billion by 2030.
The future in hospice is all about how to make a buck — make that big bucks — and increasingly at the expense of Medicare patients and taxpayers. In 1990, for-profit hospice treated 9 percent of total hospice patients; today, it’s now 35 percent of total patients. Nonprofit hospices still treat 56 percent of the total number of patients, but that figure is trending steadily downward.
What began with largely charity-based Medicare hospice providers has in the past decade or so morphed into a multibillion-dollar, profit-driven corporate enterprise. Between 1994 and 2004, Medicare saw a 400 percent growth in the total number of for-profit hospice facilities, which is six times the rate of increase of Medicare-participating non-profit hospices. In the past decade, nearly 1,000 new for-profit hospices joined Medicare.
Hospice is now a huge profit center. The Journal of Palliative Medicine cited a 2005 study that large publicly owned hospice chains generate profit margins nine times higher than those of large nonprofits and three times higher than privately owned for-profit hospices of similar size. The biggest for-profit, publicly-owned hospice is VITAS, which treats more than 11,000 patients in 16 states. Other large chains are the publicly owned Odyssey Healthcare and Vista care, and the private Heartland Hospice, a division of HCR Manor Care, which in 2007 was bought by the Carlyle Group, the mega-investment firm, for $6.3 billion.
In June 2008, MedPac reported that length of stay in a for-profit hospice is roughly 45 percent longer than the length of stay in a nonprofit facility. Of course hospices with longer lengths of stay are more profitable.
So, inversely, and cynically speaking, does a typical nonprofit hospice affiliated with the Catholic Church ruthlessly “pull the plug on Grandma” much sooner than necessary, at least as compared to the kinder, gentler for-profit Heartland Hospice facility?
Longer stays at for-profit hospices doesn’t assure better care either. A 2004 study looked at 2,080 patients in 422 hospices and determined for-profit hospices provided terminally ill patients in need of end-of-life care a “full range of services only half the time compared with patients treated by nonprofit hospice organizations.” That’s because for-profit hospices lower costs by cutting services, namely “non-core” services such as prescriptions and labor-intensive personal care such as bathing. Moreover, families of patients at a for-profit hospice received counseling services, including bereavement counseling, only 45% as often as those at a nonprofit hospice.
In other words, Medicare hospice patients stay significantly longer at for-profit hospices than at nonprofit hospices, yet receive far less personal attention and spiritual counseling. Medicare’s existing reimbursement system contains incentives that make very long stays in a for-profit hospice hugely profitable, especially if labor-intensive patient care is purposefully denied.
Given this evidence, in January 2009, MedPac recommended that beginning in 2013, Medicare alter its current payment system for hospice care providers serving terminally ill patients, the first such method change since 1983. Instead of its current predictable flat-rate per diem payment rate to hospices caring for the terminally ill, Medicare would pay relatively higher payments per day at the beginning of the episode, and relatively lower payments per day as the length of the episode increases — a fairly radical and provocative departure from current policy.
At a certain point though, any elderly patient could cost more to keep alive than Medicare’s daily reimbursement payment rate. Again — cynically speaking — the longer a Medicare patient’s hospice stay, the less incentive a hospice has to keep a near-death patient alive. Would Grandma’s plug be pulled then to protect a profit margin?
If so, to quote Palin, sort of, “such a system is downright evil.”
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John Edgell is a former Democratic congressional staffer.
Am I surprised that he couldn’t have summed all that drivel up with “I’m sorry, she was right”? Not really.
"It-will-never-happen-here" alert.
There are far too many people in the media who have no knowledge of the written word. Palin engaged in something called dramatic hyperbole. She used death panels, not as a real fact, but as dramatiztion to alert Americans as to where this hope and change may lead us. Was she successful? One five paragraph essay not only went viral, but wound up eliminating the panels people said didn’t exist.
Comments????
Sure. The amiable dunce is back, wearing a skirt and high heels.
She’s right. It’s less personalized than a star chamber death panel, but it is effectively the same thing.
At a once or twice removed level, rules are laid down about what treatment will be paid for.
But, perhaps more importantly, as the government bureaucracy becomes less like America and more like Barack’s America, you will have people interpreting those rules. If you are not somebody important, or if they don’t like your accent, you will be denied. Since it’s the government, with its sovereign immunity, what are you going to do — sue? So the death panels are distributed, but the net effect is the same, and it will be built into the system.
Good grief, are people still writing columns about death panels? She said many weeks ago and has moved on; why can’t these columnists let it go?
Sarah Palin, unlike any other Republican, effectively derailed ObamaCare.
Her “conservative” critics should shut up.
Guess he should have entitled this piece “A ‘sort of’ inconvenient truth”.
They are realizing she was on target.
Very interesting. Palin was right, but because she presented a truth with a negative effect on the Obama agenda (along with most other truth) she is a lunatic.
So far no administration spin doctor has been able to come up with an understandable explanation of how Obamacare can function WITHOUT “death panels.”
Makes no difference what you call them, the panels/patient review boards/health rationing czars or whatever — their function WILL be to allocate funds on a “years of useful life remaining per dollar” basis. Any claim to the contrary is absurd and the person making it is [fill in your own pejorative term.]
Hint to the dubious: Research any similar government program, income tax code, medicare, medicaid, welfare, any and every “great society” entitlement, or whatever and try to find ONE that did not wind up costing many, many times the promised maximum cost......
I am at that point where I honestly question the intelligence of anyone questioning Mrs. Palin's intelligence.
Regarding "time spent in a hospice", the writer assumes there's some sort of equality of condition on entry to any of these facilities ~ which there isn't, plus, the fact the for profit operators are growing at a furious clip could well be as a consequence of the religious operators not being able to expand fast enough.
What the writer needs are NUMBERS. They can be our friends in times like these.
Now, about the "death panels", that was inherant in moving the control of the "output budget" for medical care to the Congress. Right now the greater part of the nation's medical care budget is in the control of the individuals who seek it ~ not their Congresscritters ~ and it should stay that way.
This is a month old and the left is still pissed about this?
Sarah did an excellent job in bringing this up.
In the newspaper's (I still read it to see what the public slant is) op-ed section a week or so ago, there were two letters to the editor from 17 year olds.
One 17 year old said every life is precious, no matter what the age.
The other, however, was of the opinion that when a person becomes old, it is time for them to step aside so the young people can have a chance. I hope this young person feels the same when the definition of “old” becomes 30, as it well could.
When your initial argument is to call Governor Palin and idiot, you've already lost the argument.
Go home John, and start fixing up the spare bedroom, a lot of your leftist Democrat (yea John, I know it's an oxymoron) pals will be unemployed after the 2010 elections.
And with all they will have done to the economy by then, McDonalds won't need their services either.
Goodbye John, make it like we never knew ya.
He takes her death panel remark to the extreme “jackboot” stage to refute her then turns on a dime to admit that she’s right. His fear of Sarah Palin becomes palpable, as he goes to outrageous contortions to smear her right before he calls her brilliant.
The panels may be community muckymucks and not government pinheads, but the concept is well-established in American medicine, where scarcity requires selection of who shall die.
If Trig Palin had had kidney failure in 1962, he would have been condemned to die from it, while scarce lifesaving dialysis time would have been allocated to someone with a better "profile."
If he needed a liver transplant to survive today, he would likewise be comdemned to die from liver failure rather than receive a transplant that could otherwise go to someone with more "potential."
This 'rat-sucking jerkoff probably doesn't even realize that, with the induced scarcity of resources planned under Obamacare, such allocations would again be necessary, this time for a wide variety of conditions.
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