On death panels

You might have heard that people like everyone’s favorite anti-feminist, Sarah Palin, are spreading lies about the proposed US health care reform including mandatory “death panels” that encourage elderly people to just up and off themselves already to save all us youngsters some cash. You might have also heard that Sarah Palin is a lying sack of shit. Hopefully those of you who are following what passes for “grassroots activism” about health care know what’s what and do not appreciate that people who openly advocate killing elected leaders would rather have children die from a neglected toothache than bother to look up the word “socialism.”

According to national godsend Factcheck.org, here’s what these “death panels” are actually about:

In truth, that section of the bill would require Medicare to pay for voluntary counseling sessions helping seniors to plan for end-of-life medical care, including designating a health care proxy, choosing a hospice and making decisions about life-sustaining treatment. It would not require doctors to counsel that their patients refuse medical intervention.

Voluntary counseling sessions helping seniors to plan for end-of-life medical care. Voluntary counseling sessions. There’s your death panel! Heaven forfend!

Let me tell you a little something about end-of-life medical care. I’ve mentioned here before that my mother has Parkinson’s disease. What I have not mentioned here before is that she is dying. For the last several months, she has been receiving at-home hospice care. She spends most of her time sleeping in a hospital bed in the bedroom she shares with my stepfather. She can no longer sit up on her own or speak more than a word at a time. She can look at magazines but she can’t read or sign her name. She likes to listen to oldies on the radio station, and she likes to get visits from people, but she can’t really stay awake and attentive for more than half an hour or so. In the last five years or so, she has gone from having some bouts of confusion to being profoundly incapacitated. For many people, end-of-life neurological diseases operate more slowly, giving them time to adjust their lives to their progressive disabilities. For my family, by the time we had a diagnosis, things were already changing, almost too fast to keep up. This is complicated by the fact that my mother probably also has other neurological conditions which compound her dementia.

We did not get a lot of non-medical guidance throughout this process. My mom was in denial at first about how serious things were; she refused to see doctors, refused to face what was coming. By the time the rest of us realized how seriously her body and mind were changing, her dementia was pronounced enough that it became very difficult to communicate with her about long-term care decisions. You know what my family could have used, way back when we first realized that my mother had a progressive neurological disease, even before we had a specific diagnosis? A fucking death panel. Voluntary counseling sessions helping seniors to plan for end-of-life medical care. If someone had sat us down, as a family, including my mother while she could still communicate clearly and thus advocate for herself, and told us tactfully but directly that there would come a time when she would not be able to express her wishes, and that we should figure out now what she wanted then, our lives would have been, if not easier, less painful now. Because, the way it is, my stepfather and I are really just guessing. We don’t know if she would like a DNR directive, for instance. We don’t know if she would want to be buried or cremated. We don’t know what state she would want to be buried in, for god’s sake. We decided to enroll her in a neurological study (which involves an autopsy after her death) because she used to be a scientist and we think she would appreciate contributing to science even in her death. But that’s actually just an assumption we have made. We don’t know. We’re guessing.

Some of this, surely, is about family communication. Maybe we could have been more open with each other about death in general, or about our personal beliefs. But I don’t share a religion with my parents; my mom and stepfather don’t share a political ideology; we don’t necessarily have common ground to start with in our beliefs about death and care. My mom could have written a living will before she got so sick; she probably should have. Except, like the rest of us, she was scared out of her mind at what was happening to her, and she wasn’t thinking clearly about the future, because the future seemed impossibly distant compared to the terrifying immediacy of now. It took my stepfather and me almost a year to convince her to go to a neurologist in the first place; I can’t imagine that we could have, on our own, convinced her to imagine herself dying so that she could write down what we should do with her corpse.

That’s why we need counselors, professionals who know what it means to face end-of-life care and who know, pragmatically, what decisions have to be faced while you still have time to think. My family has been struggling on our own for years to coordinate my mother’s medical care while helping her have some semblance of a social life. Engaging hospice care was emotionally brutal, because it meant acknowledging that she was dying. I guess Sarah Palin and her cronies would call that giving up. But what it really meant was that we finally could get the resources we needed — medical, social, and personal — to give my mom some dignity. We are not just collections of organs that sometimes go bad. We are whole people, and counseling should be a part of medical care. When my mom was just profoundly ill, it was a family problem. Now that my mom is “officially” at the end of her life, it is a community effort: both publicly run (hospice care) and privately volunteered (help from her church community).

We are so terrified of death in this country — so sure that if we just do everything right, we will never face it, so sure that death is something that only happens to the very bad or the very old — that the idea of a counselor sitting you down to discuss your ideas about death petrifies people. We refuse to look at the reality of death, the fact that our minds are actually part of these bodies we live in, and that means they will one day cease. Death, in and of itself, is not a tragedy: it is part of our humanity. The tragedy here is that there are politicians trying to convince you that Obama wants to kill your grandma, when what he really wants is to protect my mom.

322 thoughts on “On death panels

  1. I am so sorry to hear about your mother’s situation. You and she are in my thoughts.

    I’m actually in the process of preparing my will and powers of attorney for property and personal care right now. I’ve been trying to figure out what sort of information I should be collecting, to help my family if they ever need to make decisions about my personal care. Do you have any suggestions of things that people should consider and document, in terms of their wishes for care?

    Take care,
    Chris

  2. First, my thoughts are with you and your family – I saw my grandmother slowly become a complete stranger because of Alzheimers, but cannot imagine what you are going through.

    Second, I’ve been increasingly frustrated with this “debate” (ha!) over healthcare reform. We fucking need reforms to our healthcare system and outright lying about a plan that will move us in the right direction is disgusting, immoral, and horrifying. The first time I saw an ad stating for a “fact” that Obama’s plan will ration healthcare to the point of sacrificing the lives of the elderly, I wanted to punch something.

    It just makes me sick.

  3. I don’t have much to say other than *hugs*. And I’m tired of the scare tactics that are being used, too.

  4. As great they are and as much as I love their writing, because Kate, A Sarah, and Fillyjonk are amazing writers, and I love all the writing on this blog, you’re probably my favorite writer here. Your opinions and writings are similiar to mine, but you’re so much smarter and more informed than me.

    My dad told me about the “death panels” while I was at dinner with him, and I thought “Well, that’s rude, it’s like telling people to hurry and die.” Then I just went on, because I’m 19 and getting ready for college classes to start up again, and I don’t have the stomach to read alot about politics. You have managed to clearly express this information in a beautiful, heart-breaking way, and now I know I have to look more into this on my own.

    My grandmother recently broke her hip, and while visiting her in the home she’ll be recovering in, I saw the dementia patients in the hallways. God only knows what they wanted, what their medical wishes really were, because they probably didn’t have any end of life counseling before the dementia had progressed too far. This is important stuff, and people shouldn’t be villianized(?) for supporting it.

    Thank you SM and all SP writers for keeping me informed on so many issues, and for being great caring people.

  5. So sorry to hear about your mom. My dad has been living with Parkinson’s for 10+ years, so her story resonates especially with me. My best to all of you.

    Dad just had some very serious surgery for a life-threatening bowel issue, and a doctor from his primary care practice spent 15 or 20 minutes talking about his care directives (not for the first time; the PCPs at that practice try to go over the care directives at least once every six months). Thank heaven he’s on Blue Cross, not Medicare, so that his doctor is given the chance to do that.

  6. Sorry for double posting, but also, I’m very sorry to hear about your mother’s illness, I wish there was more I could say or do. My thoughts are with you and your family. (and prayers should you want them)

  7. Courage to you, SM, and your family. That is a lot to deal with. Thank you for writing honestly.

    I’ve long noticed the fear of death in our culture–maybe it goes hand in hand with the obsession with youth and excessive materialism, that if you eat the right things and wear the right clothes and drive the right cars–follow the rules!– you’ll live forever. It’s a powerful idea that sells a lot of product.

    Several years ago a family member found she had inoperable cancer and had 4-6 months to live. The courage and calmness with which she faced her death made an impression on me. She knew she was dying, made a will, and accepted the reality of it. Her courage gave me courage too and I will always think of her as a brave person, in both life and death.

  8. This is a great post – we were just talking at lunch about how no one really seems to know what socialism actually means. Also, I am so sorry to hear about your mother-thank you for sharing your/her story.

  9. I’m so sorry your family is going through this.

    I’m so frustrated with the way this “debate” is going. Where were the “town hall meetings” before we invaded Iraq? Before the Patriot Act was passed? Before we spent billions bailing out banks? And yet suddenly, when it comes to something the American people showed that they overwhelming wanted, we suddenly decide that every dissenter, no matter how hateful, misinformed, or willfully ignorant, needs to have a public say?

    The scary thing is, I initially fell for it, too. My husband and I have both found ourselves half convinced by things we’ve read on the internet that there was something really bad or problematic within the health care reform bill, until we actually stopped to fact check. I mean, I heard they were going to force my grandmother, while she was on her deathbed, to undergo a lecture about getting a DNR. Now, my grandmother already has a DNR, but given that our country does have a history of, say, coercing poor women while they are in labor to agree to be sterilized. Of course, that is NOT what the bill says: it’s talking about voluntarily counseling, as you say. But, I think even otherwise reasonable people can be persuaded by some of the propaganda, given the woeful record we do indeed have when it comes to protecting the sick, poor, and elderly, and many people won’t stop to see if it’s actually true.

  10. Thank you for sharing your story. My heart goes out to you & your family. My own father had a lonely and lingering death after 3 years in a VA nursing home- not even correctly diagnosed until 6 months before he died. My mother is now 76 and thankfully healthy. I will not let that happen to her and I will not let it happen to me. This country lags so far behind in human services and compassion that I can barely stand to watch the news any more, filled with ignorant and mislead people. More of the ignorant and proud of it crowd. Guess what? We are all going to die and I for one am hoping to be prepared and hoping to have healthcare that addresses quality of life and death before that day comes.

  11. I’m sorry you’re having to deal with this, SM.

    My mother had Parkinson’s too. The dementia was pronounced in her last years. You are probably already familiar with The 36-Hour Day, but if not, it may be of use.

    In terms of end-of-life decisions, my parents had already decided — thanks to a telemarketing campaign from the local cemetery / funeral home — to start some arrangements in advance. Specifically they’d arranged for cremation, a spot in a columbarium, and setup an escrow account to pay for the service. That, at least, was decided.

    The DNR was harder. Mom had always believed that “she didn’t want to say never” if she was in a coma, but Dad decided that she hadn’t really considered dementia in her plans and signed the DNR. I held his other hand while he signed it.

    I’d like so say something meaningful and profound here, but lack the words.

  12. I don’t think the people who scream about “death panels” really, truly understand what happens when someone has a significant or terminal illness. I don’t think they get the kind of physical and mental energy that goes into being a caretaker for a sick family member. And it infuriates me that because of so many people’s panic over death and dying and being so obsessed with the notion that it’s not about quality of life but quantity, the chances are that only more patients and their families are going to suffer needlessly.

  13. Sweet Machine, my thoughts, too, are with you and your mom and your family.

    My father has Alzheimer’s disease and he has gotten to the point where I can’t tell if he recognizes me at any level or not. And I’ve had to make decisions that affect him profoundly without knowing what he would have wanted me to choose.

  14. I don’t have much to say other than that my family went through a 10 year downhill slide with my grandmother’s alzheimer’s. I understand some of what you must be going through with your mom, and I know it sucks.

    My parents (who are lovely people) are both die hard republicans and I don’t even try to get into poliitical discussions with them anymore. If I get brave I may send them a link to this.

    Thanks for this post.

  15. I am so sorry about your mom.

    I think our culture as a whole needs to move beyond the idea that life extending treatment is always, always better. When my grandpa was diagnosed with terminal liver cancer, he agonized over whether to accept treatment that would extend his life from a few weeks to a few months. He ended up getting it, but I think it was the wrong choice. Between the cancer and the chemo, his quality of life for those months was zero. We as his family had to watch as he slowly whittled away from a big man with a big personality to a skinny, jaundiced, broken shell of his former self. Of course, it had to be his choice, not the government’s (and it’s worth noting that I live in a country with universal health care and he still had that choice) but I wish treatment wasn’t considered by our culture to be the automatic right choice.

  16. I’m so sorry, Sweet Machine.

    My grandfather had a good end; he was able to make his wishes clear (did not want to die in a hospital, did not want to go through another round of chemo). And his wife and kids knew and respected his wishes.

    The other side of my family was very different– two firm believers in heroic measures, one firm believer in hospice, no written advance directive, and clearly inadequate pain meds. My grandmother was still able to talk, but her children couldn’t agree on whether to believe her. It was awful. If counseling sessions were more widely available to patients with terminal illnesses, situations like hers might be a little rarer.

  17. Thank you for sharing such a personal story. I’ve been through something similar and have much compassion for your situation.

    I want to say two things:

    First: Insurance companies already have a form of “death panels.” They are paid to keep costs down by denying coverage. My 52 year old aunt was diagnosed with vaginal cancer in 2004 and her insurance company’s “death panel” denied coverage for the treatment recommended by the gynecological oncologist. The “death panel” doctor that made this decision was an allergist, not an expert in vaginal cancer. She was denied twice on appeal, even with letters from various experts in her type of cancer. So don’t kid yourself that Palin’s “death panels” don’t already exist.

    Second: I believe with all of my heart that the people of the future will look back at our society’s attitude toward death and dying and our forcing dying people to “suffer it out” against their wishes as completely barbaric.

  18. Oh and I should clarify, I don’t believe for a second that Obama’s proposed health insurance reform includes death panels. This is just more red herring rubbish the opposition are inventing to rile people up.

  19. I’m so sorry about your mom. I lost my father to Alzheimer’s well before his death two years ago, so this resonates with me, too.

    We were lucky. He had always been clear about his wishes. Death was not a taboo subject in our home; my mother had been a hospice volunteer for a long time.

    Thank you for this personal post, commenting on such an important (and ridiculously handled) political situation.

  20. So sorry to hear about your mom. Thank you for this very personal post.

    As for anyone who thinks death only happens to the old and you don’t need to pre-plan until you’re on Social Security, two words:

    Terri Schiavo.

  21. I’m siting where you are sitting except it is my husband and not my mother, and it is vascular dementia and not Parkinsons. But dementia is dementia.

    We got our medical directives set before we knew what was coming. And neither of us talked to a doctor about it. Most doctors don’t understand what is going to happen with dementia, but what you described is what the end of life is like with this whole family of diseases.

    I don’t care how old you are, you need a will and a living will and you need them NOW.

  22. My heart truly wants to jump through the screen to you. Oh dear–what a burden. I’m so sorry you have to deal with this, and that our system did not do everything possible to ease your burden. I fear that the new system will be only slightly better, if at all.

    You have spoken your truth. You are clearly not “making things up.” I wish the same could be said for certain ex-governors.

  23. Redwood, you should check out the Salon article I linked to in the first paragraph — it’s all about how we should really be calling insurance panels “death panels.”

    Thank you, everyone, for your sympathy. I’m sorry to all those of you have faced similar situations.

  24. Sandy at Junkfood Science had an in-depth analysis of this topic last week:

    I’d like to officially say that we do not endorse this link. There is absolutely no evidence that the counseling is mandatory (quite the opposite — see SM’s links for more). I don’t want anybody thinking that we agree with Sandy here because her link showed up in the comments. Nothing could be further from the truth.

  25. I’m mostly a lurker but I had to speak up – my thoughts are with you, Sweet Machine; my dad died last year after a long battle with Parkinson’s. He was in a similar situation as your mom: no DNR, no decisions made for end-of-life care, and dementia.

    My mother ended up having to sign off on the DNR and other decisions because Dad hadn’t made me or my brother his health care proxy and refused to make any decisions before the dementia struck. It was extremely difficult for her (she was convinced he wasn’t that ill and would eventually get better) and she still talks about how the doctors “made” her do it. I wish she’d had decent counseling as opposed to a physician who said “I won’t treat him any more unless you sign it”, which was the only way we were able to make it happen.

  26. I don’t want anybody thinking that we agree with Sandy here because her link showed up in the comments. Nothing could be further from the truth.

    Seconded, as heartily as possible. So heartily I’m tempted to remove that link.

    ETA: I did not and will not, but edited Toni’s post instead.

  27. Sweet Machine, I’m so sorry to hear about your mother. I can imagine how difficult that must be, and I’m sending my very best thoughts to you and your family.

    I’m terrified by the displays of irrational outrage I’m seeing over this healthcare issue, and I’m disgusted that Sarah Palin would strike such a low blow as to 1) deliberately make up lies to frighten people and 2) once again use her special needs child as a pawn in those outrageous lies. (She apparently specifically included a line about “my special needs child” being at the mercy of the “death panels” in the propaganda on her Facebook page.) Not surprised, but totally disgusted.

    The worst part is that the people featured in those town hall meeting videos are probably among those who would most benefit from a healthcare reform, and they’re too brainwashed to realize it.

  28. So heartily I’m tempted to remove that link.

    At very least I feel it’s irresponsible to call it an “in-depth” analysis.

  29. Sadly, I’ve lost a loved one to a long illness, and we made the decision to take my grandmother off her feeding tube, which the nursing home would not allow because it was through the nose and not a GT. She died peacefully a week later. I know she wouldn’t have wanted to suffer like that. My grandfather has a clause in his will that says if he ever gets into a vegetative state, to not let him live. That will go in my will as well.

    As for Sarah Palin, the woman is an idiot. Her son with Down-Syndrome is not going to be tossed aside as she stated. She can afford quality medical care. Some of her ardent supporters can’t.

    But I do feel this reform is being rushed. Judging by the violent outbursts of some of these ill-informed protesters, any public option that comes to the U.S. has to be thought over very carefully. We do need a public plan though. Those who think private insurance is all we need in this country are sadly mistaken. They’re not the ones being denied for pre-existing conditions or because our society thinks just being fat kills.

  30. I agree with you Sweet. I lost my mother to cancer that seemed to come from nowhere. There was no will and everything was just a mess. Not to mention that my brother and I were under the legal age at the time. We could have used all the help we could get. I especially would have appreciated some counseling when deciding at just 17 whether or not to take my mother off life support. Especially, since her oncologist was so uncaring and unfeeling about the whole thing.

  31. SM, I’m sorry to hear about your mother, and my best wishes go out to you and your family.

    My father in law died two years ago. Shortly before he died, he had a stroke that diminished everything about his quality of life. But because he was a practical man, he already had all the necessary paperwork in order and *he had told us where it all was and made sure we had copies*. So when the time came (and the timing couldn’t have been worse for many, many reasons), we knew where it was and what to do and what he wanted. We could see the relief on his face when we told him that yes, we were made sure that what he wanted did happen.

    After his death, we kept repeating the phrase “thank you (Dad), for doing this.” We realized that you don’t just do it for yourself, you do it for those who will be managing your affairs.

    My husband and I have all the paperwork in order. Now if only my parents would. Counseling, especially from a third party source, would probably have FAR better results than I have so far. I didn’t want to think about it either, but thinking about what will happen if I didn’t have it all written down is worse.

  32. That post at Junkfood science pisses me off. As someone who spend a lot of time reading statutes, I can confidently say that she is just wrong.

    Thanks, Sweet Machine, for such a wonderful and important piece of writing.

  33. At very least I feel it’s irresponsible to call it an “in-depth” analysis.

    It’s not an “in-depth” analysis at all. She says it’s all ‘gobbeldy gook’ and ‘legalese.’ First of all, it’s legalese because it’s a fucking law. And each provision actually does something specific.

    If I had to choose an adjective to describe that analysis, I’d go with “thoroughly flawed and baseless.” Okay, that not “an” adjective, but you know.

  34. OK, I was going to comment further on the “in-depth” question, but m. leblanc did it so much better.

    And because I haven’t said it here yet, Sweet Machine, this post is fucking breathtaking. Thank you.

  35. In regard to Sandy, I find myself questioning all of the other posts she’s done. It casts a taint, for me, over all her work. I feel like she took us – the people who believed in her – a giant step backward.

  36. The most generous I could possibly be would be to call it an “at-length” analysis. She certainly writes a lot about it. It just happens to all be complete fucking bullcrap.

    I’m not inclined to be that generous, though.

  37. We are so terrified of facing up to the possibility that we may ever be incapacitated in any form. I think most people are OK with the dying part, on some level. But to imagine ever being in a state before the death part, where you find yourself unable to perfectly understand everything going on in your body and mind and your financial situation and what kind of care is available and what treatment is best — AND find yourself unable to communicate your understanding to anyone outside your skin — that terrifies people.

    To sit down and go through all these things beforehand requires that people actually imagine themselves in that condition. And that’s a boundary the vast majority of people are not comfortable crossing.

    It’s understandable why. It’s completely frightening to most people. And there’s simply the force of inertia. But…

    The people who are making the political argument that by acknowledging the possibility of incapacitation and death, you are volunteering for those positions beginning immediately — I think those people are the most terrified of it. And I hate them for their political disingenuity, but I also feel awful for them because yes — it’s scary. It’s hard to deal with.

    Thing is, we need more of the “death panels” of the sort you describe. Giving people the space and the support necessary to think through these things. If we supported every human being with respect and dignity no matter their physical/mental state, it wouldn’t be so gdawful scary to think about it.

    SM, my best to you and your family. I hope things go as well as they can.

  38. This is an amazing post, SM. god.

    amgriffin, I think Sandy does a reasonably good job of presenting medical studies to the public. But her positions when it comes to politics and medical policy are usually very biased, so I think it’s smart to read her posts with an awareness of that and come to your own decisions.

  39. amgriffin and volcanista, I think you’re right on, but everybody, please let’s not turn the comments on Sweet Machine’s deeply personal post into a Sandy-bashing session.

    We’ve denounced the post, and m. leblanc has explained why extremely well. Let’s leave it there. Maybe we can discuss issues with Junkfood Science on another thread in the future.

  40. amgriffin, no shit. I’d read some of her stuff before and liked it.

    But seriously, the idea that this is mandatory? Is completely nuts. Almost nothing in health care is mandatory. That’s why you have to sign all those goddamned consent forms. If you want to do something healthcare-related to someone involuntarily, it usually takes a legal hurdle to be able to do it (i.e. involuntary commitment, involuntary medication orders for prisoners with serious and uncontrolled psychiatric illness).

    The idea that the government wants to make 15 minute counseling sessions mandatory is absurd. Also, she seems to be having trouble reading the bill.

    Okay, I’ll stop ranting about it now but that post is really, really pissing me off. Because you know how many people will read it and go “yeah!”

  41. My heart aches for you as I read this. I’m the Director of a Hospice and speak frequently in the community about Hospice, end of life care, and advance care planning. You are right on target with all of your points.We are a death denying society. Many of us, come from famlies where these issues are not discussed. Those of us dealing with a family member facing chronic..ultimately terminal illness, are constantly scrambling to adjust to a “new normal”..never seeing how we are inexorably approaching the end. I constantly get calls from people who are totally at a loss as to what they need to do…and are emotionally and physically exhausted.

    I frequently tell people that when a Hospice intake nurse appears at the door that first time because she’s been asked to come talk to the patient and family about their options might seem like the worst moement of their lives. It’s not. The worst moment of their lives would be approaching death without the support of Hospice.

    Be well, hang in there, and know that your eloquent words will be shared with many.

  42. If we supported every human being with respect and dignity no matter their physical/mental state, it wouldn’t be so gdawful scary to think about it.

    YES. And of course it’s all terribly entwined with ableism, too: part of the reason that people believe that they’ll just be killed off if they are elderly or incapacitated is because that seems like the logical step to them. Quality of life issues don’t scare them, because they assume a life of disease or disability is a priori life not worth living.

    My mother has actually become much more at peace as her cognitive impairments increased; I think she worries less about how difficult it is to understand or control what she’s going through.

  43. Sorry, Kate! I completely agree, it’s a tangent.

    It makes me spitting mad that something as important as a debate about how to fix our health care system has been completely derailed by stupidity and lies. We aren’t even fighting about the things that we really need to carefully discuss and decide about. argh.

  44. Sweet Machine, I’m so sorry to hear about your mom. I wish you all as much peace and happiness as possible these days.

    Two of my grandparents died without ever having signed a DNR themselves; they gave my mother a medical proxy and trusted her to decide what was best. My grandmother had terminal cancer and was mentally gone by the time my mother signed the DNR and placed in her a hospice. The people there, my grandmother’s doctor…everyone was lovely and supportive. They specialized in end of life care, so they knew the realities and how to deal with them.

    My grandfather though…nothing was really wrong with him when he died. He had a blood problem and went to the hospital for it, but mostly he was old and tired and he wanted to be with my grandmother more than he wanted to keep going at that point. He just kept slowing down and slowing down until he was sleeping all the time, so he was transferred from the hospital to a long term care facility. More than one person tried to make my mother feel bad about signing the DNR for him. One rehabilitation therapist even said that he was just fat and that if he lost weight, he would want to be active again, as if it were just a matter of desire! The night before he died, he told us that he would be gone the next day and that he was okay with that.

    Maybe if we lived in a country where it was common for people to talk about end of life care, my mother wouldn’t have had to go through feeling like a monster for trying to carry out her dad’s wishes.

  45. I have a friend whose mother is rapidly deteriorating with dementia as well… they’re in a situation where basically as soon as they’ve managed to find a solution to a problem, things have already changed so much that the problem is entirely different. Dealing with all this has really overwhelmed my friend for the past year or so. *hugs for sweet machine*

    as far as the hyped-up insanity of a lot of the anti-reform people, there was a big article from someone online recently talking about how much government health care sucks, how the old and the ill would be considered not valuable enough to save, and “IF STEPHEN HAWKING LIVED IN ENGLAND HE’D BE DEAD NOW”

    … except, y’know, he *does* live in England, and the NHS *does* take care of him, thank you very much.

    They edited the article when this was pointed out enough, but knowing that they have the facts all wrong doesn’t sway them in the slightest.

  46. how the old and the ill would be considered not valuable enough to save

    Because private companies totally don’t take this perspective. It’s not like health care is currently for-profit, or anything like that.

  47. I really can’t think what to say about this except I am so sorry for you, your mom, and your family, Sweet Machine.

    I’m also sorry for all the Americans affected by this ridiculous healthcare clusterfuck.

  48. I’m so sorry about your mom. :( It’s not the same, but my great-granny had Alzheimer’s to the point of not recognizing her family, so I’ve seen how difficult it can be for a family to deal with someone changing so much.

  49. NP, Volcanista and M. LeBlanc, just wanted to stop that train before it got going. I’m right with you on wanting to rant about the post.

    And of course it’s all terribly entwined with ableism, too: part of the reason that people believe that they’ll just be killed off if they are elderly or incapacitated is because that seems like the logical step to them

    Right! And as amandaw said, having to imagine yourself in that position is horrifying to so many people, which is both a function of and contributing factor to ableism (and ageism and, less directly, fatphobia — insofar as people relate fat so closely to disability and illness). So people think “it won’t ever happen to me” — with regard to both disability and difficult end-of-life decisions — as opposed to thinking, “How would I prefer to handle that?”

    I mean, really, if you’ve actually accepted your own mortality, there should be nothing scary about deciding how you’d like things to play out at the end. Or at least, it’s no more scary than any other big life choice — e.g., whether to have kids, or how many. You can never rule out the possibility that you’re making a non-ideal choice, and the stakes are extremely high, but ultimately, making the choice is a lot better than letting someone else do it.

  50. I’m so sorry you’re going through that.

    The thing that cemented my belief in DNRs and letting people decide for themselves was working in the Alzheimer’s wing of a nursing home. We had one patient who in her very few lucid moments, refused to eat at all because she wanted to die, and her son just kept telling the home to forcefeed her and keep her alive.

    I think if more people actually were the ones giving the care, they’d feel differently about it. But so many people just warehouse their elderly relatives in nursing homes and pretend that visiting once every month gives them perspective. *

    *This is not knocking people who have to place loved ones in facilities because they just can’t do it alone, and who are active in their loved ones’ care. But we had several patients who never had visitors the entire time I worked there.

  51. “The worst moment of their lives would be approaching death without the support of Hospice.”

    Yes.

    Here’s what I wish for health care reform: that every patient get the kind of compassion and quality care that patients get at Hospice.

  52. SM, I’m so sorry about your mother. You have my sympathies.

    I lost my own mother to cancer many years ago, and before her both her parents died in my childhood home. We cared for them and it was exhausting, but deeply satisfying. Because of that over the years we were able to have many open and honest conversations about end of life care. When all this stuff about ‘death panels’ came out, my family just sat there bewildered, “you mean, not everyone casually chats about DNRs at the dinner table?” But no, apparently they don’t and honestly I think that’s a pity.

    We are all going to die. Yes, even if we make lifestyle changes. Making the inevitable as pleasant as possible for ALL involved (and no my insurance company doesn’t count as involved) just makes sense to me.

  53. Well, hell, Sandy’s got her comments turned off, and there’s no way to reach her via her website. I wrote a fairly long rebuttal to her analysis, which I’ll go over and post on the Ning, if anybody wants to read/comment/discuss. And if anybody knows Sandy’s e.mail address, would you please pass it on? Thanks — MK

  54. I think the other thing here is that doctors themselves are afraid to respect people’s end of life preferences and many (at least in the United States) are too focused on keeping people alive at any cost – including quality of life.

    When I was 11, my grandmother (not the one I mentioned above) had a heart attack. She ended up i the hospital for three months because every time the doctors fixed one problem with her heart, another one developed. Despite her protests, they just kept patching her up. Finally, a compassionate nurse suggested that she start refusing dialysis for her diabetes. When a (type 2) diabetic refuses dialysis in her situation, it should only take a couple days to die – it took her a week. No one should be put in that situation.

    End of life counselling is so important. Doctors need to be clear on the the patients’ wishes, and family members should never be made to feel guilty for doing what they believe is best.

  55. I really don’t get the hysteria. From what I can tell, anti-health-reform people are hauling out Canadian cases that might be malpractice (and doctors making mistakes or being assholes happens everywhere, regardless of how those docs are getting paid), in order to prove that “socialism” is bad.

    Course, up here we’ve got private providers and a single payer. The UK is truly socialized medicine.

    I don’t understand the having millions of uninsured people and that being okay to ANYONE.

  56. Thank you for telling your truth about your mother. I’ll be attending Kelli Dunham’s theater piece about her life with Heather MacAllister tonight, Pudding Day, so I’m thinking a lot about end of life, as I did all of those times I went with Heather to get chemo, or to fight with her doctors when palliative care wasn’t her reality, etc. Not to draw too bizarre a comparison, but I imagine that in this culture we are almost as squeamish about the inevitable existence of fat people as we are about the inevitable existence of death. (Squeamish meaning, not wanting to acknowledge the existence of such facts.)

    (Side note: There are some HAES people who help people work toward self-acceptance using Kubler-Ross’s stages of grieving.)

    Your brilliant post makes me consider more directly how with our current system of delivering (or not delivering) health care, we have a form of slow-death panel already.

    When I was 26 years old and was denied the option of buying health insurance at all, solely because of my weight, I felt that the institutions governing my medical care were telling me they would rather I go away and die. At age 42, I do not have health insurance. So long as “obesity” handwringers make it more difficult for a fat person to get access to medical care, I feel they are actively wishing (and making it more likely) that fat people like me just go ahead and die. Are they not a form of death panel?

    I totally understand that there are any number of categories of people who are denied health insurance either because of pre-existing conditions (just heard about a case of a woman who can’t get covered because she had irregular periods when she was a teen!) or because it costs too much. Nonetheless, I think fat people have a particular claim to being targeted by these go-ahead-and-die panels as a demographic group, not a diagnostic category. (Not that it’s at all okay to tell people who have survived whatever major or minor health problem to go-away-and-die!)

    I have yet to hear — in the 15 years that I’ve been paying attention — a so-called “obesity” expert show any concern about the very real barriers to obtaining medical care that fat people face, much less do anything to make access more available. So I continue not to believe that fat-fearmongers have genuine concern for the wellbeing of fat people. Given a choice between promoting fat=disease and promoting fat people’s actual health (by redefining us as eligible for medical care), they consistently choose their interest over ours.

    Grrrrrr.

  57. It’s not the ‘millions of uninsured’ part that bothers me, it’s the ‘millions without basic health care’ part. I’m not sure how the debate has managed to get people to accept that insurance=health, but it has, somehow. Maybe the insurance lobbies have got a hand in, I dunno.

    In any case, if we HAVE to do it using the insurance model (which some financial geeks have said we do — the American system just can’t shift to a completely different system in one fell swoop without severe repercussions), then I’d at least like to have it administered by someone without a profit motive for denying care.

    It’s simply NOT OK for millions of people in this laughably rich country to go without basic health care.

  58. My sympathies re your mom, SM. I hope you get to spend as much meaningful time with her as is still possible. Parkinson’s sucks.

    My own mother went slowly downhill with Parkinsonism and vascular dementia over the last few years. My brother, after a crisis last year with a DVT in her leg, did have a brief conversation with her about what she wanted for her funeral – he said he wasn’t sure how she felt about discussing that stuff, but he was pretty upset afterwards. (Our family doesn’t ‘do’ death well. My dad died some years back from lymphoma, and from diagnosis to death, fifteen years, nobody so much as mentioned the C word in connection with him, or talked about the likelihood of him dying from it.) My mother didn’t, however, discuss end of life care. In the event, she had a massive stroke back in January and spent two days in a coma before she died, during which my brother and I were asked for permission to have her put on the ‘Liverpool’ care pathway – basically, just making her comfortable, but not intervening with treatment. She was by then totally unresponsive, and we were told that her brain damage was so severe that she’d never regain consciousness, so the decision didn’t seem anything less than obvious.

    This has made both me and my brother spend a lot of time thinking about what we’d want in those circumstances. Being in the UK my situation is slightly different, but I, for one, would welcome counselling, were I ever in such a circumstance and still compos mentis enough to be able to understand the implications. (I’d also welcome open discussion of other care concerns before that point – with a fair voice for relatives, especially women, who too often get ‘assumed’ into a full-time carers’ role they’re not in any way equipped to fulfil – but that’s another issue.)

  59. My sympathies, SM. We’re sort of constantly watching my mom for signs of her mind starting to go, since there’s a family history. So far, so good, but I’m fairly certain she and my Dad have their paperwork in order.

    I actually got my advanced health directive done this summer, except I lack to non-family witnesses to sign it. I don’t feel comfortable asking anyone at work and since I have no friends within 400 miles, I’m kind of stuck. Argh.

    The thing that infuriates me about the “death panels’ nonsense is it was inserted into the bill by a Republican! From Georgia, no less. Who has now 180ed because he realized the party’s frothing extremist base didn’t care that this was a sensible, sane, and dare I say bipartisan measure to compensate doctors for having these conversations when patients asked for them. That’s all it was. Let’s pay doctors so when they do these kinds of consultations they get reimbursed for that time. That was the whole provision. But to the crazy nutcases working for the health insurance companies, it’s the end of liberty.

    I mean, really? We’re supposed to defend the health insurance companies? I can’t think of many other groups of corporations who are more generally reviled by the public. Almost everyone has a story or knows someone who has one about the insurance company screwing them over. But we’re rallying to their defense now? How did this happen?

    And now Baucus and his chickenshit allies have stripped that out of their version of the bill. Bah. This whole farcical debate, showcasing people who are so angry and so ill-informed ranting at members of Congress nonsensically because it makes for good tv while it subverts the entire actual debate makes me want to scream and throw things.

    DRST
    whose rantings on this subject are her own and do not reflect the POV of SP or anyone but her crazy, liberal, commie egghead self.

  60. there was a big article from someone online recently talking about how much government health care sucks, how the old and the ill would be considered not valuable enough to save, and “IF STEPHEN HAWKING LIVED IN ENGLAND HE’D BE DEAD NOW”

    That would be hysterical if everyone got it. Unfortunately some voters really ARE that ignorant.

  61. Thank you for writing this brilliant post. I counsel end-of-life issues several times a week (if not daily) and find it insulting that someone could take the proposal and turn it into “death panels”.

    Thanks for sharing your personal story. I lost my father last year after a long illness and I certainly sympathize. Courage!

  62. *hugs* to you and your family.

    Also, not to hijack your thread, but I’ve started a series summarizing the various provisions of the Act itself, which some might be interested in: here.

    (Full Disclosure: I’m an attorney, and the bulk of my current practice is defending insurance companies – basically, explaining to the court why the insurer should not have to pay X claim. I am also a chronic pain patient, and I have had mental health problems recently stemming mostly from my inability to continue convincing myself I’m a decent human being when I basically get a paycheck by selling out everything I actually believe. I have pretty bad health insurance, as policies go, and the majority of my income goes to paying the bills my policy will not cover.

    So no, I’m hardly impartial. But I try, in the posts, to stick to the summary, and I’m glad to answer questions in the comments.)

  63. living400lbs:Unfortunately some voters really ARE that ignorant.

    Like the folks who think the government doesn’t run Medicare or the VA.

    *presses fingers into temples firmly and breathes deeply*

  64. Thank you so much for sharing your story, Sweet Machine. I hope your mom will be as comfortable as possible in the time she has left.

  65. My sympathies, SM. I’ve watched a number of family members die, and even when … even when those dying are at peace, and not in pain, it’s still … so very difficult. I sometimes think, like trying to walk through a flood.

    … doctors themselves are afraid to respect people’s end of life preferences ….

    This is true. It helps if you keep your living will up-to-date, and file it not only with your papers, but also send copies to all of your family, your doctors, and, if possible, with the local hospitals. The hospitals do require that you’ve been treated there, and have a record on file.

    Besides a living will and a will, though, it’s very important to appoint someone in the family to have power of attorney if you’re incapacitated, and – IMPORTANT! IMPORTANT! – power of attorney for health care. That’s a *separate* document, which will allow whomever you designate – and their replacement, should they also be incapacitated – to make decisions regarding your health care. Including end-of-life care, should it come to that.

  66. When my mother died quite suddenly of a stroke, my poor father was left a little at sea. She’d never made out a will, never discussed her feelings in re: burial vs cremation, never talked about anything she wanted to go to her sister when she was gone, nothing at all. Dad had to make the decisions himself and pray that he’d followed at least some – indeed, any – of her true wishes.

    It wasn’t my father’s first brush with an unprepared death, either.

    When he was a small boy, his great grandfather had a stroke that left him incapacitated. For ten years, the man couldn’t feed himself, bathe himself, take care of his bathroom needs by himself, or speak a single intelligible sentence. And then he died.

    After my mother’s death, my father decided to prepare. He had a living will drawn up, as well as medical power of attorney given to my brother. He also drew up a will which he discussed with everyone in the immediate family and made his wishes concerning the disposal of his remains clear to all of us.

    An easy conversation? No fucking way. It’s hard to stare death in the face, whether it’s your own or that of someone you love. On the other hand, I’m damn glad he did all that.

    You see, a couple years later he was diagnosed with an advanced case of asbestos-related lung cancer and given three to six months to live. Of course nobody in my family is very big on fulfilling other peoples’ expectations, and he wound up living almost another two years and in the end while the lung cancer was a contributing factor in his death, it wasn’t the cause. In point of fact, he got to the middle of a swimming pool, and didn’t have the breath to make it back to the side.

    The family gathered. As much as none of us wanted Dad to die, we presented the hospital with every legal i dotted and t crossed. Not only that, we presented a united front. None of us was eager for the day, but at least there was no argument: we knew what his wishes were, and we had all agreed to abide by them.

    As hard as that time was, at least it wasn’t complicated by having to guess or family battles over what Dad would or wouldn’t have wanted. Having clear instructions made a horrible time in our lives a bit easier, and I’m grateful to my father for giving us the information we needed.

    Sweet Machine, you have my deepest sympathy. Losing a parent is never easy. If you ever need a shoulder or an ear and would find it useful, mine is at the ready. I haven’t been quite where you are, but I’ve been in the neighborhood.

  67. “IF STEPHEN HAWKING LIVED IN ENGLAND HE’D BE DEAD NOW”

    Well, look at this picture! Obama is clearly trying to KILL Stephen Hawking with his bare hands!

    Or he might be giving him the Congressional Medal of Honor. I’m not sure. But, since he clearly wants to kill all old and disabled people, I’m going with the interpretation that Obama must be trying to snap his neck.

  68. This is going to be a rant; forgive me. Also, forgive my anon status; I’m just not feeling brave enough to sign my usual name to this.

    But this:

    [i]I think if more people actually were the ones giving the care, they’d feel differently about it. But so many people just warehouse their elderly relatives in nursing homes and pretend that visiting once every month gives them perspective. *

    *This is not knocking people who have to place loved ones in facilities because they just can’t do it alone, and who are active in their loved ones’ care. But we had several patients who never had visitors the entire time I worked there.[/i]

    is making me apoplecticly angry. Because I am one of those people. My father had a stroke three years ago now; he is in a nursing home in a wheelchair; and he doesn’t remember any of us. Which is in my opinion a GOOD thing.

    Before his stroke he was a controlling miserly bastard, and though I don’t know if he quite qualified as abusive, he was certainly neglectful. And having him no longer in the house is an immense blessing, for both myself and my mother. So I am one of those people, who, though my father is in a home less than three miles from my house, I have not visited him in months. Since March, actually. And I refuse to feel guilty.

    I also am the person who volunteered to make the legal and health decisions for him, because both my mother and brother are narcissistic enough that I knew they would never be able to understand the difference between what *they* would want for him, and what *he* would want for him. And I will make damned sure he gets good care. Not, however, because he is my father, but because he is a human being who needs an advocate. Understand, he lost all entitlement to filial piety (or whatever you want to call it) long ago.

    And I know when it comes time to deal with whatever happens with my mother it will fall on me. She’s 82 herself, and though she’s not at a point where she needs care just yet, I can’t imagine that at some point she *won’t.* And will my brother help? Fat fucking chance. He has a wife and a house and a career and is too busy. I already hear my mother making excuses for him.

    *because they just can’t do it alone.* Fuck you. Could you get any more condescending?

  69. thanks for this post :) honestly, we already have the eerie ‘death panels’ that palin talks about – insurance companies. but aside from the propoganda from the right, this plan does not sound half bad.

  70. Thank you for sharing this very personal yet rational perspective on what has become an utter farce under the misnomer “public debate.” It just goes to show that a painful and fearful situation can be helped by honesty, reasonableness, and human care. These terrified and ‘pained’ shouters don’t need and won’t be helped by choosing dishonesty, domination, and alienation instead.

  71. Palin should be ashamed of herself for playing up the idea of “death panels” as well as asserting that children like her’s with Down’s Syndrome would be in danger. People are lacking a lot when they are filled up by a hollow, shallow person like Palin. One thing I give Palin credit for is that she is good at appealing to that fear that some folks have that individuals different from them are “un”American.

  72. SM-

    Thank you so much for writing about this. My prayers go out to you and your family. My grandmother died of Parkinson’s just this past Christmas at the age of 77. The fact that she had a living will and had literally paid for her burial plot 20 years prior saved our family alot of heartache and made the moment where my father decided not to give her a feeding tube when she was no longer capable of making that decision for herself much easier. She faced her death bravely and unflinchingly.

  73. Wow.

    I am not an American, but I have been watching this Healthcare ****storm since the beginning, and the extent of the misinformation, venom and just downright hatred that I have seen come to the fore speaks to more than divisive politics, it hearkens to the underlying cultural, idoelogical and racial divisions that still seethe in the dark underbelly of your wonderful country. I intend to start my life their with my wife, in a few months. Frankly, all of this is troubling for me, as I intend to raise and protect my family in a society where these issues are still very much existent.

    I am sorry to hear about your mother. From what I’ve seen and heard, having to watch your parent wither away from a degenerative neurological disease is slow torture, and yes, you would have benefitted from focused counselling and advice at the initial onset of this condition. In the least, it would have, in some way, prepared you for what you now have to deal with. Stay strong through these troubled times. I do believe that president Obama is trying is his very best to do what he feels is right for his country, despite the enormous levels of flak and mud that the opposition is raising to obscure this issue. That accusations of that sort can not only exist, but actually take root and infect an entire cross section of people is mind boggling to me, leading me to wonder if people don’t read and think for themselves…the answer would be, apparently not. I’ve seen stories of protesters against these healthcare reforms having ailing relatives and loved ones that will BENEFIT from the changes. That, to me, is incomprehensible.

  74. Thank you for writing about your father, Sweet Machine, and about the issue in general. I am a grief counselor, and so I see a lot of the aftermath (guilt, anger, guilt, exhaustion, did I mention guilt?) that caregivers have to deal with.

    On another site that I read, written by a doctor, she posted an advanced directive from one of her patients. She liked it a lot, and recommends it as a model for other people to use; plus, she goes through the various aspects everyone should consider when putting one together. Maybe some of y’all will find it useful, for yourself or for relatives: Case: A Plan for the End.

  75. Oh wow, this is pretty unbelievable:

    Somehow I always feel like when people flounder this much, they are either a) really that stupid, or b) really wanting to say something else that somehow they know they can’t. I’m not sure which is more true in this case.

  76. Oh, SM. I’m so very sorry, and I’m wishing strength and warmth for you, your parents, and others in your family.

    I myself was abruptly brought face to face with this issue just yesterday. My mother was diagnosed in 2005 with inflammatory breast cancer. Luckily, after chemo, radiation, and a mastectomy, she’s cancer-free. However, we were talking yesterday, and she gave me a copy of something I suspected, but didn’t know, she had. It’s her health care directive. It was a real shock to page through it and think about my mom in situations where I might have to consider not resuscitating her. It’s horrible, but in some ways it’s also a relief, because having it makes me feel more capable of doing right by her should, God forbid, I need to.

  77. You and your family are in my thoughts. And thank you for exercising some gray muscle and spending the necessary 30 seconds to get to the bottom of these scare tactics. It seems like most people would rather follow their master, Twitter, and do whatever that 140 characters tells them to do without checking out some facts.

  78. I’m so sorry for what you are going through SM, thank you for sharing this with us.

    My father was diagnosed with chronic lymphocytic leukemia earlier this week, and it’s still sinking in. I feel angry, scared, worried and emotional. We’ll know more about his prognosis after he gets additional tests next week. I talked to a friend earlier today who recently lost his parent and the first thing he recommended was that my dad get end of life counseling. I nodded but now I’m thinking, where would one start? Any advice?

    If you disagree with health care reform, well okay, there are plenty of issues to protest. But why lies? I just don’t understand the morality of people who would be so deliberately dishonest. I can see how some of the people at these townhalls might actually not understand all the ins and outs of this proposal correctly, but Sarah Palin? She knows this isn’t true. It turns my stomach.

  79. I co-sign to everyone’s thanks to SM for a great post and everyone’s condolences also.

    Seriously, I have no idea why anyone thinks making funds available for something and dictating the conditions when such funds apply is the exact same thing as putting a pillow over someone’s face before their time and against their will. Other than, of course, that someone is getting paid a lot of money to lie, lie, lie about things like that, knowing that a substantial portion of the U.S. population (eight percent of which does not even know and/or acknowledge that Hawaii, our President’s birthplace, is a U.S. state, which it has been for half a century) will fall for it hook, line, and sinker.

    That, of course, is not to say that someone couldn’t fuck up horribly and ignore someone’s advance directive, or that someone’s health care proxies might not necessarily have their best interests. That does happen. And of course, if you want to be what’s known as “full code” (do everything to keep the person breathing, no matter what) always, no exceptions ever, nobody’s going to outlaw that; just put it in writing so everyone knows. But who benefits from absolutely everyone being 100% full code, even if they’ve been in a coma for years? Not insurance companies, they don’t want to have to pay for that, and much of the time they won’t. But they’re happy to see the lie gain traction if it benefits them.

  80. (First time poster here. But I’ve been reading for a couple of months.) SM, I’m so sorry you’re going through all that with your mother! I don’t even know what to say, but I’ll keep you in my thoughts.

    I also wanted to say with regards to “death panels,” I had an “end-of-life counseling session” a month and a half ago. I had to have a very routine surgery, and it was the hospital’s policy to sit all surgical patients down before-hand and discuss the risks involved. Part of that counseling involved asking me if I had a living will. When I said no, the nurse gave me everything I needed in a little packet with a living will form, a form saying my whether or not I want to be resuscitated, everything. Filling them out involved having some conversations with my parents and my husband that none of us necessarily wanted to have, but they were important. I have no problem with giving everyone access to those forms along with someone who can explain anything confusing to them. I’m very grateful to my hospital for giving me that option.

  81. I had tears in my eyes reading this. My thoughts are with you and your family, SM.

    @Anon: I hear you. I recently finished training to be a hospice volunteer, and one of the lessons that the volunteer coordinator taught us is this: you, the volunteer, don’t know the whole story. Like, if you get a patient in a nursing home and find out that she has two kids who live nearby but are not involved in her care at all, it’s not for you to judge because you don’t know the whole story. It’s hard in practice to catch oneself making assumptions like that, but it is possible to recognize the humanity of patients without “picking sides” in family matters. I just hope I’m up to it.

  82. Sticky, you might try contacting your local hospice and/or your local hospital’s spiritual care or chaplaincy department. They may either have end-of-life counseling services themselves, or have recommendations for where else to go.

    *hugs*

  83. Also, for all of you dealing with family member’s terminal (or possibly terminal) illnesses, there are a number of websites for caregivers that have good info. Unfortunately, I’m not familiar enough with the various organizations to make any one recommendation, but it might help to at least know that “caregiver” or “caregiving” are good (and not totally intuitive) keywords for searches.

  84. My thoughts are with you and your family as well, SM.

    I had a grandfather die from Alzheimer’s (-related complications, I guess) and visiting him, which I only did once because I spent the whole time sobbing my heart out in the bathroom, was the hardest thing I ever did in my entire life. So, Anon and Kristen, I’m with you.

    I am a huge proponent of end-of-life counseling. My family had a huge fight to be allowed to let my comatose great-grandmother to die — and her only living relative was her daughter, my grandmother. It doesn’t make sense at all.

  85. My sympathies to SM and everyone else who’s dealing/dealt with death (yeah, I guess that’s most of us, and will at one point or another be all of us).

    My dad died almost nine years ago of brain cancer, and the gradual sink into dementia and incapacitation was really difficult. We talked about all of it, including what he wanted done with his remains, although, oops, he’s still up there on the shelf in his cardboard tube instead of scattered in Muir woods. It was really scary and tough to talk it all through, and we had the luxury of starting at the beginning of his illness, since it certainly didn’t get discussed all at once.

    Hospice was a godsend. I still feel like I want to hug everyone I meet who says they work for hospice. The relief, comfort, assistance, and reassurance they gave everyone in my family, but especially my mom was such a ray of light in a very dark time. Sweet Machine, I hope your family’s experience of hospice is as beneficial as mine was, and wish you and others courage and hope you too are seeing glimmers of good stuff through all the pain.

  86. Hi. I’m an Australian, and we have socialised healthcare. I suffered a disabling injury some years ago, had an operation in the public system, and still take quite a bit of medication for pain management. I’ve had physio and various other forms of therapy as well, all for free (well, the prescriptions are subsidised, so you pay about $4 for a course of anything). If I had been in the US, I could not imagine how screwed I would have been. No insurance, no surviving family…

    The previous conservative Australian government really was trying to move to a more US-style healthcare system, so they were trying pretty hard to degrade the public system. As it is now, the public system actually subsidises the private funds to help make them competitive. The public system was so good nobody saw the point in paying for anything else. And that, I think, is really how it should be.

    It’s not perfect (I had a long, long wait for the operation), but if you’re really sick you get treatment immediately, whoever you are and however much money you have. We have the second longest lifespan in the world, behind Japan, so it must be working. I’m just saying that I honestly believe what you’re going to get is a lot better than what you currently have.

    My father died of cancer some years ago, a very aggressive cancer. There was no hope of recovery from the start, but there was pressure put on him to undergo chaemo from people close to him, even though there was no point. And it was painful and quite horrible and he never came back from it, whereas he could have had a much less unpleasant end without the treatment. I also think that we would have been helped with professional counselling at this stage, to get clear-headed advice about what the real options were, and about the consequences of various actions. So again, death panels also seem to me to be a good idea.

  87. I’m so sorry to hear about where your mother is in her life, in her disease, in her mind…my father had Parkinson’s disease, diagnosed in the mid-80s when people didn’t understand it so well but right after the diagnosis and surgery for lung cancer. We watched him deteriorate steadily for five years in a nursing home, knowing he’d be horrified at the indignities he suffered.

    But the fact that anyone can stand up and lie and have people believe them—under the premise that any offer that “sounds too good to be true” probably is, the corollary is that any statement that “sounds too bad to be true” probably is as well. Oddly, people tend to be highly skeptical of the the “too good” statements, but fall entirely for the “too bad” statements, a habit that manipulative fear-mongers use to their greatest advantage.

    Eight years ago, remembering the situation with my father, despite my consistent efforts to at least have a durable power of attorney and some idea of health and property issues, my mother would not consider even discussing it. She also was diagnosed with lung cancer and barely survived the surgery, and because I had no legal rights, but decisions still had to be made and bills paid, I went through the court process of becoming her legal guardian at my own expense, which made placing her in a personal care home, selling her home and her possessions and managing her care, as well as that of my disabled brother, much more expensive and time-consuming for me and for her. I am self-employed and can manage my time, but this was overwhelming and the time it takes to be a guardian instead of power of attorney is a constant drag on my finances. Any employer would rightly lose patience with the amount of time it takes to manage the lives of these two, so a day job is no solution.

    If a professional had come along and told my mother “you should do this”, she eventually would have followed through with POA and other decisions. Generational and financial objections aside, no one likes to talk about this. However, if we don’t make our wishes clear ahead of time, we might end up like Terry Schiavo who had her end-of-life decision splashed over all the media by grandstanding members of Congress with no means of protecting herself, and we still wouldn’t have the outcome we had in mind for ourselves.

    The opponents of health care reform are those who say they want to guarantee everyone’s freedom, but apparently only to own guns and abuse employees and rape and pillage the economy for their own benefit, but when it comes to the most personal freedoms—who I love and how I love them, what I do with my body—they seem to think they have every right to abridge my freedom in the name of “values”.

  88. Thank you, Sweet Machine, for sharing an incredibly poignant and private part of your life with us here. I am sending courage and strength your way as you and your stepfather decide how best to continue caring for you mother. I, too have endured the loss of both my parents who were relatively young (70 and 71). I was going to go into further detail about their circumstances, but find it too painful to express here. Their passing has caused me to have the end of life discussion with my husband and adult daughter, and I have filled out my own directive because of that.

    I also appreciate the links you posted regarding this mindfuck of Sarah Palin’s “Death Panels”. I recently downloaded all 1018 pages of the actual health care bill and am in the process of digesting it piece by piece, so that I can see the real facts for myself. (I’m no lawyer, but I think I can decipher the lingo fairly well).

    My main issue with the objections of this long overdue health care reform bill is that most of them are not based in reality OR fact. So much ASSuming has taken place, along with fearmongering, that it’s difficult for most people to see beyond the 6 second sound byte on the news. Health care in this country has a mulititude of flaws, yet it seems many people would just rather keep things the way they are so as not to upset THEIR OWN access to health care. It often takes being denied care or coverage for people to wake up and take notice that something is amiss…and that is happening all too often in our blame-based society.

    If we could step away from blaming people for their bad health based on their lifestyle, and just provide health care…period…..we might actually be able to make real change here. I have heard many sound bytes of people saying basically that “since they work hard and pay for insurance, they are more deserving of it than those who don’t”. How shameful that is, in my opinion. It’s as if the 40 million “others” without insurance are not HUMAN BEINGS! ugh

  89. Thank you, anonymous poster, for sharing the details of your choice not to interact with your father, but to still work to be a responsible advocate for him. I really want to honor you for speaking that truth here.

  90. Oh, man. My heart goes out to you on the pain you must be suffering. *hugs you* Diseases like Parkinson’s are so terrible. My mother has told me stories of watching her grandmother who basically raised her fade before her eyes from Alzheimer’s, and I still cry when I think of how my great-aunt couldn’t remember who I was and called me Sally towards the end of her life. (We were very close.) I hate these conservatives and their total lack of empathy. My mother has had a kidney transplant. Because our current system is so fucked-up, she cannot get private insurance on her own again. She will have to work until she dies just to have insurance to cover the exorbitant cost of the transplant drugs. You see, there’s a lovely little clause where insurance companies don’t have to cover anyone who has had dialysis with private insurance, thus excluding some of the people who most desperately need insurance from ever having it. But I forgot-it’s all my mom’s fault for having lupus and getting her kidney injured when my sack-of-shit uncle beat her and my dad up! If she was a better person (aka one of God’s Own Rush Limbaugh Republicans), none of that would have happened! *vomits*
    The death squad thing is so fucking ridiculous. But what can we expect from a woman stupid enough to say that she has foreign policy experience because Russia is close to Alaska?

  91. he wanted to be with my grandmother more than he wanted to keep going at that point.

    Oh, yes, that’s another confounding factor: How people will feel after the loss of a longtime partner. After my MIL passed away suddenly and unexpectedly, my FIL, who had been very sick for a very long time, decided to stop taking all of his medications except for pain meds, and he went very quickly — three weeks. I can’t say for sure that under the same circumstances, I wouldn’t feel the same way. It sounds terrible to say, “I hope my partner has to deal with losing me rather than the other way around,” but someone has to go first, and you usually don’t know which one, or how it will affect the surviving partner.

  92. It’s very lovely to see people who have a loving relationship with their parents and care for them later in life. But not everyone is that lucky.

    Anon is very far from alone in not wanting to care for a relative, and yet doing so anyway. I haven’t had to face this situation myself, but a close friend of mine is caring, along with her sister, for a parent who psychologically abused them both all through their childhood. It’s not uncommon. Anyone recall the incidence of familial child abuse? That poor sweet old man might have repeatedly raped those heartless mean daughters who shoved him in a nursing home and don’t visit. Judging others: be wary.

  93. Hugs to SM and Anon and others dealing with dementia and death.

    My mom’s currently in the States to try and sort out her parents’ wishes because despite the fact her brother has power of attorney, he just refuses to believe the situation is as bad as it is and needs to be talked about and changed now.

  94. (((Anon))) I think it’s a really brave thing to pick up advocacy for someone about whom you have such strong feelings. I hope you have many people in your life who appreciate what a strong person you are, and who tell you so.

  95. I just want to say that although I believe Sandy Scwarc’s analysis of the health care bill is inaccurate, that doesn’t — for me — negate the very real service she has done and is doing for fat acceptance and health care generally.

    I’ve deleted my post on the ning, as one of the Shapelings was able to give me Sandy’s email address so that I could send my thoughts on the subject to her personally. If anybody wants to know what I said to her, please leave me a message on the ning, and I’ll send you a copy of my letter.

  96. Thank you for writing this, SM. My heart goes out to you and all the others who are dealing with end-of-life issues. Dementia of any sort is incredibly heartbreaking.

  97. @DRST and others who are looking for someone to witness documents – in Australia, we often witness documents at pharmacies. I’ve witnessed wills, power of medical attorney and living wills. Teachers, police officers, doctors, vets and nurses can also witness documents. Don’t be afraid to approach someone who has a public role and ask them for help.

  98. It’s sad how late we tend to take the reality of thins, death particularly. It is indeed the thing we want to look from – even when it seems obvious and ever-so definite.
    I’m sorry about your mother – I just hope you people just get to communicate with her, her last wishes in some way.

  99. SM, I am really, really sorry about what’s happening to your mom, and for everyone else on here who’s had to deal with their relatives’ end-of-life care without enough information on what they would have wanted.

    The “debate” on health-care reform in America makes me so angry I literally can’t function. I get headaches and rage and I’m all fucked up for the rest of the day, because I CANNOT BELIEVE what is happening, on so many levels. So I will leave it there.

  100. SM, I realize you’re getting deluged with sympathetic comments, but I just want to say I am thinking of your family and of your mother and you. I won’t go into detail, but I saw some pretty horrible things when some of my family members went, I have a friend with Parkinson’s, so I have some perspective here, and I know that what you are going through right now must suck beyond the telling of it. I am sorry for the pain. I am so sorry.

    *hugs*

  101. I thought I’d add my concern about the tough situation you find yourself in, SM. Dealing with the dying of a loved one is often far more difficult than dealing with their actual death. As a former oncology/hospice nurse, who now mostly cares for the elderly, I’ve seen these situations too many times.

    However, I would like to add a few thoughts about end-of-life planning. Even with counselling, education, advanced directives, etc., it often doesn’t make a big difference when the “rubber meets the road”, so to speak. I think there’s something inate in a great many (not all of course) of us that will fight until the bitter end against the loss of our own or a loved one’s life. People will change their minds, will argue with loved ones, and question decisions made. Sometimes a person is ready to die, but family members can’t accept this; other times the situation is reversed. This is normal. I also don’t think there was ever some mythical time when people just blithely accepted the experience of dying and death. What is often so different now is that we have technology available to prolong this process.

    I’m reminded of John Dylan’s poem:
    “Do not go gentle into that good night,
    Old age should burn and rave at close of day;
    Rage, rage against the dying of the light.”

  102. SM, I’m very sorry about your mother.

    However, I think it’s really disingenuous of you to quote factcheck.org as if they’re a unbiased source, especially THAT ARTICLE, and you know why. So. I think that sucks. And that’s all I’m going to say.

    Actually, I wanted to add one more thing: I thought this was a fat acceptance blog. I know you’re believers in intersectionality, etc. and I don’t actually mind reading about your political opinions (I mean, I knew you were all Lefties). But the vitriol does bother me, and its alienating. I don’t come here to be insulted. I know what’s what, thank you very much, and I still disagree with you.

  103. @Antonova, rather than just getting defensive and accusing SM of posting vitriol because you disagree, how about actually explaining why you disagree like a mature adult?

  104. Yeah, so I didn’t want that to be my only post on this thread.

    SM, I think this is an amazing post. (I know you know that because I told you over email, but I want to get on the public praise bandwagon too.)

    I once watched a Frontline episode in which a doctor said something like: “What many people don’t understand is that Parkinson’s patients eventually become unable to swallow. If you insert a feeding tube, it will sustain their lives, but it will also create a situation where they almost certainly won’t get better but now must wait die from something massive and catastrophic, like a ravaging infection. Whereas if you don’t insert a feeding tube, they will die of dehydration — which can be a peaceful way to go, if you’ve got palliative care, but which often horrifies loved ones. There are understandable reasons to choose either way, but the point is, that’s the choice to be made.”

    For whatever reason that was my wake-up call that the time to think about such issues is waaaay before they’re your reality. Even though I was then just shy of 30 I drew up a will and discussed end-of-life issues with my spouse (including funeral plans and disposition of my body). Since I was pregnant I also included things in my birth plan like “I do not want my future fertility to be considered should I require treatment for a uterine rupture or hemorrhage.” I actually don’t think I currently have all my i’s dotted and my t’s crossed, since we’ve moved to another state, so this is a much-needed reminder.

  105. Ok, I’m definitely not a fan of Sarah Palin, and it’s obvious that certain aspects of the healthcare debate are being presented in an overly dramatic fashion. That being said, I do think that concerns about end of life issues are justified. It’s a very gray issue, which is why people are understandably expressing their views with such passion, but I don’t like to see pundits, etc dismiss the entire subject simply by attacking Palin personally.

    Is she an idiot? Yeah, most of the time…but let’s put her aside for a minute and actually discuss what she’s brought up (albeit melodramatically). As much as liberal commentators love to dismiss the idea of “death panels” by making fun of the concept, the questions are legitimate–in Europe, which has universal health care, anyone can tell you that the system SUCKS. Seriously.

    A quote from my British boyfriend: “Yeah, everyone has health care, but everyone has the same shit health care.”

    When I was studying in London last semester and was sick as a dog, I walked about a mile to the nearest *free* hospital and waited forever to be seen, only to be literally told that it would be a “waste of resources” to help me. Because I was only very SICK, not obviously dying.

    But back to the subject of death panels, it’s a fact that these universal health care systems are based on “efficiency” in order to make it possible for the society to support care for everyone. Efficiency, though, means balancing cost and benefit of care, which means that there are, in fact, certain people whose job it is to assess whether or not your care is worth the government’s cost. So if you’re 78 years old and need a kidney transplant or whatever, there is a chance that that procedure, which you need to survive, will be denied on the basis of cost. Call it a death panel if you want, but this DOES actually happen.

    There was an uproar a while ago when it was discovered that certain women with breast cancer were being denied life-saving drugs on the basis of cost.

    While the wording “death panel” may seem overstated, people’s questions about end-of-life issues are, in my opinion, justified.

  106. You guys just don’t understand. The thing with right-wingers and anti-feminists is that while they may be all about denying you your rights and treating you like a chattel, that’s still no excuse not to be nice to them.

    It’s like when someone tells you you’re a disgusting cow and expects this opinion to be respected because s/he’s just “being honest” or “trying tough love.”

  107. Anon, I also would like to add my support. If I may, I think that you are doing a strong, beautiful thing for considering that chances are that your father probably didn’t do too many beautiful things for you in your life

    I think so often we look at the elderly and the infirm and we define them by those two things, pushing aside who they were as people. We see only to cute old man or the poor sick woman who no one visits and we feel bad for them. We forget that there may be a reason no on visits them. I know that when I read geekgirlsrule’s first comment, I too thought it was sad that some people never had visitors…but reading your post opened my eyes to another privilege that I didn’t even realize I had in this context: the privilege of not coming from an abusive family.

    And sometimes even if they were good, wonderful, well-loved people, not everyone can handle seeing their loved ones like that. My grandmother was one of the people I loved the most in this world, but when she was sick and dying, I visited her once in the hospital and only then because my family went and we were all going somewhere afterward. It wasn’t because I didn’t love her that I didn’t go see her, but because I was not strong enough to handle it. When my grandfather proclaimed he would be dead in a day, though I had seen him many times in the hospital, even when he was just sleeping all the time, I didn’t go to him because I was too busy bawling and trying not to vomit.

  108. Yeah, didn’t we have this conversation back around election time? And didn’t we make it pretty clear that if people are too offended by our being dirty liberals, they can go read one of the more conservative fat blogs?

    ‘Cause seriously, the idea that we should tone down our politics to avoid alienating readers who disagree is absurd. Our politics are a huge part of why we believe in fat acceptance, not to mention a huge part of who we all are. Being liberal feminists is not about playing on a team, it’s about our fundamental fucking human values. And if you find our fundamental fucking human values insulting, this is not the blog for you.

    If you still want to come here to read about fat acceptance, there’s a handy “fat” category you can access via the left sidebar.

  109. Factcheck.org is partisan? Since when? Or is this the “reality has a well known liberal bias” thing again?

    Oy with the poodles.

    DRST

  110. My 35-year old sister-in-law died suddenly last month and I have to say it’s given me a whole new perspective on wills, life insurance, and advanced directives. I guess it’s put me a little more in touch with my own mortality.

    It just no longer seems silly or scary to think about these things – it’s not like I’m going to be the special person who never ever dies. It’s going to happen some time and it may very well happen before I expect. And when that time comes, I don’t want my husband or my parents or my sister or my niece and nephew to be dealing with these sorts of decisions and making themselves crazy trying to figure out what I’d want. The least I can do for them is to think about this stuff now.

  111. re: the dirty liberal thing, I thought I made it clear that I have no problem with your politics (or your hygiene, for that matter). And I don’t want you to “tone it down.” What I’m taking issue with is the stated assumption that everyone who not a liberal is stupid, or evil, or both. I didn’t realize that was one of your fundamental fucking values! I didn’t realize that you were only interested in talking to people who agree you on basically everything. My bad.

    I’m not going to speak to the other stuff, because I’m not an asshole.

    Thanks for the category tip, Kate.

  112. I just want to express my gratitude for this post and my admiration for your willingness and ability, SM, to talk about your family’s experience. It must be difficult to speak the painful truth. However, it is probably a powerful antidote to the alarming fabrications that are taking over this important discourse. I see how you are refusing to let yourself be marginalized in this conversation and I am learning from that. My heart goes out to you.

  113. I haven’t read the comments, so forgive me if I repeat something that has been said. I don’t have a lot of time these days–two week old baby in the house! But I wanted to say I am so sorry about your mother. My grandfather died of Parkinson’s disease on April 22nd of this year. I keep thinking of him as I hear about these death panels. My grandparents could have used some counseling and advice, I think, as they negotiated by grandfather’s wishes–he did not want to be fed by IV or to be on a respirator–and my grandmother’s wishes–she couldn’t stand the thought of denying IV feeding and fluids. They eventually worked it out but they could have used help.

    It’s also pretty ridiculous to me that he never did have hospice care b/c the doctor was never willing to say he was within six months of the end. He knew he was dying. The rest of the world needed to get on board

    Anyway, I really am so sorry to hear about your mother. It is truly a horrible disease.

  114. I should say they worked it out such that he refused the respirator but would have taken the feeding tube/iv fluids. In the end, it didn’t matter. He stopped breathing and they didn’t intervene because of his DNR.

    Death comes to everyone.

  115. (((Sweet Machine)))

    Oh, honey – I’m so sorry for what you are going through. My mum is constitutionally the type to deny she’s bad off until it is too late as well, and my worst fear is that we (kids) will end up in this same position – knowing we are all at different places on the political spectrum and having no idea how to direct care for *her* in the way *she* would want it … simply because she is unlikely to wrap her mind around it in time to tell us. All this is assuming that she is even fully aware herself of what she wants; I’m not sure she is, and I think that’s a likely reason for her reluctance to address it now.

    So … gahhh. I’m so sorry, I am sure you are doing your best and making her as comfortable as you are able to do knowing what you know about her. For someone who wasn’t ready to face directing care for herself, that’s really the best you can do. You sound forgiving of yourself this way, not like you’re on the rack about it, I just want to be a(nother) voice saying yes, you’re doing your best, and that is good enough. It has to be. I wish peace and strength for you in the rough waters ahead.

  116. What I’m taking issue with is the stated assumption that everyone who not a liberal is stupid, or evil, or both.

    Please point me to this “stated assumption.”

  117. Like you I had to watch in agony as both my parents died (12 days apart). They both had terminal cancer and I was so blessed to have a program in or state that gave us a nurse twice a week that would come for about an hour. Their advice and love got us through all the stages of this horrific period. My heart goes out to you. I can say, as many others can too, that in time you will look back with pride and know that you were there for your parents.

    With regards to the health care reform…..yay! Its about time. I am surrounded by friends who are going through this issue with their parents as well. We are all getting to the age where we are losing them. Having hospice or any other program to help give them some relief and dignity is so important. Helping families understand the stages is sooo important.

    When Medicare first was proposed it was called socialized medicine. The opponents of it used fear tactics then too. But most if not all of them used it in their older years. My parents would not have had a decent life without it.

    Im not trying to make this a political thing. I just wanted you to know that you are not alone. You are thinking very clearly and I pray for peace for you mother. I pray that you will stay strong for her and your dad. You are the best! Please keep blogging. I’m sure I’m not the only one who would like to hear how you are doing.

  118. in fact, certain people whose job it is to assess whether or not your care is worth the government’s cost.

    livvy8, what do you think insurance companies do right now? Please read the links in the post for examples of this exact scenario — only now it’s not about being “worth the government’s cost” but about what boosts the insurance companies’ profits. You really think that it’s better to have profiteering businesspeople assessing what your life is worth to them?

  119. I have been trying really hard to avoid letting my liberal politics make me stereotype people with conservative politics as cruel, selfish, empathy-challenged Darth-Vader types — the “evil” stereotype @antonova mentioned. I have been committing myself to this by resisting making that judgment mentally and also by seeking out people with conservative politics for apolitical discourse. I am making baby steps. This commitment of mine is being strongly challenged right now by seeing people with conservative views shitting on this very personal thread.

  120. livvy8 – for starters, none of the versions of the bill currently being created by Congress includes universal health coverage. I only wish they did. The public option is not universal coverage, it’s a public, government-run plan that will be available to anyone who needs it, without restrictions, but it will require people to sign up and buy in. It will not be mandatory.

    Your arguments against reform, being based on your hatred for universal care, don’t apply to the current plans in the first place.

    We do have a limited form of universal health coverage and socialized medicine in this country. It’s called Medicare. Before you or anyone else continues to spew wild accusations about Medicare denying patients treatments because of cost, I’d like you to actually find evidence of this. I doubt you can. There are a plethora of cases of private, for-profit companies denying people care, some of them coming up just in this thread.

    In other words, the private, for-profit companies MAKE MONEY BY DENYING PEOPLE CARE AND COVERAGE EVERY DAY. There are people at those insurance companies whose job it is to deny any claim, to find people to eliminate because their coverage is too expensive. There are whole review boards at the private companies that cut people off from care, some of it life-saving, based on MONEY.

    And you want to paint the government as the evil force at work here? You’ve got to be kidding me.

    DRST

  121. *Just realised this is long, sorry!*
    Livvy8:

    Is she an idiot? Yeah, most of the time…but let’s put her aside for a minute and actually discuss what she’s brought up (albeit melodramatically). As much as liberal commentators love to dismiss the idea of “death panels” by making fun of the concept, the questions are legitimate–in Europe, which has universal health care, anyone can tell you that the system SUCKS. Seriously.
    A quote from my British boyfriend: “Yeah, everyone has health care, but everyone has the same shit health care.”
    When I was studying in London last semester and was sick as a dog, I walked about a mile to the nearest *free* hospital and waited forever to be seen, only to be literally told that it would be a “waste of resources” to help me. Because I was only very SICK, not obviously dying.
    But back to the subject of death panels, it’s a fact that these universal health care systems are based on “efficiency” in order to make it possible for the society to support care for everyone. Efficiency, though, means balancing cost and benefit of care, which means that there are, in fact, certain people whose job it is to assess whether or not your care is worth the government’s cost. So if you’re 78 years old and need a kidney transplant or whatever, there is a chance that that procedure, which you need to survive, will be denied on the basis of cost. Call it a death panel if you want, but this DOES actually happen.
    There was an uproar a while ago when it was discovered that certain women with breast cancer were being denied life-saving drugs on the basis of cost.

    Um, so let me get this right. You’re denouncing all of Europe’s socialised healthcare systems (all differently run, btw) based on the pronouncement of your 1 British boyfriend, who does not truly appreciate what he has in the NHS, and the fact you were ill and walked into A&E, which is where ACCIDENT AND EMERGENCY patients go? You were then surprised to be turned away because you had *not had* an accident and nor were you an emergency case. So maybe you should have called the local GP, if it was after surgery closing, you should have called the out of hours service from your local surgery, or NHS Direct, like the rest of us. If it was considered serious, you would have got either a doctor-on-call visit, or if it was very drastic, an ambulance. Of course I *don’t* know what was wrong with you, but you do make it sound rather like you had a self-limiting illness for which there was not much better remedy than bed rest and fluids. You appear to have survived. Did you stop to look around at how busy the hospital in question was dealing with actual accidents and emergencies?
    Plus I do think it’s worth noting that the proposed reforms in the US are not proposing an ‘American NHS’, so I’m not sure why you think it’s relevant to point to your misinformed view of the NHS in the UK, which you then apply to European medical provisions in general.
    It might be illustrative to point out here that in the UK we do have the choice of adding private insurance onto our NHS care if we like. I have a friend who chose to ‘go private’ for a jaw operation, because he was nervous about it and thought maybe he would get better care. The consultant he saw through private practice recommended he have the operation done on the NHS – that consultant worked for both the private scheme and the NHS and freely admitted to my friend that his NHS team was better skilled and equipped, despite the fact he would have got more money if he’d let him carry on believing private was better. But all the same, my point is that noone was saying that the NHS was your only choice. They would have responded if you’d had a proper emergency, and if you had gone to see the GP in the proper manner rather than clogging up A&E you might have been a little happier. I also think a private hospital, had you rocked up to one, would have told you to go home and rest btw.

    The issues you raise regarding age and denial of treatment do NOT stand up in the way you think. You could ask my 2x 100 year old greatgrandparents if they think their care by the NHS since it began in 1945 has been shit if you like. They will tell you that although occasionally they have been a bit grumpy about the odd long wait to see a GP (likely because someone was breaking down in tears over a health problem in their appointment and being taken seriously) and although there are other occasional small grumbles, they are extremely happy with it. They have been not only kept alive but given a variety of quality-of-life improving procedures on it after all. My greatgrandad’s hips got replaced in his 70s. He’s lived so long, he got a NEW replacement in his late 90s because noone expected him to live long enough to wear the first ones out! In the meantime he has had pneumonia 3 times, once with simultaneous pleurisy and a back infection. The NHS managed to bring him back to health each of those times. My Nana, on one side has been successfully treated for kidney cancer ‘despite her age’, and my other Grannie has been successfully treated for skin cancer in her old age too. My Grannie has also been provided with free mobility aids so that she can stay in her own home for longer, and can’t say enough good things about the care she has received. I too, have seen 3 consultants after very little wait in the past year, for separate problems. I was nervous and worried, but was looked after so incredibly well each time I had something done. Check your ‘facts’ and stop basing them on hearsay, please. You aren’t doing the debate any favours by repeating the fibs and lies being told in the media, and unfortunately now by some of our own politicians (minority, thankfully) and yours.

    Of course I’m not saying that the NHS/socialised healthcare never has problems or scandals – by the way these occur in privatised systems too. With respect to ‘rationing’ of health care by age,the way you write about it perpetuates the scaremongering and misinformation. It is true that some women were initially denied access to particular drugs for breast cancer in particular parts of the UK, on the NHS. What you DON’T mention is that this was overturned, and what you also don’t mention is that it isn’t the case that these women were denied treatment altogether. You also don’t mention that the NHS not being able to provide this drug at that time was not the same as the women being banned from buying it privately, and you also don’t mention that a private insurance company would NOT have covered it either. I also cannot see how you would begin to argue that a panel from an insurance company, looking to make a monetary RETURN from its business would be any better than an (eg NHS) ethics panel?? There are hard decisions to be made in medicine all the time. I would rather they were made for me under a system where the ethos was of care ‘from cradle to grave’ and that provided this for me free at the point of access *whatever* my financial situation. I find it so incredibly sad that the plans for long-overdue reforms to American healthcare provision is being met with misinformation and untruths which include lying about UK/European healthcare to try to prop up a series of ‘arguments’ against reform that is demonstrably needed in America. The overwhelming majority of UK residents are 110% grateful for our socialised healthcare, even though the system has its issues which need fixing. So I feel pretty lucky to live in the UK, and incredibly proud of our NHS – to me it’s like a member of the family, in the sense that we might often find fault with aspects of it, but we love it for what it is (=bloody marvellous) anyway. I wish the campaign for reform every success in America, because I wish that universal healthcare was available everywhere, because access to it ought to be considered a fundamental right of everyone.

    The point is that there is a huge and fundamental difference between the principles behind systems which are predicated on companies making actual profit from people’s health issues and systems which are predicated on being there to care for people who need it, irrespective of the depth of their pockets. Since when did ‘relative wealth’ serve as the best indicator of who is worthy of medical aid, in whatever form?

  122. zenoodle said: “The point is that there is a huge and fundamental difference between the principles behind systems which are predicated on companies making actual profit from people’s health issues and systems which are predicated on being there to care for people who need it, irrespective of the depth of their pockets.”

    THIS. Motherfucking THIS.

    Because THIS seems to be what the crux of the problem is. We Americans as individual families and people, are horrified that with universal health care, someone sitting in a room, on a panel, with a YES or NO stamp can decide whether a loved one receives treatment or not. YET THAT IS WHAT HAPPENS EVERY SINGLE DAY IN AMERICA! The ONLY difference is that the insurance companies here make a profit from those NO decisions…..a BIG ONE.

    AND…as zenoodle pointed out…it isn’t even TRUE that this happens in England’s own system!

    The REAL problem with the notion of “death panels” is that a corporation that makes a profit in the U.S. might actually MAKE LESS MONEY! Wouldn’t THAT be a tragedy of epic proportions!!! Nevermind the fact that the service insurance companies provide actually goes for the care of LIVING, BREATHING, FLESH AND BLOOD HUMAN BEINGS!

  123. I grew up in Ireland, which isn’t quite as complicated as the US in terms of getting access to healthcare, but I still ADORE the NHS and will not move my children away from it. The US system is terrifying. My mother knew people who killed themselves over medical bills. Jeez. People should be entitled to healthcare – preventive if possible, but even responding-to-ailments care is better than nothing. Food, water, medicine, clothes – you know, the stuff even people in disaster zones get as aid, because that’s how essential they are.

  124. Kate, what a great post. It should be mandatory reading for every single person in this country, it is that well stated and thought out. I particularly like the last paragraph. We ARE GOING TO DIE. That’s reality, and we should stop pretending that we are immortals. Even Lazarus eventually died.

  125. I do think it is legitimate to point out that ALL health care systems are flawed. I think that some people get the root cause wrong, tho. It’s not because we’re trying to give a basic level of care to all people that old and ill people sometimes get screwed. It’s because of our ideas about age and incapacity and the inherent worth of a life with either.

    See Lauredhel, for example.

    These criticisms need to be made. BUT: they are not criticisms of universal health care (or attempts at it). People who put it down to that are quite mistaken. These are criticisms of an ableist society. And that’s going to be a problem no matter how we structure and finance health care.

  126. Peepers, said, “I have been trying really hard to avoid letting my liberal politics make me stereotype people with conservative politics as cruel, selfish, empathy-challenged Darth-Vader types…”

    Sigh… I have too. and I am not pointing fingers at anyone here when I say that it’s become very hard for me not to do so, as family members and people I had considered friends express what are, ultimately, cruel and selfish points of view on this issue. I’ve heard too many people whose opinions I had previously respected, even when I didn’t agree with them, pretty much say of people who don’t have health care, “well, It sucks to be them doesn’t it?” No empathy. No understanding of their own privilege. No willingness to share the benefits of some of that privilege with others who don’t have it. And no awareness of the damage done to all of our lives when others are allowed to suffer, at great personal and ultimately financial cost.

    We all pay for the suffering of others, one way or another. We pay the costs of unpaid emergency room bills, we pay the fallout of personal bankruptcies, we pay to take care of children who are left behind by parents who didn’t need to die or become incapacitated. Can’t we instead pay to prevent that suffering? Because really, one way or another, we will all pay.

  127. @DRST, we got our wills witnessed by employees at our bank. My experience was that they were happy to do it. They don’t need to know what’s in the document, just see you sign it and sign that they saw it.

    SM, I am so very sorry for your mother’s situation. I watched my own mother go through the extended death of both her parents, and it’s so very hard. Best wishes to you.

    Anon, I cannot tell you how much my admire your resolve to care properly for a relative you cannot stand. Good luck to you, too.

  128. zenoodle, you are rocking my world.

    livvy8, your perspective is misinformed and ridiculous. I’m sorry you got turned away from an ACCIDENT AND EMERGENCY clinic for having neither an accident nor an emergency and are grumpy about it, but you sound like an idiot. One semester in London doesn’t qualify you to make an informed comment on any aspect of the NHS, and I suspect if your boyfriend understood the alternatives to the NHS (as seen in, for example, America) he wouldn’t be so glib about it either.

    I’ve lived under the NHS my entire life and yes, it has its problems, but is a genuinely phenomenal resource. I want to move away from the UK, but I don’t know if I can move away from it. The idea that I can’t just ring up the GP when I have a health concern, get seen that week and prescribed medication (£4) or sent to hospital (free) or sent for tests (free) to establish what’s wrong — I don’t understand that. What is more fundamental than healthcare?

    How the fucking fuck America can have healthcare on a for-profit basis is so utterly crazy I can’t get into it. UTTERLY INSANE.

  129. I’m going to go back and read the comments, but while it’s fresh in my mind, I wanted to say, first of all, my sympathies on your mother’s illness. That must be very difficult for your family, and I’m sorry to hear about it.

    And second, frankly, if these “death panels,” (I am almost sure that term was made up by opponents of the plan, btw.) result in more cases like the one we dealt with during my great grandmother’s Alzheimer’s course, I am all for it.

    When I was about 15, my great grandmother gathered all of the family around her at her house. She basically threw a party. She told us she had just been diagnosed with Alzheimers, in the early stages, and that her lawyer had her will. She had chosen a long term care facility and set up a trust to pay for it. She planned to sell her house to fund the trust if no one had any objections. When she went into her facility, we helped her move, and she gave us each items from her house that she knew we had admired. (I was supposed to get her car, but that’s another story.) I wish everyone who was diagnosed with a degenerative disease had the same opportunity to decide their own care. So, I say “Hell, yes!” to the “death panels.”

  130. This was well done. I’m a Canadian, but all of my father’s side is American, so take what I’m saying with that in mind. Looking through the observation window that is the televison we get from the US, America seems very backwards write now. What the right are saying about “death panels” are an outright lie, with zero shred of truth whatsoever. And the fact that these lies are still being heard in the media who can’t seem to shut this absurdity down is shameful. And yet, there have been video recorded of people with un-concealed guns at these town halls where the President is speaking, and the story is being swept under the rug relatively speaking. Could you imagine what the news coverage would have been if there were men seen with guns at a speech by Lyndon Johnson in 1964? That would be THE story, and Americans would have been beside themselves. That isn’t the case. Americans are afraid of basic health care, but not afraid of the people who seem intent on assassinating the president they democratically elected.

    The barns are burning in Rome.

  131. Of course I’m not saying that the NHS/socialised healthcare never has problems or scandals – by the way these occur in privatised systems too

    People in my Canadian home town often have to wait quite some time in order to see specialists in non-emergency situations. It can be really annoying, especially if you finally get to see one specialist and it turns out you really needed another.

    Of course, the population density is .11 people per square mile. Yes. Point one, one. There’s only 1 bookstore. My folks drive 40 clicks to the grocery store. Sometimes the highways get all fucked up and the stores run out of milk. Health specialists fly in and see as many people as they can on a visit.

    But, when my dad had a heart attack, he was immediately flown to the nearest cardiac center, and it didn’t cost us a penny. Nor do his flights to the same cardiac center for his check-ups. I had never met anyone who lost their house because of medical bills until I moved to the U.S. I didn’t know anyone who divorced to get government health benefits until I moved to the U.S.

  132. Thank you for writing something intelligent.

    My mother died a number of years ago. She had no health care and essentially committed suicide by failing to take her medications. She saw the decline of her estate and knew that she would fail in the end.

    I am heartsick by the healthcare debate because it is the subject of such complete sickening propaganda and misinformation. Had we a caring system of national coverage… my mother would be alive today.

    Just for the record, my mothers estate has never been of interest to me. I wish that she had understood that.

    Regards,
    Bud Houston

  133. Ok, first of all, while Congress/Obama are not currently advocating a bill that would instantly establish universal health care, it’s obvious (both Obama himself and Barney Frank have been quoted saying as much) that an exclusive government health care system is the ultimate goal. Whether you agree or disagree with such a system is your choice, but please don’t deny that this is what we’re talking about a few years down the road.

    Furthermore, I’m not “whining” because I’m too stupid to understand the correct hospital to go to…I was simply expressing my frustration with the general attitude towards treating patients in that specific hospital. Obviously I’m not entitled to smear the entire system, but in my case, everyone associated with the NHS with was rude, unhelpful, and dismissive. It was like the DMV, only I had to deal with said charm while feeling extremely sick.

    In any case, if you’re happy with the NHS and the service that you and your family members have received from it, then great. Your views should certainly be part of the debate; however, those who are wary of a government-run system also have a right to their input. Regardless of your political views, America has thus far not been a socialist country, and for that reason people naturally have passionate stances for and against implementing a socialized system for a huge part of our economy.

    Finally, in reference to health insurance companies, obviously there are major issues with access to care, coverage for major procedures, etc. However, countering concerns for a government-run system by proclaiming equal dysfunction in a private system really isn’t a persuasive argument. Reforming the private system and forming a whole new layer of government are two very different matters, and many people are simply concerned about what this change will mean in their own lives.

    And calling people idiots, criticizing political personalities with whom you disagree, and making wild assumptions about other people’s experiences is not productive in furthering this debate.

  134. it’s obvious (both Obama himself and Barney Frank have been quoted saying as much) that an exclusive government health care system is the ultimate goal.

    Can you provide links or citations, please?

  135. Regardless of your political views, America has thus far not been a socialist country

    Unless you’re a corporation that’s been deemed “too big to fail” or an industry with a powerful lobby group. Then socialism is fucking thriving in the U.S. and has for decades.

    Medicare is socialized medicine. Medicaid is socialized medicine. Sarah Palin is a liar.

    As for wild assumptions, every post you’ve made has been dripping with stupidity and privilege. Go ahead and defend the “right” of Americans to have their lives run by insurance companies if that’s your bag, but don’t expect to be taken seriously.

  136. These are Youtube videos of Frank and Obama advocating a single-payer system. The second one is strong indication that Obama envisions this system eventually being the norm; there are other videos of him saying it outright, but their editing was very anti-Obama and kind of obnoxious, so I didn’t include them.

  137. livvy8…this part of your comment caught my eye: “So if you’re 78 years old and need a kidney transplant or whatever, there is a chance that that procedure, which you need to survive, will be denied on the basis of cost. Call it a death panel if you want, but this DOES actually happen.”

    The reality, in this country, is that if you are 78 years old you are not going to get a kidney transplant, anyway. Indeed, if you are over 40 BMI and 35 you couldn’t get a kidney transplant either. There is rationing that already happens in our system that people do not recognize because they are not seeing it every day. And the way that rationing happens is completely mis-distributing the wealth.

    If primary care and even simple tests were widely available to everyone in this country we would not be paying quite so much for so many things. For example, if people who do not now have health insurance were to get free MD visits to be checked for high blood pressure or diabetes, we might be able to provide better education and early intervention which means that those folks wouldn’t be showing up in the ER in their mid-lives with kidney failure and needing dialysis (a very expensive treatment which we as a people pay for, even for those who were never able to get preventative care because we wouldn’t pay for that) and a transplant.

    To those of us who work in medicine, who see the system from the inside, it is so clear. If we provide comprehensive coverage we will have to pay less down the line for catastrophic events.

    Sweet Machine – I admire your strength at writing this post during a time that must be emotionally exhausting. Blessings to you and your family.

  138. Thank you for writing this Kate Harding. I’m deeply sorry to hear about your mother’s condition.

    I became extremely frustrated by the comments made by Sarah Palin, as well as all the other Americans claiming that the new health care reforms as well as President Obama are nazi’s, facists and socialists. It gives me hope to see that there are people like you who see through the deceit created by the media and the misinformed.

  139. Sweet Machine, thank you for sharing your story. Your family is in my thoughts.

    Re: wait lists. Who in the hell thinks that Americans don’t have wait lists? I have that good old gold-plated insurance and when I needed to see a gastroenterologist a few months ago the earliest I could get in, after calling several doctors, was five weeks. I could have gotten in earlier if I’d had an emergency but since I didn’t I waited my five weeks. JUST LIKE THEY DO IN OTHER COUNTRIES.

    The difference is, though, not everyone can even get on a wait list.

    I have good insurance right now, through the auspices of my husband’s employer. If he lost his job, we would be f-u-c-k fucked. There is no way I can get private insurance and because he’s gained a bit of weight over the last few years I don’t know if he could get it either. (I was turned down before being diagnosed with PCOS because I was too fat then.) My mom got laid off a few months ago and I’m praying that she gets a new job before her COBRA runs out because she had breast cancer. Whoops, pre-existing condition.

    The truth of the matter is that health care is a fundamental human right. I think history will show the people who don’t believe that to be barbarians. I worry about how I as a fat person would be treated underneath a system like that but I still recognize that for the greater good everyone should have access to health care.

  140. Long time lurker, first time poster.

    First of all, Sweet Machine, thank you for sharing this with us. I’m so sorry that your family has to go through this and it’s so wonderful that you and your folks are doing your best by your mother even if there’s a lot of guesswork involved.

    Big hugs to all of the people in the comments, too, who are dealing with, or have dealt with similar situations among their friends and family.

    The truth of the matter is, something has to change WRT healthcare (in the US; this is speaking as an American). Unfortunately, to hear Sarah Palin lying about something is so not a shock to me, nor is it a surprise to hear that she’s essentially capitalizing on her child’s special needs to get some quick attention. It’s still vile as all get out, though, and it’s just another example of why the truth needs to be out there in public, why more posts like this need to be written by the people with the experience and knowledge to do so, and why change needs to come about. My girlfriend lives in the UK. She’s had health issues and still does and I am always completely mindblown – in the best way, for her sake – that care is so readily available to people who need it. Not only the basics, but people going above and beyond to find out what’s wrong with patients and doing their best to help them.

    We need this here. Healthcare is a fundamental. Food, clean water, shelter, and healthcare. How does this not all go hand in hand? The disconnect is v. disturbing to me.

    I’m 21 years old. I’m fat. I was injured 10 years ago and was never sufficiently treated and at this point I can’t walk without serious help and equally serious drugs. I can’t stand for a long time, either. I’m a student and on my parents’ health insurance, but I absolutely know that if I do not get the surgery I need before it runs out at 23, I will never. ever. qualify for conventional health insurance – both in terms of weight and PEC. My ex-girlfriend, struggling tentatively with FA and HAES, found out that she would have to pay upward of $200 extra for personal health insurance based on her weight alone, and as a result rejected the principles she was slowly becoming okay with so she could be considered “acceptable” by the insurance companies.

    THIS IS NOT OKAY. It’s not okay for me. It’s not okay for her. It’s not okay for ANYBODY struggling for WHATEVER reason to be denied a basic fucking human right based on what wealthy, privileged individuals working for insurance companies in their high fucking offices think about medical reports and what’s printed on the papers they see. They’ll never meet these people and hear their stories and understand why healthcare is so important – and that sucks, but the fact of the matter is, they shouldn’t HAVE TO. Healthcare is important REGARDLESS of who, and what, and why, and how long, and etc.

    Christ alive, people.

  141. livvy8, I think it’s pretty naive to think that Obama could ever move that far to the left in this country. A few years down the road? I seriously wish. No way is that or anything like it ever going to pass Congress. (Unfortunately.)

    Hey, has anyone here ever seen a doctor under a private health care system or spoken to a representative of an insurance company that treated them badly or was rude? I’m just asking. Seriously, this doesn’t have anything to do with the kind of healthcare a country has, so it’s pretty irrelevant. Maybe saying that private insurance and healthcare also has problems isn’t persuasive to you, but if they’re equivalent on that front, then it doesn’t matter.

    Who said people who disagree don’t have a right to provide input? You can say whatever you want. That said, the health care issue was a big part of that whole election thing we had last year, and the country voted overwhelmingly in favor of an administration whose platform was explicitly pro-universal healthcare. Not single payer, though you have noted that he personally likes the idea. You of course have a right to give your input, and when we elected our representative officials the opinions they were elected to represent disagreed with you. Strongly.

    America has socialist elements. So do lots of other places, some more than here. There already is socialized medicine here; it’s just not universally available or independent of employment status. Who doesn’t know that??

    And calling people idiots, criticizing political personalities with whom you disagree, and making wild assumptions about other people’s experiences is not productive in furthering this debate.

    Criticizing a politically important person for lying about political issues is not productive? Actually, i think it’s pretty damn important. And what wild assumptions are you talking about?

    Hey you guys, you better not express anger or use strong words, because it isn’t productive, ok? DLB, folks.

  142. Regardless of your political views, America has thus far not been a socialist country,

    Can I ask, did you attend a public school? Because unless you attended private schools all the way through whatever level you attained? YOU’RE THE PRODUCT OF AMERICAN SOCIALISM.

    Public schools are paid for by taxes on citizens and administered by the government. They are free for any child who wants to attend, up to college (and then colleges that are public institutions are considerably cheaper than private ones). That is the essence of socialism – government using tax money to provide services for all citizens.

    And yet, even though public schools have been around since at least the 1800s, private schools remain in existence and are doing pretty well. I teach at one, as a matter of fact.

    So this bullshit argument that because you can think of 2 guys who’ve said they are pro-universal health care (the Obama quote is old and I remind you yet again, he’s not actually writing the damned bill, Congress is) that it means we’re headed towards a total government takeover of health care and the demise of private insurance is pretty ludicrous.

    However, countering concerns for a government-run system by proclaiming equal dysfunction in a private system really isn’t a persuasive argument.

    Nobody is countering your criticism by claiming there is equal dysfunction in private systems. The problems in the private system are significantly WORSE than in public, government run systems like Medicare. Unless you think rejecting someone’s cancer treatment in order to make more money is on par with minor cases of fraud.

    Reforming the private system and forming a whole new layer of government are two very different matters

    We HAVE this “layer of government” already. It’s called Medicare, Medicaid and Social Security. Compared to the creation of SS and Medicare, this is a minor alteration.

    Lastly, you have yet to provide an answer of what to do about the 46 million people who can’t go to a doctor because they don’t have the money for it. What happens to them? Do they just die, because in your wingnutty view of the world, they aren’t “trying hard enough” to have jobs and health insurance through an employer? Have you ever actually experienced not having health insurance? Have you ever had to decide whether or not to go to a hospital based on money? I don’t see how on earth you can say “Yes, it’s perfectly moral and right that companies continue to profit off of denying sick people access and support for medical care, because it’s better than OMG SOCIALISM! that we already have!”

    DRST

  143. Hey, has anyone here ever seen a doctor under a private health care system or spoken to a representative of an insurance company that treated them badly or was rude?

    Fuck, yeah. I had a cardiologist who was very rude and subjected me to a lot of unnecessary tests, probably because his Porsche needed servicing. OMG ALL DOCTORS WHO IN FOR-PROFIT HEALTH CARE ARE EVIL!!

    Headtilt

    Logic!

    Hey, speaking of insanity, I just got a new job (Yay!) and my health insurance doesn’t kick in until October 1. The insurance that goes with my old job ends August 31. I have the option to go on COBRA for a month at a cost of $443, which I don’ t have.

    So here’s the question. Should I put $443 on my credit card in the fear that I’ll get sick in that 30-day period, or just hope I sail through September?

    The funny thing is, by American standards I’m incredibly lucky to be eligible for COBRA and to have a credit card to use for emergencies.

  144. Sweet Machine,

    As many have above, I too offer blessings to you and your family. I agree that we often need professional guidance through incredibly difficult end of life decisions, and that this does not constitute a death panel. However, while Sarah Palin’s rhetoric may be over the top, the concerns she has voiced seem pretty valid, and here’s why: government control. About 4 years ago, I lost my full-time position and had to purchase my own health insurance. I was denied coverage for a pre-existing respiratory condition, which, though not life threatening, did require regular medication that costs me hundreds of dollars a year, which I had to pay out of pocket. But nonetheless, I had the freedom to purchase this outside of my insurance plan, which I did. But once government gains that much control over public health, and has the power to eliminate competition or individual’s choice to pay for services on their own, people won’t have that option. I understand that when insurance companies deny extremely expensive treatments to needy patients, this doesn’t seem much different, but it is.

    Now personally, I would favor some sort of catastrophic insurance (sort of like government flood insurance) for individuals who are hit with huge hospital bills that their insurance won’t pay. And I’d favor some other reforms that would increase the ability of individuals to get insurance other than through their employer, which seems like a silly system. However, it seems like too many who want to improve healthcare for all, and I believe that they are sincere, believe that this must happen through a government controlled system, which will threaten individual freedom (Palin’s concern) and have the following other problems:

    1. There isn’t really that much public support for a complete overhaul of our healthcare system. I think only something like 7% of voters in the last election chose that as their primary issue. Americans want something done about healthcare quality and cost, but they aren’t clamoring for a government takeover of one-sixth of the U.S. economy.

    2. We can’t afford any of the current proposals in congress. As popular as Medicare is, it’s going broke faster than one of Bernie Madoff’s clients. And I don’t know if you caught the Montana townhall the other day, but the President acknowledged that Medicaid and Medicare reimburse hospitals about one-third less than private insurance. This means that these “great” programs are actually increasing premiums and costs for those who aren’t on them, in addition to being paid for predominantly by people who aren’t on them. And while the CBO cost projections for the current bills demonstrate that they will be way more expensive than proponents claim, they will undoubtedly prove to be even more expensive. Within a few years of being instituted, Medicare cost 10X its initial projections. We’re going broke now. And just so some of you above know, many of the town hall protesters are just as pissed that tax money went to bailout greedy bankers as they are that it was used for a bogus stimulus plan or for health care overhaul that will further bankrupt the country. By the way, Wall Street firms gave way more money to Obama and Democrats than McCain and Republicans during the last election cycle. But I’m an independent.

    3. The ways that have been proposed to pay for this won’t work and will hurt the economy in ways that will hurt working families, not just the rich. Cutting back on charitable deductions will hurt charities at a time when many people need them. Taxing those above 250k will hit a lot of small businesses who then won’t be able to hire those currently desperate to find jobs.

    4. Nationalized healthcare will necessarily lead to lower quality care and` rationing. We’ll have too few doctors and facilities to serve too many patients. And, as I stated above, rationing by the government is a lot more invasive than denial of coverage by insurance companies. If the public option succeeds in putting private insurers out of business, what incentive will the government have to improve healthcare. Ever been to the post office? Apparently, President Obama has.

    Let’s not make the perfect the enemy of the good. Certainly there are some positive reforms that have a good chance of making health care in the U.S. better for most people, especially the poor and uninsured. But a single payer system, which is the goal of most health care “proponents” today, is the wrong answer to our health care problems. We need the right mix of government safety nets and free market innovations. Let’s take some more time to get this right.

  145. Before moving back to Massachusetts (where I grew up in Barney Frank’s district thankyouverymuch), I lived in California for five years. After graduating college and being immediately kicked off my parents’ health insurance, I ended up taking a job that didn’t include insurance, so I was forced to apply on my own. Wanna know why I was deemed ineligible for the $99/month “young adult” BCBS plan? At 5’4″ I weighed 155 lbs (TEN freakin’ pounds above the top of the BMI range), had a “history” of asthma (by which they meant I was given an inhalor at age 12 that I never used until I moved into the lovely southern CA smog), and had borderline cholesterol (like, 208 with low triglycerides, high good cholesterol, and an excellent ratio). Instead, I was approved for a $335/month plan. Which I couldn’t afford. Just to have healthcare, I had no savings, no money to pay for anything fun, barely made rent, and barely had enough money for food.

    Just so I could keep seeing a doctor once or twice a year. And of course they didn’t cover the one surgery I needed because it was periodontal, not dental, despite the fact that I’d gone in for tooth pain. Oops!

    You know what? It’s not perfect, but I was THRILLED to move back to MA, where I can get insurance for less than half the cost. I’m now on a plan through my grad school that’s even better.

    And it’s naive to think that the United States would actually shift to a completely government run healthcare system within Obama’s presidency. He’s not the imperial ruler of this country. But I do think his plan is a step in the right direction for us.

  146. Sniper, as much as it’s going to suck financially, take the COBRA. Not because you’re likely to get sick, but because if you go that month without continuous coverage, your new insurance will have grounds (or at least precedent) to deny coverage for a whole buttload of stuff for up to a year. Ultimately, it may be cheaper to take the hit on the credit card, as much as I disagree with debt as a concept. Sorry you even have to deal with it. It’s a bunch of bullshit.

  147. One of the ironies of Sarah Palin’s “death panel” comments relates to her husband’s heritage. In the days of old, long before The Dud became a glimmer in his gramma’s eyes, the Inuit practiced their own form of “death panel.”

    Yes, The Dud is of Inuit heritage. Well, barely, but there’s a drop of native blood in his stone cold veins somewhere.

    Here’s how it worked: families tended to live together in igloos during the very cold weather. If you’ve ever been to Alaska in the dead of winter (pun intended), you’ll know how cold it gets. But when the hunting had been poor and the winter real long, decisions had to be made. As oral history has it, the feeble old folks often offered themselves for the benefit of their younger family members. Right. The older people would gather themselves, say their good byes, and walk out into the cold. Never to be seen again. All to reduce the number of mouths needing fed.

    Perhaps Sarah Palin could finalize her good-byes, shut the hell up, and walk out into the cold cruel world, never to be seen (or heard from) again.

    But my dream is just that… oh well.

  148. Damnation! I posted my previous comment under a different email than I usually use – I wondered why my monster was different. Ah well. Hopefully I’ll make it through moderation soon.

  149. Ok, nm – I’m going to repost with my normal email – ignore the one waiting in moderation, ladies:

    Before moving back to Massachusetts (where I grew up in Barney Frank’s district thankyouverymuch), I lived in California for five years. After graduating college and being immediately kicked off my parents’ health insurance, I ended up taking a job that didn’t include insurance, so I was forced to apply on my own. Wanna know why I was deemed ineligible for the $99/month “young adult” BCBS plan? At 5′4″ I weighed 155 lbs (TEN freakin’ pounds above the top of the BMI range), had a “history” of asthma (by which they meant I was given an inhalor at age 12 that I never used until I moved into the lovely southern CA smog), and had borderline cholesterol (like, 208 with low triglycerides, high good cholesterol, and an excellent ratio). Instead, I was approved for a $335/month plan. Which I couldn’t afford. Just to have healthcare, I had no savings, no money to pay for anything fun, barely made rent, and barely had enough money for food.

    Just so I could keep seeing a doctor once or twice a year. And of course they didn’t cover the one surgery I needed because it was periodontal, not dental, despite the fact that I’d gone in for tooth pain. Oops!

    You know what? It’s not perfect, but I was THRILLED to move back to MA, where I can get insurance for less than half the cost. I’m now on a plan through my grad school that’s even better.

    And it’s naive to think that the United States would actually shift to a completely government run healthcare system within Obama’s presidency. He’s not the imperial ruler of this country. But I do think his plan is a step in the right direction for us.

  150. I am ready to call someone an idiot who thinks one experience with a bad doctor means the financing system is the culprit.

    Whereas I’ve had so many bad experiences with doctors I can’t count, but that’s not because they’re funded privately. It’s because they were assholes, uninformed, educated in a culture of supremacy and ableism.

    Do me a favor. Deal with the health system at least once a week (preferably three times a week minimum, as I do now), without fail, for at least five years. Then come talk to me. Maybe then you’ll have graduated out of the idioth grade.

  151. Sniper

    Logic!

    Hey, speaking of insanity, I just got a new job (Yay!) and my health insurance doesn’t kick in until October 1. The insurance that goes with my old job ends August 31. I have the option to go on COBRA for a month at a cost of $443, which I don’ t have.

    So here’s the question. Should I put $443 on my credit card in the fear that I’ll get sick in that 30-day period, or just hope I sail through September?

    If you have anything that could possibly be considered a preexisting condition (this includes something as simple as light childhood asthma that you’ve grown out of now, it really is that arbitrary), and you let insurance lapse for more than X number of days (varies by state IIRC, but it’s been 60 days wherever I’ve been) you may have to wait through an exclusion period (one year) or be rejected altogether.

    I’d recommend checking laws in your state, looking closely at your upcoming policy, and considering your own health history and current needs. It might suck, but you might get screwed if you don’t shell out for the interim coverage, even if it doesn’t do anything for you…

  152. This debate has gotten out of hand. Our system is crippled. There is a solution on the table that doesn’t meet everyone’s needs, but it is the best solution at the moment. If we don’t take action now, things will continue to get worse and worse. It is particularly encouraging that the American people are questioning what is about to happen at these town hall meetings. Unfortunately, the few in the media and Congress spreading irrational fears are undermining these meetings and preventing progress. It is an American right to stand up and ask and protest. It is also an American right to have the government and media tell you the truth. We should demand that as well.

  153. I’ve been where you are – my dad died from Parkinson’s related complications 9 years ago. And you know what? He’d have died six months sooner if not for his advance directives, because some idiot doctor decided (when he came in for a bout of pneumonia) that he could dismiss my mother’s stated insistence that Dad didn’t want to be intubated and had an advance directive to that effect. When they showed up at his bedside with the tubes, Dad had a screaming hissy fit and had to haul my mother and their lawyer out of bed to shove the physical copy of the advance directive in the doc’s face and explain to him just how huge a lawsuit he would face if he tried to violate it again. Dad had been at death’s door until that doctor came into his room; his outrage gave him sufficient impetus to get better and walk out of that hospital so he could die, six months later, at home, in Mom’s arms (literally–she was helping him to his chair when his heart gave out). So thank you very much for your post and best wishes for a warm and loving passage to the next life for your mother.

  154. If you have anything that could possibly be considered a preexisting condition…

    Crap. I suppose PCOS would definitely count – not to mention all the shit that’s associated with PCOS, i.e., depression, hypoglycemia, depression, high blood pressure.

    Sigh.

  155. I hope that you and your family live with a sense of comfort, peace and harmony. Watching a loved one suffer is not an easy thing to do. I know. My daughter passed away with a diagnosis of breast cancer. Working daily to rid myself of guilt, anger and blame left me with a sense of love, humility and joy. The darkest hours sometime yield the brightest days. You seem to be a woman of great strength and integrity. Let them lift you to a place higher than you are right now. It can be done. I am living proof!

  156. When I was studying in London last semester and was sick as a dog, I walked about a mile to the nearest *free* hospital and waited forever to be seen, only to be literally told that it would be a “waste of resources” to help me. Because I was only very SICK, not obviously dying.

    You might get that in Canada too – because hospitals aren’t really supposed to be your first line of physician care if you’re the sort of person who can walk a mile, still.

    Hospitals, by the nature of the biological hazards they have to cope with and contain, are EXPENSIVE.

    So using them for primary care is seen here as a waste of resources too – not because a sick person shouldn’t see a doctor, but because if they can walk a mile they should probably not see an emergency care physician, who should be dealing with head trauma, severed limbs, and screaming Ebola.

  157. And last thing, livvy8, I’ll tell you this: NHS might have been bitchy to you, but I’ve got American relatives with pre-existing conditions who would fucking love someone to be bitchy to them. As long as they were getting the treatment they needed.

    I’m in a “socialist” system and I’ve had bitchy docs and awesome docs, almost like docs were people, and it’s never been at all like the DMV although the claim forms of my extended, private medical are. medicine, like school teaching, is its own profession, even if the government is paying. I’ve never been treated by a bureaucrat!

    Surely you can understand there might be other parts of your experience in play. Fat prejudice, for one. Or perhaps you sound American.

  158. Sniper, ask your HR person about whether you can retroactively take the COBRA. I had almost exactly your scenario – a month between jobs, and mine explained to me that I had sixty days after the last day of coverage to take COBRA – so that I would be better off waiting to see if I had a problem during the month, and then retroactively electing it if necessary.

    Also, ask your new HR person about when your new health insurance kicks in – it may not be on the first day of work.

  159. Hey sweet machine,

    I’m so sorry to hear about your mother’s situation and all the hard choices that are involved in deciding her care. As a hospice chaplain, I see situations like what you’re coping with on a daily basis. The one thing we hear most from the families of our patients is this: “We wish we had hospice sooner.”

    While I don’t think the government should stick its hands in health care decisions that people make, I do see the need for doctors to be more proactive with their patients. Many doctors are so curative in their mindset that they don’t want to “give up hope” on their patients, which ends up doing more harm than good when the patient is terminal because the patient and family would benefit so much more from hospice care over the span of several months than only a few weeks or days (and those months are spent making those final arrangements and decisions that you wrote about without having to rush them).

    The hospice I work for does a wonderful job of educating families, doctors, facilities, etc., on the benefits of hospice care. The result: families have an easier time making those tough decisions, and patients live out their final days with much more dignity, comfort, and peace.

    Thanks for honestly sharing your story.

  160. Thanks for your advice! I’ll definitely be making those calls. If I’m reading the law correctly 63 days without coverage is considered a significant lack of coverage (which is nuts), and I do have until October 31 to decide. I think. I can’t find anything about retroactivity, so I’ll have to ask.

  161. What with all the BS flying around about health reform, it’s hard to tell what is insurance company shill noise and what is simple stupidity. I do know I would rather have a bureaucrat with a boss I can fire by voting him out than a bureaucrat with a corporation over whom I have no control calling the shots in my healthcare.

  162. More on death panels with regard to my own family: before my mother was on hospice care (which is paid by insurance), she was just on regular “someone decides if this is okay” care (paid by the same insurance). One of the main symptoms of Parkinson’s is difficulty walking, because it’s a disease that severely affects coordination of movement. First she used a cane, then a walker, then a wheelchair. Her insurance company refused to pay for her wheelchair. Let me repeat that: my mom has a disease that will inevitably make walking impossible, and her insurance company refused to pay for her wheelchair. They also refused to pay for physical therapy that would have helped her keep using the walker for longer… because it wasn’t going to “cure” her, you know, incurable disease. They consigned her to that wheelchair early by not paying for PT, and then they refused to pay for the chair once she needed it. Once she was on hospice care, though — i.e., once she was officially Not Their Problem for much longer — all kinds of things are paid for.

    Livvy8, I’m sorry you had one sucky experience with NHS. I’ve had hundreds of sucky experiences with private insurance. I think I win this one.

    And lord, if Obama wanted to institute universal single-payer coverage? I can only say: IF ONLY.

  163. I am now a fan of yours. Your comment “You might have also heard that Sarah Palin is a lying sack of shit.” did it for me. Thanks for alerting people – although I think for readers of your site, you are probably preaching to the choir.

  164. Can’t even imagine what you are going through but thank you for sharing a REAL experience. What saddens me about this whole debate is not only the lack of debate but the media coverage on it. This is the same media that followed Britney Spears for an entire summer and reported Paris Hilton as breaking news. No wonder we can’t figure out what the truth is.

  165. I don’t think most of the rage you are seeing is truly over health care. Health care is just a frame to hold the “rage picture” if you will. The issue is something much deeper and it crosses party lines. Many of the loudest screamers at these halls were Democrats. There is something very serious going. You are going to see even more screaming in the future. (and I fear you will see much worse)

  166. Sort-of-long-time-reader delurking to say that I am so sorry about your mother. You and your family are in my thoughts.

  167. At this point I’m going to chime in with a general notice to first-time readers and commenters, including those who might be wondering why their comments didn’t make it out of moderation.

    Read the comments policy.

    Also, men: don’t do this.

    Thank you.

  168. (A Sarah, your second link goes to the second page of that (totally wonderful!) article, which makes it confusing.)

  169. Aw, are we linking to Men Who Explain Things? That article changed my life. Now anytime any man tries it I just start laughing.

    I was simply expressing my frustration with the general attitude towards treating patients in that specific hospital. Obviously I’m not entitled to smear the entire system, but in my case, everyone associated with the NHS with was rude, unhelpful, and dismissive. It was like the DMV, only I had to deal with said charm while feeling extremely sick.

    livvy8, it was like the DMV if you’d showed up there and expected the counter staff to wash your car for you. Completely not the point of the facility, and absolutely a waste of resources. No wonder they were “rude, unhelpful and dismissive”; they had ACCIDENTS and EMERGENCIES to deal with. You have no idea about “the general attitude toward treating patients” in that hospital because you weren’t one. I would think turning away someone who could walk a mile is a point in their favour — they’re correctly prioritising care for those who need it.

    Anyway, I can’t believe you can’t see the distinction. You’re just ignoring it because you enjoy having an imaginary reason to hold a grudge against a healthcare system that isn’t run to make billionaires richer. That’s an interesting personality quirk, but it still doesn’t qualify you to comment on the NHS versus ANYTHING.

  170. Serial posting because I am pretty fucking sick of people implying all sorts of shit about universal health care (which isn’t EVEN on the table for America right now) which could not be less true, so they can get on with letting their fellow citizens suffer and die around them and comfort themselves that theirs is the logical position.

    But once government gains that much control over public health, and has the power to eliminate competition or individual’s choice to pay for services on their own, people won’t have that option.

    Absolute fucking bollocks, Revoltaire. Name me one Western country with universal health care where people are prohibited from buying their own private health insurance. You can’t because THERE ARE NONE.

    Man, I would have so much more respect for the Let The Poor Die squad if any of them could STOP LYING FOR FIVE MINUTES.

    I understand that when insurance companies deny extremely expensive treatments to needy patients, this doesn’t seem much different, but it is.

    Conveniently unexplained because it a) makes no sense and b) isn’t true.

    However, it seems like too many who want to improve healthcare for all, and I believe that they are sincere, believe that this must happen through a government controlled system, which will threaten individual freedom (Palin’s concern)

    Individual freedom! Individual freedom! Aye, the individual freedom to go broke, receive shitty minimum care, get fired from your job for being an insurance liability, or any number of other horrific possibilities. Jesus.

  171. Individual freedom! Individual freedom! Aye, the individual freedom to go broke, receive shitty minimum care, get fired from your job for being an insurance liability, or any number of other horrific possibilities. Jesus.

    I swear, I think that some people in this debate who trumpet individual freedom to the point of absurdity would rather that everyone – including themselves – have it worse off overall, just as long as they personally never have to do *anything* for the common good. “I’m not free unless absolutely nothing is required of me personally ever, so screw you.” Which is ridiculous because the world that creates actually *does* demand a lot of them and everyone else. Like… oh, massively-expensive and inefficient and inequitable health care. For one. Seriously, when did the language of the common good start to be a spectre for OMGTYRANNY!!!!!!

    Okay, I can’t organize my thoughts because my older son won’t give me a half second alone with my thoughts… Ugh… Anyway.

  172. I don’t live in the U.S., but I find it simply ABSURD that this controversy has lasted for so long. It’s just plain nonsense. Arguing that having the opportunity to enjoy free health care from the government is a threat to individual liberties is, at least, being blind to the way the world works. A deliberate blindness? Here in Costa Rica (an underdeveloped country, where we also have problems with taxes, something that shouldn’t bother such a large and wealthy nation like the U.S.) we have universal health care, which means that EVERYONE gets attention when it’s needed, really, EVERYONE. And still, if one wants to get private medicine, it’s still an option, and maaany people do it. Private medicine here is actually a thriving business! So I don’t see the problem. Again, I feel it’s simply blindness.

  173. Anti-socialism does NOT mean anti-woman, anti-freedom, or lack of empathy. In fact, most of us right -of-centers are fighting against our freedoms being taken away. We don’t want to live in a nanny state that provides for our basic needs, but denies us the freedom to achieve, excel, and live the way we want. There is only a small faction of conservatives who are judgemental and would deny people the right to live the way they want. Most of us are more concerned with liberty than any liberal out there.

  174. What the opponents of single payer seem to be saying is that democracy doesn’t work; only by putting our lives in the hands of big business can we truly be free. And yes, it is really, really stupid.

  175. “You’re just ignoring it because you enjoy having an imaginary reason to hold a grudge against a healthcare system that isn’t run to make billionaires richer. That’s an interesting personality quirk, but it still doesn’t qualify you to comment on the NHS versus ANYTHING.”

    Omigosh, you’ve found me out! It’s my quirkiness that’s at fault here, not a legitimate ideological difference. I’m unimpressed by the general hostility expressed on this thread towards those who do not advocate a single-payer system. The NHS is not sacred, and you can disagree with me if you want, but my opinion about the system is valid. I won’t be contributing to this thread anymore; personal attacks have no place in a public policy debate. I do hope that the few of you who have been particularly rude on this forum are more polite in person.

  176. I should probably be more outraged than I am over the healthcare debates. However, my mind is constantly being blown by the comments from Canada and the UK.

    There are places where you can see a GP for free? Not “free” as in “the insurance covers most of it but you still have a $20 copay”, free free? Any drug that your doctor prescribes, new or old, will be covered? You won’t go into debt if you end up in the hospital? Where nobody cares if you’re epileptic, you get the same amount and quality of health care as everyone else? You can have expensive surgery without fear of bankruptcy?

    Damn. It sounds way too good to be true. All my life, everyone around me has seen health care as an expensive luxury that my family is lucky to have access to. If you’re working and you can’t afford it, you pray to whatever deity you worship that you don’t get sick, break out the home remedies if you do get sick, only go to a medical professional if it’s truly serious, and prepare for massive credit card debt if you’re unlucky enough to end up in the hospital.

    Me and my Raynaud’s syndrome don’t do well in the cold. I can’t even hold a cold drink for more than a minute without crippling pain in my hands. But if I can get ironclad, guaranteed, lifelong care for my epilepsy north of the border? I’ll buy heated gloves and socks and emigrate as soon as I’m out of college. It’ll suck to be that far from my family, but it’ll suck ten times more to be impoverished, housebound, and having constant daily seizures because I can’t afford my medicine. (Yes, the ‘constant daily seizures’ part really does happen to me without my drugs.)

  177. So here’s the question. Should I put $443 on my credit card in the fear that I’ll get sick in that 30-day period, or just hope I sail through September?

    I think you have 60 days to decide whether to take COBRA or not. If this is still the case, then if you have to file a claim in Sept, then you get the COBRA after. If you go through Sept unscathed (one hopes) then you don’t pay for it. And yes, definitely make sure of the start date of the new ins.

  178. We don’t want to live in a nanny state that provides for our basic needs, but denies us the freedom to achieve, excel, and live the way we want.

    Oh good night nurse. These are not necessary contraries. I mean, really, this is like saying “I don’t want to wear a tiara that flatters my facial shape but is made of lye crystals and burns the flesh off my scalp. Wulp, I guess no tiaras for me!” Whatthehuh?

    In point of fact, if your “freedom to achieve, excel, and live the way [you] want” is being curtailed by insurance companies who don’t care if poor people die so long as they turn the most profit they possibly can then it turns out that the government’s “providing for [your] basic needs” is a means to that all-important freedom. Which, gosh, sure looks the situation we have for a LOT of people.

  179. Damn. It sounds way too good to be true.

    It is, at least in my experience. In Canada, certain health standards are set by the feds, but the provinces and territories administer the program. In my territory, coverage includes hospital care, doctor visits, long-term care, flights out for emergencies, etc. It does not cover routine dental, vision, or prescriptions, although you can get really cheap supplemental coverage (sensible if you have a family of kids who all need braces) or it might be covered as a job benefit. Of course, we all got free dental checkups at school, and if you have a chronic disease your drugs are covered. Purely cosmetic procedures aren’t covered, and some places have asshat restrictions on things like gender reassignment surgery.

    So, not perfect, but if you get sick or hurt, paying for care is not something you have to worry about.

  180. I’ll tell you something about about freedom. In Canada, a person can risk starting a small business knowing that even if it tanks, she won’t end up being denied crucial health care because of interruptions in coverage. People can go back to school without worrying about a health care crisis-induced bankruptcy. Really small businesses thrive in Canada. Doctors can get by with an office staff of one or two people.

  181. First of all, and I should have said this the first time I posted here: SM, I am so sorry that your mum, you and your family are going through this, and that on top of this that the system you’re in has added to the horribleness of helping your mum to deal with her illness, and dealing with it yourselves too. Until this debate really broke out into the media, I had no idea how bad things could really be even *with* insurance in the US. It’s fucking WRONG and I can’t even think of anything better than ‘I’m really sorry’ to say about it.

    Livvy, I was going to respond to your follow up posts tonight, but I just saw that others have, and have pretty much nailed what I would have said…

    I didn’t actually call you an idiot. The thing is that you seem to have done yourself no favours in the way you put across the points you were trying to make. You seem to have swung round from initially trying to use your one experience of the NHS (staff of which were, as Caitlin and others have pointed out, doing their job in sending you home) and some thoughtless comments from your boyfriend as the basis for what was at the very least a very strong hint that you were smearing not ONLY the NHS, but what you describe as ‘the’ European socialised healthcare system:

    As much as liberal commentators love to dismiss the idea of “death panels” by making fun of the concept, the questions are legitimate–in Europe, which has universal health care, anyone can tell you that the system SUCKS. Seriously.

    You then used your interaction with the NHS as an illustrative example of why you believe (and seem to think all Europeans believe) ‘the system SUCKS. Seriously.’ This alone shows you really don’t have handle on the subject of existing systems of socialised healthcare, because Europe is big and has lots of countries in it which are all different and have each got different healthcare systems. There is no ‘the system’. So if you’re scared of/worried about what is being proposed in the US at the moment, at least partially on the basis of your understanding of how socialised/universal healthcare has panned out in Europe, it’s obvious from your comments that it is you making the ‘wild assumptions’ on this score.

    The NHS is different to the systems in place in Germany, Holland, France, etc, etc. It has its problems. Those other systems have theirs. All big systems do, noone is saying they’re ‘sacred’, and noone thinks we should just lie down and leave them (also, they don’t tend to get left – reforms, as with anything, are usually a mixture of improvements and unforeseen setbacks = life). That there are problems doesn’t mean that highlighting some newsworthy (breast cancer drugs controversy) and less newsworthy (‘slightly ill person gets turned away from A&E in mild self-limiting illness shocker!’) examples from one system represent that system fully, but that is what you implied with your phrasing and tone, and that’s what I responded to. You have missed out all kinds of relevant detail, but undeterred by your lack of knowledge, have also gone on to make sweeping statements, which you later began to try to (I think) retract with ’ I was simply expressing my frustration with the general attitude towards treating patients in that specific hospital. Obviously I’m not entitled to smear the entire system, but in my case, everyone associated with the NHS with was rude, unhelpful, and dismissive.’

    I’m trying to remember that I don’t come from the US and so I don’t really understand what’s it’s like to live in a place where politicians/lobbyists commission so many completely bonkers adverts filled with ridiculous lies (our politicians do tell lies, don’t get me wrong, but those ads you have – the first one I saw I thought was a parody!) and to have the anti-reform message on healthcare blaring at me from all over. I routinely have to explain to bemused American students that I welcome and show around my uni that ‘yes, yes, really, they get to register and see doctors for free her… yes really they get free contraception here… yes really, no – seriously you really do not have to pay to see a doctor…’. They often look completely bemused. One girl last year actually thought I was trying to trick her. It slightly puts me in mind of conversations that have gone on here recently about the way we pick up not only blatant messages from our cultural contexts, but also the more subtle and insidious ones… I totally agree you should get a space to have your say and also to query aspects of this potential reform. But you do owe it to people, not least to yourself, to make sure you’re well informed before you go off spraying insults (based on a very small sample size of experiences) all over systems you don’t understand. At this point you really seem not to be well-informed, and yet are also coming across as being intent upon demanding to be taken seriously from a wobbly platform and are also pretty much throwing a bit of a strop when people find holes in your arguments. Believe it or not, someone showing you where your facts/logic/both are wonky is an attempt to help you out.

    Watching this debate unfold, it actually makes me feel pretty lucky that I am able to feel grateful for my healthcare and to appreciate it more actively (even though it’s not perfect). Most people in the UK, or at least those without stonking massive silver spoons in their mouths (possibly other orifices too), are profoundly grateful for and proud of their NHS. Actually, a lot of the silver spoon people are also 110% in support of the NHS… That’s the thing: it’s ‘our NHS’ and it actually does hurt when you bash it – it doesn’t belong to big profit-hungry companies, it belongs to us. Some people here in the UK mightn’t realise how grateful they truly are until something happens for them to really need it. For some people it has taken this NHS-bashing and finding out about the 47m uninsured Americans to really consciously realise the depth of their thankfulness for our system. I keep coming back to this quote from Nye Bevan:

    “no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

  182. In Canada, a person can risk starting a small business knowing that even if it tanks, she won’t end up being denied crucial health care because of interruptions in coverage.,

    But Sniper, people NEED that incentive — fear of death and devastating economic loss — to have the gumption to start BUSINESSES and to want to INVENT things!!!!!! It makes total SENSE! A Canadian might think, “Hm, I have this idea I’d like to turn into a business.” An American might think, “Hm, I have this idea I’d like to turn into a business BUT IF I FAIL I MIGHT DIE / MY LOVED ONE(S) MIGHT DIE / I COULD LOSE MY HOME!” Who’s going to take the risk? The American. Because… uh…. uh… BaldEagleFreedomJesusBabies, that’s why!

  183. Because… uh…. uh… BaldEagleFreedomJesusBabies, that’s why

    I think you’re ready for your close-up… on Fox News!

  184. Electrogirl, I can’t speak for Canada at all. So from the point of view of the UK (NHS), since it would be nice to have some truth in the debate:

    There are places where you can see a GP for free? Not “free” as in “the insurance covers most of it but you still have a $20 copay”, free free?

    Yes. I could see the GP three times a week for the rest of my life if I needed (and there were appointments — surgeries can be busy but I’ve never waited more than a week for an appointment, usually only a few days, and there are emergency appointments available on the day) and never. ever. have. to pay. anything. EVER.

    Any drug that your doctor prescribes, new or old, will be covered?

    It’s like this. The NHS has a certain amount of money, and they have to decide what they can best do with it. They won’t cover drugs that don’t have proven benefits or that will e.g. extend your life by three months but cost £47,000. I’ll tell you who else won’t cover those drugs: private insurance companies. So you are absolutely no worse off than you would be under a private system, BUT you have the right to challenge the ruling and a realistic chance that you might actually succeed (as has happened with cancer drugs here over the last few years, which after a fight are now available on the NHS). Plus you can pay for the drugs seperately if you have the money, there’s no ban on that. And drug-related decisions are made on a basis of benefit/cost as opposed to profit/loss. In an ideal world those decisions would never have to be made at all, but if they have to be made, I know what principles I want to be behind them.

    So. Apart from those rare cases, my doctor can prescribe any drug that is approved for efficacy by the NHS and I’ll get it for a flat fee, which in Scotland right now is about £4 a prescription. If you get multiple prescriptions you get a certificate that makes them even cheaper. I have never paid more than £6.60 for any prescription of
    anything (including four months of anti-malarials for COMPLETELY VOLUNTARY travel to Asia.) If you’re on a low income you can get an exemption where you don’t pay for prescriptions.

    You won’t go into debt if you end up in the hospital?

    I pay nothing if I go into hospital. Healthcare is free to me.

    Where nobody cares if you’re epileptic, you get the same amount and quality of health care as everyone else?

    Pre-existing conditions make absolutely no difference to your entitlement to healthcare.

    You can have expensive surgery without fear of bankruptcy?

    I will never pay anything for surgery here unless I opt to have it privately (WHICH HEY, I CAN OPT TO DO.) Some people do, for speed or because they like private hospitals better. The point is, they have the CHOICE. You can go on the NHS or you can pay for your own private health insurance. But if it is surgery that is necessary (or even just medically desirable — see, hip replacements for the elderly) it is available to you free free free, and reducing waiting lists is a government priority.

    Please understand, I am not trying to claim the NHS doesn’t have problems. It definitely does. It was underfunded for many years by the same Tory party that now has the nerve to turn around and criticise it on US television. Morale is low in many places, a focus on targets is a problem, some waiting lists are long, healthcare workers are underpaid and there is a lot of work to be done.

    But those problems exist in a different UNIVERSE from the ones that are plaguing the US system, because the NHS is founded on the principle that you get access to healthcare based on need, not ability to pay. Imagine.

    I do hope that the few of you who have been particularly rude on this forum are more polite in person

    I actually don’t value politeness over correcting misrepresentations when life and death are on the line, but thanks.

  185. I’m unimpressed by the general hostility expressed on this thread towards those who do not advocate a single-payer system.

    Psssst. Single-payer is NOT GOING TO HAPPEN in the US. A lot of us wish it would, and you would know if it were going to happen because we’d be talking about it. A lot.

    It’s not.

    The reforms on the table preserve the existing system with a few new regulations. That’s really it. It’s still all through private insurers, it’s still all mostly employer based, you still switch over to Medicare when you reach retirement.

    It’s not single payer.

    Honestly? I don’t give a shit. On economic grounds, one financing system may be more efficient than the other. Me? I just want every person to have access to a basic level of care. Right now, they don’t.

    The fact that you cannot distinguish between a system of financing, and some random office staff’s customer service skills — seriously, connection between those two things, WHERE IS IT? — tells me you really don’t understand the very basics of the issues at hand.

  186. In fact, most of us right -of-centers are fighting against our freedoms being taken away.

    Les, I have one question:

    Where the FUCK have you people been for the last 8 years?

    Where were you when Bush was reading our emails and listening to our phonecalls illegally?

    Where were you when Bush and Cheney and their box-top lawyers declared they could torture innocent people in our name?

    Where were you when Bush and Cheney decided they could imprison American citizens without a warrant and hold them indefinitely without a trial?

    Where were you when they lied to us to trick us into a vanity war so Bush could pretend he was Charlemagne and kill over 4000 American soldiers in Iraq alone?

    Where were you during any of their “time to tap dance & piss on the grave of the Constitution” endeavors for the last 8 years?

    WHERE THE FUCK HAVE YOU BEEN?

    You were nowhere, that’s what. You were sitting quietly and accepting that the idiot cowboy-in-chief and his malevolent handler were your Daddy and you could trust them. So you let them commit abominations against all our rights over and over and didn’t say a word.

    Now the other team is in charge – and not just another team but a team lead by a black guy – and suddenly providing 46 million people who have no insurance the ability to get medical care without going bankrupt is too dangerous for your freedoms? Only now do you suddenly have to pitch a hissy fit on television like a bunch of spoiled toddlers?

    If you expect me to believe that, I have a bridge I’d like to sell you.

    DRST

  187. “So, not perfect, but if you get sick or hurt, paying for care is not something you have to worry about.”

    Hell, nothing on Earth is perfect. I’ll happily take cheap meds and freedom from fear of healthcare-related bankruptcy.

  188. Man, I would have so much more respect for the Let The Poor Die squad if any of them could STOP LYING FOR FIVE MINUTES.

    Oh, let’s be fair. A lot of them aren’t lying. They just have no idea how various healthcare systems (including the U.S. one) actually work, so it’s really more a matter of ignorance than mendacity.

    The politicians, on the other hand? Are fucking lying.

  189. Oh! In the interests of balance, it is getting harder and harder to find NHS dentists. There are still some, and I believe people on lower incomes get priority (someone correct me if I’m wrong?), but my family have had to go private and we’re pretty fucking pissed about it. When I was growing up my dentist was NHS and all my dental care was free too. Cosmetic orthodontics was always pay-as-you-go. It’s a lot easier to find the money for that when you’re not having to pay for any other healthcare, though.

    WRT vision, if you’re on a low income you get free glasses or co-pay towards more expensive ones (if that’s where your taste extends). Other than that, you do pay for vision stuff unless it is actually medical — e.g. cataracts, which my aunt has had removed from both eyes for a total cost of £0 to her.

  190. Wowsticks. Must remember to hit refresh to see the developments in the intervening time between posts… Livvy, if you really aren’t reading any more, I think that’s a shame, not least because there are a ma-housive load of stories from your fellow citizens here which on their own, even without the analysis stuff, ought to help you out with where you stand on this, if only you would really engage.

    Electrogirl: My mind is being blown in the opposite way. In that, I knew it was bad in the US, but I didn’t realise it was that bad! Until recently I thought the problem was that lots of people couldn’t afford insurance, and some got covered by Medicaid if they were really badly-off but Medicaid was not necessarily 100% top notch. I hadn’t really realised the extent of the problem regarding insurance companies weaselling out of paying for things their customers thought would be covered. I naively even thought that surely medical insurance couldn’t be run in a manner akin to car insurance, because surely there would be some decent legislation in place to protect people because people are not just luxury vehicles. It seems that actually I got better service from my car insurers when I was in an accident last year than many of you get from your health insurers in the US… Fuck!

    If I ever got offered a job in the US (hoping to enter academia, had thought I’d consider applying anywhere at all if they would give me a job, given the market) I actually would have to think more than twice about it. Because I have always gone to see my GP when stuff has been wrong, and because this has often meant I’ve been referred to get stuff sorted out, I can only assume that in the eyes of most medical insurers I have a list of ‘priors’ longer than my arm despite being generally healthy… Hell, I am even off to get ‘hearing therapy’ for my tinnitus and hyperacusis soon – no bills!! It’s a problem which is annoying but I’m guessing I’d never have got sorted out for fear of ruining my premiums or even it not being covered in the US… What do you even do if you disagree with a diagnosis but it goes down on your records?? Double fuck! Why do American sitcoms have all those jokes about runaway Canadians in them, when surely… the converse situation would make more sense to me right now, just on the grounds of health!

  191. So, not perfect, but if you get sick or hurt, paying for care is not something you have to worry about.

    Oh, I’m sure there’s no such thing as a “perfect” system. In Canada, or anywhere else. If the US did implement a single payer system, I’m 100% there would be some problems with it, and a good bit of “growing pains” in the process.

    But, Canada’s imperfect system is still like 9000 times better than what we have right now in the US. And, really, we could use some improvement in the current system, no matter how imperfect the result. Better is, well, still better.

  192. Thank you for the explanations, Caitlin. Honestly, even with the problems and limitations you and other residents of the UK and Canada have mentioned, the concept of free universal healthcare still blows my mind. A large part of me is still gibbering, “But… but… but… everyone KNOWS healthcare is fucking expensive! Only elderly folks and really poor people on Medicare or MediCal, the rich, and middle class people get healthcare, and the only people who truly don’t worry about going bankrupt if one of the family gets long-term cancer or something are the rich folk! HOW CAN THIS BE???” The current healthcare “debates” have only exacerbated this. It’s a huge cognitive dissonance.

  193. the concept of free universal healthcare still blows my mind

    My mind was blown when I moved to the U.S. I had health insurance, but I was charged hundreds of dollars for tests anyway. I kept showing the bill to my husband and saying, “But the doctor wrote a prescription! But we have health insurance? How can they do this? Why didn’t they tell me?”

    The idea that some flippin’ customer service clerk can decide one’s health care – now that’s mind boggling.

  194. Electrogirl, I’m like zenoodle (who continues to blow me away with zir awesome on this) — I’m in complete shock going the other way. I literally cannot believe the medical system that exists in America right now. How do people live with such a lack of basic security? Why does anyone think it’s okay?

    I should probably have listened to my better judgement and stayed out of this thread, ’cause I can’t discuss this with out capsrage. (See above ;) ).

  195. Oh, let’s be fair. A lot of them aren’t lying. They just have no idea how various healthcare systems (including the U.S. one) actually work, so it’s really more a matter of ignorance than mendacity.

    I’ll hear that. Still pissing me off, though.

  196. In the interests of balance, it is getting harder and harder to find NHS dentists.

    I’ve heard this a lot, I’m sure it is a problem but I guess I just live in the right areas. I chipped a tooth over Christmas holidays a few years ago and had to find an NHS dentist at immediate notice and managed it… after moving to a new town and needing a new dentist I consulted some NHS hotline or website or both (I forget) and called a few places until I found one that would take new patients.

    My glasses still cost a lot of money, but since I *don’t* have all those other expenses to worry about, I can pay for the glasses I want.

  197. You know what’s really sad? I can get pet health insurance for my cats, about $30/month per cat, that covers more than many human health insurance policies which charge hundreds of dollars per month. I remember reading the pet health insurance brochure and thinking, “Shit, Jasper and Yoshi will have better care than I do.”

    This? This is so wrong on so many levels.

  198. Oh, let’s be fair. A lot of them aren’t lying. They just have no idea how various healthcare systems (including the U.S. one) actually work, so it’s really more a matter of ignorance than mendacity.

    I’ll hear that. Still pissing me off, though.

    Me too. It actually also makes me really sad. Especially when thought provoking evidence which contradicts the statements made is met with ‘lalala not listening’.

    BTW Caitlin – the feeling’s mutual <3 :-).
    I also have been spending much time thinking about this and posting in various places. I've written to my MP, my MEPs, Gordy, Davey C, and FailyFail McFuckwit (my new name for Hannan) and Nick Clegg to voice concerns about the antics of the aforementioned FailyFail and his overprivileged little mates. My FB profile is full of capsrage, to the point I have friends worrying about the potential irony of me needing NHS care as a result of having stayed up late defending / being angry about it and either exploding or thonking out from exhaustion. (Hey, at least it'd be free!)

  199. * I hasten to add, ‘being angry’ is re the bashers, not the NHS itself, which I <3 a lot!

    Electrogirl – re the pet insurance… wtf?! In your position if I got ill I'd consider wearing cat ears and giving the vet a try. My brain is having trouble processing this.

  200. Wow, DRST. Mighty hostile, eh? I notice this is a common trait with liberals toward anyone who doesn’t see everything the way they do.
    I don’t much care about the rights of terrorists who would like nothing more than to kill innocent Americans. They really didn’t have the right to ram planes into our buildings. And torture? They’re getting three square meals a day–not being decapitated in front of webcams–and they’re there because they’re trying to annihilate us.
    Which Socialist/Communist dictator doesn’t do everything in his power to rig elections (if elections are even allowed), deny religious freedom, ban freedom of speech, close down the presses, and filter the internet. A lot of those poor people aren’t even allowed to leave their country. Is that freedom? Maybe it’s better to be beaten or jailed for protesting.
    My question for you, DRST, is this–Where the FUCK were you when they were teaching history?

  201. I’m so sorry Kate to hear that…. my mother has lymphoma that has severely weakened her and I know how it feels to watch someone you love change so drastically. I hope things get better, even if it doesn’t seem that way.

    I’m not even going to touch this debate however, b/c the conserva-trolls seemed to have already come out of the woodwork here. I’m just hoping that they’ll finally figure out a way that makes EVERYONE happy or at least shuts up the idiots (which never happens).

  202. Wow, DRST. Mighty hostile, eh? I notice this is a common trait with liberals toward anyone who doesn’t see everything the way they do.

    Whereas you’re hostile to everyone who isn’t a conservative white American, amirite? You’d be a joke if you weren’t so dangerously stupid.

    I don’t much care about the rights of terrorists who would like nothing more than to kill innocent Americans.

    Oh lololol. Because everyone’s a terrorist until proven innocent, right? I feel like there’s a document about this somewhere. The constitu…something, I forget.

    My question for you, DRST, is this–Where the FUCK were you when they were teaching history?

    Oh, I see what you did there! You tried to replicate her rhetoric to say something clever! Since unfortunately it made no sense (relevance of “history” to Bush and Cheney’s record of “taking away your liberties” versus Obama’s — zero), you fail in this regard.

  203. Wow, DRST. Mighty hostile, eh? I notice this is a common trait with liberals toward anyone who doesn’t see everything the way they do.

    As I’m sure you could discern from having read the comments policy, Les, that’s enough to get you banned around here. There’s a big internet, though, and I’m sure you’ll find somewhere else’s playground where that sort of comment is not only allowed but the name of the game.

  204. Ah, I had it wrong. $25 for illness care and $30 for preventive care (vaccines, checkups, tooth cleaning). Still a damn good deal at ~$55/month per cat. I haven’t read the fine print, so I could very well be wrong once all the i’s are dotted and the t’s are crossed.

    Cat ears probably wouldn’t work, but it would be amusing to see the vet’s reaction! I wonder if they make catgirl costumes in plus sizes?

  205. Caitlin, I love you.

    But once government gains that much control over public health, and has the power to eliminate competition or individual’s choice to pay for services on their own, people won’t have that option.

    Absolute fucking bollocks, Revoltaire. Name me one Western country with universal health care where people are prohibited from buying their own private health insurance. You can’t because THERE ARE NONE.

    I’m so glad you got to this before I did. I’m Australian, so I can’t attest to the American system other than what I’ve heard (which is nothing good), but IMO the idea that a government-sponsored healthcare system will prevent people from buying their own medicines, private health insurance, or other treatments?? Ludicrous.

    And frankly – why would it? I don’t even understand this line of thought. What government in their right mind would forbid people from buying medicine?

    Here in Australia we have a government-funded healthcare system. It’s not perfect, but its a lot better than what I’ve heard about the US system. And I still have private health insurance. Here, I can go do the GP and have it be covered (or at least subsidised, depending on my choice of doctor), and a lot of medicines are subsidised by the government – but not all of them. When I started taking BCP, I went through 3 different brands to find one that suited me. The first 2 were subsidised – they would have cost me maybe $4-$8 a month. The third one wasn’t, and if I remember rightly, was about $25-$30 a month. Being fortunate enough to be able to afford it, I chose to pay for the third option, because it suited me better. The government made no moves to stop me.

  206. Also, because I was so busy trying to stop my head exploding before, I forgot to write what I really wanted to say, which was:

    Sweet Machine, thankyou for writing such a beautiful post. I’m so sorry for what you’re going through, and I’m sending you internet hugs and happy thoughts.

  207. @Les, let’s be honest here – conservatives can be just as hostile as liberals. Acting morally superior doesn’t make you right or more credible. And your assumption that every person being held by the US government has tried to “annihilate us” is just about as ignorant of history as you accuse DRST of being.

  208. Heh. Thanks, randomquorum.

    Being fortunate enough to be able to afford it, I chose to pay for the third option, because it suited me better. The government made no moves to stop me.

    And for me, contraception is free on the NHS. Not that I need it any more because I’m a big gay, but I’ve been on the pill and had a contraceptive implant before, both free. You can get contraception free and confidential below 16 years of age on the NHS too, if you’re considered ” mature enough to understand the information and decisions involved”.

    CRAZY, NO?

  209. I notice this is a common trait with liberals toward anyone who doesn’t see everything the way they do.

    No, it’s a common liberal response to people who lie and/or willfully ignore facts. Go figure.

    Also, who the hell let you through the mod queue?

    Finally, since it’s come up a couple of times, a reminder: Sweet Machine wrote this post, not me.

  210. Caitlin and randomquorum,

    Based on a number of news accounts and court decisions I’ve read from multiple provinces in Canada, since the passage of the Canada Health Act in 1984, it has become more difficult to go outside the government system to use private insurance and pay medical expenses out of pocket. Maybe all of the stuff I read from Canadian news and legal sites are incorrect, but that’s what they’re saying.

    And it’s true that many people in other countries, and I thank the posters above for their contributions, pay extra for private health insurance. I understand that this is very common in France. However, what does this say about the so-called “affordability” of a “public option” or of government-run health-care systems? They’re not sustainable. We’ll undoubtedly end up paying more for medical care. I welcome the debate about whether or not a more government-based system might provide better care than our current system, but the idea that it’s going to be cheaper for the nation seems laughable. And that’s exactly what we’ve found with Medicare, and Medicaid, and other government entitlements, like Social Security. While I don’t think comparing the UK or Canadian system to the U.S. is a perfect analogy, most countries with expansive systems of government provided healthcare are having trouble paying for them, including this one.

    I take exception to being included in the “Let the poor die squad”, and if you look at my post, I do believe in a government safety net especially for the poor. I even believe in expanding Medicare, if only we get the tens of thousands of those eligible to just enroll. I also believe in reforming our silly tax code so that individuals get deductions for most health related expenditures and so that they don’t have to depend on employers to get healthcare. When I lost my employer based insurance plan, I got a pretty good insurance policy through my local farm bureau and a private insurance company for about $100 a month. It wasn’t great, but it wasn’t bad either.

    For those of you on the left, I offer you this playful challenge. The entertainment industry in America is quite liberal. Why not get all of those Hollywood activists to contribute the large bulk of their salaries and royalties to pay for health insurance for the uninsured? C’mon: it’s for the good of the country. I’m willing to pay a couple more bucks per movie ticket. What does George Clooney make per picture? $20 million? How many uninsured people could that cover? What about Tim Robbins, and Tom Hanks, and Matt Damon, and Leonardo DiCaprio, and Steven Spielberg? I think a couple of Hollywood fundraisers, and we could cover just about everyone. :)

    You want to be honest? There’s very little of this debate that’s about healthcare, just like the stimulus bill wasn’t about stimulus. It’s about control.

    BTW: I noticed today the public option may be taken out of the House and Senate bills. Maybe that protesting wasn’t astroturfing after all.

  211. For those of you on the left, I offer you this playful challenge

    Yeah, “playful” and “solving the healthcare crisis” really don’t go together. It’s not a fucking game.

    BTW: I noticed today the public option may be taken out of the House and Senate bills. Maybe that protesting wasn’t astroturfing after all.

    Or maybe astroturfing worked. Or, hell, let’s say a majority of Americans DO fully understand what a public option means (snort) and still don’t support it — what’s your point? Are all of us in favor of a public option supposed to go, “Oh, gosh, I guess we must have been wrong!” now? Or are you basically just saying, “Ha ha, you lose,” but phrasing it in such a way that perhaps we won’t notice you’re being a smug asshole?

  212. I’m British, so I apologise in advance for interfering on this issue, but to be honest, I just got fed up with all the coverage. I decided to go back to the source and check out the actual bill (HR3200) to find out the truth. It appears to me that Barack Obama is not as radical on this issue as the Republicans seem to think.

  213. And it’s true that many people in other countries… pay extra for private health insurance… However, what does this say about the so-called “affordability” of a “public option” or of government-run health-care systems? They’re not sustainable.

    At least from my perspective, this is not the case. I pay extra for private health insurance because my private health insurance covers different things than the public health system (dental, physio etc), and because it will offer me more options/shorter waiting times if I need elective surgery. Plus, even with private health insurance, the public system still contributes to your care. I do not understand why the two are mutually exclusive, and having private healthcare options does nothing to indicate the sustainability of public healthcare. Does having private schools mean that the public school system is unsustainable?

  214. Kate,

    Sorrrrry about the apparent smugness, but some people take offense to being called liars and that might affect their attitudes. And I agree that healthcare is a serious issue. But the point that I think I made was that we could solve some aspects of the healthcare crisis in this country a lot more effectively than by implementing an expensive, inefficient government system. And I’ll correct myself: for most Americans, health care is a concern, not a crisis. This is why they have not embraced most of the current proposals, which I believe would have left 17 million Americans uninsured by 2020.

    Which brings me to Randomquorum’s point, which I think is a good one. You can have public and private insurance elements or insurance coexist, and we already have that in the U.S. in the form of Medicare and Medicaid. The problem is cost. Public plans increase them to a greater extent than private ones. And they create a great deal more inefficiencies which can reduce the quality of care for everyone. For example, I just read today that Canada’s top physician said that its health care system was “imploding,” and to a greater extend than some Canadians want to recognize. That doesn’t sound positive to me. The same is true for schools. I actually wrote my dissertation on the development of public and private schools in the U.S., and on average, private schools, most of which are religiously affiliated, educate children for a lot less money than public schools.

    Let me turn the question back to you: Why can’t we find a way to make private health insurance lots more affordable, and there are a number of ways to do that, and use government to provide a safety net for the poor and those individuals who are faced with cataclysmic health costs? I just think that’s a better option to get to a similar goal.

  215. To those saying that it’s harder to get private care in Canada, I don’t quite understand. The Canadian health system is provincially run so it would have to be province dependent that it is harder. Secondly, pretty much every long term job or student position comes with secondary health insurance. Doctors aren’t government officials. If you want to see any doctor and don’t have OHIP (in Ontario), you either prove insurance or health care (through your province or state) or just pay for the visit when you see them. I don’t quite understand how this jives with private health care being harder to get. Anyone can choose to pay to see the doctor if they want to. Secondly, in Ontario, there are several medical professions(chiropractor, physio, dentist, orthodontist, psychologist and optometrist are the ones that I’ve come across) that aren’t covered by OHIP so the only way to see them is to pay for them (or have insurance pay). Also, there are some clinics in at least Toronto that are private only. I don’t know about the rest of Ontario though

    Finally, to the suggestions about Hollywood paying for people’s insurance, or somehow getting more people insurance etc, I think you fail to realize how corrupt the insurance system is in the US. There are wonderful stories online of people who had insurance and were screwed over. (1.5 million lifetime coverage doesn’t go very far when your kid has leukemia, or good luck keeping a job when the insurance company adds 1 million a year cost to your employer because of your pre-existing condition or because you had cancer or whatnot).

    The scary thing is that the majority of bankruptcies in the US are because of health costs and the majority of those particular bankruptcies involve people who had insurance.

  216. For those of you who cannot fathom a public system that does not more, the facts are pretty close to hand: In 2006, the U.S. spent 15.3 % of its GDP on healthcare – Canada spent 10% of its GDP. That’s five percent less of a whole lotta money, there.

    But you know what? People who are opposed to universal healthcare pretty much just stick their fingers in their ears and go, “La la la, I can’t HEAR you!” when you tell them that the more compassionate option also happens to be the cheaper one.

    I usually hold back from telling my American friends about my experiences with the healthcare system here in Canada – it just feels too much like bragging about something they will never have.

  217. Sorry – the first line should say “…does not COST more.” Also… I’m kind of sleepy (Darned socialized fresh air!) but was Les actually saying that terrorists run the healthcare in other countries? Or that terrorists, under the rules of universal healthcare, get three square meals a day? Because all of a sudden there were terrorists in this conversation, and I have no idea how they got here.

  218. Those sneaky terrorists, always turning up where they’re least expected, just like the Spanish Inquisition. And yeah, when I go to see my (free) GP, he’s totally sitting there with a balaclava and an AK47, because that’s what you get with GODDAMN SOCIALISTIC MEDICINE!!!!! I’m just gutted Les has seen through our evil socialist plans, that’s all I’m saying.

    Sorry, reading all these comments at once seems to have given me sarcasm overload. Anybody wants me, I’ll be lying down.

  219. This is why they have not embraced most of the current proposals, which I believe would have left 17 million Americans uninsured by 2020.

    I’m sorry, this is supposed to be a point against the current proposals? On what planet is 17 million Americans uninsured not an ENORMOUS IMPROVEMENT over the current situation? Another way to put that would be, “Nearly 30 million people currently going without insurance will be insured by 2020.” Obviously, leaving 17 million people without is not ideal — but it would be progress.

    For example, I just read today that Canada’s top physician said that its health care system was “imploding,” and to a greater extend than some Canadians want to recognize.

    OK, setting aside that you neither name the “top physician” nor cite your source, you do realize Canada has conservatives, too, right? And that many of them would like to move to a system more like the U.S. has, because they’re also more interested in lower taxes than helping sick people? And that some of those are doctors?

    Let me turn the question back to you: Why can’t we find a way to make private health insurance lots more affordable, and there are a number of ways to do that, and use government to provide a safety net for the poor and those individuals who are faced with cataclysmic health costs?

    Because A) I’m not interested in continuing a system in which for-profit health insurance companies get to decide whether I get coverage and how much I pay for it. It’s not about making private insurance more affordable, it’s about loosening insurance companies’ stranglehold on health care in this country.

    B) I’m also not interested in just having a “safety net” for people who don’t have decent or any insurance coverage. Yes, at this point, catastrophic insurance would be a huge improvement over no insurance, and would at least save some people from going bankrupt. But I happen to believe that every American should have access to adequate, regular health care, including preventative care (which, ding ding ding, saves money). Everyone being able to afford a burst appendix or a car accident or a cancer diagnosis would be a step in the right direction, but if millions of people still can’t afford to see doctors for regular physicals and less devastating ailments, then they still don’t have adequate health care.

    We really don’t have similar goals, Revoltaire. Your goals are to maintain private health insurance as the only viable option for most, avoid spending any extra money that might go to a sick person you don’t approve of, and keep the government out of it. My goals (long-term, since the current proposals are only a step toward them anyway) are to see all Americans provided with access to adequate health care and, as much as possible, keep corrupt, for-profit insurance companies out of it. A Band-Aid on the current system is not common ground.

  220. Kate, it was me that let Les through the mod queue, sorry…. I’d just deleted several comments so over-the-top offensive and ridiculous that Les’ initial comment seemed very temperate by comparison, and I didn’t want to be deleting people just for disagreeing with me politically.

  221. I should really say, rather, that I’d deleted several comments that were “over-the-top offensive and ridiculous OR breathtakingly sub-101-level.” To those who exhibited no familiarity with even the most basic tenets of feminism other than a vague notion that it has to do with someone’s graciously allowing women to do things… yeahno. Try again.

  222. Me again. So, I thought it might be useful to compare Revoltaire’s statement about a mysterious Canadian doctor (who presumably is supposed to think for all doctors in Canada everywhere… they are in a socialist collective, so perhaps they have Borg-like hive brains?) with this BMA-related website dedicated to doctors’ worries about sneaky attempts at ‘backdoor’ privatisation of the NHS. On the front page it is flagged up that ‘Independent providers only allow their surgeons two post-operation follow-up appointments after which the patient has to be discharged – regardless of need.’’… because actually you would just have as many as needed on the NHS, in that you could go in every day if that was what was necessary. For £0.

    So, we’re worrying about conservative types actually buggering up the NHS by fiddling with it and privatising bits of it…

    (*BMA = British Medical Association)

  223. Another point – There is a HUGE gap between people who can comfortably afford good medical coverage and those who qualify for medicare/medicaid in the United States. Like I mentioned in a previous post, at one point I was paying almost $350/month out of pocket for private insurance, which made it difficult for me to afford other necessities like rent and food. I still didn’t make little enough to qualify for government financed healthcare.

    This is not an uncommon situation.

  224. This is not an uncommon situation.

    It also keeps $350/mo in the pockets of higher income folks who don’t want you to have real health care.

    Feel better now???

  225. Everyone being able to afford a burst appendix or a car accident or a cancer diagnosis would be a step in the right direction, but if millions of people still can’t afford to see doctors for regular physicals and less devastating ailments, then they still don’t have adequate health care.

    No shit. Mr Machine’s father has Crohn’s disease, which bankrupted his family. Literally. They went from a situation in which he HAD INSURANCE and a job, to a situation in which neither parent can work and they went bankrupt, because it turned out he’d had an autoimmune disorder all along. But that’s not “catastrophic,” so, you know, fuck it, I guess.

    Revoltaire’s concerns about affordability are just making me realize even more how much, as Kate points out, our goals differ. Let me put it plainly: I think a system in which citizens are forced to go bankrupt or die is inhumane and immoral. I think it is unworthy of my country, and it makes me ashamed and afraid. I would rather the US curtail its spending in just about every aspect of society, and I would rather pay higher taxes, if it meant that no one ever again has to die because they can’t afford to live. THAT’S my goal. Obama is nowhere near radical enough for me.

    I’m reminded of the quote attributed to Oliver Wendell Holmes: “I like paying taxes. With them I buy civilization.”

  226. @Meems – YES.
    AND all those arguments about the people who “choose” to be uninsured? They’re generally referring to those in-between folks, who could CHOOSE to have insurance by eating less or not paying for heat. It’s a myth that all these irresponsible young adults are running around without coverage out of some insane lifestyle choice… because honestly. The year I spent without employer-subsidized coverage was the scariest of my life. Every freaky bug bite, cold, bike accident, whatever was a reminder that I would go bankrupt if it were serious.

    For the love of God. No one chooses to live that way.

  227. Let me put it plainly: I think a system in which citizens are forced to go bankrupt or die is inhumane and immoral. I think it is unworthy of my country, and it makes me ashamed and afraid. I would rather the US curtail its spending in just about every aspect of society, and I would rather pay higher taxes, if it meant that no one ever again has to die because they can’t afford to live. THAT’S my goal. Obama is nowhere near radical enough for me.

    This.

    Thisthisthisthisthis.

  228. It’s a myth that all these irresponsible young adults are running around without coverage out of some insane lifestyle choice… because honestly. The year I spent without employer-subsidized coverage was the scariest of my life. Every freaky bug bite, cold, bike accident, whatever was a reminder that I would go bankrupt if it were serious.

    Yes, yes, yes!

    The vast majority of my 20-something friends, myself included, have made a great many job decisions based on health coverage, including delaying plans (possibly forever) that would put their health coverage at risk. I have a friend with a serious, chronic illness who would like to return to graduate school, but hasn’t yet because most health plans offered through schools would not fit her needs. My best friend needs her wisdom teeth pulled, they give her terrible headaches among other things, but since she has no dental insurance through her job she can not afford to go through with it right now.

    We would all love not to have to make a choice between our lives and our health. If only someone who give us an option!

  229. Revoltaire – I’m from Canada.

    Unlike other systems, because there are a WHOLE LOT OF DIFFERENT SORTS that don’t leave millions of people uninsured and most of them inadequately insured, we Canadians have to live North of your American “bankruptcy for the sick” gong show, and so are incredibly defensive about allowing HMOs and privatized anything anywhere near us. So yeah, there’s a whole shitload of pushback to all sorts of private insurers and insurance.

    Because insurance is gambling where the house wins. That’s what underwriting is; it’s making book and weighing odds.

    For health insurance, you don’t just have your money on the line, but your body, too. Health by lottery!

    So, yes. Canadians are so freaked out by y’all that we have little tolerance to anything that includes private options. Because Americans – the middle class ones, not the ones on TV – look … tortured. So we usually push back – regardless of political bent – against privatization, (although, of course, things are different in Alberta.)

    My stepdad is American, moved to Canada when he married my mom. Last year something came up and he was sent for tests and treatment, and they found a long term issue from his childhood that hadn’t been treated due to lack of complete health care. He couldn’t stop tallying up how much it would cost in the States. Being a pre-existing condition and all. $50K.

    Seriously, who the fuck has that kind of money besides the rich?

  230. I would rather pay higher taxes, if it meant that no one ever again has to die because they can’t afford to live.

    Yes, again, times a million – but also, from a purely selfish standpoint: I would to pay much, much higher taxes if it meant that I was safe. That my family will stay healthy. That my illness will never stop my kids from getting an education (or eating). That my dad can stop working and deal with his own failing health. I think too often those who can almost almost handle the costs forget that they and their families would benefit from a system where everyone had a safety net in every case, from chicken pox to catastrophic cancer.

    I agree with you, all the way to ensuring the health and well-being of strangers just because they’re people and we can do so, so much better than this – but also because this is personal, to me, to all of us. I will willingly, happily, joyfully pay to keep strangers whole and healthy because it means that me and my own will also be provided for – by people who don’t know us either but get that it’s better for every family, every person, if when the worst happens the first question never has to be “how are we paying for this?”

  231. Note to Kelly Cox Semple: I just deleted your comment because, despite your apology for derailing, it was wildly inappropriate to come into this thread about Sweet Machine’s mother’s grave illness and the desperate need for health care reform and go, “Hey, sorry to be off-topic, but…”

    If you want to make the same request in a different thread — preferably an open one — feel free. It’ll come up in the “recent comments” sidebar, and people will see it. But — and this goes for everybody — this blog is not a fucking message board, and deciding to derail the thread with the most current traffic, without even looking at the conversation you’re derailing, is not OK. I allow off-topic links pretty frequently, but when throwing one in demonstrates a total lack of respect for the contributor and the sensitive topic, it’s not gonna fly.

  232. I think too often those who can almost almost handle the costs forget that they and their families would benefit from a system where everyone had a safety net in every case, from chicken pox to catastrophic cancer.

    Or they have yet to encounter a catastrophic health situation. Only the extremely wealthy could cover the cost of a capital-I Illness, especially one that hindered or took away their ability to work, thereby putting their health insurance at risk. I think many people who haven’t been in that situation, just don’t think it could/will ever happen to them.

  233. Why not get all of those Hollywood activists to contribute the large bulk of their salaries and royalties to pay for health insurance for the uninsured?

    Great idea! We’ll raise taxes on the rich, because they can afford to pay a little more so that everyone can be spared the choice between bankruptcy and death!

    Oh wait… that’s NOT what you wanted?

  234. Why am I not surprised that SM’s post is now being overridden by rightist wingnuts who want to debate healthcare reform rather than the topic that SM brought up which was END OF LIFE CARE and so-called DEATH PANELS. No, its so much easier to come in whining about ‘you hurt my conservative feelings’ than address the fact that blatant ignorance and LIES are permeating this debate.

    “When I lost my employer based insurance plan, I got a pretty good insurance policy through my local farm bureau and a private insurance company for about $100 a month. It wasn’t great, but it wasn’t bad either.”

    Golf clap for you!!! To DAMNED BAD that in my budget that 100.00 is going to pay off credit cards that I had to use to buy my medication from ISRAEL because its too damned expensive in the States.

    “for most Americans, health care is a concern, not a crisis.”

    Seriously, just go fucking fuck yourself and the horse you rode in on.

  235. About humans resorting to veterinary treatment: That happens. Someone I know just self-diagnosed a tooth infection and treated it with an antibiotic that was manufactured for aquatic pets. Yes, he knows a person could die from that kind of infection. Yes, he is also aware of the probable quality of and dosing issues with fish meds. He is one of the millions living in that fissure between eligibility for government aid and the ability to sustainably afford insurance. Fish meds, to him, were the most reasonable option available. Which is not to say that they were actually a reasonable option.

  236. No, its so much easier to come in whining about ‘you hurt my conservative feelings’ than address the fact that blatant ignorance and LIES are permeating this debate.

    Or to think about the actual human beings who are affected by the policies they advocate. No, no, it’s all about liberty and taxes!

  237. “When I lost my employer based insurance plan, I got a pretty good insurance policy through my local farm bureau and a private insurance company for about $100 a month. It wasn’t great, but it wasn’t bad either.”

    How lucky you are that you were the perfect weight, have never smoked, have never had cancer, diabetes, birth defects, heart disease, pregnancy complications or a disability. Glad you weren’t pregnant when your insurance ran out, or were getting cancer treatment, or were old. I guess you never used asthma medication, anti-depressants or got treatment for postpartum depression.

    And the rest of us should do what? Just die?

  238. SM: “Or to think about the actual human beings who are affected by the policies they advocate.”

    But then they’d have to think about people who don’t live their lives exactly like they do! EW!

    The thing I keep coming back to inside my head is that people who oppose such things as end-of-life care or health care reform in general are people who cannot comprehend that even if they live their lives “right”, it’s not a guarantee they won’t become gravely ill or get into a catastrophic accident. They are people who aren’t taking care of someone who is terminally ill or chronically ill. They are terrified of death and think that somehow, some way, they will beat it and live forever. And ultimately, they seem to lack any sort of empathy whatsoever, which is horrifying to me.

  239. Thanks so much for sharing your story, Sweet Machine, and I’m so sorry to hear about the pain that you and your family are going through.

    I wanted to offer another Canadian perspective here on our evil, evil socialized health care system. I am 99% satisfied with our current system. To be fair, I haven’t lived in any other country before, so I don’t know firsthand what other systems are like, but from what I’ve read, the US is a terrifying place to live for a lower-middle class young person with pre-existing conditions like myself.

    Here’s how the system works for me, here in Alberta. When I am ill, I call my doctor, and depending on how busy she is and how urgent my problem is, I wait anywhere from an hour to 3 days to get an appointment. I don’t have to pay a penny for this service. If I wasn’t satisfied with the level of care I was getting from my GP, I could easy flip through the phone book or ask for friends’ recommendations and have a new doctor within a week. If I have a serious medical emergency, I can either take an ambulance to the hospital (a few hundred dollars out of pocket, since I don’t have any sort of insurance) or get a ride from someone else, and I will be seen immediately if my condition is life-threatening. The last time I was there for something relatively minor (a broken finger) I had to wait perhaps 2 hours, in a comfortable room, and they provided me with a couple of painkillers as soon as I got in and described the problem. And again, I don’t have to pay anything out of pocket. If I’m prescribed medication, I do have to pay for it out of pocket (since I don’t have insurance, again – if I had even the most reasonably priced plan, my scripts would be 80%+ cheaper) but medication here is generally much less expensive than in the US. For example, 6 months worth of birth control (nuvaring) costs me about $16.

    There’s always the argument that, well, of course I like having free health care since I’m poor, but if I was wealthy I wouldn’t like paying high taxes to support lazy poor people. Bullshit. If my career path goes the way I expect it to, it’s quite likely that I will be significantly wealthier in 20 years or so. Assuming the earth survives that long, I am looking forward to paying high taxes and giving back to my country.

  240. “So here’s the question. Should I put $443 on my credit card in the fear that I’ll get sick in that 30-day period, or just hope I sail through September?”

    Talk to your HR person at either your current job or your new one. Mine explained to me that you can retroactively activate COBRA.. so if you get sick during that period you can get care, and THEN decide that you wanted to have COBRA from the beginning of your time without insurance.

    Also I believe the “pre-existing conditions” thing only kicks in when you’ve been without insurance for more than 60 days. But again, talk to someone in HR to make sure and get more details.

  241. We don’t want to live in a nanny state that provides for our basic needs, but denies us the freedom to achieve, excel, and live the way we want.

    Gosh, I had no idea that YOUR freedom was dependent on MY inability to get help for a medical condition that basically ruins my life.

    Apparently, by wishing for health care I’ve been taking away your freedom this whole time. Terribly sorry.

    I’ll get right on suffering harder now, so as to provide you with the maximum amount of freedom possible.

  242. And:

    I am looking forward to paying high taxes and giving back to my country.

    Yeah, what she said. I can only hope to someday make large amounts of money so that not only can I personally live comfortably, but I can also contribute to make my country the best place it can be.

    Who *wouldn’t* want that, and why do they hate America so much?

  243. Dolcina: “And yeah, when I go to see my (free) GP, he’s totally sitting there with a balaclava and an AK47, because that’s what you get with GODDAMN SOCIALISTIC MEDICINE!!!!! ”

    I read ‘balaclava’ as ‘baklava,’ and I was like, oooh, killer pastry *and* socialized medicine? WANT!

    Seriously, though – it totally bewilders me that people are talking up delayed treatment and bureaucratic interference with medical decisions as flaws in government-paid health care. Delayed treatment and bureaucratic interference with medical decisions are how K—– P——— killed my father, and he supposedly had gold-plated coverage as part of his retirement package. I do not get how having the government pick up the bill could make things *worse.*

  244. If we had had a “death panel” when my dad first started having health problems, or the doctors at the end hadn’t been afraid to tell us straight out that there was no hope for enough of a recovery to give him a reasonable quality of life, he might not have gone through ten days of torture and a million dollars worth of surgeries and round-the-clock care before finally dying. Having a responsible way to end care is almost as important to me as giving care to those who need it. I hate what their fear-mongering is doing.

  245. SM: thank you for this post. I just called my parents to discuss their end of life plans even though they’re both healthy and entering their 60s. I’m so sorry to hear about your mom.

    We went through a similar ordeal with my father’s mother a few years ago including a juggling of health-care proxies and power of attorney between her children and ending in the one thing she didn’t want. The only thing Grandma didn’t want was to be sent to a nursing home. We all went through a round of about 6 months to a year of her living in each of our houses, but everyone works. So when her care requirements became too complicated for any of us to manage then she ended up in the home.

    Re: our cultural fear of death

    It came crashing home to me when I was preparing for my Senior Recital. I was translating some of the Lieder I was performing and the songs I was singing to deal with grief in a tangential fashion. I was amazed to discover that phrases that were fine, nostalgic, or romantic in German sounded creepy in English. And there was no way to express this particular sentiment in English in the modern era with out sounding creepy. One can be enjoying doing something and remember a similar experience with someone who is now dead and think “Oh, I wish they were here now” however one cannot express it in less than 250 words in English.

  246. Firstly, SM, my deepest sympathy to you and your family right now. Having lost several family members to slow, debilitating illnesses these past few years, I really admire your courage in talking about this and hope that you are okay.

    I had a long and uncomfortable discussion with my grandmother about health care reform this weekend, and she kept saying that the government couldn’t be trusted to provide decent health care because they’re a bunch of yahoos and blah blah blah. At this point, my husband chimed in, pointing out that both she and my grandfather are on Medicare. And who do you think runs that? She was remarkably quiet after that. Later I knitted in the living room while she watched a whole panel of white conservatives blather on about this very issue, and tried very hard not to yell and scream.

    I’ve been regaling my family of late with the story of my own health insurance woes. After getting married last year, I lost my benefits and immediately contracted pneumonia. I tried several times to get insurance regardless of cost–I have awesome in-laws and severe asthma, so it was a priority–and repeatedly was denied coverage. I was too sick to get health insurance.

    Anyway. It’s amazing how well people use fear to prey on the public and turn something pretty much everyone agrees is important–health care reform–into socialism communism fascism booga booga.

  247. Les – I suspect you’ve been banned for trolling, but just to clarify, where was I while they were teaching history? Getting my PhD in American Studies.

    …aaaand I’m done catering to the derail. Sorry, everyone. When my dander gets up, I have trouble not yelling.

    I remember Joe Biden saying last year during the campaign that paying taxes was patriotic. He got some crap for it and not nearly enough credit. We’re too mired in the Republican approach that all taxes for any purpose but national defense are evil. Taxes pay for everything. It’s how we pool our money to accomplish things that we are far more efficient and productive doing together than we would be separately. Which, yeah, is kind of the basis for socialism.

    Let me put it plainly: I think a system in which citizens are forced to go bankrupt or die is inhumane and immoral. I think it is unworthy of my country, and it makes me ashamed and afraid. I would rather the US curtail its spending in just about every aspect of society, and I would rather pay higher taxes, if it meant that no one ever again has to die because they can’t afford to live. THAT’S my goal. Obama is nowhere near radical enough for me.

    SM, you rock.

    DRST

  248. I just called my parents to discuss their end of life plans even though they’re both healthy and entering their 60s

    I’m so glad to hear this. My mom is only 67, by the way; her dementia began in her early 60s. It’s never too early, really.

  249. Obama’s going to cave in to the insurance companies, if he hasn’t done so already. He knows who bakes his bread and butters it, and it’s not the voters. We’re just a sideshow. They want their bailout and they’re going to get it. The very idea that “private money” doesn’t already control the U.S. government right up to and including the very highest levels, rather than the other way around, is laughable.

    The sad part is, I honestly think paying the top insurance executives a billion dollars each to go away might actually be more cost effective than continuing the current system. That’s really what they’re afraid of, right? That they’re not going to have their own private islands and private late-model planes? If we handed them each a billion and said, “Here’s your golden parachute, now go buy a beach and bury yourself in the sand,” how many would actually refuse?

  250. Meowser, I was so pissed off to see how things are going.

    I also feel really hopeless about the potential for genuine change in this country. People want real health care reform. And, Obama won in a landslide victory that was like a referendum on health care in this country. If we can’t get real reform passed under those circumstances, it’s very clear that the only time we’re getting anything we want is when The Powers That Be decide that it’s somehow going to profit them to give it to us.

  251. I don’t comment often here, and as an Australian, I’m not sure if my views are especially helpful on this topic – I’m probably preaching to the choir in this forum anyway… but what the hey. Australia does not have as much of a ‘no direct cost’ system as the UK appears to have, but its pretty good.

    General practitioners – a standard consultation costs around $55, of which, the government will refund around $36 (so $19 out of pocket). People with concession cards and children are generally ‘bulk billed’, which means they do not pay anything out of pocket.

    While it can be tricky to see a GP at short notice, whenever I’ve had something which really needed seeing, I was fitted in that day. You generally get treated more quickly if you have been ‘on the books’ at a particular practice for a while, but even if you’re new in the area, its not usually a huge problem.

    Medication – anything which has been placed on the ‘Pharmaceutical Benefits Scheme’ (PBS) will cost around $20 per prescription, around $5 for concession card holders. Most prescription medications are on the PBS.

    Hospitals – for emergency treatment, you will be treated based on severity/urgency (so someone with chest pains will be treated before someone with a broken arm). Treatment is free if you choose to be a public patient (which most do). Waiting times will vary, it depends on how busy they are, and the severity of your case and that of others. ‘Elective’ surgery is also done in public hospitals, and while there can be dramas with waiting for less severe treatments (such as knee reconstructions or similar), if you require something critical – heart surgery, perhaps, you will be treated quickly.

    There is also private insurance, which for high income earners (above $75k per year) you are obliged to have (or you have to pay an additional tax penalty). My insurance covers all hospital care, with a once-per-year payment of $500 if I need to use it. It costs me around $40 per month, from memory? Also, you cannot be denied coverage based on any conditions (although sometimes you have a waiting period before being covered).

    It is so strange to hear about the sheer FEAR which many Americans appear to have about their health. I don’t think I’ve EVER heard Australians talk about whether medical care will bankrupt them. Its just not in our idea of possibilities.

  252. My sympathies, SM.

    And for those who might be interested in showing a bit of virtual support for universal healthcare schemes, whether you live in a country that has it, nor not, please join the Facebook group (no spamming, guaranteed).

  253. Everything you’ve been going through with your Mother is terrifying and incredibly difficult. Thank you for sharing it so thoughtfully and poignantly… and getting it so darn right.

  254. My grandmother is also very ill, in the nursing home, and is so far along with alzheimers that we have no way of knowing what her wishes really are – and by the time we had thought of living wills or anything like that, she was far beyond the point where she could have understood what it was. So as caregivers we’re flying blind as to what she might actually have wanted.

    I also work in a law firm that does a lot of estate planning. It is so much of a relief, not just to the patient to know that they’ll be taken care of according to their wishes, but to the caregivers as well, who through those documents know what the patient might want after the patient is unable to express those desires.

    The whole death-panel nonsense and just outright lies and fear-mongering makes me absolutely furious.

  255. And just to respond to these points, although some have been covered off already:

    And it’s true that many people in other countries, and I thank the posters above for their contributions, pay extra for private health insurance. I understand that this is very common in France. However, what does this say about the so-called “affordability” of a “public option” or of government-run health-care systems?

    It means that you often (not always) get a private room rather than a shared ward. It often means you have a shorter waiting time if you require a specialist treatment (such as surgery). However, the public health systems generally have targets of maximum wait times for the most common treatments. Also, if it’s emergency surgery that’s required, there is no difference in the time you wait, and no difference in the care you receive, other than the fact there’s no bill waiting for you at home.

    They’re not sustainable.

    The NHS has been running for around 60 years, as has New Zealand’s universal health system. Seems pretty sustainable to me. What is getting more expensive are the kind of treatments that are getting funded by the public health systems – open heart surgery and the latest and greatest drugs that cost 100s of dollars a pill wholesale are hard for any public system to fund (but they do fund these things).

    We’ll undoubtedly end up paying more for medical care. I welcome the debate about whether or not a more government-based system might provide better care than our current system, but the idea that it’s going to be cheaper for the nation seems laughable.

    In 2003, the US was spending 15.2% of GDP on healthcare costs. The next country was Switzerland with 11.5%. Other OECD countries that spend around 10% of GDP are France, Canada, Germany, Belgium, Norway. The UK pays 7.8% of GDP towards healthcare. Other countries at that level are Ireland, Luxembourg, Finland and Japan. Most other OECD countries are somewhere between 7.5-10% of their GDP.

    The US does not get twice the level of care as the UK does (although I do think the UK should contribute more to the NHS, but they’re also paying for expensive wars), nor 50% better care than the nearest OECD countries. Therefore, you are not getting value for money. As one crude marker, the average life expectancy for OECD countries is led by Japan with an average life expectancy of 82 years. Then Australia, Canada, France, Sweden, Switzerland … UK at 18 (79 years), down to the US ranked at 24th (78 years).

    So, you’re paying between 50-100% more for a scheme that leaves out huge swathes of the population without wildly more benefit for the privileged. Doesn’t seem like the most economical system, actually.

  256. Or they have yet to encounter a catastrophic health situation….many people who haven’t been in that situation, just don’t think it could/will ever happen to them.

    What, you mean we don’t all have supernatural foresight (/ seriously ailing parents/ busted-up bikes that are fortunately not our heads) to remind us of our mortality? You’re absolutely right, and I feel dumb for not saying that – it’s good to be reminded sometimes that not everyone sits where I do.

    I am looking forward to paying high taxes and giving back to my country.

    As an American who isn’t getting a whole lot of support in terms of health care in her poorly-paid youth – I’m looking forward to paying taxes so that somewhere down the road, Americans will be able to say that too, and mean it.

    … and Sweet Machine, this is what I should have said first, but I got all caught up in the conversation. I look at my dad, who has been chronically ill but misdiagnosed (in new and exciting ways) for years, and I am beyond terrified of dealing with the end of his life. It’s stifling and silencing, that fear, and so easy (but no less scary) to just hope that he’ll finally recover.

    Thank you for sharing this; it’s a (poignant, well-written, generous) reminder that hope’s no substitute for action.

  257. This is mostly rhetorical, but why do we never ever ever ever see a response (keeping the ban-hammer in mind, of course, as an explanation for their silence) to posts like Trix’s by the people who ask the questions and make the statements Trix (and others) addressed?

    Like I said, mostly rhetorical, because I have a really ungenerous reading on what motivates pseudo-trolls to do shit like that, but it’s a mindset that I have a hella time trying to understand. Fear, I’m guessing, and greed and an inability to acknowledge the big old soup tureen full of GREEDY FAILED IDEOLOGY they’ve been slurping down their whole damn lives. Guess what folks on the conservative side? YOU ARE WRONGITY WRONG WRONG WRONG. Period. No discussion. Flat out wrong. No goddamn moral high ground to stand on here. You want people to go bankrupt and die rather than allocate some money away from zillions the US spends murdering innocent people to pay for doctor’s visits. Really. That is what you are trying to defend. GO AHEAD.

    I get not wanting to admit one’s own failures, I really really do. But if in refusing to do so you essentially condemn millions of people to short, shitty, stressful lives – all in the name of the almighty dollar – and all because you have all the power and all the microphones and they don’t because they’re too poor and/or too brown to count – and if any of those icky poor people DO have even a smidgen of what you have, then what you have just isn’t so special anymore, god forbid! – I don’t even know. I do not know what to say in the face of such unmitigated greed, inhuman behavior and cold-heartedness.

    I don’t want to live somewhere so lacking in basic human compassion, dammit! STOP RUINING MY COUNTRY.

    ((((Sweet Machine and fam)))) and (((everyone else)))

  258. (((l-zhiu))) I’m sorry your dad is so unwell and that it causes you so much anxiety. That really sucks.

    This post did inspire me to call up my mom and ask her if she and my dad had any sort of directives, as well as wills and such in place – and of course they don’t, because they are my parents and that is how they roll. It was awkward, and I know I threw her a bit, because we do not discuss death, except for my mom’s thrice-weekly update on the failing-and-then-okay-again health of my old dogs.

    Hopefully they’ll think about it. I don’t know if she quite got what I meant – I know they both want to be cremated, or whatever we decide (they’re atheists and completely unconcerned with what happens to their bodies), but stuff like DNRs and feeding tubes and all that…yikes.

    When my grandfather was dying they did have a Hospice nurse and other care, but I was only 12, and about 900 miles away, so not super involved. I do know that he did get to die at home, which was important to him, but the lead-up to everything, conversations about death and his wishes – if they happened it wasn’t within my hearing. Or even when we would get together and he was literally wasting away in front of us, it was like, no one say the D word! No one say anything! Let’s not acknowledge this at all!

  259. I had no idea the American system was so bad. American Shapelies, please move to Australia or Britain or Canada, I’m worried about you now. D:

  260. if any of those icky poor people DO have even a smidgen of what you have, then what you have just isn’t so special anymore, god forbid!

    I’ve also seen/heard this mindset expresed as, “I’ll gladly eat mud as long as Those People are guaranteed to have to eat shit.” That’s what I find truly mind-boggling, that people would rather suffer and do without if it means The Undeserving don’t get one plastic dime.

  261. Fuck yeah, Trix.

    So, to review, universal health care would prevent people going bankrupt because they have a serious or chronic illness, DOESN’T cost more, and doesn’t involve anything resembling a “death panel”.

    Also, conservatives overwhemlingly claim to be “folllowers of Christ”, whose mandates were healing the sick, feeding the poor, loving your neighbour as yourself and knowing that how you treat the least of his people is how you treat him. He also required that you give all you have to follow him, so quite frankly, even if healing all the sick cost five or ten times more IT’S STILL WHAT HE TOLD YOU TO DO.

    They just…don’t have an argument. And yet somehow this is still being presented in the media as otherwise than simply a fight between those who want to do good for all Americans, and those who don’t give a shit. I don’t understand.

  262. Also, conservatives overwhemlingly claim to be “folllowers of Christ”, whose mandates were healing the sick, feeding the poor, loving your neighbour as yourself and knowing that how you treat the least of his people is how you treat him.

    They like the virgin birth and the crucifixion and Revelations. They don’t like anything else about Jesus. The strange thing is, though, they love the shit out of the Old Testament, and that shit’s Jewish. (But this Jew is very glad they don’t know that.)

  263. @Meowser, a lot of conservative Christians really only love the violent hateful parts of the(ir) Old Testament (because really, it is a bit different from the Torah) and ignore the rest. It’s the picking and choosing that pisses me off most.

  264. I think it’s interesting that it isn’t actually upper-middle class sorts of people who object to socialized medicine, for the most part. It’s the white working class. Yes, they are badly educated and their arguments tend to be illogical and poorly thought-out.

    But I think this says something about a very longstanding distrust that can’t be bridged by dismissively calling them “wingnuts.” (Or, maybe it can; what do I know?)

    Conservative Christianity strikes a deep chord with these people because their lives are HARD, and a religion that is harsh and demanding resonates with their experiences in life a lot more than a softer-serve sort of Unitarian-lite faith does.

    There’s no way to “follow the Bible” withOUT doing some selective choosing, though. The book does not strike me as a seamlessly coherent manual for living.

    I hardly fault anybody for this.

  265. And anyway, it’s not the OT that gives conservative Christianity its piquant kick, for the most part. “If anyone should not work, neither shall he eat” is an oft-cited passage from Thessalonians, as I recall.

  266. There’s an article in the NY Times Well blog this morning that reminded me of this discussion:

    The dark side of this patient’s visit, in addition to his fight for his life against a very aggressive disease, was that he did not have good health insurance. We talked about it. He was in business for himself selling insurance, but his own personal health insurance was inadequate and didn’t cover all the care he was getting. They were a solidly middle-class family, and he explained that if he had any medical bills in the past he just paid for them out of pocket. Getting leukemia was not part of the plan, and neither was an unexpected six week hospital stay that included thousands of dollars of chemotherapy.

    Six weeks is a standard amount of time for new leukemia patients going through their first round of induction chemo. We make them so vulnerable to infection that we keep them in the hospital to ensure quick action if they do get sick. This patient’s six weeks turned into two months, and then three months, as one chemo regimen after another made no headway against his disease…

    I’m a nurse so I’m focused on need, and the treatment required to save someone’s life represents a profound need. It is also a need that is always unanticipated. My patient thought he had planned well for his health care needs. He just never thought he would wake up one day with a diagnosis of leukemia.

    But which of us does? And that’s why we need health care reform. My patient was savvy about the business side of health insurance, but not about how cruel and unfair life can be. He was suddenly confronted with an illness, and treatment costs, outside the realm of his imagination. Any of us could wake up tomorrow and find ourselves in the same terrible predicament: really sick, needing treatment we can’t afford.

    So I ask the people who oppose health care reform to consider what they would do if they found themselves in my patient’s situation — because they very well could, sooner than they know. Any of us could wake up sick, without the coverage we need, in danger of losing the very job that gives us health insurance. Our lifetime cap on insurance, which we never thought we would approach, can be brought so near that the question of costs cannot be separated from the treatment needed to stay alive.

    The rest.

  267. There’s no way to “follow the Bible” withOUT doing some selective choosing, though. The book does not strike me as a seamlessly coherent manual for living.

    I don’t argue that it is, nor that it should be. My issue is that people often select the passages that encourage hatred and intolerance rather than embracing those that encourage acceptance and love.

  268. I hope I’m not considered a troll, just because I may have some reservations about many of the measures proposed in both the House/Senate bills. I mostly read SP for its pro-size acceptance stance and appreciate the support I find here. I usually ignore political stuff I disagree with; after all, it’s not my site and I completely respect the fact that people have different views. But when I read comments accusing people like me of “unmitigated greed, inhuman behavior and cold-heartedness” as well as “lacking any empathy” I have to call foul.

    Forgive me if I’m taking those comments a bit personally right now, but I spent four hours with a home care patient of mine last night who I’ve cared for for over two years. I sat with her, her family, and several friends as she struggled through her final hours. I stayed after her dead body was taken away, cried with her loved ones, and cleaned up the messes caused by death. Trust me, I haven’t been doing this work for almost a quarter of a century because I lack empathy and am cold-hearted. It’s definitely not for the huge salary I earn (ha!). I (and millions of nurses like me) do this work because we really are invested in the well-being and dignity of others.

    So why would I possibly be wary of the health reform bills being proposed? I have several reasons, but I’ll only focus on one aspect. It’s not because of the hyperbolic claims about “death panels”, etc., but it IS because I’ve seen relatively innocuous-sounding legislation turn into a mess once federal regulators declare how that legislation should be carried out. It is extremely important to remember that if and when a bill passes, hundreds of bureaucrats in federal agencies will have years to create reams of regulations to govern the law’s details. These regulations carry the weight of law. It doesn’t matter what is explicitly written in the law; bureaucrats (who we do NOT get to vote out of office) determine the specific ways that law must be carried out, and it often happens in ways the legislators didn’t originally intend.

    I won’t get into too many details, because it would take up too much space here, but I’ll give one specific example. The 1997 Balanced Budget Act contained the following text: the Secretary of Health and Human Services may require all home health agencies to submit additional information that the Secretary considers necessary for the development of a reliable case mix system.. This requirement was made as part of an effort to cut costs in Medicare through a prospective payment system. From this short sentence, HCFA (the Health Care Finance Administration) developed regulations that require every home health care nurse to collect comprehensive health/personal data on EVERY patient we see (not just Medicare patients) in a tool called OASIS (Outcome and Assessment Information Set). This data, which contains personal identifying information (ie SSN’s), is then sent to a central OASIS database in Baltimore, MD. Data collected include patient demographics and medical history, living arrangements, type of wound, urinary tract infection, respiratory devices, medications, neurological/emotional/behavioral status, emergency care received, transfer to an inpatient facility, and death. Most data items are obtained at start of care, every two calendar months, surrounding a hospital admission, and at discharge. Millions of records have been entered into the OASIS database since 1999.

    Health care professionals have numerous continuing concerns re: OASIS, but chief amongst them is the issue of the privacy of personal medical information. I would think it would give those of us in the size acceptance movement pause that many of the same bureaucrats and politicians who developed these regulations are also some of the same ones who advocate for fat taxes, mandatory parental counseling for parents of fat children, etc.

    So can you see how some of us might not be reassured when someone says “that’s not in the bill”? That it’s entirely possible that some of us are actually concerned that the proposed reforms might have negative, unforeseen consequences? That it’s not because we’re heartless and lacking empathy?

  269. Meems, I’d argue that working-class Christians are often more accepting and loving on a person-to-person basis than their progressive cousins; the harshness and legalism of the religious/political beliefs on paper doesn’t mean they are hateful human beings.

    I’d make the same argument about conservative Muslims, some of whose stated religious beliefs are at least as starkly legalistic as Mike Pearl’s, BTW.

    And yes, the federal government has a sizable civil-servant class that exists largely for its own benefit. What can ya do? Not much, it seems to me.

  270. They like the virgin birth and the crucifixion and Revelations. They don’t like anything else about Jesus.

    a lot of conservative Christians really only love the violent hateful parts of the(ir) Old Testament

    the white working class. Yes, they are badly educated and their arguments tend to be illogical and poorly thought-out.

    Uh….do you really want to continue with these stereotypical caricatures of Christians and poor white people? Whatever your views on health care reform, I think a good argument can be made that Christ’s admonitions were directed towards the behavior of his individual followers and the church, not towards the support of programs proposed in a modern-day federal republic.

  271. Yeah, everyone, let’s not do this “working-class Christians” thing here. This is not the thread for it AT ALL. I am glad we are having substantial discussion, but I want to remind everyone that this is a post about the personal, individual aspects of health care. This is not a polemic.

    MamaD, thank you so much for the work that you do. It’s not “people like you,” who have thoughtful, experienced concerns about the proposals that are being called heartless here, as I see it: it’s the people who don’t want “their” Medicare or “their” taxes to go to anyone else, people who genuinely don’t believe that health care is a right that extends to all living people. People who, Joe the Plumber style, rant about policies they demonstrably know nothing about, and then go on TV interviews to say they just don’t trust Obama, they don’t know why.

    I appreciate your concerns about unintended consequences of any given law. As a patient, I am personally less afraid of that than I am of the *intended* consequences of bureaucratic decisions at for-profit insurance companies.

  272. MamaD, I can only speak for myself, but I think the voices like yours are also being lost during this health care debate. To me, unless I am misunderstanding you, it seems that your concerns are valid ones and come from a place of wanting the best possible system for everyone. Because there are real concerns about how this will be carried out, and those should be discussed to ensure that everyone is treated fairly and that people’s privacy remains intact.

    However, the loudest critics of the bill are the ones shouting about death panels and how Obama plans to kill the all the old and sick people in the country, and this drowns out the real concerns people might have. The goal of these groups/protesters is to stop a debate that might enact real change by drowning it out with misinformation and polarization. To me, those are the people who are coming from a place of heartlessness, the ones with the I’ve-got-mine attitude. I don’t think for a minute that Sarah Palin really truly believes that Obama wants to kill of the elderly, but if she can get enough people to believe that, than her interests, in keeping a market monopolized by private corporations and not having to contribute tax dollars towards the well being of people she doesn’t want to help, remain fulfilled.

  273. I appreciate your concerns about unintended consequences of any given law. As a patient, I am personally less afraid of that than I am of the *intended* consequences of bureaucratic decisions at for-profit insurance companies.

    This.

    (Just in general, when Sweet Machine says something, you can assume I’m somewhere going, “THAT!”)

  274. MamaD, I tend to agree with you. However, it goes without saying that plenty of the protesting about health-care reform IS from this group; I’m aware that progressives sometimes like to paint them as plutocrats (or dumb corporate shills) but the fact is that a lot of these people are NOT well-educated and tend to make poorly articulated arguments that progressives can smash to bits with little trouble in the comfort of the internet, all the while hiding behind a moral-high-ground facade.

    If I’ve seen it once, I’ve seen it a hundred times.

    I don’t like it, but it is what it is. These people have legitimate concerns and fears that can’t be painted over by calling them “wingnuts,” in my opinion. There are some class issues at play here.

    That’s my point.

  275. Wonderful thread. I’m in the UK, and I’m one of the ardent defenders of the NHS, warts and all. Anyone who wants to detract from the NHS (or any other health care system) can of course find examples of individual cases of incompetence or callousness or neglect or mismanagement, because doctors are human and in any system, errors will be made. Those exceptions aside, and broadly speaking, the problems with the NHS in my experience are largely either those which insurance companies would also share, as others have said, such as refusing very expensive drugs when the benefit to the patient would not justify the expenditure, or administrative-type issues, such as waiting lists for routine procedures.
    My husband has a high income, and our family is very comfortably off by national standards, although we are not super-rich – I’m talking detached house and children in private schools, not private helicopters. We do have health insurance as one of the perks of his job, and so do most of the relatively wealthy families whose children go to the same schools as ours. I do not know a single person who chose to have a baby delivered privately rather than on the NHS, although private maternity services are readily available in London, which we live near, and although many of my friends are from very wealthy families, because it is universally acknowledged among my privilaged (spelt wrong, sorry) friends that the NHS maternity care is better than private care – and completely free. The one time we have used our health insurance was when my husband had some gastric symptoms and, purely for convenience, saw a doctor privately in London to avoid taking the whole day off work, which he would have had to do to use the NHS. A whole raft of unnecessary additional tests were added onto the bill, without his informed consent, so that the insurance threshold was exceeded and we had to pay £500 ourselves to cover the balance. I don’t see us using the insurance again in a hurry.
    It’s true that NHS dental cover can be patchy; we don’t have an NHS dentist, so have dental insurance for the children, but my older daughter has quite severe tooth malalignment and so will get NHS orthodontic treatment, completely free, which would cost us £3500 if we had to pay (this is because her problems are bad; cosmetic-only problems are not covered by the NHS, but I think that’s fair enough). We had to wait a year for the treatment, but I think it was worth it to save so much money. My mother had a hip replacement at the age of 80, completely free, for which she only had to wait four months, and weeks of physiotherapy and followup treatment afterwards, free. The ward was full of ladies of a similar age having hip or knee replacements.
    So age is no barrier to good NHS treatment in my experience, and even those of us who are lucky enough to be able to afford health insurance will often choose not to use to because there is no advantage in doing so. The NHS makes sensible decisions based on evidence and need for the majority of the population; thus, it has just started paying for the HPV vaccine for teenage girls, so my 14 year old daughter will be vaccinated for that, free, this autumn; but it has recently decided that the benefit of mass TB vaccination (previously provided for decades here, although I know it has never been in the US) is no longer worth the cost, and so when she went to a high risk country this summer, we arranged to vaccinate her for it privately, which we had perfect freedom to do (since we could afford it, I realise: but those at particularly high risk of TB, such as children in certain immigrant communities, are still vaccinated by the NHS – why should it pay for my privileged daughter’s holiday vaccine?)
    But I am rambling. What I really wanted to say was:

    To my mind, the single, single biggest plus is the lack of fear about finance when disaster strikes unexpectedly and lives are turned upside down. I had a good friend who developed acute myeloid leukaemia and died 6 months later, this March, at the age of 48. She did not pay a penny for her treatment, which included several different types of chemotherapy, a bone marrow transplant, about 5 months in hospital, and a week in a hospice at the end. As I understand it, if she had been American there is a good chance that the insurance money would have run out, and as well as dealing with the loss of a mother and wife, her husband and two teenage children would be worrying about bankrupcy as well, even though they are comfortably off. In fact, given her husband is a lung cancer survivor, they maybe wouldn’t have had health insurance at all in the first place. That family could be mine next year, and I thank my lucky stars that, with all its faults, we have the safety net of the NHS so that if the unimaginable happens, we wouldn’t have financial disaster as well as emotional disaster. I don’t think most people in the UK have any idea that even the insured in the US can find themselves abandoned by the system, and to me that seems just unbelievably unfair and cruel.
    Sorry to be so long. And, SM, my sympathy to you. As I wrote once before, my dad has dementia, and I feel for you so much.

  276. Alison S, I think you should see about trying to get that comment up somewhere as it’s own piece as well – it’s brilliant and clear! Why on earth isn’t something like this what is being put into newspaper opinion columns and stuff? You write so well (actually as do loads of people writing here in comments, and obv the SP bloggers!) that I can’t understand how some of the substandard journalists who have writing *as their job* aren’t sacked in favour of people like you with your skillz!

  277. SM, I’m so sorry. Facing a parent’s terminal illness is really, really hard.

    I lost my mother this spring to brain cancer, seven years after her initial diagnosis. I was so grateful that she had a personal directive and power of attourney put together after she was first diagnosed. The cancer hospital provided good counselling services and helped her figure out what she would want, and then her lawyer drew up the documents.

    My grandmother really opposed the directive initially because it prioritized alleviation of suffering over extension of life, but she came to support it later. Mum did undergo treatment to extend her time with us (chemo, radiation and surgery), and that gave her several good years before she ended up needing full-time care. She spent her last two years in a hospice, and the care she received was amazing–as was the care the staff and volunteers gave us as her family.

    Thanks to Canadian public healthcare, we didn’t have to pay for any of it–not the surgeries, not hospice care, nothing. No “death panel” decided she couldn’t get care, even though we knew from the start that her condition was terminal. Her physicians did everything they could to give her as much quality time as possible, which was important to her because my youngest brother was still in his teens when she got sick.

    I was glad for those documents when it came near the end of Mum’s life. I had to fight with one of my aunts who was trying to get the nurses to intervene (wanting to force food and fluids/do a naso-gastric feeding tube). It was good to have that piece of paper to back me up when I said my mother wouldn’t want that.

    All this is a long and rambling way of saying that public healthcare provided the best standard of care I could imagine my mother having, and that making end-of-life care arrangements doesn’t mean deciding to die. It means thinking ahead so that your grieving family doesn’t have to figure out what you’d want. I don’t get why that’s so hard for people to grasp.

  278. For the record, what I said applies to wealthy fundies as much as it does to poor ones, and every SES point in between. I never specified anything having to do with “working class” Christians at all. I was just pointing out the internal inconsistency between claiming to be a “follower of Jesus” and resenting the shit out of helping those less fortunate than oneself. (And no, from my understanding of the New Testament, I don’t think Jesus would be okay with corporate profits taking precedence over everything else.)

    And also, I think it’s eminently possible our government would fuck up health care horribly. (Witness MassCare, where everyone was required to buy health insurance before they made sure they had enough primary care providers to go around. Not something you want to repeat on a national scale, that’s for sure, especially with all the people who have let health problems go for years because they couldn’t afford to get treatment.) I just reject the idea that it’s inevitable that they would fuck it up because Government Bad, Private Money Good. Private money is already the de facto ruler of our government.

  279. Skinner – find me a job, dude, and I’m there!

    MamaD I suspect if we were trying to create a government run public plan entirely from scratch I’d have a lot of the same concerns as people offering actual thoughtful criticism, as you are. And I have rather serious concerns about privacy issues, especially with electronic records (there’s too much recent history of government stealing our information and invading our lives for no reason other than it could get away with it for me not to be alarmed).

    That said, we have an existing model, Medicare and Medicaid, to build off of. Rather than having to invent the entire bureaucracy from scratch, it can be patterned after them. Which of course does not mean there will be no problems with it, but at least we have an idea of what will be involved.

    One of the most important things that’s gotten lost in the shuffle here is that no matter what passes, it’s not going to be perfect right out of the gate. Social Security and Medicare/Medicaid weren’t either. The thing progressives should (and seem to be) focus on here is getting the public option passed. That’s the hurdle. Refining it will take more rounds of reform, but we have to get that on the books to start with before we can make it work well.

    All this conversation about Christians who seem to not really follow some of the most basic instructions of Jesus reminds me of this whole C Street/The Family thing that Rachel Maddow was talking about. It sounded like some seriously skewed reinterpretation of the New Testament in particular that completely undermined what I was taught and believed the message of the Gospels was. It’s like a mutant version of Christianity warped to serve the interests of very rich, very powerful white guys and assure them their religion doesn’t actually really contradict with their unbridled avarice. Scary shit.

    DRST

  280. Sweet Machine, I am so sorry for you, your mom, and your family.

    I also think your “Intended Consequences” statement should go on a t-shirt that I can wear everyday, because that’s what I want to say to anyone and everyone.

    My thoughts and best wishes to the whole Machine collective.

  281. I am also going through a similar situation with my husband. I know the fear and sadness. I hate insurance companies. I have a post on my blog called “We already have death panels lurking inside insurance companies” at http://newsy1.wordpress.com I don’t usually promote myself on another blog but it is in line with your subject matter .

  282. I don’t know if I can link to it here, but I think if you google ‘avaaz petition healthcare lies’ you get links to two petitions against the lies being told about both UK and Canadian healthcare — asking people to ignore the lies etc. I think the idea is if enough people sign them it will hopefully make some news splashes in a bid to help the debate in the US get back to what is *actually* being proposed as opposed to what is being fibbed and lied about what is being proposed.

  283. What an eloquent post about something so very difficult to negotiate. I wish you and your family lots of love and peace during this time.

    It’s tragic that politicians use an issue such as this to further their own agenda, when in fact, it would be immeasurably helpful to so many people. I fail to grasp why a) the mind is not included in health care in many respects (our heads are attached to our bodies, last time I checked) and b) it is more socially acceptable to discuss the process of deciding to euthanize an animal than end-of-life care of a family member.

  284. lucizoe,

    Compassion is a fine thing, and I’m all in favor of it, which is why, though I’m opposed to a “public option” as proponents lay out, I’m for a government fund that would pay the medical bills for people who are hit with catastrophic medical bills. A similar situation actually happened to my parents and it was very difficult for them. And I don’t believe that medical care in countries with government-run systems is terrible. And I think that many liberals and conservatives are compassionate people.

    The problem we have isn’t as much compassion as arithmetic. In the U.S., social security and medicare are going broke. We’ve tripled the deficit this year alone. Unemployment, which is under-calculated, is creeping toward 10%.

    How compassionate is it to make young people pay into these bankrupt systems, that basically transfer money from poorer young people to older, more well-off people?

    How compassionate is it to force the children of today to pay for another entitlement program by paying off gynormous loans to the Chinese?

    How compassionate is it to tax small businesses out of business at a time when so many people are looking for work?

    How compassionate is it to reduce charitable deductions to help pay for this (which Obama has repeatedly proposed), which will undoubtedly hurt the work of charities and the people they serve?

    How many other worthwhile government programs could we fund with the money we’ll put into a government healthcare system that will be more expensive and less effective than instituting market based reforms?

    Or should we just keep printing more money?

  285. Revoltaire, I know concrete information makes abstract political musing less fun, but see Trix’s post up there for the information that universal health care is actually cheaper than anything the US has now or is likely to have in the near future.

    So by your own logic, clearly you will now switch to supporting universal health care, because the alternative is to “keep printing more money”?

    I won’t hold my breath.

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