Posted by Thomas Nephew on August 12th, 2009
I got one of the health care e-mails that have been ricocheting around the Internet yesterday. It was forwarded by a dear relative of mine, with the subject line “FW: SENIOR DEATH WARRANTS.” I’ve posted it on my Google Docs site — of course, without any identifying information, and without editing. I want to respond to various claims made in that e-mail.
Throughout the discussion below, I’ll link to relevant parts of proposed legislation to back up what I’m saying. I’ll usually be referring to the text of H.R.3200, also known as “America’s Affordable Health Choices Act of 2009″ — this is one of the main House bills. The link leads to an “all about H.R.3200″ web page at govtrack.us that enables links to very specific parts of the bill. However, readers with slow browsers or older computers may be better off consulting the text version of the bill.
The email begins by recounting a conversation with a doctor:
|…He then asked how old I was, and when I replied 70, he said that if this legislation goes through as intended by the powers that be, that I probably would not be able to get [a cancer treatment] next year, as that would be money better spent on someone else with greater longevity. I would be referred to someone to “counsel” me.|
The provision merely provides coverage under Medicare to have a conversation once every five years if – and only if – a patient wants to make his or her wishes known to a doctor. If desired, patients may have consultations more frequently if they are chronically ill or if their health status changes.
|I asked him why the AMA had recently endorsed the plan. He replied that only about 15% of the nation’s doctors were members of AMA, and most of them were not really on the front lines of doctorhood but in some other areas of medicine. [...]|
REPLY: NOT RESPONSIVE. It’s true that the AMA has endorsed a health care reform plan; given the organization’s opposition to health care reform in the past, that’s big news. The main reason, according to reporter Jeffrey Young of The Hill, is that the bill envisions a “permanent fix to a Medicare payment system that annually calls for doctors fees to be cut.”
This was potentially an expensive gift to doctors; so if the doctor is advocating keeping annual fee cuts intact, I’m right there with him.
|SENIOR DEATH WARRANTS: In England anyone over 59 cannot receive heart repairs or stents or bypass because it is not covered as being too expensive and not needed.|
REPLY: FALSE. First, while it’s too bad, no major health care reform bill advocates a health care system anything like England’s. But second, the statement is flatly wrong. Factcheck.org actually contacted the U.K. Department of Health and and an English nonprofit group advocating for older persons about this claim:
[A spokesman] said medical procedures in the U.K. are not routinely denied for older people. The National Health Service, the U.K.’s public health care service, has a constitution which prohibits discrimination on the basis of age and other factors. “The NHS Constitution states that the NHS provides a ‘comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief,’ “ the spokesman said.
We also contacted a nonprofit group, England’s Age Concern and Help the Aged, which works to stop age discrimination in various facets of life, including employment and health care. Age Concern’s press office had never heard of any kind of prohibition on heart surgery for those 60 and older.
|Obama wants to have a healthcare system just like Canada ‘s and England ‘s.
REPLY: SADLY, NO. First, it would be impossible to have a healthcare system “just like Canada’s and England’s” because they have different systems. Canada has a “single payer” health care system, in which health care costs are negotiated between health care providers and the government or an independent agency — a kind of “Medicare for all” instead just for older persons. Another country with a successful kind of single payer health care system is France — according to that left wing magazine Business Week.
For its part, England takes things a step farther with a socialized system in which the government directly employs health care providers. There’s no rationing, and excellent health care; one of the excellent hospitals there recently cared for quadriplegic* Stephen Hawking, no matter what you’ve heard differently on that score. In a 2000 World Health Organization report, the US ranked well behind England, France and Canada* in overall health system performance and health levels.
Of these two models — ‘single payer’ system and ‘socialized’ system — Obama has in the past spoken favorably of a “single payer” model, especially in 2003. During the 2008 campaign, he said that was the system he’d go with if he were building a health care system “from scratch,” but when asked “Why not single payer?” responded:
“People don’t have time to wait,” Obama said. “They need relief now. So my attitude is let’s build up the system we got, let’s make it more efficient, we may be over time—as we make the system more efficient and everybody’s covered—decide that there are other ways for us to provide care more effectively.”
He essentially reiterated this at a town hall meeting on Tuesday in New Hampshire:
I have not said that I was a single-payer supporter because, frankly, we historically have had a employer-based system in this country with private insurers, and for us to transition to a system like that I believe would be too disruptive.
To weigh in on the controversy this caused: the transcript shows his questioner had already made the point that Obama supported single payer in the past. I don’t think he meant anything other than that in the current debate, since taking office, he has not said he’s for a single payer plan.
To me that was and is a disappointment, and it makes the claim that he wants a Canada-style system (let alone an English one) seem especially far-fetched. He should, but he doesn’t. It’s been said the U.S. doesn’t have a health care system, it has a risk management system. That system is designed to extract profits by minimizing the amount it pays out for health costs; that’s achieved by not insuring people who might cost a lot, and by reneging on payments when people actually do cost a lot.
So: Obama doesn’t want a single payer system? That’s a shame; I’m as disappointed as you are.
|Please do not let Obama sign senior death warrants. [...]|
REPLY: VERY MISLEADING. To restate what’s written above, most of the claims about this misunderstand or misrepresent something completely different: the idea that many people want to make their own plans about how long to stay on life support if there’s no chance of recovery, rather than leave that up to anyone else. That takes time, some expert advice, and therefore some money to understand the choices involved; the bill simply authorizes that such time and resources are allowable — not required, but allowable — Medicare expenses, every five years, or more often if the person has a life-threatening illness.
There will be no senior death warrants. I promise. But no need to take my word for it — here’s what Republican Senator Johnny Isakson (GA) has to say about it in a Washington Post interview on Monday:
I just had a phone call where someone said Sarah Palin’s web site had talked about the House bill having death panels on it where people would be euthanized. How someone could take an end of life directive or a living will as that is nuts. You’re putting the authority in the individual rather than the government. I don’t know how that got so mixed up.
|Most of you know by now that the Senate version (at least) of the “stimulus” bill includes provisions for extensive rationing of health care for senior citizens.”|
REPLY: AGAIN, FALSE. The stimulus bill (H.R. 1) contains no mention of rationing whatsoever, ‘extensive’ or otherwise. The claim appears to echo** a February article by one Betsy McCaughey that claims, “If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face … rationing.”
Instead, Title VIII of that bill simply authorized the Agency for Healthcare Research and Quality to conduct “comparative effectiveness research” (a.k.a. “CER”) — essentially, studying which alternative treatments got the most health care bang for the buck. Nothing in the bill requires doctors to blindly adopt any particular medical treatment.
More to the point, the Senate Health, Education, Labor and Pensions (HELP) Committee “Affordable Health Choices Act” actually prohibits such medically unsound use of comparative effectiveness research findings. As Senator Barbara Mikulski put it,
If you go to page 323 of the actual bill, where it says ‘Incorporation.’ We absolutely prohibit that this, anything related to the Center For Health Outcomes, otherwise known as comparative effectiveness, that there “shall not be construed as mandates for payment, coverage, or treatment.” It is in the bill. Page 323, lines 5 through 7.
No need to take her word for it, either — have a look at page 323 of the HELP bill for yourself. This (non)issue got quite a bit of attention when the stimulus bill was being discussed. To watch a good review of McCaughey’s claims by CNN’s Elizabeth Cohen, click here.
|The author of this part of the bill, former senator and tax evader, Tom Daschle was credited today by Bloomberg with the following statement: Bloomberg: Daschle says “health-care reform will not be pain free. Seniors should be more accepting of the conditions that come with age instead of treating them.”|
REPLY: BADLY MISQUOTED. The miracle of Google reveals that Daschle said only the first sentence attributed to him here — the second, concluding double quote should have come after the words ‘pain free.’ The whole passage is actually from the same article by conservative pundit Betsy McCaughey***; the rest of the ‘quote’ is her characterization of what she believes Daschle is implying, not a direct quote of what he actually says. Go ahead, see for yourself.
Moreover, Ms. McCaughey herself told Politifact (a fact checking column in the St. Petersburg Times) that the second sentence — “Seniors should be more accepting…” — “was her paraphrasing of an argument in Daschle’s book in which he quotes David Mechanic, a health care policy expert at Rutgers University, saying, “more and more of what were once seen as social, behavioral, or normative aspects of every day life, or as a normal process of aging, are now framed in a medical context. … Whether wrinkles, breasts, or buttocks, impotence or social anxieties, or inattention in school, they all have become grist for the medical mill.” (via Snopes.com)
To use that quote in the way Mccaughey did was exceptionally dishonest. As Politifact put it, ” Not treating wrinkles is one thing. Not treating, say, heart disease, is another.”
|If this does not sufficiently raise your ire, just remember that our esteemed Senators and Congress men have their own healthcare plan that is first dollar or very low co-pay which they are guaranteed the remainder of their lives and are not subject to this new law if it passes.|
REPLY: PARTLY TRUE, PARTLY FALSE. The Senators and Congressmen do have their own healthcare plan, which they share with thousands of other federal employees. As the “Urban Legends” site snopes.com wrote about an earlier draft of the same email:
Members of Congress (along with all other federal employees — everyone from the President to postal workers) are eligible for the Federal Employee Health Benefits Program (FEHBP), which is not a single health care plan but rather a collection of many different private health insurance plans from which enrollees can choose. In general, the FEHBP offerings are similar to Medicare but provide significantly better medical coverage and benefits than many Americans have ..
…perhaps most significantly, no “pre-existing conditions”: once a federal employee is hired, any illness or injury is covered regardless of prior health status.
I can’t confirm or rebut the claim that members of Congress can keep this coverage after they leave Congress. According to Tom Philpott of Military.com, they pay premiums set to cover 28% of health care costs. As the new law does not compel anyone to join any specific health care insurance plan, it’s misleading to speak of anyone — Congressmen included — as being somehow “subject” to it.
|…we have the ability to address and reverse the dangerous direction the Obama administration and its allies have begun and in the interim, we can make their lives miserable.|
REPLY: HERE’S WHAT I THINK IS DANGEROUS: more than 26,000 Americans die every year because they lack access to medical care. A million families declare bankruptcy each year due to medical costs—62% of all bankruptcies. America spends 16% of GDP on health care, about twice as much as any other country, and if we do nothing, those costs will rise to 37% by 2050. People are camping out by the hundreds when they have a chance to get free health care.
I understand very well opposing an occupant of the White House — I felt that way myself for eight years. But I didn’t make up stuff about my opponents or their plans, I did my best not to relay stuff before I’d tried to check it out, and when I was wrong I said so.
We’re all entitled to our own opinions, but we’re not entitled to our own facts. We should all check what we write — and check what we read.
CROSSPOSTED to American Street, DailyKos.
CREDITS: In the course of drafting this, I discovered that Snopes.com beat me to parts of it with a long debunking of a prior draft of this email (one mentioning Natasha Richardson’s death). I arrived at many of the same conclusions myself (see, e.g., the McCaughey/Daschle quote mixup), but cite Snopes for the FEBHP reply.The stats in the final reply are via Kathy Flake, from an excellent roundup of the health care debate at this point.
EDITS: 8/13: footnote on Stephen Hawking added; France has a “successful kind” of single payer system in that everyone has a basic Medicare-like coverage, and people supplement that coverage with personal insurance, often through their employers (thanks, Kathy). 8/14: “Moreover, Ms. McCaughey told” paragraph and links added.
UPDATES: 8/13: Welcome, OpenCongress readers! 8/14: “False ‘Death Panel’ Rumor Has Some Familiar Roots” (Rutenberg, Calmes, NYTimes): “Rather, [the death panel rumor] has a far more mainstream provenance, openly emanating months ago from many of the same pundits and conservative media outlets that were central in defeating President Bill Clinton’s health care proposals 16 years ago, including the editorial board of The Washington Times, the American Spectator magazine and Betsy McCaughey, whose 1994 health care critique made her a star of the conservative movement.”
* Stephen Hawking suffers from a “variant of the disease known as amyotrophic lateral sclerosis (or ALS, a.k.a. Lou Gehrig’s disease),” so that he has lost the use of “his arms, legs, and voice, and is now almost completely paralysed.” This loss of use of arms and legs broadly fits the definition of ‘quadriplegic’, though it’s not the usual kind of ‘injury to the spinal cord.’
* WHO year 2000 rankings on overall health system performance, out of 191 countries: France 1st, UK 18th, Canada 30th, and USA 37th out of 191 countries. Rankings on health level per se: France: 3rd, Canada: 12th, UK: 14th, USA: 24th. See the report for definitions.
** True, others may have said the same thing, but the next paragraph is definitely from the McCaughey article, so the simplest conclusion is that both claims were prompted by that article.
*** It turns out that McCaughey has a very long history of, um, making demonstrably false claims about health care proposals.
UPDATE, 4/21/10: More Malarkey About Health Care (Henig, FactCheck.org)