Do the Math: What Happens when Bureaucrats
When 53-year-old Randy Stroup of Dexter, Ore., applied to Oregon's
state-run health plan for help with his chemotherapy, bureaucrats sent
him back a letter. The letter stated that the state would not cover his
chemotherapy but would pay for the cost of an assisted suicide.
The incident revealed an important truth about government health
bureaucrats: they are not always compassionate, but they are good at
Sen. Max Baucus
The latest U.S. Senate healthcare reform proposal, by Montana Democrat
Sen. Max Baucus, recently raised a ruckus by calling for reducing
Medicare payments "by five percent if an aggregation of the physician's
resource use is at or above the 90th percentile of national
Grading on such a curve, physicians who provide the least care win.
When the government calls the shots in medicine, cost can replace care
as the measure of effectiveness.
That's why some U.S. legislators have triggered protests by proposing
to have government bureaucrats virtually barge into the physician's
exam room by funding the counseling of patients about end-of-life
considerations. Concerns grew even more when the assisted suicide group
Compassion & Choices bragged of helping to shape the counseling
"America's Affordable Health Choices Act" (HR 3200) in Section 1233
directs government funds to pay healthcare professionals to give
patients "an explanation of orders regarding life sustaining treatment
or similar orders, which shall include--the reasons why the development
of such an order is beneficial to the individual and the individual's
Note that the one-sided "counseling" includes no information about why
such an order might not be beneficial to the individual.
Of course, counseling by impartial experts and determining written
guidelines for end-of-life decisions can be helpful, especially when
the patient also secures a personal proxy whose devotion to her welfare
is unquestioned. Yet while advance directives may be used to specify
the continuance of or quality of care, in actual practice they tend to
emphasize limitations on care. Advance directives also offer no
guarantee that a healthcare institution will actually follow the
patient's wishes in a healthcare crisis.
published in the New England Journal of Medicine put it bluntly:
"The effectiveness of written advance directives is limited by
inattention to them." 
In a paper aptly titled, "The Limited Wisdom of Advance Directives,"
the President's Council on Bioethics noted, "Advance directives cannot
be understood in the abstract, separate from the specific context in
which they emerged or the legal and public policy environment in which
they now operate."
The context of the end-of-life "counseling" program of HR 3200 is the
bill's explicitly stated purpose--to "reduce the growth in health care
spending." As health bureaucrats in assisted suicide states like Oregon
and Washington have quickly discovered, premature deaths are cheaper
Even absent legal assisted suicide, government bureaucrats can save
money simply by convincing patients to accept a denial of care, and to
put it in writing through an advance directive.
The context of state-sponsored chats with patients about their
expensive end-of-life care also includes President Obama's revealing
call for "a very difficult democratic conversation" about "those toward
the end of their lives [who] are accounting for potentially 80 percent
of the total health care bill out here." (Click
here for report)
In fact, according to a story in USA
"Estimates show that about 27% of Medicare's annual $327 billion budget
goes to care for patients in their final year of life."
Dr. Ezekiel Emanuel
The counseling context is also found in the writing of Dr. Ezekiel
Emanuel, a health policy advisor to President Obama and brother of the
President's chief of staff. Dr. Emanuel has written that some medical
services should not be guaranteed to those "who are irreversibly
prevented from being or becoming participating citizens....An obvious
example is not guaranteeing health services to patients with dementia."
With just 41 percent of Americans supporting President Obama's
healthcare reform plan, the President and his Congressional allies
would like us all to forget such revealing statements and simply heed
their reassuring sales pitch.
The vast majority of American patients who want to keep the government
out of their private conversations with their physicians simply aren't
Jonathan Imbody serves as Vice President for Government Relations for
the Christian Medical Association, the largest faith-based association
Contact: Jonathan Imbody
Date: October 12, 2009
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coordinating body for local pro-life chapters representing thousands of
Illinois citizens working to restore respect for all human life in our
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persuasions, various faiths and diverse economic, social and ethnic
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been working to end abortion and restore legal protection to those members of the
human family who are threatened by abortion, infanticide and euthanasia. Diverse though we are, we hold one common belief - that
every human being has an inalienable right to life that is precious and must be protected. IFRL is
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