Time Magazine promotes Death Care Agenda


The new ‘pull the plug’ care system is now being celebrated by re-known writers and philanthropists as a way to cut down healthcare costs. Not a word about preventive care, though. In an article authored by writer Joe Klein, Time praises the goodness of austere medical care when it comes to keeping the elderly alive, and how doctors together with sons or daughters make the decision about whether a sick, old person should live or not.

The June 11 issue of Time Magazine sells the idea that is should be fine for anyone to decide on someone else’s health or death based on the premise that it will help save resources for others who remain alive, or as Bill Gates said, to hire more teachers. In a video interview, Joe Klein explains how the Geisinger medical system helped him during a time when he was not convinced what to do with his sick parents.

The phone call came on a cloudy morning in Iowa. I was interviewing Senator Chuck Grassley in his farm kitchen, surrounded by a sea of corn. Mom was back in the hospital again. She had pneumonia. She wasn’t eating. “If we don’t put in a feeding tube,” my mother’s internist told me, “she won’t survive on her own.”

Mom had always been vehement about how she wanted to go. “Just pull the plug. Let me die,” she would say, with more than a hint of melodrama. “I don’t want to be a vegetable.” But was she a vegetable now? She had…

See Klein’s video on Time Magazine’s page here. In the video, he sort of blames the traditional medical system for providing services or procedures that he says aren’t necessary, and that doctors usually request because most doctors are paid based on the number of services or procedures they ask patients to take. Klein says that the Geisinger model is better than the traditional one because it saves money as it rations care for patients under the doctor’s guidance and a son or a daughter’s decision not to feed a parent with a tube, but to let him or her die.

One of the biggest cheerleaders of the Geisinger model is US president Barack Obama, whose death panels ran by people who believe that saving a money in the government run healthcare system must come before providing care to an elderly or sick patient. During a September 9, 2009 speech in Congress, Obama spoke about how rationed medicine implemented by the Geisinger system was an example of high quality care at a lower cost. He did not mention, though, that the costs are reduced due to the denial of care, not because the services are somehow cheaper as provided by Geisinger medical centers.

Joe Klein himself admits that the Obama administration wants to change healthcare by moving it in the direction of the Geisinger system. He portrays doctors as bad people because “they do not want to be told what to do,” says Klein. He believes that this opposition stems from the fact that doctors income would be greatly reduced and not because doctors actually know better what services and procedures are needed in order to save the life of a patient, elderly or otherwise. “Fee for service medicine is more profitable for them”, adds Klein. For Mr. Klein just as for Mr. Obama and his advisers, the extra test or monitoring of a patient is often unnecessary even though those tests are the closest thing to preventive medicine. Meanwhile, the establishment of real preventive care is continuously denied by the corporate-controlled healthcare system that refuses to offer it to patients.

In the case of Klein’s father, he says the doctors at Geisinger advised him not to hydrate his dad because even if he did that, he would have to be back in the hospital in a few weeks due to his kidney problems. In his mind, keeping his father properly hydrated to have him around for a longer period of time was not worth the expense that the medical care system would have to endure. According to Klein, the doctors kindly convinced him that it was better to let his dad go. “That level of candor is the kind of thing that most people do not get from fee for service medical doctors,” said Mr. Klein. “That’s what made the death of my parents tolerable,” he concluded.

“For five months, I was my parents’ death panel. And where the costly chaos of Medicare failed, a team of salaried doctors and nurses offered a better way,” reads one of Joe Klein’s revealing comments about his experience. That is what the Obama administration and any other government that advocates for the unsustainable government-controlled socialized medicine model want everyone to have access to. Socialized medicine is not about providing medical care at a lower cost which makes it accessible to most people, but about reducing the costs of medical attention by letting people die when they are no longer profitable. Socialized medicine, for example, does not invest anything more than the current system into preventing disease, which most doctors do not even know how to do. An initiative to fund preventive medicine instead of providing resources to corporate-controlled healthcare systems or government managed Obamacare, would greatly reduce the costs of medical attention without having to choose between keeping a parent alive or hiring a new teacher.

The only thing more successful for big government than establishing death panels composed by bureaucrats who decide whether a person lives or not, is to actually convince people that death panels is the way to go and to turn them into their relatives’ own death panels, as Joe Klein confesses he was in the case of his parents. Under the new medical system that is taking root in the United States, quality care is synonymous with rationed care. To say that the current medical care system is bad because doctors issue requests for services and procedures that may or may not be necessary, but that people can trust other medical professional in hospices because for some reason they are more ethical about providing care, is simply preposterous. On the contrary, in a rationed care system, medical professionals are assured to receive a minimum compensation they are comfortable with, which might facilitate their decision not to provide care to patients if they believe it is not necessary or worthwhile and that it would lower the costs of the most likely government-controlled medical system.

A healthcare system that promotes austerity and rationing for patients is not one that will offer the best care for patients, especially for elderly people, but one that will look for every possible reason not to provide much needed medical attention. Its goal is to cut expenses, not to improve the life of the patient. It is naive to believe that doctors under the Geisinger or any other rationed system will have the interests of the patient at heart when they don’t have any incentive to do so. In fact, their incentive is mostly to cut costs and deny care while making the choice of death look kind and benevolent.

The way to solve the debacle of the medical care system anywhere is to prohibit the medical industry from writing the laws that govern such system, invest in preventive care and not in the perpetuation of the mass drugging of the population, to actually prepare doctors to treat patients as supposed to put them on pharmaceuticals — which by the way kill more people than they help — for the rest of their lives and to educate people about the the thousands of poisonous ingredients being put in the food and water, so that they can choose not to consume them. A good healthcare system is not mutually exclusive. It is possible to have great care without rationing.

In U.S. Elderly Medicare Patients Get Less Attention

Washington Post

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you’re a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he’ll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District’s Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

“It’s not easy. But you realize you either do this or you don’t stay in business,” she said.

Doctors across the country describe similar decisions, complaining that they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

And that’s not even taking into account a long-postponed rate-setting method that is on track to slash Medicare’s payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy’s overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors’ pay rates in 2002, Congress has chosen to put off the ever steeper cuts called for by the formula ever since.

This month, the Senate passed its fourth stopgap fix this year – a one-month postponement that expires Jan. 1. The House is likely to follow suit when it reconvenes next week, and physicians have already been running print ads, passing out fliers to patients and flooding Capitol Hill with phone calls to convince Congress to suspend the 25 percent rate cut that the SGR method will require next year.

Such temporary reprieves have increased the potential pain down the road, compounding not only the eventual cut but the cost of doing away with it for good, now estimated in the tens of billions.

The lobbying blitz by doctors also comes amid concern in Washington that Medicare spending is spiraling up so fast the nation can’t afford to boost it further by significantly raising doctors’ pay. And government analysts and independent experts suggest that although doctors could not absorb a 25 percent fee cut, the claim that they have been inadequately compensated by Medicare until now is wildly exaggerated.

Among the top points of contention is the complaint by doctors that Medicare’s payment rate has not kept pace with the growing cost of running a medical practice. As measured by the government’s Medicare Economic Index, those expenses rose 18 percent from 2000 to 2008. During the same period, Medicare’s physician fees rose 5 percent.

“Physicians are having to make really gut-wrenching decisions about whether they can afford to see as many Medicare patients,” said Cecil Wilson, president of the American Medical Association.

But statistics also suggest many doctors have more than made up for the erosion in the value of their Medicare fees by dramatically increasing the volume of services they provide – performing not just a greater number of tests and procedures, but also more complex versions that allow them to charge Medicare more money.

From 2000 to 2008, the volume of services per Medicare patient rose 42 percent. Some of this was because of the increasing availability of sophisticated treatments that undoubtedly save lives. Some was because of doctors practicing “defensive medicine” – ordering every conceivable test to shield themselves from malpractice lawsuits down the line.

“Then you have doctors who order an MRI for an unremarkable headache or at the first sign of back pain,” said Robert Berenson, a Commissioner of the Medicare Payment Advisory Commission, an independent congressional agency. “It’s pretty well documented that it doesn’t help patients to have those scans done in these cases. But if you have the machine in your office … why not?”

Whatever the cause, the explosion in the volume of services provided helps explain why Medicare’s total payments to doctors per patient rose 51 percent from 2000 to 2008.

A review of physicians’ incomes suggests that specialists – who have more opportunities to increase the volume of the services they offer than primary-care doctors – reaped most of the benefit.

On average, primary-care doctors make about $190,000 a year, kidney specialists $300,000, and radiologists close to $500,000, figures that reflect the income doctors receive from both Medicare and non-Medicare patients. The disparity has prompted concern that Medicare is contributing to a growing shortage of primary doctors.

Still, even if primary-care doctors had to rely exclusively on Medicare’s lower payment rates their incomes would only drop about 9 percent, according to a recent study co-authored by Berenson, who is also a fellow at the non-partisan Urban Institute.

“The argument that doctors literally can’t afford to feed their kids [if they take Medicare's rates] is absurd,” said Berenson. “It’s just that doctors have gotten used to a certain income and lifestyle.”

Regardless of their motivation, if doctors skew their patient base away from Medicare too drastically seniors’ access to medical care could be limited.

Is that happening? Again, opinions vary. Based on its studies as well as those done by others others, the Medicare Payment Advisory Commission has concluded the share of affected seniors has been small, and perhaps most significantly, lower than the share of privately insured patients ages 50 to 64 who also report access problems.

But the American Medical Association cites a recent online survey that it commissioned in which nearly one-third of primary-care doctors said they are currently restricting the number of Medicare patients in their practice.

For Michael Trahos, the geriatric specialist in Alexandria, that has meant spacing out routine visits by his Medicare patients such that their share of his weekly appointments has dropped from about half to less than one-third. Trahos said that if a Medicare patient has a serious condition, he will see the person more frequently. But Trahos said it makes him uneasy to push even apparently healthy elderly patients back to twice yearly visits.

“Is it the proper thing to do? Probably not,” he said. “These are patients who should be scheduled for proper maintenance every three months.”

Adam Weinstein, the kidney specialist in Easton, has taken to supplementing his three-doctor practice by doing medical IT consulting several hours a week. But although the pay is far greater than what he would receive seeing Medicare patients, who make up 70 percent of his practice, the side work means he has less time to serve them. Not only must Weinstein make them wait longer for an appointment, he said, he can no longer afford to answer their phone calls.

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