Although the Supreme Court this past June upheld the Affordable Care Act, voices within the Republican Party seem unfazed by the high court’s ruling as new calls for repealing Obamacare have gone forth from none other than Paul Ryan and other individuals as well.
Health care reform, in its most robust sense, is a moral imperative that a society and a nation will be ultimately judged upon by its treatment of its most vulnerable citizens — the least of these.
And here we are, once again, hearing talk of repealing Obamacare and death panels. It is vital in light of these renewed, at best nonsensical assertions, and at worst, a craven example in fear-mongering, that we remember how and why health care reform was and is necessary.
Care delayed is care denied
While Obamacare has already barred insurance companies from denying insurance to children with pre-existing conditions, this consumer protection will be extended to all Americans by January 2014. Why this protection is important is supported by a tremendous amount of data.
A national survey (Commonwealth Fund Biennial Health Insurance Survey, 2007) estimated that 12.6 million non-elderly adults, 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market, were in fact discriminated against because of a pre-existing condition in the previous three years. It wouldn’t be a tremendous leap to say that amongst those who were discriminated against were the chronically and terminally ill.
When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/ her initial health status questionnaire. In most states’ individual insurance markets, insurance companies can retroactively cancel the entire policy if any condition was missed, even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.
Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition. If the disease is serious enough, could such a decision lead to death? And if so, wouldn’t that indeed be the very definition of a death panel?
And as the justifiable howls ascended into the atmosphere about not wanting government coming between the patient and the doctor, the fact is that was and is exactly what insurance companies had been doing for decades and was ignored and went unchallenged.
Resuscitation is futile
Although Obama’s health care program addresses the needs of the uninsured in a number of ways (uncapped coverage, employer incentives, etc.) it is uncertain how it corresponds to futile care laws in various states.
Futile care laws give doctors and hospitals the right to withdraw treatment from patients even when the patients have a living will or health care proxy expressing the desire to continue these measures.
According to a 2005 report by the National Right to Life Committee, 11 states require that a patient be given life-sustaining treatment until a transfer is completed, without prescribing a deadline. Fifteen states and the District of Columbia have laws that require treatment pending a patient’s transfer but do not define the type of treatment.
Twenty-four states and territories have laws addressing the issue but are ambiguous about treatment pending a transfer. In general, futile care laws enable the following situation: Person A has a severe medical condition and/or disability. He or she desires to continue life sustaining treatment that the doctor considers futile or wasteful. The doctor brings the case to a hospital ethics committee (or panel), which, after deliberation, overrides the patient’s stated desires regarding treatment.
The person and his or her family then have 10 (in Texas) to 14 days (in Virginia) to find another hospital that will treat them, or the treatment will be withdrawn, resulting in death.
Unfortunately, many hospitals will not treat patients whose treatment is considered futile by another hospital, which condemns these patients and their families to hospital/state imposed death, or contentious court battles, often in their last few weeks of life. And yet, in the midst of all this reform, it seems that futile care laws are still binding in various states — in position to nullify or negate the impact of the Affordable Care Act in certain cases.
At last check, only 10 states have passed laws forbidding hospitals to withdraw treatment if family members or guardians object and require treatment to continue until the patient can be transferred.
This type of state and medically-sponsored, life and death discrimination does not need to be codified to be a threat. For example, the 2005 Haleigh Poutre case involved Massachusetts social services attempting to remove her feeding tube and ventilator against her biological mother’s wishes (she had been abused by her adopted family), which was only stopped when she began showing signs of alertness after a judge gave the go-ahead to override her family’s wishes.
Similar cases have occurred in New Jersey, Alaska and other states without specific futile care laws. This would be considered legislative or policy (public and business) death panels. Where has the outrage been all those years? Where were the chants of Hitlerism and fascism?
To illustrate this hypocrisy (and in some cases cognitive dissonance), during the Terry Schiavo case what made the actions of the White House and the then Republican-led Congress (with plenty of Democrats in tow as well) even more duplicitous, is that on March 15, 2005 at Texas Children’s Hospital, Sun Hudson (a six-month-old infant) was taken off of a ventilator — in spite of his mother’s objections — and died in his mother’s arms.
He was born on Sept. 25, 2004 with a rare and potentially fatal genetic disorder. He was placed on a ventilator because his lungs had failed. This child died without fanfare, protest or judicial review. The cruel irony is that Texas Children’s Hospital was well within its “rights” to do so because of the “Texas Futile Care Law” signed by then Gov. George W. Bush in 1999.
According to this law, a Texas hospital with the consent of a doctor and ethics committee can withdraw care they deem futile and too costly even against the wishes of the patient or legal guardian. Where were the platitudes about “erring on the side of life” as this six-month-old baby took its last breaths in his grieving mother’s arms?
Cross my heart and hope not to die
The absence of health insurance creates a range of consequences, including lower quality of life, increased morbidity and mortality and higher financial burdens. In 2002, the Institute of Medicine (IOM) an estimated that 18,000 Americans died in 2000 because they were uninsured. Since then, the number of uninsured has grown.
Based on the IOM’s methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.
Much subsequent research has continued to confirm the link between insurance and mortality risk described by IOM. In fact, subsequent studies and analysis suggest that, if anything, the IOM methodology may underestimate the number of deaths that result from a lack of insurance coverage.
More broadly, these estimates should be viewed as reasonable indicators of the general magnitude of excess mortality that results from lack of insurance, not as precise “body counts.” The true number of deaths resulting from being uninsured may be somewhat higher or lower than the Institute of Medicine’s estimates, but that number remains significant.
Once again, is this not the very definition of death panels? Are we not already consigning people to die? Are we supposed to get worked up about the people who, according to the myths and lies about death panels, might die and not show any concern for those who are already dead and dying?
Counting the cost
Let’s conclude this composition with some questions and an appeal. The estimates for Obamacare has ranged anywhere from $700 billion to 1.5 trillion — according to the numbers that have been crunched by various entities.
A high sticker price to be sure and yet we are already footing the bill for the uninsured and underinsured: In emergency room visits, when our neighbors homes are foreclosed because of bankruptcy related to medical debt (about 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs) the property value of our homes go down, and the preventable loss of human life to diseases and illnesses of the primary bread winners of families comes back on us as a country and society one way or another.
Nevertheless, the most compelling argument one could construct against the “repeal Obamacare” voices is that in the run-up to the Iraq War, by and large, we did not ask the cost of one bullet or bomb; we did not ask the cost of the care for the mangled body of one soldier; we did not ask the cost, in pain, of the families in America and Iraq who would lose their sons and daughters (another kind of death panel).
We didn’t ask the cost of the displacement of millions of Iraqis; and we did not ask the cost of one single brick used in rebuilding a country we were misled into invading.
The actual dollar amount for both wars were not even items included in our budget up until five years ago, and we as American citizens, for the most part, didn’t ask to see the books. Now, when it comes to health care reform, it’s all about costs and deficits?
Because of past and present policy, health insurance companies enjoy fat bottom lines and unjust health care practices – the millions spent in lobbying Congress doesn’t hurt either — subsidizes the multimillion dollar bonuses and salaries for their executives. So what were these protestations regarding death panels really about?
If it was really about death and the sustaining of life, then why were the voices muted before Obamacare? If one believes so strongly in life, how can they ignore the threats to life that have been posed by our past, and yes, current health care system?
Going back to the contrast concerning the dialogue before the Iraq War and our current health care reform discussion: What does it say about us as a nation when we are silent and malleable in our decisions to kill, but resort to fear, hate and dishonesty in our decisions to heal?