The Wisdom of an Obamacare Doc

Just over a week ago, Wesley Smith bloggedthat Diane Meier Speaks Wisdom.  As discussed in an earlier post here at Belbury Review, Smith’s column left a misleading impression that Dr. Meier might be pro-life.  Now Smith’s story is popping up in all sorts of places (for example here and here and here).

The story was this:  Last month, at the end of an hour-long speech in Vermont, Dr. Diane Meier explained why she is against assisted suicide  (video of entire speech is here).  Great.  Good that she is against assisted suicide.  But here is the really important question:  Where is the virtue in renouncing assisted suicide while, at the same time, working to establish (dare we say it) death panels?

Titled “Palliative Care:  A Cure for Meaningless Suffering,” Meier’s talk had little to do with medicine and a lot to do with politics.  Here are some samples:

[click photo to go to video page]
“The palliative care patient population [is critical because they are] the 10% of Medicare beneficiaries who have five or more chronic conditions.  And that group of Medicare beneficiaries accounts for two-thirds of all spending.  OK? . . . The sick Medicare beneficiaries are driving the overwhelming majority of spending.”

She wants single-payer healthcare (socialized medicine):

When you guys [in Vermont] pass the first single-payer bill, maybe there will be a job for me [applause] Because maybe you guys will establish a rational model and the rest of us will fall like dominoes.

Mocking conservatives:

And here’s the New Yorker, commenting on our political situation.  It’s two guys hauling themselves through the desert, and one guy says “rescue be damned; our Conservative principles will see us through.

Same old lies:

[Regarding quality]:  We know that about 50 million Americans have no health insurance at all, and therefore no access to healthcare.  And we know that there is a great deal of preventable mortality that is associated with not having health insurance.

More lies, and a threat:

And as President Obama said both during his campaign and afterwards with the healthcare reform debate, healthcare spending is THE primary threat to the American economy and way of life.  . . .There was talk about this in the ’90s . . .   The smart money is that this time we’ve got to get real about it, and get control over this open spigot, or as what I like to say to my colleagues, “The party’s over, guys.”

Embarrassed to be an American:

The US [spending] is so far above all our neighbor countries, it’s breathtaking and embarrassing to be an American . . .

That evil old traditional fee-for-service is like heroin:

It’s not fair to expect the US government to be able to change the US’s addiction to fee-for-service overnight.  Those of us in medicine know you don’t take an addict cold turkey off of his or her heroine overnight; you have to taper, or the patient will die. So I would argue that fee-for-service is an ADDICTION in this country.  We are addicted to it; many people make a lot of money on things the way they are, and are determined not to have them changed.  It has to be a gradual process of change.  And that gradual process is what’s built into the health reform bill.  Very gradual increases in paying people for quality; helping people to get used to working under a fixed budget, which we used to call capitation, but now we call it accountable care organizations and patient-centered medical homes, and bundling strategies.  These are all politically correct terminology for capitation; and gradually increasing levels of capitation.  Now, that was very effectively bashed both during and after health reform, as rationing and euthanasia.  And it was very easy to attack it as rationing and euthanasia, but the fact remains that unless we are able to think about both quality and costs, we will become a third world nation ourselves, just because of healthcare spending.”

Come to think of it, candy makers and farmers are evil too:

The people on the committee I was working on were trying to get that Food Safety Law passed, and so many interests groups – from both the people who make candy and sell it in the machines in schools, to the Small Farms Administration that did not – small farms did not want to be restricted on what pesticides they could use – so that was a huge lobby – everything was a negotiation.  It’s really hard to do good.  But, the voice of the people is determinative, and if we are not talking to and engaging the people and the public the value of our work, we will have no voice; so public awareness is crucial.

Take money from healthcare and put it into social goods (redistribution):

We have no resources for social goods.  New York State . . .between prisons and health care, spends 90% of its budget.  That leaves 10% for everything else:  schools, prenatal care; everything.  I mean, what kind of society are we, if those are the only things we think are worth spending money on

Comparative effectiveness (Berwick’s thing):

[on Comparative effectiveness] This is has become a political football labeled rationing and euthanasia and death panels.  Death panel caricatures have made this topic completely untouchable.  You…They won’t even talk about comparative effectiveness research; that’s CODE for rationing and euthanasia in Washington at this point.  And as my colleague Bob Wachter said in a masterpiece of understatement, “American political discourse is not yet mature enough to support realistic discussion about difficult issues.”

Another way to ration:

The Affordable Care Act – health reform – basically seeds expansion of new delivery and payment models – all of them aimed to improve the value equation by setting limits on spending, and paying for quality or penalizing for poor quality.  So actually just as a consumer would not buy a washing machine that Consumer Reports said was terrible, the government is saying “we oughta be paying for what helps people, and not for what doesn’t help people.  [Editor’s note:  See Competitive Enterprise Institute, “Consumer Reports Becomes National Snitch,” for how this might work.]

The really sick people are the expensive people . . . If you talk to them, they’ll do the right thing:

Palliative care is central to the success of health care reform.  And the reason for that is, that [pause] you have [pause] When you take the time to talk to patients and families about what is really happening, to them medically, what the medical treatment options are, and the pros and cons of those treatment options, and you take the time to understand what patients are hoping for in the future, and what their fears are in the future, 90% of the time patients make much more conservative choices.

[break transcript]

The palliative care patient population [is critical because they are] the 10% of Medicare beneficiaries who have five or more chronic conditions.  And that group of Medicare beneficiaries accounts for two-thirds of all spending.  OK? So 90% of all Medicare beneficiaries spend almost nothing.  They’re healthy.  They don’t need much.  The sick Medicare beneficiaries are driving the overwhelming majority of spending. . . . My particular hope for influencing policy is to make this case at both the state and the federal level:  if we intend to get a handle on costs, and improve quality at the same time, it will not be possible without fully integrated palliative care

President Obama explains how palliative care works: “At least we can let doctors know — and your mom know — that you know what . . . maybe you’re better off not having the surgery, but taking the painkiller.”