Friday, 7 March 2014

Liverpool Care Pathway - A Political Football

While the pundits kick the political football back and forth, Big Bro' leaps from the Waltzer and dances into our lives.

The Political Carnival reports on downsizing healthcare Stateside -
My husband has a brain tumor and has been under care of Memorial Sloan Kettering in Manhattan, and receives his radiation treatment from Memorial Sloan Kettering in Commack, Long Island, New York. He became ill from side effects, was taken to our local hospital on January 28th, where he remains today.
We have been fighting Empire Blue Cross Blue Shield for the past 2.5 weeks, as they refuse to allow him to be transferred to Memorial Sloan in Manhattan (MSK) for acute care and resumption of his remaining radiation treatments to the brain. We receive our insurance through my husband's employer, and we pay an additionally for Direct Point of Service care, which allows us choice of doctors and facilities. To note, my husband has been under the care of Memorial Sloan Kettering for the prior 4 years.
Blue Cross, at first, wanted to transfer my husband to a hospice facility with a standing DNR (do not resuscitate) order. My husband is not in end stages of his illness.
They fought us for a precious week of treatment time until they agreed that my husband did not warrant end of life care. They still refuse to allow us to take him to MSK, where his doctors know him, have knowledge of the rare form of tumor he has, and where until 5 weeks ago, he was receiving his treatment.
This same tragic story of downsizing care and care expectations is being acted out across the States. ‘Affordable Care’ means affordable to the provider, not the recipient.

The pundits continue to fire broadsides. The New York Post reports on Obama on the sly –
Section 1342 of the Affordable Care Act forces taxpayers to make insurers whole for most of the losses they incur selling policies on the ObamaCare exchanges through 2016. The bailout is meant to hide the full failure of the president’s signature health law until after the next presidential election.
This provision was under the radar until last fall, when ObamaCare’s first ugly surprise hit many Americans. The law forced insurers to cancel 5 million to 6 million health plans effective Jan. 1 because they didn’t comply with ObamaCare’s one-size- fits all coverage requirements.
The law was designed to do that, but the public outrage moved President Obama to ignore his own law and tell insurers on Nov. 14 that they could keep selling the old plans after all.
Of course they're still on the sly. That's not what it's about. The Left mudslings the 'Death Panels' and denying healthcare options back into the court of the private insurers. That's not what it's about. It's about policy underwritten by the State.

Simon Stevens of United Health and, latterly, the NHS says it how it is.

This is United Health 

Working together, we can 
ensure that quality health care 
is accessible to all Americans,
and that it is affordable and sustainable - not a burden to future generations.

This same mantra is repeated across the NHS. It is about a policy of grooming to downsize care expectations. It is about a programme to limit life.

This is US liberal commentator and blogger Matthew Yglesias writing on Slate –

"...not only is this health care spending on the elderly the key issue in the federal budget, our disproportionate allocation of health care dollars to old people surely accounts for the remarkable lack of apparent cost effectiveness of the American health care system. When the patient is already over 80, the simple fact of the matter is that no amount of treatment is going to work miracles in terms of life expectancy or quality of life."
Here's more Communitarian reasoning from Mr. Yglesias -
"Read Frakt for a bit of an account of how this arises operationally, but what I think is more important is that it arises on a meta-level because we have such a fragmented health care system. When your health care spending is all in one bucket, then at any given level of spending you face a question about how to allocate it. And when allocating spending between young and old, you're cross-pressured. On the one hand, older people have more need for health care services which militates in favor of allocating spending to them. On the other hand, providing health care services to younger people generally offers better value in terms of years of life and quality of life saved. A 25 year-old who's in a bad car accident can, if found in time and treated, still live a very happy and healthy life. If you're 95 and get into the same car accident, then treatment is going to be much more difficult, recovery will be much less complete, and in the grand scheme of things you're not going to live very long anyway."
The political class of the Left and the Right rail against each other...

Kaiser Health News reports 
The CT Mirror: Uninsured Connecticut: Obamacare Comes To HartfordIn their quest to help people sign up for insurance offered under the federal health law, the staff at Charter Oak Health Center have talked to more than 3,000 people. But a few stand out, like the man who was so happy to have insurance -- for $49 a month -- he was shouting on the way out. Or the young man with bad eyes who couldn't afford glasses but would, as of Jan. 1, qualify for Medicaid. "He can get those much-needed glasses, and he was so freaking happy," said Jesse Grant, the health center's outreach enrollment case manager and self-appointed promoter of Obamacare to just about anyone who will listen (Becker, 1/14). 
Meanwhile, a new study assesses efforts to curb enrollment in some states. 
NBC News: State Efforts To Block Obamacare Are Working, Study FindsStates whose governments are hostile to Obamacare are also hindering efforts to get people signed up for health insurance, according to a study released Tuesday. Laws restricting outreach and enrollment efforts have handicapped community health centers that are a key component of plans to get health insurance to millions of Americans who lack it, researchers at George Washington University found. "This is the first study to attempt to measure the impact of restrictive state policies," said Sara Rosenbaum, who led the team at GW’s Department of Health Policy that did the study. "The navigator laws are having a real effect" (Fox, 1/14)

And Big Bro’, leaping from the Waltzer, grins at the sideshow.

Pertinent reading –
Liverpool Care Pathway - What Prospect Does This Bode...?

Liverpool Care Pathway - The Communitarian Imperative

Liverpool Care Pathway - Living Wishes

Liverpool Care Pathway - Three Steps To Heaven

Liverpool Care Pathway - Time To Wise Up

    “There’s no left wing and no right wing, only up wing and down wing,”
    “I tell you there are no politics.”
    - Bob Dylan

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