Thursday, July 23, 2009

Obamacare and Disability

photo credit-irina slutsky
creative commons license

Like many Americans, I watched President Obama talk about his health care plan on TV tonight. Many others will comment on the plan in general, but I want to point out what I think are some possible implications for care of the disabled.

First of all, FULL DISCLOSURE-***I am a DOCTOR***. Now I know in a lot of people's minds that immediately may make them tune out anything that I will say, assuming that whatever I say will be self serving. I happen to think that since I have worked continuously in health care in one job or another continuously for decades (yikes!) that I may just have some insights into a couple of things. Your mileage may vary.

Basically, on the surface, today's talk by the President promised that nearly everyone will be covered, you won't lose your present doctor or insurance choice, you'll get all the health care you need, and it won't cost you or the country any more money. Sounds great, right?

Well, anyone with a lick of sense knows that all of that can't be true. So let's look at one of the things that WAS said, and think about it's implications.

One of the things that has been advocated (and that the President heartily endorses) is some sort of a national group of "health care experts" that would determine what treatments should be covered. This group would be a "non-partisan" group in Washington, D.C. This is being sold as "We'll eliminate unnecessary treatment", but there have been no parameters floated saying exactly what kind of treatments they will eliminate in order to save money.

I suspect that some of them may be reasonable, such as requiring prescription of generic drugs when available (though there are several times when patients react badly to a generic, and not to a brand name). Also, undoubtedly, many services for senior citizens will be either delayed or denied. Such things as hip replacements and knee replacements, as well as cataract surgery. Criteria will be imposed, and if someone is judged either to be not debilitated enough, or not to have enough useful years left, then they will be left without service. No one in the administration will admit this, but all healthcare economists pretty much agree on this. This is certainly what happens in other countries that have nationalized their healthcare system.

Now the reason I bring this anonymous, faceless committee up is the effect they may have on the disabled. The whole concept of futility and futile care has been big in ethical circles of late, and this concept is sure to enter into any decisions made by such a committee.

The problem becomes when this central committee decides on what constitutes futile care for a particular person. Instead of a decision being made with the person themself, their doctor, and their family (if the patient cannot communicate), this central committee will make decisions as to whether a particular person's life is worth investing more health care dollars into.

I don't know about you, but I don't have much trust that such a committee won't have an inbred bias against the disabled. Society as a whole is biased against the disabled, but society as a whole up to now hasn't been able to out and out condemn individuals to die from lack of treatment. Such a committee will.

For those of you that will disagree with me, ask your legislator if he/she can guarantee you that no disabled person will be denied care based on their disability. They can't.

Also one last thought for tonight. The non-partisan Congressional Budget Office predicts that millions of Americans will be forced out of their present insurance plans by the institution of Obamacare, and force into the "public option". The most telling thing (IMO) regarding the public option is that both the House of Representatives, as well as the President himself tonight, refuse to include themselves in the public option. The President waffled tonight when asked whether he would submit himself to the same requirements as the public option. The House last week voted down an amendment to the health care bill which would have required House members to take the public option.

If they don't want that option for themselves, why is it good enough for millions of other Americans?


farmwifetwo said...

Actually, I read your post expecting a slap at "Canadian Style Health Care" which IMO American's think they know all about but have no idea. Not saying it's perfect... but your current system I would NEVER, EVER want. But this description is nothing like ours.

When Maddy writes of the HUGE cost to send her children for an hour to the Child Psych and my son is going for 2hrs on Tues, and it's cost to me is to hand him my son's Health Card.... who got the better service and I only waited 2 weeks (I had to postpone it) to get the appt.

Obama's system seems strange to me. Yes, OHIP and the other Provinces decide what treatments to provide, yes, sometimes we send people to the USA for treatment. We also don't have a large population base to justify some treatments so, in the end it cheaper to use your infrastructure.

Usually they say "yes" and send people. If the Dr's here think it will help. If they don't they recommend that the patient won't survive the system won't pay for it. Some then pay to go on their own, some win, some don't.

I like to think they try very hard here to help everyone.

I don't think any health care system is perfect.... some would claim my ultrasound in a few hours is "unnecessary" b/c I haven't had problems (gallbladder).... but something was seen a month ago when I had problems (kidney stone) and my Dr is checking, just incase... cost... my Health Card.

farmwifetwo said...

Oh, and just and FYI... they don't leave people to die in their beds here without treatment.

My Oma had her knees replaced even though she had severe arthritis and except for pain relief she was still mostly housebound... a neighbor's Father (severe dementia) had his leg taken off with an epidural (going under would have killed him). He had gangrene... he had no idea of what was going on around him... but the surgeon refused to let him die from gangrene poisoning. He lived a couple of more years. My FIL and Opa had their cataracts fixed.

We don't cut people off here, or refuse them services. Actually in Ontario they are trying to shorten wait times on those "quality of life" services.

I think your system abandon's them quicker. No insurance... no service.

"But this is what happens in other countries"... Yes, but IMO those in the USA truly have no idea what happens in other countries and use the threat of "other countries" a little to quickly to prove what they are doing is correct.

Mekei said...

Given that BO's science czar is an eugenicist, I have no faith in this proposal. "Bipartisan"? What does that mean? Agreement btwn Dems and Reps on the expert panel? Both can be equally swayed and bought off under this bully administration. God help us all.

Club 166 said...

I didn't intend to make this about comparing Canada's system to the US. But one interesting fact is that if you have cancer, the US is the place you want to be. That's compared to all of Europe, or Canada.


kathleen said...

Hi Joe, once again-a thought provoking piece. I had the same thoughts crossing my mind...just who is this committee and what is their agenda? Obviously I worry about disability-and how it will be viewed..I worry about possible mandatory genetic testing in the future-and the ramifications of that.Thinly veiled eugenics? I don't know. I find it extremely worrisome.

codeman38 said...

Of course, private insurance isn't off the hook either. I know that at least at some insurance companies, autism spectrum disorders are considered pre-existing conditions that prevent someone from getting an individual insurance plan. And given the employment difficulties that some autistics have, getting a group plan isn't necessarily an easy task either...

Club 166 said...

Of course, private insurance isn't off the hook either. ...

No, private insurance shouldn't be able to "cherry pick" only the healthiest individuals.

But the insurance companies DO need to be protected against those who know they have a chronic condition, and would just wait until they knew they would soon start needing care before signing up.

So IF there is universal coverage, then there should be no waiting periods, and no coverage exclusions.

But if you DON'T have to sign up for insurance, then there should still be no coverage exclusions, but a reasonable waiting period for chronic conditions (perhaps six months to a year) would be a reasonable protection to both parties.


Club 166 said...

@ Kathleen,

Eugenics, indeed. I did a paper recently for one of my ethics classes on how eugenics never really died out, but has just morphed into a much more high tech form thru the use of genetic screening.