One of the first things children are taught in our society, once they’re old enough to speak, is to listen to others and respond appropriately. The lesson is usually imparted these days in some variation of the phrase “Use words.” What we really mean is, don’t use your fists. Don’t cry or shout or throw yourself on the ground. Say what you have to say and then listen to what the other kid wants to say. That’s how we resolve our disagreements. We call this “communication.”
Some of our fellow citizens seem to have missed kindergarten that day. Right now, while the rest of us are trying urgently to hash out our national values and priorities, they’re busily working to make a hash of the whole thing.
Yes, there are many excellent reasons to lament the way Americans are sorting out their disagreements over health care this summer. But there are many more reasons to lament the way America delivers health care year-round. It would be a shame to lose sight of that. The fuss over town hall chaos simply diverts us from the essential issues. Which, of course, is the point of the disruptions.
Why get worked up about health care delivery, when so many of us like our plans? One reason is the number of Americans who die every year because they lack proper insurance and can’t get decent health care. Back in 2000, that number was 18,000, according to a study published by the federally chartered Institute of Medicine in 2002. More recent studies, using the institute’s math and factoring in the rise in the uninsured, show that annual deaths now top 22,000. Cancer victims and diabetics rank high on the list, according the institute.
Another reason is the number of families driven into bankruptcy by medical expenses that aren’t covered by insurance. In 2001 that figure was about 750,000, or half of all the nation’s personal bankruptcies that year, according to a study by Harvard’s medical and law schools. The number of persons affected, counting dependents, was more than two million. About three-quarters had insurance when the illness began. Half of that group lost their insurance when the illness forced them to stop working. The other half incurred expenses that weren’t covered under their policies. More than half of the total were college-educated and owned their own homes. An update in 2008 found the percentage of personal bankruptcies stemming from health coverage had topped 60%.
Here’s another reason to care: The United States ranked 45th in the world in life expectancy in 2008, according to CIA figures. We lagged behind nearly every other industrialized nation, every one of which had some sort of universal national health plan — and none of which, it’s worth noting, has shown any inclination to switch to our system.
Simply put, our current system does a worse job of keeping people alive than any of those other systems. It’s not hard to figure out why. The other systems begin with medical care as a human right and universal coverage as an entitlement. In our system, medical care is a commodity that is bought and sold. If you want to be crude about it, human life is for sale in America. And here, unlike Humphrey Bogart’s Casablanca, life isn’t cheap.
Astonishingly, the reform that President Obama is trying to pass, in all of its congressional permutations, doesn’t actually offer a reasonable, morally sound system. It’s far more watered down than the universal health plans proposed over the years by Theodore Roosevelt, Harry Truman and Richard Nixon. It leaves the main burden on private businesses, driving up labor costs and hurting American competitiveness. The notion that Obama is pressing for some radical reordering of American society is just plain silly. It’s a wonder anybody buys it.
Indeed, it’s a wonder that Americans, with all their religious faith, remain so resistant to guaranteed health care. You might think that people who take religion so seriously would be the first to place human life beyond barter.
As a matter of fact, America’s churches actually take life and health quite seriously, whatever their parishioners might think. The Catholic Church has favored guaranteed health coverage for years. The nation’s biggest Jewish organizations and denominations, working together under what’s now called the Jewish Council for Public Affairs, have unanimously endorsed universal health coverage since the 1950s.
This summer, several dozen of the country’s main religious denominations, including some of the biggest Protestant synods along with Catholics, Jews and Muslims, are mounting a national campaign to bring the moral urgency of health reform home to their congregants. Called “40 Days for Health Reform,” it kicks off August 19 in a conference call with President Obama.
The Jewish community will be represented by the Jewish Council for Public Affairs, speaking for the major organizations and denominations, United Jewish Communities representing the Jewish charitable federations, plus the National Council of Jewish Women and the Religious Action Center of Reform Judaism acting on their own.
Cynics might argue that the Jewish involvement is just another case of soggy liberalism. That’s short-sighted. The Jewish community owns scores of hospitals and nursing homes across the country, with combined budgets in the billions of dollars. Simple community self-interest dictates that Jews get involved in getting this thing under control.
But there’s one more good reason. When the summer is over and Labor Day is behind us, the kids will return to school and Congress will reconvene. When we gather in synagogue that Saturday, we’ll read a biblical portion that concludes, in Deuteronomy 30, with the commandment that the sages considered the final and overriding dictate: Choose life.
Contact J.J. Goldberg at goldberg@forward.com
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Most alarming for people like me, who at 84 years of age recently needed a quadruple bypass and aortic valve replacement, are the pronouncements of Obama's appointee, Dr. Ezekiel Emanuel, brother of Obama's Chief of Staff Rahm Emanuel.
According to a New York Post op ed by Betsy McCaughey, former lt.-governor of the State of New York,
Savings, he [Emmanuel] writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, 'as an imperative to do everything for the patient regardless of the cost or effects on others' (Journal of the American Medical Association, June 18, 2008)."
Emanuel, however, believes that 'communitarianism' should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those 'who are irreversibly prevented from being or becoming participating citizens... An obvious example is not guaranteeing health services to patients with dementia' (Hastings Center Report, Nov.-Dec. '96)."
Dear friend,
Time magazine says that Betsy McCaughey seriously misrepresented Ezekiel Emanuel's views in her N.Y. Post article. Here's what Time says about it:
Ezekiel Emanuel, Obama's 'Deadly Doctor,' Strikes Back
Time Magazine By MICHAEL SCHERER / WASHINGTON – Wed Aug 12, 3:25 pm ET
Dr. Ezekiel Emanuel, the medical ethicist and oncologist who advises President Obama, does not own a television, and if you catch him in a typically energized moment, when his mind speeds even faster than his mouth, he is likely to blurt out something like, "I hate the Internet." So it took him several days in late July to discover he had been singled out by opponents of health-care reform as a "deadly doctor," who, according to an opinion column in the New York Post, wanted to limit medical care for "a grandmother with Parkinson's or a child with cerebral palsy." (Read an interview with Obama on health care.)
"I couldn't believe this was happening to me," says Emanuel, who in addition to spending his career opposing euthanasia and working to increase the quality of care for dying patients is the brother of White House chief of staff Rahm Emanuel. "It is incredible how much one's reputation can be besmirched and taken out of context." (See pictures of health care for the uninsured.)
It would only get worse. Within days, the Post article, with selective and misleading quotes from Emanuel's 200 or so published academic papers, went viral. Minnesota Representative Michelle Bachmann, a fierce opponent of Obama's reform plans, read large portions of it on the House floor. "Watch out if you are disabled!" she warned. Days later, in an online posting, former Alaska Governor Sarah Palin attacked Emanuel's "Orwellian thinking," which she suggested would lead to a "downright evil" system that would employ a "death panel" to decide who gets lifesaving health care. By Aug. 10, hysteria had begun to take over in places. Mike Sola, whose son has cerebral palsy, turned up at a Michigan town-hall meeting to shout out concerns about what he regarded as Obama and Emanuel's plans to deny treatment to their family. Later, in an interview on Fox News, Sola held up the Post article. "Every American needs to read this," he declared. (Read "What Health-Care Reform Really Means.")
By this point, Emanuel, who has a sister who suffers from cerebral palsy, had arrived in northern Italy, where he planned to spend a week on vacation, hiking in the Dolomites. Instead, he found himself calling the White House, offering to book a plane home to defend his name. "As an academic, what do you have? You have the quality of your work and the integrity with which you do it," he said by phone from the Italian Alps. "If it requires canceling a week's long vacation, what's the big deal?" (Read TIME's cover story "Can Obama Find a Cure?")
The attacks on Emanuel are a reminder that there is a narrow slice of Americans who not only don't trust government, but also have come to regard it as a dark conspirator in their lives. This peculiar brand of distrust helps create the conditions for fast-moving fear-mongering, especially on complex and emotionally charged topics like the life and death of the elderly and infirm. Prairie fires of that kind are hard to douse when the Administration's own plan for health care remains vague, weeks away from being ready for a public rollout. The health-care bill that recently passed the House does not contain, as some have suggested, any provisions that would deny treatment to the elderly, infirm or disabled like Sola's son. One provision allows doctors to be reimbursed for voluntary discussions of so-called living wills with patients, but does not in any way threaten to deny treatment to dying patients against their will. The legislation anticipates saving hundreds of billions of dollars by reforming the health-care system itself, a process that would try to increase the efficiency of medical care by better connecting payments to health outcomes and discouraging doctors from unnecessary tests and procedures. The Obama Administration hopes that many of these reforms will be made in the coming years by independent panels of scientists, who will be appointed by the President and overseen by Congress. (See 10 health-care-reform players.)
This is where the criticism of Emanuel enters the picture, since he is just the sort of scientist who might be appointed to one of those panels. For decades, Emanuel has studied the ethics of medical care, especially in situations where a scarcity of resources requires hard decisions to be made. His work sometimes deals with the hardest possible decisions, like how to choose who gets a single kidney if there are three patients in need, or the reasons that doctors order tests with little medical value. Emanuel's reputation ranks him among the top members of his field. He is published often in the best journals; he has been given multiple awards for work to improve end-of-life care. At the White House, he has taken a free-floating role at the Office of Management and Budget, advising on a wide range of health issues.
But in a country where trust is in short supply, Emanuel has become a proxy for all the worst fears of government efforts to rein in costs by denying care. "The fundamental danger is that the American people are being asked to delegate all these life-influencing decisions," explains Betsy McCaughey, the conservative scholar who wrote the New York Post attack on Emanuel. "There is a lack of transparency here."
In her Post article, McCaughey paints the worst possible image of Emanuel, quoting him, for instance, endorsing age discrimination for health-care distribution, without mentioning that he was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources. She quotes him discussing the denial of care for people with dementia without revealing that Emanuel only mentioned dementia in a discussion of theoretical approaches, not an endorsement of a particular policy. She notes that he has criticized medical culture for trying to do everything for a patient, "regardless of the cost or effects on others," without making clear that he was not speaking of lifesaving care but of treatments with little demonstrated value. "No one who has read what I have done for 25 years would come to the conclusions that have been put out there," says Emanuel. "My quotes were just being taken out of context."
For Emanuel, the entire experience has been a painful education in the sometimes brutal ways of politics, something his brother has long endured and dolled out. "I guess I have a better appreciation for what Rahm had to go through for years and years," Emanuel says. But that appreciation does not solve the question raised by the controversy. There is universal understanding that the nation's fiscal course is doomed without major changes to health care, but whom will the American people trust to carry it out?
Emanuel, for his part, plans to continue his work, which is focused on finding the most equitable and ethical way for this reform to be carried out, even if he has opted against returning from the Italian Alps. "I am an Emanuel," he says. "We are pretty thick-skinned. I am not going to change my colors. I am not going to crawl under a rock."
"Health care rationer" appears to be basically correct. The Democratic bill in the House will result in health rationing, with disastrous consequences for the very young and old, and diminished health care for most in between.
No American is today denied health care in America, and even illegal aliens receive emergency care. "Reforms" of health insurance are a wonderful idea. Obamacare is not reform, it is a power grab, meant to result in a "single payer", i.e. socialist health care, and that means rationing.
Poor people are presently entitled to Medicaid. The problem with millions of the "uninsured" is that they refuse to sign up. Others are young and healthy and refuse to insure (so when they require expensive care, they walk away by filing Bankruptcy). Some lose their jobs and cannot find or afford insurance because of pre-existing conditions (anyone covered under an employer's group plan is not denied coverage due to pre-existing conditions) - and THAT is an issue which can be fixed by legislation. The last group is the illegal aliens - and Americans should decide whether they want to foot the bill for their insurance.
Those are all issues which can be solved by corrective legislation, and none of them should result in massive taxpayer expenditures. After all, it will be cheaper for the uninsured who now use the ER's to see clinic doctors. So why the Trillion Dollar price tag? It is an extraordinary boondoggle, with money for Acorn, and government special interest make-work. Read the bill!
By the way, the issue of the alleged number of people who die each year for lack of "decent" health care sounds fishy. If some significant portion of those alleged numbers are denied expensive heroic care, they will likely not get it, or get it in time with Obamacare. Rationing will kill many times that number. The alleged number is made to sound large, but "decent" health care itself now kills between 100,000 to 200,000 people a year due to medical "errors" (depending on whose "statistics" you use). Under Obamacare, there will be cost-saving attempts to limit the expensive end of life life-saving and life-extending care that represents a huge percentage of total healthcare costs (including the extremely expensive cancer and late-stage diabetes care that the author is concerned about), particularly later in life. Many more will die.
The debate would be more "healthy" if the proponents of the bill (and Obama) were honest about what is really in the bill, if Union thugs were not dispatched to attack Americans expressing dissent (it is only they who are using their "fists"), and if honest dissenters were not vilified by leftists - those same leftists who "marched" and "demonstrated" and "sat-in" and "organized" and screamed and yelled and even broke the law for their favorite causes. The leftists were far more "disruptive" than these elderly, ill, and concerned citizens are. Its no surprise that concerned middle Americans who are turning out to challenge their representatives, particularly when their representatives refuse to read the bill they will be voting on, and misrepresent what is in it.
There are many improvements possible in health care, but destroying it is certainly not "reform".
Dear Mr Goldberg Im not saying that I distrust the government, but I do distrust the Emanuels. Nowhere in your rebuttal does Dr Emanuel deny that he said that doctors take the Hippocratic Oath too seriously. I think that Dr Emanuel is raising a trial balloon to see if they can slip this over our public without too much opposition. Dr Emanuel may be uncomfortable performing euthanasia on his own initiative, but it remains to be seen whether he would be uncomfortable with it as government policy.
Hadamar Clinic From Wikipedia, the free encyclopedia Jump to: navigation, search The Hadamar Clinic was a psychiatric hospital in the German town of Hadamar, used by the Nazis as the site of their T-4 Euthanasia Program, which performed mass sterilizations and mass murder of "undesirable" members of Nazi society, specifically the physically and mentally handicapped.
Operations As the 2nd Infantry Division marched across Germany, it uncovered several sites of Nazi crimes. In early April 1945, the unit captured the German town of Hadamar, which housed a psychiatric clinic where 10,072 men, women, and children victims were gassed by asphyxiating them with carbon monoxide in a gas chamber in the first phase of the killing operations (January to August 1941) in the Nazi "euthanasia" program. Another 4,000 were then murdered by starvation and lethal injection until March 1945.
Thick smoke billowed over Hadamar in the summer of 1941 while the staff celebrated the cremation of their 10,000th patient with beer and wine served in the crematorium. Despite precautions to cover up the T-4 program, the local population knew of the operation. The people killed in the Hadamar hospital would arrive by train or bus and ostensibly vanish behind the site's fence. Furthermore, since the crematorium ovens were usually fed with two corpses instead of one, the cremation process was faulty. This often resulted in a cloud of stinking smoke hanging over the town. In the local schools, students would often taunt each other by saying "You'll end up in the Hadamar ovens!"
Up to 100 victims arrived in post buses every day. They were falsely told to disrobe for a "medical examination". Sent before a physician, instead of examining them he assigned one of a list of 60 fatal diseases to every victim, then marked them with different-colored band-aids for one of three categories: Kill; kill and remove brain for research; kill and break out gold teeth.[1]
Following a groundswell of opposition, Hitler announced an official stoppage of "euthanasia" activities. However, after a short hiatus the killing went on, the difference being that victims were no longer gassed.
Resident physicians and staff headed by nurse Irmgard Huber directly killed the majority of these victims, among whom were German patients with disabilities, mentally disoriented elderly persons from bombed-out areas, "half Jewish" children from welfare institutions, psychologically and physically disabled forced laborers and their children, German soldiers and foreign Waffen-SS soldiers deemed psychologically incurable. The medical personnel and staff at Hadamar killed almost all of these people by lethal drug overdoses and deliberate neglect.
The Hadamar psychiatric hospital is still in operation today and houses both a memorial and an exhibition about the mass murder of the T-4 Euthanasia Program.
Wow Mr. Goldberg, you write a column about healthcare reform and you get a comment about Nazi Germany. And the relationship isThat healthcare reform is going to make us Nazi Gemany? LOL!!!!!!
The comments from "healthcare rationer and Frank" here are an example of the crazies in this healthcare debate, when you don't have anything pertinent to say you just say a lot of hyperbole and throw in some Nazi references.
As british person living in america i have been fortunate enough to experience both health care systems on offer here. I have also lived in Australia and Sweden all of which offer varying degrees of public/private health care. Firstly, the current american system (only my experience) does appear to be poorest. Reflective of american capatalism, care is either excellent or bordering on appalling and third world. Medicare is insufficient and i have been unfortunate to lose close friends who had either insufficient insurance or simply could not afford it. As someone with comprehensive insurance, the care i have experienced has howevewr been truly excellent(for this the system should be praised).
My overriding impression is that other countries have a broader and more secure system. Generally, health care is fairer and on average of a superior quality. Finanical position does not dictate standard of care (money for life seems unfair in my opinion especially for children). HOWEVER, these systems do not have extremes. The best care (Sweden particulary) is still not compariable to finest care available in the US (if insured obviously).
Instead of political extremes heckling each other, should the US not be assessing the strengths of each system? Surely a balanced system whereby medicare is improved yet private insurance is still available would be prefered? Closing the divide between rich and poor should be the focus. Placing choice in the hands of the individual yet taxing sensibly to provide for a better society would surely not be prefered?
Placing health care in the hands of private companies, driven by profit, may be a neccessary evil supplemented by a better medicare plan.
Can anyone defending the current system explain high infant mortality rates and low average life expectancy in the United States? This surely can simply be attributed to a poorer diet and standard of living to the other 28 industralised countries...Surely some form of change is needed.
Finally, references to Nazi germany are bordering on absurd, offensive and ignorant. To compare any health care system to the mass extermination of the Jews is extremely offensive to those which dedicate their lives to assisting others and government officials with only good if misguided intentions. Not needed and unhelpful.
As british person living in america i have been fortunate enough to experience both health care systems on offer here. I have also lived in Australia and Sweden all of which offer varying degrees of public/private health care. Firstly, the current american system (only my experience) does appear to be poorest. Reflective of american capatalism, care is either excellent or bordering on appalling and third world. Medicare is insufficient and i have been unfortunate to lose close friends who had either insufficient insurance or simply could not afford it. As someone with comprehensive insurance, the care i have experienced has howevewr been truly excellent(for this the system should be praised).
My overriding impression is that other countries have a broader and more secure system. Generally, health care is fairer and on average of a superior quality. Finanical position does not dictate standard of care (money for life seems unfair in my opinion especially for children). HOWEVER, these systems do not have extremes. The best care (Sweden particulary) is still not compariable to finest care available in the US (if insured obviously).
Instead of political extremes heckling each other, should the US not be assessing the strengths of each system? Surely a balanced system whereby medicare is improved yet private insurance is still available would be prefered? Closing the divide between rich and poor should be the focus. Placing choice in the hands of the individual yet taxing sensibly to provide for a better society would surely not be prefered?
Placing health care in the hands of private companies, driven by profit, may be a neccessary evil supplemented by a better medicare plan.
Can anyone defending the current system explain high infant mortality rates and low average life expectancy in the United States? This surely can simply be attributed to a poorer diet and standard of living to the other 28 industralised countries...Surely some form of change is needed.
Finally, references to Nazi germany are bordering on absurd, offensive and ignorant. To compare any health care system to the mass extermination of the Jews is extremely offensive to those which dedicate their lives to assisting others and government officials with only good if misguided intentions. Not needed and unhelpful.
Good News ! A staff writer at The New Yorker and some experts have examined Medicare data from the successful hospitals of 10 regions, and they have found evidence that more effective, lower-cost care is possible. Please be 'sure' to visit http://www.nytimes.com/2009/08/13/opinion/13gawande.html?hp for credible evidence ! Some have followed the Mayo model with salaried doctors employed, Other regions, too, have found ways to protect patients against the pursuit of revenues over patient. And a cardiac surgeon of them said they had adopted electronic systems, examined the data and found that a shocking portion of them were almost certainly unnecessary, possibly harmful. According to analysis, their quality scores are well above average. Yet they spend more than $1,500 (16 percent) less per Medicare patient than the national average and have a slower real annual growth rate (3 percent versus 3.5 percent nationwide). Surprisingly, 16 % of about $550 billion (the total of medicare cost per year) is around $88 billion per year, except for Medicaid (total cost of around $500 billion per year), medicare 'alone' can save $880 billion over the next decade. In addition, under the reform package, along with the already allocated $583 billion, the wastes involving so called "doughnut hole" , the unnecessary subsidies for insurers, abuse, exorbitant costs by the tragic ER visits etc are weeded out, the concern over revenue might be a thing of the past.
(( Net Medicare and Medicaid savings of $465 billion + the $583 billion revenue package = $1048 billion - the previously estimated $1.042 trillion cost of reform = $6 billion surplus - $245 billion (the 10-year cost of adjusting Medicare reimbursement rates so physicians don’t face big annual pay cuts) = the estimated deficit of $239 billion ))
In modernized society, the business lacking IT system is unthinkable just like pre-electricity period, nevertheless, the last thing to expect is happening now in the sector requiring the best accuracy in respect to dealing with human lives. Apparently the errors by no e-medical records have spawned the crushing lawsuits (Medical malpractice lawsuits cost at least $150 billion per year), and these costs have led to the unnecessary tests, treatments, even more profits so far. And in different parts of the U.S., patients get two to three times as much care for the same disease, with the same result.
Thank You !
Nothing in these comments addresses the alarming comments of Mr Emanuel in saying that doctors take the Hippocratic oath too seriously. I am in agreement with health care rationer that this is a trial balloon to see what the public will put up with. In terms of Dale's comments on our infant mortality, a large part of our infant mortality arises from single moms who are drug addicts and dont take care of their babies
Clement Fong other countries have the same drug problems as we do so what is your point?
"In terms of Dale's comments on our infant mortality, a large part of our infant mortality arises from single moms who are drug addicts and dont take care of their babies" if this is the case surely america should be looking to address this issue as its highest priority! A society which produces so many single mothers with drugs addtions to point it effects national statitics of a country with a population of 300+ million is more than alarming!!
"In terms of Dale's comments on our infant mortality, a large part of our infant mortality arises from single moms who are drug addicts and dont take care of their babies" if this is the case surely america should be looking to address this issue as its highest priority! A society which produces so many single mothers with drugs addtions to point it effects national statitics of a country with a population of 300+ million is more than alarming!!
IS OBAMA AMERICA'S HINDENBURG?
Seeing the SMALL mobs crowding the Townhalls of Congressmen and behaving as disrupters or totally maisarticulating words off of a sheet from which they practiced, nevertheless giving a smug look of triumph as the mob applauds their murder of the King's English, I remember how the Nazis came to power. It wasn't an armed coup. It was uneducated "little" people feeling like heroic giants being the puppets of CORPORATE GERMANY. They were rowdy but not violent...that came later. So where are we going? People think: I have health "INSURANCE." But they don't realize that insurance is not for your health but a sure bet for Corps to get rich. It is like a fixed roulette table at Las Vagas. So you get ONLY the amount of health care that makes huge profits for the insurer. The moment you pass a threshold, you or your doctor will be denied payment for your care. Now banks figure: if the healthcare industry can make "RISK" such a sure thing, why not us. Soon CORPORATE AMERICA will say: IT IS OUR AMERICA-- CORPORATE AMERICA, not the little guy's. And the dictator now, like Hitler then, will dictate to you what you give to the corporations. That's how we in Europe got Nazism.
The dangers posed by the Democrats plan ("Obamacare") are very frightening. The socialization of healthcare poses not only economic dangers, but personal ones, involving denial, delay, and rationing of care, loss of privacy, and the destruction of what is, for almost all Americans, the best health care system in the world.
The issue involving the "progressive" socialist tendency towards eugenics should be frightening to everyone. It has recently been disclosed that the end-of-life part of the Democrat's bill was written by the "Hemlock Society". It may save the government a lot of money to have a doctor help you to kill yourself, but none of use want to end our lives earlier in order to save money.
The essence of "healthcare" is to protect and preserve life - to "first do no harm". That is also the essence of Judaism, to choose life. When the government decides what healthcare is "guaranteed" to you under your insurance, you are in danger - grave, mortal danger. Dr. Emanuel, as part of Obama's administration, has become significant for what he has, shockingly, written:
.....
"services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed.
An obvious example is not guaranteeing health services to patients with dementia.
A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities."
http://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf
Frank, I read your comment and you are implying that that the government is going to kill people at the end of their life. Do you have a tinfoil hat? Are you receiving this information from the people who live under the Earth? Frank, I recommend you see a doctor for your paranoid delusions
We live in a Democratic Republic, when we don't like what OUR politicians are doing we can vote them out of office, unlike the insurance companies who are now making healthcare decisions for this country. The medical industry is only loyal to their share holders and their bottom line. They have limited interest in real healthcare where preventing disease is the focus, of course if you prevent disease this would have a negative impact on profits.
combine Obamas vote as a state senator for late term abortions plus Mr Emanuel's callous comments and you can understand our concern about their health care plan. We already know that Obama and a medical advisor have a cavalier attitude towards the value of human life. I am curious whether under the new health care plan, would crack addicted whores get the same treatments that would be denied to demented adults or learning disabled children
All countries have drug problems, but the US has it on a larger scale, hence the increased infant mortality
I AM suggesting that the government would find it useful not to provide healthcare to people toward the end of their lives.
For "progressives" it is a political-economic trade-off. On average 25% of health care costs are spent in the last year of life. If sick old people can be disposed of more cheaply, billions of dollars can be diverted to more "important" purposes. Eugenics was a modern "progressive" invention. (The Spartans and later, modern totalitarian regimes practiced it; to Jews it is inherently evil and a grave sin.)
When it is suggested that, "not guaranteeing health services to patients with dementia" is appropriate because, "services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed", that horrific political-economic philosophy is legitimated as a valid point of view. To speak out strongly against that evil philosophy is a very "healthy" debate. Personally, I think that there is no more important value than one's health and life, and this society has far more than enough resources to make that its highest priority. Of "life, liberty, and the pursuit of happiness", life comes first. The liberty to purchase and benefit from the best healthcare, and the pursuit of whatever happiness one can find at the end of ones life, are part and parcel.
The idea of depriving the overwhelming majority of Americans of the best healthcare available, in the name of "insuring" a small percentage of uninsured, is obscene. The answer is to fix what is wrong. And if it is true that the problem is that uninsured citizens go to ER's rather than clinics, then providing clinic care should be cheaper, not cost close to a Trillion Dollars. Yes, something is very "fishy" indeed. The so-called "reforms" being pressed on Americans appear to be a totalitarian "progressive" scheme which will result in government control over personal health care choices, huge taxes misused for "progressive" political purposes, loss of freedom, privacy, and lives.
I agree that private insurance should be more stringently regulated as affecting the public interest, with basic underwriting and claims handling standards set by the state. That is theoretically already the case, but there has been a lack of political will to establish and enforce laws already on the books. At this moment, there is no reason that an insurance reform cannot be agreed to by virtually all Americans. BUT, there are two dangers that need to be written into the law: (1) No "public" insurance company [to protect against all the nefarious dangers noted above], and (2) No rationing allowed [ditto].
For over 90% of Americans the healthcare system should not be degraded. For the remaining 10%, lets make it better.
Understanding Obama's code words:
"Cut costs and increase efficiency": Quality Adjusted Remaining Years ("QARY"). If you are not already old, your relatives are, and you will be. Whether you will receive medical care will depend how many years the government thinks you have left, and its assessment of the "quality" of your life.
If you need a hip replacement or heart bypass surgery at 50, you will probably (after an unnecessary delay) get it. If you are 80 years old, your "remaining years" will not warrant it, and even less so, after the "quality adjustment" for your developing dementia. Those life-benefiting and life saving treatments will be denied you by the Congressional Democrats who pass their law, and the government bureaucrats who decide who shall be treated and who shall suffer and die.
For a society to so utterly devalue and disrespect its elderly, who have spent a lifetime of being "participating citizens" (or even if due to mental or physical disabilities they never could be a "participating" lobbyist, congresswoman, or even an Acorn member), is depraved.
So as you see the attacks (such as the Forward's) on the elderly and middle class citizens who confront their elected representatives, and you hear the flim-flam and lies by Obama and others, consider your relatives', and your own coming "QARY".
Recollections of Ruth and Victor Nussenzweig
( both MD.PhD, Professors at New York University School of Medicine)
Ruth and I are happy to describe the very beginning of our scientific careers. It was really lots of fun: we had no deadline to meet, no thesis to complete, no prelims, practically no advisors, and doing mainly research which we thought could be useful, what is now known as "translational research".
What we will tell you involves two entirely different projects that Ruth and I started during our last two years of Medical School. Both projects were very ambitious: the first dealt with the possibility of killing Trypanosoma cruzi in blood destined for transfusion. The other was an attempt to reproduce published results by two Soviet investigators who claimed that the T. cruzi extracts could treat certain types of cancers. The only link between the two projects was that both required the isolation of a virulent strain of
T. cruzi highly infective for mice.
We entered medical school in 1947, after high school, when we were 18 years old (no college in Brazil). A few years earlier, shortly after the end of the Second World War in 1945, Ruth had escaped from Vienna where she was born. At that time, democratic ideals permeated Brazilian society and the dictatorship of Getulio Vargas ended. For the first time in 15 years, free elections were held with the participation of several political parties. During our first two years in Medical School, Victor did not contemplate a career in science. He joined a group of leftist students that wanted to combat the obvious social inequalities in Brasil. In the third year he started dating Ruth, who was wiser. She convinced him that he might make a much greater contribution to Brazilian society by becoming a scientist, than by attending boring, and mostly useless political meetings.
At that time we read a sensational article by two Soviet scientists, Professors Ruskin and Klueva. They claimed that T. cruzi extracts inhibited the growth of cancer in some patients, and that T. cruzi infection did shrink certain transplantable tumors in mice. A well-known group of scientists from the National Cancer Institute in the US had confirmed the effect of live parasites on certain cancer of rodents. The findings of Ruskin and Klueva were widely reported. In fact, many years later we found that Cruzin, the Ruskin/ Klueva T. cruzi extract, was still sold in certain drugstores in Paris! The French are conservative, and may be Cruzin is still available there.
We decided to discuss the Russian’s claims with Samuel Pessoa, the Parasitology chairman of our Medical School, an internationally renowned Public Health scientist. He was loved by students: he gave very funny lectures, was socially minded, and had a very upbeat personality. When we told him that we might cure cancer with a parasite, he told us that this was a fantastic idea. Surely he knew that our project was crazy, and that we had absolutely no laboratory experience. Nevertheless, he immediately provided us with space, and the required equipment (a microscope and a small centrifuge) and supplies. To this day, we are grateful to him.
The "space" was a large empty laboratory that belonged to an Associate Professor (Dr. J.L.P. Freitas) of his department who worked on T. cruzi.
However, no highly virulent T. cruzi strains that could be maintained by passage in mice, were available at that time in Brazil. It took some months to isolate T. cruzi from the feces of Triatoma bugs that had fed on a woman suspected to have chronic Chagas disease. Ruth and I were so appalled with the xenodiagnostic procedure (live bugs, as large as roaches, feeding in patients) that we decided to feed the bugs on drawn blood in vitro. This worked, and the Departmental Chair, not only encouraged us to publish these findings, but included the description of the "in vitro xenodiagnosis" in his textbook of Parasitology. He certainly knew how important it is to feed the ego of budding scientists!
Many years later, during a visit to the Weissmann Institute, we met a Soviet scientist who told us that Ruskin and Klueva got in serious trouble in the Soviet Union in the late 1940’s. Both of them, together with their direct supervisor, were asked to attend a special meeting of the Central Committee of the Communist Party. In the presence of Stalin, they were severely admonished for having disclosed a state secret to American scientists! Their careers ended, and their supervisor was sent to a labor camp in Siberia.
After multiple needle passages in mice (with no gloves!), the newly isolated T. cruzi strain had the required properties. The parasitemias were consistently high, and the mice died during the acute infection. We then obtained a transplantable tumor from another Research Institute, in Sao Paulo. We set up experiments to measure the tumor growth in T. cruzi -infected and non-infected outbred mice. No inbred strains of mice were available in Sao Paulo, nor elsewhere in Brazil, at the time. The growth of the tumor in the controls was so variable that it was impossible to reach any conclusions-- so the second project was a failure.
The Y strain of T. cruzi, (initial of the patient’s name) that we had isolated has since been widely used in Brazil and abroad. The manuscript describing its properties, is widely quoted (but most likely not read). It was co-authored by a colleague and close friend of ours, Luiz Hildebrando Pereira da Silva, who later went on to become head of the Parasitology Department of the Pasteur Institute, in Paris. He is now back in Brazil, in the Amazon region, training as well as directing a malaria research group and others working on local diseases, and writing his memoirs.
Our third project dealt with the transmission of Chagas Disease by blood transfusion, and its prevention. An important figure in this story was Dr. Freitas, who had developed a more precise diagnostic tools for this disease based on the fixation of complement by antibodies in the patients serum. For a while, during medical school, Victor was in charge of performing routinely this assay in the University Hospital. This is how Victor developed an interest in basic complementology, a subject he later pursued for many years.
One day in 1951 Dr. Freitas held a meeting with us and two colleagues, a young resident in infectious diseases and a blood bank physician. He proposed to us a project to determine whether Chagas disease could be transmitted by transfusing blood from chronic carriers of this disease. In these patients the parasite is extremely rare. Although transmission by transfusion was likely, and widely discussed, a definitive answer was not available. Dr. Freitas suggested that we perform the new optimized serological test in a large group of blood donors, and follow the recipients patients who had received serologically positive blood. Ethical concerns were discussed during that meeting. But blood donors had never before been screened serologically for Chagas disease, neither at our University’s hospital, nor anywhere else. The blood would be transfused without knowing the results of the assay, and we were not sure that transmission would indeed occur. It was decided to proceed. It is unlikely, however, that this project would nowadays be approved by the ethics committee of any hospital!
The outcome of this trial was that 3 out of 13 transfusion recipients became infected by T. cruzi. This was particularly frightening because, at that time, in some endemic areas of Brazil and other South and Central American countries, more than 20% of all blood donors were estimated to be at a chronic inapparent stage of Chagas’ disease. Moreover, blood banks did not perform any serological tests to exclude these donors.
There was another meeting in which two additional topics of investigation were raised: to determine the prevalence of chronic inapparent Chagas disease among blood donors in various blood banks, and whether it would be feasible to add trypanocydal drugs to the blood prior to transfusion and thus prevent disease transmission. Ruth and I were asked to deal with the latter question, and we accepted the challenge. Dr. Freitas must have realized the difficulties of this project, but thought that it was appropriate for crazy medical students who had tried to cure cancer.
By that time our relationship with Dr. Freitas had soured. We did not ask for his advice, nor discuss our research with him. We now believe that he had good reasons to be upset. Victor was quite arrogant, and our laboratory was very messy, with mouse cages, racks of used tubes, notebooks, etc. scattered all over the place. In sharp contrast, Dr. Freitas was extremely well organized, and his laboratory a model of neatness. Aggravating the situation the chairman of the Department had given us space that belonged to him!
Our approach to find a trypanocidal drugs was simply to add different drugs to samples of heavily infected mouse blood infected with the Y strain, and examine the blood under the light microscope to observe the T. cruzi parasite motility. If abolished, we injected the treated blood sample into naïve mice to be certain that those highly virulent parasites were no longer infective. It was a time of suspense, one experiment a day! We went to the laboratory, clipped the tails of the mice we had infected with blood containing immobilized T. cruzi and examined it under the microscope.
After a few failures we decided to try dyes. The main reason was that we had read Paul de Kruif’s book "The Microbe Hunters" (we highly recommend it). We were impressed with Paul Erlich’s use of dyes for chemotherapy. The question was which dyes to try? Dr. Michel Rabinovitch at that time working in the Department of Histology and Embryology of our Medical School (later on at the Rockefeller University) gave us a text book listing the dyes available for staining tissue sections.
Our first choice was gentian violet, because we knew that humans afflicted with severe infections by Strongyloidis stercoralis, were treated by intravenous injections of this dye, without deleterious side effects. This information was in the Parasitology textbook written by our chairman, and we had to read it thoroughly since both of us were laboratory instructors.
To our delight, the first experiment showed that gentian violet inhibited the motility and abolished the infectivity of T. cruzi trypomastigotes. We determined that the amounts of gentian violet needed to kill the parasites in one unit of blood were routinely used for the intravenous treatment of several worm infections. These experiments were done in collaboration with Ms. Judith Kloetzel who received a small fellowship from the owner of a publishing empire in Brazil. Several years later our friend Judith got her PhD degree, continuing to contribute to Parasitology research.
We had one serious concern while performing these studies. The precise composition of the gentian violet was not given on the flask. We only knew from the Merck Index that gentian violet is a mixture of three dyes: crystal violet, methyl violet, and brilliant green. We wrote a letter to Eli Lilly, the manufacturer, inquiring about the precise composition of their product. In it we presented our results (no thoughts of patent protection), explaining the importance of the problem. After several months the response came by a non-signed letter from the company, stating that the composition of gentian violet was a business secret. Years later Judith determined that crystal violet alone was as effective as gentian violet. By that time gentian violet had already been added to hundreds of transfusions, without any ill effects, except that the blood had a bluish tint.
The remaining question was whether gentian violet was in fact effective. We did not want to repeat the study that had revealed the potential of blood transmission of this disease by blood coming from known sero-positive blood donors. The ethical concerns were obviously too great. This was resolved when one member of the team who needed frequent blood transfusions (neither of us), transfused himself with 420 ml of blood from a patient in the acute stage of Chagas disease, that had circulating parasites detectable by light microscopy!! Before transfusion, gentian violet was added at a concentration of 0.5 g per liter, and the blood kept at 4ºC for 48h. This physician had witnessed our experiments, and had faith in gentian violet power. He was carefully monitored parasitologically and serologically. No infection ever developed.
New experiments were then done soon afterwards. Eighteen recipients of gentian violet –treated blood from chronic Chagas disease were closely monitored. To our great relief, none were infected. The results of our experiments were communicated in various meetings, and then published. Many blood banks in Chagas endemic areas of Brazil and elsewhere in Latin America, started to add routinely this dye to all blood packages. It did not take long for gentian violet-containing transfusion bags, manufactured in the US, to be distributed in Latin America. In a review published in 1990, more than 100,000 patients had received blood transfusions containing gentian violet, without side effects. The maximum amount of treated blood given to a single patient within six months was 68 units (34 liters),s and no toxic effects were observed. Most importantly, there has been no reported case of Chagas disease transmission among the very large number of recipients of gentian violet-treated blood. What is the mechanism of action of gentian violet? Drs. Roberto Docampo and S. Moreno, professors at the University of Illinois, showed that this cationic dye affects the function of the parasite’s mitochondrion and depletes ATP.
Chagas disease is currently under control in Brazil. Spraying DDT on the walls of the mud houses kills the vector and to date Triatomes have not developed DDT resistance. Although acute Chagas is extremely rare in Brazil, a large number of carriers still remain. These can now be excluded as blood donors by epidemiological screening, and by sensitive serological tests available in most blood banks in Brazil.
However, transmission of infectious agents by blood transfusion remains a challenging problem. Blood banks have now to deal with the threats of inadvertent transmission of hepatitis B and C virus, HIV and West Nile Virus, and the possibility of sterilizing the blood with drugs is under investigation. We were happy to learn at a recent meeting dealing with blood transfusion, that our rather primitive studies performed during medical school while skipping most of our classes pioneered this field.
Frank I hope you have great health insurance policy and live near the Mayo clinic, because if don't you have more problems then you realize. The average age of a working nurse in this country is 47 because no one wants to be nurse .
The healthcare industry to keep costs down have targeted nurses, we have been replaced by "techs" with a week of training, we have been out sourced to agencies with no benefits, and we have left the profession in disgust as staff to patient ratios have steadily been eroded. Every major nursing organization, state and national, has supported real healthcare reform, at the very least a public option and most support single payer.
You better hope we get reform, because if we don't, if you or a love one ends up in a hospital and you press that call button, without reform you're goin