Thursday, August 20, 2009

Joe Klein on the Republican Political Machine

Joe Klein in Time Magazine has an article that calls the Republican Party out since it has handed itself over to the lunatic fringe:
The same people who rail against a government takeover of health care tried to enforce a government takeover of Terri Schiavo's end-of-life decisions. And when Palin floated the "death panel" canard, the number of prominent Republicans who rose up to call her out could be counted on one hand.

A striking example of the prevailing cravenness was Senator Johnny Isakson of Georgia, who has authored end-of-life counseling provisions and told the Washington Post that comparing such counseling to euthanasia was nuts — but then quickly retreated when he realized that he had sided with the reality-based community against his Rush Limbaugh-led party. Mitt Romney, the Republican front-runner for President according to most polls, actually created a universal-health-care plan in Massachusetts that looks very much like the proposed Obamacare, but he spends much of his time trying to fudge the similarities and was AWOL on the "death panels." Why are these men so reluctant to be rational in public?

An argument can be made that this is nothing new. Dwight Eisenhower tiptoed around Joe McCarthy. Obama reminded an audience in Colorado that opponents of Social Security in the 1930s "said that everybody was going to have to wear dog tags and that this was a plot for the government to keep track of everybody ... These struggles have always boiled down to a contest between hope and fear." True enough. There was McCarthyism in the 1950s, the John Birch Society in the 1960s. But there was a difference in those times: the crazies were a faction — often a powerful faction — of the Republican Party, but they didn't run it. The neofascist Father Coughlin had a huge radio audience in the 1930s, but he didn't have the power to control and silence the elected leaders of the party that Limbaugh — who, if not the party's leader, is certainly the most powerful Republican extant — does now. Until recently, the Republican Party contained a strong moderate wing. It was a Republican, the lawyer Joseph Welch, who delivered the coup de grĂ¢ce to Senator McCarthy when he said, "Have you no sense of decency, sir, at long last?" Where is the Republican who would dare say that to Rush Limbaugh, who has compared the President of the United States to Adolf Hitler?

... the Republicans are curling themselves into a tight, white, extremist bubble — but there may be enough of them raising dust to render creative public policy impossible. Some righteous anger seems called for, but that's not Obama's style. He will have to come up with something, though — and he will have to do it without the tiniest scintilla of help from the Republican Party.
The whole article by Klein is worth reading. He talks about his parents who are in the late 80s and the worries he has for them. His experience was my experience, your parents don't take kindly to advice, they want to be independent, and they don't plan for the inevitable end. It can be messy. The idea of having professionals talk to the elderly to get them to be realistic about their future is a great idea, but the idiot right wing has turned this into a "death panel" shout-down. Nuts!

My own experience was that when my mother at age 85 had a brain tumour I was left trying to decide what to do. I queried the surgeon carefully about adverse outcomes, the possibility of loss of function or mental deficits. He assured me the operation was easy and "not to worry". Unfortunately my mother came out of it with a condition called left neglect and other cognitive impairments.

There no professional input to help in the decision, either before or after the botched surgery. I couldn't find anybody on the hospital staff to explain what happened or what to expect. It took a week of effort asking anybody who came near my mother's hospital room before I was told about a hematoma. At first I was happy because a hematoma in the body is a blood bruise which the body clears up. It took a few more days before a family doctor told me that a hematoma in the brain means loss of function forever. In short, the medical system completely failed me.

Within a month my father at age 87 died. What I found absolutely bizarre is that over the next 10 months I received lots and lots of medical bills, well over $150,000. The insane thing is that none of these bills covered any real "help" for my parents. The medical system in the US is completely dysfunctional, expensive, and criminally negligent. At no point did the system really stop to make an intelligent decision or even invite me into the decision-making process. Mostly they hid things from me and simply blundered along doing more tests and procedures.

After two weeks, when my mother realized she wasn't going to get better, and was getting worse lying in a hospital bed, she asked me to get her out. The only available option was hospice care. So I signed her up for that fully expecting to get her into long term nursing care. I spent a week running all over trying to find a nice place. I was constantly hounded by the hospice saying that "you have to get her out of here since this is for the actively dying". Then late one day they called and said, "you need to get here quickly, her breathing has changed and it indicates death is imminent". So I rushed down to spend the last hour with my mother.

I could have spent the last week of my life with my mother, but the hospice had me out trying to located "long term nursing care". At every step the medical system failed me. They operated saying "not to worry" when in fact they turned my mother into a cripple with not just left neglect but visual problems that meant she could recognize me by looking at me, she had to use clues like voice, clothing, etc. They let me move her to a hospice but then they forced me to be on the road to find a permanent place when in fact she died within 6 days of being admitted to the hospice.

My mother caught H. Influenza while in the hospital and passed it to all of us. My brother and I bounced back after a week, but it hospitalized my father for a week, then he spent 2 weeks in a nursing home, and within a week of them releasing him from the nursing home back to his (now empty) home, he died of unnamed "heart problems".

In short, the medical system in the US is a disaster. The Republican "death panels" is a joke, but the system does in fact condemn people to death. It doesn't give them dignity. It doesn't give them reasonable choices. It simply runs up the bill and refuses to spend any time on simple human gestures.

(My mother with left neglect was given meals that required two hands to open. She was constantly being left in bed with the service button on her left of behind her head, but she had left neglect and saw nothing on her left and since she was paralyzed on the left, she could never find a service button left hanging behind her. When I raised these issues with staff they always blame "others" and assured me they didn't do it and they would make sure it never happened again. But of course i did happen again.)

In short, the last month of life for my parents was miserable, unnecessarily miserable by a "medical" system that was heartless, that didn't give options, and that kept making mistakes while refusing to admit mistakes. They ran up a huge bill -- paid for by the American taxpayer -- a hugely wasteful bill. Simple home care would have been a hundred times cheaper, but that isn't allowed. Instead they were put through a high-tech hell. They had signed living wills saying "no heroic measures" but I never got to talk to any doctors about any choices. The very day that my mother died I was being advised to have her undergo a series of "radiation therapy". Nutty!

So... read Joe Klein's article. The first bit about his parents gives you a little peep hole into the problems of dealing with the older generation. The fix isn't more technology. It is simple human compassion, not a "death panel" but a system that takes the time to identify options with realistic assessment of outcomes so you can make a reasonable choice (not the "don't worry" brain surgery I was corralled into).

Instead of the idiotic shouting matches, the American public needs to have a real honest discussion of their medical system. It is a mess. The first step is to admit that it is too expensive with too many bad outcomes and too many uninsured people. It needs radical surgery.

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