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Let's hear it for some reconciliation moral equivalence! (pg. 4)
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| Shakka |
Some Obama comments:
| quote: | CBS Interview 11/2/04
My understanding of the Senate is that you need 60 votes to get something significant to happen, which means that Democrats and Republicans have to ask the question, do we have the will to move an American agenda forward, not a Democratic or Republican agenda forward? |
| quote: | Change to Win Convention 9/25/07
The bottom line is that our healthcare plans are similar, the question once again is, who can get it done? Who can build a movement for change? This is an area where we're going to have to have a 60% majority in the Senate and the House in order to actually get a bill to my desk. We're going to have to have a majority to get a bill to my desk. That is not just a fifty plus one majority. |
| quote: | Obama Interview with the Concord Monitor 10/9/07
You've got to break out of what I call the sort of fifty plus one pattern of presidential politics. Maybe you eke out a victory of fifty plus one. Then you can't govern. You know, you get Air Force One, there are a lot of nice perks, but you can't deliver on healthcare. We are not going to pass universal health care with a fifty plus one strategy. |
| quote: | Center for American Progress Conference 7/12/06
Those big-ticket items: fixing our health care system. You know, one of the arguments that sometimes I get with my fellow progressives, and some of these have flashed up in the blog communities on occasion, is this notion that we should function sort of like Karl Rove where we identify our core base, we throw 'em red meat, we get a fifty plus one victory. See, Karl Rove doesn't need a broad consensus because he doesn't believe in government. If we want to transform the country, though, that requires a sizeable majority. |
And this from good ole' KKK Byrd back in 2005 (note: It is not I that makes the Hitler comparison--Byrd did):
| quote: | Many times in our history we have taken up arms to protect a minority against the tyrannical majority in other lands. We, unlike Nazi Germany or Mussolini's Italy, have never stopped being a nation of laws, not of men.
But witness how men with motives and a majority can manipulate law to cruel and unjust ends. Historian Alan Bullock writes that Hitler's dictatorship rested on the constitutional foundation of a single law, the Enabling Law. Hitler needed a two-thirds vote to pass that law, and he cajoled his opposition in the Reichstag to support it. Bullock writes that "Hitler was prepared to promise anything to get his bill through, with the appearances of legality preserved intact." And he succeeded.
Hitler's originality lay in his realization that effective revolutions, in modern conditions, are carried out with, and not against, the power of the State: the correct order of events was first to secure access to that power and then begin his revolution. Hitler never abandoned the cloak of legality; he recognized the enormous psychological value of having the law on his side. Instead, he turned the law inside out and made illegality legal. |
http://www.washingtontimes.com/webl...ion-strategy-n/
But I digress... |
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| Comrade Stalin |
| Frankly, who cares? He changed his mind. |
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| Shakka |
| quote: | Originally posted by Comrade Stalin
Frankly, who cares? He changed his mind. |
You're right. Who am I to question His infinite wisdom? |
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| Comrade Stalin |
| So what if Obama preached the virtues of the super-majority? If it actually worked, that'd be great, but it isn't. I'm glad he's realized that when the other party doesn't play that game, don't try to play it. Actually, try it, just to demonstrate who the "party of no" is. |
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| Shakka |
| quote: | Originally posted by Comrade Stalin
So what if Obama preached the virtues of the super-majority? If it actually worked, that'd be great, but it isn't. I'm glad he's realized that when the other party doesn't play that game, don't try to play it. Actually, try it, just to demonstrate who the "party of no" is. |
The "party of no" is a label that really really creative people came up with to describe partisanship. It's been going on for decades. Healthcare was incredibly contentious in the 1990s and nobody wanted to compromise much then. It has been going on since the dawn of man.
The funny thing about what you say is that on one hand you clearly suggest that Obama and partisan Democrats should rule with an iron fist, while on the other you criticize the opposition for actually having an opposing and quite legitimate point of view. Stop buying into the acrimony, man. The pendulum is always swinging. |
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| jerZ07002 |
| quote: | Originally posted by Shakka
The "party of no" is a label that really really creative people came up with to describe partisanship. It's been going on for decades. Healthcare was incredibly contentious in the 1990s and nobody wanted to compromise much then. It has been going on since the dawn of man.
The funny thing about what you say is that on one hand you clearly suggest that Obama and partisan Democrats should rule with an iron fist, while on the other you criticize the opposition for actually having an opposing and quite legitimate point of view. Stop buying into the acrimony, man. The pendulum is always swinging. |
Opposition is healthy when it is based on substantive differences. I'm ok with republicans fighting against health care overhaul if the opposition is based on, for example, budget issues. My problem with republicans blasting obama's health care policy on budgetary concerns is that most republicans don't give a about the budget when it comes to financing the pentagon and wars. In short, i hate inconsistency and politicians (democrats and republicans) who play both sides of the fence and their position on either side depends on the issue.
as a total aside, i think it's absolutely ridiculous that the senate is the more important chamber of congress. We give too much power to states with small populations. There is no situation when Wyoming SHOULD have as much say on federal issues as California. |
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| Comrade Stalin |
| quote: | Originally posted by Shakka
The "party of no" is a label that really really creative people came up with to describe partisanship. It's been going on for decades. Healthcare was incredibly contentious in the 1990s and nobody wanted to compromise much then. It has been going on since the dawn of man.
The funny thing about what you say is that on one hand you clearly suggest that Obama and partisan Democrats should rule with an iron fist, while on the other you criticize the opposition for actually having an opposing and quite legitimate point of view. Stop buying into the acrimony, man. The pendulum is always swinging. |
Hey man, I accept the reality of the political situation. Which is why I want to see the Democrats initiate their agenda irrespective of what the opposition thinks, because as I said, the minority party is called the "opposition" for a reason. Let them oppose. When they get voted into office, they can do their thing. The American voters didn't vote for coombaya between Republicans and Democrats, they voted for the Democratic agenda, and they should damn well get the Democratic agenda. |
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| Shakka |
An emotional "hearstrings" article I just read in the latest BusinessWeek. Speaks to the issue of all of the money spent on end-of-life care and expensive testing/retesting/procedures/etc.
| quote: |
Lessons of a $618,616 Death
Two years after her husband's death, Amanda Bennett's cover story examines the costs of keeping one man alive
It was sometime after midnight on Dec. 8, 2007, when Dr. Eric Goren told me my husband might not live till morning. The kidney cancer that had metastasized almost six years earlier was growing in his lungs. He was in intensive care at the Hospital of the University of Pennsylvania in Philadelphia and had begun to spit blood.
Terence Bryan Foley, 67 years old, my husband of 20 years, father of our two teenagers, a Chinese historian who earned his PhD in his sixties, a man who played more than 15 musical instruments and spoke six languages, a San Francisco cable car conductor and sports photographer, an expert on dairy cattle and swine nutrition, film noir, and Dixieland jazz, was confused. He knew his name, but not the year. He wanted a Coke.
Should Terence begin to hemorrhage, the doctor asked, what should he do?
This was our third end-of-life warning in seven years. We had fought off the others, so perhaps we could dodge this one, too. Terence's oncologist and I both believed that a new medicine he had just begun taking, Pfizer's (PFE) Sutent, would buy him more life.
Keep him alive if you can, I said.
Terence died six days later, on Friday, Dec. 14.
What I couldn't know then was that the thinking behind my request—along with hundreds of decisions we made over the years—was a window on the impossible calculus at the core of today's health-care dilemma. Terence and I were eager to beat his cancer. Backed by robust medical insurance provided by a succession of my corporate employers, we were able to wage a fierce battle. As we made our way through a series of expensive last chances, like the one I asked for that night, we didn't have to think about money, allocation of medical resources, the struggles of roughly 46 million uninsured Americans, or the impact on corporate bottom lines.
Terence's treatment was expensive. The bills for his seven years of medical care totaled $618,616, almost two-thirds of which was for his final 24 months. Still, no one can say for sure if the treatments helped extend his life.
Over the final four days before hospice—two in intensive care, two in a cancer ward—our insurance was billed $43,711 for doctors, medicines, monitors, X-rays, and scans. Two years later the only thing I can see that the money bought for certain was confirmation he was dying. Along with a colleague, Charles Babcock, I spent months poring over almost 5,000 pages of documents collected from six hospitals, four insurers, Medicare, three oncologists, and a surgeon. Those papers tell the story of a system filled with people doing their best. Stepping back and looking at that large stack through a different lens, a string of complex questions emerges.
31% FOR PAPERWORK
Health-care costs represent 17% of today's U.S. gross domestic product. Medicare devotes about a quarter of its budget to care in the last year of life, according to the policy journal Health Affairs. Yet as I fought to buy my husband more time, it didn't matter to me that the hospital charged more than 12 times what Medicare then reimbursed for a chest scan. It also didn't matter that UnitedHealthcare (UNH) reimbursed the hospital for 80% of the $3,232 price of a scan, while a few months later our new insurer, Empire BlueCross & BlueShield, paid 24% for the same test. And I didn't have time to be thankful that the insurers negotiated the rates with the hospital so neither my employers nor I actually paid the difference between the sticker and discounted prices.
Looking at that stack of documents, it is easy to see why 31% of the money spent on health care went to paperwork and administration, according to research published in 2003 in the New England Journal of Medicine. That number has stayed the same or grown since then, says Dr. Steffie Woolhandler, a professor at Harvard Medical School and a co-author of the study. Often Terence's bills, with their blizzard of codes, took days to decipher. What did "opd patins t" or "bal xfr ded" mean? Was the dose charged the same as the dose prescribed?
The documents revealed an economic system in which the sellers don't set the prices and the buyers don't know what they are. Prices bear little relation to demand or how well goods and services work. "No other nation would allow a health system to be run the way we do it. It's completely insane," said Uwe E. Reinhardt, a political economy professor at Princeton University who has advised Congress, the Veteran's Administration, and other federal agencies on health-care economics.
In reviewing Terence's records, we found Presbyterian Medical Center in Philadelphia charged UnitedHealthcare $8,120 in 2006 for a 350 mg dose of the drug Avastin, which should have been free as part of a clinical trial. When my Bloomberg colleague inquired, the 80% insurance payment was refunded. A small mixup, but telling.
Some drugs Terence took probably did him no good. At least one helped fewer than 10% of patients. Today, pharmaceutical companies and government agencies are trying to sort out the economics of developing drugs that will help only a small subset of patients. These drugs are very expensive. Should every patient have the right to them?
Terence and I answered yes. Each drug potentially added life. Yet that, too, led me to a question I still can't answer. When is it time to quit? Congress dodged the question last year as it tried to craft a health-care bill. The mere hint of limiting the ability to choose care created a whirlwind of accusations of "death panels."
One thing I know is that I don't envy the policymakers. As the health-care debate heated up, I remembered the fat sheaf of insurance statements that had piled up after Terence's death. Our children, Terry, 21, and Georgia, 15, assented to my idea of gathering every record to examine what they would show about end-of-life care—its science, emotions, and costs. Terence would have approved.
Taking it all into account, the data showed we had made a bargain that hardly any economist looking solely at the numbers would say made sense.
Why did we do it? I was one big reason. Not me alone, of course. The system has a strong bias toward action. My husband, too, was unusual, said Keith Flaherty, his oncologist, in his passionate willingness to endure discomfort for a chance to see his daughter grow from a child to a young woman, and his son graduate from high school.
After Terence died, Flaherty drew me a picture of a bell curve, showing the range of survival times for people with kidney cancer. Terence was way off in the tail on the right-hand side, an indication he had beaten the odds. For many, an explosion of research and drug discoveries had made it possible to daisy-chain treatments and extend lives for years—enough time to keep our quest from having been total madness.
Terence used to tell a story, almost certainly apocryphal, about his Uncle Bob. Climbing aboard a landing craft before the invasion of Normandy, Bob's sergeant was said to have told the men that by the end of the day, 9 out of 10 of them would be dead. Said Bob: "Each one of us looked around and felt so sorry for those other nine poor sonsabitches."
For me, it was about pushing the bell curve. Knowing there was something to be done, we couldn't not do it. Believing beyond logic that we were going to escape the fate of those other poor sonsabitches.
It is hard to put a price on that kind of hope.
A SHADOW, BUT GOOD ODDS
We found the cancer by accident, on Sunday, Nov. 5, 2000, in Portland, Ore. Terry had invited a dozen friends for a sleepover to celebrate his 12th birthday. I was making pancakes and shipping the boys home. Terence had been having stomach cramps for weeks. Suddenly he was lying on the bed, doubled over in pain. Our family doctor ordered him to the emergency room.
We were immediately triaged through. Not a good sign, I thought. The kids sat on the waiting-room floor, Barbies and X-Men around them, while Terence writhed in a curtained alcove. When he returned from a scan, the doctor said, almost as an aside: There's a shadow on his kidney. When he's feeling better, you should take a look at it. Both of us were annoyed. Why would we think about a shadow on his kidney? That wasn't the problem. He was in such pain he could barely breathe.
The cause of the pain turned out to be violent ulcerative colitis. The damaged colon was removed on Dec. 13, in an operation that left Terence so weak that he spent three weeks, including Christmas morning, immobile in a chair. Colleagues delivered meals to the house. My sister wrapped presents. My boss sent over her husband to put up our lights. I felt so bad for Terence that I got him a cat, the pet he had long wanted. The orange kitten howled in a box under the tree.
And the shadow? We were so grateful he was out of pain that we would have ignored it had someone from the hospital not called to urge us to find out what it meant. Within a month, Terence was in surgery again. On Jan. 18, Dr. Craig Turner removed the diseased kidney. Emerging from the five-hour operation, Turner confirmed the worst: He believed the shadow was cancer. A week later, when Terence was well enough to walk into the doctor's office, Turner was reassuring.
"We got it all," he said.
Terence teared up. "Thank you for saving my life."
The bills from Regence BlueCross BlueShield of Oregon show the operation was relatively inexpensive, just over $25,000, about 4% of the eventual total charged to keep Terence alive. Our share was $209.87. I never looked at or thought about the total cost, or the $14,084 that our insurance—in reality, my employer—paid. We never had to consider who was actually shouldering the bills.
Kidney cancer is uncommon, accounting for about 3% of all cancers, or about 50,000 new cases in the U.S. last year, according to the Kidney Cancer Assn. Terence was a typical patient: an older man, overweight, and an ex-smoker. Asymptomatic for a long time, most kidney cancers are discovered accidentally or too late. So we felt lucky. The first tool for fighting kidney cancer is usually the one used since medieval times: the knife, or its technological equivalent. If a tumor is removed early enough, before it flings microscopic cells into the bloodstream that can implant in other organs, surgery is close to a cure.
For Terence the odds looked good. His 7-centimeter tumor showed no signs of having spread. According to the traditional method of evaluating, or staging, the cancer, that meant he had an 85% chance of surviving five years. A lab report soon chilled our optimism. Tests on Terence's tumor showed that he had so-called collecting duct cancer. Named for the part of the kidney where it is thought to originate, collecting duct is the rarest and most aggressive form of kidney cancer. In my online research, almost everyone who had it died within months, sometimes weeks, of diagnosis.
Most kidney cancers don't respond well to chemotherapy. There was no accepted treatment after surgery. Almost nothing was known about collecting duct cancer. Only about 1% of kidney cancer patients receive that diagnosis. Dr. Turner and I could find just 50 cases documented in the medical literature worldwide, and nothing had proved effective in halting it. "Watchful waiting" was the recommended path.
Waiting for him to die was what we feared.
He didn't die. He got better. We didn't know why. We tried not to think about it.
By the spring of 2002, we had moved to Lexington, Ky., where I was the editor of the local newspaper and Terence was creating an Asia Center at the University of Kentucky. He seemed fine. He began moving Chinese and Japanese history books to his office. On Saturdays we drove through the bluegrass to take seven-year-old Georgia to riding lessons. We reluctantly let 13-year-old Terry crowd-surf at his first rock concert.
Then, on May 6, 2002, Terry called me at work, panic in his voice. "Mom, come home. Dad is very sick."
His father was in bed, his face flaming with fever, shaking with chills under a pile of blankets. He could barely speak. "The cancer is in my lungs," he said. "I've got six to nine months left."
FEAR, AND AN INTERNET PLUNGE
He had been keeping that secret for months. In February, routine follow-up scans had spotted the cancer's spread. "The first thing Terence said was, 'Doc, do you have any female patients who have recently died? I need to find a widower so my wife can meet her next husband,' " his Lexington oncologist, Dr. Scott Pierce, later recalled. After more tests, Dr. Pierce prescribed Interleukin-2 because there were no other options. Injections of the protein, at $735 a dose, were intended to stimulate the immune response to help fight the cancer's invasion. The overall response rate was only about 10%. For most patients, Interleukin-2 did absolutely nothing.
Terence hadn't wanted to worry us. In his mind, if he recovered, we would never know how close he came; if he died, he would have spared us months of anguish. He started a diary and spent more time in the office so we would get used to his absence.
His secret was betrayed by his violent reaction to his first dose of IL-2. Suddenly his actions over the last several weeks made sense. He had been giving away musical instruments and pieces of art. "I have too much stuff," he had told me, a bizarrely improbable statement coming from him. I was amused, exasperated, and touched by his desire to protect us. Even under the strain of his disease, he was so much himself. "Did you think I wouldn't have noticed if you didn't come home one day?" I asked.
I spent that night awake in our dark living room. For the first and only time, I felt pure terror. A few days later I visited a therapist.
"I can't survive without him," I said.
"What does he say when you feel this way?" she asked.
"He says I can handle anything."
"You'll need to say that to yourself."
Terence stopped taking IL-2 after a few weeks of treatments, unable to stand the side effects.
I plunged into the Internet. If there were something out there that could save him, I was going to find it. Years before, one of my former colleagues, dying from AIDS, had suddenly come back to vigorous life because of a chance introduction to a doctor who prescribed what was then an experimental antiviral cocktail. Another had beaten leukemia with a cutting-edge bone marrow transplant. We could defeat this.
I downloaded papers, presentations to the Kidney Cancer Assn., abstracts from the National Library of Medicine. I called researchers and oncologists, pathologists and fellow journalists. When the research became overwhelming, I hired a retired nurse to help. My boss's wife, a nurse herself, dug in too. After I messaged one couple about a clinical trial in Texas, they offered us their spare bedroom.
Throughout the spring and summer of 2002, Georgia, then 8, rode her bicycle up and down shady South Ashland Avenue. Thirteen-year-old Terry and his friends Shannon, Hughes, and Tanner came in last at their first battle of the bands. Terence sounded optimistic. "It's my dream," he said. "Some day we're going to gig together."
AWAITING SCANS, LEARNING THE VIOLIN
The truth was we were both shaken by the dire prognosis.
"What would you regret dying without having seen?" I asked. He answered without hesitation: "Pompeii." We pulled Terry from his eighth-grade class, Georgia out of second, and flew to Italy to see the excavated remains of the city once buried under volcanic ash. We walked the cobbled streets, poked into frescoed houses, taverns, and baths, and took an eerie comfort from the 2,000-year-old shapes of families huddled together, trying to ward off disaster.
By then our research had led us to the Cleveland Clinic, where Dr. Ronald Bukowski had specialized in kidney cancer for over 20 years. At our first meeting, in August 2002, Terence explained that he had collecting duct cancer.
"No you don't," Bukowski said.
We were confused. How did he know?
"You're sitting here," he said. "If you had collecting duct, you would be dead."
Bukowski argued that the disease was growing so slowly that we should simply watch and wait. We did, for three years. Then, in December 2005, a scan showed that the cancer in his lungs had begun to grow.
By this time, research had progressed. New drugs designed to attack a tumor's blood supply were appearing to slow the growth of a wide range of cancers. Bukowski recommended we enter a clinical trial, pretty much the only way to get these targeted therapies. He referred us to Dr. Flaherty in Philadelphia, where we had moved in June 2003 when I changed jobs.
The drugs Flaherty was testing—Genentech's Avastin and Bayer's Nexavar—had showed promise individually. The trial would find out how they worked together. In March 2006, Terence took his first intravenous dose of Avastin, an hour-long process, and swallowed his first Nexavar. The side effects were hard. There were rashes, sometimes debilitating stomach pains. But he continued teaching, picking up the kids at school, studying and writing. He worked on his book, a grammar text based on classical Chinese poetry. He started to learn to play the violin and to read and write Arabic. Every two weeks he went for an Avastin drip. And every month we anxiously awaited the results of a chest scan.
At first the cancer didn't budge. Then it began to retreat.
Because Terence was in a clinical trial, Genentech and Bayer provided their drugs free. I learned that over the years of Terence's battle with cancer, some insurers drove harder bargains than others. In December 2006, for example, United Healthcare paid $2,586 to University of Pennsylvania Hospital for a chest scan; in March 2007, after I switched employers, Empire BlueCross paid $776 for the same $3,232 bill.
When it came to the insurance companies, the sticker price meant little since they had negotiated their own deals with the hospital. Neither the hospital nor the insurance companies would elaborate. The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 was lowered to $254,176 when the insurers paid their share and imposed their discounts. The portion of the charges that were not covered for the most part vaporized. Terence and I were responsible for and paid $9,468—less than 4%.
During the trial, Terence packed boxes for the troops in Iraq and Afghanistan, loading them in our kitchen with deodorant, wet wipes, Mars bars, Kool-Aid, beef jerky, batteries, and magazines. A veteran of Naval Intelligence and the U.S. Air Force reserves, he walked almost every day to the post office with a box addressed to "Any Soldier." Behind the counter, the smiling lady with the long red hair extensions became his friend, and every so often a soldier would drop him a thank-you note.
Life went on.
Then, in August 2007, from half a world away, I heard the cancer return.
I was on a business trip to China when Terence coughed during one of our phone calls. By the time I got home, scans had confirmed growth of one of the lung's cancerous spots.
By now, more than six years had passed since we first saw the shadow, and I was used to the scares. Avastin's side effects—fatigue, stomach ailments, rashes—had been getting him down, and the doctor had agreed back in May to let him stop treatments. So we'll go back on the Avastin, I thought, or cut out or laser out the growth, add new treatments, and go on.
The records document our renewed fight. Terence resumed Avastin. Because he was no longer in a trial, our insurance company was billed $27,360 a dose, every two weeks, more than the cost of the kidney surgery in 2000. Empire BlueCross paid $6,566.40. We paid nothing. So who did the paying? The health insurance system depends on healthy people bearing the cost for sick ones like Terence. For all its incredible treatment benefits, the system is untenable. Should you have had a voice in Terence's final days? Would I make the same decision with my money for your loved ones? These are things I think about now but can't answer.
NO CONSENSUS
He coughed almost continuously. His weight plunged. He needed help on the stairs. He began to use a cane. When his friend Woody came to visit, Terence couldn't muster the breath to blow his cornet. He coughed and coughed and coughed. In the last week of October, he called me at work.
"I can't pick Georgia up at school," he said. "I can't get out of the chair." On Halloween, his Dracula costume stayed in the basement. We left the candy on the doorstep.
On Nov. 8 we saw Dr. Ali Musani, a pulmonologist specializing in cancer. We hoped that the growing tumor in Terence's chest could be removed. Unable to stand or sit unassisted, he lay on the floor and refused to get up. Alarmed, Musani admitted him to the hospital. He said there was nothing he could do about the tumor. He gently mentioned that it might be time to consider hospice. We brushed off the suggestion.
Terence stayed in the hospital four days. Meanwhile a quiet tension was building. Flaherty and I believed this episode to be a temporary setback. Other doctors and nurses saw a patient near the end.
On Nov. 11, before discharging him, a doctor propped one of Terence's scans on a light board so we could clearly see the blizzard of white spots, hundreds of tumors, covering his lungs.
Avastin wasn't stopping them.
Flaherty was not fazed by the growth, and pointed out that many of the doctors looking at the scans didn't understand the course of kidney cancer. He and I wanted to move on to the next link in the daisy chain of newly available drugs. Sutent, another targeted therapy, had been approved the year before. It worked as Avastin did, by stopping cancer's ability to build extra blood vessels to feed its growth, but in a different way. One $200 pill a day. A shot at more life. Sutent might have more serious side effects—rashes, fatigue, stomach distress, strokes—but Terence was game. He began taking it on Nov. 15.
At home, he drew a line down the middle of a piece of paper. On one side he wrote things to throw away. On the other, things to keep.
"Stop that!" I snapped. "You aren't going to die."
I prepared for what I expected would be a new phase of our life. I found protein drinks online and protein bars in a bodybuilding shop. I got forms for a handicapped license plate, looked into outfitting our row house with a stair lift.
Terence was no longer able to get in and out of bed alone, so I hired a health aide. Whatever he craved, I bought. I wrote down everything he ate. Cold grapefruit slices. Chicken noodle soup. Clam chowder. I counted the calories he consumed one day: 210.
On Friday, Dec. 7, just as the aide was packing to leave for the day, Terence looked up, startled, as the corners of his mouth foamed bright red with blood. It was a struggle to get him down our narrow stairs to the ambulance. In the emergency room it was clear something was seriously wrong. "What's your name?" asked the ER doctor. Terence responded correctly. "What's the date?" Terence gave the doctor what the kids and I recognized as "Daddy's 'Just how dumb are you?' " look. But he couldn't answer.
"Who's the President of the United States?" That triggered something. "That moron, Bush," he said.
Terence was admitted that night to a ward where Eric Goren was doing his last intensive-care overnight shift of a three-year residency. In a small break room, alongside vending machines selling soft drinks and chips, Goren told me that bleeding from the lungs might suddenly become uncontrollable. If that happened, what should he and his team do?
I wanted to see whether Flaherty still believed Sutent could make a difference, but I couldn't reach him. Goren and I settled on what the hospital called Code-A. Do everything possible to prevent a major bleed or anything life-threatening. But don't take heroic measures if death seems inevitable.
I called the children to the hospital.
My decision about Terence's treatment, so hard on Saturday, was easy by Monday. The scans now were showing signs of cancer in his brain, surrounded by a cascade of hundreds of tiny strokes. I had Terence's signed living will, but I didn't need it. I knew what this man who lived for books, music, and ideas would want.
When Flaherty arrived, he looked shaken. "I didn't expect this," he said.
That afternoon I signed the papers transferring Terence to hospice. The next day the hospital staff took away the machines and the monitors. The oncologists and radiologists and lab technicians disappeared. Hospice nurses, social workers, chaplains, and counselors for me and the children—began to arrive and the focus shifted from treatment to easing our transition.
Over the next three days we were charged $14,022 for the same hospital bed. Included were the pain and anxiety medications Ativan and Dialaudid, his monitoring, and counseling for a different kind of pain management for me and the children. The bill was less than a third of the previous four days' $43,711.
Terence drifted into a coma on Tuesday. I e-mailed his friends and read their goodbyes aloud, hoping he could hear and understand. I slept in a chair. At about 2:30 a.m. Friday, a noise in the hall startled me. I awoke just in time to hold his hand as he died.
They gave me back his wedding ring the next day.
Ten days later, the kids hung Daddy's Christmas stocking alongside our three. I mailed the cards he had addressed months earlier, slipping in a black-bordered note. I threw away the protein bars, gave the energy drinks to a shelter, and flushed an opened bottle of Sutent down the drain.
Looking back, memories of my zeal to treat are tinged with sadness. Should I have given up earlier? Would earlier hospice care been kinder? I hadn't believed Terence was going to die so I had never confronted any of those dilemmas. And I never let us have the chance to say goodbye.
I think had he known the costs, Terence would have objected to spending an amount equivalent to the cost of vaccine for nearly a quarter million children in developing countries. That's how he would have thought about it.
But when I ask myself whether I would do it all again, the answer is—absolutely. I couldn't not do it again.
SECOND-GUESSING
Late last year, I waded through a snowstorm to Keith Flaherty's office in Boston, where he had moved to a new job. Did we help Terence or harm him? There's a possibility, he said, that the treatment actually made the cancer worse, causing it to rage out of control at the end. Or, as another doctor suggested in passing at the time, the strokes were a side effect of the Sutent and not the cancer.
But neither Flaherty nor I believe that. The average patient on Flaherty's trial got 14 months of extra life. Without any treatment at all, Flaherty estimates that for someone with Terence's stage of the disease it was three months. Terence got 17 months—still within the realm of chance but on the far-right side of the bell curve.
There is another bell curve that Terence did not live to climb. It charts the survival times for patients treated not just with Sutent, Avastin, and Nexavar, but also Novartis' (NVS) Afinitor and GlaxoSmithKline's (GSK) Votrient—both made available since Terence's death. Doctors and patients now are doing what we dreamed of, staggering one drug after another and buying years more of life.
Slides on the results of Flaherty's clinical trial, presented at the 2008 meeting of the American Society of Clinical Oncology, showed that Avastin and Nexavar worked well on a wide variety of patients. Only Flaherty and I know that the solitary tick mark at 17 months was Terence.
Only I know that those months included an afternoon looking down at the Mediterranean with Georgia from a sunny balcony in southern Spain. Moving Terry into his college dorm. Celebrating our 20th anniversary with a carriage ride through Philadelphia's cobbled streets. A final Thanksgiving game of charades with cousins Margo and Glenn.
And one last chance for Terence to pave the way for all those other poor sonsabitches.
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http://www.businessweek.com/magazin...70032321836.htm
Sad story. |
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| Shakka |
So, does this make the government look hypocritical for criticizing the 39% increase that Wellpoint pushed through a couple of months ago? Don't tell me this is just a justification of an unconstitutional mandate. Yay government!
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A Big Insurance Rate Increase for Pennsylvania Poor
2010-03-17 08:14:42.310 GMT
By IAN URBINA
March 17 (New York Times) -- Facing a sharp rise in costs, Pennsylvania has almost doubled the monthly bill for a state health insurance program for poor people who do not qualify for Medicaid and are on a waiting list for a less costly option.
On March 1, the cost of the plan rose to about $600 a month, up from $313 a month, for the roughly 2,400 state residents on the waiting list.
The increase comes as Congress is poised to act on a health care overhaul and as the Obama administration has been highly critical of insurance companies for rate increases of 30 percent to 40 percent.
State officials said that the program had become a magnet for the sickest people in the state, even as rising unemployment had driven more people to sign up.
Joel Ario, the state insurance commissioner, said that while unavoidable, the price increase would probably make matters worse. "This is very likely going to send us into a death spiral," he said.
The increase may cause even more people to drop out of the program, he said, leaving mainly the people most in need of costly health care and making the program even more expensive.
Mr. Ario, who has been an ally of the Obama administration in its effort to overhaul health care, said his state's predicament was one of the reasons that it was important for the federal law to require virtually everyone to have health insurance, so the costs can be spread around more widely. Without such a requirement, he said, there will be little way to prevent the sickest people from burdening state-financed "safety net"
programs.
The former president of the National Association of Insurance Commissioners, Sandy Praeger, echoed Mr. Ario's point.
"Unless you require everyone to carry insurance," Ms.
Praeger said, "you will have people able to sign up just when they are sick, but you will lack any of the financial support from people when they are healthy. That's the situation you are seeing in Pennsylvania."
In Pennsylvania, Katherine Chavis, 63, received a letter in February informing her of the price change. "I broke down and cried," she said, adding that she lives on Social Security income of $1,383 a month and cannot afford $600 for health insurance.
She has since decided to cancel her enrollment in the program, she said.
Established in 2002, Pennsylvania's state insurance program, called AdultBasic, covers adults ages 19 to 65 with incomes lower than twice the federal poverty level, or about $21,672 for a single person, at a cost to participants of about $36 per month.
About 39,000 people are enrolled in AdultBasic.
About 390,000 other people are on a waiting list to join the AdultBasic program. While they wait, the state gives them the option to pay for the same insurance at a higher rate. It is the cost for members of the waiting list that rose on March 1 to about $600 a month.
The AdultBasic program began after it was revealed that several health insurance plans that provide care for many state residents had billions of dollars in "surplus" funds, even though they were supposed to be nonprofit.
In response, Gov. Edward G. Rendell negotiated an agreement with the plans under which they would make a charitable commitment of $900 million over six years, with 60 percent of the money financing AdultBasic. The agreement expires on Dec. 31, near the end of Mr. Rendell's term.
"Our fear is that the state is being pressured by insurers to raise rates as a way to limit the number of people enrolled in the program," said Kristen Dama, a staff lawyer with Community Legal Services of Philadelphia. "Then if insurers decide not to continue underwriting the program after Dec. 31 of this year, there will be fewer people enrolled in it that suddenly will lose coverage."
Ms. Dama said that her organization had asked the state to provide documentation that justifies such a drastic price increase but that it had yet to receive any information.
The insurance program for people on the waiting list allows them to get coverage on a month-to-month basis, which means that most of the 2,400 or so enrollees sign up only when they are sick, Mr. Ario said.
For every person in the AdultBasic program, the state provides a subsidy of about $350 a month. But for those in the waiting list program, the subsidy is roughly $1,000 monthly.
"We had to make a difficult decision," Mr. Ario said. "Do we raise the rates on the people in the main program that enrolls about 40,000 people for $36 per month, or do we raise the rates on the 2,400 people on the waiting list program?"
He said, "In the end, we thought it was smarter to salvage the main program, which covers more people."
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| Shakka |
P.S. Great editorial.
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We're not sure American schools teach civics any more, but once upon a time they taught that under the U.S. Constitution a bill had to pass both the House and Senate to become law. Until this week, that is, when Speaker Nancy Pelosi is moving to merely "deem" that the House has passed the Senate health-care bill and then send it to President Obama to sign anyway.
Under the "reconciliation" process that began yesterday afternoon, the House is supposed to approve the Senate's Christmas Eve bill and then use "sidecar" amendments to fix the things it doesn't like. Those amendments would then go to the Senate under rules that would let Democrats pass them while avoiding the ordinary 60-vote threshold for passing major legislation. This alone is an abuse of traditional Senate process.
But Mrs. Pelosi & Co. fear they lack the votes in the House to pass an identical Senate bill, even with the promise of these reconciliation fixes. House Members hate the thought of going on record voting for the Cornhusker kickback and other special-interest bribes that were added to get this mess through the Senate, as well as the new tax on high-cost insurance plans that Big Labor hates.
So at the Speaker's command, New York Democrat Louise Slaughter, who chairs the House Rules Committee, may insert what's known as a "self-executing rule," also known as a "hereby rule." Under this amazing procedural ruse, the House would then vote only once on the reconciliation corrections, but not on the underlying Senate bill. If those reconciliation corrections pass, the self-executing rule would say that the Senate bill is presumptively approved by the House—even without a formal up-or-down vote on the actual words of the Senate bill.
Democrats would thus send the Senate bill to President Obama for his signature even as they claimed to oppose the same Senate bill. They would be declaring themselves to be for and against the Senate bill in the same vote. Even John Kerry never went that far with his Iraq war machinations. As we went to press, the precise mechanics that Democrats will use remained unclear, though yesterday Mrs. Pelosi endorsed this "deem and pass" strategy in a meeting with left-wing bloggers.
This two-votes-in-one gambit is a brazen affront to the plain language of the Constitution, which is intended to require democratic accountability. Article 1, Section 7 of the Constitution says that in order for a "Bill" to "become a Law," it "shall have passed the House of Representatives and the Senate." This is why the House and Senate typically have a conference committee to work out differences in what each body passes. While sometimes one house cedes entirely to another, the expectation is that its Members must re-vote on the exact language of the other body's bill.
As Stanford law professor Michael McConnell pointed out in these pages yesterday, "The Slaughter solution attempts to allow the House to pass the Senate bill, plus a bill amending it, with a single vote. The senators would then vote only on the amendatory bill. But this means that no single bill will have passed both houses in the same form." If Congress can now decide that the House can vote for one bill and the Senate can vote for another, and the final result can be some arbitrary hybrid, then we have abandoned one of Madison's core checks and balances.
Yes, self-executing rules have been used in the past, but as the Congressional Research Service put it in a 2006 paper, "Originally, this type of rule was used to expedite House action in disposing of Senate amendments to House-passed bills." They've also been used for amendments such as to a 1998 bill that "would have permitted the CIA to offer employees an early-out retirement program"—but never before to elide a vote on the entire fundamental legislation.
We have entered a political wonderland, where the rules are whatever Democrats say they are. Mrs. Pelosi and the White House are resorting to these abuses because their bill is so unpopular that a majority even of their own party doesn't want to vote for it. Fence-sitting Members are being threatened with primary challengers, a withdrawal of union support and of course ostracism. Michigan's Bart Stupak is being pounded nightly by MSNBC for the high crime of refusing to vote for a bill that he believes will subsidize insurance for abortions.
Democrats are, literally, consuming their own majority for the sake of imposing new taxes, regulations and entitlements that the public has roundly rejected but that they believe will be the crowning achievement of the welfare state. They are also leaving behind a procedural bloody trail that will fuel public fury and make such a vast change of law seem illegitimate to millions of Americans.
The concoction has become so toxic that even Mrs. Pelosi isn't bothering to defend the merits anymore, saying instead last week that "we have to pass the bill so that you can find out what is in it." Or rather, "deeming" to have passed it. |
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| Comrade Stalin |
| It's funny how a lot of the very same people who will benefit from this are the one's who are against it. |
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| NeoPhono |
| We live in a world of nirvana fallacy. I'm really starting to enjoy watching Rome burn as we're increasingly afraid to act because it might make things "worse." This country, this world, is looking more and more like an alcoholic each day; we're going to have to hit rock bottom before anything really changes. |
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