On death panels.

I've been reflecting on why this lie, among all those that have been told about what improving health care financing models in this country means, stuck with the public psyche so powerfully.

I think the popular notion is that one of the ways that those looking to improve access to health care in this country will pay for it is by denying care based on age, as a proxy for social worthiness. There will exist some panel that decides that an aged person's care is just too expensive, that some sick people are of such an advanced age that they are really just costing us money. We'll then decide that it is time for this person to die, so we'll push their gurney down to the far end of the hall and wait for something to start smelling bad instead of starting another round of chemotherapy.

How black does someone's heart have to be to believe that is possible? How misanthropic must one be to think that legislators would even craft such an idea? How little faith does one have to have in humanity to believe that you could find people to do this even if it did become law? It really is tragic that we have people who are capable of believing such things, but we do. My heart goes out to them, they exist in their own personal version of hell instead of looking at the world around them.

What was in the bill was a provision that pays people for helping patients anticipate decisions at the end of life, and it makes the provision of this kind of care-planning a potential quality measure. In my business, that's about as controversial as praising someone for keeping their desk organized. Of course we should do this, and experts should be paid for their service. There are a number of complicated decisions to be made. People should have the opportunity to consider them with a sound mind and body, and they should be given that opportunity widely and robustly because people get paid to do this. Right now this kind of excellent health-care is essentially subsidized by a concerned provider. If it gets done, it gets done for free.

That's right, right now, this kind of excellent care is provided to people, but it is done for free. There's no way to pay for a conference between an end-of-life expert and a well person about their choices concerning end-of-life decisions. There's no code for it in the Medicare rules.

We socially engineer health-care in this country by what Medicare pays for. Don't even start to believe that your private plan is in any way different. Medicare sets the rules, everyone else just adopts them as a starting place from which to further deny people care. If Medicare doesn't pay for it, no one pays for it. The best health insurance in this country is Medicare. It's rules are the most thoughtful and fair, it's benefits are the most generous, and it's overhead is less than one third of private equivalents (because those other two-thirds are not going in executive and shareholder pockets).

That's government-run health care for you--cheap, fair and generous.

I think this whole national psychosis about "death panels" belies a deeper concern. People know that we don't have the money to keep the promises of the government, particularly after eight years of the profligate larceny during the Bush administration. Remember back before the bust, when financial concerns were taking huge salaries and obscene bonuses year after year after year? Where do you think they got the money from? They got it from this ponzi scheme of financial instruments that came crashing down a year ago. That TARP money and all the related taxpayer pay-outs ultimately ended up filling the gaping voids left in the system by the larcenous cash-out by the people running the financial industry. And they got their taxes cut while they did it.

At some level, people know this. They know that there will come a day when these roosters are home to roost. Someone is going to have to be hurt, so they're hunkering down, putting up as much resistance as possible, so it won't be them, or if it ends up being them, they can delay it as long as possible.

It is this desperation, this coming apocalypse mentality, that drives the opposition to improving our badly-broken system of health care financing. People don't want a health care system that is fair because, in fairness, you can't get all the care you can demand. There are people sicker than you who need the resources. That's the boogey-man in the distance, not death panels.

We have death panels now, by the way, they are called Ethical Review Boards and I sit on one. It exists almost entirely because a decision has to be made and the patient didn't have a chance to make the decision before becoming too ill to participate in it. Usually a balance has to be made between the benefits and burden of some treatment, i.e., do we keep causing this person to suffer pain and discomfort in pursuit of delaying death?

Most ironically, if the controversial provisions of this bill were enacted and practiced as intended, we'd have drastically fewer cases to review. There are usually two unknowns to consider: first, will their treatment do any good? Second, what would they have wanted? We actually have pretty good guesses for the former. We could have definite, unambiguous answers for the latter in a lot more cases. Then, those patients would have made these life-or-death choices for themselves, rather than having someone like I make it for them.

And the people fear-mongering with death panels are the same ones screaming "choice" as a slogan. We're not in a good place here, a lot of people are going to have to die prematurely before we collectively will be able to mature enough as a society to face our decisions here. This isn't going to be pretty.

My first Facebook death

Regular readers might remember that I posted a note about this weird experience I had with thinking about someone from my distant past (like pre-1974) and then having the experience of that person submitting a friend request over Facebook a couple of days after I thought about him.

We had gotten back in touch, talked about the women we lusted over in high school and how kind or unkind the years had been to them (failing to note, of course, that the years had been unkind to both of us). We had plans to get together whenever I was in the part of Texas he called home, I was assuming that was going to happen in the next year or so. He lived near Houston. "Near Houston" is a part of the world I endeavor to avoid, but I knew I would eventually have to go near enough for some reason, and I would divert to see him.

This morning I saw a Wall post from a mutual Facebook friend that he died on Saturday morning from a heart attack. He's my age, we went to school together and were close friends, sharing the kind of mischief in which teenagers in small town indulge. He was truly more of a brother than a friend, and I regarded his father as one of my many surrogate parents from my youth.

Two things stand out in my mind about this.

1. We are the same age (he is exactly nine months older than I), had the same vices. I could die suddenly of a heart attack any day now just as surely. I may be taking better care of my health than he was, I don't really know, but the possibility exists.

2. This is the first time Facebook has been the conduit for finding out about someone's death. Without this Facebook connection, I would have never found out about this, ever. No one who knows us both has any other way to get in touch with me.

I last saw him in 1976, I think. His messages were warm and familiar--I recognized my childhood friend's unique personality there even after all these years. He was one of the very few people from that time in my life that I regretted having lost touch with.

Weird. Facebook just crossed some threshold for me.

How to *prepare* to fix the US health-care system.

Outlaw the private financing of political campaigns.

That's right, make it illegal to campaign for public office with private money of any kind, including the candidate's.

Run a direct-mail agency, a travel agency, some TV studios, a server farm (with a VOIP solution), and make it possible for candidates for public office to effectively communicate with the citizenry on the public dime.

Give them a campaign staff, house a central campaign office, make hotel-ing offices available around the country. Give them a budget to hire political technocrats like pollsters and opposition researchers at G-whatever wages, or at some contractor standard. Give them 6 weeks to run for the primary election, two weeks off, then four weeks to run for the general election.

They can still use volunteers for the same reasons they use them now. Warm bodies will become the true campaign currency. Dominant campaigns will become dominant because they have a lot of people willing to put shoulder to the wheel for the cause.

You know what else would happen? Politicians would be forced into being accountable because the only way they could campaign for re-election outside of the above parameters would be by actually doing their jobs. Gone would be the constant stream of self-congratulatory fund-raising speeches to small groups of people with an excess of money with which to purchase political influence, which is legal now because these same grifters have convinced us that spending money is what Madison meant by freedom of speech. This string of empty polemics is what is perceived to be the politician's position. The politician is free to say whatever works best, because they are never bound to see that any of this actually happens. They can campaign literally non-stop.

What if they had to actually get things done? What if the only way a politician could claim to support health care access is by actually producing health care access? What if a politician could only lay claim to fiscal responsibility by actually doing fiscally responsible things?

I'm not sure a person currently in office would still have that privilege following the next election.

Yes, I mean him, too.

So, this will have to be done before we can get health-care fixed. Right now, the insurance and pharmaco companies have Congress bought and paid for. The current health care system works really well for the insurance companies. They get to keep 30 cents of every dollar that you send them. It's working pretty well for the pharmaco's too. It's illegal for the government to negotiate price with them, and they are the biggest customer. Sweet.

So, it won't change. And people won't vote these people out of office because they keep getting told it is not their fault, it's the other guys fault, and they know how to fight them, and they will win if they can only get the support they need to accomplish such big things.

Or, on Sunday they'll tell you that God loves people who send money to the church, and he rewards their generosity with abundant wealth and health in THIS life, and then eternal bliss in the after-life.

Either way, just pay up and you're in, unless those awful evil people thwart us again and we'll need your support now more than ever if that happens. Dang, those people are so obstructionist!

Health-care reform is going to require a wholesale change in the way it is done, and we are going to need some time to ramp-up to the new system, because we don't have enough people to see everybody right now.

This reform will utterly destroy the health insurance industry, and it will cripple the pharmaco industry. Pharmaco research will return to the academy, where it belongs. Yes, we will cure fewer obscure forms of cancer, but we will have cheaper and better treatments for chronic diseases. We will give something up there.

It's not pretty, and this sausage is going to be particularly ugly when being made, but the other choice, what we have now, will lay economic waste to this country when your children are your age. We can't afford to give-away 21% of the money we spend of health care (the difference between administrative over-head in private vs. government-run programs). We need it all, and we need to control the remuneration collectively to optimize the allocation of resources, just like a public utility.

Yes, there are things best done this way. Not making cars, not designing software, not journalism, those are best done as we do them now. We're smart enough to know the difference.

But, it will take real people committed to really solving problems in power in order to make this happen. Those people see no way into public office that doesn't involve selling themselves like soap. We need to fix that first.

I think that's the future I see coming through that door.

The story of Veronica Ballestrini is also the story of a lot of uncredited hard work by countless people. So was that last sentence, and in tribute I am editing this post by directly writing the HTML.

Young girl, precocious talent, figures out that she needs an audience, knowing that if she gets that, she can get everything else. She dreams it up and does it. It's good when a plan comes together.