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The Right to Life in Missouri

posted by awelborn

Cuts to Medicaid define feeding tubes and respirators as "optional."

Patients who are losing feeding tubes and other equipment have been told they can file appeals. But the results to date are less than encouraging. As of last Wednesday, 1,048 people had filed appealed. Of the 427 appeals hearings held, the patient lost in 396 of them.

Peggy Bishop of Theodosia, Mo. appealed the loss of her Medicaid coverage. Mrs. Bishop depends on a battery of medical equipment, including a nebulizer that shoots medicine directly into her lungs.

Mrs. Bishop submitted a half-dozen letters from doctors attesting to her need for care. The letters were "irrelevant," an administrative hearing officer decided.

Jan Everett, whose 21-year-old son, Joey, depends on a feeding tube to get nutritional formula, said her request for an exception was denied. An appeal still is pending. The feeding tube is the only way that Joey can eat. He can’t swallow because of a traumatic brain injury he suffered in an auto accident four years ago



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T. Marzen

posted September 1, 2005 at 12:36 am


Here’s where prolife hot air meets cold reality. Does tube feeding/hydration become a disproportionate/extraordinary means when no has the money or will pay for it? Would it have been morally OK to cut-off Terri Schaivo’s tube feeding if the expense of her tube feeding and over-all care had not been covered by her trust fund or some other private source? If so, then doesn’t this mean that there is a double standard for murder-by-omission of the rich and of the poor built into the Catholic distinction between ordinary/extraordinary or proportionate/disproportionate treatment and care? How outrageous is that?
Or is it morally obligatory for the taxpayer to pay for medical treatment/care that no one else can or will pay for? Is “socialized medicine” morally obligatory to avoid euthanasia-by-omission for those who cannot afford treatment or care that is “ordinary” for those who can afford it? And shouldn’t prolifers be strongly in favor of government schemes to guarantee health care and politicians who favor them? Shouldn’t they oppose politicians who oppose schemes to make sure the poor have the same access to health care as the rich? After all, a politician who claims he was against starving patients like Terri to death but who won’t work to make sure they have means to eat and survive isn’t any more prolife than a politician who would allow patients to starve if that’s what their family wants, but who would assure that they will have the means to consume food if they want it.



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Jenn

posted September 1, 2005 at 1:22 am


T. Marzen, don’t you mean pro-death hot air meets cold reality? Because it seems to me this is the natural result of determining that if it isn’t obligatory for one person, then it isn’t obligatory for anyone. As far as I’m concerned it is morally obligatory.



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Maureen

posted September 1, 2005 at 5:46 am


Feeding tubes are low tech. Feeding tube food is low tech. Both are pretty cheap, on the scale of medical care.
So basically, this is just ye bigge pro-death lie.
Apparently, being poor means you don’t have quality of life; and that means they can kill you. Yeah, buddy.



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Donald R. McClarey

posted September 1, 2005 at 7:40 am


“Does tube feeding/hydration become a disproportionate/extraordinary means when no has the money or will pay for it?”
No, and there is plenty of money to pay for it. This is a wrong-headed and foolish attempt to get control of state Medicaid budgets. This is a problem that must be addressed by Congress. Denying respirators and tube feeding to the indigent is morally unacceptable. This is also a ominous warning about what could happen in this country if we were foolish enough to enact national health insurance. Once health care is simply a line on the budget of a government, the urge to cut care to save money is always a factor.



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lourdes

posted September 1, 2005 at 9:07 am


This is the progeny of the Nancy Cruzan case decided in Missouri some years ago and appealed to the U.S. Supreme Court. Last year at the annual N. Y. State Bar Assoc. conference on Elder Law, the attorney who handled that case spoke of the courage of the judiciary and the legal team who fought for the right to remove Nancy Cruzan from her feeding tube. This was the pivotal case that determined that food and water were not medically necessary and could be removed upon request. Like many decisions in our pro-death culture, it has been extended to mean the request of others besides the patient. So now we have the government deciding that feeding tubes are too expensive. When we have bureaucrats making life and death decisions based on cost and their own perception of quality of life, we are all in trouble.



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Nancy

posted September 1, 2005 at 9:42 am


Donald, it’s already a line on the government budget for the medically indigent (which is more and more of us every day).
Your alternative suggestion for paying for health care would be what?



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Donald R. McClarey

posted September 1, 2005 at 12:51 pm


“Your alternative suggestion for paying for health care would be what?”
Keep government out of funding for health care entirely except for those completely indigent. When any government gets to call the shots on health care funding, health care quality and access will inevitably suffer. The free market should govern health care costs with government only stepping in to pay for health care when indigent people simply cannot.



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Nancy

posted September 1, 2005 at 1:30 pm


When any government gets to call the shots on health care funding, health care quality and access will inevitably suffer.
My daughter and her family live in the UK. Their experience does not support your statement.
Neither does my experience living here. We’re fairly wealthy (oh, maybe the top 2% in the US), but we’re finding our access to heallth insurance increasingly restricted (not to mention expensive!) while “self-pay” is unaffordable for all but the super-wealthy, which we are not. How people without our resources cope I cannot begin to imagine.
We need a better system. This country spends more money per capita for health care than any country on earth, whereas by every measure of success – infant mortality, longevity, you name it – we’re at the bottom of the class among the industrialized nations.
What’s wrong with this picture?



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Donald R. McClarey

posted September 1, 2005 at 3:25 pm


Nancy, national health care in the UK has been in crisis as to funding for years, and the quality of health care provided is low even by European standards.
“27 Aug 2005
Job losses and department closures in hospital trusts in England could be on the cards because of the financial crisis of some trusts, according to the BMA’s Consultants’ Committee.
The Committee has been receiving examples of hospitals in difficulty and will now survey all trusts in England to get a more accurate picture of what is going on.
In the interim, Dr Paul Miller, Chairman of the BMA’s Consultants’ Committee has sent a letter1 to the Secretary of State for Health, Patricia Hewitt expressing doctors’ concerns.
In his letter Dr Miller said that cuts would “pose a significant threat to patient care and innovation in the NHS”.
He added that consultants were increasingly infuriated that despite considerable Government NHS funding, money was not getting to the frontline and there were grave concerns whether value for money was being achieved:
“The cash shortages in the NHS contrast dramatically with the generous terms negotiated with companies such as Netcare UK and Alliance Medical despite significant under-performance.
“We are deeply concerned that managers running frightened for their jobs are making knee-jerk decisions about the reduction or closure of services in response to short-term funding problems.”
Dr Miller has asked to meet the Secretary of State to discuss these issues as soon as possible.
Below is the letter Dr. Miller wrote to the Secretary of State for Health
Rt Hon Patricia Hewitt MP
Secretary of State for Health
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NL
26 August 2005
Dear Ms Hewitt
NHS funding crisis
I am sure that, like the BMA’s consultants’ committee, you are extremely concerned about the growing number of reports of NHS trusts facing serious funding shortfalls and consequent proposed cuts in patient services and in jobs. For the first time in my memory, we are now receiving widespread reports of proposed freezes on consultant recruitment and even the threat of consultant redundancies. There is a significant threat to patient care and innovation from the widespread freeze on consultant and other recruitment.
The BMA has said on many occasions that it welcomes the considerable increase in NHS funding introduced by this Government. Given the increase in funding, the prospect of widespread service closure and redundancies (including consultants) is all the more difficult to understand. Serious questions have to be asked about where the increased NHS resources are going and, in particular, whether value for money is being achieved from the funding being preferentially ploughed into contracts for clinical services with private sector providers.
The cash shortages in the NHS contrast dramatically with the generous terms negotiated with companies such as Netcare UK and Alliance Medical. This is all the more concerning when the contracts agreed with such companies have allowed payment to continue despite significant under-performance, for example the orthopaedic contracts in South Yorkshire and Trent, the Alliance Medical MRI contract and the Netcare eye contract.
We are deeply concerned that managers running frightened for their jobs are making knee-jerk decisions about the reduction or closure of services in response to short-term funding problems. Indeed, many such decisions by SHAs are penalising the good NHS performers and rewarding those with poorer records. Crucially, these decisions are being taken without the input of front-line clinicians, particularly consultants. As a result, there is no appreciation of the long-term consequences for patient services.
There is a desperate need for clinical engagement in local decision-making otherwise the potential impact of these cuts on the NHS could be catastrophic. Furthermore, most of these processes are taking place without the knowledge of the local public, surely in contravention of the basic principles of a patient-centred NHS?
The BMA’s consultants committee would be pleased to work with you to try to address these difficulties and I would welcome the opportunity to meet with you to discuss our concerns with you at the earliest opportunity.
Yours sincerely
Dr Paul Miller
Chairman
Central Consultants and Specialists Committee
British Medical Association BMA House Tavistock Square London WC1H 9JP http://www.bma.org.uk



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Nancy

posted September 1, 2005 at 6:02 pm


Donald,
You are invited to compare our heath care stats with those of the UK, hysterical doctors’ letters notwithstanding. (Dr Miller probably doesn’t think he’s making enough money.) Patients are quite happy, though doctors may not be.



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Donald R. McClarey

posted September 1, 2005 at 7:34 pm


“(Dr Miller probably doesn’t think he’s making enough money.)”
Nancy, attorney to attorney, we as members of perhaps the greediest profession in the world should always be wary about accusing others of being motivated by money.
For your reading pleasure another article comparing NHS to the French health care system. This article is one among hundreds written in recent years in the UK bemoaning the shortcomings of the NHS.
“Passport to health
The best healthcare system in the world is just a train ride away – but the train is Eurostar. As patients and staff cross the Channel and ‘health tourism’ grows, Jo Revill reports on what we can learn from the French
Sunday May 25, 2003
The Observer
Silence hangs over the accident and emergency department of the hospital in Lille, northern France. To Robert Thompson, a senior nurse manager who runs a casualty unit in a British hospital, such profound calm seems eerie. The emergency cases are all being seen in separate rooms. Each tiled room is immaculately clean and full of high-tech equipment. There is no noisy waiting room, no stressed-out staff, no long wait for an X-ray.
It is a world away from Thompson’s busy A&E in Kent. He is proud of his department, having reduced waiting times to four hours, but sometimes he still has to put patients on trolleys. ‘I deal with 150 patients a day – my French counterpart sees perhaps 30 cases,’ he said. ‘But they have lots of beds here, too – they seem to be running at maybe 50 per cent capacity, and there are days when we’re over 100 per cent, which means more patients than available beds.’
The two hospitals are part of a unique experiment to see what England and France can learn from each other. Under a two-year project using £1million of EU funding, staff will be encouraged to cross the Channel and work in the other hospital. The British health professionals want to see how the French manage their surgery so well, to the point where waiting lists don’t exist. Is it simply down to a much higher level of funding – or are they doing something different? The French are amazed by the efficiency of the NHS, and the way teams of carers can provide an important bridge between hospitals and the community.
Although the two regions share many similarities and are joined by the high-speed Eurostar, fascinating differences between the two unfold as staff take a tour of the St Philibert hospital. They are as impressed by the kindergarten set-up for the hospital staff as they are by the spotless corridors and beautifully designed palliative care unit, which has ensuite bathrooms for each patient.
Thompson is interested in the way French patients can avoid putting pressure on the hospital by making more use of their GPs and local pharmacy. ‘Patients in Britain often come into casualty because they face a two-week wait to see their GP,’ he said. ‘Here you seem to see your doctor that day, and the GPs still do home visits at night. I don’t know how the French system would work during a big emergency though. Our nurses are very skilled at dealing with all kinds of situations – they have to be – and they also have more responsibility than their French equivalents. I think we’re more efficient because we have far fewer beds in which to place people.’
Thompson works at the Darent Valley Hospital in Dartford, which was only recently opened and feels more clean and well-designed than many NHS hospitals. Yet it does not have the feel of a hotel, which is the impression given by the wide, airy spaces in Lille.
For Tony Blair and his Health Secretary Alan Milburn, the question of why French hospitals offer a first-class, consumer-driven service when ours do not is causing unease. Last week the Prime Minister was caught out in the Commons when a Tory MP spoke of a constituent who recently had a successful hip operation in a clean and modern hospital. Nigel Waterson, MP for Eastbourne, congratulated the Government on Velma Paterson’s happy outcome under the auspices of the NHS. The Tory benches erupted in laughter as Waterson then asked Blair: ‘But can he explain why she had to have her operation in France?’
No one in the Government relishes such comparisons, but the reason for her trip to France was that Blair has pledged to cut waiting lists by sending certain types of patients for routine operations to France and Belgium to make up for the shortfalls of the NHS.
Health tourism of this kind is likely to become increasingly common as British authorities battle to meet the tight deadlines set for waiting times. Already this year 247 patients needing hip and knee operations have travelled to France, paid for by the NHS. They are accompanied by ‘care advisers’ who ensure they are properly looked after. Managers insist that even with the cost of travel these operations work out cheaper than in a private UK hospital because consultants’ private fees here are so high.
Heart patients also benefit from the new entente cordiale. The first two British men to travel abroad for major heart surgery on the NHS are now recovering in Leeds. One of those is 73-year-old Denis Waistell, who had a double heart bypass operation in Ghent, Belgium, last month after being on the waiting list for six months in Britain. He said this weekend: ‘I had a heart attack eight months ago and was told I needed a double heart bypass. When I was offered a choice I said I would go anywhere because I just wanted to get the operation over and done with.’
Patients like Mr Waistell, who are fit enough to make the journey, are the ones who currently benefit from foreign expertise, but soon the overseas teams will be coming to Britain to carry out thousands of operations. The Government will award contracts to international companies to run diagnostic and treatment centres across the country, and hopes this will make major inroads into the waiting lists. The firms, and their staff, will be French, South African, Italian or German but will be expected to meet the same clinical standards as their British counterparts. In short, it will be foreigners who come to rescue the NHS, because there is too little time to train all the staff needed to turn around the NHS under the 10-year timescale set by the Government.
Health Minister John Hutton told The Observer that the old ideological barriers to looking abroad for new ways of doing things were breaking down. Speaking during a break from a conference with his foreign counterparts to discuss health reforms, Hutton said: ‘There are other countries like us that face constraints, such as Sweden and Slovenia, and we’re all trying to find ways of build ing up our services to make them more responsive. The overall capacity of the NHS holds us back. We don’t have enough beds or doctors or operating theatres. But it’s also about the way we organise the services, and that’s what we’re working on. The NHS needs to be able to learn from other countries. It’s important that we are prepared to listen to how others do things.’
But Hutton is not talking about the way other countries fund their health service. France enjoys a level of spending far beyond ours. Last year, 9.9 per cent of its gross domestic product went on healthcare, compared with 7.7 per cent in the UK. The money has given them nearly twice the number of beds and a larger number of doctors and other staff.
The French system was rated the best in the world by the World Health Organisation when it looked at access to healthcare, efficiency and effectiveness. But it is not the highest spender; that dubious honour goes to America, which puts an astonishing 14 per cent of its GDP into healthcare but still leaves a large section of its population without proper medical cover.
In France, every working person contributes towards healthcare, through the securité sociale which comes straight out of their pay packet, typically at around 14 per cent of their wages. Different professions also pay into insurance schemes, known as the mutuelle, which is a top-up system resulting in their healthcare being free at the point of delivery. The unemployed, elderly and children receive free care at the state’s expense.
This system gives patients enormous bargaining power. They can see the doctor of their choice, whenever they want. They can go to their local GP or refer themselves straight to a specialist. Yet politicians are now looking at ways of curbing health spending, amid concern that the costs could rise and rise if there is no limit to what patients can demand. They want treatments to be based more on evidence of what works, and less on individual whim. Family doctors have far greater rates of prescribing antibiotics than in Britain, for example. Hospitals also have less incentive to encourage staff to work harder to get patients out of bed and back home because there is no pressure on bed availability.
Myriam Brunswic, a health expert at the University of Greenwich, set up the cross-Channel initiative between Kent and Lille and believes the NHS has become used to working to maximise its limited resources. ‘The French health teams are just beginning to face serious reductions in funding. There is so much we can learn from each other. I think our team will be really interested in looking at how they manage their paperwork and their patients.’
Another great bane of NHS patients – the food – may also come in for inspection. British health staff marvelled at the quality of the hospital meal served to them in Lille, with a fresh salad followed by chicken escalope with macaroni, none of it overcooked. ‘Do you have a cook-chill service?’ asked one of the British dietitians to the French caterer. ‘No, of course not,’ the woman replied indignantly. ‘How would patients get their fresh vegetables if we didn’t prepare the food properly in our own kitchens?’ It was a salutary moment for those accustomed to the cost-cutting ways of the dear old NHS.”



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Boniface McInnes

posted September 1, 2005 at 8:15 pm


I was going to post a few links on the terrible state of medical care in the UK, but…
I must confess that I am reeling that being in, roughly, the top one tenth of a percent of the world’s population in income doesn’t qualify someone as “super-wealthy”.
What does?



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Boniface McInnes

posted September 1, 2005 at 8:21 pm


As to funding medical care, I see no reason for government to fund even the indigent. The medical industry should have to treat all people, regardless of ability to pay, as a price of doing business. Let those who can afford to pay for health care or health insurance subsidize those who can’t. In other words, doctors have to make a living, but they also have to treat anyone presented to them.



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Donald R. McClarey

posted September 2, 2005 at 7:59 am


“As to funding medical care, I see no reason for government to fund even the indigent. The medical industry should have to treat all people, regardless of ability to pay, as a price of doing business. Let those who can afford to pay for health care or health insurance subsidize those who can’t. In other words, doctors have to make a living, but they also have to treat anyone presented to them.”
Actually Boniface that is largely the current system for any hospital that recieves federal funds. I represent a hospital in a rural county, the only hospital in the county. Care is given to people we know, based on past experience, will never pay their bills, for one reason or another. No one is turned away, although the hospital does attempt to collect the bills, usually without success.



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Nancy

posted September 2, 2005 at 9:44 am


Donald,
Point granted about the French medical system as compared to NHS. However, this is also government-sponsored health care, far from the free-for-all”system” you advocate.
In France, every working person contributes towards healthcare, through the securité sociale which comes straight out of their pay packet, typically at around 14 per cent of their wages. Different professions also pay into insurance schemes, known as the mutuelle, which is a top-up system resulting in their healthcare being free at the point of delivery. The unemployed, elderly and children receive free care at the state’s expense.
I’m all for it.
And as for lawyers being greedy…speak for yourself. Or not. I do a lot of pro bono work, and I bet you do too.



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