Friday, June 10, 2011

How to profit from "death panels"

I am taking some CE credits online and am reading an article with the learning objective outlined as "Learn areas where professional psychologists might need to respond over the next decade to practice ethically." Apparently, if health care is rationed to the elderly, the psychologist simply helps them adjust or simply moves onto greener pastures:

One supporting argument for age-based limiting of care is that increased spending for seniors deprives younger patients of resources that are rightfully theirs, and thus the ratio of cost to benefit justifies and validates age related rationing of medical services for seniors. Those in opposition stress that age is a weak marker for predicting clinical benefit, and further emphasize that such rationing will lead society to be less and less troubled about this apparent devaluing of elders (Gordon, 2000). Psychologists have been well schooled in the treatment of older patients (American Psychological Association, 2004; Hinrichsen, 2010), but have not been trained to face situations where medical and mental health care are rationed. Through research and clinical experience they might be called upon to help shape the allocation of resources among older patients.

Professionals are placed in a difficult position when asked to screen for problems if services to address them are not readily available. For example the suggestion that primary care physicians routinely screen all their patients for depression must be tempered with the fact that these physicians do not have the time or expertise to comprehensively treat those found to endorse depressive symptoms, and mental health referral systems may be limited in their ability to handle a large influx of depressed patients (Linton, 2004). Psychologists may face a similar ethical quandary when diagnosing dementia or geriatric depression if rationing withholds services from older patients, eliminating their chance to be treated. This trend might offer a challenge or an opportunity for psychologists. Psychologists in settings that care for the elderly might lose jobs or be relocated to working with younger patients, but since psychoactive medication accounts for a good deal of the cost associated with care of older patients, if such medications are restricted or eliminated, there may be an opportunity for psychologists to expand their roles by filling the void with non-pharmacological (and hopefully more cost effective) behavioral interventions.

What about the ethics of fighting back against rationing healthcare to those over a certain age? I just got back my bill from the hospitial for my ICD battery change --the charge was high. As I get older, instead of a battery change, will I just get sent to a psychologist who can help me adjust to dying without treatment? Or perhaps the psychologist will be too busy trying to move to "greener pastures" with younger patients. What an opportunity (or is it a challenge?) for the psychologist.

But at least compassionate psychologists will make a buck! And why is it that when Sarah Palin talks about "death panels", she's an idiot, but when a psychologist does (because isn't that what is implied by restricting care to the elderly?), his ideas are printed up in a journal?

I sometimes wonder if the movie Logan's Run

34 Comments:

Blogger TMink said...

"but have not been trained to face situations where medical and mental health care are rationed."

Excuse me? I deal with rationed care all the time. Private insurance companies do it by denying authorization for psych testing or further sessions, or by limiting sessions on the front end. Medicare, TennCare in Tennessee, does it by paying next to nothing and sending high ups in the company to work to keep kids out of residential facilities or get them out before their treatment is done.

Psychologists who take insurance have a leg up in dealing with rationed care. Now it will only get worse if Obamacare goes through, but then I might just quit taking insurance altogether if that happens.

Trey

4:05 PM, June 10, 2011  
Blogger ZorroPrimo said...

Nice analogy with Logan's Run. Which, when you think about it, is a perfect depiction of socialism at play with itself.

Everything is rosy and splendid...until...

4:26 PM, June 10, 2011  
Blogger Xiaoding said...

We already have rationed care; people too poor are left on their own.

6:08 PM, June 10, 2011  
Blogger Helen said...

Xiaoding,

No, they are on Medicaid or Tenncare etc. And I have met many people without insurance who get care. It really depends on your knowledge of the system, more than anything. Many of the people you see who do not get care don't know how to work the system and find doctors or programs to help them.

7:08 PM, June 10, 2011  
Blogger DADvocate said...

Our society's respect for the elderly has steadily decreased over the past few decades. More and more people see the elderly in a variety of negative qualities, slow, demented, intolerant, helpless and so on.

Indeed, we've lost much of our respect for human life in general. Maybe some it's due to increasing population density, although I don't think we're nearly that crowded in this country except for the megalopolises. But, the megalopolises serve as cultural centers for us.

I see the gun control movement as devaluing human life. Their message is that your life isn't worth defending. Quite a bit of the gun control stuff you see in Great Britain falls into this line of thinking.

The more we go along with socialist, leftie thinking, the more we can expect to see this kind of stuff. By definition, socialism devalues the individual and over values society. Plus, socialism simply doesn't produce the economic prosperity capitalism does.

8:37 PM, June 10, 2011  
Blogger george said...

The thing about Palin is that everything she has said has been right on the money. She is hated because she points out how transparent the left actually is.

All resources are finite and the successful countries are the ones who figured out that the government has no role to play in their allocation. Obamacare is a HUGE reason there are no jobs now and no one is talking about it... except Palin and any small business guy you care to ask.

1:00 AM, June 11, 2011  
Blogger JG said...

"All resources are finite and the successful countries are the ones who figured out that the government has no role to play in their allocation."

------

Sure governments play a role in the allocation, for instance by prohibiting (with force) transfers that the general public considers to be "unfair". Every society decides what that means exactly.

You want government out of everything? Good, if you are smaller than me or less well-armed, I'm simply going to take all your stuff away from you. Better for me, then I have more stuff.

You only want government against people who initiate force? Good, I'll con you out of your money, either directly or with identity theft.

1:15 AM, June 11, 2011  
Blogger JG said...

I can only think of one country where the government plays no role in allocation (because there really isn't much of a government): Somalia.

I don't consider that to be a successful country, but the government really does stay out of shit.

Otherwise, government is heavily involved in people's affairs in Europe, North America and the successful countries in Asia, so I have no idea what you are talking about.

1:20 AM, June 11, 2011  
Blogger JG said...

This comment has been removed by the author.

1:36 AM, June 11, 2011  
Blogger dr.alistair said...

in some societies the elderly are asked to go walk out onto the ice when the time comes.....

9:14 AM, June 11, 2011  
Blogger br549 said...

Where I live, it would have to be "take a long walk off a short pier". But it's coming.

11:18 AM, June 11, 2011  
Blogger Bob said...

Helen,
Thank you for this post. I appreciate and agree with your sentiments wholeheartedly.

8:24 PM, June 11, 2011  
Blogger Political said...

If you want to take a break from the Weiner story, I think you'll enjoy a piece called Mitt Romney Comes to Michigan and Liberals Have a Hissy Fit http://mittromneycentral.com/2011/06/09/mitt-romney-comes-to-michigan-and-liberals-have-a-hissy-fit/ You won't believe some of the stuff in that article.

9:18 PM, June 11, 2011  
Blogger Doom said...

From what I have seen, less psychiatry, at any age, is probably a good thing. Oh, sure, there are special cases. For the most part, however, I think that field and psychiatry are used when the real medical condition is not found (or in my case was never sought). No offense meant, I really don't know what your methods, techniques, or skills are (thought compassion means nothing without skill, knowledge, and experience).

I am not sure medical ethics haven't run a bit communist, either, considering the make-up of the panels who regulate ethics in physical health and psychiatry/psychology. How many, on any of those panels, boards, and groups would, for example, decry "assisted suicide", let alone abortion or refusal-of-treatment for... pick a reason? The medical field in all it's variations is looking more like the science fields. The fields of science, en masse, have abandoned man as a hope or even as something special. We are just... test subjects, probably to both groups, to the elites in those areas.

3:08 AM, June 12, 2011  
Blogger SGT Ted said...

Funny how a bunch who mouth concern for "social justice" are really concerned about making lots of money.

11:31 AM, June 12, 2011  
Blogger John Russell Turner said...

Oh, my God-send grandma to the shrink so she can better deal with being refused medical treatment? This is just one of the many costs of government-run healthcare, and if the freakin' market were allowed to rule here, grandma wouldn't need the shrink, now would she? This is beyond the pale. When you put it this way, you see the evil lurking behind the facade. Anyway.

7:49 AM, June 13, 2011  
Blogger eric said...

Telling Dr. Helen that there is already rationing is to commit the equivocation fallacy.

Rationing is generally understood as a finite amount of something which is then split up amongst the population desiring it. So, if you have 10 meals and 20 people, you have to ration the meals.

Currently, in the United States, there is healthcare for everyone. No rationing required.

Just as there is water for everyone.

It doesn't mean everyone gets health care, nor does it mean everyone gets water. Someone stuck out in the desert may not have access to water unless they can afford to have it brought to them. This in no way means the water is rationed.

Don't let supporters of Obamacare pretend like healthcare is rationed and it will be rationed under Obamacare just like it is rationed now.

It's not. It's a lie. There is plenty of healthcare in the United States, just as their is plenty of water.

Under Obamacare, there will not be plenty of healthcare for everyone for various reasons. Healthcare will become scarce. Just as water would become scarce if we did the same thing to water that we're doing to healthcare.

Just as gasoline became scarce when Jimmy Carter was president and gasoline had to be rationed. It wasn't that suddenly oil vanished from the face of the earth. It was government intervention that caused it to be rationed.

In the same way, your healthcare will go away.

Water, gasoline, healthcare, these things are not rationed under our current free market system. And it takes a fallacy to argue that it does.

8:06 AM, June 13, 2011  
Blogger SDN said...

"Good, if you are smaller than me or less well-armed, I'm simply going to take all your stuff away from you. Better for me, then I have more stuff."

All you'll have is a plot about 6'x3'x6', because myself and half a dozen of my TX neighbors will fill you fuller of lead than a fishing weight factory. And we can do that because TX got the government to stop preventing citizens from defending themselves.

8:27 AM, June 13, 2011  
Blogger JG said...

SDN:

Oh yeah? Well, you mess with me and you mess with the whole trailer park.

--

LOL

Grow up, dude, and recognize that some arguments are there to make a point and not to serve as one of a nearly infinite amount of triggers for you to pretend like you're a bad-ass.

8:41 AM, June 13, 2011  
Blogger PatD said...

@JG: I can think of several cases where the government had complete control over the allocation of resources: the Soviet Union, Nazi Germany, Communist China, Cuba, and North Korea. This did not work out well for tens of millions of people, now deceased courtesy of their government.

The government should have a role but that should be limited to protecting property rights equally. When it becomes an active participant, disaster ensues. The government run Ponzi schemes (aka Social Security, Medicare and Medicaid) are bankruping the country.

9:39 AM, June 13, 2011  
Blogger CBDenver said...

Ezekiel Emanuel, brother or Rham, wrote an article about the need for rationing of healthcare via the "Complete Lives System" as practiced in Great Britain. In it he gave two examples of rationing -- antibiotics during WWII and dialysis machines.

While it is true that antibiotics and dialysis machines were once scarce, what actually occurred was not an elaborate system for rationing those goods but rather the increased availability of antibiotics and dialysis machines. The reason the latter occurred is that companies were allowed to compete and make a profit by producing antibiotics and dialysis machines.

What is more moral -- a system that provides "free" medical services but lacks the ability to produce them in abundance, or a system that provides needed goods in abundance? Maybe capitalism and the profit motive is not as "immoral" as some leftists would have us believe.

9:39 AM, June 13, 2011  
Blogger JG said...

"I can think of several cases where the government had complete control over the allocation of resources: the Soviet Union, Nazi Germany, Communist China, Cuba, and North Korea. This did not work out well for tens of millions of people, now deceased courtesy of their government."

--

I agree. Complete control of resources (central planning, communism) doesn't work out well.

I'm not advocating heavy government control of allocation, I was pointing out above that Western governments ARE involved.

I don't understand why more people don't want to get rid of the very intrusive income tax (a national VAT could cover the tax receipts).

9:43 AM, June 13, 2011  
Blogger Joan of Argghh! said...

.
I think we can safely assume that burying those costly Seniors is likely the "shovel-ready" jobs Obama was touting.

10:17 AM, June 13, 2011  
Blogger McGehee said...

"...deprives younger patients of resources that are rightfully theirs..."

And here lies the danger of any system where any kind of health care is paid for by someone other than the recipient -- the perception that someone else has the right to it instead.

10:36 AM, June 13, 2011  
Blogger John Russell Turner said...

"I think we can safely assume that burying those costly Seniors is likely the "shovel-ready" jobs Obama was touting."

Ayn Rand wrote a passage in Atlas Shrugged about this issue. It's been so long..."Madame, when you see the world around you in flames, and people dying of starvation in the streets, your cries of "I didn't mean it" will mean little." Did I get that right?

10:42 AM, June 13, 2011  
Blogger RebeccaH said...

I understand your worry, Dr. Helen, about health care rationing, as I'm in much the same position and far more advanced in age. Almost as bad as not receiving needed treatment will be the assault on our self-worth. "Counseling" to accept "death with dignity" will make those of us who are elderly question our own worth. We are old, and sick, so why should we continue to take up space? Our own lives become valueless.

Thank you, Obama and Democrats.

11:02 AM, June 13, 2011  
Blogger John Russell Turner said...

"Water, gasoline, healthcare, these things are not rationed under our current free market system. And it takes a fallacy to argue that it does."

Well said. "Whatever their motives are, the benefit of mankind isn't one of them"

11:09 AM, June 13, 2011  
Blogger paul a'barge said...

As I get older, instead of a battery change, will I just get sent to a psychologist who can help me adjust to dying without treatment?

You betcha!

Sweet, isn't it?

11:16 AM, June 13, 2011  
Blogger Wayne said...

And why is it that when Sarah Palin talks about "death panels", she's an idiot, but when a psychologist does (because isn't that what is implied by restricting care to the elderly?), his ideas are printed up in a journal

You see, the difference is that the psychologist didn't use the words, "death panel", so there are no such things, and Sarah Palin is a dirty, filthy liar!

At least, that's their typical argument.

4:54 PM, June 13, 2011  
Blogger SH said...

"I just got back my bill from the hospitial for my ICD battery change --the charge was high. As I get older, instead of a battery change, will I just get sent to a psychologist who can help me adjust to dying without treatment?"

I have one too that also has CRT function. I'd note that most Euro 'public' systems don't offer CRT defibrillators… the stats say 80% of people with heart failure die within 5 years so why spend the extra money? Putting aside most people with heart failure are older, than you and I are, so it throws off the same (details details…)… not to mention it makes life easier for even those who do die.. Hey, it costs more (funny how the anti health corporation people jump right on these bandwagons when it is done by the government… in the same of ‘science’). In the US the government already is putting more pressure on drug and medical device makers to not talk about off label uses (such as the CRT might save a younger person’s heart / life) that is common knowledge with doctors but not supported by a study… In order to save on their future expenses…

7:27 PM, June 13, 2011  
Blogger SH said...

ack...
" so it throws off the same"

I meant, sample. It throws off the sample...

7:28 PM, June 13, 2011  
Blogger SH said...

"What about the ethics of fighting back against rationing healthcare to those over a certain age?"

Starting with their poor logic. I ask rhetorically of course; why assume that rationing will work (and even get more care to the young). It’s the typical lefty mercantilist set sized pie worldview (re: the existence of the rich makes others poor).

The reality is new classes form in ‘public’ systems. The well and the ill. The well are the majority and they will vote their class interest, which is spending less on the ill and more on them. Whereas today, the ill have the option of paying more (which pumps more money into the overall system than in Euro countries)… and they get to pick what the more goes to (re: stuff they need)… We won’t in the rationed system. Money will be replaced by the vote… The well run the show since there are more of them. They will want feel good preventative programs (that no studies show do anything). They will want fast access to primary care doctors (who a: don’t need to be doctors, b: tell them they have the flu and there is nothing they can about that… unless you’re a big pain and they give you an old antibiotic to get you to go home). Whereas the sick need things like specialists, and expensive machines, and new medicines… you know, stuff that costs so darn much. So spending declines and what it goes to is picked by voters and pols vs. the hold hidden hand...

7:50 PM, June 13, 2011  
Blogger SH said...

Helen said...
Xiaoding,

"No, they are on Medicaid or Tenncare etc."

and county medical assistance programs, free clinic networks, pro bono work, private orgs, and the tax code... re: the hospitals have a loophole that lets them get a good tax write off for helping those who can not pay the bill (which is why everything is so overpriced on their bills... re: at levels cash payer patients and insurance companies do not pay)...

8:06 PM, June 13, 2011  
Blogger JG said...

This comment has been removed by the author.

5:23 PM, June 15, 2011  

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