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Death By Bureaucracy
why uncle sam is the wrong choice for fixing healthcare
By haystack Posted in Policy — Comments (14) / Email this page » / Leave a comment »
[update: Emilio gets a reprieve:
Travis County Probate Judge Guy Herman this morning allowed more time for a child on life support at Children’s Hospital of Austin to find another place for care.
The respirator keeping Emilio Gonzales alive was to be disconnected on Wednesday, but Herman said he will hear the case with evidence on April 19 so no further action could be taken until then. The decision came to the relief of the 17-month-old’s mother Catarina, 23, of Lockhart, who bowed her head and prayed during the 40 minutes the judge was out of the room before the ruling.
Texas is not to blame here, but a case can be made against "the" Government placing itself in the middle of our personal health care decisions by peering into the Lonestar state and considering the case of 17 month old Emilio.
Emilio is terminally ill, lying in a hospital ICU, waiting for the Government and his family to agree on just which day he will die.
Tempting as it may be to jump to Schiavo comparisons, there are none here. In Terri's case, family members couldn't agree between themselves, and wherever you came down on Terri's life and death, no similar analogies can be made.
This is about Medicaid, Hospitals being given the power to determine WHEN to pull the plug, and whether or not a bureaucracy is the best arbiter of life and death decisions when THEY make them based on money, while loved ones make them based on far more personal, religious, and meaningful terms.
More below the fold...
Texas is about to pass some new legislation regarding Medicaid in order to satisfy a very old court fight over whether qualified recipients were given sufficient coverage and sufficient access to providers.
The fight stems, in part, from the problem the Texas legislature created for themselves when they cut reimbursement rates [free subscription required] back in 2003 when faced with budget shortfalls.
See, Doctors are in the business of making money, not handing out charity. They saw reductions in their reimbursement rates, and they did what any of us would do - they stopped taking on NEW Medicaid patients.
The obvious result? Less access for Medicaid qualified patients, followed by the expected court battles that went all the way to SCOTUS before being handed back to the State to resolve.
Now comes new legislation that will dip further into the coffers of the taxpayer. From the Statesman:
The state would pay physicians and dentists 25 percent to 50 percent more to see Medicaid patients, families would spend less time waiting on toll-free phone help lines and the state would hire more case workers to help families navigate the health care system under the terms of a preliminary agreement reached by lawyers representing the state and children on Medicaid.
Lawyers outlined the settlement Monday for Senior U.S. District Judge William Wayne Justice in an effort to resolve Frew v. Hawkins, a 14-year-old dispute over the state's obligations to children on Medicaid, a federal-state health care program for people with low incomes. The sides are putting the final touches on the plan before submitting it in writing to the judge in the next few weeks.
Legislators must pave the way for the agreement before the session ends May 28. House Appropriations Committee Chairman Warren Chisum, R-Pampa, estimates that the plan will cost the state about $700 million over the next two years. "To say that it's just going to wreck the budget is probably not right," Chisum said.
But he said House members might have to revisit some of the spending decisions they have made. He did not specify what those could be.
Lawmakers also might have to dip into the billions of dollars they have set aside to cover property tax cuts in 2010 and 2011.
Federal law requires the state to provide Medicaid to families that qualify. At issue in the Frew case is whether the state is doing enough to make sure Medicaid services actually reach patients. Lawyers hope the settlement will entice more doctors to see children on Medicaid, improve the quality of care that those doctors provide and improve the state's efforts to help families overcome barriers such as language, transportation and geography.
"The major problems are access problems," said Susan Zinn, a lawyer for the families that sued the state. "Children are having to wait a long time, particularly for specialty care."
For now, however, little 17 month old Emilio sits on life support. Emilio is on Medicaid, you see, and the bills are really racking up.
While the Children's Hospital in Austin vehemently denies the decision to pull Emilio's plug has ANYTHING to do with cost, it is quite clear from where I sit that this has EVERYTHING to do with cost.
As Emilio's family and their lawyers fight to keep him alive, the Texas taxpayers continue to pay...not ONLY for Emilio's healthcare, but for the Texas Attorney General's office and all his lawyers as they continue to go before the State and Federal court system trying to pick the best and right time to kill this poor innocent child.
Say what you will about whether Emilio SHOULD be allowed to die, it is NOT and should NOT be up to the Hospital and the Federal courts. As long as Uncle Sam calls the shots, his actions will not be in the best interest of the patient.
Emilio will die. Likely he will die a horrible death by asphyxiation on April 11, 2007 considering that the family's last ditch efforts to get a restraining order against the Hospital to extend his life beyond that date will likely fail. Even if they succeed for now, his time is short.
The taxpayers will continue to pay. The Government will continue to intervene. And, with the jillions of lawyers, administrators, case workers, and Hospital boards continuing to grow to accommodate this ever-expanding and bloated bureaucracy, Emilio will still die...and his family will ultimately have had little say in the matter.
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Death By Bureaucracy 14 Comments (0 topical, 14 editorial, 0 hidden) Post a comment »
left it out on purpose
by haystack
because whether Emilio should die or be kept alive isn't the point here. The attempts by the family to find alternate facilities continues, and successful or not, Emilio WILL die eventually.
The point here is the bureaucracy and its mechanisms that got all of us here in the first place...and if this is how Government Healthcare works, we should all want OUT before it even starts.
haystack's 12th:
Conservatives (and Presidential Candidates especially) shall offer no aid and comfort to the opposition in times of legislative conflict (and ensuing political campaigns).
Government health care will involve rationing and even more decisions based on money.
When I was in England several years ago, I asked someone about their national health service. She told me that if you had a life-threatening problem the care was very good, but for anything else all bets were off. The example she gave was that you might need hip replacement. Well regardless of how painful and inconvenient it is, it's not life-threatening so you might have to wait many months.
and she could tell after a shift which babies were going to make it and which ones were not. One family chose to prolong their brain dead baby's life for fourteen years a couple of months ago. The volume of money that is required for that is phenominal and the parents have admitted their son is not interactive but still cannot bring themselves to do anything about it.
small quibble
by haystack
the mother actually refutes the hospital claims about his responsiveness...that said...
again, this is about the system that got us here in the first place.
No denial here that Emilio isn't going to make it.
haystack's 12th:
Conservatives (and Presidential Candidates especially) shall offer no aid and comfort to the opposition in times of legislative conflict (and ensuing political campaigns).
and
by ProgCivLib
The American and Texas tax payers would be the ones to pay to keep him alive and on life support for his entire life. Why should they pay to keep a few organs functioning for years and years? This was a law signed by GWB. Don't you think doctors are qualified to determine the responsiveness and likelihood of recovery of the patient? How much medical school has the mother been through by the way? This shouldn't be an emotional/religious/family decision. It should be a medical decision.
fine...and AGAIN
by haystack
do you want the bureaucrcy to set medical decision policy?
haystack's 12th:
Conservatives (and Presidential Candidates especially) shall offer no aid and comfort to the opposition in times of legislative conflict (and ensuing political campaigns).
actually
by ProgCivLib
They're not. If you read the article, you'll see that it is the doctors making the decision.
No, it should be a family decision
by The Gadfly
and if the government weren't there with Medicaid, it would have been strictly a family decision. But since the government is, it has become a mess.
actually
by ProgCivLib
It is precisely the family that is making this a mess. The doctors have determined medically what the right thing to do is. The bureaucracy is giving them the power to do it and the family is fighting it.
Ok...
by zroxx
This is about Medicaid, Hospitals being given the power to determine WHEN to pull the plug, and whether or not a bureaucracy is the best arbiter of life and death decisions when THEY make them based on money, while loved ones make them based on far more personal, religious, and meaningful terms.
So, any thoughts on how to approach this subject in a more rational manner?
It seems to me if that if the principles of increasing personal responsibility and decreasing wealth redistribution and coercion are prime, then we ought to agree that taxpayers ought not be forced to contribute an endless flow of cash dependant only on the decision of loved ones to extend care as long as they prefer. Instead we should recognize the rights of legal guardians to shop around for the best care possible, their obligation to take responsibility for paying for said care, and the right of care providers to freely set rates that they feel the market will bear.
What we seem to have now is a system that starts out assuming an endless stream of taxpayer cash is available, and operates accordingly only up to some trigger point wherein the hopsitals are legally able to convene some kind of ethics board or other decision making body to rule on whether to continue extraordinairy life support measures. I'm not sure whether this is the worst of both worlds or the best of both worlds, but the sudden change in operation from assumed endless-funding to sudden life or death decision making appears to be a major point of contention and understandable stress for citizens dealing with these scenarios.
I do think it's fair that if the loved ones in question are not paying for the care, that the preponderance of the decision making as to whether care should continue lies with those who are paying for it. But I dont see any practical way for taxpayers to make meaningful decisions as to which cases they feel their cash should be spent and which shouldn't. So I guess we end up with, as you say, bureaucrats making the decision for them.
Would it not be better if taxpayers weren't forced to pay into this system, and health care was negotiated between providers and customers like any other consumer-based marketplace? And then we allow that the extreme edge cases where life support, extraordinairy care, and high expenses are issues could perhaps be aided by charitable organizations that funnel money from concerned donors in order to help those persons that need it?
for the most part, I couldn't agree more
by haystack
I DO believe the system as defined by Govt. policy is ripe for being gamed.
I also agree that the Emilio case is an example of the extreme, and thankfully, rarest of likely contentious scenarios.
In a small Govt. world, your description is well articulated:
It seems to me if that if the principles of increasing personal responsibility and decreasing wealth redistribution and coercion are prime, then we ought to agree that taxpayers ought not be forced to contribute an endless flow of cash dependant only on the decision of loved ones to extend care as long as they prefer. Instead we should recognize the rights of legal guardians to shop around for the best care possible, their obligation to take responsibility for paying for said care, and the right of care providers to freely set rates that they feel the market will bear.
But for the Emilio scenario where the parent is unwilling to come to terms with the reality of his situation and the need for some decent level of "final say" on the matter, you make the case yourself in these words.
haystack's 12th:
Conservatives (and Presidential Candidates especially) shall offer no aid and comfort to the opposition in times of legislative conflict (and ensuing political campaigns).
you are famous, haystack
by CloselyBrilliant
The left has dedicated an article exclusively to you.
link
Don't listen to them and keep up the good work.
Local news story
by bk
Judge grants nine more days to try to find a new facility and appoints an independent guardian.
http://www.kxan.com/Global/category.asp?C=4427&nav=menu73_2
http://keyetv.com/topstories/local_story_100175959.html
http://www.kvue.com/news/top/stories/041007kvuelifesupport-cb.af975c3.ht...
http://www.myfoxaustin.com/myfox/pages/News/Detail?contentId=2892352&ver...
http://www.news8austin.com/content/your_news/default.asp?ArID=182286
I can't say I blame her, but the mom seems a bit incoherent to me. She knows he's dying, but wants to stretch it out as long as possible regardless of whether it's causing the baby pain or not. It sounds at this point like her attorneys are just trying to buy time to build up evidence for future lawsuits. The statements they are making about the hospital making decisions are false as I understand it.
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The deadline allows time for the family to find alternate care. It's been extended once already. There is nowhere that will take this baby. Apparently every doctor/facility sees the kid as dead and it's just a matter of time before it becomes official.
I agree it's a very tough situation, but if he could be kept alive artificially for 50 or 60 years does that do anyone any good? Here there seems to be no question that there is zero chance for any sort of recovery, but the parents won't give up. I can't blame them - maybe I'd do the same in their position.