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Tuesday, March 27, 2012

Did Dick Cheney deserve a new heart?

Former Vice President Dick Cheney continues to have a healthy spirit, a joy of living, an eagerness to live, and a good quality of life -- even at the age of 71. He and his physicians decided he was a viable candidate for a heart transplant.  After waiting 20 months, a heart transplant he received.  And all goes well, or so we are told.

Except, some are claiming he was too old, and that someone else should have received that heart.  Some say he gained special favors due to his status.  Some even are as farfetched to say he's too conservative to deserve a new heart.  These few believe that a "rule" should be set in place that doesn't allow a doctor, patient and insurance company the right to add a patient to the heart transplant list who is above a certain age.  These people believe "they" should decide who lives and dies, and not the patient.  I believe the term some use for this is "death panels."

Instead, they believe people who are too old  should just "take the painkiller," as Obama said to Jane Sturm when she asked him in June, 2009, if he would let her 100 year old mother, who could afford it, and had a "spirit" and a will to live, get a pacemaker. 

Obama said:  " I don't think that we can make judgments based on people's 'spirit.'  Uh, that'd be, uh, a pretty subjective decision to be making.  I think we have to have rules that say that we are gonna provide good quality care for all people.  End-of-life care is one of the most difficult sets of decisions that we're gonna have to make.  But understand that those decisions are already being made in one way or the other.  If they're not being made under Medicare and Medicaid, they're being made by private insurers.  At least we can let doctors, you know  -- and your mom know -- that, you know what, maybe this isn't gonna help.  Maybe you're better off not having the surgery but taking, uh, the painkiller.

For his fame and fortune, Cheney earned no special favors.  While the average wait for a heart transplant is three to six months, Cheney waited 20 months to get his.  And it wasn't like he broke the rules to get on the list.  In the past there was an age limit of 55, yet age is no longer a determining factor.

The qualification now is good kidney health, no stroke history, and a good quality of life.  So as long as the physician, insurance company and the patient think it's a good idea, then any person, regardless of age, qualifies for a heart transplant. 

This is a good thing, I think, because a new heart can buy a person, on average, six to seven years of quality life.  Surely there are complications to getting a heart transplant, the least of which is taking medicine every day to prevent your body from rejecting the heart.  Yet if you love life, it should be YOUR decision to make, not some rules made by some non-medical workers who sat in leather chairs in Washington 20 years ago. 

Yet this is where Cheney's new heart enters the realms of politics.  Many claim that Cheney made a selfish decision and he should have just "taken a painkiller."  He should have just let himself die.  Yet he didn't.  In our free society, he was able to choose to live.  I think this is good.  I think the decision to live should be made by the individual person, not a set of criteria, order sets, rules, or what not.

This is where I have a problem with Obamacare.  Once Obamacare is fully enacted, and the government is paying for health care, they are going to want to cut costs.  This is when costs will matter.  The government will set criteria for who will live and who will die.  It may not be passed by law, but it will happen by default.  It will happen because healthcare is expensive, and Uncle Sam will want to lower his costs.

Why do I think this? Because i't already happens as Obama noted in his statement above.  Look at Medicare and Medicaid and Diagnosis Related Groups (DRGs).  They already tried to cut costs by setting criteria for hospital admissions and criteria for reimbursement.  No matter how sick you are, your doctor or hospital will not be reimbursed unless you meet certain criteria.

In this way, to meet such criteria, we now have order sets.  When you are admitted, certain procedures and tests are "automatically" ordered based on your diagnosis. They are called core measures, intensity of service, and order sets.  Since I've already discussed these in the links provided I won't go into further detail here.  Yet what treatment you get when you are sick is not always what your doctor thinks is best for you, but what the "rules" say you must get.

When you're flipping your own bill you get to decide the future course of your medical treatment.  However, when your mother -- which in this case will be the government -- is flipping the bill, she gets to make decisions for you.  Since she's flipping the bill, you have to follow her rules.  And with Medicaid, we already do this.  We have rules.  We have criteria.  We have many, many, many, many things that are ordered that you will never need, but we will do them just because someone sitting in a chair in Washington decided you needed it, in many cases, years before you were ever even sick.

In the future such "criteria" may determine whether you get that pacemaker or heart transplant, I think this is bad, scary even, because it results in a sheet of paper deciding your treatment, rather than caregivers and family members at the bedside, and despite the spirit, desire to live, and wishes of the patient. 

The bottom line here is what I have been preaching all along on this blog since it's inception in October of 2007:  decisions about how to proceed with patient care should be made by the physician, family and patient, not by set of rules and guidelines.  Every patient should be treated individually, not as a collective.  I say this because every patient is unique; every patient is an individual, not a number.

So did Dick Cheney deserve a new heart?  If he has the desire to live, and the means of funding it, then YES HE DID!  It's not up to you or me to decide what's best for Dick Cheney, it's up to Dick Cheney.  That's my humble opinion, what is yours?

1 comment:

Anonymous said...

Great post.
And if a person's spirit, will to live, past practices which have kept him in otherwise good health, are not to be considered as relevant, then it is all indeed up to the death panels.