If you were to stop looking at the world through the lens of
libertarianism, xfree, you might discover the real world.

If you were to stop looking at the world through the lens of
libertarianism, xfree, you might discover the real world.

I'm not sure that I fully understand your code that you used in your last sentence. Is there some sort of secret handshake that only Limbaugh worhsippers understand? Does *that* convey some special meaning that only insiders understand, or is that just a fancy way of adding expletives that will not be deleted by Sojo?

Nevertheless, there's a lot of faulty logic in your post and I'll do my best to respond to them in terms that you can understand.

“That's assuming the government agent hasn't misplaced it.”
The government agent does not have a copy of my advanced directive. There's a copy on file with my family physician and with the hospital in which I have been treated several times, but not with the “government agents.”

“I know my family, and I know the government.” The primary reason for an advanced directive is to keep the government out of those end of life decisions. Nowhere was this issue more adequately demonstrated than the case of Terrri Schiavo in which George Bush and Jeb Bush thought that they knew more than Terri's doctors and Dr. Bill Frist provided a long-distance diagnosis on the basis of video footage. That case alone resulted in me and millions of other Americans writing advanced directives to prevent the kind of government intrusion that you so eloquently lament.

So when you do prepare an advance directive, do leave a copy with your family, your doctor, and the hospital where you would expect to be treated in case of an emergency. But don't mail a copy to the government.

The problem is, *you* are not available, *you* are unconscious or at any rate not lucid. If you were conscious and aware of what was going on the doctor wouldn't worry about pieces of paper or the guesses of your relatives, he'd ask you directly.

With you unfortunately unavailable what the doctor has is a document bearing your signature that may or may not adequately address the condition you are in. That's assuming the government agent hasn't misplaced it. If your precious document isn't clear or something comes up that you didn't anticipate, then the doctor's back to talking with your relatives.

I don't know your family so I can't say what they might do or if they might respect your wishes. If you really fear that they will mistreat you then you have my pity. As for me, I know my family, and I know the government. In a situation like this, I trust my wife and kids. They know me better and they care about me more.

That's really the question here. Living wills serve their purposes and if they are drafted well they can be valuable — if nothing else they can tough decisions easier — but a living will is only as good as the people who apply it. There's nothing magical about a piece of paper that guarantees it will be followed.

Someday I may decide to leave some advance directives of my own. If I do, I'll leave my family a copy, not because I want them to decide everything, but because I expect they will understand and respect my wishes. I'm less convinced of that as far as the government is concerned.

Now, does *that* shock you?

LV

I don't consider it to be sarcasm when I question the credentials of an individual who you cited in your original contribution. If I decide on “one fine summer's day” when I am totally healthy and lucid that I don't want a lot of tubes keeping me alive, I don't want my loved ones to follow Dr. Krauthammer's advice to keep me plugged in. By the same token, if my choice on that summer day was to keep the stuff coming through the feeding tube and keep me drugged up on pain-killers, then I would not want my loved ones to contravene that decision either. No one knows me better than me despite what you and Dr. Krauthammer say. And yes, to suggest otherwise really is shocking.

Between updated software, OEM devices, and aging technology, it is nearly impossible to put together a system that can seamlessly integrate the various images, records, past prescriptions etc… This is especially problematic since most patients are elderly, and therefore have long medical histories.

One answer is to streamline care via the insurer, forcing people to choose doctors within particular networks, which can then share data. This proved unpalatable in an era of employer-provided coverage, but in a free market, it would be very appealing to have a doctor who was intimately familiar with your medical history.

Unfortunately, none of his proposed fixes (or identified challenges, for that matter) can be condensed into a political slogan.

Lord, I need some help here. How should I revise my advance directive/living will so that my wishes are respected and that close family members do not decide? Do either you or the good doctor have some ironclad language that I can insert so that my intentions override those of those gathered at my bedside?

2. I agree every publicly financed system allocates care. Is there a system that does not??

Yes, because 99.99% assurance of death is the equivalent as inadequate access.

At any rate, this is a red herring. Living wills exist now. There's no reason to think that the government will be any more likely to respect the wishes of a near-dead and unconscious patient than his or her relatives would be. Government bureacracies have their own incentives that might be contrary to the desires of the terminally ill, and there are lots of places in government office buildings in which to hide inconvenient documents.

LV

2. Death Panels: I think cost controls and our fundamental values are the risk here; not whether physicians discuss care options with patients. These choices get made everyday. It is part of life and death. A hospital today has both the capacity to unduly ram care down a patient's throat and can make it abundantly clear they think the plug should be pulled. There is no perfect way. But the time to give the patient a bit of power, knowledge and say so is not when their life is on the line, when they are unconscious, or in unbearable pain, or burning through their last asset–and with a smile ask if we should pull the plug. Yes the issue is real. But “no” in this context the reality of what was in the bill was not of concern and subtracts greatly from the legitimacy of those who chose to exploit fears.

3. Yes everyone has a right to priorities. I think his attempt is to not to try to play one issue against the other. Let's acknowledge we can attempt to address a multiplicity of issues in a bill and not all threaten to walk away from governing because one issue isn't exactly what we want. Tony Perkins (for example) cannot legitmately say he wants to address issues of access; but only if abortion funding is dealt with in a certain way. Either we are going to work together to increase access, outcomes, and reduce costs or we are not. If we do not work together the thing will fail because the values and issues of many sides need to accomodated. They are not accomodated through compromise but through wisdom.

4. Treatment decisions: The goal is to maximize the patient's health supported by patient's healthcare choices in consultation with provider of their choice–placing appropriate value on varied treatments (treatment can kill as well as save). I think we have to fight for this goal. I don't think the choice of third-parties is a plus or minus on this. It is how he payer functions. I think presenting the “public option” as expanding the field of competition is wrong. It may do so. But it may not. The point is to be clear on what we are after when we advocate for any changes. If you and I are after the same fundamental goals–we can be clear on that. If we are after different things–that is OK.

5. Lines. You agree with Dr Jones. Lines exist. What is our goal here?? I would think we want people to make good decisions about what lines to get in and when to get in them; allow them to get in line freely; and make them as short as possible. So let's work to that end and agree to neither obfuscate or exaggerate the line issues in the US or other countries.

6. Is anyone proposing or desiring a “Federally Funded National Clinic” with government doctors? No.

I believe Obama would like a universal single payer. This might take us there. Dr. Jones states that. That is not a national clinic and the fear language implying such is the case is wrong. And again by playing on this the opponents seriously dilute the full range of serious concerns about even heavier federal involvement in healthcare. There are too many serious issues here to cloud the air with false issues.

2) There has never been a publicly financed health system that did not lead to rationing of care. Can you imagine the horror of the 65 year olds in England who were denied admission to ICU after surgery?