Have We Lost Grassley et al. to the “Death Panels”?
For a moment, just for a brief moment, I thought that we were beginning to step back from the brink of all-out, take-no-prisoners combat on one of the most divisive issues surrounding healthcare reform.
After alleging that her parents and her Down Syndrome baby would have to stand in front of Obama’s “death panel,” “so his bureaucrats can decide…whether they are worthy of health care,” former governor Sarah Palin is now revisiting her incendiary implications that Obama’s “evil” health care plan will kill children and Grandmas.
For whatever reasons—it doesn’t matter: it’s good—in her latest Facebook entry, Palin now encourages a more civil discourse on the health care issue:
There are many disturbing details in the current bill that Washington is trying to rush through Congress, but we must stick to a discussion of the issues and not get sidetracked by tactics that can be accused of leading to intimidation or harassment. Such tactics diminish our nation’s civil discourse which we need now more than ever because the fine print in this outrageous health care proposal must be understood clearly and not get lost in conscientious voters’ passion to want to make elected officials hear what we are saying. Let’s not give the proponents of nationalized health care any reason to criticize us.
Even Rush Limbaugh, while still fiercely criticizing the health care proposals, indirectly—in the “obscene profit center” segment of his show—supported one aspect that the alleged “death panel” section of the House bill: The importance of having a living will.
In an interview with the Washington Post, Republican Senator Johnny Isakson from Georgia indicated that he was “befuddled” that the issue of end-of-life counseling and planning had become a question of euthanasia, called Palin’s interpretation ‘nuts,’ and emphasized that all 50 states currently have some legislation allowing end-of-life directives.
What is significant, according to the Post, is that “One of the foremost advocates of expanding Medicare end-of-life planning coverage is Johnny Isakson… He co-sponsored 2007′s Medicare End-of-Life Planning Act and proposed an amendment similar to the House bill’s Section 1233 during the Senate HELP Committee’s mark-up of its health care bill.”
Here are some of Senator Isakson’s remarks on this issue:
Q. Is this bill going to euthanize my grandmother? What are we talking about here?
A. In the health-care debate mark-up, one of the things I talked about was that the most money spent on anyone is spent usually in the last 60 days of life and that’s because an individual is not in a capacity to make decisions for themselves. So rather than getting into a situation where the government makes those decisions, if everyone had an end-of-life directive or what we call in Georgia “durable power of attorney,” you could instruct at a time of sound mind and body what you want to happen in an event where you were in difficult circumstances where you’re unable to make those decisions.
This has been an issue for 35 years. All 50 states now have either durable powers of attorney or end-of-life directives and it’s to protect children or a spouse from being put into a situation where they have to make a terrible decision as well as physicians from being put into a position where they have to practice defensive medicine because of the trial lawyers. It’s just better for an individual to be able to clearly delineate what they want done in various sets of circumstances at the end of their life.
Q. How did this become a question of euthanasia?
A. I have no idea. I understand — and you have to check this out — I just had a phone call where someone said Sarah Palin’s web site had talked about the House bill having death panels on it where people would be euthanized. How someone could take an end of life directive or a living will as that is nuts. You’re putting the authority in the individual rather than the government. I don’t know how that got so mixed up.
According to ABC News’ Jake Tapper, “Isakson also sponsored a bill in 2007, that would ‘amend title XVIII of the Social Security Act to provide for coverage of an end-of-life planning consultation as part of an initial preventive physical examination under the Medicare program.’ That’s very similar to what the House bill would do, although with much less specificity.”
So far so good on a more civil discourse. But it gets better.
During his Tuesday town-hall meeting in Portsmouth, N.H., while debunking the “death panels” issue, the president also had praise for Republican senators, including Iowa Sen. Chuck Grassley, the powerful Senate Finance Committee’s ranking member and one of three Republicans negotiating the health care proposals with three Democrats on that committee:
Now, I think that there are some of my Republican friends on Capitol Hill who are sincerely trying to figure out if they can find a health care bill that works — Chuck Grassley of Iowa…They are diligently working to see if they can come up with a plan that could get both Republican and Democratic support.
He also had kind words for Johnny Isakson for his proposed end-of-life legislation.
But then all hell breaks loose.
First, Senator Isakson who, to be fair, did vote against the Senate health reform bill in committee, but who, also, did add an end-of-life consultation amendment to it, was quite irate that the president had complimented him for his work .
He blasts the House bill—especially the now infamous Section 1233— and says, “My Senate amendment simply puts health care choices back in the hands of the individual and allows them to consider if they so choose a living will or durable power of attorney. The House provision is merely another ill-advised attempt at more government mandates, more government intrusion, and more government involvement in what should be an individual choice.”
Again, ABC’s Jake Tapper :
Isakson’s amendment to the Senate bill, they say, is very different because, “anyone who participates in the long-term care benefit provided in the bill – if they so choose – may use that benefit to obtain assistance in formulating their own living will and durable power of attorney. ”
And it’s true that his amendment is two pages whereas the section in the House bill is ten. But the bill Isakson offered has more similarities with the House Democrats’ bill than it has differences.
Then, Senator Grassley, who according to Joan Wash at Salon.com has “been held up as a paragon of reason and bipartisan comity,” went totally rogue and, in my opinion, went even beyond Sarah Palin’s (now tempered) original rant.
Here are some of Grassley’s comments made during town hall meetings in Iowa yesterday:
Referring to counseling for end-of-life, Grassley told the crowd: “And from that standpoint, you have every right to fear… We should not have a government program that determines if you’re going to pull the plug on grandma.”
And later, “There are some people who think it is a terrible problem that grandma is laying in a bed with tubes in her…and that the government should intervene…I think that’s a family or religious thing that needs to be dealt with.”
Well, so much for putting the “death panel” issue to death rest.
Can we still step back from the disinformation abyss in other areas?
UPDATE:
Apparently I was premature with commending former Alaska Gov. Sarah Palin for her more civil and reasoned discourse on the so-called “death panels.”
According to Politico.com, Sarah Palin last night defended—“doubled down” on—her claim that the Democratic health care proposal would create “death panels.”
She wrote in her Facebook page:
Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly and the disabled would suffer the most under such rationing; and that under such a system, these ‘unproductive’ members of society could face the prospect of government bureaucrats determining whether they deserve health care.
She then accused Obama of “misleading” about the now infamous Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.”
Perhaps, in the future, I should wait at least 48 hours before commenting—especially in a laudable manner—on any of the former Governor’s remarks.
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Shameful. Still some people wonder why Obama is so brazenly refusing to kowtow to the brave and broad swathes of the population who hate his “government takeover” of health-care. Simple: anyone can see that far too many of the anti-reform crowd are either willfully ignorant or misled, or just not acting or speaking in good faith about the issue.
There are some very average folk who actually have substantial misgivings about the current reform plan. I propose a division between the alter-reform crowd and the anti-reform crowd. The latter – who plain don’t want any reform – is the crowd for idiots like Grassley and Palin.
Remind me again why someone who perpetuates misinformation and fear, such as Grassley, is given an equal seat at the table in negotiating the plan.
I would prefer that the people at the table be inclined to craft a plan that will work. Grassley sounds like a saboteur. Haven't the Republicans already demosntrated enough that they idealogically cannot stand government to function?
I'll have to examine more of what Grassley has to say but there's reasonable cause for concern about so much that's wrong with this health care effort by the Dems (not to mention the broader context which the majority of the Left is incapable of conceiving, the progressively worse misconduct by the Dems since the start of this year), especially among the elderly. It's not a surprise at all to the already-inforned and it's no surprise the growing public concern (for a number of reasons) is notably including the elderly.
* The hurriedly, sloppily-thrown-together effort that initially deliberately evaded the cost issue claims now that costs will be paid for in part by taking $500 B from Medicare, so naturally senior citizens will object or be concerned.
* The elitist chatter in support of this effort includes desires (or threats) to subject future funding and care provision to examination and review and approval on the basis of “appropriateness” or rationalized by the harnessing (if only politically, as with global warming so often) of science to lend a patina of superficial credibility (a contemporary revision of something we've seen since the late 19th century) to the review and approval of future care giving. That means rationing and denial of care as a threat, notably to the elderly; naturally, senior citizens will object or at least be concerned.
* The experience of health care “reform” in Oregon that arbitrarily (or politically or “scientifically”) defines what will and what will not be allowed (paid for, approved, provided), and experience in the UK with the National Health Service (particularly with limitations of care for the elderly), the chatter in academia and practice already (involving ethics boards) in hospitals in the USA of care denial on the basis of “futility,” and earlier experience (such as with the first dialysis machines in the early 1960s, notably in Seattle), is not lost on the informed public, and naturally, senior citizens will object or at least be concerned.
There is, nor at least should should be, no mystery whatsoever to this. (And obviously the rational, intelligence response for several other reasons as well to this effort is to be concerned about it and to oppose it, and should obviously not be a crime even if it's not politically correct at the moment.)
“I would prefer that the people at the table be inclined to craft a plan that will work. Grassley sounds like a saboteur.”
Rather than correct your other misstatements I'll just address this by noting that someone remarked after the Dems tried to steal the White House in 2000 after they lost it, that it seems the Dems know best (as you no doubt believe now about their misconduct related to health care “reform”) and that here, as in the case of the 2000 election, and other elections, why should we have elections and representatives at all, as “obviously” the Dems are “constructive” and know what we all need, and what we thus should want; we should simply have perpetual one-party (Democratic Party) rule, eternally. That's where you lead us.
As as resident of Iowa, I can tell you with tremendous experience that good ole Chuck Grassley is a total BS artist who continually strings people along and then pulls out at the end. This week it is death panels that he is lying about, last week it was Ted Kennedy would be dead if he lived in the UK.
I lived in Iowa for a couple of years. The one thing I'll ask about is if Grassley was involved with a federal rainforest demonstration project there. (Iowa already produces enough pork on its own, thank you.)
“a contemporary revision of something we've seen since the late 19th century”
You're talking about the reports on global man-made climate change here, correct?
Just want to know whether you can be written off as an eternal fool with no credibility or not.
I live in Iowa too and think Grassley is usually a pretty straight shooter. I actually talked to the president of our local hospital about Grassley (she had met with him earlier) and she felt he was sincerely committed to reform.
“You're talking about the reports on global man-made climate change here, correct?
Just want to know whether you can be written off as an eternal fool with no credibility or not.”
You're in no position to leap to such a ridiculous conclusion, but to answer your question on behalf of those who deserve to know and who may be curious about the distinction, I was not referring to Arrhenius (much less to scummy leftist political contamination of “science” that has so infected and ruined what is in truth a fascinating subject) nor to Tyndall decades before him and the question of the greenhouse effect and man's potential augmentation of it, but to the more general misuse of “science” and rationality in at least its name (and often no more than that) in excusing of justifying one conceited insistence on being able to impose order and direction and control over things and over people rather than leave things freely to develop on their own. The silliness we see now has some roots in “rational positivism” and in a number of examples in the Progressive movement, and haven't changed much emotionally since then.
There really are people who are convinced that they know how everyone _should_ live (or at least everyone else but themselves, so often in practice) because they, the elite [believe they] know better.
The Dems' misconduct began this year with the bank bailout and failed “stimulus” measures and only has gotten worse from there. That the worst misconduct by the Dems prior to this health care building fiasco involved destructive, stupidly pursued environmentalist lunacy-legislation is simply a happenstance.
“I live in Iowa too [...] Grassley [...] committed to reform.”
It stands to reason he would be among those favoring reform because Iowa is largely rural (and filled with a great number of small towns associated largely with agriculture) and Iowa logically stands to gain from serious reform, which would logically include measures to improve provision of health care to rural areas.
(Not just building new facilities, supporting care where it is deficient, but, for example, providing financial aid for medical education in exchange for serving for a number of year, say five years, in places like Iowa and other underserved areas, which aren't limited to Decrepit Old Central Large Cities in this country.)
DLS:
“The experience… in the UK with the National Health Service (particularly with limitations of care for the elderly)”
You wouldn't be referring to British physicist Stephen Hawking (who has been just awarded the Medal of Freedom and who suffers from motor neuron disease) about whom a July 31 Investor's Business Daily editorial titled “How House Bill Runs Over Grandma” warned:
“People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.”
You wouldn't be referring to the same Hawking who as recently as April received emergency treatment at Cambridge hospital in England, and who a couple of days ago said:
“I wouldn't be here today if it were not for the NHS [British National Health System]. I have received a large amount of high-quality treatment without which I would not have survived.”
No, you couldn't be…
“but to the more general misuse of “science” and rationality in at least its name (and often no more than that) in excusing of justifying one conceited insistence on being able to impose order and direction and control over things and over people rather than leave things freely to develop on their own. “
You mean the inevitable conclusion that we can't do whatever we want because we share our climate with people who have never polluted much yet will suffer the most from AGW? You seemingly assume I care about your ledger of misgivings and grievances, so I don't know how you seem to think the current fight against AGW represents a case of technocrats and idealists imposing anything on John Q.
” That the worst misconduct by the Dems prior to this health care building fiasco involved destructive, stupidly pursued environmentalist lunacy-legislation is simply a happenstance.”
Pray tell how else would you have wanted them to fashion a climate bill, and how could you ever come to the conclusion that a GOP in power would produce a better bill?
Regarding cap-and-trade, it's the same as with health-care reform: no one is really satisfied with it, but every year that goes by without reform worsens the issue, causes financial problems for the citizens and the government and only shifts the problem forwards. There is nothing to suggest that reform will be improved if left to some vague future, especially considering the GOP is at best no better than the DNC.
“You wouldn't be referring to British physicist Stephen Hawking [...] No, you couldn't be…”
No, I'm not referring to a celebrity, but to the plight of the public at large, as well as to what we continue to see even despite the criticism of the current state of affairs. What would we see here in the USA like the following, for example? It's something we're going to have to face sometime, eventually.
http://www.telegraph.co.uk/news/uknews/1576704/…
http://www.telegraph.co.uk/news/uknews/1549595/…
“Delay, Denial, and Dilution” is probably inevitable here in the USA with Medicare for All, you realize.
http://www.civitas.org.uk/pdf/cw55.pdf
http://www.independent.co.uk/life-style/health-…
* * *
“You mean the inevitable conclusion that we can't do whatever we want because we share our climate with people who have never polluted much yet will suffer the most from AGW? [trimmed for quality]“
This obviously does not follow from what I wrote.
“Pray tell how else would you have wanted them to fashion a climate bill, and how could you ever come to the conclusion that a GOP in power would produce a better bill? “
You wrongly presume a climate bill should have been fashioned, when in fact it's not needed, much less a destructive bill like this (sillier as well as more destructive than what the GOP could conceive).
The GOP may be dysfunctional, but in no way does that ameliorate (much less justify) the progressively worse Democratic misconduct this year (including Obama's, beginning in earnest when he neurotically agitated for passage of the climate bill).
The public rightly objected strongly to the climate-bill lunacy (pathological at its heart or in its roots) and now with the health care effort we're seeing not only overreach but fracture as the Dems' effort not only raises several issues and concerns among the public but exposes problems among or within the Dems themselves. I just wonder if they'll learn anything from this and reform themselves (even if the childish resent this) and actually accept defeat of at least some of their worst attempts (even if they resent it).
And don't forget how obviously something like this would be considered by food faddists and the PC crowd here:
http://www.dailymail.co.uk/health/article-42487…
“You wrongly presume a climate bill should have been fashioned, when in fact it's not needed”
Yeah it is. Americans do not deserve to act as if their pollution will not cause serious problems for others much less fortunate and vulnerable.
“The public rightly objected strongly to the climate-bill lunacy (pathological at its heart or in its roots)”
What is pathological is demanding that the economy of your nation does not try to lessen its pollution when said pollution will kill others abroad.
“with the health care effort we're seeing not only overreach but fracture as the Dems' effort not only raises several issues and concerns among the public but exposes problems among or within the Dems themselves. “
The only fracture is between democrats who are beholden to insurance company lobbyists and democrats who aren't. There is no ideology or philosophy at play here – if the Blue Cross democrats didn't have a financial reason to argue about the reform, they wouldn't.
DLS, you wouldn't be referring to statistics such as as health spending per capita, infant mortality and life expectancy, each one shpowoing Britain outperforming the U.S.?
Please peruse:
http://www.washingtonpost.com/wp-dyn/content/ar…
hpid=topnewshttp://www.washingtonpost.com/wp-dyn/content/article/2009/08/12/AR2009081202955.html?hpid=topnews
http://blogs.ajc.com/jay-bookman-blog/2009/08/1…
http://blogs.ajc.com/jay-bookman-blog/2009/08/1…
http://www.kaiserhealthnews.org/Daily-Reports/2…
http://www.washingtonpost.com/wp-dyn/content/ar…
Three words:
Wizard's First Rule
DLS wrote: “There really are people who are convinced that they know how everyone _should_ live (or at least everyone else but themselves, so often in practice) because they, the elite [believe they] know better.”
Funny, for my entire life that has been my direct experience of the Republican Party and its blindly loyal “base”. Take at look at the last few years of Republican leaders and compare them with your “family values”. If Sarah Palin were of color her and her family's scandalous behavior would get them politically crucified by the sanctimonious hypocrites of her own party. Instead, she gets a stack of free passes.
DLS wrote: “There really are people who are convinced that they know how everyone _should_ live (or at least everyone else but themselves, so often in practice) because they, the elite [believe they] know better.”
This is almost perfect bait, isn't it? How many far right Christian fundamentalist politicians this year have been caught with their zippers down? Are they, God forbid, “elitists” on top of hypocrites?
Submitted on 2009/08/13 at 5:02pm and somehow deleted
DLS, you wouldn't be referring to statistics such as as health spending per capita, infant mortality and life expectancy, each one shpowoing Britain outperforming the U.S.?
Please peruse:
http://www.washingtonpost.com/wp-dyn/content/ar…
hpid=topnewshttp://www.washingtonpost.com/wp-dyn/content/article/2009/08/12/AR2009081202955.html?hpid=topnews
http://blogs.ajc.com/jay-bookman-blog/2009/08/1…
http://blogs.ajc.com/jay-bookman-blog/2009/08/1…
http://www.kaiserhealthnews.org/Daily-Reports/2…
http://www.washingtonpost.com/wp-dyn/content/ar…
WHO has stated that you can't equate stats from different nations because of different reporting criteria. I'm tired of people using the US infant mortality rate as a talking point when in reality our rate is not worse than Euro. More than a bit of that difference is that we record as live births children that other countries would not. Since the highest reason for newborn death is tied to low birth rate one would assume that the US would less success with neonatal mortality in infants with low birth weight. Surprisingly though the US has one of the best best records, where info is available, in infant survival with low birth weight. A 4 month preemie has a real chance in the US other countries wouldn't record it as a birth. Norway has one of the lowest infant mortality rates in the world. But when birth weight is factored in, Norway has no better survival rates than the US. Since 2000, 42 of the world’s 52 surviving babies weighing less than 1 lbs. were born in the US.
That also affects overall life expectancy.Factors like crime, poverty, obesity, tobacco use, and even the number of highways and vehicle usage vary widely between countries and have a significant effect on such statistics. How would you explain the US having higher survival rates for cancer?
My point being that trying to use stats collected by different countries to different standards in different environments with different challenges to “prove” anything is beyond absurd.
wow look what I found
Americans who don’t die from homicides or in car accidents outlive people in every other Western country.
http://mjperry.blogspot.com/2007/10/standardize…
So by DE's reasoning we shouldn't touch medical care in the US. Not my personal opinion but………
Ah, those “different reporting criteria” and those “different standards, environments, and challenges” to the rescue….”they don't prove anything” Yes I get it
However, “Americans who don’t die from homicides or in car accidents outlive people in every other Western country,” now there is resoundingly valid and relevant statistic…
Back to those infant mortality statistics.
I remember having this discussion before. I believe one reader blamed (ane even discounted) the higher U.S. infant mortality rate on all those (African American) “crack mothers,” and perhaps other sociocultural factors. I am no expert, but I believe, sociocultural factors or not, like it or not, these crack mothers are part of America. Am I wrong?
No you wouldn't but that doesn't really fall under health care reform does it? Sickle cell anemia has a much high rate of incidence in African Americans. So saying that the US having a higher rate of the disease than Norway because of deficiencies in the healthcare system would be illogical and misleading.
“However, “Americans who don’t die from homicides or in car accidents outlive people in every other Western country,” now there is resoundingly valid and relevant statistic…”
Much more relevant than yours because though they were gathered by different places the data used met the same criteria, which is not true for infant mortality.
D.E., I'm not aware of anyone making the claim that you refer to, that socioeconomic conditions are a leading cause of infant mortality in the US. EEllis already gave the appropriate debunking of the myth about the US having higher infant mortality rates- it has to do with whether or not a live born baby is actually counted as a live born baby or not. It's amazing how you can make your infant mortality rates go way down by simply calling a live, underweight baby a stillborn one. Voila! One less dying infant to report.
But even if people were making the claim you mention, or if were true- that still shows how this stat would not be an example of our healthcare system not performing up to the standards of other countries' systems. No matter how good a healthcare system is, if the citizens are engaging in unhealthy practices, the doctors and hospitals can't change that and the stats on outcome will be skewed by the behaviors, not the performance of the healthcare system.
The biggest difference for infant mortality rate differences is what constitutes a live birth. In the US any baby that shows any signs of life, even when undersized or extremely premature, is recorded as a live birth. Many countries wait 24hrs, have size and weight considerations, ect. This drastically affects both infant mortality rates but life expectancies as well.
Low birth weight is the leading cause of infant mortality. This is a growing issue in the US for many reasons. Women who have multiples (twins, triplets, etc) have babies with low birth weight 50% of the time. Women who are older, have diabetes, don't gain enough weight during pregnancy, etc are all at risk for babies that are prime and/or low birthweight. There are also demographic differences with African American women more likely to have children with low birth weight and although drug/alcohol use could play a part it is not the whole story and we really don't know or understand all the factors that cause low birthrate. There have been studies that show education as a link to low birth weight though the underlying reason has not been agreed upon.
With regard to the multiples, EEllis, if I'm not mistaken I think I've seen data on the high rates of IVF leading to higher rates of multiples here in the US, which also skews those low birth weight numbers.
goes without saying that fertility drugs increase the likelihood of multiple births and thus low birth weight as well as many mothers who resort to such treatments being older which in and of itself is a factor.
I believe one reader blamed (and even discounted) the higher U.S. infant mortality rate on all those (African American) “crack mothers,” and perhaps on other sociocultural factors.
That could have been me although I did not bring race into it. All states I have lived in provide for prenatal care, but the problem often is getting the mothers-to-be to come in. The clinics are there, the money is there, the providers are there, what isn't there often is the patient.
Also as you mention it is sometimes difficult to get women who are abusing drugs, alcohol or tobacco to quit while they are pregnant. These are not issues related to a bad health system, cost problems and lack of availability. These are socio-economic problems.
When people point to infant mortality I don't see it as mostly a health systems problem, I see it as a larger societal problem. I know that's not the popular way to look at it. I would encourage you to talk to an obstetrician and see what they have to say on this.
DG:
thanks for “coming to my rescue” I have been raking my brain as to who brought it up. I wasn't sure as to whether there was a reference to the race of the crack baby mothers, that's why I put “African American” in parentheses.
EEllis, DLS et al.:
Let me just “borrow” a very pertinent quote from an article that Don Quijote quoted in a different thread.
I believe it uniquely applies to what has been discussed in this thread: comparions of mortality rates, etc.
“In a Commonwealth Fund-supported study comparing preventable deaths in 19 industrialized countries, researchers found that the United States placed last. While the other nations improved dramatically between the two study periods—1997–98 and 2002–03—the U.S. improved only slightly on the measure.
In “Measuring the Health of Nations: Updating an Earlier Analysis” (Health Affairs, Jan./Feb. 2008), Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., both of the London School of Hygiene and Tropical Medicine, compared international rates of “amenable mortality”—that is, deaths from certain causes before age 75 that are potentially preventable with timely and effective health care. In addition to the U.S., the study included 14 Western European countries, Canada, Australia, New Zealand, and Japan. According to the authors, if the U.S. had been able reduce amenable mortality to the average rate achieved by the three top-performing countries, there would have been 101,000 fewer deaths annually by the end of the study period.
The concept of amenable mortality was developed in the 1970s to assess the quality and performance of health systems and to track changes over time. For this study, the researchers used data from the World Health Organization on deaths from conditions considered amenable to health care, such as treatable cancers, diabetes, and cardiovascular disease.
U.S. Ranks Last
Between 1997–98 and 2002–03, amenable mortality fell by an average of 16 percent in all countries except the U.S., where the decline was only 4 percent. In 1997–98, the U.S. ranked 15th out of the 19 countries on this measure—ahead of only Finland, Portugal, the United Kingdom, and Ireland—with a rate of 114.7 deaths per 100,000 people. By 2002–03, the U.S. fell to last place, with 109.7 per 100,000. In the leading countries, mortality rates per 100,000 people were 64.8 in France, 71.2 in Japan, and 71.3 in Australia.
The largest reductions in amenable mortality were seen in countries with the highest initial levels, including Portugal, Finland, Ireland, and the U.K, but also in some higher-performing countries, like Australia and Italy. In contrast, the U.S. started from a relatively high level of amenable mortality but experienced smaller reductions.
Many Lives in U.S. Could Be Saved
The researchers estimated the number of lives that could have been saved in 2002 if the U.S. had achieved either the average of all countries analyzed (except the U.S.) or the average of the three top-performing countries. Using this formula, the authors estimated that approximately 75,000 to 101,00 preventable deaths could be averted in the U.S. “[E]ven the more conservative estimate of 75,000 deaths is almost twice the Institute of Medicine's (lower) estimate of the number of deaths attributable to medical errors in the United States each year,” the authors say.
Future Implications
The rate of amenable mortality is a valuable indicator of health care performance, say the authors—one that can point to potential weaknesses in a nation's health system that require attention. “[T]he findings presented here are consistent with other cross-national analyses, demonstrating the relative underperformance of the U.S. health care system in several key indicators compared with other industrialized countries,” they say.”
Sorry DE doesn't do it for me. You don't link the study so we can't tell what amenable mortality encompasys but I believe in includes auto accidents and violent deaths which are not directly medical related in origin. The impact of health service is believed to account for only 50% of change and no studies at all have been done to examine the impact of ethnic variations on amenable mortality and with a uniquely diverse population it would be hard to dismiss the possible impact. A study of this type could show the possible improvement after changing systems or philosophies for medical care. That type of study would be good to see a countries improvement but wholly inaccurate as a comparison of quality of care between systems. This is people not examining evidence to see where it leads, but finding evidence for what they want.
I did further investigation.
<quote>The quest for accountability has generated an industry engaged in ranking performance in many different sectors. This approach developed from control systems in industrial management, where it has long been used with processes where the inputs and products are simple and unambiguous, and there are few if any extraneous factors. It is intuitively appealing, especially to politicians who are anxious to know how public funds are being spent. It is seen as a means to reduce a mass of complex information into a format that almost anyone can understand. Yet its apparent simplicity can be misleading, and many commentators have noted numerous technical problems, ranging from lack of validity to creation of perverse incentives as those involved change their practice or recording methods to achieve higher rankings, despite leading to worse performance.
We have looked at one of many possible issues related to health system rankings that has so far been unexplored. The hypothesis was that a measure of health attainment more closely linked to the health-care system would produce a systematically different ranking. This hypothesis was confirmed, with the Nordic countries doing better than in the WHO model of the 2000 report.
However we do not argue that amenable mortality should substitute disability adjusted life expectancy even if performance was to be ranked. Firstly, it is impossible to rank all countries by amenable mortality given the widespread absence of data by diagnosis. It should be noted, though, that lack of even total mortality for many countries was not seen as an obstacle by the authors of the 2000 World Health Report, who used regression modelling to impute figures for disability adjusted life expectancy. A recent study that looked at the method used in the report to generate data on disability adjusted life expectancy showed that, where actual data became available, the regression result produced a quite different value.17
Secondly, amenable mortality has itself some limitations. The diagnostic categories and the age range used involve some choices that are inevitably arbitrary. A major limitation is that, for many conditions, death is the final event in a complex chain of processes that involve issues related to underlying social and economic factors, lifestyles, and preventive and curative health care. Partitioning deaths among the categories is an inexact science. The example of ischaemic heart disease is instructive. Accumulating evidence suggests that advances in health care have contributed to the fall in mortality from ischaemic heart disease in many countries, yet it is equally clear that large international differences in mortality are caused primarily by factors outside the healthcare sector.16,18-21 Thus our second analysis included only 50% of mortality from ischaemic heart disease. Obviously many different proportions could be used, from 40% up to 70%, and the choice may vary by country.16,22 However, it is important to note that the inclusion of ischaemic heart disease in our measure of healthcare outcomes again changes the rankings of countries compared with those of the 2000 World Health Report. This highlights the problems associated with rankings that are based on summary measures, as they can be sensitive to underlying definitions and concepts.
</quote>
from http://www.pubmedcentral.nih.gov/articlerender….
Now I'm not saying that there is no difference or that you can't learn from these studies just that any attempt to portray them as “proof” of something as complex as what system works “better” is absurd. It also leaves out all other conciderations possible. We might improve amenable mortality rates more by boosting spending on urban medical centers or minority outreach programs than we ever could by Govt insurance. There is no way for these studies to tell us that untill after we have tried something and even then it's only in reference to what has already been in practice.
EEllis says:”
“Sorry DE doesn't do it for me. You don't link the study so we can't tell what amenable mortality encompasses but I believe in includes auto accidents and violent deaths which are not directly medical related in origin.”
Below are two links to the study I quoted, followed by a series of authoritative (medical world/sources) definitions of “amenable mortality” which clearly do not include auto accidents, violent deaths,etc., just deaths that are potentially preventable with timely and effective health care.
http://www.pnhp.org/news/2008/january/united_st…
We compared trends in deaths considered amenable to health care before age seventy-five between 1997-98 and 2002-03 in the United States and in eighteen other industrialized countries.
and
http://www.commonwealthfund.org/Content/Publica…
In “Measuring the Health of Nations: Updating an Earlier Analysis” (Health Affairs, Jan./Feb. 2008), Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., both of the London School of Hygiene and Tropical Medicine, compared international rates of “amenable mortality”—that is, deaths from certain causes before age 75 that are potentially preventable with timely and effective health care.
http://ije.oxfordjournals.org/cgi/content/abstr…
Background Amenable mortality is used to assess the effects of health care services on gains in mortality outcomes.
http://74.125.47.132/search?q=cache:0UYXIKkhc2Q…
Amenable mortality is mortality that can theoretically be averted by good health care. The concept of amenable mortality first appeared in the 1970s and a substantial amount of work in this area was undertaken in the 1980s (Ruststein et al 1976, Charlton et al 1983, Mackenbach et al 1988, Holland 1988). More recently a comprehensive review was published which evaluated the conditions considered amenable to medical intervention (Nolte & McKee 2003, 2004).
http://www.demogr.mpg.de/cgi-bin/publications/p…
We used the concept of deaths from certain causes that should not occur in the presence of timely and effective health care (amenable mortality) and calculated the contribution of changes in mortality from these conditions to changes in life expectancy between birth and age 75 [e (0-75)] for the periods 1980/81 to 1988 and 1992 to 1997.
http://blogs.consumerreports.org/health/2009/08…
Enter the concept of “amenable mortality.” Invented years ago in the United States and used worldwide by researchers ever since, it’s basically a body count of people who die for want of “timely and effective health care.” A higher rate is bad, because it means the country’s health care system is falling down on its one and only job, which is to keep people healthy and do the best job possible of treating them if they get sick.
http://www.maorihealth.govt.nz/moh.nsf/indexma/…
Amenable mortality is a subset of avoidable mortality and is restricted to deaths from conditions that are amenable to health care (Ministry of Health 1999).
Wow all that without refuting any of the main points, just that I said I wasn't sure what they included in the study
“Wow all that without refuting any of the main points, just that I said I wasn't sure what they included in the study”
The fact that ameniable mortality does not peripheral stuff such as auto accidents, violent deaths,etc., but just deaths that are potentially preventable with timely and effective health care, is at the core of the discussion here.
” No matter how good a healthcare system is, if the citizens are engaging in unhealthy practices, the doctors and hospitals can't change that and the stats on outcome will be skewed by the behaviors, not the performance of the healthcare system.”
Wrong: Ameniable mortality inclludes just deaths that are potentially preventable with timely and effective health care.
The fact that ameniable mortality does not include peripheral stuff such as auto accidents, violent deaths,etc., but just deaths that are potentially preventable with timely and effective health care, is at the core of the discussion here
Not really, my points stand anyway.
Wrong: Amenable mortality includes just deaths that are potentially preventable with timely and effective health care.
No they don't. That is not how they calculate it. They don't say “that guy who is 500lbs doesn't count as a heart attack because he is so fat” or was using drugs or didn't exercise. Come on. Now what they do is attached a number to it and say 50% of heart attacks are due to lifestyle so only 50% will count towards the total but the number is arbitrary and could be anything.
You, and others, are trying to make these studies do something they are not designed to do.
EEllis/
I have quoted a dozen authoritative, medical, etc., definitions of “amenable mortality.” They all say that amenable mortality rates represent deaths that are potentially preventable with timely and effective time care.
If you choose to put forth your own definitions, feel free, but that's not how a sensible discussion/debate goes.
it has been a pleasure
“potentially” they also leave out factors and as I said you are trying to use them for something the original studies were not designed for. It does not and can not on it's own serve as a basis to state which philosophy of medical care is best. The link I posted talked about the problems and other possible ways of examining the question and you decided to ignore or decided not to bother reading it.