Last night Jon Stewart's interview of Betsy McCaughey was equal parts maddening and enlightening. The Daily Show cut off the interview when they ran out of time, but the uncut version is below (in two parts).
| The Daily Show With Jon Stewart | Mon - Thurs 11p / 10c | |||
| Exclusive - Betsy McCaughey Extended Interview Pt. 1 | ||||
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| The Daily Show With Jon Stewart | Mon - Thurs 11p / 10c | |||
| Exclusive - Betsy McCaughey Extended Interview Pt. 2 | ||||
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Note that Jon makes my point about epistemic trust. The issue is less about the actual wording of the bill than it is about the presumptions that control the interpretation of the wording of the bill. At issue: do you assume that the people writing health care reform bills are trying to reform health care, i.e. extend and improve access to health care for the citizens of this country, or, do you assume, like Betsy McCaughey, that this health care bill is a "Trojan Horse" for the nefarious intent to deny access to health care for those who now have it?
Unfortunately, though Stewart did ask "do you really distrust doctors that much?" to which McCaughey answered, "I distrust politicians"--he didn't follow up much further. Cynicism about politics I get. But surely it's not in the self-interest of career politicians to make nefarious plans to kill off their constituents--so how, even in the twisted worldview of those who believe human beings only ever act in intelligent and ruthless self-interest--how does it make any sense at all to assume that the writers of HR 3200 want to kill old people?
Regardless, there are two points of McCaughey's regarding the content of the bill that I want to respond to. First, she indicates more than once that there is a long list of specified interventions that the bill mandates that your doctor try to talk you out of. Here is the part of section 1233 I think she is referring to:
‘(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—.
‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
‘(iii) the use of antibiotics; and
‘(iv) the use of artificially administered nutrition and hydration.’
Of course, there are other issues about whether this is "mandated" (I don't see that it is, and her arguments regarding indirect financial incentivizing seem a little stretched to me), and whether or not your doc is asking what you want versus talking you out of interventions (again, that trust thing. If you're that scared of your doctor, I suggest you find a new one). But on the single point of whether a bullet list of four item introduced with the phrase "may include indications respecting, among other items" constitutes a long list of specified interventions your doc must address? I don't see it. "May" still, I believe, remains a modal auxiliary verb indicating, among other things, permissibility, but not obligation (that would be "must"). I suppose though, like the word "mandatory," someone who's got skillz in reading this stuff can see where those words are crammed into the invisible subtext even when they're not there. (Ah, but that's that trust thing again.)
The second point she makes that I want to take issue with is that doctors will somehow be financially penalized if their patients don't adhere to the advance directives they create in consultation with their doctor, thus creating a situation in which people can't change their minds later if they want to. Leaving aside the discussion about financial incentivizing--which Stewart challenges her on--if her concern truly is to provide for a situation in which someone might change their mind about their advance directive, the bill itself provides for this:
‘(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.'
So there's no sense in which you only get one shot at making an advance directive, after consultation with your doctor which you don't have to pay for out of your pocket--paragraph 1 provides you can revisit this in any case every five years, but the paragraph above specifies that you can revisit your advance directive, in consultation with your doctor, more often in the event of getting terminally ill. So the scenario she paints, of your doctor collaborating with the evil politicians to talk you out of life-sustaining measures which you then cannot change your mind about later, is the opposite of what this bill actually says. Further, if you buy her financial incentivizing bit, you might could even argue that doctors have an incentive to revisit this issue with you at least every five years, and more often in the case of your getting terminally ill in some way. (But, you might not want to argue that to Betsy McCaughey; she would probably take it as further evidence that your doctor's being bribed by your government to kill you.)
P.S. I really hate the way she mugs for the camera.
