Americans who wonder how their medical care will evolve once the Affordable Healthcare Act is fully implemented should turn their attention to the UK. After a sustained campaign by the UK's Daily Mail, the so-called Liverpool Care Pathway (LCP) that provided end-of-life care to thousands of patients in Britain's government-run National Health Service (NHS) will be phased out over the next six to 12 months. This is due to the reality that an independent review board found "shocking examples of abuse" regarding the treatment of the system's most vulnerable patients.
"We need a whole new system of better end of life care tailored to the needs of individual patients and involving their families," said Care and Support Minister Norman Lamb. "I took the decision to launch this review because concerns were raised with me about how patients were being cared for and how families were being treated during this difficult and sensitive time."
The review was undertaken by Baroness Julia Neuberger, Senior Rabbi at the West London Synagogue, and former Chief Executive of the King’s Fund. Lady Neuberger, who has written about care for the dying, was tasked with talking to patients, families and medical professionals; reviewing hospital complaints; examining incentive payments made to hospitals for putting patients on the LCP; and analyzing literature informing the public about the benefits and limitations of the program.
The report, "More Care--Less Pathway," said that while LCP was working well in many places, numerous examples of abuse made it impossible to continue its implementation.
According to excerpts obtained by the Daily Mail, patients were subjected to a catalogue of indignities. These included patients so heavily drugged they could no longer communicate with family members, completely eliminating the chance to say goodbye. "There have been too many coming forward to the review panel to say they left their loved one in a calm and peaceful state, able to communicate, for a short time, or with a doctor or a nurse for a check-up only to return and find a syringe driver had been put in place and their loved one was never able to communicate again," the report states.
Patients had also been put on the pathway without consent. The Mail notes that last year as many as 60,000 patients "placed on the scheme were never asked for their consent, or their families were not asked, further revealing that many of those involved "found out by accident, and others recovered fully after relatives found out and got their loved ones taken off the pathway."
With regard to protocols that call for nurses to moisten the lips of the dying after food and water have been withdrawn, many family members noted that their loved ones were sucking on the sponges, indicating that the LCP's promise of "comfortable death" was misleading--and in some cases, possibly premature. Family members further reported that they were forced to hydrate their loved ones in secret, "disobeying instructions from medical staff to withhold fluids" according to the report.
Those instructions were part of what were described as a "tick box" approach to medical care, where standard practices trumped the needs of individual patients. "Where care is already poor, the pathway is sometimes used as a tick-box exercise, and good care for the dying patient or their relatives or cares may be absent," the report reveals.
Far more damning is a 2012 investigation by the Mail in which they alleged that hospital trusts were being "bribed" with cash payments to insure that a certain percentage of patients were put on the LCP. According to the paper, payments were made though a system known as Commissioning for Quality and Innovation, or CQUIN. One trust that confirmed such targets was Aintree University Hospitals NHS Foundation Trust. They received $462,000 for the financial year that ended in March 2012, when 42 percent of their patients were placed on the LPC, versus a target number of 35 percent. On the other side of the equation, Salford Royal NHS Foundation Trust had CQUIN payments cut nearly in half for failing to reach targets where a certain percentage of patients on the LCP would be discharged to die at home. They were tasked with hitting a rate of 47.6 percent. When they only reached 45.5 percent their payment was reduced from $54,588 to $27,900. In 2012, the Daily Telegraph confirmed that two thirds of NHS trusts using the LCP had received millions of pounds in payouts for hitting similar targets.
Neuberger's report found no evidence of misuse regarding such payments, a telling revelation in and of itself, given the reality that monetary incentives for reaching such targets undoubtedly colors decisions made by healthcare professionals. Yet Minister Lamb refused to dance around the allegations, saying he thought the "bribes" make such a bad impression that they should be ended. The Department of Health apparently agreed, noting they will be abandoned under whatever new system is created.
As Melanie Phillips notes "it is far from clear, despite the advance reports of the LCP’s demise, that the Government will do more than usher in a merely cosmetic change, rather than tackle the attitudes which lie at the very heart of this problem." Minister Lamb promises that any new system will be tailored for individual patients, but Phillips contends that idea "fails to identify the very confusion at the core of this problem. This arises over the issue of medical staff being able to identify correctly when someone’s life is about to end."
Phillips then gets to the meat of the problem. "Health care professionals either did not understand that someone who was extremely ill or mentally incapable was not actually dying--or, worse, they thought such a life was not worth extending and so terminated it." According to Phillips, this "deeply troubling modern development" centers around "the progressive inability to distinguish between someone who really is dying and someone who it is thought should be dying because they are deemed to have such a poor quality of life." As a result, "decency, compassion and simple kindness" have been trumped in far too many cases by "hatchet-faced self-interest, an arrogant and unchecked abuse of professional power and a brutal utilitarianism which has substituted a tendentious judgment of usefulness for innate respect for human life."
If this sounds familiar, it's because it describes the essence of command-and-control, big-government bureaucracy where the needs of the many outweigh the concerns of the individual--all for the "greater good."
Here in America, "brutal utilitarianism" will be embodied in ObamaCare's Independent Payment Advisory Board (IPAB). Dr. Tracy C. Miller succinctly explains what the IPAB is all about--and why the much-maligned description of it as a “death panel” is on the mark:
Although intended to be a pejorative term, the term ‘death panel” accurately reflects decisions that have to be made about whom to save when resources are scarce. We simply do not have the resources to provide as much health care as people might desire for prolonging their lives or the lives of their loved ones. If government pays for health care, as it does for Medicare and Medicaid beneficiaries, limited funds necessitate that sometimes people will be denied access to care.
The IPAB will consist of 15 members, presidentially nominated and Senate-confirmed, serving staggered, six year terms. They will be tasked with helping to cut $500 billion out of Medicare over the next decade, and providing reports to Congress about how to keep Medicare spending within limits outlined by the law. When the IPAB acts, ObamaCare stipulates that there "shall be no administrative or judicial review" of the board's decisions, which can only be overturned by a two-thirds vote in both houses of Congress.
As bad as that is, it gets worse. If the president fails to nominate, or Congress fails to confirm, IPAB board members, then a smaller board--or even a single individual, the Health and Human Services (HHS) Secretary (currently Kathleen Sebelius), can unilaterally impose cuts to Medicare that affect tens of millions of Americans.
Since Congress is currently at loggerheads regarding the IPAB's creation, and can only kill off the IPAB completely with a three-fifths supermajority vote that can only take from Jan. 1 to Aug. 15 in 2017, ceding unprecedented power to Sebelius or her successor seems increasingly likely. That would be the same Kathleen Sebelius who was recently willing to let a 10-year-old girl named Sarah Murnaghan die, rather than allow her access to the adult lung-transplant list. The little girl was saved only after a judge overruled the HHS Secretary.
Equally important, the IPAB absolves Congress from having to make critical decisions about the future of Medicare, shifting that responsibility to the executive branch of government. The Democratically-controlled Congress that enacted ObamaCare also made the IPAB exempt from sunshine laws, even as it “may accept, use, and dispose of gifts or donations of services or property.”
In other words, Americans will have their healthcare decisions adjudicated by an unelected group of unaccountable bureaucrats whose decisions can be influenced by lobbyists, undoubtedly willing to provide gifts or donations of services or property to board members for favorable treatment.
The IPAB's defenders note that the healthcare law mandates that even as the board is required to make deep cuts to Medicare, rationing of healthcare itself is prohibited. This nonsensical provision means that cuts to service providers, as in doctors, hospitals and other healthcare entities, will be the only viable cost-cutting alternative to pursue. Many doctors are already limiting the number of Medicare patients they take due to current cuts in reimbursements. As for hospitals, Medicare's Chief Actuary estimated that ten years of IPAB cuts will force 15 percent of America's hospitals to go out of business.
Thus, the "brutally utilitarian" wheels of ObamaCare have been set in motion. Yet Americans must never lose sight of the reality that, as far as progressives are concerned, the current healthcare law is merely the penultimate part of a journey whose final destination is the complete government takeover of our healthcare system.
As imperfect and aggravating as the current system is, Americans can still access private sector alternatives when seeking treatment denied by the government. Once those alternatives are eliminated, we will be just like Great Britain -- pathway and all.
A modest suggestion: Americans should demand that every member of Congress, the Executive branch, every other government employee currently enjoying their “Cadillac” healthcare plans, be required to use the same healthcare system being imposed on the rest of us. That demand should be an integral part of the 2014 election campaign. "Brutal utilitarianism" should apply to everyone -- or no one.
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