"If they would rather die they had better do it, and decrease the surplus population."
-- Ebenezer Scrooge in A Christmas Carol
Should Michael J. Fox be put to death?
Celebrities and death. Now there's a potent cocktail.
Several parts fame, a few jiggers of Hollywood and a splash each for sports, business and journalism. Did I mention politics and government bureaucracy? Sorry. Without that essential element the mixture has no wallop. And a wallop this concoction surely will have, particularly if you believe actor Michael J. Fox has overstayed his welcome on the planet.
Let's pour the dry ingredients of politics and government bureaucracy into the pitcher first, beginning with the politics of death and dying.
Laws in America come into being because someone somewhere saw a problem, devised a would-be answer and then persuaded politicians to pass the law based on the philosophy and politics one group or another saw as underlying that answer. Need revenue? Raise taxes. Global warming? Shut down the coal plants. Dopey kids? Pay more to teachers. Everyone knows how this works.
So what is the driving philosophy underpinning the Obama health care plans for all of us? Let's begin with a few short quotes and one definition that outlines the idea succinctly.
• President Obama; "There is a whole bunch of care that's being provided that every study, every bit of evidence that we have indicates may not be making us healthier."
• Peter Singer, Professor of Bioethics at Princeton University: "Life as a whole has no meaning. Life began, as the best available theories tell us, in a chance combination of gasses; it then evolved through random mutation and natural selection. All this just happened; it did not happen to any overall purpose."
• America's Affordable Health Choices Act of 2009 as introduced in the U.S. House of Representatives (H.R.3200) by Congressmen Dingell, Waxman, Rangel, Stark and others: "The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research…with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures."
• QALY: Quality-Adjusted Life Year. A formula devised by left-wing policy wonks that purports, as David Catron has so ably illuminated on these pages, to measure the worth of your life by assigning a numerical value to each year of your existence. In Catron's words: "A year of perfect health, for example, is given a value of 1.0 while a year of sub-optimum health is rated between 0 and 1. If you are confined to a wheelchair, a year of your life might be valued at half that of your ambulatory neighbor. If you are blind or deaf, you also score low. All that remains is to assign a specific dollar value to the QALY and, voilà, your life has a price tag."
This is all a bit dry to the taste, isn't it? QALY, Center for Comparative Effectiveness Research, HR 3200. Blah blah blah. Let's add the fizz to this baby.
So. Who will tell Michael J. Fox he needs to die?
Which health care mouse out there will have the guts to bell the cat who is one of the most famous Parkinson's Disease sufferers in America? Who is going to tell him that the treatments that are associated with Parkinson's -- drugs like Sinemet, Symmetrel, Eldepryl, Parlodel, Permax, Mirapex, Requip, and surgery with the quaint name "deep brain stimulation" -- are just no longer possible for Fox because, well, Mike, your QALY just isn't up to snuff, babe. You have Parkinson's. You boozed (according to you). As a result, the government has decided treatment for you, Mike, lacks "appropriateness." The "outcome and effectiveness" of treating you -- which is to say the worth of your 47-year old life -- just isn't worth it for the rest of us.
Sorry Mike. Say Goodbye to Hollywood. Close your Parkinson's Foundation (waste of scarce resources, to wax Singeresque). Just go home to the wife and kids, cut off these expensive meds and please die. Quietly. And for heaven's sake, get yourself buried in private. We don't want any of this Michael Jackson type-hoopla disrupting our favorite programs. We have lives to get on with.
A bit harsh?
Heck, we haven't begun to shake this cocktail. There's more to mix.
You see, the philosophy behind ObamaCare, as promoted just a week ago in the New York Times Sunday Magazine by Professor Singer, is the hard cold necessity Obama sees for government to ration health care for people like, well, Michael J. Fox. As Mr. Singer says: "Health care is a scarce resource, and all scarce resources are rationed in one way or another." And quite obviously, with Mike Fox's QALY being what it is (and Singer is a big proponent of using QALY to judge the worth of a life), the time to cut his treatment off was... yesterday. Actually, a lot of yesterdays ago.
This is what President Obama believes when he says "there's a whole bunch of care" that someone -- this would be the government -- will have to decide not to employ in treating someone like Mike Fox. What about the idea that Michael J. Fox -- not to mention his wife and children, extended family and friends who might actually love the little lug -- think Mike's spirit should count for something here? After all, he did an entire documentary on The Adventures of an Incurable Optimist. In the President's words: "I don't think that we can make judgments based on peoples' spirit. That would be a pretty subjective decision to be making. I think we have to have rules...."
Right. Rules. Got it. Government rules. Which is another way of saying decisions on Mike Fox's life will, if Obama and company get their way, be resting in the hands of this whiz bang group of policy wonks and bureaucrats called the Center for Comparative Effectiveness Research. Located, but of course, within the Agency for Healthcare Research and Quality. Where the Rule of QALY will reign. Did I leave out that this will all be established by The Secretary?
Let's get rid of the bureaucratese here and just call this agency what it really is: The U.S. Bureau of Death (or "BOD" in the acronym form loved by bureaucrats everywhere).
Now let's toss in all the rest of this cocktail's ingredients and give it a shake. Take a real, deep drink.
So. Whose bod in Hollywood will BOD be coming for? Who in celebrity land -- and here we can add in journalism, sports and business -- will be on the BOD Squad's hit list when the information is received that well, sadly, like poor old Michael J. Fox, their QALY just doesn't make the grade? Let's take a look into this perilously close future for all of us as the BOD Squad makes its rounds.
Elizabeth Taylor. La Liz. Born in 1932, her age alone raises the appropriateness question She's had more health problems than husbands, as one BOD Squad staffer apparently scribbled on a report. Are you kidding? The Secretary of the Department (known internally as the SOD BOD) was furious to see what the American people had been putting up with from this woman: Congestive heart failure, a benign brain tumor, skin cancer, a back five-times broken, both hips replaced, bouts with pneumonia, osteoporosis and scoliosis. In the succinct observation on her leaked file: "Toast." Say hello to Jacko.
David Letterman: A quintuple bypass was given to Dave. That was under the old pre-Obama system and it won't be allowed again. Dave's QALY is nowhere near that of a healthy teenager who might have a case of pneumonia that is cheaper to treat and not likely to recur. Former Governor Palin's last official act as Governor of Alaska was to file an addendum to Dave's file at BOD Squad HQ. To be officially classified a "dirty old man" takes 10 points off anyone's QALY.
Patrick Swayze: As this is written, the National Enquirer is on the stands proclaiming this famous cancer victim has had a heart attack. According to news accounts, Swayze has been undergoing "pioneering Cyberknife radiotherapy at California's Stanford University Medical Centre." Cool. But alas this kind of thing doesn't meet the BOD Squad standards for appropriate or effective treatment. Loved you, Patrick, but the government says you have to go. Worse, you wasted a lot of people's resources with all this dancing around that you were going to fight on. Shameful.
Magic Johnson: Eighteen years ago, the legendary Los Angeles Lakers star had to quit because he contracted the AIDS virus. He is still here, healthy and active at 50. The problem: every day Magic has to swill a "multidrug cocktail" of GlaxoSmithKline's Trizivir and Abbott's Kaletra to keep himself healthy. Let's face it, if you're a BOD Squad staffer eighteen years ago looking at the paperwork from Mr. Johnson, you will believe that if his primary activity in life was professional basketball -- and he has had to quit because he has AIDS -- well, no more magic for Magic. The Glaxo cocktail will go elsewhere.
Larry King: CNN's talk star suffered a heart attack in 1987 and had quintuple bypass surgery. In signs of just what a racket this Hollywood-Big Surgery connection is, Larry and Dave Letterman had the same surgeon. I guess that's one Doc who can retire, huh? Sounds like one of those thieving tonsil doctors the President gripes about. Larry's father had died at 44 of a heart attack, and Larry was a smoker. Gee, you think this QALY is gonna be wearing brassy suspenders? Ole Lar was supposedly so shocked by his experience that he has written not one but two books on the subject. Mr. King, You're Having a Heart Attack: How a Heart Attack and Bypass Surgery Changed My Life and Taking On Heart Disease: Famous Personalities Recall How They Triumphed over the Nation's #1 Killer and How You Can, Too. As with Michael J. Fox, King too set up a foundation based on his illness, the Larry King Cardiac Foundation. Alas, this kind of thing can now easily be deemed irrelevant if not a stealer-of-resources by the BOD Squad. Who cares if Larry has a Foundation? Do we really need more heart attack books? Sorry Larry, if the BOD Squad had been here in 1987, you wouldn't be. Memo to Mrs. King: Stop sending Larry's daily QALY updates to the SODBOD.
Regis Philbin: Regis had a triple-bypass at 75 years of age, after having an angioplasty fourteen years earlier. Seventy-five? Whoa! There's no QALY statistic in the world that will say these resources were better used on Regis than on some 21-year-old. Regis, buddy. What were you trying to pull? The BOD Squad almost had a coronary when they saw this. Sorry. But if ObamaCare were here, you'd be chatting with your friends Dave and Larry somewhere not on the planet. Or maybe nowhere at all, as Professor Singer says life is meaningless anyway.
David Hasselhoff: News reports out there say the ex-Baywatch star and current judge on America's Got Talent was rushed to the Cedars-Sinai Medical Center back in May, yet again undone by a battle with the bottle. The Hoff's alcohol level registered at .39, more than four times the legal limit in California. Alcohol poisoning, yet again, came close to doing him in, say the stories, this one in Radar Online.com. This, says the always juicy quote from a Hollywood source, "is about the 7th time he's been taken to a hospital over the last few years with alcohol poisoning. How many visits will it take before he dies?" Well, considering the BOD Squad has that video of a while back taken by the Hoff's daughter, which displayed the star's agonizing battle in disturbing detail, the answer is: not long. Sadly, the Hoff just drank himself into a seriously bad QALY. Sorry to say, the bottom of the bottle has at last been reached. America will be one talent less.
Joan Rivers: Can we talk? A dozen plastic surgeries? A dozen…meaning twelve? Joan, sweetheart, America can't grow plastic fast enough to do this. You're surely in violation of a good dozen environmental laws before we even get to the health care issues. Multiple facelifts? OMG! That's before or after the "brow lift, botox, soft tissue fillers, jaw implants, multiple nose jobs, veneers, blepharoplasty (eye work), liposuction, cheek implants, breast implants" catalogued on FamousPlastic? Honey, the BOD Squad has a memorandum from the EPA and determined that you can't be buried, burned or dumped with all this stuff inside you. Please have your lawyer file an "Extinction and Burial Application Form 1A." Immediately.
And now, one last report. Perhaps the most interesting in the celebrity death struggle with ObamaCare.
Steve Jobs: A liver transplant for the creator of Apple? Well, well, well. Now this celebrity death struggle is particularly interesting. Why? Because Mr. Jobs had his transplant only three months ago, just as the ObamaCare toxin was seeping into the political atmosphere. This has already resulted in news stories speculating that the secrecy of the operation, the fact that Jobs traveled unannounced and unknown to Tennessee to have it, means that Jobs was, in the words of an actual news report, "gaming the system." How? The wait-time for a liver in Tennessee is about 48 days, on average. The United Network for Organ Sharing says the national wait time is 306 days. In other words, before the BOD Squad legislation has even passed Congress, one prominent American celebrity is under fire for "gaming the system" when it comes to transplants. Another couple of months and Mr. Jobs would have been either dead because of instructions on his QALY or brought up on charges for getting around "the rules." There will be penalties for trying to save your life, right?
Gaming the system. An interesting concept. You mean government rules can be manipulated? Nooooooo! Really?
Perhaps you've heard of a federal agency called the IRS? Like the soon-to-be bureaucrats at the BOD Squad, the Internal Revenue Service is in theory designed to be a "just-the-facts" kind of agency. And yet….hmmm.
In 1952, a controversial Senator from California named Richard Nixon found his tax returns leaked from the Truman-run IRS to a virulently anti-Nixon columnist named Drew Pearson. (In those days, candidates did not release their tax returns as they frequently do today.) In 1963, a few months after Nixon lost a humiliating race for governor of California, his political life was presumed by all seers of the day as dead. Yet low and behold, private citizen Nixon found himself subject to a lengthy and exhaustive audit by the IRS. Years later, the IRS supervisor of the case admitted that, well, his Washington superiors in the Kennedy administration had ordered him three times to re-open the original audit and try and get Nixon for tax evasion.
Thus, when Nixon became president at last, he tells us he was so furious at his treatment by the IRS when in the hands of Democrats that he personally and repeatedly "urged Haldeman and Ehrlichman [the Rahm Emanuel and David Axelrod of the day] to have IRS checks made on [1972 Democratic nominee] McGovern's key staff and contributors."
In other words, power can be abused. In a blink. You think David Letterman is sorry now for the things he said about Sarah Palin's daughter? Wait 'til ole Dave discovers he has a recurrence of heart problems down the road and appeals for a little Obama-esque empathy from the BOD Squad -- and the response he receives telling him to go pound sand and die is coming from an appointed bureaucrat of President Palin's. FYI to the Reverend Jeremiah Wright: Watch your QALY, brother.
Or imagine the current kerfuffle with Harvard's Professor Henry Gates and Cambridge police Sergeant James Crowley. Let's change the story a bit. Instead of Crowley being a policeman, let's make him Dr. James Crowley, a member of the BOD Squad. He and his fellow bureaucrats have told the sick Professor Gates that, gee, sorry. Your QALY just isn't that good. Please file an Extinction Application. To which Professor Gates snaps off from his hospital bed exactly the same reply he gave to Sergeant Crowley in his house: "Why…because I'm a black man in America?"
What's the racial composition of the BOD Squad? How many Wise Latinas are there to decide on the worth of a brown-skinned life over the worth of a white-skinned life? Have Al Sharpton and Jesse Jackson gotten wind of this yet? If civil rights activists believe there are too many blacks in American prisons, what will they say if the number of blacks being sent off by the BOD Squad is, percentage wise, higher than the number of whites? Whose life has more -- or less -- value? A white? Or a black, brown, yellow or red life? Does the black guy live or the Latina? The American Vietnamese or the Native American? Just what Washington, D.C. needs -- more lobbyists. Not to mention the QALY law practices that will quadruple the size of the trial bar.
You think the gay community is upset over same-sex marriage prohibitions? This is as nothing compared to the fuse that will be lit when gays come to believe the BOD Squad is filled with homophobics intent on claiming AIDS is such a disqualifying QALY feature that simply being gay means a death sentence ASAP.
We haven't even gotten to Senator Kennedy's brain surgery, the latest hospitalization for West Virginia's 91-year old Senator Robert Byrd, Lance Armstrong's testicular cancer or Tiger Woods's knee operation. Needless to say, the agonized Farrah Fawcett would never have been allowed to struggle on as she did from the moment of her cancer diagnosis, Ed McMahon's QALY, with a broken neck and two neck surgeries in his eighties on file, would have had him announcing himself to God long before the other week. And Michael Jackson? Maybe the Bod Squad already made their first call.
Which returns us to Michael J. Fox. Remember the dust-up a while back when Mr. Fox was appearing in political ads supporting stem-cell research? One can agree with Mr. Fox, or not. But without doubt his opponents on the issue believed the importance underlying the issue was the larger point of respect for human life. The issue was at play in Missouri, where state funding was under discussion, and it elicited this fairly standard response from a Missouri State Senator: "I believe that a human embryo is worthy of legal protection," said state Sen. Matt Bartle (R), who vows to press the fight. "Western medicine has been founded on a principle: First, do no harm."
For Fox, this issue now falls precariously close to the old caution about being careful what you wish for. Once upon a time in America the issue of "life" was about the death penalty for murderers. Then it was abortion. Next it was about stem cell research. Now, it's about whether Michael J. Fox's life has sufficient QALY points to justify letting him live.
Does Michael J. Fox's life deserve respect? Of course.
But if they can come for Michael J. Fox, they can come for you.
And they will.
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