Why Is America Committing Suicide?

[BWV 1080]

Why Is America Committing Suicide?
The US of A on the road to ruin

by Justin Raimondo, August 05, 2011
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America is committing suicide. That’s the only explanation I have for the course followed by US policymakers in the past decade, a period in which the US budget deficit has skyrocketed beyond all reason. While we have run up deficits before, some of them considerable by the standards of the day, in 2001 – the year we launched our endless “war on terrorism” – the deficit began to enter new territory. Whereas before it had fluctuated, going up, down, and effectively maintaining a steady state of neutral, after the 9/11 terrorist attacks this country went into debt bigtime, with the deficit climbing steadily, doubling in 2007, and nearly doubling again the next fiscal year.
In the name of fiscal “austerity,” Congress recently authorized yet another raising of the debt ceiling, and everyone sits around waiting for the “draconian” cuts to fall – a “cut,” that is, in the rate at which government spending is projected to grow. Only in Washington, D.C., is a “cut” actually an increase – just not as much of an increase as was anticipated. As Ron Paul pointed out, if Congress had simply frozen spending at 2004 levels, we’d have more of a “cut” than we do now.
No one is surprised by this Washington doubletalk: that’s the language they speak in the Imperial City, where murdering civilians is “collateral damage” and taxation is “revenue enhancement” instead of good old-fashioned theft. It’s silly season on Capitol Hill: so what else is new? Yet I sense a more sinister pattern in this Kabuki theater known as the debt ceiling drama, the implications of which are darker than I care to contemplate — but then again, that’s my job …
While governments can only finance their completely non-productive (in reality: counter-productive) activities by incurring debt, it’s rare in human history to find profligacy comparable to our own. One has to go all the way back to ancient Rome, under the heel of its more depraved emperors, to find a precedent. The numbers are not merely astonishing: they are inconceivable. The figure — $14.3 trillion – must forever remain in the world of abstractions, because any attempt by the human brain to concretize it fails. How do our lawmakers imagine we can continue to spend at these levels, living light years beyond our means?
Their recklessness is epitomized by how the military budget came out in all the deficit dickering. As it stands, real defense cuts only kick in if the “super-Congress” fails to come to an agreement on what cuts to make. Then and only then will the misnamed “defense” department come in for something approximating its fair share of cuts. Put another way: only in the most extreme and politically next-to-impossible case will Congress even consider cutting back on its overseas empire. They’ll yank your grandmother off her dialysis machine before they’ll contemplate getting rid of “foreign aid.”
We ordinary folk live in a completely different world than the movers and shakers of the Imperial City: no one outside the Beltway bubble can really understand the mental processes that allow for such a massive evasion of reality, a kind of collective madness that infects the ruling elite in this country, regardless of party. They talk down to the hoi polloi, and use a different language when they converse among themselves, but occasionally the truth comes out. In 2004, Ron Suskind wrote a piece for the New York Times Magazine which included this quote from an unnamed top White House aide:
“The aide said that guys like me were ‘in what we call the reality-based community,’ which he defined as people who ‘believe that solutions emerge from your judicious study of discernible reality.’ … ‘That’s not the way the world really works anymore,’ he continued. ‘We’re an empire now, and when we act, we create our own reality. And while you’re studying that reality—judiciously, as you will—we’ll act again, creating other new realities, which you can study too, and that’s how things will sort out. We’re history’s actors…and you, all of you, will be left to just study what we do.’”
While the context was a discussion of the Iraq war, this mindset – which is dominant in the Washington of Barack Obama just as it was during the Bush era – pervades our ruling elite in all matters. Why shouldn’t they run up a $14.3 trillion debt — after all, don’t they create their own reality? Armed with such supernatural powers, we aren’t going to let a little thing like impending bankruptcy stand in our way – not when we can wish it out of existence.
Except we can’t. World markets trembled this week, and all indications are that the Big One is just now visible over the horizon. Americans are waking from their decade-long dream – or is that nightmare? – to discover that the world as they used to know it is falling apart, and a new world – a poorer, more restrictive, grayer world — is dawning. Yet our “leaders” in Washington are oblivious to the crisis, as much as they posture and pose: they are, personally, practically invulnerable to the effects of the economic collapse – at least, so far – and so don’t take it seriously. Encased in their self-created bubble, and imbued with the radical subjectivism that has taken hold everywhere but in the sorely beleaguered reality-based community, our rulers pursue policies that are suicidal in their effect, if not their intent. And I am beginning to wonder if that isn’t their intent, at least on some level….
I put this out there as a proposition, a speculation, based solely on evidence of the circumstantial sort. When someone habitually engages in suicidal behavior, repeating the same pattern in spite of recognizing, on some level, that their actions are self-destructive, one has to wonder if they harbor a death wish. Which raises the question: So why is the American ruling class intent on committing suicide?
There is a theory of history, which I don’t agree with, that treats civilizations as organic entities which go through a process of maturation, progressing from youth to senility in stages roughly comparable to the life process of a human being. Could the Spenglerians be right? Is American civilization entering a new phase — one of terminal decadence? This isn’t the first time I’ve thought of these lines from Robinson Jeffers’ poem, “Shine, Perishing Republic”:
“While this America settles in the mould of its vulgarity, heavily thickening
to empire

And protest, only a bubble in the molten mass, pops and sighs out, and the
mass hardens,

I sadly smiling remember that the flower fades to make fruit, the fruit rots
to make earth.

Out of the mother; and through the spring exultances, ripeness and decadence;
and home to the mother.

You making haste haste on decay: not blameworthy; life is good, be it stubbornly
long or suddenly

A mortal splendor: meteors are not needed less than mountains:
shine, perishing republic.”

Read more by Justin R

[absinthe]

A splendid article.

There is a theory of history, which I don’t agree with, that treats civilizations as organic entities which go through a process of maturation, progressing from youth to senility in stages roughly comparable to the life process of a human being. Could the Spenglerians be right? Is American civilization entering a new phase — one of terminal decadence?

I remember reading a treatise by Jay W Forrester (long ago, now) about the rise and fall of cities and possible solutions to regeneration, for which he constructed a complex computer model in true systems fashion. There were comparisons to empires/countries that seemed to respond to the same variables in similar functional relationships.

I seem to remember one treatise was "Urban Dynamics" the other, "World Dynamics".

On a practical level, the supremacy of America must one day crumble just as that of the British after WW1 and for that matter Rome, Spain, France and on. It's not 'in the cards' but in the maths.

[jbuck919]

A splendid article.

It isn't right, you know, except in the general sense that our constitutional government is currently working monstrously against the interests of its own people. The Republicans are far more deeply committed to never raising taxes and slashing spending than they are to the defense establishment. The programs that are crucial to the Democrats have actually been protected, so they have no reason to care if the committee ends up being deadlocked. So I suspect there will be a tie, and the automatic cuts will actually happen. Or they may come up with a solution which is nearly the same thing but spares the businesses in their own districts.

And it is not a super-Congress. It is very obviously a sub-Congress, and these days that is a very low form of life indeed.

[John F]

Hype running to hysteria. This kind of "big thinking" is neither illuminating nor helpful.

[Agnes Selby]

A splendid article.

There is a theory of history, which I don’t agree with, that treats civilizations as organic entities which go through a process of maturation, progressing from youth to senility in stages roughly comparable to the life process of a human being. Could the Spenglerians be right? Is American civilization entering a new phase — one of terminal decadence?

I remember reading a treatise by Jay W Forrester (long ago, now) about the rise and fall of cities and possible solutions to regeneration, for which he constructed a complex computer model in true systems fashion. There were comparisons to empires/countries that seemed to respond to the same variables in similar functional relationships.

I seem to remember one treatise was "Urban Dynamics" the other, "World Dynamics".

On a practical level, the supremacy of America must one day crumble just as that of the British after WW1 and for that matter Rome, Spain, France and on. It's not 'in the cards' but in the maths.

You are right, Abs! Churchill would not recognise the Empire he believed he could
save from disintegrating. But so it must have been when Rome's power slowly disappeared.

As far as the US is concerned, it is the cancer that grows from within. The destructive
hatred of opposing political parties are slowly eating into the very existence
of the nation. It is tearing the nation apart. One only has to read the remarks on these
pages to realize that all is not well within the family. Divorce within a nation is not
possible, taking up arms against each other is not advisable, although it could happen.
What is left is a slow deterioration and a loss of power in the end. A nation's
"exceptionalism" (which Americans believe the possess), depends not only on
military power but on total co-operation within the nation. What was it that Churchill
said about a nation "that sticks together...?

[Teresa B]

You are right, Abs! Churchill would not recognise the Empire he believed he could
save from disintegrating. But so it must have been when Rome's power slowly disappeared.

As far as the US is concerned, it is the cancer that grows from within. The destructive
hatred of opposing political parties are slowly eating into the very existence
of the nation. It is tearing the nation apart. One only has to read the remarks on these
pages to realize that all is not well within the family. Divorce within a nation is not
possible, taking up arms against each other is not advisable, although it could happen.
What is left is a slow deterioration and a loss of power in the end. A nation's
"exceptionalism" (which Americans believe the possess), depends not only on
military power but on total co-operation within the nation. What was it that Churchill
said about a nation "that sticks together...?

True, and sad for our country. We no longer have statesman (or women) in charge, but only politicians whose interests lie in getting themselves reelected--and/or in blindly advancing an ideology. This will backfire on them as the American people finally realize that we are the ones who suffer while the fat cats who are financing these pols get richer.

The inmates are running the asylum, and we put 'em there.

Teresa

[Cosima___J]

You are right Teresa! What can we do?

[Teresa B]

You are right Teresa! What can we do?

Great question, Cosima! (I'm tempted to say, "Move to Australia"!)

Unfortunately, what we tend to do is react and vote the opposite way the next time, only to find that that didn't work either. As long as our system of government itself is so terribly dysfunctional, what are we to do indeed? How about these (admittedly long-term, but there's no quick fix) ideas?

--***Real campaign finance reform***
--Go back to a reasonable news cycle and get RID of all 24/7 "news" stations with clear political agendas. (I dunno how this can actually happen, but...)
--go to Australia's (see, here I go again ) system of electioneering limited to only a few weeks ahead of the elections
--Institute Medicare for All, and relegate private health insurance companies to selling supplemental plans for those who choose them
--Reasonable but real regulations for Wall Street (this could be filed under campaign finance reform, though)
--A requirement that ALL young people serve the country for a year--not necessarily in the armed services, but in some public sector--if you've really seen first hand what life is like for people at subsistence level, for example, you will WAKE UP.

How's that for starters?
Teresa

[BWV 1080]

--***Real campaign finance reform***
--Go back to a reasonable news cycle and get RID of all 24/7 "news" stations with clear political agendas. (I dunno how this can actually happen, but...)
--go to Australia's (see, here I go again ) system of electioneering limited to only a few weeks ahead of the elections
--Institute Medicare for All, and relegate private health insurance companies to selling supplemental plans for those who choose them
--Reasonable but real regulations for Wall Street (this could be filed under campaign finance reform, though)
--A requirement that ALL young people serve the country for a year--not necessarily in the armed services, but in some public sector--if you've really seen first hand what life is like for people at subsistence level, for example, you will WAKE UP.

How's that for starters?
Teresa

how about some that don't trample over free speech, freedom of the press and freedom from involuntary servitude?

[Cosima___J]

And maybe this needs to change. BTW, this is just an example which I'm sure Republicans also engage in:

Obama Looks to 'Bundlers' for 2012 Re-Election Campaign
By William Lajeunesse

Published August 03, 2011 | FoxNews.com

Despite the recent public lashing President Obama gave millionaires and billionaires, in private, Team Obama is once again diving into the pockets of the super rich to fund its campaign.

With the 2012 campaign barely under way, Obama has already raised some $35 million from the biggest donors -- so-called 'bundlers' who collect money by the truckload from the wealthy elite.

"A bundler is someone who collects checks from other people," said Susan Estrich, a former Democratic campaign manager. "They may be people who work for him, who hired him as a consultant or in many cases, want to do business with them."

Some of the high-profile bundlers Obama signed up this year include former New Jersey Governor and Goldman Sachs CEO Jon Corzine, Vogue editor Anna Wintour, Dreamworks’ studio head Jeffery Katzenberg, and David Cohen of Comcast, the new owner of NBC-Universal.

Wall Street, including the hedge fund managers blasted by Obama, gave the president's 2012 campaign $7 million, followed by lawyers at $6 million and businesses at $4 million.

"We're going to see a different mixture of fundraisers and bundlers this time," said Bob Stern with Los Angeles-based Center on Governmental Studies. "In 2008, it was about ideology. It was people who were committed to Obama the person. What we see now are the Wall Street types, business types -- people who want something from government."

That's not to say Obama's 2008 bundlers didn't want something. Obama rewarded half of his top money men plum government appointments. Matthew Barzun, who raised $500,000, was named Ambassador to Sweden. Bill Eacho, who bundled a similar amount, received the Ambassadorship to Austria.

"When you call up the White House and you've raised $500,000, I can guarantee you your call will go through," said Stern.

Yet some of Obama's 2008 bundlers have yet to join the president's 2012 team. Some are disillusioned, others are busy. In Los Angeles, just 55 of Obama's 97 top bundlers are back, according to figures from the Center for Responsive Politics. In Chicago, only of 11 of the campaign's 84 bundlers returned.

"There are a lot of disappointed Democrats today," said Estrich. "So you're going to see a little bit of coolness in the short run. But in the long run, California Democrats will be with Barack Obama."

It's still early in the campaign, and some don't have the stomach for another year of phone calls and fundraisers. And while Obama may win the money war, Stern said it doesn't mean he'll win the election.

"If he can't get the liberals excited, if he can't get his base excited, he could be in real trouble, no matter how much money he spends," he said.

[Teresa B]

--***Real campaign finance reform***
--Go back to a reasonable news cycle and get RID of all 24/7 "news" stations with clear political agendas. (I dunno how this can actually happen, but...)
--go to Australia's (see, here I go again ) system of electioneering limited to only a few weeks ahead of the elections
--Institute Medicare for All, and relegate private health insurance companies to selling supplemental plans for those who choose them
--Reasonable but real regulations for Wall Street (this could be filed under campaign finance reform, though)
--A requirement that ALL young people serve the country for a year--not necessarily in the armed services, but in some public sector--if you've really seen first hand what life is like for people at subsistence level, for example, you will WAKE UP.

How's that for starters?
Teresa

how about some that don't trample over free speech, freedom of the press and freedom from involuntary servitude?

I know they can't all work as stated. (In fact I said as much on the news cycle one.) Of course the media shouldn't be muzzled, but why should they not be required to reveal that they are politically motivated/funded, etc, instead of pretending they're news programs? How does it benefit Americans to have lies and distorted information delivered as facts?

As far as "servitude", you make it sound like I'm proposing slavery, or something. If you recall, we used to have a draft, and during the Bush administration with its wars, we often had spokespeople comment in favor of re-instituting one, although it's an unpopular view. I am not necessarily in favor of involuntary military service. I qualified it by saying that it shouldn't have to be in the armed forces. Perhaps instead of requiring the service, it could be achieved with incentives--for example, I know many doctors whose medical education was paid by the military, and they then served for 4 years.

I fail to see how the other things I suggested have anything to do with freedom of speech or servitude. Campaign finance reform in a big way might go a long way toward our problems.
Teresa

[BWV 1080]

campaign finance reform is nothing more than a ruse to muzzle free speech and protect incumbents, which is why the ACLU has consistently opposed it

It is good for some people to volunteer and serve, but you cannot force citizens to serve in some government-run service program

[Teresa B]

campaign finance reform is nothing more than a ruse to muzzle free speech and protect incumbents, which is why the ACLU has consistently opposed it

It is good for some people to volunteer and serve, but you cannot force citizens to serve in some government-run service program

I'm not talking about the ruse called "campaign finance reform", I'm talking about actually reforming campaign financing. If politicians were not in all the pocket of special interests, they might act more in the interests of the public, and this could actually (gasp) help get them reelected. No one is out to muzzle free speech--does it really fall under "freedom of speech" when the only thing that talks is money, or could it be considered bribery? I'm sorry, but when 82% of Americans polled believe we should roll back the Bush tax cuts on those making over $250K, and it still can't be passed by our elected officials, it's a sad state of affairs. If incumbents are favored, then institute term limits; I know that has problems too, of course. I can't claim I know exactly how reform can be effected (if I did I might be a lot richer now), but when the government is so corrupted that democracy cannot function, something needs to be done.

And do you consider the draft during WW II to have been immoral? Just a question.

Teresa

[Werner]

A simplistic answer, Teresa: The existence of our nation - our world - was threatened then, and we had to defend ourselves. Having no built-in mechanism for doing so, it still strikes me that the darft was the only possible measure.

As it happened, as a fairly recent immigrant, I thought I should volunteer (didn't tell my parents, I seem to remembeer, who would have been shocked.) As a non-citizen, I was rejected then, but when my turn to be drafted came later, citizenship or not was no issue. But I and many other immigrant GIs were naturalized before being sent abroad.

I'm still not sure about the answer to your question about the draft's morality. It seems to me that now, with a strictly volunteer force, the defense function is left to a much smaller portion of the populace than the draft would prrovide. Which is fairer?

[lennygoran]

>You are right Teresa! What can we do?<

Stop giving tax exemptions to the fat cats. Make sure we don't give those fat cats any more bonuses! Regards, Len

[lennygoran]

>Institute Medicare for All<

Yeah but stop Medicare from paying so much money to keep hopelessly terminal people alive while the Medicare system goes bankrupt--stop calling those who oppose some reasonable approach to hese miracle medical experiments members of death panels. Regards, Len

[John F]

stop Medicare from paying so much money to keep hopelessly terminal people alive while the Medicare system goes bankrupt

Lenny, you do realize that you've just spoken in favor of "death panels"? The medical profession is not in the business of deciding who lives or dies, and the government certainly isn't in that business either, even when the government is paying part or most of the cost of keeping the terminally ill alive until they themselves, or their legally authorized agents, decide otherwise. I know you're in favor of killing extreme criminals, but are you also in favor of killing off the extremely ill?

[Teresa B]

A simplistic answer, Teresa: The existence of our nation - our world - was threatened then, and we had to defend ourselves. Having no built-in mechanism for doing so, it still strikes me that the darft was the only possible measure.

As it happened, as a fairly recent immigrant, I thought I should volunteer (didn't tell my parents, I seem to remembeer, who would have been shocked.) As a non-citizen, I was rejected then, but when my turn to be drafted came later, citizenship or not was no issue. But I and many other immigrant GIs were naturalized before being sent abroad.

I'm still not sure about the answer to your question about the draft's morality. It seems to me that now, with a strictly volunteer force, the defense function is left to a much smaller portion of the populace than the draft would prrovide. Which is fairer?

Thanks, Werner, for a thoughtful reply (and for serving in WW II !). I agree with you--I think the answer to the question of the draft's morality is very unclear--although I admit, I did pose it in regard to WW II because in that case it was more clear cut that we hardly had a choice.

Teresa

[lennygoran]

>but are you also in favor of killing off the extremely ill?<

Whose in the best position to decide when a patient is hopeless--how much should Medicare or Medicaid spend? Should it always be the family that makes the decision? These are tough questions but I feel we may not always be able to afford the costs when a case is hopeless. There was a wonderful show on PBS that dealt with this subject--granted it's a tough matter.

There's much more here:

http://www.pbs.org/wgbh/pages/frontline/livingold/cost/

Regards, Len

[Teresa B]

stop Medicare from paying so much money to keep hopelessly terminal people alive while the Medicare system goes bankrupt

Lenny, you do realize that you've just spoken in favor of "death panels"? The medical profession is not in the business of deciding who lives or dies, and the government certainly isn't in that business either, even when the government is paying part or most of the cost of keeping the terminally ill alive until they themselves, or their legally authorized agents, decide otherwise. I know you're in favor of killing extreme criminals, but are you also in favor of killing off the extremely ill?

End of life medical costs are a huge part of Medicare expenditures. Most people do not want heroic measures to prolong their lives a few days or weeks if they are terminally ill and suffering. No one would ever propose that there be "death panels" (thank you Sarah Palin, for making that a household word) making such decisions.

As a physician (who also has a living will, thank you), I can attest that I have never known a physician who wanted to kill off his/her patient, and the thought of government deciding is absurd. On a person-by-person basis, it certainly is a small expenditure for Medicare to cover a physician visit to discuss what a patient's wishes are. This would probably be a $50-100 cost per patient to Medicare, something in that ballpark. No patient would ever have his arm twisted, and it would be a voluntary discussion. That's all. Physicians are dedicated to saving lives, and it pains them whenever they think they possibly could have done something more, something different--in any case with a sad outcome. I know this first hand. The decision on end-of-life treatment is difficult, but should be made by an individual with family and physician whenever possible, with the best possible information regarding his/her prognosis.

Teresa

[Agnes Selby]

stop Medicare from paying so much money to keep hopelessly terminal people alive while the Medicare system goes bankrupt

Lenny, you do realize that you've just spoken in favor of "death panels"? The medical profession is not in the business of deciding who lives or dies, and the government certainly isn't in that business either, even when the government is paying part or most of the cost of keeping the terminally ill alive until they themselves, or their legally authorized agents, decide otherwise. I know you're in favor of killing extreme criminals, but are you also in favor of killing off the extremely ill?

End of life medical costs are a huge part of Medicare expenditures. Most people do not want heroic measures to prolong their lives a few days or weeks if they are terminally ill and suffering. No one would ever propose that there be "death panels" (thank you Sarah Palin, for making that a household word) making such decisions.

As a physician (who also has a living will, thank you), I can attest that I have never known a physician who wanted to kill off his/her patient, and the thought of government deciding is absurd. On a person-by-person basis, it certainly is a small expenditure for Medicare to cover a physician visit to discuss what a patient's wishes are. This would probably be a $50-100 cost per patient to Medicare, something in that ballpark. No patient would ever have his arm twisted, and it would be a voluntary discussion. That's all. Physicians are dedicated to saving lives, and it pains them whenever they think they possibly could have done something more, something different--in any case with a sad outcome. I know this first hand. The decision on end-of-life treatment is difficult, but should be made by an individual with family and physician whenever possible, with the best possible information regarding his/her prognosis.

Teresa

I agree with you, absolutely, Teresa. My husband truly suffers whenever
one of his patients dies. My grandson, who is studying Medicine is
intent on saving lives not doing away with life.

On another subject, thank you for recommending Australia. Yes, do come
over, all of you! It is winter but it is warm and sunny 20 degrees C today.

...and Lenny, the "oldies" who will attend my daughter's concert this afternoon,
many of them confined to wheel chairs, would prefer to listen to a good concert,
have a nice cup of tea and cake in the interval and have a little chat rather
than contemplate death. Let death take its course...

Agnes.

[lennygoran]

>and Lenny, the "oldies" who will attend my daughter's concert this afternoon,
many of them confined to wheel chairs, would prefer to listen to a good concert,
have a nice cup of tea and cake in the interval and have a little chat rather
than contemplate death. Let death take its course... <

Agnes I agree on attending a good-concert--uh, let's make that a good opera! Still that's not what is on my mind--those people who are beyond cure but are kept alive because of modern science--it costs money but these tragic cases can be kept alive forever--how much should Medicare pay to do that? Regards, Len

[Werner]

Dear Agnes, I'll presume to butt into this conversation to suggest that you, Theo, and Teresa are closer to the truth than Lenny, whose impression of Medicare speding fortunes to keep incurable patients alive is based more on assumptions than the experience of professionally engaged physicians. I don't need to add to Teresa's remarks.

I should add, though, that I've seen the pictures of that beautiful new concert hall which I gather Kathy inaugurated today. It was nice to imagine myself being one of the "oldies" on scene - while I feel lucky to be able to still hear some concerts here at Lincoln Center.

But a cup of tea and a piece of cake in addition - that WOULD have been nice. And after that..........

[Agnes Selby]

Dear Agnes, I'll presume to butt into this conversation to suggest that you, Theo, and Teresa are closer to the truth than Lenny, whose impression of Medicare speding fortunes to keep incurable patients alive is based more on assumptions than the experience of professionally engaged physicians. I don't need to add to Teresa's remarks.

I should add, though, that I've seen the pictures of that beautiful new concert hall which I gather Kathy inaugurated today. It was nice to imagine myself being one of the "oldies" on scene - while I feel lucky to be able to still hear some concerts here at Lincoln Center.

But a cup of tea and a piece of cake in addition - that WOULD have been nice. And after that..........

Dear Werner,

The concert this afternoon was what my grandkids call the "oldies" concert.
Do you remember when Professor Schwartz from New York ended the Macquarie
University concerts in order to turn the university away from the Arts to Technology,
many of the older subscribers found it difficult to transfer to the City Recital Hall in
center city. They requested that Kathy create a series of concerts at a convenient
place so that they would not have to travel to the city. The "oldies concert" is now part
of Kathy's national tour five times a year. However, it is more a family gathering as
Anna, my granddaughter bakes cakes as I do too. Coffee is served by my son-in-law
and Nicholas, our grandson turns pages for Kathy. Everyone knows everybody,
and everybody has a grand time. They vary in age between 70 and 95 and very spright
they are. They enjoyed trios by Beethoven, Lalo, Brahms and Nigel Westlake
an Australian composer. There is one problem though, today 400 people turned
up and we ran out of cakes.

The concert in the new concert hall will take place on September 27 with Kathy and
the Sydney Camerata Orchestra.

Regards,
Agnes.

[lennygoran]

>whose impression of Medicare speding fortunes to keep incurable patients alive is based more on assumptions than the experience of professionally engaged physicians. I don't need to add to Teresa's remarks.<

Yes but maybe youneed to watch the show or at least read at this link:

http://www.pbs.org/wgbh/pages/frontline/livingold/cost/

Doctors are not always making these decisions--it's the family members--the doctors may realize that the situation is hopeless. Regards, Len

[Teresa B]

Doctors are not always making these decisions--it's the family members--the doctors may realize that the situation is hopeless. Regards, Len

This is the very reason we need discussions among patients, families, and doctors. If the doctor realizes a situation is hopeless, he or she would best speak to the patient and/or family in a compassionate but honest manner. The choices of treatment should be presented, and the expected outcomes with or without the treatment. Then the patient/family can make an educated decision.

Teresa

[lennygoran]

>Then the patient/family can make an educated decision. <

But aren't there some families who needlessly decide on what turns out to be the most expensive and maybe the least wise choice--people kept alive on machines who have little or no recognition of anything--isn't this costing the Medicare and Medicaid system a lot of money. And the machines that keep these worst case patients alive are getting more and more sophisticated. And once hospitals get these new machines there's a great incentive to use them. It seems to me this is truly a hard choice to deal with and I don't think our politicians will go near the issue. Regards, Len

[Teresa B]

>Then the patient/family can make an educated decision. <

But aren't there some families who needlessly decide on what turns out to be the most expensive and maybe the least wise choice--people kept alive on machines who have little or no recognition of anything--isn't this costing the Medicare and Medicaid system a lot of money. And the machines that keep these worst case patients alive are getting more and more sophisticated. And once hospitals get these new machines there's a great incentive to use them. It seems to me this is truly a hard choice to deal with and I don't think our politicians will go near the issue. Regards, Len

Yes, there are some families who will decide on the most expensive, and possibly unwisest choice. There always will be, but if more families are informed of the likely results of those choices, is it not likely that more of them will choose wisely?

Yes, there may be more incentives to use expensive technology--but compassionate and honest end-of-life discussion will not change the technology situation anyway. What must accompany the technology is the discussion, and it must not be guided by what might bring revenues to a hospital. And no, I wouldn't expect politicians to address the issue, especially now that it has been cast in the absurd "death panels" light. If the issue had simply been Medicare coverage for end-of-life discussion and palliative care, it wouldn't even be a controversy.

Teresa

[lennygoran]

>but if more families are informed of the likely results of those choices, is it not likely that more of them will choose wisely? <

Thanks, yes I agree with that! Regards, Len

[John F]

But aren't there some families who needlessly decide on what turns out to be the most expensive and maybe the least wise choice--people kept alive on machines who have little or no recognition of anything--isn't this costing the Medicare and Medicaid system a lot of money. And the machines that keep these worst case patients alive are getting more and more sophisticated. And once hospitals get these new machines there's a great incentive to use them. It seems to me this is truly a hard choice to deal with and I don't think our politicians will go near the issue. Regards, Len

Our politicians have the good sense not to go near the issue because it's none of their business to decide it or to make these life-or-death health care choices for us. Nor is it your or my business either, except if we're personally involved in such a case and legally responsible for making a decision. Otherwise, respect for each other and respect for life should forbid us to interfere.

When the time comes, if you personally decide to roll over and die, or let Sue die, in order to save the Medicare system some money, that would be very public-spirited of you. Also weird, don't you think? But such decisions must not become a matter of public policy, made on a cost-effectiveness basis by impersonal officials who would effectively be rationing health care and would quite rightly be called "death panels."

Let it go, Lenny, let it go.

[lennygoran]

>Let it go, Lenny, let it go.<

I certainly will not--please don't be a bully. The taxpayer has a right to at least discuss the issue since taxpayer money is involved. Regards, Len

[Werner]

John has never been a bully, Lenny.. Moreover, he's right - you've made the same point over and over without showing any reaction to posts such as Teresa's, who is involved with this issue professionally, and others, including myself having given the issue some thought over what's getting to be nine decades. Yes. and we're all taxpayers, too. That does not entitle you - freedom of speech aside - to keep parrotting the Palinesaur "Death Panels" platitudes.

As one who appreciatsd your posts generally, allow me to say, as nicely as I can: enough already!

[lennygoran]

>you've made the same point over and over without showing any reaction to posts such as Teresa's<

Werner I thought Teresa and I had reached an agreement that it is very good to discuss the matter with the family and educate them--didn't you see those exchanges? And what's this about Palin--she's my enemy--are you saying I'm supporting her--isn't it some of her people in the tea party who were calling Obama Hitler? Regards, Len

[Werner]

As they say, Lenny, you can tall people by their friends - or enemies. Thius would seem to make you and me friends,because we've got a mutual enemy. And your agreement with Teresa seems to me to settle the matter. So we're all on the same page.

[lennygoran]

>So we're all on the same page.<

This is great--I feel I'm in good company! Regards, Len

[Teresa B]

Our politicians have the good sense not to go near the issue because it's none of their business to decide it or to make these life-or-death health care choices for us. Nor is it your or my business either, except if we're personally involved in such a case and legally responsible for making a decision. Otherwise, respect for each other and respect for life should forbid us to interfere.

When the time comes, if you personally decide to roll over and die, or let Sue die, in order to save the Medicare system some money, that would be very public-spirited of you. Also weird, don't you think? But such decisions must not become a matter of public policy, made on a cost-effectiveness basis by impersonal officials who would effectively be rationing health care and would quite rightly be called "death panels."

Let it go, Lenny, let it go.

A couple of years ago I had a patient who died of melanoma at age 65. I had treated him until his disease metastasized, after which he was treated at a cancer center. Aggressive surgical and medical treatment got him about 4 more years of quality life. I continued to follow him in my office, along with the cancer center. When his disease recurred again in his brain and lungs, and he was offered a powerful chemo that would cause him to become very ill and had perhaps a 15% chance of reducing his tumor burden (not remission), he decided not to take it, after discussing it thoroughly with his oncologist. His wife privately asked me if I thought this was the right decision. Knowing this man very well, knowing his other doctors, and knowing his prognosis at this point, I answered "yes". A couple of months later he died at his home under hospice care, his pain controlled, and his family with him.

You could say Medicare potentially saved a lot of money, because this man might well have spent weeks in the hospital fighting complications from aggressive therapies that would likely do him little to no good. But why would you frame it that way?

Can we please put "death panels" to rest? They are a figment of the imagination of politicians who wanted to kill the health care plan, and have never been proposed by anyone, ever.

Teresa

[John F]

As long as people like Lenny see the cost of end-of-life care as a Medicare budget issue, implying that limits need to be set as a matter of public policy, then we're talking death panels whether or not we use the term, and I'm going to keep calling it by its proper name. End-of-life care is an important topic, and it has its financial side too; without Medicare and Medicaid, many families have been financially ruined by the cost of caring for their helpless and dying loved ones. But let's just drop the subject of setting limits on how much we're willing to spend to keep living people alive.

Many of us have personal experiences they might bring to a broader discussion of end-of-life decisions. My brother and I had to decide whether our father - 91 years old, with kidney failure, and demented - should be kept alive indefinitely with frequent hemodialysis or should be allowed to pass on. My stepsister had a similar decision to make about her 89-year-old mother, who had said more than once that she was ready to die, but was in a deep coma and unable to state her wishes when the time actually came. Thanks to Medicare, the choice between treatment and hospice care could be made in purely human terms with no concern about which option would cost us more. That's how it should be.

[lennygoran]

>As long as people like Lenny see the cost of end-of-life care as a Medicare budget issue, implying that limits need to be set as a matter of public policy, then we're talking death panels whether or not we use the term, and I'm going to keep calling it by its proper name. End-of-life care is an important topic, and it has its financial side too; ...Thanks to Medicare, the choice between treatment and hospice care could be made in purely human terms with no concern about which option would cost us more. That's how it should be.<

I don't think it should be completely that way-- Obama had to consider politics and his people caved imo on the issue--I'm not running for office so I can see I feel that hard choices like this have to be at least considered--it's costing tremendous sums of money--if you or other people to the right of me on this issue feel differently so be it. I too can cite personal examples--keeping my mother alive as a vegetable for over a year and a half--in retrospect did that make sense--the costs for doing this must have been astronomical--I'm certain there are many cases like that. Whether it's called death panels or consultations with doctors I for one don't favor completely forgetting financial considerations on this matter.

Obama Admin Removes Death Panels After Pro-Life Backlash

http://www.lifenews.com/2011/01/05/obam ... -backlash/ Regards, Len

[Teresa B]

Thanks to Medicare, the choice between treatment and hospice care could be made in purely human terms with no concern about which option would cost us more. That's how it should be.

We nearly all end up facing these kinds of choices at some point. The decision for each individual should never be based on cost, but compassionately based on on the person's situation and quality of life. The point is that better patient education may result in a decrease in the use of ineffective heroic treatment; the potential cost savings is a positive offshoot, not the deciding factor. No one proposes that some Medicare panel make the decisions for patients based on projected expenditures.

Teresa

[lennygoran]

>No one proposes that some Medicare panel make the decisions for patients based on projected expenditures. <

I think at some point the taxpayer has a right to say that enough is enough--if that's called a death panel so be it. In my case my mother suffered a massive stroke while I was away--as I remember it he signed certain papers and the hospital was able to keep her alive for a year of more--aamof there was then no way my father could insist the hospital remove the life system. Finally my father got a call from the hospital that a part of the life support needed replacement due to rust or some other problem--then my father and I had a consultation and after talking and it was his choice to make first he told the hospital not to replace the part. Meantime my mother was a vegetable from the moment she entered the hospital until the end. Can you as a doctor estimate what that cost New York?

Of course politicians don't want to touch tough issues like this so Medicare and Medicaid costs will continue there rise. Regards, Len

[John F]

We nearly all end up facing these kinds of choices at some point. The decision for each individual should never be based on cost, but compassionately based on on the person's situation and quality of life. The point is that better patient education may result in a decrease in the use of ineffective heroic treatment; the potential cost savings is a positive offshoot, not the deciding factor. No one proposes that some Medicare panel make the decisions for patients based on projected expenditures.

I'm afraid that this is exactly what Lenny Goran has in mind; "I think at some point the taxpayer has a right to say that enough is enough--if that's called a death panel so be it." And he really means it. But let it go.