Motley Moose – Archive

Since 2008 – Progress Through Politics

naming fear

It always happens that the reactionaries among us, and those rugged individualists, react to any public program with fear.  The fear is personal, that someone will be able to tell them how to live.  In some ways they do the rest of us a service, by complaining about any government intervention, they force a debate, individual choice vs. public good, think gun control.

This fear is there, and ready to be tapped by any Rovian who’s read the book.  We could not have had such high public approval for invading Iraq without that fear, and the name that was put on it by the ad men, mushroom clouds, and expanded ‘terrorism.’  For two.

We are now seeing this fear directed at the so-called public option in the health care reform debate and in the ideas to control cost.  In the past the signifier communism worked fine, but that word has lost its impact, capitalism has clearly won, and we already have examples of public insurance that work.  

So, the new fear word isn’t WMD, or even international terrorism (which are still actual threats, just not so feared right now) but death care and it just may sink health care reform, which scares me (but how to name it?).

Bogus doesn’t matter, there is no doubt that most of us will grow old, and that we’ll protect our rights to hang on as long as we can.  But bogus never matters.

So, how does it work?

It’s the human factor, humans are riddled with fears we ignore in the same way as the ostrich who bites the butt of the one with his head in the sand, but isn’t looking behind to see who’s about to bite him.  The point is to name it, not everything, just it, and don’t look behind it.  

So the pugs have a winning meme, those who fear death can instead fear death care, it’s easy, it’s available, it’s bogus but so what, and it will protect those who adopt this name for their fear from fearing all those unknowns, the ones that will indeed bite us all in the butt, in good time.  


  1. or at least clear and consistent countering.  I find myself having this conversation over and over, which I supposed I recommend to all of us (yes, I am one of the “us” who wants this now).

    Gramma doesn’t have to die.  It doesn’t happen in Canada, it doesn’t happen in the UK and it won’t happen here.  Won’t.

    I met a guy the other day who immediately launched into something of a tirade against Obama and the big spending Gov’t, but within ten minutes he was agreeing with me on health care.  Having lost his steady sales job and not being able to afford +$1,200/month for decent family care it wasn’t much of an effort to convince him that: Gramma wasn’t going to have to die and doesn’t in Canada; and we are already spending more than enough to pay for it.

    Rinse and repeat, times a few million…

  2. that opponents are calling the euthanasia section. Sorry for the line numbers and poor formatting. I copied it from this pdf –… That is the bill as it came out of the energy and commerce committee.


    16 (a) MEDICARE.-

    17 (1) IN GENERAL.-Section 1861 of the Social

    18 Security Act (42 U.S.C. 1395x) is amended-

    19 (A) in subsection (s)(2)-

    20 (i) by striking ”and” at the end of

    21 subparagraph (DD);

    22 (ii) by adding ”and” at the end of

    23 subparagraph (EE); and

    24 (iii) by adding at the end the fol25

    lowing new subparagraph:

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    f:VHLC071409071409.140.xml (444390|2)


    1 ”(FF) advance care planning consultation (as

    2 defined in subsection (hhh)(1));”; and

    3 (B) by adding at the end the following new

    4 subsection:

    5 ”Advance Care Planning Consultation

    6 ”(hhh)(1) Subject to paragraphs (3) and (4), the

    7 term ‘advance care planning consultation’ means a con8

    sultation between the individual and a practitioner de9

    scribed in paragraph (2) regarding advance care planning,

    10 if, subject to paragraph (3), the individual involved has

    11 not had such a consultation within the last 5 years. Such

    12 consultation shall include the following:

    13 ”(A) An explanation by the practitioner of ad14

    vance care planning, including key questions and

    15 considerations, important steps, and suggested peo16

    ple to talk to.

    17 ”(B) An explanation by the practitioner of ad18

    vance directives, including living wills and durable

    19 powers of attorney, and their uses.

    20 ”(C) An explanation by the practitioner of the

    21 role and responsibilities of a health care proxy.

    22 ”(D) The provision by the practitioner of a list

    23 of national and State-specific resources to assist con24

    sumers and their families with advance care plan25

    ning, including the national toll-free hotline, the ad-

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    1 vance care planning clearinghouses, and State legal

    2 service organizations (including those funded

    3 through the Older Americans Act of 1965).

    4 ”(E) An explanation by the practitioner of the

    5 continuum of end-of-life services and supports avail6

    able, including palliative care and hospice, and bene7

    fits for such services and supports that are available

    8 under this title.

    9 ”(F)(i) Subject to clause (ii), an explanation of

    10 orders regarding life sustaining treatment or similar

    11 orders, which shall include-

    12 ”(I) the reasons why the development of

    13 such an order is beneficial to the individual and

    14 the individual’s family and the reasons why

    15 such an order should be updated periodically as

    16 the health of the individual changes;

    17 ”(II) the information needed for an indi18

    vidual or legal surrogate to make informed deci19

    sions regarding the completion of such an

    20 order; and

    21 ”(III) the identification of resources that

    22 an individual may use to determine the require23

    ments of the State in which such individual re24

    sides so that the treatment wishes of that indi25

    vidual will be carried out if the individual is un-

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    1 able to communicate those wishes, including re2

    quirements regarding the designation of a sur3

    rogate decisionmaker (also known as a health

    4 care proxy).

    5 ”(ii) The Secretary shall limit the requirement

    6 for explanations under clause (i) to consultations

    7 furnished in a State-

    8 ”(I) in which all legal barriers have been

    9 addressed for enabling orders for life sustaining

    10 treatment to constitute a set of medical orders

    11 respected across all care settings; and

    12 ”(II) that has in effect a program for or13

    ders for life sustaining treatment described in

    14 clause (iii).

    15 ”(iii) A program for orders for life sustaining

    16 treatment for a States described in this clause is a

    17 program that-

    18 ”(I) ensures such orders are standardized

    19 and uniquely identifiable throughout the State;

    20 ”(II) distributes or makes accessible such

    21 orders to physicians and other health profes22

    sionals that (acting within the scope of the pro23

    fessional’s authority under State law) may sign

    24 orders for life sustaining treatment;

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    1 ”(III) provides training for health care

    2 professionals across the continuum of care

    3 about the goals and use of orders for life sus4

    taining treatment; and

    5 ”(IV) is guided by a coalition of stake6

    holders includes representatives from emergency

    7 medical services, emergency department physi8

    cians or nurses, state long-term care associa9

    tion, state medical association, state surveyors,

    10 agency responsible for senior services, state de11

    partment of health, state hospital association,

    12 home health association, state bar association,

    13 and state hospice association.

    14 ”(2) A practitioner described in this paragraph is-

    15 ”(A) a physician (as defined in subsection

    16 (r)(1)); and

    17 ”(B) a nurse practitioner or physician’s assist18

    ant who has the authority under State law to sign

    19 orders for life sustaining treatments.

    20 ”(3)(A) An initial preventive physical examination

    21 under subsection (WW), including any related discussion

    22 during such examination, shall not be considered an ad23

    vance care planning consultation for purposes of applying

    24 the 5-year limitation under paragraph (1).

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    1 ”(B) An advance care planning consultation with re2

    spect to an individual may be conducted more frequently

    3 than provided under paragraph (1) if there is a significant

    4 change in the health condition of the individual, including

    5 diagnosis of a chronic, progressive, life-limiting disease, a

    6 life-threatening or terminal diagnosis or life-threatening

    7 injury, or upon admission to a skilled nursing facility, a

    8 long-term care facility (as defined by the Secretary), or

    9 a hospice program.

    10 ”(4) A consultation under this subsection may in11

    clude the formulation of an order regarding life sustaining

    12 treatment or a similar order.

    13 ”(5)(A) For purposes of this section, the term ‘order

    14 regarding life sustaining treatment’ means, with respe

    15 to an individual, an actionable medical order relating to

    16 the treatment of that individual that-

    17 ”(i) is signed and dated by a physician (as de18

    fined in subsection (r)(1)) or another health care

    19 professional (as specified by the Secretary and who

    20 is acting within the scope of the professional’s au21

    thority under State law in signing such an order, in22

    cluding a nurse practitioner or physician assistant)

    23 and is in a form that permits it to stay with the in24

    dividual and be followed by health care professionals

    25 and providers across the continuum of care;

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    1 ”(ii) effectively communicates the individual’s

    2 preferences regarding life sustaining treatment, in3

    cluding an indication of the treatment and care de4

    sired by the individual;

    5 ”(iii) is uniquely identifiable and standardized

    6 within a given locality, region, or State (as identified

    7 by the Secretary); and

    8 ”(iv) may incorporate any advance directive (as

    9 defined in section 1866(f)(3)) if executed by the in10


    11 ”(B) The level of treatment indicated under subpara12

    graph (A)(ii) may range from an indication for full treat13

    ment to an indication to limit some or all or specified

    14 interventions. Such indicated levels of treatment may in15

    clude indications respecting, among other items-

    16 ”(i) the intensity of medical intervention if the

    17 patient is pulse less, apneic, or has serious cardiac

    18 or pulmonary problems;

    19 ”(ii) the individual’s desire regarding transfer

    20 to a hospital or remaining at the current care set21


    22 ”(iii) the use of antibiotics; and

    23 ”(iv) the use of artificially administered nutri24

    tion and hydration.”.

  3. anna shane

    physicians trained in elder care.  And so many horror stories.  My mom was hospitalized with organ failure six months before she died.  Her doctor didn’t visit her in the hospital, even though she had top coverage, and even though she had coverage for a private room, she shared with five others and transferred several times before she was discharged, with no follow up.  Her doctor insisted she travel to attend a diabetes awareness class, cause she was ‘at risk,’ two weeks before she died.  She loved her doctor, and trusted her, and it took some convincing to keep her from getting on a bus to attend a class she had no use for.   Her elevated sugar was probably a sign that she was dying, at the very least she didn’t have it, and she was eating very little at that point, and was weak.  At the end of my father’s life, his doctors had not communicated any of the possibilities, and it was confusing and terrifying, and I only later knew that there was something that could have been explained, that might have kept him from some needless suffering.  Both had top insurance.

    The fear that having standards in elder care and end of life care might allow doctors to kill old people is so weird.  Inattention and lack of coordination and poor training leads to suffering and confusion.  But I guess wer’e not supposed to know how bad it could be for us, when our tickets are about to get punched.

    Why can’t we fear incompetence and lack of adequate training.    

  4. creamer

     The right is led by entertainers who make money being in oposition of everything considered liberal or democratic.Insurance companys make money opposing reform. Banks make money investing in insurance and drug companies. For them this is all about dollars.

    Their tool is white ignorance and fear. A group of white’s who think their future as the dominant species is in peril. They will never aknowledge anything good coming from a government led by a black man.

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