Thank you very much for your insights. I will think on what you’ve said. I do know that I’m skeptical of most of how the Medicare scheme is laid out and plays out, as I am also HIGHly skeptical of performance-based measures, as they fail to recognize the medical folks who take on the tougher cases.

The concept to which I am referring is “pay for performance” (PFP) In basic terms this is how it works: Insurance (or the government programs-remember they are bed partners) pays the hospital for having good statistics of patient care. Meanwhile other factors fueled by the understandable concept of wanting high quality and good results are militating for the concentration of the attack on difficult and dangerous conditions such as pancreatic and esophageal cancer and major trauma into major centers.

Now it does not take a rocket scientist to figure out that if I am a surgeon paid by the major center and a physician from out in the boonies.. lets say Wasilla Alaska and I am working in the big referral center… Anchorage perhaps or Juneau calls me up with a difficult case of pancreatic cancer I am incentivized to take it if the patient is healthy otherwise and has good insurance. BUT WHAT IF the patient is pretty sick and likely to have post op complications…. maybe even die…. or worse for the hospital … stay a long time and consume a lot of resources…. and what if on top of that the patient is on Medicare….. what difference you ask?

Well Medicare utilizes what is known as “prospective payment” in which the hospital (my employer) gets paid by the diagnosis (you have probably heard the term DRG -diagnosis related group.

For the diagnosis “pancreatic cancer” the hospital will be compensated a lump sum. If the patient gets well quickly and goes home soon the hospital’s bottom line is happy. But if the patient has complications… and the hospital has to use a lot of supplies and expensive medications to treat the patient…. NOT VERY GOOD FOR THE BOTTOM LINE!

PFP takes this a step further. If the patient has complications or dies this is recorded as a statistic by the hospital’s own “performance improvement” personnel and this contributes to the hospital’s receiving less payment… or maybe the insurer refuses to pay for patients with pancreatic cancer to go there at all.

NOTE you Christians or for that matter anyone other religion or non religion… this happened under the aegis of the Republicans!

All this “death panel ” stuff is already going on today. Every hospital has an “ethics committee” even the tiny rural hospital where I practice in third world Louisiana.

SO…. back to Liz comment. Yes Sarah Palin and nearly everyone on the “religious right” have a tendency to politicize moral issues and so does the Sojourner’s organization.

In a society where we attempt to settle religious/moral differences with ballots rather than bullets (as was done in Spain in the late 1930s, and is currently going on all accross the Islamic world) it is difficult to resist the temptation to resort to political means.

This may not be necessary. All goodChristian conservatives need to rise to the challange thrown down by Cal Thomas syndicated columnist titled ” Relgious Right Rest in Peace” after the most recent presidential election in which he makes the point that laws don’t change peoples hearts but adherence to the teaching of Jesus Christ does.

John Sobieski’s comments strike home since I am a 19 year survivor of Hodgkin lymphoma just waiting for the second cancer to strike. John’s mother falls into a well recognized group of patients. Its well known that prior irradiation of the chest for cancers in youth places the patient at risk for cancers in this area… breast particularly but also lung and esophagus. The chemotherapy predisposes to a somewhat higher risk of other malignancies such as leukemia.

As a physician I recognize all this. As a Christian I can read St Paul “if this life is all there is we (believers) are most of all to be pitied.

Whether rationing occurs via government dictum or market forces (and again, not having either total government health care or an unimpeded free market it is difficult to separate the two) or… as was done in the “good old days” by deliberation between patient family and doctor… we all come down to the “last things” death judgement heaven hell.

Hopefully caregivers such as myself who wish to obey God will join together and provide care as best we can despite all the roadblocks and obstacles ahead.

C. L. Lee, MD, FACS

Oh yes, as Christians we are to care for those in need… and that’s why I’m so opposed to the government taking money from Christians and giving to others in other-than-Jesus’-name. I “hate” how Palin, and really anyone deemed to be “conservative” becomes the whipping boy/gal for the religious left.

You should read some of the junk on their website… pretty bad. Next I think I’m going to call out Matthew25.org.

One thing I forgot to say is that the left is not held to the standards of honor they hold the right to. If somebody ran a campaign against Sotomayor (or however you spell the reverse sexist/racist’s name) the way they’re beating up on Sarah Palin, they would be respected as an evil, sexist, hate-mongering, nazi, yada yada yada. The double standard is extraordinary, and from this snippet I can see that Sojourners helps the double standard exist, grow, and fester. A very unChristian thing to do.

My mom is the perfect example. Back before I was born, she had Hodgekin’s Disease. All I know is that it is some kind of cancer. A few years ago, my mom got breast cancer. Having a previous cancer drastically increases the possibility of mom having the cancer come back. With government rationing, she would not have recieved treatment for the second cancer because of mere statistics.

Thanks be to God, my mom’s cancer has been in recession for three or four years now.