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This morning, as I was riding to work on the bus, I was flanked by two older gentlemen with daily newspapers. We started to chat about current events and I mentioned that Ted Kennedy had passed away during the night. One of the older gentlemen says, “Yes, well, I hope at least this can help this whole health care mess.” As we three continued to talk, they discussed how happy they were with care at the VA, how they didn’t understand how Americans as a society could turn their backs on each other, how a few bad eggs were derailing the conversation, turning it into an anarchic free-for-all.

Watching the media, I too have been troubled by the darkening tone towards any fundamental change in healthcare. I have been worried that we may have a whole lot of reform and not a lot of change. Perhaps, however, my bus companion is right; maybe we now have a rallying point. I sometimes find myself mired in doubt. Don’t Americans want fairness, equity, a just society? I sometimes wonder if I am just deluded about what Americans want. Listening to the vitriol, I wonder if I just live in some insulated pocket and am out of touch with what people really think. And then I ride the bus, and I get to hear that I am not alone.

I am ambivalent towards Ted Kennedy as a person. As a member of a younger generation, I have never felt a personal connection to the Kennedy mystique, as heretical as that sounds. But we are all human, and it’s our choices which define us. And, in his final days, as I knew he was dying, his commitment to equity and justice moved me. He called healthcare reform, “the cause of my life.” Instead of summarizing his mission, I will let the man speak for himself,

Finally, we cannot have a fair prosperity in isolation from a fair society. So I
will continue to stand for a national health insurance. We must not surrender.
We must not surrender to the relentless medical inflation that can
bankrupt almost anyone and that may soon break the budgets of government at
every level. Let us insist on real controls over what doctors and hospitals can
charge, and let us resolve that the state of a family’s health shall never
depend on the size of a family’s wealth.

I would direct anyone who has felt downhearted at the recent turn-of-events to go to this site: Doctors for America and read some of the moving comments from physicians around this country. I think we do have an obligation to speak up and speak out. I hope that we can learn from his deeply personal commitment to justice and fairness and continue to push for real change. The hard work is still ahead, and though we are now one voice short, I too am dedicated to these ideals. It is good to know that I am not alone, not on the bus, not in my office, not in my country. It’s good to know.

Ted Kennedy was a masterful negotiator and understood the importance of compromise, but never let political maneuvering interfere with his primary goal. He said that his greatest regret as a Legislator was turning down President Nixon’s offer for a universal health plan. The most meaningful tribute we can make to Senator Kennedy, and to all of those who have carried the standard of health care reform, is to continue the hard work and the good fight. To listen to the concerns of older citizens who worry about losing coverage, those who are concerned with rationing and death panels, and speak to them honestly and plainly, and appeal to the common sense and decency that I believe still lives in the hearts and homes of America.

Chrissy Kistler

This Post Has 11 Comments

  1. Is anyone else bothered by the fact that, though he had a fatal disease, Sen. Kennedy chose to seek treatment at the "best money can buy" facilities? Had his version of health care payment reform been applied to himself, would he have been able to do this? I personally believe he missed a HUGE opportunity to show the value of advance care planning, palliative care and hospice, by taking advantage of those programs himself. Had he done so, I suspect we would be hearing a lot less about the factitious death panels trumped up by reform opponents.

    I am not trying to besmudge the legacy of a great statesman. I believe the Kennedy family's mark on this country has been overall extremely positive. I grieve his loss, and pray for his family. I just wish he would have used his leadership to guide others with terminal illness to consider their options.

  2. Well said, Chrissy. I happened to be at the Kennedy Library the day Senator Kennedy was diagnosed. The TV cameras were there, and I was interviewed by the channel 5 in Boston, video here. As I said then, his legacy has been as a champion for health care reform, and his death may serve as a call to action for those of us, myself included, who have sat on the sidelines for too long.

  3. Interesting thoughts anonymous – I'm actually not bothered that senator Kennedy didn't choose hospice. For all I know he considered it and decided not to enroll. That's fine – he had the choice – and he would have had it with health care reform. There are many people who don’t have the choice because they can’t afford insurance.

    Same thing goes for where he got his health care – he could have gone to a small hospital in Martha’s Vineyard, but he decided to go to places like Duke and Mass General instead. That's fine – he had the choice – and he would have had it with health care reform. There are many people who don’t have this choice because they can’t get insurance due to a pre-existing condition or can’t afford it because they lost their job or own their own small business.

    Not having the choice is the part that bothers me and is the reason I'm for health care reform. What do others think?

  4. Anonymous, I had a similar thought then I caught myself – perhaps aggressive care was completely in line with his goals. What if Ted Kennedy told his physicians something like "I know my chances are slim but I want to give myself every chance to be around during the upcoming health care debate – I think we may finally be at a place where we could do something and I want to help."

    Also, he did die at home which says something about his level of aggressiveness.

  5. I absolutely agree that it was good that he had the choices he did, and he was able to make them. Following your goals, is, as you say, the greatest thing we help folks do in our profession. I firmly disagree that those choices would remain if healthcare payment reform goes through. We will all have access, but that access will be limited by the finances, as currently proposed, whether we like it or not. There is not an unlimited pot of money for coverage for all these treatments for everyone. It just isn't there. Sen. Kennedy would have had his choices in either case simply because of his status and wealth. What bothers me most is that he wasn't really honest about what that might mean to those who would gain access to care.

    I also recognize clearly that limited access is far superior to no (real) access. I am not opposed to payment reform. I just think we need to be clear about what it truly means to everyone, and also REQUIRE those in Congress to play by the same rules as the rest of us.

    By the way, it is not health care reform at all, just payment reform. If we want health care reform, we go after the causes, i.e. smoking, obesity, sedentary lifestyles, etc.

  6. I have been wondering about a few things:

    1. Why don't I know more about celebrities who choose hospice? (I know that, like Helen Kao said, we're not good spokespeople, but you'd think there might be a celebrity or family member of a celebrity who would praise hospice now and again). With Farrah Fawcett's recent death, and Patrick Swayze "fighting for his life", and now Ted Kennedy, I wondered: did someone mention hospice as an option? Did someone tell them that there was another way? It's just got me wondering.

    2. I actually think wonder about whether it's okay for a patient to go to a hospital that is significantly inferior to another hospital. Oh, and I obviously allow that hospitals need a chance to improve. But we know that hospitals that do low volumes of procedure X, tend to do it worse. I have wondered if setting limits on choices might not be a good idea. Now, Leslie Kernisan's work shows that it's hard to figure out where are the "bad" and "good" hospitals, but Dartmouth and other places are working on this. How do we balance quality and choice

    3. How do we get people to understand that more is not always better? Do we need MRI machines every block? Could we cut down on the unnecessary testing and administrative costs, and fund the uninsured? How do we get people comprehensive discussions about end-of-life planning and not another CT-scan? And, Anon, we could tax alcohol, tobacco, gasoline, sweetened beverages, if we really wanted to work at health care reform. Sweetened beverages are being considered for tax in NY, I think. I believe in social justice, and think that higher earners need to pay more to help those who make less, and if that includes my family, then so be it. I don't want to be someone who says they believe in equity out of one side of my mouth and then cry about taxes out of the other. I would state however that Hillary Clinton called for a public plan very similar to the Senate plan during her run for the White House. At least, that's my understanding.

    They're just some thoughts that stew around in my head.

  7. Chrissy, when I worked as a hospice case manager in Marin county, our hospice cared for many celebrities. I can't speak to why they chose not to make their choices public. And, of course, the hospice holds that information confidential.

  8. Some of the above comments make me think of the challenge of not bringing in our personal opinions into the palliative care consult.

    While I too feel that our society expends exorbitant resources to no avail as people are dying. I never want that opinion to change the way I see patients. I want to be a values neutral advocate for people's wishes – even if that means they wish to die ventilated in the ICU with a back-up ventilator at the bedside.

    We shouldn't use the phrase "high end-of-life costs" or "wasted expenses" but rather, we should talk about "unwanted expenses" That is, when patients are truly informed and not making decisions based on naive preferences, they often choose the less aggressive option. Thus, good patient-centered palliative care can often (but not always) avoid "unwanted expenses" near the end-of-life.

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