When Brandeis professor Stuart Altman appeared before the Senate Finance Committee last week, he acknowledged, “I’m reluctant to mention it— but,  why waste money on in-depth treatment for people who won’t live long anyway? Better to warehouse them and save the resources for the young.”

At least, that’s what hotair.com says Altman said.  

Writing on “Hot Air,” Ed Morrissey takes his interpretation of Altman’s testimony and runs with it: “What happens when the state controls all the resources? New resources do not develop, and the government winds up rationing care based on its own priorities, and not the priorities of the patients or caregivers. . . . Anyone whose value does not show a positive “cost-benefit” ratio to the state will also likely wind up without the kind of care necessary to stay alive and healthy. . . . We’ve essentially returned to the eugenics arguments of the early 20th century, a dark period of human history we should be avoiding rather than embracing on the floor of the Senate.”

Below Morrissey’s post, an alert reader will notice a “Note from Hot Air management: This section is for comments from Hot Air's community of registered readers. Please don't assume that Hot Air management agrees with or otherwise endorses any particular comment just because we let it stand.”

Hmmm. . . .Apparently Morrissey is a member of Hot Air’s “community.” And it seems that the purpose of forming the community is to provide a platform for anyone to say anything that he or she cares to say, whether or not it is true.

But one shouldn’t pin all the blame on Morrissey. In his post, he credits Greg Hengler at Townhall.com for having “captured this revealing moment.” Here’s what Hengler had to say:

Hengler’s kicker: “Don't tell me government healthcare will be free.”

Now I’m becoming curious. What did Altman actually say? Did he really suggest that we shouldn’t bother operating on people after they reach a certain age? Has the man never heard of the Grey Panthers? Would a professor from Brandeis really want to be accused of recommending eugenics?

Morrissey, to his great credit, does actually quote a chunk of Altman’s testimony to back up his claim.  Here it is:

When Morrissey listened to Altman, he didn’t listen to Altman’s whole argument. He simply reacted  to “buzz-words” like “cost-benefit”. In truth, nothing Altman said  suggests that we should refuse to pay for an expensive procedure for an older person because he or she has fewer years left than a twenty-something.

First consider the context of Altman’s remarks. He was talking about is end-of life care—as this report from talkreadionews makes clear: “Stuart Altman, professor of national health policy at the Heller School for Social Policy and Management, Brandeis University, Waltham, Mass., held that end-of-life care was a significant driver of cost in America vs. peer nations.”

Altman then recommends that we try to weed out: “technologies that either don’t work at all, or keep people alive for a very limited [time] and [at] very high cost.

In the first case, we’re torturing the dying with treatments that provide no benefit, only the risk of side effects. In the second case, we’re prolonging the process of dying—often with chemo for cancer patients that gives the patients a few additional weeks, or possibly a couple of months (what Altman refers to as a “very limited time”) of poor quality life. One Harvard Medical School study found that almost 12 percent of cancer patients were given chemotherapy during the last two weeks of life.

Of course, often a doctor doesn’t know how close a patient is to dying. But the case of cancer, when the end is that near, it is usually pretty clear. At the stage, chemo may only add to the patient’s suffering.

Often the patient isn’t asked if she wants the 11th hour treatment. She is simply told: “this is the protocol.” If she resists, she may be made to feel that she is letting everyone down– the doctors and nurses who are trying so hard, the family that doesn’t want to lose her.

When Altman mentions “hospice” in the same sentence as “the cost-benefit of some of the things we do”, commentators seem to think that he is suggesting that hospice care is too expensive.  This makes no sense. Admittedly, the syntax of the sentence is confusing (as written transcripts of oral commentary often are), but as anyone who understands what hospice care is knows, Altman  is talking about care that is less expensive than most  end-of-life care. Today, many patients receive hospice care in their homes.  And when a patient chooses hospice care, he has acknowledged that he is dying and has chosen to stop treatment altogether. No more surgeries, no more chemo.  The hospice caregiver uses only painkillers to keep the patient as comfortable as possible—while helping both the patient and the family come to grips with the fact of death.  Hospice care is both less costly, and more compassionate than end-of-life care in a hospital or an ICU.   That is what Altman means when he refers to the “cost-benefit”— as is often the case in the world of healthcare, the patient derives a greater benefit from a less expensive treatment.

Altman then goes on to talks about “bundling payments.”  Here is referring paying providers a lump sum for an episode of care, rather than paying “fee for service.”  As medical research fee-for-services payment provides an incentive to “do everything possible” to the bitter end, even if that means prolonging the patient’s suffering.

Altman also speaks of “providing more information for people to make the right decisions, both for themselves and for the care.”  Here he is talking about sharing decision-making with the patient. Rather than telling him: “This is what we are going to do next”, the doctor explains the options, pointing out the possible risks and benefits. If the patient has only a matter of weeks left, the doctor is honest about this. A palliative care specialist is often the best person to help the patient make the decision.

Nowhere is Altman talking about denying care that an elderly person needs “to stay alive and healthy.”  He is talking about the dying and the futile care that too many patients receive in the final weeks of life.

Yet those who oppose health reform are becoming increasingly desperate. Thus, when I Googled “Altman” “Senate Finance,” and elderly, I found ten posts with titles like “Let’s Just Throw the Elderly Under the Healthcare Bus!” and “Exposing Liberal Lies: Will the Elderly Be the Victims of Obama Care?”

White House Health Care Adviser Recommends Ditching the Hippocratic Oath ??

Unfortunately, such distortions of the news are becoming all too common.  Last week, Media Matters exposed yet another Big Lie on Fox News. During the Cavuto segment of Fox Business, former New York Lt. Gov. Betsy McCaughey warned that White House health care policy adviser Dr. Ezekiel Emanuel has said something “that is very disturbing to patients. . . He said if you want to save money in health care, we're going to have to push doctors to eliminate the Hippocratic Oath and give more attention to costs when they're treating a patient. Don't be focused so much on the welfare of your own patient; think about where else the money could be spent — maybe for prenatal care for the lady down the hall.”

Think about it for a minute. How likely does it seem that a physician who, until recently, was the Director of Bioethics for the National Institute of Health, would say such a thing?   Not very. And McCaughey did not cite her source, nor did she quote Emanuel directly.

Media Matters points out that McCaughey is twisting what Emanuel actually wrote in a Journal of the American Medical Association commentary in 2008. (McCaughey attacked the JAMA piece in an Investors’ Business Daily Op-ed just last month. ) “Contrary to McCaughey's claim, “ Media Matters explains, “Emanuel did not call for "eliminat[ing] the Hippocratic Oath," but wrote that the culture of health care "overuse" has led physicians to interpret the Hippocratic Oath "as an imperative to do everything for the patient regardless of cost or effect on others.” 

Here is the relevant section of the JAMA article: “At least 7 factors drive overuse, 4 related to physicians and 3 related to patients. First, there is the matter of physician culture. Medical school education and postgraduate training emphasize thoroughness. When evaluating a patient, students, interns, and residents are trained to identify and praised for and graded on enumerating all possible diagnoses and tests that would confirm or exclude them. The thought is that the more thorough the evaluation, the more intelligent the student or house officer. Trainees who ignore the improbable ‘zebra’ diagnoses are not deemed insightful. In medical training, meticulousness, not effectiveness, is rewarded.

“This mentality carries over into practice. Peer recognition goes to the most thorough and aggressive physicians. The prudent physician is not deemed particularly competent, but rather inadequate. This culture is further reinforced by a unique understanding of professional obligations, specifically, the Hippocratic Oath's admonition to "use my power to help the sick to the best of my ability and judgment" as an imperative to do everything for the patient regardless of cost or effect on others. [emphasis added]

 Media Matters goes on to observe that Fox News has repeatedly provided a platform for McCaughey’s falsehoods.   As I noted in an earlier post on “Spinning Health Care Reform” propaganda experts recommend repeating a Big Lie over and over.

How do readers and viewers protect themselves against misinformation?  If someone claims that health care reformers are saying something  totally outrageous, probably it isn’t true.  Keep in mind that as Adolf Hitler pointed out in Mein Kampf, to be effective the “Big Lie” must so “colossal” that no one in the audience will believe that the speaker “could have the impudence to distort the truth so infamously.”   While listeners  might be skeptical about a small lie, they  will believe the truly brazen big lie..

Secondly, look for evidence in the form of a quotation that gives you the context of what was said. If there is no quote, and no reference to where and when the inflammatory remark was made, this is suspicious. If there is a reference to where and when, Google it, and see what was actually said. If someone has subverted the speaker’s words, you will know that you have found a news source that you cannot trust.
In the battle over healthcare reform, misinformation will be a powerful weapon.  Beware.