This is a question President Obama was asked in an AARP town hall meeting last week. A Congressional website refutes claims that health care reform will start “us down a treacherous path toward government-encouraged euthanasia”. What’s the truth? This article will help you sort through the facts to find it.
The source of the confusion appears to be a few pages (of more than a thousand) in H.R. 3200, America’s Affordable Health Choices Act of 2009 – one of the health care reform bills Congress is considering. Section 1233 of that bill, titled ‘Advance Care Planning Consultation’, lets Medicare pay doctors to talk with patients about living wills and similar legal documents. If that’s all that Section 1233 did, we would not be having this conversation.
A living will is a kind of advance health care directive. These are instructions that say how decisions about your health care should be made if you cannot make those decisions because you are too ill or are incapacitated.
Some believe that Congress either doesn’t think doctors know what to talk about in such a discussion or Congress don’t trust doctors to talk about what Congress thinks is important. The proposed law includes a list of six topics the doctor must talk about – presumably on pain of not getting paid.
That’s right. Congress seems to believe that doctors need to be told exactly what an end-of-life consultation should include. Maybe it’s that kind of detail that bothers many people with government health care reform. It reminds too many people of insurance companies that tell doctors how to practice medicine – and threaten to withhold payment unless the doctor complies.
What Does Congress Want Doctors to Tell Their Patients?
Most of the topics in the government’s ‘must-talk-about’ list are not controversial. The topics include key questions and considerations, important steps, people you should talk to and a discussion of living wills, durable powers of attorney, etc. The doctor would have to give you a list of resources to help with advance care planning and would have to explain the different kinds of end-of-life services and orders regarding life sustaining treatment. Few people will find a problem with any of those.
The next requirement is probably what causes the problem. The proposed legislation says the doctor “shall include … the reasons why … an order [regarding life sustaining treatment] is beneficial to the individual and the individual’s family…” [emphasis added]
Most people agree that living wills are beneficial. So what’s wrong with including a discussion of those benefits in the consultation?
If I understand those who object, it’s not that the law requires a discussion of benefits – it’s that the language used in the proposed law suggests a one-sided discussion of living wills and other end-of-life planning. How would you feel if your doctor told you only about the benefits of an operation but didn’t talk with you about the risks?
“Wait a minute,” you say. “There’s nothing in the bill that says a doctor is prohibited from talking about disadvantages. It only wants to make sure that people are told about the benefits.”
Maybe people are nervous about the government getting involved in end-of-life planning because they simply do not trust the government for much of anything. Any time the government suggests that something is good for them, those people reach for their pocket books and ask themselves, “What do they really want? It’s sure not my benefit!”
Perhaps it is Congress’ failure to have the law require that doctors tell both sides of the story that makes people uncomfortable. After all, how hard would it be (assuming it is even appropriate to mandate this kind of detail) to have the law say that the doctor’s discussion must include the ‘benefits and disadvantages’ of living wills and other end-of-life planning.
Picking at gnats? Probably. The law does not explicitly say a doctor may not talk about the disadvantages. But, is it written in such a way that some government bureaucrat could read it in a way that justified Medicare refusing to pay a doctor if the end-of-life consultation did include those disadvantages? Maybe you should ask your family doctor about problems with Medicare billings.
Why Are They Doing This?
The motivation of the government to encourage people to get a living will should be clear.
A large part of the cost of medical care during a person’s life occurs during the last few days or weeks of a person’s life. Much of that cost may be related to ‘heroic’ measures to preserve life where it’s clear there is no realistic hope of survival beyond a very short period. A living will allows (encourages?) doctors to not provide that care, thus saving a significant amount of medical costs. Since we’re talking about Medicare here, those savings are savings for the government.
Are There Disadvantages to a Living Will?
“What,” you ask “could possibly be a disadvantage of having a living will or other advanced care directive?” Here are some I found in just a few minutes of browsing the Internet.
- Some religions have taken a position against living wills.
- One underlying assumption of living wills is that the doctor’s determination that further care is futile is correct.
- Another assumption is that it is appropriate to forego possible advances in medical technology that could, at least theoretically, occur in the near future.
- The use of living wills also assumes that your wishes when signing the living will be the same as when you become incompetent.
- It can be hard to translate the words of a living will into actual medical action.
- If you change your mind, you must change your living will. Not everyone does.
- It’s hard to adequately imagine what it’s really like to be in the situation described in a living will. In other words, it’s one thing to talk about end-of-life care as a theoretical consideration. It’s another to deal with it in the cold, hard light of day. Laying in a hospital may not be the best time to not be able to change your mind.
- Almost by definition, you are putting your life into the hands of another. Often that person stands to benefit financially from your death.
- Whether you have advanced directives or not, family members may disagree with your decision or the decisions made by those you’ve given that authority to.
Again, I hasten to say that I feel there are significant benefits to living wills, health care proxies, durable powers of attorney and similar legal documents. I think Medicare should pay doctors (maybe even attorneys) to have this discussion. But like many others, I’m concerned about the possibility of statutory language being construed to even encourage doctors to have only a one-sided discussion – or to use threat of nonpayment to discourage them from having a two-sided discussion.
Ademola Oladimeji Okeowo of the University of Groningen Law School (The Netherlands), in a 2007 paper, provided a good overview of the history and purposes of living wills. It’s short (14 pages) and well worth reading.
Final Thoughts
If we feel it’s even necessary to mandate this detail in an end-of-life discussion, it’s one thing to talk about what a living will does, how it works, what happens if there is no living will, and so on. It’s another thing entirely to premise – as I believe this legislation does – such a discussion on the assumption that those legal tools are always going to benefit the individual and his or her family. That is where Congress and I must part ways.
The House Committee on Education and Labor, on their website, says “The Committee wishes these were just the occasional rumor…” Good. Then make it clear Congress isn’t advocating (or requiring) a one-sided discussion that it’s always in the individual’s and family’s best interest to have a living will.
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The article starts out as a discussion of whether or not the Government is mandating euthanasia, and drifts away over into a discussion of whether or not it’s good for the government to enumerate what actions constitute a reimbursable consultation on end of life decisions. A bit off-topic, I think.
Many of the objections you give for the living will are the same as those one could make for a disposition of one’s material possessions at the end of life. Fact is, without a living will, family members are left to guess about what the dying would prefer. With a living will, that is not an issue. One updates one’s will when circumstances change… it’s up to the individual to update one’s living will when circumstances change. Is it a perfect system? What humanly constructed system is? But it’s better than nothin’.
First of all, there is no mandate that a person must participate in ANY consultations about end-of-life care. There is simply the distinction that Medicare will pay for such a discussion if it is desired. Secondly, a living will simply states your preferences regarding how you wish to be cared for if you cannot make the decision yourself. In other words, you can specify in writing that you want EVERY extraordinary measure taken to keep you technically alive, even if you’re brain dead.
This part of the proposed legislation has been seriously distorted by those who would like to “euthanize” real healthcare reform before it has a chance to see the light of day. Apparently cries of “socialism” weren’t having the desired effect as a scare tactic, so the decision was made to pretend that the government wants to kill your grandparents. Let’s stick to facts and have a substantive debate so that we can arrive at the best solution for the American people.
Any way you spin it… you can’ trust the Obama White House. [Posted on The Official Brigham Young University Alumni Network on LinkedIn.com]
Yes, its called a living will and doctors have been encouraging patients to have one for oh about 30 years.
The Mayo Clinic’s web site describes a living will as “one part of advance directives and describe your treatment preferences in end-of-life situations. Unexpected end-of-life situations can happen at any age, so all adults need advance directives.”
We should all have one even you Merrill!
I have one, they are a great idea… but Obama’s bureaucrat to choose who lives and who dies… is not the same thing
Merrill, may I politely suggest you do some homework before you cast dispersions on the President and his administration. Walt’s thoughtful blog posting on a living will is a good place to start.
There’s much to disagree with in the current version of the health care bill. This issue, like the controversy over the President’s birth certificate, is completely fabricated.
And, just for the record, I find there is a lot I can trust with this current administration.
I have read the bills Ken. All 1018 pages of the house version HR3200, and 615 pages of the Senate version. I have also read many articles regarding the House and Senate versions, talked to my Congress persons offices about them, read their website comments about them, discussed the topic with several close personal friend Doctors and the Director of Personnel for a Multi-state many location non-profit Hospital.
What Obama has stated publicly in his press conferences and comments do NOT agree with what is written in the bills.
Maybe you should do your homework Ken?
Here is a start:
http://energycommerce.house.gov/Press_111/20090714/aahca.pdf
You might want to start with the Senate version. It is only 615 pages.
http://help.senate.gov/Maj_press/2009_07_15_b.pdf
I suppose you trust President Obama’s claim that the stimulus bill had no earmarks too?
President Obama’s own words condemn my ability to trust him on this Health Care endeavor. His public statements on Health Care in the last few weeks show that he is intentionally trying to drive the present health care proposals through now with the intent to morph them into a solitary, mandatory single payer government funded program later. His campaign statements and his writings even say this would be his plan.
I am all for responsible health care reform, but what President Obama, the current House and Senate proposals have to offer is NOT reasonable reform and will do harm to Americans, further strain the economy, ration Health Care, force the elderly to die rather than receive treatment but they will get pain pills to die in dignity and not be a strain on the system.
Merrill, you and I will have to agree to disagree. First the “sausage” is being made so we’re not anywhere close to the final version. Hopefully the final version will be reasonable and beneficial to a majority of Americans. It will strain the economy but not doing anything will strain it even more. Healthcare is rationed now so the charge of “rationed” is at best vacuous. Your last charge of “force the elderly to die” is a bit over the top of your otherwise thoughtful response.
I for one appreciate the dialog.
Merrill, I doubt you read the bills. I clicked on the link to the House version and looked at pp. 425-428 which deal with the topic. These pages amend the Medicare legislation to allow payment for elective consultations on advance directives. It DOES NOT REQUIRE that anyone have a consultation. It just states that it won’t PAY for such consultations more than once every 5 years unless there is a change in health like contracting a terminal illness like cancer. In the summary of the Senate bill, your second link, there is no mention of this.
Your credibility on this subject has greatly diminished in my eyes.
Crazy. I hope this bill never passes.
I hope that health care reform legislation will finally happen this year. When Medicare was passed in the ’60s, the same arguments about socialized medicine and government control over the lives and deaths of the elderly were raised. 40+ years later, we see Medicare as a tremendous benefit for the elderly. There may be abuses as far as false claims and overuse by some unscrupulous doctors and hospitals, but overall it is seen as a very successful program. The provision of a public option for health insurance will do the same for the rest of America’s uninsured and underinsured.
That sounds like a preconceived notion. You can’t argue with someone who has already made up their mind. I hope Obama succeeds because America will succeed as well. If he fails, as Rush Libaugh wishes he would, then America would have remained in the same sorry rut it has been in since 9/11/01.
Walt, I think you’re absolutely right in your interpretation. When this concept was launched during the Clinton administration, it told the same sad tale…if you’re over a certain age, you’re too expensive to preserve.
I don’t think there’s anyway for the government to sell this concept to intelligent middle aged people, people like me who will be facing this new healthcare reform right between the eyes in a few short years. I want to determine what happens to me but I don’t want to tell them to pull the plug ahead of time when who knows what can happen between now and then? I agree with your point on medical advancements and new therapies that could result in the extension of life. I think that’s where we taxpayers would like to see our money invested. I also believe that all people should be able to have free medical treatment. So is that to be paid for by those who will forego treatment to a living will and relatives who would rather let them meet their maker prematurely so the funds from the will clear faster???
Not sure, my friend, where this is going but as you said, who in their right mind should trust the government, especially in unknown territory!
[Posted on the General Electric Alumni group on LinkedIn.com]
See my reply to Merrill’s August 4th comment above.
Rosemary, I think you must be speaking out of fear or misunderstanding because there is NOTHING in the bill that states or implies that “if you’re over a certain age, you’re too expensive to save.” Why do you say these things when anyone can look at the bill and see the pertinent sections on living wills (or anything else) and see what it says for themselves?
I’ve been hearing all the scary talk lately (death boards, mandatory abortions, euthanasia) and I’m ashamed that Americans are resorting to these kind of tactics to discourage democracy. I’ve gone over the bill and have not found any of these items in the bill. This is not informed debate; it’s a witch hunt. It’s nothing less than baseless fear mongering. I thought we, as Americans, were better than that.
I suppose if one cannot win an argument on merit then unsubstantiated fiction is the only recourse. I have not heard a single person point to a section of the bill that substantiates any of these horrifying claims. As Michael Yantachka clearly stated above, pages 425-428 discusses the physician’s responsibilities in regard to providing information on living wills. Please read it. You can find a pdf of the bill here: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf
As a Canadian watching this health care debate south of US, I find the misinformation in circulation absolutely astounding. Every Canadian has 100% no-cost access to health care from open heart to the flu for everyone…that’s EVERYONE folks, (mostly funded with tax dollars of course). Every Canadian will tell you we need to “continuously improve” but every Canadian will also tell you that the system works and we would NEVER go backwards. I hope I haven’t offended anyone, but in terms of a ‘world standard’, a condition of uninsured or under-insured citizens should not be acceptable in a 1st world country! [Posted on the General Electric Alumni group on LinkedIn.com]
As an Australian who is watching this healthcare debate from the US (I live and work here in the US and enjoy every minute of it so I’m not even remotely whining – just making an observation), I come from a country where healthcare is also free. It’s paid for in 2 ways. Firstly, there is an incentive to get private health insurance so as to take pressure off the public system. I don’t care where you come from, the fully private system provides better service than any fully public system and as a result, many people are happy to take the incentive and “get what they pay for” in terms of better service in the private system. The second method of payment is a surcharge (ie, a tax) of 1.75% of your taxable income or AGI. That potentially seems steep but bear in mind that in Australia, there are no state income taxes and the Australian equivalent of property taxes (council rates) are extremely low, much lower than in the US. Personal income tax rates at the Federal level are slightly higher.
So with what would likely be essentially the same tax burden, in Australia you get free healthcare and next-to-free university education at world class schools. Our best schools are, probably, the University of New South Wales, the University of Sydney and the University of Queensland. Check where they rate. My 4-year degree at UNSW cost $9,000 and I only started paying it back when I earned over $36,000. It’s interest-free too. Granted, it’s indexed but if I paid it off early in one lump sum, I got a 15% discount. So I did.
Apart from Iraq, can someone please tell me where my tax dollars go in this country?
I’m with Karl on at least one thing – the healthcare system, in general, in the US is sub-standard for a developed nation. Not enough people have access to it and regardless, healthcare is far too expensive. Perfect example – my sister had 2 kids in Australia with a total cost to her of exactly $0. My wife and I had one kid here and it cost $28,000 for which we were liable for about $2500. And I have very good insurance.
Are you kidding? Something as fundamental as having kids costs $28,000? There’s a better way. I don’t know if Obama’s way is it but it sure as hell isn’t the current system.
[Posted on the General Electric Alumni group on LinkedIn.com]
I’m hoping it lets me decide whether I WANT to die or not.
If I have to die then I’m for any program that encourages me to think through what kind of care I want or don’t want as my due date draws nearer.
I’m 100% supportive of the national discussion around nationalizing health insurance. While the conversation is difficult and sometimes ugly, its a conversation we must have. I salute President Obama and the Democrats for having the courage to tackle the issue head on. Its time we stop delaying important conversations like this.
[Posted on the LDS Professionals group on LinkedIn.com]
Yes…we are having a national discussion and it is long overdue. I didn’t vote for President Obama and I have some serious concerns about our economy as well as other issues. But he is doing some very positive things such as organizing the big phama which resulted in serious discounts. He is smoking out the insurance industry and I’m hopeful they will come to the table with something other than trying to kill reform. It’s easy to understand why they don’t want anything to change….their fat…..it’s the public that’s needing some relief.
It appears to me that with the recent storming of town hall meetings in Texas and Florida and the constant inflamed references by Rush Limbaugh…”I hope he fails” “they are socialist” and yesterday…references to Nazi are pushing me away from the Republican party….this is getting much too radical for me.
As far as the government deciding when and how I die…..oh boy…this was created by the fear merchants…not by our elected officials in Congress. I thought things were crazy during the election. They have really let the crazy people out lately.
Typically I am not one to get involved in discussion of this type because I find them to be unproductive. However, let’s look at health care as it currently stands. First, there is some rationing of health benefits under current insurance providers, but options are available if you can afford to pay for them. This is very different than rationing health care as described by Obama and others in our current government. If you want to have a system like Canada’s, then move to Canada, I have spoken to many Canadians and they save up their money and come to the U.S. so they can get treatment because it is not available even for purchase in Canada.
Second in our current system, people sue over spurious things, not with intent of correcting mistakes, but solely for the purpose of getting money. As long as we allow unrestricted and unfounded lawsuits, the cost of insurance for doctors will continue to skyrocket and the cost of treatment will go up because those costs get passed on to the patients.
Third, our current system only focuses on treatment of disease. This is a huge mistake and the focus of our system needs to shift to prevention. If we focus on prevention, then the number of people who need to go to the doctor for treatment will decrease, alleviating the strain on our current system. This is where the drug companies come in because they don’t sell medications in an environment that is focusing on prevention instead of treatment.
Any reform bill coming from Washington should be focused on correcting the causes of the problem, not limiting our access. Mr. Obama and his cronies in Washington are on a power grab cycle and if we don’t step in and put a stop to it our rights as citizens of this great country will be curtailed and then you will wish you had taken action when the opportunity was there. I don’t trust them, they have mishandled everything they have done and they have been trampling the Constitution right and left in an effort to create a Socialist state that curtails freedom and enslaves the people to the Government’s will.
[Posted on The Official Brigham Young University group on LinkedIn.com]
I agree with Mr. Morgan that we need a system that focuses on the prevention of disease. But, don’t count on Medical Doctors to do that. They consider giving you blood pressure medications and statins preventative medicine. I have been a nutritionist for many years and realize that most doctors are very hesitant to suggest to patients that they might feel better if they practiced a healthy lifestyle with real food and exercise. Lifestyle issues will never be a part of this discussion. People want the freedom to do what they want and eat what they like and when they get sick, they want some else to pay for it. Go figure!
I have to agree Ms. Dick, I don’t think the medical profession will get involved. At least not until the education of doctors includes the use of natural products vs synthetic. It is unfortunate that treatment has more sex appeal than prevention, but that is our current system. I work with health and wellness products and there are some phenomenal products on the market if you know where to look. You have to be careful that you get high quality products, there is a lot of snake oil on the market as well.
There are movements afoot to improve medical education to include healthy lifestyle considerations. Functional medicine programs exist. (as apposed to disfunctional medicine, I guess) But, there is a lot of prejudice against them. I look for doctors who include integrative approaches to their practices and they are few and far between. I am a convert of about 7 years to this new perspective in healthcare and I wish we could move it along faster. Mr. Morgan, you are right about the availability of wonderful supplements and products, but the average person doesn’t have a clue when it comes to discerning the wheat from the chaff. They don’t know about drug-food, drug-supplement, supplement-supplement interactions. You can take a little knowledge and enthusiasm and hurt yourself. The science is developing and will eventually win out. I hope we all live long enough to see it.
First I thought I’d comment that the blog post is well thought out and appreciated. Specifically I thought I’d chime in with some comments that may be of encouragement to Ms. Dick. Several years ago I went to see a physician for a physical at my wife’s insistence, since I hadn’t been to the doctor in several years. This good doctor laid into me in a way that was totally unexpected. All my lab results were pretty good and I felt I was in good health, but the doctor insisted I was a medical nightmare waiting to happen because of my lifestyle and eating habits, as well as family history. He did not offer any medication, just recommended changes to diet and a regular exercise program.
It took a little while for all that to sink in, but I’ve made a lot of changes in my approach to life because of it I’ve lost over 40 lbs, done a lot of research on what constitutes good health and have seen my risk factors decrease dramatically. So, there are Doctors out there willing to deal in a real preventative approach, but participants need to be proactive as well.
Mr. Young, YOU are the hope of the future. If more people would take responsibility for their own well-being and do as you have done, there would not be a healthcare crisis. Please give me the name of your Doctor, I will add him to my list of recommended Physicians. In the words of one of my patients, “I had no idea how good I could feel. I thought the way I used to feel was normal; bloated, sluggish, brain-fogged. You have ruined me for junk food. I can’t believe it.” All it takes is being mindful and caring enough to think it through. Building new habits isn’t easy, but once they are established, they work as automatically as the old ones. Congratulations, you deserve it!
I could not agree more Ms. Dick, I wish these programs would move faster. I know several doctors here in Utah that are more open to these ideas. One that I know and would recommend is Dr. Vaughn Johnson in Springville I believe, I would have to double check his office location. Education is the key, we need to re-educate the populace and retrain our physicians. Mr. Young you are an inspiration, Congratulations!!
Obama’s gonna kill Grandma?
See:
http://notionscapital.wordpress.com/2009/08/07/obama-wants-to-kill-your-grandma/
So often Canada is mentioned when comparing proposed health care reform options with the status quo. I live in Canada so I’m experiencing it first hand. I respect the point of view that freedom and liberty should also extend into medical care. I love freedom too.
Americans might be surprised to know that whenever health care reform is proposed in Canada by provincial governments, private citizens and special interest groups know that they can throw cold water on any reform by stating that the proposed reforms will only lead to “American style health care”. Thereby entrenching the current systems and processes. Most Americans probably didn’t realize that their system is feared by Canadians.
From my point of view the single payer system is OK. It provides affordable coverage to all citizens regardless of pre-existing conditions, employment status, age or ability to pay.
What I think is misunderstood about the Canadian system is the barriers placed by provincial governments of private capital investment for medical facilities and equipment. It is the restrictions to capital investment that rations the supply, not the single payer system. Private medical clinics in Alberta are restricted by law to what services they provide. Private capital can not be invested to build new hospitals or special medical facilities. (There may be some facilities in Canada run by non-profit societies that are grand-fathered from the 1960’s before health care systems in each province were set up)
So unless the health care reform being discussed in Washington includes restrictions about who can operate hospitals or build facilities to provide specialized medical procedures, then you are most likely not going to get a Canadian style medical system.
[Posted on The Official Brigham Young University group on LinkedIn.com]
Frankly, the health care system in the U.S. now is SO out-of-step with the rest of the developed world (Europe, Canada)that it is almost ridiculous.
The advantages of the public payer option are so obvious that one must be severely intellectually disabled not to be able to see it.
If only the uninsured had the problem of access to decent health care in this country, it would already deserve the debate on the topic. The ugly truth is that the INSURED (and many paying as much as $30,000 annually for a family of 4 for this “privilege”) have serious problem once there is serious health problem.
That is not to mention that the U.S. health care system is remarkably unproductive:
once one has a complaint and goes to “PCP”, the PCP sends the poor soul to multiple specialists, who, in turn, send the patient for multiple testing, then they suggest THE MOST EXPENSIVE treatment possible, so they could make more $. After a surgery (usually unnecessary), they tried to get rid of the patient as soon as possible, often sending them home the same day, and providing minimum after-care – because it is time-consuming and not profitable.
Meanwhile, months of work productivity are lost and even the most insured patients end up broke.
The ugly truth is that it is not the illness that cripples the patients but the treatment.
If we could get rid of the incentive for the doctors to choose the most expensive treatment (i.e. surgery), and, instead, give them the incentive to choose the best treatment for the patient’s health, we would all win.
So I applaud the Obama administration for looking at such treatment models as the Billings, etc. and for suggesting a public payer option.
Unfortunately, with people like Merryl, this administration cannot even suggest the better existing models of health care, as the French or Danish ones – that would be too radical for many entranced by “swifboating” by insurance and pharmaceutical lobbies.
Merryl, you can always write a living will where you could specify indefinite life on ventilation and stomach tubes, if other options scare you so.
You may also continue to pay more and more to your existing insurance providers for less and less care.
With all these options being continuously available to you, reform or not, is not the life grand?
Back up and look at the bigger picture here. It doesn’t matter what’s in this bill. What’s not in this bill can be added to the next one. What is in this bill can be removed from the next one.
The heart of the issue — and in my opinion this is all that really matters — is that the national government must not be permitted to usurp this power over our lives.
A socialized healthcare system will place a new collar and chain around our necks and God forbid, around our children’s necks forever. Make no mistake about it. All these arguments about the meaning, intentions, and affects of the health reform bill amount to nothing more than discussion about how long the chain will be. Make it long, make it short. It doesn’t matter. It is still a chain — a chain that can and will be shortened as time passes.
“Is life so dear, or [healthcare] so sweet, as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take; but as for me, give me liberty, or give me death!” (Patrick Henry, 1775, Virginia Conventions)
What do we really value? Have we forgotten about being free? Not me. I am with Patrick Henry on this one. The rest of the debate is at its heart meaningless.