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Friday, September 28, 2012

This Is How You Handle Those Conservative E-Mails from Your Relatives

Posted by on Fri, Sep 28, 2012 at 1:54 PM

This is going to be a long one. Slog tipper Sara sent along a conservative e-mail that a relative of hers forwarded around about the nightmare of government-run health care. Sara is a family doctor, and she decided to respond to the e-mail with facts and life experience. After the jump, I've included the conservative e-mail—minus the comic sans—and Sara's thoughtful, well-researched response. This is exactly how you handle those e-mails: Not by getting into a pissing match, but by pointing out the untruths and then providing facts.

Here's the e-mail Sara got:

Jackie is a dear friend of mine who has seen, first hand, many destructive results of government-run health care. Our health insurance industry needs reform, especially as it regards pre-existing conditions and the cost of coverage. But an actual reading of the Obamacare law reveals its true danger to lives and liberty. This law must be repealed and replaced with a better plan; otherwise, we will write our own sad stories. It's not too late. If enough of us will support Romney/Ryan, our vote will lead to a better plan.
~Cynthia

England, my home country, has mandatory Government run health care.
My Mum, at 73 years old, after being diagnosed with blocked carotid arteries, was told she was TOO OLD at 73 for surgery and was put on an 81mg aspirin daily. Of course 4 years later, she died of a massive stroke.
Dad at 69 died of prostate cancer while still on a waiting list for cataract surgery,
Who has seen the movie “The Best Exotic Marigold Hotel”? Did anyone take note that the character played by Maggie Smith was going to India for hip surgery, as the waiting list was at least 6 months in England?
None of this should be taken lightly.
Ask me about others; brothers, cousins, uncles, aunts.
Jackie

What followed these two forwarded e-mails were a series of highlighted quotes "taken" from Obamacare "proving" the existence of death panels. If you're really curious to read it—the formatting would be a nightmare here on Slog—there are links below to the whole list. Here's the e-mail Sara sent in response, with a couple identifying characteristics removed:

Thanks.

This stuff does have real-life consequences—- ones that I see every day in my community health center. Just as an example, I certainly wouldn't want people to be required to talk to their doctor about end of life care (which HR3200 doesn't do—). But my goodness! I should be able to be reimbursed for discussing this important part of health care with my patients. I currently am not reimbursed for this, and thus am supposed to squeeze this very important topic deserving of 1-2 hours, into a 15 minute visit that is also for diabetes, hypertension, back pain and depression.

The Affordable Care Act signed by President Obama does NOT mandate end-of-life counseling nor seminars; and unfortunately, due to myths about "death panels" such as the ones contained in this email, reimbursement for this important health care service was dropped from the final version of the bill. So even with "Obamacare" I will continue to have to squeeze this important discussion into already-packed visits.

So I struggle with these issues every day as I sit down with my patients. My patients come from all walks of life and circumstances. I take care of countless working families, where one or both parents might work 2-3 jobs to try to make ends meet, and may or may not have insurance coverage to show for it. Choices sometimes come down to new school clothes for the kids, or this month's blood pressure pills, or Gramma's walker which needs to be fixed.

It is for them that I am taking time out of my evening when I have notes to finish and medications to refill, in order to respond to this email. It's important that forwarded emails ascribed to so-called/self-described "experts" be cross-referenced, researched, and independently reviewed. Without this, the result is partisan misinformation, scattershot blog-based lists of bite-size pseudo-facts, half-truths, and distortions that muddy the water, and prevent real, pragmatic solutions to problems that cause great suffering for millions of people right now— today, this minute. It's easy for these to be masked and hidden online—- which means doing the research is doubly important and the responsible thing to do.

The rationing we have now is based on income... and it is a spectacularly brutal and tragic system for those at the bottom who struggle with even having the barest minimum of disaster-insurance. My patients would love to be on a 6 month waiting list for a hip transplant. Health insurance and healthcare are unique markets, with unique market forces, unlike any other—- proposals that suggest otherwise are fantasy.

The list of claims in your forwarded email are made to appear to originate from a letter from a Judge Kithil, but are actually those of a conservative blogger named Peter Fleckenstein, who originally developed this list on a series of tweets and blog posts. Please take the time to read these links from multiple reputable sources which address and refute the claims below in detail.

Additionally, here is a timetable from the American Academy of Family Physicians which details when the major provisions of the bill will be rolled out:

Bottom line for me: The problems—-millions without insurance, out of control health care costs, and incentives to do more procedures rather than spend time with patients. Is Obama's plan going to fix all this? Nope. It doesn't go nearly far enough to fix these problems. But it is in the right direction. By propagating inaccurate information about its contents, we are not doing anyone any favors.

Love you all, no matter how you're voting—— which is precisely the liberal position of the matter—— :) Just have to throw in my two cents from the boots-on-the-ground perspective of a family doc in a community health center....

Your niece (who you may now want to throw some arugula and a latte at),
Sara

Thanks, Sara. You're awesome.

 

Comments (39) RSS

Oldest First Unregistered On Registered On Add a comment
yelahneb 1
Definitely helpful - thank you!
Posted by yelahneb http://www.strangebutharmless.com on September 28, 2012 at 2:02 PM
2
Dad at 69 died of prostate cancer while still on a waiting list for cataract surgery,


Are they trying to imply that cataracts cause prostate cancer?
Posted by keshmeshi on September 28, 2012 at 2:13 PM
pfffter 3
You could do that. Or you could reply "please remove me from your misinformation distribution list" because I guarantee you all those words and time spent probably didn't change Aunt Cynthia's mind one bit.
Posted by pfffter on September 28, 2012 at 2:20 PM
4
A comprehensive reply like that takes a long time to write. And unfortunately, it may not even be read very closely by a relative who chose to forward unsourced material to you (and likely everyone else in his/her addressbook).

It's a good battle, and it's well worth your writing, but your response just makes me sad. Sad because a person who forwards rumor-based emails is unlikely to be interested in reading reasoned responses, and it takes much more effort to write a reasoned response to one person than it takes to forward a bunch of half-researched talking points to a hundred.

Now if it turns out that this letter does engage your aunt into a reasoned conversation, and if your aunt then decides to write a second letter explaining her change of heart on this matter to all of the people she previously spammed, then I will admit that my cynicism is unjustified. But I've gone through too many of these kinds of discussions, and after the hearts are unchanged through patience and reason, my energy gets weak.

Good luck..
Posted by uubuntu on September 28, 2012 at 2:21 PM
5
@2
Nope.
They're trying to imply that basic tests are either being performed inaccurately or not at all.
Is it because of ... RATIONING!?!
Are the Europeans just letting OLD PEOPLE die because it is TOO EXPENSIVE to care for them?
HORRORS!

And once you realize that then you can see all the flaws in the logic of that letter.
Only a six month waiting list for a hip replacement?
How long is the waiting list for the cataract surgery?

Now, how long is the waiting list for cataract surgery in the USofA if you don't have insurance?
Is it likely (in the USofA) that an uninsured 69 year old man will die of something else BEFORE getting surgery for his cataracts?

I predict a lot of replies from people who do not understand what "rationing" is.
Posted by fairly.unbalanced on September 28, 2012 at 2:23 PM
Catalina Vel-DuRay 6
I think that replies like this are worthwhile, even if it doesn't convince the recipient, because it makes you organize your thoughts coherently, and fact check your assumptions.

It also makes the recipient feel like they have at least had someone pay attention to them - and that's 99% of the problem with half these conservatives: They live such dull little lives that their day revolves around forwarded emails and conservative programming. It provides the excitement which they crave, but it also skews their perspective.

Mother Vel-DuRay has an elderly friend (she herself is 88) who has grown more reclusive and depressed, in part because she listens to Limbaugh & company all day. She lives too far away for Mom to go visit, so she bought some boxes of cards at the dollar store, and sends her a greeting card every few days, with a few lines of inconsequential, non-political news. Her daughter says that has worked wonders for her.
Posted by Catalina Vel-DuRay http://www.danlangdon.com on September 28, 2012 at 2:33 PM
7
So instead of preforming a surgery that at 73 may have been very risky depending on her health, especially if this was more than a decade or so ago, they used a non-surgical option and she lived for 4 more years? This seems a lot more like the doctors did not think she was up to the surgery and that the risk was not worth it than some kind of rationing.
Posted by giffy on September 28, 2012 at 2:43 PM
8
@6 -- I'm glad you wrote that.

Sometimes we forget that the reason to write something is more for the exercise of thinking about an issue rationally and reasonably rather than trying to change someone else's mind (or heart). And simply taking the time to interact regularly is probably more critical to creating change than issuing a point-by-point refutation to an argument that shouldn't need to be made in the first place.
Posted by uubuntu on September 28, 2012 at 2:53 PM
COMTE 9
@7:

Which is, unfortunately, a pretty common assumption. It's not necessarily the cost of the procedure per se, but the risk to the patient that's the determining factor. Some people might be willing to take that risk, but in our litigious-happy society, that puts the doctor in a very precarious position: if the patient insists on the procedure, despite being informed of the significant risks and consenting anyway, and then ends up dying on the table, there's still a good chance some relative is going to sue for malpractice, regardless. So, the doctor, who's probably seen enough colleagues lose their practices because of similar suits, simply refuses to take the risk, and the patient, or the patient's family, ends up translating that as "gubbamint rationing mah health care!"
Posted by COMTE http://www.chriscomte.com on September 28, 2012 at 2:58 PM
south downtown 10
this is the type of wingnuttery i get:

And the progressive program is ??............ Way too much effing gubbmunt.... it's all wunnerful and the money comes from WHERE ???... Oh that's right... I fergot dammut... Allzz we have to do iz PRINT MORE MONEY...!@#$%^&.. AND the largest benefit of all is that we just get to grow more government... same sex marriage legislation... my goodness gracious...I know of a lot of "gays" that are quiet about their sex life(sorta like we straights are).. They wear business suits or doctor's garb or mechanics garb and that's just the guys. The same conduct applies to "gay" women. You know.. they are plain clothed professionals just like straight women. They won't parade in those silly ass parades with all of the politically correct gays that are DEMANDING GAY CIVIL RIGHTS. They remind me of out of control adolescents parading in response to too much parental control of their freaking childish freedoms... What president has ever used "The Executive Powers" to bypass the legislature in order to have things go his way with damaging results. Like making the millions of illegal Mexicans and others of unknown origin citizens of the United States of America so that they can get legal (illegal) drivers licenses or food stamps AND( guess what?) voting privileges !!. How about the DOJ suing Arizona for trying to defend Arizona from very dangerous people crossing it's southern border with GUESS WHAT "Fast and Furious's " moving 1000's of military level weapons to ----a rival cartel on the Mexican border. OR DOJ suing the state of Florida to disallow their rights to remove 1000's of dead peoples name off the voter roles>>> and how about the unelected cartel of obama's staff of enforcers(Some being of the muslim extraction) there to do the bidding & wishes of hizz majesty"s desires. Now that's progressive... Now I understand... More government... massively reduced military(chuckle-assuming that our good friends Russia and China and Iran will probably follow our lead)...RIGHTTTTT!!! The dissing of Benjamin " Bibi" Netanyahu., one of our very few friendly nation in Europe...obama's bowing lowly to the King of Saudi Arabia....AND we really didn't need to vet obummer's place of birth or any of his college records. We really didn't need to contact any of former college friends or professors. NO NO. He did cover his past almost perfectly at the cost of over $1,000,000.00 of tax payer $$$.. ALMOST...Now it's all very clear to me, Thanks, bj
More...
Posted by south downtown on September 28, 2012 at 3:08 PM
11
@5,

I know that; I was mostly just trying to make fun of them.

Considering that the guy didn't have much longer to live, maybe it wasn't such a bad thing that he didn't endure surgery, while he was already sick with something else, just to die a few months later.

And having insurance doesn't guarantee you'll get prompt surgery anyway. There may be a dispute with insurance over whether the procedure is covered; pre-op consultations and care can take some time. It's only emergency situations that get you in to the operating room straight away, and universal health care rationing wouldn't apply in that case.
Posted by keshmeshi on September 28, 2012 at 3:16 PM
Michael of the Green 12
It's shocking, this new "news source" of forwarded, unreviewed partisan emails. Shocking how many people take these emails as news. I've managed to get off of most people's forwarding lists, but when I do get them, I link them to Snopes.com which often has addressed the very email in question.
Posted by Michael of the Green on September 28, 2012 at 3:18 PM
13
@9 That and who wants to kill an old lady with a risky surgery lawsuit or not?

@10 I know a lot of idiots who are quite about their stupidity. Give it a try.
Posted by giffy on September 28, 2012 at 3:18 PM
14
@9,

Quality of life is also a factor.

For example, surgery and chemo for elderly women with breast cancer aren't generally recommended because, in the elderly, breast cancer is slow growing and because surgery and especially chemo so negatively affect the quality of life of the patient.

But this paranoid relative would conclude that the gummint just wants to see her dead.
Posted by keshmeshi on September 28, 2012 at 3:18 PM
15
Go on, Sara! Such a lengthy, well-detailed answer. And true!
Posted by Patricia Kayden on September 28, 2012 at 3:26 PM
Dr_Awesome 16
What Mrs. Vel-Duray said is quite good. I find myself doing sort of the same thing -after reading something especially wingnutty on my doltish republican cousin's facebook, I mentally think of and assemble rebuttals before typing anything. Likewise after reading an especially good article on some pinko liberal site I take a minute or two to mentally repeat it as if I was explaining it to said doltish cousin, or to The Future Mrs. Dr. Awesome's equally doltish republican brother.
It helps set the facts in my head, and in my own words.
Posted by Dr_Awesome on September 28, 2012 at 3:44 PM
17
I used to take the time to explain stuff to my late brother-in-law, but my sister finally told me he didn't read them. I also tried the Snopes thing, but he didn't read that either. In fact, he didn't even read what he'd forwarded to me, because he and his buddies just tossforward these mass emails around to everyone without reading any of them. They all know they think the same thing, so if Joe forwards something to Frank, Frank knows it's OK and just forwards it on.
Posted by sarah70 on September 28, 2012 at 4:02 PM
COMTE 18
Geez @10, sorry you got bounced from freerepublic.com, but you know, there was probably a reason for that...
Posted by COMTE http://www.chriscomte.com on September 28, 2012 at 4:05 PM
Mike 19
Thanks to Sarah for writing this, because regardless of the impact on her aunt, it was good for me to read it.

There's an interesting disconnect between these two perspectives, though. Sarah's evaluation is about how the law would affect the health care of her poor patients. Cynthia's is based on how it would affect her own health care. This seems illustrative to me of the larger disconnect between conservatives and liberals generally: are you voting in your own interests, or in the interests of the group? There's also a subset of people who vote in their own interests and convince themselves that it's in the interests of the group (trickle-down economics, "job creators," sports stadia as engines of economic growth, saving souls, etc).

Posted by Mike on September 28, 2012 at 4:38 PM
20
I believe that @10 was quoting an e-mail [or several e-mails] s/he received and those are not his/ her opinions.
Posted by Schweighsr on September 28, 2012 at 4:53 PM
21
@10, You could have taken that straight off a Seattle Times comment thread--maybe you did. I find it truly frightening how the misinformation in cyberspace continues to grow, and how many people swallow it whole.
For the record, I have excellent health care coverage, and I just waited nearly 4 months for cataract surgery even when there was no question that it was a covered procedure. Good health care providers manage non-critical procedures to provide care for critical ones while remaining cost effective. Probably not unlike how it's done in such socialistic hell-holes as the UK and Canada.
Posted by crone on September 28, 2012 at 5:39 PM
22
Yeah, people's minds are set and they're not willing to listen. But if the exercise of writing a response sharpens your mind, go for it, even if it's only for you.
Posted by floater on September 28, 2012 at 6:55 PM
23
"this is the type of wingnuttery i get:"

Didn't anybody but @20 and I read this?
Posted by POH on September 28, 2012 at 7:03 PM
skjaere 24
I used to try sending reasoned responses to those emails, but never seemed to get anywhere. These days, I deal with them by dropping them straight into the trash, unopened.
Posted by skjaere on September 28, 2012 at 7:26 PM
imbecile 25
@10 you are an imbecile
Posted by imbecile on September 28, 2012 at 7:35 PM
26
@25, see @23, and yes 23, I got it and apologize to 10 if he/she didn't think I did. Whew!
Posted by crone on September 28, 2012 at 8:02 PM
27
@3: Yup. It's a big TL:DR on your idiot relatives' minds.
Posted by wasted too many hours on them on September 28, 2012 at 8:07 PM
thene 28
The NHS is wonderful and I miss it a little more every day I spend in America. It has its ups and downs but in terms of the dignity and quality of life it offers, the US cannot compare. I know you all know this but every time I see this sort of crap, I feel like it has to be said one more time. When I lived in suburban Georgia there were a few occasions when people asked me what I missed most about my homeland, and you bet I told them.
Posted by thene http://thene.dreamwidth.org on September 28, 2012 at 8:24 PM
29
@14 Its funny you mention that. My grandma was diagnosed with a slow growing lymphoma. We decided to treat due to some other issues we thought related. Turns out they were not, plus the medicine given to prevent nausea from the chemo massively depletes bone density and now she has serious problems with her spine.

I think we made the best choice given the facts we had at the time, but man, I can see why they'd not treat in a lot of cases. The slow motion 9/11 now taking place in her back is much worse than what the lymphoma would have done.
Posted by giffy on September 28, 2012 at 8:45 PM
Chelydra_serpentina 30
If they're Christian, maybe it would help to add a reminder about that pesky false witness commandment?

Naaaah...
Posted by Chelydra_serpentina on September 28, 2012 at 10:08 PM
ScrawnyKayaker 31
Ah, yes, a long, nuanced, reality-based response. *That* certainly won't get you a rebuttal of "COMMIES!!! USA! USA! USA1 USA!"

Still, it has to be tried.
Posted by ScrawnyKayaker on September 29, 2012 at 6:44 AM
VelhoSorriso 32
Best thing to do is provide the facts. Don't repeat untruths. The more they are repeated, the more you believe them.

According to psychology research, "To be effective, corrections need to tell people what's true without repeating all the stuff that's wrong," said Norbert Schwarz. "The more often people hear a false message, the more likely they are to believe it."

Some strategies for setting the record straight:

* Provide people with a narrative that replaces the gap left by false information

* Focus on the facts you want to highlight, rather than the myths

* Make sure that the information you want people to take away is simple and brief

* Consider your audience and the beliefs they are likely to hold

* Strengthen your message through repetition.
Posted by VelhoSorriso on September 29, 2012 at 9:21 AM
33
Beautiful response, Dr. Sara. Thank you for sharing it. Few people know how dysfunctional and inhuman the US medical system is – let alone what changes are coming.

My family is the poster child for the system gone wrong. My parents worked hard and saved steadily. They aren’t “one-percenters,” but maybe top 3-5. They’ve carried very comprehensive health insurance forever. Two years ago, my Dad started into a serious health crisis. While we spent long days waiting for appointments or correcting doctors’ files or being ignored in ERs or getting “pre-approval” for everything – surgery and hospital stays being a special hell all their own – etc., etc., we also paid hundreds of thousands of dollars out of pocket. And very early on, a nurse practitioner who ran his case, said to us, “well, he IS 62” when decisions were being made to save his life.

My Dad just turned 65 and pays around $300/month for his Medicare coverage, because of his pre-illness income - down from $600+ for insurance. [No, Medicare’s not totally free for all. No, he can no longer work.] But, we’ve found the coverage to be much better under the feds.

The system has to change. We already have the worst of all worlds - healthcare “socialized” under for profit insurance companies.

Dr. Sara, you sound like one of those rare thoughtful and diligent doctors we encountered through this ordeal and held on to tightly. From a patient’s family, please know that you are greatly appreciated.
Posted by lawgeek on September 29, 2012 at 11:05 AM
34
I appreciate Dr. Sara's letter above. I hope her effort makes a difference.

My efforts have not made a difference. I try to write well and edit myself when I go to right wing sites to comment and to refute lies. Well written responses result in ad hominem attacks. Responses without citations result in queries requesting my sources. Then those sources are attacked since "reality has a liberal bias" as Stephen Colbert has informed us.

I think it would have been wiser to go out to a VFW hall to drink some beers and talk face to face with folks from the right rather than to have been a keyboard commando.
Posted by BigGuy on September 29, 2012 at 3:09 PM
35
@34 (BigGuy): Good point, but bad off-the-cuff choice of alternative venue. The Veterans Health Administration is the closest thing we have in the US to the UK's National Health Service. Thanks to initiatives begun during the Clinton Administration, it now delivers the most cost-effective, high-quality care of any major provider in the US. (Yes, in quality of care surveys, it even beats out the famous clinics and hospitals that are routinely cited as proof we have the medical care in the world.) Now, if you talk veterans who have been screwed out of VHA coverage because they don't have a service-related disability, you might get some of those anti-government-run-health-care views. But just try to suggest to VHA patients that they'd be better off with private health insurance and private providers...
Posted by PCM on September 30, 2012 at 12:41 PM
36
For what it's worth, the NHS does ration. It rations care on a cost/benefit basis, as determined by the UK's National Institute for Health and Clinical Excellence (or "NICE"). The reason we hear so many "horror stories" from the UK is because they have been one of the stingiest health-care funders in the First World. When you have very little money to spend, you have to be very careful that you're getting the most bang for your buck.

We also hear stories of excessive waits in Canada, but we never hear that while the Canada Health Act requires the federal government to pay 50% of the provinces' (Canadian) Medicare costs, through the use of accounting subterfuges, the actual contribution is down to 25%. (It actually went as low as 17% at one point in the recent past.) Harper's Conservative Party would reportedly like to eliminate that contribution completely.

We don't hear many horror stories from countries with more or less adequately funded national non-profit single-payer systems, like France and Australia. Curious, that.

Finally, the US rations care based on ability to pay, and while our media doesn't expose our domestic horror stories with the same vehemence they do foreign ones, we have the highest infant mortality rate, the highest maternal mortality rate, and the highest amenable mortality rate in the developed world, and we have by far the highest health-care costs in the world, period. We are, indeed, number one.
Posted by PCM on September 30, 2012 at 1:25 PM
37
Its great that she took the time to craft a cogent, intelligent, informed response. However, in dealing with these sorts of people, it's been my experience that their mind is immutably made up and that no amount of logic and reasoning is going to change that.

They are just regurgitating talking points that they've been handed. Their response is usually to ignore the facts you've presented (they can be so annoying, and get in the way of preconceived notions....but what is one to do??) and go off on another tangent. It's like dealing with a phone tree that keeps bringing you back to the main menu before finally disconnecting the call.

The "inter webs" is a great place for a free and open exchange of opinions, and I'll be the first to admit that I've had long held (mis)conceptions changed by listening to what others are saying on message boards. It also has allowed a lunatic, bat shit crazy fringe to post things anonymously that they'd never had the moxie to say aloud for public attribution.
Posted by Global Traveler on October 1, 2012 at 1:47 AM
38
I have noticed that most conservatives who send such emails often don't know how to use the bcc field. So when I respond to them with the cold hard facts (usually a link to the appropriate Snopes page will suffice), I always "reply to all." This makes them hopping mad. But I am rarely disappointed with the outcome. I get my two cents in with their whole mailing list and the really annoying people stop sending me their crap.
Posted by MelissaBee on October 1, 2012 at 12:04 PM
Tracy 39
Sara, you helped inspire me to engage in an all weekend comment-a-thon with an anti-vaccine FB friend of a friend. It was great fun, actually. Didn't even approach it thinking I'd convince him. But I stayed civil and logical and provided lots of sources, hoping some of the information would reach the others reading/seeing the debate. Thanks!
Posted by Tracy on October 1, 2012 at 1:24 PM

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