Saturday, August 8, 2009

End of Life: ObamaCare and the Elderly

The Washington Post has a new piece up, "Seniors Remain Wary of Health-Care Reform: Administration Aims to Reassure Older Americans Fearful of Losing Access to Care."

The report covers the big issues of debate on ObamaCare and medical treatment of the elderly.

On the one hand, there's the suggestion, stretching back to early this year, that President Obama favors the steep rationalization of elderly care, which has been described by some as "
euthanasia." More recently, former Gov. Sarah Palin wrote a post on Facebook this week suggesting:

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.
The Post's article responds, saying "There are no such "death panels" mentioned in any of the House bills." And of course, right on cue, leftists attacked Palin as wacko. But as both William Jacobson and Ann Althouse indicate, the former vice-presidential candidate is on solid ground. And Althouse, pointing to this video below, argues that Palin's conclusion is "cool-headed and manifestly sane."

There's also a second strand of debate on "end-of-life" counseling, which is sounds less dramatic than "euthanasia," but in some respects comes pretty close to it. Charles Lane addresses the issue in his piece, "Undue Influence: The House Bill Skews End-of-Life Counsel." Looking at the House bill, Lane argues:

Section 1233 ... addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice -- even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs?

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they're in the meeting, the bill does permit "formulation" of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would "place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign," I don't think he's being realistic.

What's more, Section 1233 dictates, at some length, the content of the consultation. The doctor "shall" discuss "advanced care planning, including key questions and considerations, important steps, and suggested people to talk to"; "an explanation of . . . living wills and durable powers of attorney, and their uses" (even though these are legal, not medical, instruments); and "a list of national and State-specific resources to assist consumers and their families." The doctor "shall" explain that Medicare pays for hospice care (hint, hint).

Top administration officials have been developing a policy known as "The Complete Lives System." The model provides the theoretical basis for President Obama's plan for the rationaliztion of elderly care.

It's really awful, no matter how you look at it. Leftists will keep pulling their hair out over this, screaming that it's just a bunch of right-wing demagoguery. But all folks have to do is READ THE BILL itself. This first passage, from page 429, Lines 10-12, is particularly gruesome, and later sections indicate the "limitation" of treatment:

‘‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

‘‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—

‘‘(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in igning such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the in dividual and be followed by health care professionals and providers across the continuum of care;

‘‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, in cluding an indication of the treatment and care desired by the individual; ‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and ‘‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the in dividual.

‘‘(B) The level of treatment indicated under subpara12 graph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified 14 interventions. Such indicated levels of treatment may include indications respecting, among other items—

See also, "The HC Monstrosity-All 1,018 Pages."


Anonymous said...

Dude, the order they are talking about is a living will. It's a legal document to help ensure that a person's wishes are held after they die. A third of the US population has living wills.

Anonymous said...

Well, after they die, or in end of life situations like vegetative states.

riddim1903 said...

The two persons before me have it correct. When and big if someone feels that he wishes to have a living will then he/she can have consultation with his/her physician which always happened before but such conversation with your chosen Dr was something where your doctor wasn't paid for by insurance. All this clause will accomplish is to make sure that this Dr. gets paid for this visit. Basically what you do is to give your consent to your own dr. that you'd rather have the plug removed if you were brain dead or comatose so that your children/spouse/relatives don't get to be financially drained trying to keep your never to wake up body on tubes and medicines which cost a fortune but won't ever heal you.
An elderly friend of mine had this taken care of, a living will done by an attorney, you can even write it on your own and sign and under such circumstances it is honored. This man got electricuted in the shower. His was recussitated in the ambulance , but after long enough where the oxygen flow to brain had stopped.
In the hospital he was pronounced brain dead, his daughter and son in law adhered to his will. He did not suffer like a vegetable and he also saved thousands of unncecessary dollars from being spent so that he could be kept "alive" like a ragdoll.

For anyone to believe death panels and death squads, it just shows how incredibly stupid these panicking morons are.

Yeah true, if my aunt had she'd be my uncle. This is the level of poor judgement and total void of any common sense. Wooow!

ThatDeborahGirl said...

Why is merely asking people to talk about death with their doctor equated to people having to answer to a "death panel"?

Dennis said...

End of life decisions should be initiated by the patient, not a doctor. To do otherwise is to provide a monetary incentive, something the government will do if allowed, to prey on people when they are most at risk. Why does the federal government need to be involved here?
At a minimum this is a decision better left to the families. It is a little scary that the previous posters cannot see the danger in this, but given that we started making decisions on whether a child should be born or aborted by whether or not they will have a good life it makes sense.
This is nothing more than aborting older individuals and eventually the disabled, et al, so someone else's life can be better in their own selfish estimation.
When you see these posters starting to appear you can tell they are part of an organized attempt to deceive people. Very deceptive utilizing the very worst case scenario. I especially love the screen ID Riddim. It just fits the mind set.
The question is, "Is this the federal government's responsibility or does it reside somewhere else"? The answer is it resides outside of the federal government's preview unless you want to use the federal government's imprimatur to legalize euthanasia.
The federal government has no place even insinuating itself into this at all!

repsac3 said...

But Dennis, these are "end of life decisions," not "end of life orders." This is you and your doctor discussing and deciding what you want to happen in the event you can't speak for yourself later on. I don't see anything in there suggesting that you make a particular decision one way or another (& further note that financially, your doctor would probably be better off steering you toward taking and using every medical treatment and device possible, rather than "aborting oneself," so there's a good argument to be made that this provision will increase life, rather than cause more death--assuming doctors really do put their financial well-being ahead of their patients medical well-being, I mean).

I don't happen to personally care who initiates the conversation, if the conversation is worth having. And in the name of preventing family tragedies like Terry Shiavo, I believe it is.

Imagine if she had a legal document stating what her wishes were, rather than leaving it to her husband on one side and her parents on the other to argue for what they claim she would've wanted. I can't speak for everyone on any side of that debate, but personally, I would've respected and accepted her spelled out wishes, whether it meant her life or her death.

In my view, (and legally, btw) individuals have the right to get treatment, but they also have the right to refuse treatment, and making that latter choice for oneself isn't euthanasia. YMMV...

Average American said...

I have no problem with discussions concerning living wills and the like, BUT I DO NOT want the government MANDATING that I go through their SALES PITCH every 5 years.

Another thing that really pisses me off about this plan is covering ILLEGALS for free! That is just plain out and out BULLSHIT! And IT IS most certainly in HR3200. Don't believe me, read the GD thing, unlike our asshole congressmen who for the most part haven't!

Dennis said...

Again this is NOT the federal government's business. I do care when doctors are paid to initiate these conversations by the federal government.
The federal government should not and does not have a place at the table.
How is it a federal government responsibility? We have state governments if we actually need some government entity to be part of these decisions.

Doctor Biobrain said...

End of life decisions should be initiated by the patient, not a doctor. To do otherwise is to provide a monetary incentive, something the government will do if allowed, to prey on people when they are most at risk. Why does the federal government need to be involved here?

This is absolutely hilarious. As I mentioned at my blog, before, we were being warned that the government was going to get in-between doctors and patients. Now it's the doctor you're worried about, as if we can't trust them. And Dennis, guess what, doctors already have financial incentives to provide more care than you might want; and both Medicare and private insurance reimburse them for this. Yet you trust them to be ethical. How is it any different for end-of-life counseling services?

And just so you understand, the reason the government is "involved" in this is because they're paying for it. Medicare will pay for this. And all this provision says is that doctors can be paid by Medicare only once every five years for these services. That's it. There's nothing nefarious going on. Everyone should have a living will and this provision explains what doctors need to do to be reimbursed for these services. Otherwise, people can pay for this themselves...or not do anything at all. But everyone should have a living will, including you.

And as the bill that Donald quoted from states, this also means they can choose to be kept on life support indefinitely (ie, "full treatment"). I personally wouldn't prefer that for myself and have told multiple family members that I DON'T want to be kept alive indefinitely, but others do. This is all about personal choice, so we don't end up with situations like Terry Schiavo, where the husband insisted she didn't want to live and her parents said she did. A living will would have prevented that situation and I'm glad that the government will reimburse for these services.

Honestly, this isn't the least bit controversial, except to those looking for some great "evil" in the reform bill. If you're unhappy about having to pay for these services, I might understand. But suggesting that this is somehow euthanasia is absurd. Again, everyone should have a living will.

Doctor Biobrain said...

Wow Donald, this post was delusional enough to warrant its own post by me, but in the meantime, I thought I'd point you to a post I made regarding the "solid ground" you cite in defense of Palin's crazy claim.
In Defense of Palin's Death Panel

In short: Both Jacobson and Althouse had to insist that none of Palin's claim was meant literally and, to their knowledge, even the concepts aren't in the plans being considered. But if you change everything she said into something less crazy, it's not so crazy anymore. And that's the BEST they could do. Gee, Donald. That sure is some solid ground she was standing on.

Doctor Biobrain said...

And here's my rebuttal to this post:
Delusional Conservatives Join Reality

Here's one of my favorite parts:
Conservatives are now admitting that doctors might act unethically to make extra money, which is such a rampant problem that we should forbid them from mentioning end-of-care services to their patients. Apparently, conservatives now want the government to get in-between you and your doctor. Brilliant.