Sunday, August 9, 2009

Sorta, there is an Obama "death panel" in House health care bill.

Tapper goes after Palin for her interpretation of Page 425, Section 1233 of the House Dems bill titled advance care planning consultation. Polifacts says its not true but they are not thinking the plan all the way to its logical conclusion.

In her chat with Thompson, McCaughey said the language can be found on page 425 of the health care bill, so we started there. Indeed, Sec. 1233 of the bill, labeled "Advance Care Planning Consultation" details how the bill would, for the first time, require Medicare to cover the cost of end-of-life counseling sessions.

According to the bill, "such consultation shall include the following: An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to; an explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses; an explanation by the practitioner of the role and responsibilities of a health care proxy."

Medicare will cover one session every five years, the legislation states. If a patient becomes very ill in the interim, Medicare will cover additional sessions.

Jon Keyserling, general counsel and vice president of public policy for the National Hospice and Palliative Care Organization, which supports the provision, said the bill doesn't encourage seniors to end their lives, it just allows some important counseling for decisions that take time and consideration.

"These are very serious conversations," he said. "It needs to be an informative conversation from the medical side and it needs to be thought about carefully by the patient and their families."

In no way would these sessions be designed to encourage patients to end their lives, said Jim Dau, national spokeman for AARP, a group that represents people over 50 that has lobbied in support of the advanced planning provision.


Charles Lane is kinda disturbed by it.

Section 1233, however, 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).

Admittedly, this script is vague and possibly unenforceable. What are "key questions"? Who belongs on "a list" of helpful "resources"? The Roman Catholic Church? Jack Kevorkian?

Ideally, the delicate decisions about how to manage life's end would be made in a setting that is neutral in both appearance and fact. Yes, it's good to have a doctor's perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party -- the government -- recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don't have to be a right-wing wacko to question that approach.

As it happens, I have a living will and a durable power of attorney for health care. I'm glad I do. I drew them up based on publicly available medical information, in consultation with my family and a lawyer. No authority figure got paid by federal bean-counters to influence me. I have a hunch I'm not the only one who would rather do it that way.


The bolded part is the problem because now the Dems have introduced an incentive for doctors or their offices to intiate end of life discussion and/or treatments that are not 100% in the patient's best interests of having a longer or healther life. Senior citizens trust their doctors and the influence of an authority figure who is being pressed to watch their payments could transfer over to their patients. Government run health care is all about rationing resources.

Look at this woman in Oregon.


Barbara Wagner has one wish - for more time.

"I'm not ready, I'm not ready to die," the Springfield woman said. "I've got things I'd still like to do."

Her doctor offered hope in the new chemotherapy drug Tarceva, but the Oregon Health Plan sent her a letter telling her the cancer treatment was not approved.

Instead, the letter said, the plan would pay for comfort care, including "physician aid in dying," better known as assisted suicide.

"I told them, I said, 'Who do you guys think you are?' You know, to say that you'll pay for my dying, but you won't pay to help me possibly live longer?' " Wagner said.

Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan, said Wagner is making an "unfortunate interpretation" of the letter and that no one is telling her the health plan will only pay for her to die.

....Saha said state health officials do not consider whether it is cheaper for someone in the health plan to die than live. But he admitted they must consider the state's limited dollars when dealing with a case such as Wagner's.

"If we invest thousands and thousands of dollars in one person's days to weeks, we are taking away those dollars from someone," Saha said.


But the medical director at the cancer center where Wagner gets her care said some people may have incredible responses to treatment.


Thank that attitude to a federal level and you see why people are outraged over section 1233. It pushes end of life consultation to the same level as prolonging someone's life instead of being a part of someone's legal rights to use of their own time and place.

Update: Malkin with various roundups on the death panel talk including links to the UK's NHS where medical treatment borders on get them in and get the out fast.

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