Government will ask you to decide how you want to die!
Before you read this post I recommend you first go to ABC News and watch the video.
The lady, Mary, called in from North Carolina and informed President Obama she had been told there is a clause in the healthcare reform bill that provided the government would send someone to talk with “everyone of Medicare age to decide how they wish to die.” President Obama told her no, but seemed to miss what Mary was getting at, and began explaining about Living Wills.
My interest in all this.
I am one of those Medicare age people of which Mary spoke. I’m 76 years old, with heart problems from cardio-vascular disease. I am a type I diabetic. I have, over the past decades, been in hospitals with medical bills ranging from $30,000 to $60,000. I am on Medicare and also have private insurance coverage through my wife’s former employment with the State of California. We are both retired. The odds of me dying or having a stoke and becoming incapacitated within the next few years are very high.
My bias in all this.
I am a retired trial lawyer. In the 27 years I practiced law in California I have dealt with insurance companies many times. I represented people who sued for injuries, loss of income, pain and suffering caused by persons insured by those companies. It has been my experience that insurance companies will spend tens of thousands of dollars to avoid settling a case for $15,000. I do not like insurance companies. I do not trust them. I do not believe “you’re in good hands with Allstate.” Nor do I believe State Farm is your affable friendly neighborhood insurance company.
I do not trust Blue Cross or Blue Shield. I have learned that before you enter any hospital you had better get absolute assurance that they will pay your hospital bill and physician’s fees before you are admitted. Those companies will exert every effort to avoid paying if they can find a way out. They are in the business of making a profit. Their aim is to collect your monthly premiums year after year after year and never have to pay any medical claim on your behalf. That is how they survive. Profit means attracting more shareholders.
With all that, disclosure about my biases let me return to that Mary’s question to President Obama. She prefixed her question by telling the President she heard about this clause in the bill saying she hoped that those who vote on the bill would read every line of it before voting to insure no such clause was included.
Mary, bless her heart, thinks Senators and Congressmen/women may actually read and understand those bills before they cast their vote. Those that read those bills and understand what they are reading are a minor few, if any. They probably leave that chore up to their staff. Nor does Mary seem to comprehend that there is a lunatic fringe seeking to confuse and scare her. That lunatic fringe are backed and financed by the insurance and pharmaceutical industry.
Our personal experience.
My wife and I personally encountered the issue Mary raises some years ago. Our youngest son, Timothy, age 22, was home on leave from the United States Air Force. On July 6, 1983, while driving, Timothy failed to make a curve in the road striking a tree head-on. He suffered a severe head injury. He was unconscious. He was on life sustaining support the next four days, never regaining consciousness. His skull was opened to relieve the pressure on his swelling brain. Four days later the attending physicians informed my wife and I that Timothy was brain dead and that his blood flow and breathing was being maintained only by the hospital apparatus he was connected with.
The awful question no one ever wants to face was presented to us. To maintain the life sustaining apparatus and retain the status quo indefinitely or remove it and let him die. His mother, sister, brother and I spent the next several hours agonizing over a decision. Most of our focus was “What would Tim want us to do?” The four of us knew him better than anyone else. We unanimously concluded Tim would want to be removed from the life-sustaining apparatus rather than remaining a vegetable.
My oldest son and I stood next to Tim’s bed as the medical attendant unhooked the apparatus, one by one. Tim’s breathing ended, the color fading from his face as the blood flow ceased. Whether he had already been dead for four days or just died before my eyes I’ll never know.
Neither the doctors or the hospital pressed us one way or the other in what decision we should make. Neither did the Air Force, who was paying the hospital and medical bill. Of course Air Force medical care is a form of socialized medicine. As is Medicare. Both are single-payer systems, paid for by the taxpayers.
Back to Mary.
When President Obama fielded a question about end-of-life care at yesterday’s AARP-sponsored town-hall meeting, he appeared not to comprehend that he was confronting the latest conspiracy theory being floated by members of the far right: that his health care plan is a nefarious scheme to euthanize the nation’s elderly, writes Adele Stan on AlterNet.
Representative Virginia Foxx, R-N.C., one of the lunatic fringe, minutes after Obama’s remarks, made the following statement on the floor of the House of Representatives.
Foxx spoke against the Democratic health care plan, and in favor of a mysterious Republican plan that no one has seen, saying, the GOP plan would “make sure we bring down the cost of health care for all Americans and that ensures affordable access for all Americans and is pro-life because it will not put seniors in a position of being put to death by their government.” (Emhasis added.) [AlterNet]
Did Mary hear right? Will the government send someone to talk with “everyone of Medicare age to decide how they wish to die.” Of course at this moment in time Congress is still fiddling around with the healthcare reform bill. It is just a bill, not a law. Congress keeps sticking provisions in it and taking provisions out of it. So nobody, yet, knows what will finally remain in the bill once it goes to the White House for the President’s signature. Once he signs it then it becomes law, not before.
Everybody is talking about the bill, but precious few, including me, has read the whole blooming thing. It is HR 3200 “America’s Affordable Health Choices Act of 2009” (Introduced in House).
You are welcome to read the whole bill here
You might want to read the analysis of HR 3200 before you tackle reading the entire bill. See the prior post on this blog called Analysis of HR 3200 America’s Affordable Health Choices Act of 2009. It was prepared and published by the Committee on Energy and Commerce of the United States, in the House of Representatives.
The section Mary is referring to is Section 1233 which reads as follows:
SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
(a) Medicare-
(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended–
(A) in subsection (s)(2)–
(i) by striking `and’ at the end of subparagraph (DD);
(ii) by adding `and’ at the end of subparagraph (EE); and
(iii) by adding at the end the following new subparagraph:
`(FF) advance care planning consultation (as defined in subsection (hhh)(1));’; and
(B) by adding at the end the following new subsection:
`Advance Care Planning Consultation
`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include–
`(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decision maker (also known as a health care proxy).
`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State–
`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that–
`(I) ensures such orders are standardized and uniquely identifiable throughout the State;
`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;
`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
`(2) A practitioner described in this paragraph is–
`(A) a physician (as defined in subsection (r)(1)); and
`(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.
`(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).
`(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
`(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 signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual 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, including 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 individual.
`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items–
`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
`(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
`(iii) the use of antibiotics; and
`(iv) the use of artificially administered nutrition and hydration.’.
(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(FF),’ after `(2)(EE),’.
(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended–
(A) in paragraph (1)–
(i) in subparagraph (N), by striking `and’ at the end;
(ii) in subparagraph (O) by striking the semicolon at the end and inserting `, and’; and
(iii) by adding at the end the following new subparagraph:
`(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;’; and
(B) in paragraph (7), by striking `or (K)’ and inserting `(K), or (P)’.
(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.
(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-
(1) Physician’S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:
`(3) Physician’S QUALITY REPORTING INITIATIVE-
`(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.
`(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’.
(c) Inclusion of Information in Medicare & You Handbook-
(1) MEDICARE & YOU HANDBOOK-
(A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:
(i) An explanation of advance care planning and advance directives, including–
(I) living wills;
(II) durable power of attorney;
(III) orders of life-sustaining treatment; and
(IV) health care proxies.
(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including–
(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);
(II) website links or addresses for State-specific advance directive forms; and
(III) any additional information, as determined by the Secretary.
- (B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.
I didn’t find anything in Section 1233 that I could possibly construe as an effort by the government to euthanize or kill us Medicare recipients. What they are referring to is what Mr. Cuthbert, the AARP moderator of President Obama’s appearance, says:
As I read the bill, it’s saying that Medicare will, for the first time, cover consultation about end-of-life care, and that they will not pay for such a consultation more than once every five years. This is being read as saying every five years you’ll be told how you can die.
What I see in Section 1233 is a provision about what doctors and lawyers refer to as an Advance Healthcare Directive commonly referred to as a Living Will.
Go read up on Advance Health Care Directives on Wikipedia.
Every hospital I’ve ever been admitted to will ask me, “Do you have a Living Will?” 
It was the centerpiece of all the hubbub in the Terri Schiavo case in Florida in 2005. The Schiavo case brought involvement by politicians and advocacy groups, particularly those involved in the pro-life movement and disability rights, including members of the Florida Legislature, the United States Congress, and the President of the United States.[4]
In March 2005 President Bush returned to Washington D.C. from a vacation to sign legislation designed to keep Schiavo alive, making the case a major national news story throughout that month. In all, the Schiavo case involved 14 appeals and numerous motions, petitions, and hearings in the Florida courts; five suits in federal district court; Florida legislation struck down by the Supreme Court of Florida; a subpoena by a congressional committee to qualify Schiavo for witness protection; federal legislation (the Palm Sunday Compromise); and four denials of certiorari from the Supreme Court of the United States.
The Schiavo case was a circus in which the Republican Party went beserk trying to politicize a private family matter into a political circus in which they were trying to whip up their pro-life base. Every right wing lunatic on the planet got their TV face time in that fiasco. Those dimwits will be doing the same as this healthcare reform task drags forward.
As for me, I am going to follow the advice of Martin Welsh, a family doctor, suffering from ALS (Lou Gehrig’s disease) as he approaches his date of death. You ought to read what he says too. You can, here.
Good luck to you all. Keep your heads screwed on and don’t let that lunatic fringe fog up your brain. They are only interested in serving their insurance company masters, not you, or me.
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