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August 14, 2009

Comments

JM Hanes

Thomas Collins:

"I think we should give Xanthippas a round of applause....."

Don't forget the plaudits for "en friend" (probably en friend of Xanthippas)! Not only has Isakson blasted the President for claiming he had endorsed end of life provisions in the healthcare legislation, Sarah Palin made mincemeat of the spin that she "endorsed some of the same end of life counseling she now decries."

Last year, I issued a proclamation for “Healthcare Decisions Day.” [6] The proclamation sought to increase the public’s knowledge about creating living wills and establishing powers of attorney. There was no incentive to choose one option over another. There was certainly no financial incentive for physicians to push anything. In fact, the proclamation explicitly called on medical professionals and lawyers “to volunteer their time and efforts” to provide information to the public.

Comparing the “Healthcare Decisions Day” proclamation to Section 1233 of HR 3200 is ridiculous. The two are like apples and oranges. The attempt to link the two shows how desperate the proponents of nationalized health care are to shift the debate away from the disturbing details of their bill.

Palin has been doing a knock out job of laying out the traps (rationally!) and single handedly setting Obamacare back on its heels. I hereby officially retract my previous critique of her leadership. She has turned offensive media into a media offensive in the most politically astute fashion Republicans have seen in a long, long time.

Parking Lot

((So maybe she wasn't productive in the go to work each day sense, but her contributions after her stroke were many and many lives were touched by her still being with us instead of left to die because she had the bad sense to wait until 90 to have her first major medical problem.))

Sara, what a beautiful post and tribute to your mother.

Respect for elders is traditional value. Progressives want to throw out traditional values.

Jim Ryan

Ouch.

Jim Ryan

Ouch was to JM Hanes/Palin/mincemeat post.

More Palin, please.

PeterUK

Parking Lot.

"Progressives want to throw out traditional values. "

And make each and everyone of us chattels of the state,"from the cradle to the grave".

Except them of course.

Parking Lot

((...Obama's been stalked by his own statements ))

Once again a time-tested aphorism is proven true: what a tangled web we weave, when we practice to deceive.

Cecil Turner

There are legitimate concerns with some of the health care proposals out there. The fact that some people are focusing on things that don't exist is a pretty good sign that they're happy with factors that actually DO exist.

Nonsense. The reason this is an issue is because supporters made it one (including the supporter-in-chief), as they blasted away at Gov Palin for spreading "disinformation" (that turned out to be mostly true). And I'd note some of the naysayers are still conflating the end-of-life counseling with the decisionmaking function that will actually deny care based on economics.

The real issue here is that we're intending to implement a system that most people believe will result in worse care, and that the CBO insists will not save money, and add hundreds of billions of dollars to the deficit. Considering the great product he's marketing, I'd say it was rather smart of the President to change the subject.

Fresh Air

So I guess we have winner in the "Guess What the Topic Discussed on Journ-O-List Today" was.

Neo
“I am in this race because I don’t want to see us spend the next year re-fighting the Washington battles of the 1990s. I don’t want to pit Blue America against Red America; I want to lead a United States of America.”

… Obama has failed to do this on oh so many levels.

PeterUK

Obama is losing Huffington. Sorry to re-post, but if Obama is losing it in the base after only seven months,he is losing it big time.

Parking Lot

((I'd note some of the naysayers are still conflating the end-of-life counseling with the decisionmaking function that will actually deny care based on economics.))

I wish I knew how to do the strikeout thingie; I'd replace "naysayers" with "truth-twisters"

Ignatz

--Palin has been doing a knock out job of laying out the traps (rationally!) and single handedly setting Obamacare back on its heels. I hereby officially retract my previous critique of her leadership.--

Totally agree, JMH.
Her reply to Barry's weak-tea criticism of her intitial "death panel" comment was exceptional.

Jim Treacher

It's a false rumor because Obama says it's a false rumor. Now shut up, deathers.

Jack is Back!

I just heard on the radio that Grassley has stripped the so called "death panel" language from the Senate Finance Committee's version of ObamaCare. How could that be? There is no so called "death panel" language. Now I am really confused. Do you think Obama is misleading us? And why would such a nice, articulate, clean man like him do that?

I know what his health care plan really is! LUN

Jim Ryan

More Treacher and more Palin, please.

Captain Hate

I hereby officially retract my previous critique of her leadership. She has turned offensive media into a media offensive in the most politically astute fashion Republicans have seen in a long, long time.

Welcome aboard JMH.

Btw, did anybody hear clips of Slick speaking to the nutroots last night? Whether it's the impact of lack of blood to the brain during his heart attack, untreated STDs (although the slouching bovine in lavender should be safe from those) or something else, I thought I was listening to Walter Brennan's character on "The Real McCoys" only making no sense. It was vintage Clenis, blaming everybody else for "don't ask/don't tell" being handled the way it was and Muffer's scuttled health care takeover. Having the mendacious mulatto in the Oval Office makes people forget what an utter lying POS Slick was and is.

Parking Lot

((Totally agree, JMH.
Her reply to Barry's weak-tea criticism of her intitial "death panel" comment was exceptional.))

You don't work your way up from dog-eat-dog smalltown muni politics to a state governorship of an important state like Alaska without learning one hell of a lot on the way up. Whereas the senator who voted present in IL progressed mostly via the silver spoon method. Despite the latter's excellent acting ability, his political instincts are not as acute as the cuda's.

Ignatz

--Whether it's the impact of lack of blood to the brain during his heart attack, untreated STDs (although the slouching bovine in lavender should be safe from those) or something else, I thought I was listening to Walter Brennan's character on "The Real McCoys" only making no sense.--

LOL (again).

How about bgates and Cap'n Hate collaborate on a blog?
Any suggestions for a title?

Jim Treacher

He thinks it was a waste of money for his own grandmother to get a hip replacement, because she had terminal cancer. Why alleviate her suffering if she's just going to die anyway? Just give her a wheelchair and some pills.

Cecil Turner

Palin has been doing a knock out job of laying out the traps (rationally!) and single handedly setting Obamacare back on its heels.

Yeah, but she's cheating. It's not easy having to appease a bunch of nutroots, ambulance chasers, and marxist-leninists at the same time. She's just focusing on effective governance, which is relatively simple.

Gotta hand it to her, though . . . this is a whole lot more effective than "kill granny" ever was.

narciso

What is he doing talking to the netroots, they may have arose in part in defense of him, but they most unreservedly shanked his
wife last year. He's a sell out in their view

Captain Hate

narciso, you're obviously forgetting how Slick will say anything to please any audience (telling bidnessmen that he'd raised their taxes too much; Jews in Canada that he'd bear arms to protect Israel); the man is utterly shameless in his bullshitting ways. Plus I'll bet there was plenty of young strange at the convention...

And LOL @ you if you think he cared a whit about what happened to Pantsuits; when he became President the donks controlled everything and when he left they controlled nothing.

centralcal

During lunch, it was all Obama at the Montana townhall on all channels.

Anybody watch? Did ya notice Tester? Good grief he had the most awful scowl on his face the whole time like his Tester-cals were being pinched or something.

Ann

It's a false rumor because Obama says it's a false rumor. Now shut up, deathers.

Jim Treacher,

Funny how the arguments have come down to birthers or deathers or:

Life or Death
Liberty or Death
Liberty or Tryranny
Live, Liberty, and the Pursuit of Happiness or Socialism
etc.

Steve

Our 20 and 30 year old generation has an entitlement mentality bred into them by us. In a few years they are going to have hell to pay as we boomers qualify for Social Security and Medicare and the stimulus bills and cap and trade and Obamacare. Death Panels might be a real popular issue for a few years. Assisted suicide is already legal in Oregon, maybe Washington. Does anybody think it is a far stretch to say it will become legal nationwide? Hell, who knows it may become mandatory.

matt

Re; end of life panels

Can we start with the following candidates just to test drive the concept:

Teddy Kennedy
Barney Frank
Harry Reid
Nancy Pelosi
Barbara Boxer
Dick Durbin
Henry Waxman
Arlen Specter

Guys, get back to us on how it all works out. Let us know who drew the short straw.

Extraneus

Sure, Waxulon-6 might have some sort of science backround, but weren't we supposed to get doctors and and ethicists on the panel, too?

Dean

Tom:

Here's the provision, in full. It's about Advance directives.

Advance directives are a way that you can give your loved ones directions to take regarding your health if you are incapacitated, so that someone else does not impinge on your freedom to decide how you would like to be treated if you are unable to state this yourself. They are a standard part of medicine--something that have been in place for years.

What the section does is provide for the ability for you to issue advance directives. That's it. You can read more into it, but that's exactly what you will be doing--reading more than is there.

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

1
(a) Medicare-CommentsClose CommentsPermalink

(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--CommentsClose CommentsPermalink

(A) in subsection (s)(2)--CommentsClose CommentsPermalink

(i) by striking ‘and’ at the end of subparagraph (DD);CommentsClose CommentsPermalink

(ii) by adding ‘and’ at the end of subparagraph (EE); andCommentsClose CommentsPermalink

(iii) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink

‘(FF) advance care planning consultation (as defined in subsection (hhh)(1));’; andCommentsClose CommentsPermalink

(B) by adding at the end the following new subsection:CommentsClose CommentsPermalink

‘Advance Care Planning Consultation

10
‘(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:CommentsClose CommentsPermalink

‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.CommentsClose CommentsPermalink

‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.CommentsClose CommentsPermalink

‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.CommentsClose CommentsPermalink

‘(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).CommentsClose CommentsPermalink

9
‘(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.CommentsClose CommentsPermalink

‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--CommentsClose CommentsPermalink

‘(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;CommentsClose CommentsPermalink

‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; andCommentsClose CommentsPermalink

‘(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 decisionmaker (also known as a health care proxy).CommentsClose CommentsPermalink

‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--CommentsClose CommentsPermalink

‘(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; andCommentsClose CommentsPermalink

‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).CommentsClose CommentsPermalink

‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--CommentsClose CommentsPermalink

‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;CommentsClose CommentsPermalink

‘(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;CommentsClose CommentsPermalink

‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; andCommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

‘(2) A practitioner described in this paragraph is--CommentsClose CommentsPermalink

‘(A) a physician (as defined in subsection (r)(1)); andCommentsClose CommentsPermalink

‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.CommentsClose CommentsPermalink

‘(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).CommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

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

‘(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--CommentsClose CommentsPermalink

5
‘(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;CommentsClose CommentsPermalink

3
‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;CommentsClose CommentsPermalink

‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); andCommentsClose CommentsPermalink

‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.CommentsClose CommentsPermalink

‘(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--CommentsClose CommentsPermalink

‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;CommentsClose CommentsPermalink

‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;CommentsClose CommentsPermalink

‘(iii) the use of antibiotics; andCommentsClose CommentsPermalink

‘(iv) the use of artificially administered nutrition and hydration.’.CommentsClose CommentsPermalink

(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),’.CommentsClose CommentsPermalink

(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--CommentsClose CommentsPermalink

(A) in paragraph (1)--CommentsClose CommentsPermalink

(i) in subparagraph (N), by striking ‘and’ at the end;CommentsClose CommentsPermalink

(ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘, and’; andCommentsClose CommentsPermalink

(iii) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink

‘(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;’; andCommentsClose CommentsPermalink

(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.CommentsClose CommentsPermalink

(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.CommentsClose CommentsPermalink

(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-CommentsClose CommentsPermalink

(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:CommentsClose CommentsPermalink

‘(3) Physician’S QUALITY REPORTING INITIATIVE-CommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

‘(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.’.CommentsClose CommentsPermalink

(c) Inclusion of Information in Medicare & You Handbook-CommentsClose CommentsPermalink

(1) MEDICARE & YOU HANDBOOK-CommentsClose CommentsPermalink

(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:CommentsClose CommentsPermalink

(i) An explanation of advance care planning and advance directives, including--CommentsClose CommentsPermalink

(I) living wills;CommentsClose CommentsPermalink

(II) durable power of attorney;CommentsClose CommentsPermalink

(III) orders of life-sustaining treatment; andCommentsClose CommentsPermalink

(IV) health care proxies.CommentsClose CommentsPermalink

(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--CommentsClose CommentsPermalink

(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.);CommentsClose CommentsPermalink

(II) website links or addresses for State-specific advance directive forms; andCommentsClose CommentsPermalink

(III) any additional information, as determined by the Secretary.CommentsClose CommentsPermalink

(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.

RichatUF

These are not the Death Panels you are looking for.

Dean

Hi Tom,

Section 1233 of H.R. 3200 is about advance directives.

Advance directives allow you to name a loved one who will carry out your freedoms--your desires for treatment--if you are incapacitated and therefore unable to do so.

They have been a part of medicine for years.

Here is the entire section 1233 of H.R. 3200. Unless you read something into it that isn't there, it provides for advance directives:


SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

1
(a) Medicare-CommentsClose CommentsPermalink

(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--CommentsClose CommentsPermalink

(A) in subsection (s)(2)--CommentsClose CommentsPermalink

(i) by striking ‘and’ at the end of subparagraph (DD);CommentsClose CommentsPermalink

(ii) by adding ‘and’ at the end of subparagraph (EE); andCommentsClose CommentsPermalink

(iii) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink

‘(FF) advance care planning consultation (as defined in subsection (hhh)(1));’; andCommentsClose CommentsPermalink

(B) by adding at the end the following new subsection:CommentsClose CommentsPermalink

‘Advance Care Planning Consultation

10
‘(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:CommentsClose CommentsPermalink

‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.CommentsClose CommentsPermalink

‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.CommentsClose CommentsPermalink

‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.CommentsClose CommentsPermalink

‘(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).CommentsClose CommentsPermalink

9
‘(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.CommentsClose CommentsPermalink

‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--CommentsClose CommentsPermalink

‘(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;CommentsClose CommentsPermalink

‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; andCommentsClose CommentsPermalink

‘(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 decisionmaker (also known as a health care proxy).CommentsClose CommentsPermalink

‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--CommentsClose CommentsPermalink

‘(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; andCommentsClose CommentsPermalink

‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).CommentsClose CommentsPermalink

‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--CommentsClose CommentsPermalink

‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;CommentsClose CommentsPermalink

‘(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;CommentsClose CommentsPermalink

‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; andCommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

‘(2) A practitioner described in this paragraph is--CommentsClose CommentsPermalink

‘(A) a physician (as defined in subsection (r)(1)); andCommentsClose CommentsPermalink

‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.CommentsClose CommentsPermalink

‘(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).CommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

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

‘(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--CommentsClose CommentsPermalink

5
‘(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;CommentsClose CommentsPermalink

3
‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;CommentsClose CommentsPermalink

‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); andCommentsClose CommentsPermalink

‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.CommentsClose CommentsPermalink

‘(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--CommentsClose CommentsPermalink

‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;CommentsClose CommentsPermalink

‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;CommentsClose CommentsPermalink

‘(iii) the use of antibiotics; andCommentsClose CommentsPermalink

‘(iv) the use of artificially administered nutrition and hydration.’.CommentsClose CommentsPermalink

(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),’.CommentsClose CommentsPermalink

(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--CommentsClose CommentsPermalink

(A) in paragraph (1)--CommentsClose CommentsPermalink

(i) in subparagraph (N), by striking ‘and’ at the end;CommentsClose CommentsPermalink

(ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘, and’; andCommentsClose CommentsPermalink

(iii) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink

‘(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;’; andCommentsClose CommentsPermalink

(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.CommentsClose CommentsPermalink

(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.CommentsClose CommentsPermalink

(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-CommentsClose CommentsPermalink

(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:CommentsClose CommentsPermalink

‘(3) Physician’S QUALITY REPORTING INITIATIVE-CommentsClose CommentsPermalink

‘(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.CommentsClose CommentsPermalink

‘(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.’.CommentsClose CommentsPermalink

(c) Inclusion of Information in Medicare & You Handbook-CommentsClose CommentsPermalink

(1) MEDICARE & YOU HANDBOOK-CommentsClose CommentsPermalink

(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:CommentsClose CommentsPermalink

(i) An explanation of advance care planning and advance directives, including--CommentsClose CommentsPermalink

(I) living wills;CommentsClose CommentsPermalink

(II) durable power of attorney;CommentsClose CommentsPermalink

(III) orders of life-sustaining treatment; andCommentsClose CommentsPermalink

(IV) health care proxies.CommentsClose CommentsPermalink

(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--CommentsClose CommentsPermalink

(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.);CommentsClose CommentsPermalink

(II) website links or addresses for State-specific advance directive forms; andCommentsClose CommentsPermalink

(III) any additional information, as determined by the Secretary.CommentsClose CommentsPermalink

(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.


Dean

If they are not the "Death Panels", please point to the relevant section of the Act where you propose they are listed. NOTE: This is the section cited by all those who have proposed that they are "death panels".

Dean

Apologies for the double post

RichatUF

I take it you are unfamiliar with the Star Wars quote. How much are you getting paid by Axelrod to put up a portion of the proposed house legislation? Organizing for America was out advertising for astroturfers for $15/hr. Hope you aren't getting cheated.

Dean

1) It's the entire section;

2) It's the actual language--so all of the members of the House--Republican and Democratic-- are also being paid as you suggest?

3) Not a dime--as they say, just read the Bill. In fact, why not go there and read the entire section yourself. You'll see that it is the entire section.

4)Enjoy Star Wars.

bgates

If they are not the "Death Panels", please point to the relevant section of the Act where you propose they are listed

Are we saying that Obama is in some way connected to proposed legislation again this afternoon? I thought he'd contracted out to (the lobbyists who dictate the content of) (the staffers who write the bills that have) Pelosi and Kennedy('s name on the front page.

This is the section cited by all those who have proposed that they are "death panels".

Except those who point out that meeting Obama's - sorry, the Democrats' - twin goals of cutting costs and decreasing the number of persons not covered will require spreading a fixed amount of resources more thinly, and rationing medical care according to the principles (if you'll pardon the word) articulated by Obama and his advisors in happier times when they weren't in position to carry out their schemes will result in people dying. The government will choose which people die. Death panels.

JM Hanes

Cecil:

"this is a whole lot more effective than "kill granny" ever was."

I think Palin is hitting just the right nails, but I wouldn't underestimate the power of "kill granny." It's a legitimate concern; folks don't like the idea of denying care to their parents; and seniors themselves could be the very definition of "likely voters." Every time Obama & Dem leadership say those words says those words in public, it's a twofer. It highlights a sore subject, and swings the protest-too-much door open.

Extraneus

The point is to set up an "independent" (i.e., unaccountable) group to help us determine how to ration care, which itself is a necessary outcome of adding tens of millions of people to the "system" at no additional cost. As Obama has said:

It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance.

These are the death panels, which of course will go by a different euphamism in reality. We need these experts to help guide us as to how to ration care in order to cut costs. In other words, somebody needs to determine the specifics as to what care will be witheld from which patients. In Obama's opinion, this question will require a panel of "doctors, scientists, [and] ethicists."

Section 1233 would only engage doctors in discussions with patients. One could logically presume that this engagement will help implement the "guidance," at least in part, but surely 1233 can be removed without preventing the implementation of the guidance.

Cecil Turner

Not sure why the draft bill is dispositive, as we've already seen how such things can change by hundreds of pages literally overnight. But these sections would be a bit more concerning to me:

SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE. [. . .]
(1) RECOMMENDATIONS ON BENEFIT STANDARDS.—The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) benefit standards (as defined in paragraph (4)), and periodic updates to such standards.
In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
and:
‘‘SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED.—
‘‘(1) IN GENERAL.—The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the ‘Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.
On the more obvious front, Mr President wasn't talking about counseling, so the section you proffered ain't the ticket.

caro

What happens when bureaucratic advance directives come in conflict with previous legal living wills?

PeterUK

"Advance directives allow you to name a loved one who will carry out your freedoms--your desires for treatment--if you are incapacitated and therefore unable to do so. "


No they won't,they don't now. It is absolute tosh to say "a loved one will carry out your freedoms". They will,in the main,go with medical advice. The permutations are too wide to encompass what treatment and for what ailment a patient may suffer from in the future.
It is possible to have,say, a bad heart,for years and suddenly be stricken with cancer.
Why should politicians,a scurvy bunch at best,have a say in ones death?

MotherRedDog

The basketball presidency....fakes to the right....doesn't appear to be working as well as it did back in November.

Dean

"Except those who point out that meeting Obama's - sorry, the Democrats' - twin goals of cutting costs and decreasing the number of persons not covered will require spreading a fixed amount of resources more thinly, and rationing medical care according to the principles (if you'll pardon the word) articulated by Obama and his advisors in happier times when they weren't in position to carry out their schemes will result in people dying. The government will choose which people die. Death panels."


And the proposed statutory language?

narciso

They need to 'nuke this bill from orbit, only way to be sure' the allusion to the
Alien hive is not accidental.

Original MikeS

The truth is that the Democrat health-care proposals create government boards charged with deciding which medical treatments you will receive and even whether or not you receive medical treatment.

From all we have heard about these plans it appears they suck. It is hard to pin down all of the sucky stuff, because the Dems present a moving target or in this case targets. There are about 5 bills out there and each is ever changing. Some more vague than others.

One thing is clear, in general these proposals suck for the same reason that the misnamed 'stimulus' bill sucked. They are less about fixing health-care and more about fixing elections. What brand of lunacy would refuse to limit awards to trial lawyers and instead prefer to limit medical treatment to people.

Dean

Cecil:

Section 1233 of H.R. 3200 is the section from which "Death Panels" were being inferred.

If you disagree, can you please point to the other more relevant section?

RichatUF

Oh you've read a 1017 page bill that is only from 1 committee. Forgive me if I'm skeptical the sprawling bureaucratic nightmare it will create won't have death panels regardless of whether 'and' is inserted, paragraph "K" is revised, or whatever form the Secterary advises.

And the Republicans were cut out of the committee. This is a house dem bill using the guildlines that Obama himself came up with.

PeterUK


"And the proposed statutory language?"

Was there a "proposed statutory language" that emerged from the Wannsee Conference?

Dean

Peter,

Please realize that advance directives have been in place long before President Obama. This is why they were supported by so many in the GOP in 2003, the American College of Physicians and Surgeons (many Republicans there), etc. etc.

Let me make a suggestion--try it. Type "advance directives" into Google. Read a bit. You'll see this is not an Obama idea.

Dean

Caro:

Living wills, like power of attorney *are* advance directives.

From Medline (the standard medical database):

Alternative Names Return to top
Power of attorney; DNR; Do not resuscitate; Living will

Definition Return to top

Advanced care directives are specific instructions, prepared in advance, that are intended to direct a person's medical care if he or she becomes unable to do so in the future.

Information Return to top

Advanced care directives allow patients to make their own decisions regarding the care they would prefer to receive if they develop a terminal illness or a life-threatening injury. Advanced care directives can also designate someone the patient trusts to make decisions about medical care if the patient becomes unable to make (or communicate) these decisions.

Federal law requires hospitals, nursing homes, and other institutions that receive Medicare or Medicaid funds to provide written information regarding advanced care directives to all patients upon admission.

Advanced care directives can reduce:

* Personal worry
* Futile, costly, specialized interventions that a patient may not want
* Overall health care costs
* Feelings of helplessness and guilt for family
* Legal concerns for everyone involved

Read the bill.

Fresh Air

Dean--

Give it a rest. You already hogged more pixels on this thread than anyone else with your ridiculous cut-and-pastes.

You cannot cut health care costs in toto if you don't do something dramatic for the last month of life. Bureaucrats should have nothing to do with these decisions. I'm sure PUK can give you chapter and verse on what happens in England to the aged and infirmed. We don't want that here, and there is no reason that has been offered as to why we should have to have it.

P.S. Your check from OFA is in the mail.

JM Hanes

Dean:

What is it about the "shall" in "shall include" that you don't get? The government has no business mandating when, where, what, and how doctors are to shepherd their patients into end of life decision making -- and, of course, turning in their reports of such sessions for reimbursement. Wouldn't want them to game the system by revisiting the issue every four years -- or reap those nasty windfall profits, if a patient becomes terminally ill 2 years ahead of schedule.

Will patients get to opt out of such discussions -- Obama has made it clear just how greedy those doctors are! -- or will their government mandated insurance require them revisit the issue every five years till they turn in their living wills? Who decided on the 5 year repeat anyway? Are we sure the old folks can remember life and death conversations that long?

Frankly, there are far greater benefits to be had in mandating organ donor consultations for teenage drivers, don't you think? We could pay both doctor and patient for their time, and give doctors a tax break for every potential donor they sign up. Productive citizens would no longer have to wait in line for their transplants!

If informed decision making is the object, of course, I'm sure you'll a agree that government should also mandate a full range of pro-life and pro-choice counseling for women considering abortions.

caro

Dean, I know that living wills are advance directives. My question relates to what happens when what is already in my living will, freely agreed to long ago, is in conflict with the determined course of treatment proscribed by the panel.

Dean

Actually, Peter, I'm very familiar with the Wannsee Conference. That was a plan for the systematic extermination of the Jewish People in all European nations then under the power of Nazi Germany, as well as for its implementation by Amt officers (e.g. Eichmann). You'd be better off citing the euthanasia actions of 1937.

Why don't you first read the language above? Nothing whatsoever about extermination there.

Now. What evidence do you have that Obama plans systematic extermination? In the Wannsee conference, there were minutes taken by Eichmann, as well as contemporaneous notes. There were the order for ovens from Todt and Sons, orders for Zyklon B.

Here you have nothing at all. But your fears. And for that, I am sorry for you.

Dean

But Richard--you've cited no language at all.

Therefore, any fear could be true. Any at all.

Dean

Fresh Air,

Facts are troublesome things. You don't get to have your own--but I respect your opinions.

Sorry--I have nothing to do with OFA. I just don't enjoy reading factual information that's wrong.

Sue

How odd that physicians are being tasked with counseling on a document that at present neither they nor anyone tasked with the care of an individual can sign as a witness. And even odder still that the very documents, one called a Directive to Physician and one called a Medical Power of Attorney (there are others, like a DNR, etc.) are prepared in a law firm by lawyers tasked with explaining to the individual what they are signing. So, tell me, is this a twofer? Doctors will get paid to send the patient to a lawyer to prepare the documents at a significant cost to the individual?

Dean

Caro,

1233 provided voluntary assistance with living wills. There was no proscription.

Ranger

Dean, I posted previously that the issue of "Death Panels" relates more to an attitude towards end of life care, rather than a specific section of the bill. That attiude is encapsulated in this http://hotair.com/archives/2009/07/21/video-let-them-eat-painkillers/>exchange from Obama's ABC informercial for Obamacare:

Jane Sturm told the story of her nearly 100-year-old mother, who was originally denied a pacemaker because of her age. She eventually got one, but only after seeking out another doctor.

“Outside the medical criteria,” Sturm asked, “is there a consideration that can be given for a certain spirit … and quality of life?”

“I don’t think that we can make judgments based on peoples’ spirit,” Obama said. … “Maybe you’re better off not having the surgery, but taking painkillers.“

Tough luck granny. You may be the most amaizing person in the world, but the rules say no pacemakers for people over X years old.

"Death Panels" are just the means to impliment Obama's vision of end of life care, which is that 'those people' should 'just take a pain killer.' It is that vision people are objecting to.

Dean

Sue,

If you want to do away with DNR, Power of Attorney and Living Wills, that's certainly a position one can take. It does, however, remove your freedom to decide what will occur if you are incapacitated. This is why such measures were created--for individuals, and long before Obama.

Dean

JM:

I think this is an excellent question.

It's important to realize that what "shall" occur is information about voluntary advance directives. As they say, read the bill.

Sue

Dean,

I am a paralegal in a law firm that deals with estate planning. I am very familiar with the documents. I prepare them, I review them with our clients, I explain what they are signing. You didn't answer my question. Why are doctors being involved with couseling on a document they can't even sign as a witness because of an appearance of a conflict of interest?

Extraneus

I would recommend a perusal of the actual facebook posts from the person who originated the term under discussion. She never claimed that 1233 was the death panel. Her point was that Obama's advisors have a history of recommending various life-worth calculations as to "allocating" medical care, such as this latest one referring to the "Complete Lives System."

In this post, she asks a few questions I haven't seen the answer to; namely:

Why the silence from the president on this aspect of his nationalization of health care? Does he agree with the “Complete Lives System”? If not, then why is Dr. Emanuel his policy advisor? What is he advising the president on?
Considering the source, I imagine these questions might be considered too dumb to merit a response, but the lack of a response is telling regardless.

Dean

Hi Ranger,

I hear you. The day that ABC commercials become law, there will be reason for real concern.

The problem is that there is no law, proposed law, language of any kind supporting this "vision" or of "death panels".

One could just as easily say that the ABC commercial promotes Big Pharma and the use of painkillers--and rise up against that. You see your "vision", you make your choice.

Yet, there is nothing in what many have repeatedly cited--hence, "read the bill"--in the bill.

PeterUK

Dean,
You have to understand that legal is not synonymous with moral,that politics has no place in the most ultimate privacy of death.

Further,you know perfectly well that legislation will at some point end up in the courts,this monstrosity is only the beginning.

Dean

Sorry Sue, too many questions at once--an excellent question.

The doctor, of course, must be involved, as they are the ones who will act upon the patient's wishes. For example, in a DNR order, as you know, it would be necessary, if the individual is hospitalized, for the treatment team to be made aware of the patient's wishes--e.g., do not resuscitate.

PeterUK

"Advanced care directives can reduce:

* Personal worry
* Futile, costly, specialized interventions that a patient may not want
* Overall health care costs
* Feelings of helplessness and guilt for family
* Legal concerns for everyone involved

Read the bill.

Just about states your position.

"Futile, costly, specialized interventions that a patient may not want".

They might, of course,have wanted them if they had known.

"Overall health care costs".

Which gets us to the nub. "Kill Granny"

Dean

Peter,

I could not agree more. And this politicization of the personal decisions of individuals regarding their living wills and DNR orders--the long-standing practice of advance directives--into political incitement about "death panels" is exactly such infringement.

As you may know, federal laws have regulated advance directives for years--to ensure that patients have these voluntary protections. That's what section 1233 is.

To transform them into death panels is the politicization, unfortuanately.

You don't have to believe me. Read about advance directives and read the language.

Dean

Peter:

In an advance directive--they--the patient--specifies these in advance. That's why it's called an advance directive. They make sure that they--no one else--gets to make that call. That's why they were developed--long before Obama, by the GOP as well as Dems--to protect individual rights and freedoms.

PeterUK

Dean,You are googling again,only a Troll digs up irrelevant information.

You see Old chap we have no evidence of the Democrat's good intentions either. But my point was,again.LEGAL is not MORAL.

Interesting that there is no CONTINUATION of Life Counselling.

Sue

Dean,

Who is going to prepare these documents in the future? The doctor? Or the lawyer? The doctor is involved, at present, only to the extent that he is required to carry out the wishes of the patient, or the duly designated agent of the patient if the patient is unable to do so.

Sara (Pal2Pal)

There is a difference between advance directives and a Durable Power of Attorney for Healthcare.

An AD specifies what your wishes are. My Mother had one that had a DNR (Do Not Resuscitate) clause, but also included a section on what type of "extraordinary" care she wanted. She specified she would want the proper drugs to control pain and hydration. After the Schiavo case, she changed it to read hydration & sustenance.

The PofA is your designation of who can legally speak on your behalf when you cannot speak for yourself. Usually more than one designee is listed in order in the event your first choice is unavailable or opts out of the decsion-making process at any point.

The Persons(s) listed on your PofA for Health Care (not to be confused with a Standard PofA) should have in their possession a copy of your Directive, as should your doctor and your attorney.

And these documents should be discussed with your loved ones to make sure everyone is on the same page. My Mother and I did not see eye to eye exactly on one of her wishes. She at first wanted no measures at all, I was okay with that if it meant the only way to keep her alive was with machines, but I also thought that was too extreme for, say, a situation where she might need assistance for a few days until they could get her stabilized. So we agreed that her most extreme directive measures would be given a 14 day grace if the doctors indicated they were for assistance and not just hard working machines keeping her alive with no hope of recovery. It gave her satisfaction that she wouldn't turn into a freak hooked up to machines to live and it gave me the comfort of knowing that I would have a chance as the holder of her PofA to assess the situation before having to make the ultimate decision.

EVERYONE OVER AGE 18 SHOULD HAVE BOTH A DIRECTIVE AND PofA. The only reason the Shiavo case became what it did is because she did not have either and her scummy hubby had the say, while her parents wanted something different.

Dean

Peter:

There is: Look in the bill under Mental Health Parity.

Dean

Sue,

Another on point question.

As you know, doctors provide advance directive forms now--they are called POST forms--or they ca be written down by the person themselves. In either case, it is the patient's wishes that constitute the advance directive.

Read 1233. Nothing there changes this.

JM Hanes

Dean:

"And the proposed statutory language?"

Did you get a handout on the Comparative Effectiveness Commission? If you're up to the challenge, try figuring out what, precisely, the language in that section of the bill is describing, and precisely what use is to be made of the research they underwrite and conduct, and the data they collect.

HR 3200 would be archetypal bad law on the basis of convoluted language alone. It will keep the Supreme Court occupied for decades attempting to determine legislative intent. That's because the Supremes will be addressing the "statutory language" instead of the rule making authority granted to a cornucopia of newly created bureaucratic entites. That's where the regulations which will actually govern implementation will be written. If you don't know what that means, try coming up with a list of such agencies which have voluntarily reduced governmental intrusion in our lives and businesses.

If you like endlessly looping telephone menus, you're going to love your new healthcare plan. You don't really believe you'll be keeping the one you have, unaltered, do you? Medicare is in trouble for the same reason the VA -- and the Post Office -- are in trouble. Government is the problem, not the answer. Costs would start going down tomorrow if the feds lifted their own restrictions on selling policies across state lines.

Ignatz

Dean,

We don't trust the morons writing these laws you quote.

We were told Medicare would cost just a few billion when it was started and it immediately began doubling every four years and now has an unfunded liability somewhere in the scores of trillions and is ballooning the cost of our private health care.
Social Security was sold as a tiny backstop pension which now has a negative rate of return for anyone under 45 and also has unfunded liabilities of trillions of dollars and eats up 15% of our wages.
These Ponzi schemes and others were sold to the country with the same earnest assurances you toss around and virtually none of them were honored.
We don't trust the crooks who sell this stuff because of hard bitter experience. Why do you?

Dean

Sara,

Thank you for this. Your post actually gets to the real, ongoing issues about PofA and ADs, rather than its current politicization.

Parking Lot

((Considering the source, I imagine these questions might be considered too dumb to merit a response, but the lack of a response is telling regardless.))

Ol' Deano won't respond on point because he's trying to muddy the waters. He is pretending that Palin was talking about living wills; that is the essential talking point that must get out.

Which is actually a good thing because people who argue strawmen don't win debates.

RichatUF

the ABC commercial promotes Big Pharma...

Sort of like how Obama promotes Big Pharma by cutting a deal in secret for $150 million in advertising, then altering the terms of the deal because it wasn't sufficently "progressive" or "fair" for Obama's political supporters.

At least we aren't arguing over whether the NYT has a relevant editorial page anymore. How is it a facebook comment from a private citizen could be in the nation's attention for days? It could have just as easily been Obama slamming Tom Maguire blog post a couple days back.

Dean

JM,

You may be right about this. It, of course, is a general commentary on legislative drafting. I also have concerns about interpretation of laws--given the way that "death panels"--or seemingly anything else--have been inferred out of 1233.

Ignatz,

Much the same point--I'm all for strict legislative drafting--and we should apply the same rigorous standards to our interpretations.

PeterUK

"In an advance directive--they--the patient--specifies these in advance. That's why it's called an advance directive".

Dean, Don't be such a patronising anus. We know what it means. But the layman is utterly reliant on the medical profession advising him on the latest treatments. Twenty years ago,a cancer sufferer would have probably directed that they should not suffer. Now we know that some cancers can be successfully treated.
Under Obama cost cutting,it is a certainty that some treatment will not recommended because of cost.It is easy to see a patient opting for a painless death if they fear that there is no hope.
Hey and Mengele was a doctor too,s was Dr Shipman.Google.

Sue

Dean,

Again, the directive is a legal document. Are doctors now going to become quasi-lawyers?

Jane

The doctor, of course, must be involved, as they are the ones who will act upon the patient's wishes.

That is utterly ridiculous. Doctors pull the plug, they don't adjudicate the death sentence.

Who but an idiot thinks the same person chopping off limbs to make a buck is qualified to advise someone on a living will. Unless of course the government pays those doctors by the dead body - I'm sure that wouldn't be a conflict for a guy removing tonsils unnecessarily.

So will Congress repeal the Hippocratic oath before or after Christmas?

Dean

Parking Lot:

I'm happy to respond on point:

1) Section 1233 of H.R. 3200 proposes voluntary advance directives, PofA and and LWs, all long standing practices supported by Repubs and Dems

2) In a politicization of these, these were transformed into "death panels";

3) This, on reading the language, is false.

Jane

BTW Fox News led with the enemies list story tonite - of course vowing that it couldn't possibly be an enemies list without explaining what it could be. Apparently Gibbs is not returning Major's calls.

Dean

Sorry Richard,

I said this:

I hear you. The day that ABC commercials become law, there will be reason for real concern.

The problem is that there is no law, proposed law, language of any kind supporting this "vision" or of "death panels".

One could just as easily say that the ABC commercial promotes Big Pharma and the use of painkillers--and rise up against that. You see your "vision", you make your choice.

Yet, there is nothing in what many have repeatedly cited--hence, "read the bill"--in the bill.

In other words, you can make the commercial "cite" whatever one would like.

Extraneus

The coincidences are starting to become eerie. Did someone say that our erstwhile HHS nominee Tom Daschle was for health care rationing?

Say it ain't so! [sob]

Amazing that these fools would so cavalierly throw away their senior citizen advantage.

Dean

Jane,

"Act upon the patient's wishes".

Not adjudicate.

PeterUK

I don't think Dean gets the point,you don't want the Bill.

Sara (Pal2Pal)

Sue: You bring up a good question re: doctors being involved in generating Directives or PofA for HC. If my Mother hadn't had hers in place years before she had her stroke, it would have been mayhem. As I've stated many times, she had 4 very active years after her stroke, but that was because I stood up for her as the holder of her PofA. I was able to make demands for her that I know prolonged her active life. The doctors were done with her. Not because they thought her life was over, but simply because as one said, "she's 90 years old, she already beat the odds." I only had to step in after they started filling her with so many drugs, especially sleeping pills and tranquilizers, to keep her docile and quiet. Once I got her weaned of 15 of the 17 drugs they were loading her up with, she was quite able to speak for herself. And she did. Doctors have their place, but they should not be involved with generating legal documents or conflating legal decisions with medical ones.

Dean

Peter,

That's why they have Advance Directives--so they won't be subject to the doctor's will, or to that of other's, but can be sure to assert their own individual rights.

Squishy Squashy

Former House majority leader Dick Armey resigned his position at the lobbying firm DLA Piper on Friday in response to a growing chorus of critics who claim his "grassroots" advocacy group, FreedomWorks, is little more than an extension of the American pharmaceutical industry.

Naturally, Armey blamed his decision to resign on the liberal media. "The firm is busy with its business, and shouldn’t be asked to take time out from their work, to defend themselves of spurious allegations,” he told Politico. “No client of this firm is going to be free to mind its own business without harassment as long as I’m associated with it."

FreedomWorks has not been shy about its role in inflaming protests against health care reform. Last week it released an "August Recess Action Kit" and its website even provides a ten-point action guide on "How to Organize Your Own 'Tea Party' Protest."

http://www.politico.com/news/stories/0809/26128.html

He doesn't like the deal cooked by Pharm.

Very interesting.

Dean

Sue,

Nothing about 1233 changes the physician's legal status in AD.

Parking Lot

Deano

(((2) In a politicization of these, these were transformed into "death panels";)))

Sorry Deano, you are arguing a straw man. That is not what Palin was talking about, not at all.

You are attempting to muddy the waters and it's a pathetic attempt at best.

Dean

Really? Armey resigned from Piper? Now that's news.

Dean

Parking Lot,

Can you cite the provision she was then referring to--or was it no provision at all?

clarice

Utterly OT--Until very recently Jackson Hole had a small airport apparently well equipped to hsndle the few commercial flights here a day. Right now it's undergoing an expansion thanks to the stimulus bill. Maybe a number of those owners of $35 million ranches felt the private runways were getting too crowded.

Cecil Turner

And the proposed statutory language?

At the risk of repeating myself again, the "statutory language" will change at least once (in conference), and is likely to get a substantial overhaul (if past experience is any guide).

Section 1233 of H.R. 3200 is the section from which "Death Panels" were being inferred.

May be what you inferred. It isn't the topic of the conversation with the President, which is handily summarized in the post above (and linked).

If you disagree, can you please point to the other more relevant section?

Just did. Somebody ain't payin' attention.

PeterUK

Dean,

"That's why they have Advance Directives--so they won't be subject to the doctor's will, or to that of other's, but can be sure to assert their own individual rights. "

Having seen all sorts of contracts and wills being broken and suppressed,I can only say you have a touching belief in the law which does not not reside in the world of reality.

The main problem is government is again encroaching on the rights of the private citizen. Government is now telling you what is permitted.

Ranger

I hear you. The day that ABC commercials become law, there will be reason for real concern.

Posted by: Dean | August 14, 2009 at 07:19 PM

No, the reason for concern is that the people writing the current law have clearly expressed their desire to limit healthcare to those who are lower on the non-subjective, total life value scale.

As others have pointed out, what is "in the law" and how the law gets used in the future once it is passed are totally differnt things. We have been told over and over again that 'this law will never lead to this result' only to see that very result shortly there after.

The moment in the ABC infomercial for Obamacare was a glimps into the thinking behind the project. I have no desire to give those pushing that project even a little bit of room to enact their vison of how to run the health system.

tonguengroove

Is anyone old enough to remember when TV networks engaged in an expensive disinformation campaign directed at the Public, calling cable TV 'PAY TV'?

Kinda like the AMA's 50's campaign against 'Socialized Medicine', ain't it?

The Boogieman is gonna getcha.

Beware, 'The Shadow'.

The comments to this entry are closed.

Wilson/Plame