Posted on 07/17/2014 6:40:22 AM PDT by wagglebee
In a recent Politico Magazine article titled, “Let’s Talk About Death Panels,” Harold Pollack urges reviving one of the most notorious proposals that did not make it into the Obama Health Car Law – “advance planning consultations.”
During the debate over Obamacare’s enactment, there was considerable controversy over a provision in an early version under which health care providers would have been paid by Medicare to discuss with their patients whether they would want life-saving medical treatment.
After former Alaska governor and vice-presidential candidate Sarah Palin dubbed the planning sessions “death panels,” the provision was dropped from the law ultimately enacted.
As Pollack acknowledges, “The ‘death panel’ charge stuck because it tapped into the primeval fears of millions of Americans. It’s only human to worry that we might someday be abandoned when we are old and sick, and thus judged to be a social burden. Such worries run especially deep among senior citizens, who had the most reason to feel vulnerable, and who perceived that they had the least to gain from the ACA.”
In the time since the “advance care planning” provisions were struck from the Obama Health Care law, there have been several attempts to resurrect the concept through various stand-alone bills in the House and Senate. Now, according to media reports, the American Medical Association (AMA) is working directly with the Obama Administration to implement reimbursement by administrative action, bypassing Congress.
In to a Stateline Article from the Pew Foundation titled, “Feds to Consider Paying for End-of-Life Planning,” Michael Ollove writes, “The current effort began last year, when the Illinois State Medical Society recommended that the AMA adopt specific medical codes for the reimbursement of doctors for advance care conversations. Medical codes provide a uniform description of hundreds of medical procedures and services and are used by medical providers, hospitals and insurers across the country. In response to the Illinois request, an AMA panel approved a new code for advance planning.”
The AMA is expected to submit the proposal to the Centers for Medicare & Medicaid Services soon so that providers all across the country can be reimbursed for these “advance planning conversations.”
Such federally funded “advance care planning” conversations pose a very real danger, because they are likely to be used to nudge people to reject life-saving medical treatment they might otherwise want.
Advocates of using tax dollars to pay for “advance care planning” claim it is intended to promote neutral, fully informed planning by which patients can be assisted to implement their own values through legally valid advance directives. Unfortunately, however, there is abundant evidence that a combination of cost pressures and the ideological commitment of a significant number of health care providers to limitation of life-saving treatment for those deemed to have a “poor quality of life” would in practice lead to many federally funded advance care planning sessions being used to exercise subtle – or not-so-subtle – pressure to agree to reject life-preserving treatment.
While the advance care planning provision in the early version of what became Obamacare was being debated in Summer 2009, author and blogger Lee Siegel, in general a strong advocate of President Obama’s approach to health care restructuring, wrote:
[O]n one point the plan’s critics are absolutely correct. One of the key ideas under end of-life care is morally revolting.
. . . .
The section, on page 425 of the [original House] bill, offers to pay once every five years for a voluntary, not mandatory, consultation with a doctor, who will not blatantly tell the patient how to end his or her life sooner, but will explain to the patient the set of options available at the end of life, including living wills, palliative care and hospice, life sustaining treatment, and all aspects of advance care planning, including, presumably, the decision to end one’s life.
The shading in of human particulars is what makes this so unsettling. A doctor guided by a panel of experts who have decided that some treatments are futile will, in subtle ways, advance that point of view. Cass Sunstein, Obama’s regulatory czar, calls this “nudging,” which he characterizes as using various types of reinforcement techniques to “nudge” people’s behavior in one direction or another. An elderly or sick person would be especially vulnerable to the sophisticated nudging of an authority figure like a doctor. Bad enough for such people who are lucky enough to be supported by family and friends. But what about the dying person who is all alone in the world and who has only the “consultant” to turn to and rely on? The heartlessness of such a scene is chilling.
It has become widespread to now talk about treatment as being costly and burdensome, depending on one’s ‘quality of life.” Pollack himself illustrates this, writing, “Under the current system, physicians can bill Medicare for aggressive imaging, procedures and chemotherapies treatments that may bring little patient benefit in advanced illness. Doctors and hospitals are far more handsomely rewarded for the placement of a feeding tube or a ventilator than they are for meeting with patients and families to determine whether these therapies are helpful or wise.”
In a taxpayer-funded advance care planning session, a patient with cancer might well be told chemotherapy provides little benefit because it will leave him or her with a disability and only “prolong life,” without a cure. The extra period of life might be exactly what a person would want, but because the treatment was presented in such a negative way the patient might well be lead to agree to reject treatment.
A major campaign (the subject of a forthcoming NRL News Today article) is now being waged to show videos to patients that are clearly weighted to persuade them to forego cardio-pulmonary resuscitation, and its proponents do not hesitate to cite the financial savings associated with the increased number of viewers (as opposed to patients not subjected to the videos) who agree to DNRs. Importantly, there is no apparent realistic way to adequately monitor the interactions in such tax-funded sessions to ensure that the presentation of options is done in a neutral way, rather than one biased toward rejection of treatment.
A precedent on the federal level is a Veterans Affairs patient decision-making aid that was the subject of considerable discussion during the debate over the Patient Protection and Affordable Care Act, a 53-page production entitled “Your Life, Your Choices.” The booklet had worksheets to fill out for “Current Health,” “Permanent Coma,” “Severe Dementia,” “Severe Stroke” and “A future situation of concern when I might not be able to express my wishes.”
For each of these there was a section on “quality of life.” Only for current health was there a choice to affirm that life is worth living without reservation. For all of the others, the choices were “Life like this would be difficult, but acceptable,” “Life like this would be worth living, but just barely,” and “Life like this would not” – the “not” is underlined – “be worth living.” In each circumstance except current health a negative picture was given. For example, “Terminal Illness” was described as a state in which you “have a lot of discomfort that requires medication [,] are in bed most of the time due to weakness [, and] need help with getting dressed, bathing, and bowel and bladder functions.” You can read more about this at www.nrlc.org/archive/news/2009/NRL07-08/RationingPage1.html; and www.nationalreview.com/articles/228199/your-life-not-worth-living/jim-towey.
Of course, what people experience when terminally ill varies widely depending on the particular illness and many other factors, but this booklet seemed designed to lead people to believe that life with terminal illness will be almost unremittingly bleak. In the words of Paul Malley, President of the national non-profit organization Aging with Dignity, “’Your Life, Your Choices’ encourages our nation’s service men and women to look at illness and disability as things that render life not worth living.”
When “advance planning” is so heavily promoted by advocates of cost-cutting and the “quality of life” ethic, we need to consider it with a critical eye – one that asks “who is driving these conversations, and what will they say to people in a vulnerable position?”
Note: The National Right to Life Committee supports the use of advance directives by which individuals may indicate their wishes regarding medical treatment should they become incapable of making health care decisions; indeed, we promote our own alternative, the “Will to Live,” and make available separate forms complying with the laws of each of the states.
Our concern is that in practice federally funded “advance care planning sessions” are likely to pressure patients into rejecting treatment essential to preserving their lives in a manner they would be unlikely to agree to under conditions of truly informed consent.
LifeNews Note: Jennifer Popik is a medical ethics attorney with National Right to Life. This column originally appeared in its publication National Right to Life News Today.
Actually, the charge stuck because it's TRUE.
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End of Life discussion? Who are we talking about here? The patient......or the doctor?
“advance care planning sessions”
how special.....and ever so very Planned Parenthood like
Or Obama?
There's a certain amount of Cosmic justice involved here.
Our vaunted and venerated Senior Citizens have been voting for these control freaks for decades. Falling for their promises of goodies and bennies while not considering that it will be their own children and grandchildren who will pay for it all.
Not ALL of them obviously, but enough.
I saw a bumper sticker on an RV once that read, "Spending our kids' inheritance"
Yeah. Not to mention their taxes.
Okay. Commence flaming.....now.
I predicted that they would make us pay for abortions, sex ‘change’ operations, aids treatment, and euthanasia, while sending normal old people off to die.
I know these people.
Please be careful what you say, because all of ‘The Greatest Generation’ aren’t dead, yet. You have no idea how many of the Boomer generation were Patriots. A bunch of insane kooks like Ayers do not represent the whole group.
I have a family member facing the death panel soon, as she has run out of money (over $100,000 cash wiped out within 2 years by dems who took control of the money via her disgruntled sister) and is being transferred from the DSS control of person, to an agency for the person that makes these ‘end of life planning’ decisions.
She told everyone beware Obama, and did not vote for him.
I find the following statement offensive....ignorant. My generation is more conservative than younger generations.
“There’s a certain amount of Cosmic justice involved here.
Our vaunted and venerated Senior Citizens have been voting for these control freaks for decades. Falling for their promises of goodies and bennies while not considering that it will be their own children and grandchildren who will pay for it all.”
Unbelievable!
As obama once proudly stated: “Just give ‘em a pain pill”.
I have been saying for sometime now that I pity the fate in store for the Boomers.
A great many in my generation will have little issue with this. After hearing for years that we OWE them a second childhood, the next logical step is that the one paying the bills gets to make the decisions.
Sadly, most don’t want to hear that. The life of a turkey is mighty fine till the day before Thanksgiving I guess.
They never dreamed the government would morph into such a corrupt and self-serving organization. Who ever imagined a government systematically dismantling the fabric of this great nation AND a media so willing to aid and abet?
I think you should cut them a little more slack.
I was careful. Didn't you notice how I capitalized the word "all" after the word "not"? Apparently not. Please re-read. I accept your apology ahead of time.
You have no idea how many of the Boomer generation were Patriots.
It's not a question of their patriotism. It's a comment on their gullibility and selfishnesss.
A bunch of insane kooks like Ayers do not represent the whole group.
Please re-read my opening statement once again. I didn't say he did. Obviously these Congressholes handing out goodies garnered more than 50% of the vote, though, and I wasn't around to vote for them when they started their careers 50 years ago.
I have a family member facing the death panel soon, as she has run out of money (over $100,000 cash wiped out within 2 years by dems who took control of the money via her disgruntled sister) and is being transferred from the DSS control of person, to an agency for the person that makes these ‘end of life planning’ decisions. She told everyone beware Obama, and did not vote for him.
This didn't start with Obama. It started decades ago. Your family member may very well have voted for Congressholes her entire life who promised him or her a lifetime of ease. If she didn't, enough of her friends and fellow family members obviously did. That's my whole point.
I find the following statement offensive....ignorant. My generation is more conservative than younger generations.
I have no idea who the ignoramus was who made such an ignorant statement, but I wholeheartedly agree.
“There’s a certain amount of Cosmic justice involved here. Our vaunted and venerated Senior Citizens have been voting for these control freaks for decades. Falling for their promises of goodies and bennies while not considering that it will be their own children and grandchildren who will pay for it all.”
Amen.
Unbelievable!
And that is why people like Obama (if that's his real name) will continue to be elected well into the future.
It takes courage to face facts.
Obamacare allows ‘death panels’ with nice names for local beaurocrats, who take over from your STATE agency (DSS) who controls the person, if even one complaint is filed against a caretaker, DPOA, or child... They appoint a Guardian of the Estate, and then they can fleece the person. Once the money is gone and no money left for nursing home, then that person is transferred from ‘DSS guardianship of the person” to” ‘local group (name?) guardian of the person’ by a court hearing. Then decisions for their care is made by that panel.
They counsel them in ‘end of life’ decisions.
Sarah Palin termed it ‘death panels’ as suicide is part of that ‘end of life’ decision. Dementia patients will sign anything.
It was onlhy a matter of time until Death Panels reemerged.
Once government becomes the sole provider of medical care the financial incentive to reduce the amount of health care that individuals consume must become of paramount importance.
Who uses the most medical care? Those approaching the end of life of course. How can we reduce the amount of health care these people consume? Obviously by ending their life sooner.
Other financial incentives also emerge. It is typically the old who are approaching the end of life. The old are typically also not paying taxes any longer but are receiving entitlement payments.
So there are several financial incentives pushing the government toward Death Panels. Ending life prolonging treatments cuts the cost of medical treatment for those dying and cuts short the payments to the old and no longer productive (tax wise) entitlement recipients.
Now that government health care is reality it is only a matter of time before we are all subjected to the advise from a government health care advisor Time to Die'
I agree.
But if you look at how many Congressholes are in their 80s, 90s and 100s, you cannot deny they started their careers well before people even in their 50s such as myself ever had a chance to vote for them.
Admittedly, my fellow Baby Boomers have our own slate of Candymans (Candymen?) to account for.
We will pay the piper ourselves one day unless we warn our own children and grandchildren what their future holds because of our selfishness.
Start by begging their forgiveness.
That's all true. It's also true that between the screwed up coverage and the screwed up reimbursements, both doctors and patients could easily find some common ground in their private conversations.
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