A Basis Is Seen for Some Health Plan Fears Among the Elderly

9 comments on “A Basis Is Seen for Some Health Plan Fears Among the Elderly”

1. Cennydd says:

   August 24, 2009 at 2:15 am

   Some would see doctors and hospitals as taking the elderly in one door, waiting for death to take them, and then shoving them out another door in a box. That’s called “efficiency.” Thanks, but no thanks……seniors will have no part of that!

2. Branford says:

   August 24, 2009 at 3:37 am

   Charles Lane from the Washington Post had a clear article on this:

   . . . Enter Section 1233 of the health-care bill drafted in the Democratic-led House, which would pay doctors to give Medicare patients end-of-life counseling every five years — or sooner if the patient gets a terminal diagnosis.

   On the far right, this is being portrayed as a plan to force everyone over 65 to sign his or her own death warrant. That’s rubbish. Federal law already bars Medicare from paying for services “the purpose of which is to cause, or assist in causing,” suicide, euthanasia or mercy killing. Nothing in Section 1233 would change that.

   Still, I was not reassured to read in an Aug. 1 Post article that “Democratic strategists” are “hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors.”

   If Section 1233 is innocuous, why would “strategists” want to tip-toe around the subject?

   Perhaps because, at least as I read it, Section 1233 is not totally innocuous.

   Until now, federal law has encouraged end-of-life planning — gently. In 1990, Congress required health-care institutions (not individual doctors) to give new patients written notice of their rights to make living wills, advance directives and the like — but also required them to treat patients regardless of whether they have such documents.

   The 1997 ban on assisted-suicide support specifically allowed doctors to honor advance directives. And last year, Congress told doctors to offer a brief chat on end-of-life documents to consenting patients during their initial “Welcome to Medicare” physical exam. That mandate took effect this year.

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

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

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

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

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

3. Jeffersonian says:

   August 24, 2009 at 4:06 am

   Didn’t Obama tacitly admit this with his “give Granny a pain pill” reply? If some bureaucrat is making the determination that Granny gets Advil instead of a pacemaker, thus leading to her premature shedding of this mortal coil, can someone tell me why this isn’t the equivalent of the much-derided “death panel?”

4. Branford says:

   August 24, 2009 at 4:19 am

   And from the Wall Street Journal:

   . . . Last year, bureaucrats at the VA’s National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, “Your Life, Your Choices.” It was first published in 1997 and later promoted as the VA’s preferred living will throughout its vast network of hospitals and nursing homes. After the Bush White House took a look at how this document was treating complex health and moral issues, the VA suspended its use. Unfortunately, under President Obama, the VA has now resuscitated “Your Life, Your Choices.”

   Who is the primary author of this workbook? Dr. Robert Pearlman, chief of ethics evaluation for the center, a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing.

   “Your Life, Your Choices” presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political “push poll.” For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be “not worth living.”

   The circumstances listed include ones common among the elderly and disabled: living in a nursing home, being in a wheelchair and not being able to “shake the blues.” There is a section which provocatively asks, “Have you ever heard anyone say, ‘If I’m a vegetable, pull the plug’?” There also are guilt-inducing scenarios such as “I can no longer contribute to my family’s well being,” “I am a severe financial burden on my family” and that the vet’s situation “causes severe emotional burden for my family.”

   When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel? . . .

5. Daniel says:

   August 24, 2009 at 4:22 am

   Guys, you don’t get it. Follow the money. In 2010, absent any legislative changes, the Bush tax cuts expire. Among all of them, the estate tax exemption will drop back down to $600,000. That has the potential to pump a lot of dollars, even post-2008 crash, into the federal coffers to be distributed to those who will vote reliably Democratic. So, hastening Grandma and Grandpa’s journey to the great beyond is a twofer – it cuts expensive medical costs and gets the government’s hands on any money they saved, which, of course, they already paid taxes on when they earned it.

6. Capt. Father Warren says:

   August 24, 2009 at 4:48 am

   #5 Daniel, which is another reason why a whole lot of folks have said this whole Obama agenda is not about health care: it is about control and Grandma’s money. Thank you for your point.

7. The Lakeland Two says:

   August 24, 2009 at 5:20 am

   Good points, all.

8. Cennydd says:

   August 24, 2009 at 5:32 am

   This is ONE Grandpa who has absolutely NO INTENTION of “shuffling off to Buffalo” via Obama’s plan. And he AIN’T getting MY money……it’s going to my wife, our children and our grandchildren……I made sure of that! And my wife did the same thing.

9. Cennydd says:

   August 24, 2009 at 9:44 am

   And a good chunk will go to the Church when the time comes; our attorneys have seen to that.