[owen] RE:Death panels

Thu Aug 13 16:35:42 UTC 2009

I bet Obama does not fully understand this bill, and I bet his top advisor does not fully understand this bill.
For several years now it is federally mandated that every patient that enters a hospital is asked if they have an Advanced Directive and if not do they want one. This is asked at the admissions desk, before they see a Doctor. When the patient is then admitted to the hospital the nurse then asks this same question again. I find most patients old and young are very decisive if they want everything done, including life support, or they do not want life support.  When the patient is non responsive it is very hard for the family to answer this question. 
I personally do not like the wording of the Advance Directive that we now have. It only adresses terminal conditions and persistently vegatative states. It does not address chronic conditions that can be controlled if the patient spends months and years on life support. Most people think they sign this form and they will not be put on life support. Their is another form that prevents this, but, the media does not address this other form. The bill had some wording that I thought might address this form, but did not specify it.

Yes, we do pull the plug on grandma now. When the family and Doctor agree that there is no chance of recovery. In the Advanced Directive there is a place to name a health care proxy to make your medical decisions when you cannot. Many, many times this health care proxy person is not emotionally able to make the decision to stop treatment and/or withdraw treatment, because they feel they are playing God. I feel we are letting God decide when we stop or withdraw treatment.
I am so glad we have family members who voiced their decison to not be put on life support, and signed forms. Go visit a long term facility where people on life support are living.

  ----- Original Message ----- 
  From: Daniel Owen 
  To: Owen Connections 
  Sent: Thursday, August 13, 2009 10:59 AM
  Subject: [owen] RE:Death panels

  In light of the continued harping on Sarah Palin's "Death panel" comments, I thought it appropriate to post her response.
  Call it fear mongering, call it vicious attacks, call it tripe or whatever you like.  I found it well researched, informative, and most importantly, truthful.  More than I can say for just about anything currently coming out of Washington.
  Please pay close attention to the quotes from Ezekiel Emanuel.  Scary, scary stuff coming from a top Obama advisor.  

  Concerning the "Death Panels"
   Yesterday at 10:55pm
  Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly, and the disabled would suffer the most under such rationing; and that under such a system these “unproductive” members of society could face the prospect of government bureaucrats determining whether they deserve health care.

  The President made light of these concerns. He said:

  “Let me just be specific about some things that I’ve been hearing lately that we just need to dispose of here. The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma because we’ve decided that we don’t, it’s too expensive to let her live anymore...It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, etc. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready on their own terms. It wasn’t forcing anybody to do anything.” [1]

  The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” [2] With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.

  Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program." [3] During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services. [4]

  Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” [5] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones.... 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?” [6]

  As Lane also points out:

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

  Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic. [7]

  Even columnist Eugene Robinson, a self-described “true believer” who “will almost certainly support” “whatever reform package finally emerges”, agrees that “If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.” [8]

  So are these usually friendly pundits wrong? Is this all just a “rumor” to be “disposed of”, as President Obama says? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:

  Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives.... It is egregious to consider that any senior citizen .... should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. [9]

  Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens....An obvious example is not guaranteeing health services to patients with dementia.” [10] Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” [11]

  President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.

  [1] See http://blogs.abcnews.com/politicalpunch/2009/08/president-obama-addresses-sarah-palin-death-panels-wild-representations.html.
  [2] See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
  [3] See HR 3200 sec. 1233 (hhh)(1); Sec. 1233 (hhh)(3)(B)(1), above.
  [4] See HR 3200 sec. 1233 (hhh)(1)(E), above.
  [5] See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
  [6] See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html].
  [7] Id.
  [8] See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.html]. 
  [9] See http://www.nysenate.gov/press-release/letter-congressman-henry-waxman-re-section-1233-hr-3200.
  [10] See http://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf
  [11] See http://www.scribd.com/doc/18280675/Principles-for-Allocation-of-Scarce-Medical-Interventions.

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