OFFLINE

keep in mind guys, this is from the uber-lib NY times.



WASHINGTON — When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress.

Opponents said the Obama administration was bringing back a procedure that could be used to justify the premature withdrawal of life-sustaining treatment from people with severe illnesses and disabilities.

Section 1233 of the bill passed by the House in November 2009 — but not included in the final legislation — allowed Medicare to pay for consultations about advance care planning every five years. In contrast, the new rule allows annual discussions as part of the wellness visit.

Earl Blumenauer of Oregon, the author of the original end-of-life proposal, praised the rule as “a step in the right direction.”

After learning of the administration’s decision, Mr. Blumenauer’s office celebrated “a quiet victory,” but urged supporters not to crow about it.

“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”

Moreover, the e-mail said: “We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ — e-mails can too easily be forwarded.”

The e-mail continued:   “Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”

i guess they just planned on keeping it a secret for our own good.

OFFLINE

Having recently death with the death of a parent earlier in the year, I don't see anything in what was written above that is different than what has gone on before.  My mother had been in declining health for several years and as the end neared, the drawing up of a "Do Not Resuscitate" (DNR) document was discussed regularly and in morbid detail.  As hard as it was it was the right thing to do.  The whole family went into this with our eyes open and under absolutely no duress.  

OFFLINE

I know many have had problems with elders in their care not having a "plan" in regards to the way they are cared for before and after they pass.  It is a fight that no one wants to have if their elder parent doesn't want a feeding tube but there is no DNR order in effect, the doctor will do whatever they chose to do.  It is designed to frighten people.  The way the Republican party presents this isn't accurate, NY Times or not.

OFFLINE

Working in health care and in a field with a large mortality rate (cancer registry so cancer patients) I can tell you that there is a lot of confusion over palliative care, living wills, DNRs and the whole dying process.  My main concern that I see is that patients and families need to be educated LONG before this is even a concern.  

I recently had surgery and at age 30 had my living will, health care power of attorney, and organ donation information completed and copied to the hospital and my doctors.  My surgeon whom I asked about the living will (just that I didn't want to be a vegetable if something happened) and he seemed perplexed that I (a young person) would be concerned about this.  With the growing medical malpractice/medical litigation claims, hospitals and providers feel the need to protect themselves and patients need to state what they want.  The days of doctors making the decisions alone are gone because I think a lot of them are afraid.

Palliative care is a valid medical practice and I think the labeling of "death panels" is just a scare tactic that was deployed to make others fearful... aka fearmongering.

OFFLINE

i don't have a problem with this the way it reads. my only concern is with the unintended consequences/possible abuses, and of course with the, shall we say, less than transparent way its being implemented.

OFFLINE

Originally Posted by Dødherre Mørktre:
i don't have a problem with this the way it reads. my only concern is with the unintended consequences/possible abuses, and of course with the, shall we say, less than transparent way its being implemented.

But I think that again comes from the fear that many have about what this could mean instead of what it will mean...

OFFLINE

Palliative care is assuming the patient is being proactive about their end of life decisions, and that ultimately it is him/herself that is making the decision. Death panel implies that a government bureaucrat(s) is playing a role in those decisions. Since Obamacare has a bureaucrat influencing every healthcare decision there will to be a death panel somewhere.

Sarah Palin was brilliant in this regard, she set the phraseology on this debate, and that pretty much guarantees that she will win it. E.g. the Ground Zero Mosque was relabeled as the Park51 Mosque;  also notice how illegal immigrant is being replaced by undocumented worker. We live in such a soundbite world the name or phrase something takes on determines if it wins or loses in the battle for public opinion.

OFFLINE

Originally Posted by Laura Vondenhuevel:

Originally Posted by Dødherre Mørktre:
i don't have a problem with this the way it reads. my only concern is with the unintended consequences/possible abuses, and of course with the, shall we say, less than transparent way its being implemented.

But I think that again comes from the fear that many have about what this could mean instead of what it will mean...

yeah, i trust my government about as far as i can throw it.