"end-of-life" care and rationing under Obamacare...

[shagdrum]

Undue Influence
The House Bill Skews End-of-Life Counsel

About a third of Americans have living wills or advance-care directives expressing their wishes for end-of-life treatment. When seniors who don't have them arrive in a hospital terminally ill and incapacitated, families and medical workers wrestle with uncertainty -- while life-prolonging machinery runs, often at Medicare's expense. This has consequences for families and for the federal budget.

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.

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.

What's more, Section 1233 dictates, at some length, the content 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.

As it happens, I have a living will and a durable power of attorney for health care. I'm glad I do. I drew them up based on publicly available medical information, in consultation with my family and a lawyer. No authority figure got paid by federal bean-counters to influence me. I have a hunch I'm not the only one who would rather do it that way.

 

[shagdrum]

Obama's Euthanasia Mistake
by Lee Siegel

he Republicans carping about limitations on end-of-life care have a point. Lee Siegel on why the plans Obama is endorsing are dangerously sympathetic to "cost effective" end-of-life treatments.

For those of us who believe that the absence of universal health care is America’s burning shame, the spectacle of opposition to Obama’s health-care plan is Alice-in-Wonderland bewildering and also enraging—but on one point the plan’s critics are absolutely correct. One of the key ideas under consideration—which can be read as expressing sympathy for limitations on end-of-life care—is morally revolting. And it’s helping to kill the plan itself.

Make no mistake about it. Determining which treatments are “cost effective” at the end of a person’s life and which are not is one of Obama’s priorities. It’s one of the principal ways he counts on saving money and making universal healthcare affordable.

Obama told Diane Sawyer in June that government should “study and figure out what works and what doesn’t. And let’s encourage doctors and patients to get what works. Let’s discourage what doesn’t.”

Sawyer then asked him: “Will it just be encouragement? Or will there be a board making Solomonic decisions?”

Obama replied, “What I’ve suggested is—is that we have a—a commission that helps—made up of doctors, made up of experts, that helps set best—best practices.”

When Sawyer pressed him to say whether those practices would be enforced by law, he evaded the question.

This reeks of the Big Brother nightmare of oppressive government that the shrewd propagandists on the right are always blathering on about. Except that this time, they could not be more right.

Leave aside the argument for ending life when its prospects for continuing seem too painful or too hopeless. Leave it aside because this is one case where Kant’s beautiful categorical imperative—act as though your particular deeds should be a universal law—will never apply. We know that theft and murder are wrong because if they were universally committed, the world would explode in chaos. But the decision to end your life before nature wrenches it away is as rational and humane as the decision to prolong your life by whatever means necessary. Life is too specifically precious to turn its final phase into any type of universal practice, whether it’s enforced by custom or by law.

As for the argument that fruitless tests and “senseless” procedures are bankrupting the health-care system, that is an insult to the intelligence. No one knows which tests and procedures will be effective beforehand. No amount of “study” and research is going to address the particular case and the particular condition, let alone the particular, desperate, irrational will to live—which, in animal terms, is pragmatic and rational.

(And anyone who thinks that we are not all animals—even the “experts” Obama is so enamored of— must read David Rieff’s remarkable account of his mother Susan Sontag’s refusal to accept her doctors’ verdict of imminent death. The will to live does not suddenly become an error of judgment just because a “system” cannot “afford” to accommodate it, especially when the system has the means to do so.)

Most consequential of all, even if limitations were put on certain tests and procedures, the only people who would be affected by it would be the people who, presumably, are the ones meant to be rescued by the very plan that would be imposing those limitations. The financially strapped, in other words, who are the intended beneficiaries of the health care plan would be the only people forbidden access to expensive life-extending technology. The rich will always be able to afford it.

Once the technology to extend life has become available, you cannot restrict its availability. That would be like only letting some people use cell phones. Such technology is a drain on the system? Then save money elsewhere. It’s ironic that lacking the will to tax the very wealthy, some of health-care supporters in Congress now wish to save money by limiting end-of-life options to the economically burdened.

Where is Obama coming from? Why is such an apparently humane man not more strongly condemning a utilitarian initiative straight out of Victorian England? A good part of the explanation has to do with the University of Chicago Law School milieu that Obama comes out of. By far, the most influential figure in that world is Judge Richard Posner, who teaches law at Chicago and publishes streams of pompous, robotically written books that are much praised and little read.

Judge Posner is both an enthusiastic advocate of euthanasia and an energetic eugenicist. He once wrote of Oliver Wendell Holmes’ ideas about eugenics—Holmes believed that a just society “prevents continuance of the unfit”—that “we may yet find [Holmes’] enthusiasms prescient rather than depraved.”

Cass Sunstein, who is Obama’s nominee for regulatory czar, is a disciple of Posner and believes in what Time magazine describes as “the statistical practice of taking into account years of life expectancy when evaluating a regulation.” In other words, Sunstein believes that the lives of younger people have a greater value than those of the elderly. This, obviously, would have a radical bearing on end-of-life considerations.

End-of-life treatment is still under consideration and would be a tiny sliver of Obama’s health-care package. But it is a highly volatile sliver. Betsy McCaughey, who singlehandedly killed the Clintons’ health-care initiative 15 years ago with her infamous and infamously inaccurate cover story in The New Republic, claims that this small passage in the bill “would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.” Not quite. But—painful as it is to concede anything to an ideological hack like McCaughey—it’s uncomfortably close.

The section, on page 425 of the 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 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.

Yet many liberals seem drawn to such fantasies of power and control. We live in a highly quantified society, entertained on all sides by divertissements that reduce human life to cute little anecdotes illustrating the morality of statistical, utilitarian analysis, from Malcolm Gladwell to Freakonomics and beyond.

A few weeks ago, The New York Times Magazine unfathomably ran an entire essay arguing, in effect, for a eugenic attitude toward end-of-life treatment written by Peter Singer, a Princeton University “bio-ethicist” whose views are squarely in line with those of Posner and Oliver Wendell Holmes. The essay drove the conservatives opposing Obama’s health-care plan into even greater apoplexy, as it should have. The only point on which it convinced was that euthanasia is morally acceptable only as an antidote to tenure.

One of Obama’s most alluring traits has been what some see as a literary bent that relishes complexity, irony, and even the mystery of the human personality. Let him turn toward that part of his nature and leave the sterile precincts of utilitarian social and legal theory behind. He should immediately and publicly declare his commitment to not placing economic hurdles in the way of people who want to prolong their life, or the life of their loved ones. In that way, he would take the air out of charlatans like McCaughey. And he would calm the fears of people who, far from being right-wing fanatics, are in clear-eyed possession of perhaps the only universal truth there is. No one wants to die.

 

[shagdrum]

And from here...

In any system that promises top-down control of medical care costs, the end effect will be rationing of services by artificial methods that get at least partly disconnected from the patient. The specific methods may be murky, but Charles Lane at the Washington Post has some questions about one section of the House version of ObamaCare. Section 1233 imposes a requirement for end-of-life planning sessions every five years for Medicare patients — and immediately after patient gets a terminal diagnosis. Lane wonders why that section gets dropped into a bill that purports to “bend the cost curve”...

While people should be able to access “end-of-life planning” when they desire, and having a living will is a good idea, it isn’t the role of government to push those ideas in a hard-sell approach. It shouldn’t be the government’s business in any case, but this shows how getting the government involved in your health care reduces your privacy and your rights to individual choice.

These aren’t “death panels,” but they’re creepy nonetheless. They’re sales presentations for surrender. If HMOs required patients over 65 and with potentially life-threatening diagnoses to sit through presentations about how great hospice care and plug-pulling orders are, people would rightly scream about it from the rooftops. And patients can change HMOs and insurers now, or opt to pay out of their own pocket; when government takes over health care, there will be nowhere to run.

And what happens when these sales presentations fail to get people to agree to die quickly for the greater good, and the projected cost savings do not appear? How long will Section 1233 remain “voluntary,” even in name?

This is nothing other than an attempt to save money by convincing the sick and the elderly not to seek life-saving medical treatments. In Barack Obama’s words, Section 1233 is where government says, “Maybe you’re better off not having the surgery, but taking painkillers.“ Monty Python had it just about right more than thirty years ago:

YouTube - Monty Python-Bring out your dead!​

 

[shagdrum]

Look at the trend in any country with universal healthcare, they eventually have to start rationing costs because of the economic unsustainablity of universal healthcare. That disproportionately effects the very young and the elderly.

This bill already is putting mechanisms in place to pressure the elderly to not get the coverage they could in order to save costs. The porkulus bill already established a National Coordinator of Health Information Technology which, "monitor(s) treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446)." (page numbers refer to the H.R. 1 EH version of the bill at this link)

According to this link:

Hospitals and doctors that are not “meaningful users” of the new system will face penalties. 'Meaningful user' isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose'“more stringent measures of meaningful use over time' (511, 518, 540-541)

What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the 'tough' decisions elected politicians won’t make.

The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192).​

Death panel indeed.

 

[foxpaws]

Shag, you need to stop....

Of the many, many, well, way tooooo many provisions in this bill - this one is one of the few that had bi-partisan support. It is an excellent provision that will help our elderly who are poor, or just need some crucial information. It will also help families and loved ones understand what the desires would be of someone who is dying, and who might not be able to communicate those desires any longer.

What you are posting sounds like 'whoops we were caught with our pants down - so now we need to find a way to make this provision sound bad, so we won't look foolish'.

I have an afternoon of meetings - but, to say something that is 'voluntary' and is a good thing will turn out to magically be 'mandatory' and a terrible thing is really going over the edge with assumption and fear.

 

[shagdrum]

to say something that is 'voluntary' and is a good thing will turn out to magically be 'mandatory' and a terrible thing is really going over the edge with assumption and fear.

It is going "over the edge" when it has happened in other countries that have enacted this type of legislation? While you may want to characterize this as an unrealistic fear and nothing more then fearmonguring, reality and the historical record prove you wrong.

These are very legitimate concerns about these type of systems that go back to before this specific legislation was even written. It is not only rude of you to dismiss those concerns out of, but either disingenuous or exceedingly naive; based in unrealistic wishful thinking. If you don't take these concerns seriously, you are going to have to make better argument then simply trying to marginalize them to relieve those concerns.

In fact, mocking, smearing, condesending or otherwise trying to ostracize those legitimate concerns only serves to marginalize you and your argument to anyone who has those concerns (which is most of the country) by showing an arrogant dismissal for those concerns.

Maybe you should look past your liberal worldview and attempt to understand this point of view if you hope to actually be taken seriously in this discussion.

Trust the Government
by Newt Gingrich

How much is one additional year of your life worth?

Or one more year of life for your father or your wife? For your child?

In Great Britain, the government has settled on a number: $45,000.

That’s how much a government commission with the Orwellian acronym NICE has decided British government-run health care will pay for one additional year of life for a British subject.

Think it could never happen here? Then you need to pay closer attention to what Washington is planning for your health care.

British Government Bureaucrats Literally Decide if Your Life is Worth Living

The British single-payer bureaucrats arrived at the price of an additional year of life in the same way they decide how much health care all British people will get, through a formula called “quality-adjusted life years.”

That means that if you’re sick in Great Britain, government bureaucrats literally decide if your life is worth living and, if so, how much longer and at what cost.

If it’s more than $45,000, you’re out of luck.

A Well-Connected White House Advocate for Allocating Health Care Based on Perceived Societal Worth

In the highest levels of the Obama Administration there is a theory of how to ration health care that is troublingly reminiscent of the British system of “quality-adjusted life years.”

Dr. Ezekial Emanuel is a key health care advisor to President Obama and the brother of White House Chief of Staff Rahm Emanuel. Earlier this year, Dr. Emanuel wrote an article that advocated what he called “the complete lives system” as a method for rationing health care. You can read it here.

The system advocated by Dr. Emanuel would allocate health care based on the government’s perception of the societal worth of the patients. Accordingly, the very young and the very old would receive less care since the former have received less societal investment and the latter have less left to contribute.

“Forstall[ing] the Concern that Disproportionate Amounts of Resources Will be Directed to Young People with Poor Prognosis”

“The Complete Lives System” would also consider the prognosis of the individual.

Quoting Dr. Emanuel: “A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern that disproportionately large amounts of resources will be directed to young people with poor prognosis.”

When fully implemented, Dr. Emanuel’s system, in his words, “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”

“Chances that are attenuated” is a nice way of saying the young and the old are considered less worthy of health care and, under this system, will get less.

Once Government Becomes the Provider of Health Care, Personal Decisions Become Public Decisions

The point is not that a health care rationing system like the one favored by Dr. Emmanuel will be implemented in the United States tomorrow.

The point is that, as in the British system, once government becomes the single payer or even the main payer of health care, what were once intensely personal decisions become public decisions. And as costs rise, government will look for ways to contain them.

The inevitable result of this pressure to control costs will be rationing, whether it occurs during this administration or the next. At some point, the government will be forced to deny care to those who don’t meet the latest “quality-adjusted life years” cost-benefit analysis.

So the decision on what treatment to pursue that once would have been made by you and your doctor is now made for you by a bureaucrat using a formula -- a formula to literally determine if your life is worth saving.

The Camel’s Nose Under the Tent of Health Care Rationing

Societies don’t arrive at this point overnight.

British health care was nationalized soon after World War II, but NICE, the health care rationing agency, wasn’t created until the late 1990s as a way to control costs.

Today NICE routinely denies Britons life-prolonging drugs that are deemed not “cost effective” -- drugs that are widely prescribed in America to treat cancer, Alzheimer’s disease and other serious conditions.

The result, studies show, is that Great Britain’s cancer survival rates are among the worst in Europe and lag behind the United States.

In America, Rationing Begins with Comparative Effectiveness Research (CER)

In our country, the road to dehumanizing, bureaucratic health care rationing begins with something called comparative effectiveness research (CER). It sounds completely innocent. In practice, CER means comparing different treatments for diseases to see which works best. And what doctor or patient would object to that, right?

The problem is that, in the context of a government-run health care system, comparative effectiveness research becomes a way to find a cheaper, one-size-fits-all approach to medicine that will limit health care choices for patients.

But don’t just take my word for it. Congressional Democrats included $1.1 billion in the Stimulus Bill for CER. Report language explaining the bill noted that the treatments found to be “more expensive” as result of the research “will no longer be prescribed” and that “guidelines” should be developed to manage doctors.

Congressional Democrats also killed several amendments to the current health care bill that would have prevented CER from being used to ration care. (To learn more about the common-sense amendments to the bill that have been blocked, click here).

The Government Has Determined You Must Take the Blue Pill

President Obama innocuously described the intended result of comparative effectiveness research like this: “If there’s a blue pill and a red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that’s going to make you well?”

Listen to what the President is saying here. He’s saying that the government is capable of determining which pill works best for you and should therefore only pay for that pill.

But this one-size-fits-all approach goes against everything modern medicine is learning about the genetics of the human body. Different individuals and members of different ethnic and age groups respond differently to treatments. More and more, treatment of diseases like cancer is highly individualized and based on a genetic analysis of both the patient and her disease. Science is leading us in one direction and the administration and the Congress are taking us in the other.

What if you get sick and your doctor says you need the red pill, but the government has determined that the blue pill is what works best for its budget? In a single payer health world, what do you do then?

Creating a Commission to do the Dirty Work

Government bureaucrats limiting health care choices is terribly unpopular of course, which is why politicians use terms like “comparative effectiveness research” instead of “rationing.”

Another method Washington uses to avoid complicity in health care rationing is the creation of government boards or commissions -- like Britain’s NICE -- to do the job for them.

President Obama has expressed his support for using the Medicare Payment Advisory Commission (MedPAC), a commission created to advise Congress on Medicare, to achieve cost savings under health care reform.

Because the commission’s decisions could only be over-ridden by a joint resolution of Congress, it would be virtually unaccountable to the people -- and nervous members of Congress could blame the commission for unpopular decisions.

Combine this kind of a commission with the “complete lives system” advocated by White House health care advisor Dr. Ezekial Emanuel and you end up with a government rationing board literally determining which Americans should live and which should die.

Just Trust the Government

Supporters of government-run health care dismiss these worries as alarmist. They argue that because their big government health care bill doesn’t overtly call for rationing, it is somehow illegitimate to talk about this danger.

But it is always legitimate to consider the long-term consequences of a government program. By refusing to have an honest debate of this issue -- to explore honestly the consequences of the “painful choices” that all supporters of government health care say must be made -- their argument boils down to nothing more than this:

Trust the government.

Trust the politicians who are passing 1000-page bills they haven’t read.

Trust the leaders who are demonizing the citizens seeking to express their disagreement by calling them “un-American.”

Trust the advisors who advocate sacrificing the weak and the old and then hide in the shadows.

Trust the government to know what’s best for the most intimate, most personal part of you and your family’s life: your health.

Go ask a British citizen if it’s worth it.

To just shut up and trust the government.
​

 

[luxuryrules]

Flat out, end of life counseling is OPTIONAL. End of story.

 

[shagdrum]

Flat out, end of life counseling is OPTIONAL. End of story.

It is "optional"...for now.

This bill (as well as the provisions set up in the porkulus bill) would establish certain precedents and puts in certain mechanisms to allow the government to indirectly ration health care, paving the way for them to do it forcibly later, as is the historical record of these type of programs.

Do you trust the government to not use those mechanisms to ration healthcare when costs inevitably blow up in their face?

Look at the, by itself innocuous Community Reinvestment Act (CRA) and how it, in large part, ultimately lead to housing bubble.

As it was originally written, all the CRA did was establish that government could influence and even dictate lending standards due to political concerns through a number of mechanisms. In the 1990's, an aggressive political agenda was attached to it and you saw the government flat out promoting the lowering of lending standards and bad loans. Long story short, that paved the way for the housing bubble.

How much worse is that going to be when government has mechanisms and precedents in place to start rationing healthcare, to determine weather you live or die? Leftists have already started trying to rationalize government rationing of healthcare (Peter Singer, Tom Daschle, etc.). Obama has danced around and dodged any question concerning it. In every country with universal healthcare, rationing has become and inevitable consequence. In Britian they write you off at $45,000 per year.

Look at the way Medicare and Medicaid costs have spiraled out of control. The reaction of the government is to try price controls which further skyrocket the price of medical procedures leading to more spiraling costs.

So, I as again, do you really trust the government to not use those mechanisms to ration healthcare in some fashion when cost inevitably blow up in their face?

 

[shagdrum]

I will point out that, weather you think this is a legitimate point or not, most of the country clearly has this concern. To arrogantly dismiss the point out of hand and simply smear those who make the point as "fearmongoring" only works to offend and inflame those of us who hold this concern and marginalize anything you say in this debate.

If you want to be taken seriously in this debate, you would be doing yourself a favor to treat this concern with respect because most in this debate hold that concern and treat it as legitimate. If you are only going to mock the concern and those who defend it instead of understanding it and reasonably countering it, you are basically shooting yourself in the food.

Trying the typical leftist tactic of condesendingly exerting a type of "cultural peer pressure" to marginalize this concern will backfire on you.

 

[foxpaws]

This is a concern, a huge concern - and how dare the right misrepresent this provision - it is fear mongering at its worse...

Show me shag, the link between voluntarily creating a living will and rationing…

Show me where in England there is anything in their health care plan that shows them forcing people to having living wills, which fall in line with the $45000 limit and then the British government using that living will to pull the plug to save money. Oh, guess what – there is no living will provision, they don’t get an opportunity to have a paid consultation with a physician and discuss this…

Oh, by the way-there are limits here, in the good ol’ USA - private insurers do dictate in their policies on how much they will pay and when the insurance money runs out, Medicaid or Medicare takes over. Guess what, without those programs – the insurance companies would be pulling plugs – but, they know they don’t have to deal with this, because they have the safety net of the government… how convenient…

So, in steps this bill – which allows you to talk to your doctor about this, and he will be reimbursed for his time, because you can’t pay him. So, for your little scenario to work out, the doctor will have to go against his Hippocratic oath and instead go with some ‘hypothetical’ government mandate (remember this is all speculation- there is absolutely nothing that would indicate this would happen – it is just this author’s assuming that this is the way doctors and government function). The doctor and the government will decide that you will put a dollar amount or a time limit in your living will.

I will allow the plug to be pulled after 45 days, or 45,000 dollars, which ever comes first…​

In fact, the author assumes that the doctors will be pressuring patients to shorten their lives, according to some government guideline – under the guise that the ‘nice, white coated doctor wouldn’t steer me wrong – would he?”

Doctors will be all for this, won’t they? Hell no…. not only does it go against everything they stand for, but, guess what, hypothetically, it gets them in the pocket too…. Less patients, less money. Far less money than the small amount of compensation that they would receive for giving the consultation in the first place. (Now, doctors wouldn’t do this – because it does go against what they stand for – but it is as ‘realistic’ as the inane scenario that this author has put into motion).

Maybe we should be worried that the doctors would be pressuring patients to hold out as long as possible – ‘never turn off the equipment, there is always that chance…’

Or, to offset this – I guess there would be a bonus program initiated by the government, so doctors are still allowed to make money. For every living will they get signed that meets government requirements, they get a check for $1000. After 10 patients, the government will throw in a all inclusive paid vacation for 2 in the US Virgin Isles, all you have to do is take 2 hours one afternoon and tour the lovely condo on the beach that can be purchase for only…

This provision is put in very specifically to make sure that it is your wishes being met. You have an option to talk to a doctor, without feeling that you are taking up his time needlessly (because he will be paid for this, just like he gets paid to consult with you regarding options of new knee vs rebuilt knee). Doctors are trusted professionals, with cause. Now everyone will feel like they can be in control of their end of life options. To have in writing that you don’t want extreme measures taken to keep you alive. Or that maybe you do want to be kept alive, because you believe that God will take you once he feels you are ready. The living will gives you options, not having one is what takes away options.

The author boasts that he has a living will, created with his family and an attorney’s input. He obviously trusted them both enough to feel comfortable with the decisions he has made with their consultation. Is that what it takes - a lawyer? I personally trust my doctor more, but would the provision be better if it also paid for a visit to your local law office? Or would we then have to be on the look out that the government would be rounding up lawyers for the same ‘bonus’ program I outlined for physicians?

Getting a living will is totally optional, there is no mandate, no penalty (other than the penalty everyone has if you don’t have a living will-that your wishes won’t be known, or followed), nothing that states the government will be suddenly in the rationing business by pushing off living wills with ‘expiration dates’.

For the right to take this provision and make it somehow evil and twisted shows how evil and twisted they are. They are using scare tactics in the very worse way. Preying on the fear of not having control over your body, even when death is approaching, when in fact this provision gives you the opportunity to have choices, to be in control. To talk to your doctor and make informed decisions. The right is demeaning doctors by assuming that they would fall in line with this horrendous scheme that they have created in their sick minds. This is so wrong in so many ways….

I don't like the health plan - but, when I read this provision I thought that here was something that they got right.

 

[Calabrio]

I don't like the health plan - but, when I read this provision I thought that here was something that they got right.

If you isolate any of these "objectionable" provisions and review them without the context of the entire plan, the context of economic reality, or you do so without a healthy skepticism of the federal government, you're more inclined to think they are innocuous.

No need to get bogged down in details, but generally speaking, why don't you support the page health care program, foxpaws?

 

[shagdrum]

This is a concern, a huge concern - and how dare the right misrepresent this provision - it is fear mongering at its worse...

Show me shag, the link between voluntarily creating a living will and rationing…

I have already done so (in as much as can be done with a bill that is written to dance around the issue of rationing while setting up the framework for it).

And now you are mischaracterizing the argument. Claiming I am "misrepresent[ing] this provision" when I am going well beyond that provision as you must to be able to reasonably examine the consequences of the bill including those various provisions.

You claim to take the concern seriously, but then mock it as "fear monguring" and attempt to reframe the debate to only focus on the provision and not the nature of government, the history of these type of provisions, the record of the people pushing this bill, the record of governmental abuse with these type of seemingly "innocuous" peices of legislation, etc.

There are core philsophical views and historical trends which are very relevant in examining the likely consequences of this bill and you are trying to reframe the debate to exclude those.

We are once again back to a lack of any good faith here.

If you wanna have an honest discussion on this I will (this issue is VERY important to understand). But if you are going to dishonestly try and reframe the debate, mischaracterize arguments, and resort to those dishonest tactics, I am not going to waste my time playing another game with you.

You have already shown a disregard for this, so why should I take the lip service you now give to treating this concern with respect as anything more then disingenuous?

 

[fossten]

Shag, you need to stop....

Yes, Shag, SHUT UP. The left doesn't like your misinformation, and this conversation isn't interesting enough for fox to comment.

 

[foxpaws]

I have already done so (in as much as can be done with a bill that is written to dance around the issue of rationing while setting up the framework for it).

No you haven’t shag – there isn’t one place where you can show where having a living will is going to lead to rationing – in fact, having a living will does just the opposite, it allows the individual, and not the government or any outside influence (including greedy heirs) to have control over your ‘end of life’ circumstance. The only way you can create a connection is with some way out scenario where doctors are in on this evil scheme, set up by the government where they will advise their patients to put a government approved (stated or unstated – but none the less implied) expiration clause.

And now you are mischaracterizing the argument. Claiming I am "misrepresent[ing] this provision" when I am going well beyond that provision as you must to be able to reasonably examine the consequences of the bill including those various provisions.

Nope, I don’t have to go beyond that provision at all, I don’t have to come up with some hair brained scheme where the government will tell the doctors that they need to follow some unforeseen – in the future - big government is dictating my very existence - rationing clause. The provision states that people will have the opportunity to discuss with their doctor end of life options and ways to deal with them. There isn’t anything about any government dictates, other than the doctors will get paid for it. To make your whole scary future come to pass you are the one that has to misrepresent this argument – adding in some weird speculations, making some biased assumptions, all of which have nothing to do with having your doctor available to discuss a living will with you – if you want. You don’t even have to talk to him about it.

You claim to take the concern seriously, but then mock it as "fear monguring" and attempt to reframe the debate to only focus on the provision and not the nature of government, the history of these type of provisions, the record of the people pushing this bill, the record of governmental abuse with these type of seemingly "innocuous" peices of legislation, etc.

Fear mongering isn’t ‘mocking’ something – it is as scary as it gets. But go ahead – I retract that the right is fear mongering. What I am afraid of that if people don’t actually read this section, and instead take to heart the opinions of right wing pundits, they won’t understand that there isn’t anything in this provision about rationing or government dictating how you end your life. It is in fact the very opposite. It is giving you the opportunity to find out about it from a trusted professional, one you have a very close relationship with, your doctor. You can feel comfortable talking to him about it and get the information you need, without feeling like you are just ‘taking up her time.’ And then you decide what you want to do. You get the opportunity to take that whole decision making process away from everyone, the government, the doctor, your family, and give it back to you. You get to be in control.

Why would rationing be the end result of a living will? The only way that would happen is if you believe in some science fiction story that the doctor and the government are somehow in league with each other to kill off dying people. And it wouldn’t be in ‘secret’. Something like that would be shouted out from the highest rooftops. Do you really believe that doctors will be doing that? Do you believe that the people of this country would stand for that?

 

[foxpaws]

Yes, Shag, SHUT UP. The left doesn't like your misinformation, and this conversation isn't interesting enough for fox to comment.

Go troll somewhere else

 

[foxpaws]

If you isolate any of these "objectionable" provisions and review them without the context of the entire plan, the context of economic reality, or you do so without a healthy skepticism of the federal government, you're more inclined to think they are innocuous.

No need to get bogged down in details, but generally speaking, why don't you support the page health care program, foxpaws?

Another thread, another time...

 

[fossten]

Go troll somewhere else

Too angry to finish your sentence with a period? Or maybe that's what the problem is?

Yes yes, I'll SHUT UP too.

 

[fossten]

Another thread, another time...

I'll speculate. You, like LaRouche PAC, want the bill to be MORE socialistic.

 

[foxpaws]

I'll speculate. You, like LaRouche PAC, want the bill to be MORE socialistic.

Well, since I have stated in the past I am against single payer health care - that is unlikely- I don't like socialized medicine.
But, go ahead - let's make some more assumptions, let's speculate on the future - it always happens just the way you think it will...
Done trolling? (Note - punctuation used.)

 

[shagdrum]

Another thread, another time...

No. This thread, right here. I don't think you are being honest. You are already mischaracterizing and injecting false premises (simply about a living will, or simply about individual provisions). Again. For once, demonstrate some good faith and answer a question straight forward and honestly. I for one am not going to waste time going 'round and 'round with you yet again and waste time when there are very important issues to discuss here.

You say you are against socialized medicine yet, besides that claim, every time I have seen you discuss socialized medicine in this forum, you are defending it.

You are willing to "read between the lines" and apply an agressive skepticism when analyzing the Patriot Act but when a healthy skepticism is applied to this bill you mock it as coming up with, "some hair brained scheme".

I (and likely others) think you are being disingenuous here. Show some good faith and give a straight forward, honest answer. Otherwise, I am not wasting any time with you here.

 

[foxpaws]

No. This thread, right here. I don't think you are being honest. You are already mischaracterizing and injecting false premises (simply about a living will, or simply about individual provisions). Again. For once, demonstrate some good faith and answer a question straight forward and honestly. I for one am not going to waste time going 'round and 'round with you yet again and waste time when there are very important issues to discuss here.

You say you are against socialized medicine yet, besides that claim, every time I have seen you discuss socialized medicine in this forum, you are defending it. I (and likely others) think you are being disingenuous here. Show some good faith and give a straight forward, honest answer. Otherwise, I am not wasting any time with you here.

Start another thread - it does not belong here - this provision of this bill is one of the good things about the current bill - it needs to be discussed, alone, for the reason that if some sort of health care does end up in front of the congress again (I have my doubts about the current one, I think it has seen it's end), a clause like this would be a very good thing to have in it.

This is the only provision I have defended...

 

[Calabrio]

Another thread, another time...

Let me know the time and place.

 

[shagdrum]

Cal, I would suggest moving the relevant posts to another thread and letting her answer there...

 

[fossten]

Well, since I have stated in the past I am against single payer health care - that is unlikely- I don't like socialized medicine.
But, go ahead - let's make some more assumptions, let's speculate on the future - it always happens just the way you think it will...
Done trolling? (Note - punctuation used.)

So you acknowledge that Obama is LYING when he says the bill isn't Single Payer Healthcare?

 

[foxpaws]

So you acknowledge that Obama is LYING when he says the bill isn't Single Payer Healthcare?

I was answering this question of yours Foss...

I'll speculate. You, like LaRouche PAC, want the bill to be MORE socialistic.

There was nothing said about Obama's bill being single payer... Only your speculation that I would want socialistic/single payer health care. I don't want single payer healthcare. Obviously you would rather judge me on speculation and innuendo... nice try.