Obama to Bring "End of Life" Planning in Through the Back Door

[bonnie]

Obama to Bring "End of Life" Planning in Through the Back Door

Rick Moran

The idea that "end of life planning" paid for once every 5 years by Medicare will morph into euthanasia counseling was one of the more bizarre arguments against Obamacare when it was proposed two years ago. People have to make informed decisions about how they want their doctor to treat them if they sicken and are unable to make choices about resuscitation and other important end of life issues.

Everyone should have a Living Will that spells out for their family where to draw the line about extraordinary measures that could keep one alive. If you wish to remain in a vegetative state, that should be your choice and should be reflected in the body of the Living Will. With the force of law, no one - not family or government - can alter that decision. As long as it is clear you were of sound mind when you made that decision, your wishes must be respected.

The question isn't whether Living Wills are necessary. The question is should Medicare be paying for such consultations?

Conflating euthanasia with Living Wills is silly, but Obama has decided to bring the issue through the back door through regulation - a dangerous precedent that the president apparently feels will be necessary with other Obamacare issues that never made it past the finish line in Congress:

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.

It would probably be better if the government was totally out of the loop on making these decisions but most people who take advantage of such counseling will be seeing their family doctor - someone they trust to advise them with their interests at heart. I doubt whether a family physician will be pushing old people to end their own lives rather than receive critical care according to their wishes.

However, the principle of bringing this in by stealth, through back door regulation is abhorrent and should be stopped in its tracks. The issue was withdrawn because it was politically impossible to leave in the original legislation. To sneak it in by this manner just shows how little respect Obama has for constitutional niceties.

[Dr. Shane]

God bless that man. It sure is nice that he wants to educate our seniors.

[Dr. Shane]

I don't think cost saving has anything to do with it. I think it has to do with getting all the paper work done ahead of time so that there is no guessing about what the person wants. It is just like doing a will. I am 41 years old and have a will. Everyone should have a will. That doesn't mean I am going to die any quicker. Nor does end-of-life consulting mean a person is going to choose a less costly way to die.

[phkrause]

I don't think cost saving has anything to do with it. I think it has to do with getting all the paper work done ahead of time so that there is no guessing about what the person wants. It is just like doing a will. I am 41 years old and have a will. Everyone should have a will. That doesn't mean I am going to die any quicker. Nor does end-of-life consulting mean a person is going to choose a less costly way to die.

I agree, and not only that, when I was younger I can remember my parents talking about this. Not sure about all doctors but when we had actual house call doctors, which I saw a news report maybe gonna make a return, they were already doing this some 40/50 years ago.

[bonnie]

Originally Posted By: Shane

I don't think cost saving has anything to do with it. I think it has to do with getting all the paper work done ahead of time so that there is no guessing about what the person wants. It is just like doing a will. I am 41 years old and have a will. Everyone should have a will. That doesn't mean I am going to die any quicker. Nor does end-of-life consulting mean a person is going to choose a less costly way to die.

I agree, and not only that, when I was younger I can remember my parents talking about this. Not sure about all doctors but when we had actual house call doctors, which I saw a news report maybe gonna make a return, they were already doing this some 40/50 years ago.

.It is the government paying for Dr's to do this. I can do that with my Dr now for no additional charge. Most do discuss these issues with Dr's as time goes on.

This was brought up as part of my pr-op physical for kneee replacements.Not to many die from that.

But Please Obama stop fixing my health care,I cannot afford you any longer under the pretense of compasssion

[Dr. Shane]

It may take a few years to get the kinks worked out but I believe this healthcare reform bill will do a lot of good.

[bonnie]

It may take a few years to get the kinks worked out but I believe this healthcare reform bill will do a lot of good.

You mean kinks like this?? More and more of these little kinks keep cropping up

Union Drops Health Coverage for Workers’ ChildrenSearch Metropolis Article Comments (277) Metropolis HOME PAGE »Email Print Permalink Twitter

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UPDATE Dec. 1: Health-Care Reforms Not to Blame for Coverage Woes, Union Says

By Yuliya Chernova

Associated Pree

Jason Morales, an 1199SEIU member from Brooklyn, protested proposed health-care cuts in the state budget in June. A benefit fund for the union is dropping insurance coverage for workers’ children. One of the largest union-administered health-insurance funds in New York is dropping coverage for the children of more than 30,000 low-wage home attendants, union officials said. The union blamed financial problems it said were caused by the state’s health department and new national health-insurance requirements.

The fund is administered by 1199SEIU United Healthcare Workers East, an affiliate of the Service Employees International Union. Union officials said the state compelled the fund to start buying coverage from a third party, which increased premiums by 60%. State health officials denied forcing the union fund to make the switch, saying the fund had been struggling financially even before the switch to third-party coverage.

The fund informed its members late last month that their dependents will no longer be covered as of Jan. 1, 2011. Currently about 6,000 children are covered by the benefit fund, some until age 23.

The union fund faced a “dramatic shortfall” between what employers contributed to the fund and the premiums charged by its insurance provider, Fidelis Care, according to Mitra Behroozi, executive director of benefit and pension funds for 1199SEIU. The union fund pools contributions from several home-care agencies and then buys insurance from Fidelis.

“In addition, new federal health-care reform legislation requires plans with dependent coverage to expand that coverage up to age 26,” Behroozi wrote in a letter to members Oct. 22. “Our limited resources are already stretched as far as possible, and meeting this new requirement would be financially impossible.”

Behroozi estimated that the fund faced a $15 million shortfall in 2011 and more in the following years for the coverage of workers’ children.

The union said in a statement that the state required the fund to participate in a new program — the Family Health Plus Buy-In Program — beginning in 2008. The union said it expected that by joining the program, many of its members would qualify for state assistance for health-insurance coverage. “Instead they raised insurance rate increases without any increase in funding, and then cut Medicaid funding to the same workers nine times in the last three years,” the union said in a statement.

But the state denies requiring the union to join the program. “The state is not forcing 1199 to do anything regarding its employee health insurance,” said Jeffrey W. Hammond, spokesman for the New York Department of Health.

Home-care agencies that contribute to the union fund collect their revenue from the state’s Medicaid program. Over the past two years the state cut about $370 million in Medicaid reimbursements to home and community-based care programs, according to New York State Association of Health Care Providers Inc., a trade association that represents agencies that employ home attendants.

“In home care in general, whether in a union or a non-unionized workplace, they are dealing with the crisis of trying to do more and more with less and less, and cut on top of cut,” said Christine Johnston, president of the association.

For the 1199 fund, premiums rose because Fidelis realized that the home health-care attendants are sicker than average, according to Mark Lane, president and chief executive of Fidelis Care. “These people are hard working people. There’s physical labor, which manifests itself in terms of more chronic and acute care type of illnesses,” said Lane.

As premiums went up and employer contributions remained constant, the benefit fund started cutting the rolls of eligible members. In the past three years the 1199 fund reduced its total enrollment in half, to less than 40,000 currently.

“We hope the state of New York will do the right thing and provide the funding necessary for this most vulnerable population of direct caregivers,” the union said in a statement.

[Dr. Shane]

You mean kinks like this??

Yep, kind of like that. Praise God Obama got something done. It really shows that God is involved in the affairs of man. The Republican do-nothing Congress sat and watched as health-care premiums went up at two to three times the rate of inflation year after year and did nothing. More and more people were losing coverage and the do-nothing Republicans played the fiddle while poor Americans died due to lack of health care.

Yes, there are some kinks and some big ones. That is mostly due to the ways Democrats had to pass this. If Republicans would have come to the table and said "let's do something good for the American people." we would have had less kinks. But Republicans drew a line and said, "we must defeat Obama on this issue".

[bonnie]

Originally Posted By: bonnie

You mean kinks like this??

Yep, kind of like that. Praise God Obama got something done. It really shows that God is involved in the affairs of man. The Republican do-nothing Congress sat and watched as health-care premiums went up at two to three times the rate of inflation year after year and did nothing. More and more people were losing coverage and the do-nothing Republicans played the fiddle while poor Americans died due to lack of health care.

Yes, there are some kinks and some big ones. That is mostly due to the ways Democrats had to pass this. If Republicans would have come to the table and said "let's do something good for the American people." we would have had less kinks. But Republicans drew a line and said, "we must defeat Obama on this issue".

There are always those that don't care what gets done,just so it looks like busy work and all is happy.

I sure hope the republicans drew that line in the sand good and deep.

Personally I cannot afford to much more of the savings the "messiah" is offering. A lot of others are finding out the same thing.

For those that truly cannot afford insurance there should be help.If you have a TV,computer,cell phones and other unnecessary conveniences TOUGH.

Then there is always the unthinkable,one paycheck doesn't quite do it,get a second part time job.Lot's of us have had to do just that.

Learn to stretch the food dollar,Get food stamps,spend them wisely.Knock of the excuse I don't know how.LEARN like many of us had to.

Forget the expensive brand name clothing.Garage sales and goodwill gives a big bang for the buck.

Teenagers,going to screw around,get free birth control.

Use free clinics where available. Grocery stores all thru our area has very inexpensive clinics set up. If you have no money immunizations for children are free.

There are dozens of ways without leeching from somoeone else's pocket.

When all else fails,create a crisis with sick dying in the streets,people will take care of you

[Bravus]

...and yet, here in socialized medicine country healthcare is excellent and very affordable.

[Jeannieb43]

...and yet, here in socialized medicine country healthcare is excellent and very affordable.

Yes! Because you have a single-payer system in Oz.

And that's the best type of system -- which should operate the way Medicare does in the US. There should be no private companies making money off our illnesses; it's a shame those insurance companies have a death-grip hold on our legislators. They're making money at our expense.

The only improvement needed in the Obamacare law would be to change it to a single-payer system.

[bonnie]

...and yet, here in socialized medicine country healthcare is excellent and very affordable.

I have a friend in Australia. She waited a little over 6 months for hip replacement.

While neither the need for knee or hip replacement is crucial to life but I can tell you for those waiting it can seem like it.

I need a new hip and because of other issues I need to have taken care of first it will be done in Feb. While I am not big on suicide the thought of going another 6 months makes jumping off a bridge pretty attractive.

Without the other issues I could be evaluated,have MRI and surgery scheduled within days.

The following pretty well spells out my friends experience before she received a new hip

|

Cutting the wait for new hips and knees

“I’ve got have a crook hip, so I go to my GP. He makes a referral to a hospital. You

get a letter from the hospital to say you have been placed on a waiting list. If you’re

lucky 18 months later you might get a call to go to the hospital to be assessed. After

a 10-minute consult you’re told, “yeah, you need a joint replacement, you’ll go on the

waiting list”. Then it’s months of waiting, and you don’t hear from anyone again until it

is time for your surgery.”

It’s a story that thousands of Australians with osteoarthritis waiting for hip

or knee surgery could tell.

But following an innovative piece of Australian health services research, a new and

fairer system has dramatically cut patient assessment times from months to a few

weeks, and for many, reduced waiting times for hip and knee replacement surgery.

Osteoarthritis is a degenerative joint disease affecting around 1.6 million Australians10,

particularly those over the age of 65.

The disease can lead to pain, stiffness and immobility, impacting on a person’s ability

to walk, get up from a chair or bed, or go up and down stairs. In its most severe form,

patients are unable to cook, clean or look after themselves.

Joint replacement surgery (knee and hip replacement) is considered one of

the most cost-effective interventions of any medical procedure, and for severe

osteoarthritis, greatly reduces pain and disability and restores many patients to near

normal function.11

In 2007–08 the Australian Institute of Health and Welfare reported 86,000

hospitalisations in Australia for osteoarthritis, and more than 44,800 total knee and

hip replacements.12

Managing the growing waiting lists in a way that was fair and transparent, through a

system that was supported by patients, clinicians and policymakers, was the goal for

the Orthopaedic Waiting List Project, a multidisciplinary team led by Professor Richard

Osborne, now Professor of Public Health and Director of Public Health Innovation at

Deakin University.

“The project started with colleagues at Royal Melbourne Hospital and The University

of Melbourne. We began measuring the quality of life of people on the orthopaedic

waiting list and we discovered that for about 20% of people their quality of life was

close to zero. Women were worse off than men,” Professor Osborne said.

“People would be put on the waiting list, at times in terrible, terrible pain, and they could

wallow there for up to three years without seeing a health care professional. They would

sit at home and wait for that letter. Sometimes they would lose their caring roles, lose

their jobs and withdraw from society.

10 Australian Institute of

Health and Welfare (2010),

Australia’s health 2010;

186–193

11 ibid, citing Bachmeier

et al. 2001.

12 ibid

© Research Australia Limited 2010 Vital Research for a Vital Australia: Personal Stories

Page 10 | Vital Research for a Vital Australia: Personal Stories © Research Australia Limited 2010

“In the old system, there was little conservative treatment like checking that patients had

adequate pain medications. They were rarely referred to physiotherapists. There was little

or no encouragement for weight control which can reduce their pain and reduce risks

from undergoing surgery. ”

Adding to problems was the lack of coordination around waiting lists, and the lack of a

common evidence-based assessment tool to allow prioritisation of patients based on

the burden of their disease.

There were reports of GPs referring patients to specialists prematurely purely because

they believed that by the time the patient was eventually seen (up to one or two years

later in some hospitals) they would need a joint replacement.

This meant that some patients were being seen by a specialist long before they needed

surgery and when physiotherapy or other treatment could have been more appropriate,

while others in greater need waited for months, even years, for surgery.

The researchers consulted widely and, with the strong support of the Victorian

orthopaedic surgical community, developed and implemented the Osteoarthritis Hip

and Knee Service.

This included creating a simple but detailed questionnaire to assist in prioritising

people with hip or knee joint disease for surgery based on the severity of their disease,

including their level of pain and mobility and also their psychosocial health, economic

risks and whether they had a caring role that was at risk.

The researchers also established a new role of musculoskeletal coordinator (a

physiotherapist or nurse) at each hospital to assess, refer, manage and prioritise

patients for surgery. This role includes helping patients to manage other conditions they

may have, such as obesity and hypertension, and also reviewing patients regularly.

The research has meant that in just a few years, assessment waiting times have

been cut from months or years to a few weeks, and surgeons spend their time

assessing fewer people who do not need their level of help, while fast tracking those in

greatest need.

The new model has now been incorporated into Victorian Government policy, rolled

out to all 14 major Victorian hospitals, and its key principles of early and common

assessment and prioritisation based on patient need have been adopted or are being

considered by other States.

In South Australia, the Repatriation General Hospital worked closely with the Victorian

researchers as it developed a new service design for patients from the time they are

referred for hip and knee assessment, to 10 years after surgery.

The hospital’s Orthopaedic Management Facilitator, Registered Nurse Christine Doerr,

said the new design was now being considered as the model to be used statewide,

with a pilot of a clinical model similar to that developed in Victoria currently underway at

several sites.

“At the Repat you are now guaranteed an assessment within three months,” Ms Doerr

said. “We will work with you to make decisions about what options are available to you.

|

“Once you go on the waiting list for surgery, then we start what we call prehabilitation –

we organise a patient’s discharge needs and look at options to get that patient as fi t for

surgery as possible. We also regularly monitor you.”

In addition to shorter assessment waiting times, the hospital has experienced shorter

surgery waiting times (from an average 18 months to nine to 12 months) and fewer

patient complaints. More patients are able to discharge straight to their own home,

rather than needing further care.

[Dr. Shane]

Yes! Because you have a single-payer system in Oz.

And that's the best type of system -- which should operate the way Medicare does in the US. There should be no private companies making money off our illnesses; it's a shame those insurance companies have a death-grip hold on our legislators. They're making money at our expense.

The only improvement needed in the Obamacare law would be to change it to a single-payer system.

I am not opposed to a single-payer system and agree it would be an improvement to Obama-care. That said. I am not convinced that a government-run health care system would be a cheaper or a more efficient system. I do think we can keep a private system without throwing the baby out with the bath water.

1. The government should create health-care plans that specify what is and is not covered. There could be three, five or seven different plans. All health care insurance companies would have the same set of plans.

2. All insurance forms would be standardized by the government. All health care insurance companies would use the same forms,

3. All medical treatments would be coded the same regardless of the health care insurance company.

4. All employers would be required to provide health insurance. Those that do not would be fined three times the cost of the insurance they should have been providing.

5. Since all insurance companies would offer the same plans, insurance could be sold across state lines.

[Stan]

THis is being moved to US politics, please post US Politics in US POLITICS

[Woody]

I haven't followed this thread . But I just heard on the news that Obama will most likely not get approval for his 'death panels' plan. Praise God. At least there is now going to be some common sense returning to Washington with the return of Republican Power.

[Jeannieb43]

I just heard on the news that Obama will most likely not get approval for his 'death panels' plan. Praise God. At least there is now going to be some common sense returning to Washington with the return of Republican Power.

You're already subject to "death panels" -- your own health insurance provider -- right now. They sit at their office computers and dictate to the doctors just which drugs and surgeries, and how much of them, each patient deserves, given his age and his current diagnosis. Some elderly, sickly individuals are not permitted any curative treatment whatsoever -- merely palliative meds. And some who have "heavy" diseases are not permitted any type of transplants, etc., to prolong their lives.

Believe me, the "death panels" are already working against us out there, in the form of our health insurance providers.

[Woody]

You may be right Jeannie. But for sure we don't need Obama getting in the mix trying to decide who will die and who will live. For sure I don't trust Obama to do that fairly.

[Dr. Shane]

Of course we have death panels today. That is why the Left was so wrong when they criticized Palin when she correctly pointed out that universal health-care will have death panels. Of course it will. It has to.

The issue is simply this: do we want government death panels with government oversight OR do we want private-sector death panels with government oversight?

I tend to think the government is more likely to overturn the decision of a private-sector death panel than it is to overturn the decision of a government death panel. So I tend to think that we are better off with the private-sector death panels with government oversight. Basically, if you are denied coverage by your private insurance company, you can appeal the decision to a government oversight agency or court.

[bonnie]

Of course we have death panels today. That is why the Left was so wrong when they criticized Palin when she correctly pointed out that universal health-care will have death panels. Of course it will. It has to.

The issue is simply this: do we want government death panels with government oversight OR do we want private-sector death panels with government oversight?

I tend to think the government is more likely to overturn the decision of a private-sector death panel than it is to overturn the decision of a government death panel. So I tend to think that we are better off with the private-sector death panels with government oversight. Basically, if you are denied coverage by your private insurance company, you can appeal the decision to a government oversight agency or court.

I am not sure where all the insurance "death panels" are coming from,but I do know where Obama's will.As one with a very painful hip,the last thing I want is good old compassionate Obama telling me to go home and take a pill

My MIL had two hip replacements,one in her late 80's and one in her early 90's.No one decided as Obama seemed to with his grandmother,"go home and Take a pill"

My FIL entered the hospital on July 9th,resuscitated twice. He was kept in ICU till he passed away on nov 9th of that year.

My mother passed away from cancer.She had the best medical had to offer and was not given a pill and told to go home

[Dr. Shane]

My MIL had two hip replacements...

My FIL entered the hospital on July 9th,resuscitated twice. He was kept in ICU till he passed away on nov 9th of that year.

My mother passed away from cancer.She had the best medical had to offer and was not given a pill and told to go home

Were they on medicaid or private insurance? I am just wondering which death panel allowed them to live.

[bonnie]

Originally Posted By: bonnie

My MIL had two hip replacements...

My FIL entered the hospital on July 9th,resuscitated twice. He was kept in ICU till he passed away on nov 9th of that year.

My mother passed away from cancer.She had the best medical had to offer and was not given a pill and told to go home

Were they on medicaid or private insurance? I am just wondering which death panel allowed them to live.

They were all on Blue Cross/Blue Shield supplemental and medicare.I don't recall if medicaid kicked in for my FIL.

There never seemed to be a question as to whether they should be allowed to live. They received the best of care and they were not told to go home and take a pill instead of hip replacement as Obamna would have done.

The man is nuts if he thinks a little pill takes care of that type of hip pain.You are talkig some pretty heavy duty narcotics whichpretty well takes care of the patient with hip pain

[bonnie]

Just a little aside. During the time my mother was on medicare she had two strokes.One we did not think she would make it.She was sent to Denver for rehab and did very well.Was able to live independently for sometime.She had two cancer surgeries + radiation.In her late 70's and early 80's what do you think her chances woud have been with the tender mercies of "our earthly messiah"?

[Dr. Shane]

Well, I think that private insurance is more willing to cover things because of government oversite than a government-run health system would. The private insurance companies pretty much know what the government will make them cover. If we go to a government-run health system I am a little bit concerned that the government doing oversight on itself may not work out as well as the government doing oversight on private insurance companies.

We certainly do have death panels today. Both in private insurance companies and in government medi-caid.

[bonnie]

Well, I think that private insurance is more willing to cover things because of government oversite than a government-run health system would. The private insurance companies pretty much know what the government will make them cover. If we go to a government-run health system I am a little bit concerned that the government doing oversight on itself may not work out as well as the government doing oversight on private insurance companies.

We certainly do have death panels today. Both in private insurance companies and in government medi-caid.

The insurance paid foe exactly what it stated it would.

To bad Obama doesn't have someone watching his system

[Dr. Shane]

The insurance paid foe exactly what it stated it would.

Oh, I doubt that. Those insurance companies have their death panels filled with CPAs, MBAs and PhDs all dedicated to see how little they can pay out. They are not in the business of helping people. They are in the business of making money. Praise our loving Father in heaven and His gracious Son, Jesus Christ, we have a government that oversees insurance companies and protects the consumer.