View Full Version : When people here post about death panels, refer them here
NeedKarma
Aug 22, 2009, 03:42 AM
Here's John Steward who takes on Betsy McCaughey, the first who equated end-of-life planning with government-ordered euthanasia, goes on the Daily Show to make her case.
US link:
Part 1- http://www.thedailyshow.com/watch/thu-august-20-20 ... (http://www.thedailyshow.com/watch/thu-august-20-2009/betsy-mccaughey-pt--1)
Part 2- http://www.thedailyshow.com/watch/mon-august-17-20 ... (http://www.thedailyshow.com/watch/mon-august-17-2009/exclusive---betsy-mccaughey-extended-interview-pt--1)
Part 3- http://www.thedailyshow.com/watch/mon-august-17-20 ... (http://www.thedailyshow.com/watch/mon-august-17-2009/exclusive---betsy-mccaughey-extended-interview-pt--2)
Canadian link:
The Daily Show with Jon Stewart : August 20, 2009 (http://watch.thecomedynetwork.ca/the-daily-show-with-jon-stewart/full-episodes/the-daily-show-with-jon-stewart---august-20-2009/#clip204169)
tomder55
Aug 22, 2009, 07:31 AM
Yes it is not death panels... it is a commission .
excon
Aug 22, 2009, 07:35 AM
Hello tom:
I heard they changed it to make sure they only knock off CONSERVATIVE old farts... We can't have any pesky red necks laying around...
excon
inthebox
Aug 22, 2009, 07:38 AM
http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=1
Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.
I wish all people [ those who defend government intervention, and those defending the private sector ] would be "transparent" and acknowledge this.
Why can't Obama be honest with us about this?
---------------------------------------------------
NK
I'll have to watch the videos first, thanks for the link
G&P
excon
Aug 22, 2009, 07:46 AM
I wish all people [ those who defend government intervention, and those defending the private sector ] would be "transparent" and acknowledge this. Hello again, in:
https://www.askmehelpdesk.com/current-events/alternatives-obamacare-387127-11.html
Post number 109.
excon
inthebox
Aug 22, 2009, 10:57 AM
HR 3200, specifically 425 deals with advanced directives.
Why does this even have to be put in this bill, when discussions about end of life decisions ARE ALREADY BEING MADE ?
Why on page 432
STEWART: And so let me just read it very quickly. "In general, for purposes of reporting data on quality measures for covered professional services, the secretary shall include quality measures on end-of-life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment."
Stewart goes on and on about "life sustaining treatment," but what he does not understand is that if a person chooses to be DNR that means "life sustaining" treatment, mechanical ventilation, ACLS resuscitation, will be withheld.
Why does the government need to oversee that someone is or is not truly DNR?
Why is this even in this bill?
Does the government not trust doctors and nurses to respect the wishes of the patient in regard to their "code status?"
Stewart goes on and on about "life sustaining" is childish. That is like me proclaiming " I have a vette" over and over while neglecting to say the "che" in front of the vette.
G&P
excon
Aug 22, 2009, 11:10 AM
Hello again, in:
I don't know what that little piece of gobbeldy gook bureaucratise said either... But, if you want to believe that it says that it's OK for the Dems to pull the plug on Grandma, then I'm not going to convince you otherwise.
excon
tomder55
Aug 24, 2009, 03:42 AM
"Your Life, Your Choices" is a guide document for Veterans that was suspended under the Bush administration, but has been revived under the current Department of Veterans Affairs. This 52 page guide document essentially tells Vets to "hurry up and die".
"Your Life, Your Choices" (http://74.125.93.132/search?q=cache:NwWZ3TYn_LEJ:www.rihlp.org/pubs/Your_life_your_choices.pdf+Your+Life,+Your+Choices&cd=1&hl=en&ct=clnk&gl=us)
Dr. Robert Pearlman ,who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before SCOTUS and supports health-care rationing is the author of this guide . He is currently chief of ethics evaluation for the VA's National Center for Ethics in Health Care .
So not only are their death panels... oops I mean commissions ;but there are also death books for Vets.
On page 21 there is a questionnaire with loaded questions the Vets who are making end of life decisions ;they should consider the following : “I can no longer contribute to my family's well being,” “I am a severe financial burden on my family” and “my situation causes severe emotional burden for my family.”
On page 24 it mentions things like you "cant shake the blues" as a possible reason to not continue your life.
So do I believe that the Dems would add something like that to their bill ? Yes ;they've done it before.
NeedKarma
Aug 24, 2009, 04:36 AM
Betsy McCaughey, the healthcare reform opponent who helped tank the Clinton administration's plans and has been spreading misinformation about the current proposals, has resigned from the board of directors of a medical equipment company.McCaughey resigns as director of medical company - War Room - Salon.com (http://www.salon.com/politics/war_room/2009/08/21/mccaughey/)
That's what happens when you get caught.
tomder55
Aug 24, 2009, 04:50 AM
McCaughey is a long time patient advocate . I'll take her word above that of David Axelrod's
Obama Campaign Ad Firms Signed On to Push Health-Care Overhaul - Bloomberg.com (http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aV3dLt6wmZH4)
NeedKarma
Aug 24, 2009, 04:55 AM
I'll take her word ....Oh I know you will, the same crap she got caught speweing is the same crap you spew.
speechlesstx
Aug 24, 2009, 06:52 AM
NK, I don't recall having spewed any crap about "death panels" but I have spoken of what was in the bill and I also noted (https://www.askmehelpdesk.com/current-events/alternatives-obamacare-387127-11.html#post1937479) the VA's "planning" book which was rightly suspended by the Bush administration. Why is any of this in a government program allegedly providing health care?
I'm not here to knock advance planning but it has no place in a government program, designed by advocates of physician assisted suicide, providing financial incentives to doctors and presented in a format as unbiased as a push poll.
ETWolverine
Aug 24, 2009, 08:16 AM
Nah... refer them here instead.
Michelle Malkin Death panels? What death panels? Oh, those death panels (http://michellemalkin.com/2009/08/09/death-panels-what-death-panels-oh-those-death-panels/)
There are a bunch of good links to what is ALREADY going on in nationalized health care.
Or just tell them to look up the "Massachusets Model" medical system. THAT is national health care.
Elliot
tomder55
Aug 24, 2009, 08:20 AM
Or just read the words of Zeke Emanuel.
Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years."
-
"Services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia."
"When implemented, the complete lives system 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."
"Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years."
"Strict youngest-first allocation directs scarce resources predominantly to infants. This approach seems incorrect. The death of a 20-year-old woman is intuitively worse than that of a 2-month-old girl, even though the baby has had less life. The 20-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects....
Adolescents have received substantial substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments.... It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies, and worse still when an adolescent does."
"Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change. Savings will require changing how doctors think about their patients. Doctors take the Hippocratic Oath too seriously, as an imperative to do everything for the patient regardless of the cost or effects on others."
"Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."
spitvenom
Aug 24, 2009, 08:22 AM
If there are death panels where do I submit a resume to be a panelist. I know a few people that should be taken out legally. I'll start in Oakland those poor Raiders fans have suffered enough with Al Davis crazy out of touch mind.
ETWolverine
Aug 24, 2009, 08:29 AM
NK,
There have been about 10 or 12 attempts by Republicans to amend the legislation in both the House and the Senate so that there is no confusion about "death panels"... to essentially change or eliminate the language that Reps point to as proof of the death panels existence. To remove the confusion, in essence.
The Dems could easily change the language of the legislation, either with their own amendments or by adopting the Republican amendments. They could EASILY clean up the language and eliminate the entire argument from the Conservatives side (thus weakening the conservative position) in about 5 minutes.
They haven't. They have chosen to leave things as they are without change, even when they know that this is part of what is killing the bill for them.
Why not make a simple change in language to fix things so that the American people aren't scared of death panels? It would make passing the bill easier, wouldn't it? And they could do it quite benignly, without killing the nature of their bill. So why don't they?
Answer: Because the death panel is exactly what we have said it is and they WANT IT TO BE IN THE LEGISLATION. THEY WANT DEATH PANELS. If they didn't, they'd kill this political hot potato that is destroying them in the polls with a simple amendment to the bill.
They know what it says. They know our interpretation is correct. And they WANT it in the bill anyway. There is no other explanation for their stubborn refusal to make simple changes to on the issue to eliminate any confusion. Because there is no confusion.
Elliot
speechlesstx
Aug 24, 2009, 08:33 AM
If there are death panels where do I submit a resume to be a panelist. I know a few people that should be taken out legally. I'll start in Oakland those poor Raiders fans have suffered enough with Al Davis crazy out of touch mind.
Or perhaps Detroit, with their ailing auto industry, widespread political corruption and suffering through Lions football. Probably wouldn't be hard to push them over the edge.
excon
Aug 24, 2009, 08:34 AM
Hello again:
I'm done arguing with the dining room table. I'm out of here.
excon
ETWolverine
Aug 24, 2009, 08:35 AM
Hello again:
I'm done arguing with the dining room table. I'm outta here.
excon
You're even getting beaten in debate by the dining room table?
Man, you've lost your touch.
Elliot
NeedKarma
Aug 24, 2009, 08:52 AM
Why not make a simple change in language to fix things so that the American people aren't scared of death panels? It would make passing the bill easier, wouldn't it? And they could do it quite benignly, without killing the nature of their bill. So why don't they?
Answer: Because the death panel is exactly what we have said it is and they WANT IT TO BE IN THE LEGISLATION. THEY WANT DEATH PANELS. Ok, I'll bite, show me the language in the bill that advocates death panels.
ETWolverine
Aug 24, 2009, 09:38 AM
Ok, I'll bite, show me the language in the bill that advocates death panels.
Sections 1233, 141 & 142.
As well as several places where it mentions "efficiency testing" or "efficiency measuring" because they aren't talking about the efficacy of the medicines and therapies themselves, but rather the COST EFFECTIVNESS of giving those meds to some people instead of others.
These are death panels, regardless of what you want to call them. If their purpose is to determine who gets therapies based on age or life expectancy, they are a death panel. If they are counseling people to sign away their rights to health care via DNRs and DNIs and "living wills"... if they are trying to convince people that it is better that they die than that they live... they are death panels.
Joseph Mengele would have been proud.
Elliot
tomder55
Aug 24, 2009, 09:40 AM
As I said the "commission " became law when the President signed HR1 which creates the Federal Coordinating Council for Comparative Effectiveness Research.
HR3200's provisions will be decided by the "commission" .
spitvenom
Aug 24, 2009, 09:41 AM
ET do you really think that your and my private insurance companies don't do this already?
NeedKarma
Aug 24, 2009, 09:47 AM
Sections 1233, 141 & 142.
No, no... quote the TEXT of the bill that supports these death panels you speak of.
ETWolverine
Aug 24, 2009, 09:56 AM
ET do you really think that your and my private insurance companies don't do this already?
Sure they do.
But as I have pointed out before, if they deny me a therapy or a medicine, I can purchase it on my own out of pocket or try to get another form of insurance, including SUPPLEMENTAL INSURANCE that covers what primary insurance doesn't cover. I can work out a payment plan with the doctor to pay over time. I can even try to obtain charity to get the services that I need. AND I can challenge the insurance company via it's own internal systems... and win more often than I lose such an appeal.
But in a single-payer national health system, if you are denied, you die. There are no other options to pay for it yourself or get other insurance, or obtain charity, because it is a SINGLE-PAYER SYSTEM.
Furthermore, have you ever heard of an insurance company sending in counselors to get patients over the age of 65 (who may have as many as 20 more years of life ahead of them or more) to sign DNIs or DNRs or living wills? Only the government plan calls for this. This isn't something happening in private insurance.
Elliot
ETWolverine
Aug 24, 2009, 09:56 AM
No, no ... quote the TEXT of the bill that supports these death panels you speak of.
I did. Several times in this thread alone, and several other times in other threads. You ignored it. I have no interest in doing your homework for you again. Look it up yourself.
excon
Aug 24, 2009, 09:56 AM
Hello NK:
Dining room tables can't read text. But, they can hear right wing radio.
excon
ETWolverine
Aug 24, 2009, 10:00 AM
Hello NK:
Dining room tables can't read text. But, they can hear right wing radio.
excon
Apparently the 15 times that it has been posted in various places on this board by me, Steve and Tom wasn't enough for you... but WE'RE the ones who can't read text.
Riiiiigggghhhht.
NeedKarma
Aug 24, 2009, 10:05 AM
I did. Several times in this thread alone, Show the several times in this thread where you posted text from the bill that supported your assertion. It's only a 3 page thread it shouldn't be hard.
ETWolverine
Aug 24, 2009, 10:19 AM
Been there, done that. Look it up yourself.
I don't have the time to waste on you anymore.
Elliot
NeedKarma
Aug 24, 2009, 10:19 AM
Hahahahahhhahaha. Buh-Bye!
ETWolverine
Aug 24, 2009, 10:22 AM
Don't go away angry. Just go away.
NeedKarma
Aug 24, 2009, 10:24 AM
Don't go away angry. Just go away.Ah yes, the passive-aggressive. Sorry mate, I'll call bull$hit when I see it and I won't go away just because you screech the same stuff every day.
spitvenom
Aug 24, 2009, 10:29 AM
Et you really think if the government says to your Dr. no we will not cover that procedure and you tell your Dr hey I'll pay for it myself the Dr is going to say no to you. Come on now.
inthebox
Aug 24, 2009, 10:43 AM
NK
Tell me why the government has to have this section, in a 1000 page plus bill, when in fact COUNSELING FOR ADVANCED DIRECTIVES ALREADY OCCURS?
I think advanced directives are good and they can save the system money, because care in the last 6 months of life when people are obviously ill is what costs money.
Have you ever asked a critically ill person and or there family what their advanced directive may or may not be? I have, on a fairly regular basis.
Remember, even though this may be an endstage Alzheimer's patient who has not been out of bed in the past month or so and has other chronic medical problems like heart disease and stroke, you are speaking to their spouse, children, and other loved ones. Some may want him to just be comfortable and a DNR, [ which is my opinion ] and some may want everything possibly done just to gain another few weeks. Do you think the cost to the government/ taxpayor should be the ultimate decider of code status?
What do you tell the parents of a child with CF or Down's or the middle aged spouse who's husband/ wife has no ability to care for themselves, due to a car accident?
These are individual decisions best left between doctor and patient['s family].
G&P
ETWolverine
Aug 24, 2009, 10:45 AM
Et you really think if the government says to your Dr. no we will not cover that procedure and you tell your Dr hey I'll pay for it myself the Dr is going to say no to you. Come on now.
Yes. Because it will be illegal to pay for it myself. That is, in fact, the definition of SINGLE-PAYER.
I MIGHT be able to do it in the "black market", but do you want a system of black-market medicine to supplement medical care in the USA? Is that how you want to be taken care of? (Remember how awful black-market back-room abortions were? Imagine an entire medical system based on that sort of thing.)
That's how things work in both Canada and the UK. It is ILLEGAL to pay for services outside of the government system. That's why so many people come to the USA for their care. That's the law in those places.
Certain parts of Canada are changing that now, and UK is looking in to changing that... which means that while NK is lauding the greatness of the single-payer system, the Canadian government is actually PRIVATIZING parts of the Canadian health system. Ditto for the UK. And Sweden, by the way. (Norway too, I think, but I need to double-check that.)
So while we're going socialist, the rest of the world is trying to find ways to privatize their health care.
Bottom line, though, in answer to your question: yes. If Obamacare passes and the government insurance denies me my care, I will NOT be able to legally go to the doctor and pay out of pocket.
Why? Because nationalized health care is as much about social engineering as it is about health care. (Moreso, really). It is about making sure that everything is fair. If I am denied care but have the ability to pay out of pocket, I am in a preferential position over the person who cannot afford to pay out of pocket. Such preferential treatment for me is "unfair" and a function of my wealth. Therefore, my ability to receive preferential, unfair treatment needs to be stopped. Thus, the only group that is permitted to pay for my medical care is the government... so that everything is fair for everyone.
There's a REASON for this madness.
Elliot
NeedKarma
Aug 24, 2009, 10:46 AM
These are individual decisions best left between doctor and patient['s family].And that's exactly what would happens. What do you think is going to occur?
NeedKarma
Aug 24, 2009, 10:49 AM
If Obamacare passes and the government insurance denies me my care, I will NOT be able to legally go to the doctor and pay out of pocket. Se, that's the mentality you have to get out of. You have grown up knowing that insurance companies deny health care all the time and you have to fight to get some care that has been denied by an insurance agent. You don't get denied in universal healthcare, I've never known anyone who has.
inthebox
Aug 24, 2009, 10:53 AM
Then why is it in this bill? What is the MOTIVE
That is like putting a section that says people should stop at red lights. There is no need for this section and it has been removed.
The politicians who wrote this bill are not like Nicholson's character in "A few good men,"
And blurt out "you can't handle the truth, - we need everyone to be DNR to keep costs under control!" ;)
G&P
NeedKarma
Aug 24, 2009, 10:57 AM
Then why is it in this bill? What is the MOTIVEThe motive is simple to understand. The universal healthcare system would now be your provider of healthcare i.e.. That's how the doctor gets paid, so those provisions lay out the procedure to follow for a doctor to keep up to date with a very ill patient.
inthebox
Aug 24, 2009, 10:57 AM
Se, that's the mentality you have to get out of. You have grown up knowing that insurance companies deny health care all the time and you have to fight to get some care that has been denied by an insurance agent. You don't get denied in universal healthcare, I've never known anyone who has.
No care is the same as denial.
Featured Article - WSJ.com (http://www.opinionjournal.com/editorial/feature.html?id=110006813)
"Access to a waiting list is not access to health care," wrote Chief Justice Beverly McLachlin for the 4-3 Court last week. Canadians wait an average of 17.9 weeks for surgery and other therapeutic treatments, according the Vancouver-based Fraser Institute. The waits would be even longer if Canadians didn't have access to the U.S. as a medical-care safety valve. Or, in the case of fortunate elites such as Prime Minister Paul Martin, if they didn't have access to a small private market in some non-core medical services. Mr. Martin's use of a private clinic for his annual checkup set off a political firestorm last year.
G&P
NeedKarma
Aug 24, 2009, 11:02 AM
Dude, that article is from 2005. There is some waiting for elective stuff but not for emergency procedures. I'm OK with that, especially if you add other intangible benefits like no paperwork, never having to deal with lawyers or insurance bureaucrats, etc.
inthebox
Aug 24, 2009, 11:03 AM
The motive is simple to understand. The universal healthcare system would now be your provider of healthcare ie. that's how the doctor gets paid, so those provisions lay out the procedure to follow for a doctor to keep up to date with a very ill patient.
Excuse me? Doctors have to refer to this bill in order to keep up with a very critically ill patient?
Is that all? Read what the politicians tell you? Forget about medical school, or continuing education credits, or board certifications, or conferences, or textbooks, or online guidelines, and resources, or consulting with other physiscians and specialists, read what this bill tells you to do?
End of life counseling, great NK you made it so clear now. Thanks :rolleyes:
G&P
NeedKarma
Aug 24, 2009, 11:09 AM
You're right. It's all a plan to kill you. The doctor has no say. Every time you are ill you will seen by a gov employee in a suit. You'll never see a doctor. I see your point now. <sigh>
spitvenom
Aug 24, 2009, 11:22 AM
ET please show me actually proof where it says that it will be illegal to pay for something on your own. I don't want your words SHOW ME WHERE IT SAYS IT IN THE BILL.
ETWolverine
Aug 24, 2009, 11:27 AM
The motive is simple to understand. The universal healthcare system would now be your provider of healthcare ie. that's how the doctor gets paid, so those provisions lay out the procedure to follow for a doctor to keep up to date with a very ill patient.
It doesn't keep track of "very ill" patients. It keeps track of patients over the age of 65, whether they are ill or not. And THAT is the problem.
ETWolverine
Aug 24, 2009, 11:42 AM
ET please show me actually proof where it says that it will be illegal to pay for something on your own. I don't want your words SHOW ME WHERE IT SAYS IT IN THE BILL.
It doesn't. It only says so in Obama's SPEECHES about his INTENT. And those of Ezekiel Emanuel. He has said clearly that he intends for the "public option" to become a single-payer system. Therefore, he intends that the only legal payer will EVENTUALLY become the US government.
And he points to Canada, the UK and France as his models. These are single payer health systems where it is illegal to pay out of pocket.
Ergo, if these single-payer systems are his models, and if this is his stated intent, then it becomes clear that this will be the law if Obama is permitted to have his way.
Therefore, to prevent it, don't give him his way.
End of story.
Elliot
NeedKarma
Aug 24, 2009, 11:54 AM
It doesn't keep track of "very ill" patients. It keeps track of patients over the age of 65, whether they are ill or not. Excellent then. Better preventative care for the elderly.
ETWolverine
Aug 24, 2009, 12:12 PM
Excellent then. Better preventative care for the elderly.
I guess you could consider a "Do Not Resucitate" or a "Do Not Intubate" order good "preventive medical care". It would definitely prevent the elderly from getting medical care.
But somehow I don't think that's what proponents of preventive health care had in mind.
Elliot
speechlesstx
Aug 24, 2009, 12:18 PM
Here's a nice example of government run health care, 1200 veterans were mistakenly told (http://www.dailymail.com/News/200908240456) they have ALS (Lou Gehrig's disease), a fatal neurological disorder. It's a good thing the VA has it's "death book" again to finish pushing these heroes over the edge.
NeedKarma
Aug 24, 2009, 12:20 PM
I guess you could consider a "Do Not Resucitate" or a "Do Not Intubate" order good "preventive medical care". It would definitely prevent the elderly from getting medical care.
But somehow I don't think that's what proponents of preventive health care had in mind.
ElliotOnce again show me the text of the bill where it advocates that.
speechlesstx
Aug 24, 2009, 12:42 PM
Just so this doesn't get lost at the end of the previous page, 1200 veterans mistakenly told they have fatal neurological disease (http://newsbusters.org/blogs/kyle-drennen/2009/08/18/msnbc-no-mention-black-gun-owner-among-racist-protesters).
NeedKarma
Aug 24, 2009, 12:43 PM
Once again show me the text of the bill where it advocates that.
He always seems to run away when he gets asked this question. Ummmm...
ETWolverine
Aug 24, 2009, 01:43 PM
Once again show me the text of the bill where it advocates that.
Fine.
But this is the last time. It is in section 1233:
SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
(a) MEDICARE.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
(A) in subsection (s)
—(I) by striking ''and'' at the end of subparagraph (DD);
(ii) by adding ''and'' at the end of subparagraph (EE); and
(iii) by adding at the end the following new subparagraph:''(FF) advance care planning consultation (as defined in subsection (hhh)(1));''; and
(B) by adding at the end the following new subsection:
''Advance Care Planning Consultation''(hhh)(1)
Subject to paragraphs (3) and (4), the term 'advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
''(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
''(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
''(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
''(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
''(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are availableunder this title.
''(F)(I) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
''(I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons such an order should be updated periodically as the health of the individual changes;
''(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
''(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a healthcare proxy).
''(ii) The Secretary shall limit the requirement for explanations under clause (I) to consultations furnished in a State—
''(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
''(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
''(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—
''(I) ensures such orders are standardized and uniquely identifiable throughout the State;
''(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;
''(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
''(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association,and state hospice association.
''(2) A practitioner described in this paragraph is—
''(A) a physician (as defined in subsection (r)(1)); and
''(B) a nurse practitioner or physician's assistant who has the authority under State law to sign orders for life sustaining treatments.
''(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).
''(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
''(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
''(5)(A) For purposes of this section, the term 'order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—
''(I) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional's authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
''(ii) effectively communicates the individual's preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
''(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
''(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
''(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—
''(i) the intensity of medical intervention if the patient is pulseless, apneic, or has serious cardiac or pulmonary problems;
''(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;
''(iii) the use of antibiotics; and
''(iv) the use of artificially administered nutrition and hydration.''.
In case you can't understand it, section 1233 is the one where the bill requires that every person of the age of 65 be visited by a counselor and be "advised" or "counseled" to sign DNR orders, DNI orders, do not hydrate orders, do not feed orders, do not medicate orders and any other orders that would prevent "heroic measures" from being administered.
How do I know that this isn't about giving orders to GIVE those measures instead of refusing them? Well first of all, it says to in the final section above.
But also, because doctors are not allowed to withhold those measure unless they are given a specific order to do so. Without an order, doctors are required by law to take care of the patient, no matter what. The only reason to counsel a patient to write out a standing order for doctors is if they want the doctor to WITHHOLD care. There is no other reason for such counseling.
Therefore, what section 1233 is saying is that counselors should visit people of the age of 65 years or older and try to convince them to sign standing orders (living wills) that require doctors to withhold treatment. It is NOT about counseling them to sign standing orders to require doctors to take care of them because that care is AUTOMATIC unless they are deliberately ordered otherwise.
In other words, Death Counselors. People who counsel patients who may have 20 or 30 more years left to live to decide to die rather than fight for life... and to write that decision down for the doctors.
Note subsection IV (3) A above, the one that I bolded AND underlined. You had stated before that these "advanced care consultations" would simply be a part of a normal visit with a doctor by the patient and is just part of the normal doctor/patient relationship. This section specifically states that such a consultation CANNOT be part of the normal doctors visit and has to be a separate consultation. Which means it ISN'T part of the normal doctor/patient relationship and is really something else entirely.
The purpose is clear... this is an attempt by the government to impose counseling sessions in which patients will be coerced, cajoled and harassed into signing DNI and DNR orders, orders to withhold care, and orders to move the patient to final hospice care and palliative care at the slightest excuse in order to save the government money.
As I said, if the purpose were to GRANT care, there would be no need for these counseling sessions, because doctors automatically have to grant care unless ORDERED not to. The only time you need to give a signed, notarized order is to WITHHOLD care.
So, NK... do you see it yet? Or have I wasted more of my time posting something you could read by yourself and instead deny is really there? Does it not talk about specifically withholding care in subsection 5 B? Or did I just make that up too?
You're wrong, NK. It says exactly what we have been saying it says. Denying what is written in black and white is a waste of time and just makes you look foolish.
This is the last time I post this for you. Next time look it up for yourself.
Elliot
spitvenom
Aug 24, 2009, 01:56 PM
You really get death panels from that. Because What I get from that is explaining to people why they should have a living will and why they need to pick someone to have power of attorney.
I like how you put in bold pulseless you do know that means YOU ARE PRETTY MUCH DEAD. So if you are pulseless unless God or a vampire is working on you odds are you ain't coming back.
NeedKarma
Aug 24, 2009, 02:01 PM
You really get death panels from that. Because What I get from that is explaining to people why they should have a living will and why they need to pick someone to have power of attorney.
I like how you put in bold pulseless you do know that means YOU ARE PRETTY MUCH DEAD. So if you are pulseless unless God or a vampire is working on you odds are you ain't coming back.That's what I get too. My wife (works with public trustee office) has those conversations with clients and their doctor. There's no evil, it's planning for the future when the patient may not be able to vocalize it. This already happens everyday in hospitals and long-term care homes.
speechlesstx
Aug 24, 2009, 02:22 PM
NK and Spit, I already said I'm not advance directives and such, on a purely voluntary basis, but I also said it has no place in a government program, designed by advocates of physician assisted suicide, providing financial incentives to doctors and presented in a format as unbiased as a push poll.
I've also pointed out it's not "purely voluntary." As Charles Lane (not a right-winger) said, "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. "
It's not as evil as some say but it's certainly not as innocuous as supporters say. I think I've been quite fair about that. But when 1200 veterans are told mistakenly told they have a fatal neurological disorder, how many might mistakenly lean too much on the VA's new advice booklet? Multiply that by the remainder of the country depending on the same incompetent government that already bumbles VA and Native American health care and tell us what you get.
NeedKarma
Aug 24, 2009, 02:27 PM
I think I've been quite fair about that.
It's true you have been Steve. :)
ETWolverine
Aug 24, 2009, 02:28 PM
You really get death panels from that.
No, I get death counselors from that. Death panels come from sections 141 and 142, and other parts of the bill that talk about "efficiency modeling" and "quality of life assessments" and "cost sharing".
Because What I get from that is explaining to people why they should have a living will and why they need to pick someone to have power of attorney.
I know you do.
But you only need those things to PREVENT someone from getting care, not to request it. Therefore any discussion of convincing people to sign DNRs and DNIs is the same as telling them to refuse care. THAT is someone counseling people to die rather than accept medical care. Death counselors.
I like how you put in bold pulseless you do know that means YOU ARE PRETTY MUCH DEAD. So if you are pulseless unless God or a vampire is working on you odds are you ain't coming back.
I'm a former EMT. I have actually brought patients back from the dead on three occasions. (Several of my colleagues have more resucitations than that, I'm nothing special in that area. This was just a statement of fact.) One of them was my own grandfather, about 15 years ago.
If there had been a DNR or DNI on file, I would not have been allowed to try to resucitate these patients. In my grandfather's case, he lived another 20 years (he died this past April) that he would not have lived had he been convinced by some government bureaucrat to sign a DNR. (He was actually my first patient... I brought him back literally the day after receiving my EMS license from NY State. So that was in late 1990.) He would have missed the weddings of 4 grand children and the births of 10 great-grand children. Not to mention graduations, bar mitzvahs, birthdays and other happy occasions. And a few sad ones as well to be sure. He lived a very full life in those final 2 decades.
Not that his first 70+ years were all that empty. He saved a lot of people's lives in the 40s during his time in the Concentration camps by smuggling them food and medicines... he was a great man. But I digress.
My point: please don't tell me about patients without a pulse being dead. Or the odds of their coming back. Because the brain can live on after the heart stops. And if you resucitate soon enough, the patient can live on with very high functionality.
DNRs and DNIs and No Heroic Measures orders should be put in place in the final days (or even hours) of life... not at age 65 when the patient has the potential of 30 years of life ahead of them, EVEN if they are sick. Much less if they are NOT sick.
Any attempt by the government to convince people to put such orders in place so early in their lives (and 65 is VERY early by today's standards) should be looked on with suspicion. What is their motive? The motive is COST CUTTING, just as Obama has indicated in his own speeches about "making end of life decisions that are cost effective".
You can deny it all you want. Section 5B specifically tells us what the purpose of these DNI orders and "living wills" is... to LIMIT care to the elderly, not extend it.
Elliot
inthebox
Aug 24, 2009, 08:07 PM
ET
Just want to clarify that DNR [ to the lay public ], does not mean no treatment. Just that if someone has a "cardiac arrest" someone who is DNR will not have CPR, "shocking," etc. They will be let go so to speak.
Or that if someone stops breathing or is on the maximum amount of supplemental oxygen, short of putting a tube in so a machine can ventilate you: a person with a DNR order will and should be given something to relieve that sense of breathlessness and allowed to die as comfortably as possible.
DNR does not mean a person will not get otherwise routine treatment. A DNR heart person will still get their heart medicine, a DNR person with chronic emphysema will get their oxygen and breathing treatments.
I do think that the each individual should be allowed to make that decision while they are not acutely ill, and in consultation with their doctor.
It is hard for that person, family and loved ones, and medical staff to start asking end of life questions when they are breathing hard, and or short of breath and or in pain, what they want their end of life to be? It is too emotional and they may not even be competent at the time to render that kind of decision. Many times the decision is "do everything, but so so would not want to be kept alive by machines."
----------------------------------------
This type of counseling already occurs:
Why is it in this bill?
---------------------------------------------
Where in this bill does it state that the doctor or counselor gets paid, let alone payment dependent upon a certain code status. I don't read it, in what you have posted as such.
G&P
ETWolverine
Aug 25, 2009, 06:25 AM
ET
Just want to clarify that DNR [ to the lay public ], does not mean no treatment. Just that if someone has a "cardiac arrest" someone who is DNR will not have CPR, "shocking," etc. They will be let go so to speak.
Or that if someone stops breathing or is on the maximum amount of supplemental oxygen, short of putting a tube in so a machine can ventilate you: a person with a DNR order will and should be given something to relieve that sense of breathlessness and allowed to die as comfortably as possible.
DNR does not mean a person will not get otherwise routine treatment. A DNR heart person will still get their heart medicine, a DNR person with chronic emphysema will get their oxygen and breathing treatments.
I do think that the each individual should be allowed to make that decision while they are not acutely ill, and in consultation with their doctor.
It is hard for that person, family and loved ones, and medical staff to start asking end of life questions when they are breathing hard, and or short of breath and or in pain, what they want their end of life to be? It is too emotional and they may not even be competent at the time to render that kind of decision. Many times the decision is "do everything, but so so would not want to be kept alive by machines."
----------------------------------------
This type of counseling already occurs:
Why is it in this bill?
---------------------------------------------
Where in this bill does it state that the doctor or counselor gets paid, let alone payment dependent upon a certain code status. I don't read it, in what you have posted as such.
G&P
To clarify, here are the definitions of a few medical acronyms and terms:
DNR = Do Not Resucitate - no CPR, no defibrilation, no medicines given to make the patient's heart beat, no oxygen administered.
DNI = Do not Intubate - no tubes put into the patient to help them breath.
No Heroic Measures = no medicines or treatments of any kind other than painkillers to keep the patient comfortable. Also referred to as "palliative care". This is essentially an order to "let me just die".
No Nutrition & No Hydration = do not feed or give liquids to the patient. This is how Mary Schiavo was eventually killed by the courts.
Do Not Transfer = Do not move the patient to another facility for "better" or more intensive care... let them die in their current facility (generally used in hospices or nursing homes).
RMA or RMC = Refuse Medical Assistance or Refuse Medical Care... signing out of the hospital against medical advice of the doctor. (Not specifically discussed in the bill above, but another good medical acronym to know).
Elliot
earl237
Sep 4, 2009, 11:41 AM
I have always been a strong supporter of euthanasia for people who want that option and I think that it should be legal. Many religious types refer to supporters as Nazis which I think is really unfair and ignorant because the term actually comes from an ancient Greek word meaning good death.
ETWolverine
Sep 4, 2009, 12:25 PM
I have always been a strong supporter of euthanasia for people who want that option and I think that it should be legal. Many religious types refer to supporters as Nazis which I think is really unfair and ignorant because the term actually comes from an ancient Greek word meaning good death.
You're a Heinlein-style Libertarian in this area. Not a position that I agree with, but I understand it.
My real issue with euthenasia, though, is when the "option" is encouraged by the government (as per HR3200) and in some cases FORCED by the government (as in Norway's medical system).
Elliot
NeedKarma
Sep 4, 2009, 12:44 PM
My real issue with euthenasia, though, is when the "option" is encouraged by the government (as per HR3200)It isn't.
speechlesstx
Sep 4, 2009, 01:47 PM
It isn't.It apparently is in the UK (https://www.askmehelpdesk.com/current-events/can-anyone-explain-article-me-392459-7.html#post1960831), and budget troubles in B.C. (https://www.askmehelpdesk.com/current-events/can-anyone-explain-article-me-392459-7.html#post1961358) mean they are expecting "to cut surgeries, seniors' programs and services for the mentally ill to make up a budget shortfall of up to $160 million."
This universal care stuff is sounding better all the time :rolleyes:
excon
Sep 4, 2009, 02:04 PM
This universal care stuff is sounding better all the time :rolleyes:Hello Steve:
Then this should make you feel really good:
Aetna's Ron Williams - CEO Compensation
Total Compensation: $24,300,112
CIGNA's H. Edward Hanway - CEO Compensation
Total Compensation: $12,236,740
Unite Health Group's Stephen Hemsley - CEO Compensation
Total Compensation: $3,241,042
WellPoint's Angela Braly - CEO Compensation
Total Compensation: $9,844,212
Coventry Health Care's Dale Wolf - CEO Compensation
Total Compensation: $9,047,469
Just to name a few.
excon
speechlesstx
Sep 4, 2009, 02:55 PM
Hello Steve:
Then this should make you feel really good:
Aetna's Ron Williams - CEO Compensation
Total Compensation: $24,300,112
CIGNA's H. Edward Hanway - CEO Compensation
Total Compensation: $12,236,740
Unite Health Group's Stephen Hemsley - CEO Compensation
Total Compensation: $3,241,042
WellPoint's Angela Braly - CEO Compensation
Total Compensation: $9,844,212
Coventry Health Care's Dale Wolf - CEO Compensation
Total Compensation: $9,047,469
Just to name a few.
excon
How much to run the new health care bureaucracy which will not face any pressure to compete and succeed in the marketplace?
inthebox
Sep 7, 2009, 02:03 PM
Hello Steve:
Then this should make you feel really good:
Aetna's Ron Williams - CEO Compensation
Total Compensation: $24,300,112
CIGNA's H. Edward Hanway - CEO Compensation
Total Compensation: $12,236,740
Unite Health Group's Stephen Hemsley - CEO Compensation
Total Compensation: $3,241,042
WellPoint's Angela Braly - CEO Compensation
Total Compensation: $9,844,212
Coventry Health Care's Dale Wolf - CEO Compensation
Total Compensation: $9,047,469
Just to name a few.
excon
2010 Congress | OpenSecrets (http://www.opensecrets.org/politicians/index.php)
Millions of dollars raised to keep them in power and buy influence: by both Reps and Dems. :eek:
G&P
excon
Sep 7, 2009, 02:27 PM
Millions of dollars raised to keep them in power and buy influence: by both Reps and Dems. Hello in:
It'd be fine with me if we got rid of the for profit insurance companies and we got rid of permanent politicians by instituting term limits.
excon
ETWolverine
Sep 8, 2009, 09:13 AM
Excon,
Just out of curiosity, what makes you think that if we nationalized health care, that would put an end to insane executive pay levels?
Fannie Plans Retention Bonuses As Outlined by the Government - washingtonpost.com (http://www.washingtonpost.com/wp-dyn/content/article/2009/03/18/AR2009031803188.html?hpid=topnews)
Fannie Mae and Freddie Mac are losing money... but they are paying 7-figure "retention" bonuses to their top execs.
At least private-sector medical insurance companies are making a profit before paying their execs bonuses.
What's the government's excuse?
Sorry, excon, but every problem you find in the private insurance companies you can also find in the government... only bigger, more wasteful and more expensive.
Again, there is no economic, financial or mathematical justification for nationalizing health care.
Elliot
NeedKarma
Sep 8, 2009, 09:19 AM
At least private-sector medical insurance companies are making a profit before paying their execs bonuses.You mean companies like AIG or GM? They are private sector too.
ETWolverine
Sep 8, 2009, 09:44 AM
You mean companies like AIG or GM? They are private sector too.
Yes they are.
The thing about private companies is that if the shareholders think that management is overpaid, they can take action to have those execs fired. If they think that their pay is unjustified, they can move for a vote to eliminate that exec. I've seen it happen. I've been part of such votes (ei: when Michael Eisner was removed as CEO of Disney after they suffered significant annual losses for several years and Eisner made a few deals that turned out to be less than profitable for Disney).
What do you do if a government employee is overpaid in an agency that is losing money?
Nada.
That's the advantage in a private system, NK. There are OPTIONS... shareholders can take action to redress problems. In a government-run system, there are no options.
It's always about options, NK.
Elliot
NeedKarma
Sep 8, 2009, 09:48 AM
Yes they are.
The thing about private companies is that if the shareholders think that management is overpaid, they can take action to have those execs fired. If they think that their pay is unjustified, they can move for a vote to eliminate that exec. But in these cases and in many other cases that did not happen. The execs went for years sucking the failing company dry behind closed doors.
ETWolverine
Sep 8, 2009, 09:59 AM
But in these cases and in many other cases that did not happen. The execs went for years sucking the failing company dry behind closed doors.
Yes... but that's the decision of the owners of the companies. Not yours or mine (unless you happen to be a shareholder of either GM or AIG). And certainly not the government's decision.
These companies put out financial statements every year. Shareholders knew exactly what was happening with these companies and how much the execs were getting paid. They chose not to take action. That's their decision to make.
But apparently you don't believe that shareholders, who own the company, have the right to make such decisions. I guess you think that ownership of a company doesn't really mean anything... such decisions are only for the GOVERNMENT to make. And never on themselves, of course... only on private sector businesses. I haven't seen the government fire any FANNIE MAE or FREDDIE MAC execs or limit their executlive pay levels, despite the fact that they each lost over a billion dollars in 2008.
Elliot