[inthebox]

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

"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]

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]

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]

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]

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]

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]

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]

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]

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]

Here's a nice example of government run health care, 1200 veterans were mistakenly told 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]

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

Once again show me the text of the bill where it advocates that.

[speechlesstx]

Just so this doesn't get lost at the end of the previous page, 1200 veterans mistakenly told they have fatal neurological disease.

[NeedKarma]

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]

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]

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]

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]

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]

I think I've been quite fair about that.

It's true you have been Steve. :)

[ETWolverine]

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]

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