I have been alerted today that a Betsy McCoy claimed on the Fred Thompson radio show that there is a “mandatory counseling” session required for seniors in the House health care reform bill intended to induce them to make health care decisions that would end their lives sooner. As you can imagine, that got my attention, so I decided I should look it up. She said the offending passage began on page 425 of the bill, so I went there.
Is she right? It is very hard to tell. That section of the bill refers to existing law without quoting it. But it does seem to require that people on Medicare receive an “Advance Care Planning Consultation” every five years or when their health status changes. Here’s the relevant language from the bill:
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, 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 available under this title.
OK, this would seem to require such counseling, the purpose of which would be to get seniors to sign advance directives–in the hope, obviously, that they will elect to refuse interventions–since much of this is supposed to be about saving money. However, the legislation does require that the full range of options should be discussed. Indeed, on page 430 it states:
(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.
Nothing wrong with that. But is that all there is?
Here’s the thing: I’m a lawyer and I couldn’t figure out what this section of the bill would actually require because it refers to existing laws, and to look up and cross reference those against the bill would require hours to figure out. That in itself should send up warning flares. From what I have seen, this bill is simply incomprehensible.
It is urgent that our representatives slow down, figure out what these bills really contain, and let the people weigh in before the legislation is finally decided upon. That the President of the United States, the Speaker of the House of Representatives and others in political leadership want to deny us that opportunity tells me this bill is toxic–and on that basis alone, it should be rejected unless sufficient time is allowed to permit the democratic process to operate in a proper fashion.
July 18th, 2009 | 6:19 pm
This was discussed last night on the O’Reilly factor and I found it very disturbing. Whatever Laura Ingram, who was standing in for Bill OReilly, read called for consultation regarding feeding tubes, etc. I don’t like the idea that this is targeted toward elderly people. If end of life planning is so important, than they should do it for everyone, not just for the elderly-doing so implies the hope that elderly people will purposefully elect to die sooner…who knows what kind of pressure a government buorocrat would put on an aging person to “do the patriotic thing” and not accept life sustaining procedures? Moreover, isn’t this in conflict with Obama’s very “pro choice” ideology, which does not tolerate such governmental interference in people’s personal decisions? What if someone suggested that the government send people to the houses of women in their childbearing years to talk about contraception, family planning, and childbirth vs. abortion? There would be no way.
July 19th, 2009 | 7:34 am
[...] of death??? Healthcare bill savings come from killing off old people? – Yahoo! Answers Secondhand Smoke — A First Things Blog Here are a couple of articles, I am sure you can find more on the subject. Some of the comments on [...]
July 19th, 2009 | 10:20 am
To find out the implications of this bill, you can go to the website the the American Association of Physicians and Surgeons:
http://www.aapsonline.org
Or call them here: 800-635-1196. If you still have questions, they can give you answers.
July 19th, 2009 | 10:14 pm
Is that the same Betsy McCoughey (sp?) (which I believe is pronounced “McCoy”, not sure) who was Lieutenant Governor of New York? If I understood this blog section right, she has raised the alarm about the danger of this bill, which would not surprise me, because she is a good woman, and a standout from most of the rest of what we have had going on in New York State politics. Only Albany, for example, could have produced the state’s current “guardianship” law, which was enacted on April Fool’s Day of 1993 and has received much valid criticism, yet remains in effect. This whole “end of life” stuff is a buzzword-saturated shibboleth whose endgame is to exploit, victimize, and get rid of the elderly, and has made an industry out of same. Too many people lacking the talent, perspicacity, and/or character and integrity to do other than make their living in the “elder” field have made it into an industry that is a lucrative feeding trough for themselves, and “cost” is just another buzzword that could not exist if the insurance companies, without whose existence medicine would be more apt still to be medicine rather than having been corrupted into becoming the “health care field/industry,” did not. A whole bunch of people who are absolutely unfit to be in any profession and would not have survived, nor should have, in a less “nice” world now have degrees, white-collar jobs, titles, a sense of entitlement, and those who are most vulnerable at their mercy, ethics have flown out the window at the same time we’ve now got “ethicists,” and the country isn’t producing anything any more. Because this bunch has taken over and feels work, at which they’d be incompetent, is beneath them. Of course they write self-serving statutes that are sometimes, as in this case, opaque and incomprehensible. Both because they lack the talent to operate a canopener and on purpose. Good for Betsy and for SHS for calling them on it.
July 19th, 2009 | 10:31 pm
And how is any of this anyone else’s business but that of the person him- or herself in the first place? But the only way this crew can make a living is by butting into the lives of those off whom they make a living, and taking away their rights while trying to bamboozle them into believing that this way their rights will be “protected”; of course they want to make it mandatory. That’s Democrats and liberals and dogooders for you, and if Republicans weren’t on the side of insurance companies and tort reform, they’d have a better shot at actually being Republicans again. That’s it in a nutshell, and a big part of the solution to the problems we’ve got in the U.S., and the rest of the world would be more able to solve its own versions of the same problems if it did likewise in its own ways.
July 20th, 2009 | 10:10 am
I work in Catholic health care. Clearly we must resist any effort to coerce patients to forego life sustaining treatments or procedures. We also need to acknowledge that the American way of death is a complex, and expensive, process that for some patients makes it harder to attain a peaceful death. Most Americans, studies reveal, do not want to be “hooked up to machines” when they reach the end stage of a disease, but that is the default position in the acute care setting unless the patient expressly refuses CPR, mechanical ventilation, hemodialysis or other interventions that delay death by a few hours, days or weeks. Hence, the need for advance care planning. You can’t do it well in 5-10 minutes and most plans don’t reimburse for it. Maybe that’s one reason the proposed law would make it mandatory. Even a detailed advanced directive is no substitute for frank discussion between the patient, physician, family members and surrogate decision makers. Timely provision of information and options shows respect for the patient’s autonomy so he or she can make informed decisions about end of life care. Is this proposal the best way to go about it? No, but attitudes about death and dying is an area that must be addressed if we’re going to have reform that respects human dignity.
July 20th, 2009 | 11:24 am
People may SAY they don’t want to be “hooked up to machines” when the prospect of that is presented to them, which is telling, because whose idea was it for that prospect to be put into the person’s mind in the first place? But until it happens, no one knows what they would really want in circumstances they have never experienced before, and when it actually is, for them, a matter of living or dying. “Dignity,” “timely provision of information of options,” “end of life,” etc. are buzzwords and shibboleths that serve the purposes of the health care establishment and all the butting in it now entails. Nothing is more personal than dying, and those who have not yet been old, or in the position they are forcing the person to imagine in advance, have no business butting in to the equation. “Attitudes about death and dying” is yet another buzzword,” and all these things serve the system that provides salaries to those who butt into what is truly none of their business. Even saying that attitudes about death and dying must be addressed is a form of coercing people to think about what someone else wants them to think about. This is no one’s business but that of the person him- or herself, and if that concept were truly respected we wouldn’t have the mess and tragedy we have on our hands now. Loss of respect for the individual’s autonomy and the value of life goes along with the loss of ethics in medicine which once accompanied actually taking care of the patient, rather than trying to get rid of them, which is what all this “caring” and “concern” and butting in really is all about, and without which those who purport to “care” about strangers re things they don’t even know about and have never experienced themselves would have to find other employment. If they could. You know, like doing actual work, and producing something of value. Not running around with clipboards all day full of self-importance.
July 21st, 2009 | 2:35 am
“If end of life planning is so important, than they should do it for everyone, not just for the elderly-doing so implies the hope that elderly people will purposefully elect to die sooner”
Obviously the elderly are going to die in far greater numbers, then the young. There is nothing wrong with helping them prepare for their inevitable death. When both my parents were diagnosed with cancer, they opted to talk to someone about the decisions that needed to be made. It made it much easier for their children.
July 21st, 2009 | 2:33 pm
It is one think for me to decide an another for them to try an talk old people into an early death. I think I will change my end of life papers. I want all medical care now the the hell with them.
July 21st, 2009 | 3:25 pm
[...] I: Over at Secondhand Smoke, Wesley J. Smith tries to determine what the bill really says: Here’s the thing: I’m a lawyer and I couldn’t figure out what this section of the bill would [...]
July 22nd, 2009 | 2:22 am
Soylent Green, people!!! This is so obvious…
July 22nd, 2009 | 5:30 pm
Egulch: As long as it was their idea in the first place and it was for their own sake with it making it easier for their children only as a byproduct, that’s fine.
Karen: GOOD FOR YOU!!! If only enough other people were that smart.
July 23rd, 2009 | 2:40 pm
All this does is define and allow medicare to pay for an “Advanced Care Planning Consultation” once every five years (more often if the situation warrants). No one is compelled to do so.
July 27th, 2009 | 5:29 pm
[...] comment refers to section 1233 (page 425 of the pdf file) of H.R. 3200 (Open Congress) which, according to Wesley J. Smith, seems to “require that people on Medicare receive an ‘Advance Care Planning [...]
July 29th, 2009 | 8:58 pm
[...] two weeks ago (July 16) Betsy McCaughey first charged on the Fred Thompson radio program (reported here on July 18) that the House health care reform bill required “mandatory counseling,” about end of [...]
August 1st, 2009 | 11:55 am
I looked into this, and interviewed several House members about this issue. They pointed out that the only thing that this bill does is make it mandatory that the Federal Government PAY for the consultation, and not force the patients to pay for it themselves. Too many people are intimidated by all the legalese involved, and can be confused as to what the option really are for them and their families. This suggestion (and it is still just a suggestion within a much larger bill) is being offered to simply allow seniors to get the information they need without having to pay for the consultation.
No one is encouraged to do anything to end their life, and the consultation is provided by the patient’s own trusted physician. This is just more of Betsy McCoy’s fear mongering, and why she gets paid so well by the Health Insurance Industry to be a public advocate for their side in this debate.
This is the sleaziest tactic to date, and it shows just how frightened the Insurance companies are that the gravy train is about to be derailed by the 73% of the American public that’s fed up with being abused in the name of billions in profits.
August 1st, 2009 | 1:12 pm
Rick: You are way behind the times on this. I have updtated the issue.
The fault of any misunderstanding is with the authors and the inability of supporters to explain for two weeks. I have suggested what needs to be done to erase any misconceptions and to keep the “counseling” from becoming “persuasion” to refuse care.
August 1st, 2009 | 1:35 pm
I had my doubts to begin with that there would be provisions in the HR bill [not Obama's bill, since he hasn't endorsed any in particular, and that is too bad as far as I'm concerned)] that would have the implications, let alone the dreadful provisions some are fearing, but it did not take long to get the drift that the campaign to make something out of it was going to be used by the Tories, the ever self-serving health industry, and the Obama-haters who wanna use anything to defeat everything he proposes, to latch onto this part of the bill.
It’s an interesting idea: Medicare will pay for an every-five year counseling session about very sensible things like living wills, DPOA, etc. I don’t think the bill says it’s mandatory, though I think it would be great if it were.
You will see below in the “sig” accompanying my name that I have made some of that a part of my psychiatric practice. Anyone who has worked in the health field saw a lot of the consequences of not having any idea of what terminal folks really wanted in the way of care. I used to do some lecturing on the matter, and had this great quote from a woman whose father was in a coma in the hospital for several weeks at the age of 85, and the woman had said “I don’t know what to do; he’d never had a chance to tell me what care he wanted” to which I would say to folks “Did he, did she, think he was gonna get out of this life alive? There was plenty of time from the time this guy, and her, and you, were thirty years old to have such conversations.” Doctors, too, are reluctant to have such conversations, and if docs are paid to have this session they may bring themselves to have it, to the benefit of patients, their loved ones, and –by the way — the guy who pays the bills…
…………..
Richard R. Palmer, MD, FAPA Alexandria, Virginia Board-Certified Psychiatry… Psychotherapy, Pharmacotherapy, Combined Therapy, Geropsychiatry, End-of-Life Issues, Out-of-Network® Psychiatric Services
……………
“…A man burdened with a secret should especially avoid the intimacy of his physician. If the latter possess native sagacity, and a nameless something more,–let us call it intuition; if he show no intrusive egotism, nor disagreeably prominent characteristics of his own; if he have the power, which must be born with him, to bring his mind into such affinity with his patient’s, that this last shall unawares have spoken what he imagines himself only to have thought; if such revelations be received without tumult, and acknowledged not so often by an uttered sympathy, as by silence, an inarticulate breath, and here and there a word, to indicate that all is understood; if, to these qualifications of a confidant be joined the advantages afforded by his recognized character as a physician;–then, at some inevitable moment, will the soul of the sufferer be dissolved, and flow forth in a dark, but transparent stream, bringing all its mysteries into the daylight…” — Nathaniel Hawthorne, The Scarlet Letter (1850)
“Never eat at a place called Mom’s, never play cards with a guy named Doc, and never go to bed with anyone who has more troubles than you.” – Nelson Algren
“Every normal man must be tempted, at times, to spit on his hands, hoist
the black flag, and begin slitting throats.” –H. L. Mencken
“….But the effect of her being on those around her was incalculably diffuse: for the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs.”
– George Eliot Middlemarch
August 2nd, 2009 | 3:30 pm
[...] while I waited for Fred’s reply (and I’m still waiting) a commenter tipped me off to these posts by Wesley Smith at Secondhand Smoke. Concerning McCaughey’s claim he [...]
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