The new House Obamacare bill is in and the criticisms about the end of life counseling issues appear to have been addressed seriously. These are my initial impressions, subject to change. But I must say, it’s better. On page 129, the bill states (with my italics):
SEC. 240. DISSEMINATION OF ADVANCE CARE PLANNING INFORMATION.
(a) IN GENERAL.—The QHBP offering entity —4(1) shall provide for the dissemination of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating health benefits plans offered through the Exchange; (2) shall present such individuals with—(A) the option to establish advanced directives and physician’s orders for life sustaining treatment according to the laws of the State in which the individual resides; and (B) information related to other planning tools; and (3) shall not promote suicide, assisted suicide, euthanasia, or mercy killing.
The information presented under paragraph (2) shall not presume the withdrawal of treatment and shall include end-of-life planning information that includes options to maintain all or most medical interventions.
(b) CONSTRUCTION.— Nothing in this section shall be construed—(1) to require an individual to complete an advanced directive or a physician’s order for life sustaining treatment or other end-of-life planning document; (2) to require an individual to consent to restrictions on the amount, duration, or scope of medical benefits otherwise covered under a qualified health benefits plan; or (3) to promote suicide, assisted suicide, euthanasia, or mercy killing.
The new text blunts the criticisms about end of life counseling made here at SHS and elsewhere. I am especially pleased that the counseling is not to be directed toward a particular result and that the option of receiving care is to be included in the directives. However, the bill does not, as far as I can tell, guarantee that the provider cannot be sanctioned for not pursuing the issue. Moreover, as Rita Marker told me in a conversation this morning, the language is far from air tight and regulators may interpret it in ways that take back what appears to have been gained. For example, the requirement not to “promote” assisted suicide certainly doesn’t preclude it from being brought up or discussed in the counseling sessions. And let us not forget, there is still a pending Senate Bill that would deprive providers of payment if they did not offer the counseling.
So, here’s the bottom line as I see it: The House drafters clearly responded to valid criticism–no matter how invalid they claimed it was at the time. Further improvement is warranted. Credit Sarah Palin and Betsy McCaughey for bringing so much attention to this important issue that Obamacare pushers were forced to respond.
Don’t get me wrong: The bill still stinks on many levels--e.g., rationing boards. It is a fiscal disaster. It would empower the bureaucrats to control lives across the breadth of society. It should be soundly defeated.
There is also more to be said about assisted suicide. But I’ll do that in a separate post.
October 30th, 2009 | 1:42 pm
[...] In a previous post about the new House version of Obamacare, I concluded that the end of life counseling provisions had been improved but could still use further clarification. But I have a concern about assisted suicide in an area not connected to end of life counseling or advance directives. [...]
October 30th, 2009 | 3:00 pm
The bottom line is…if and when the bill passes, end of life counseling will either be interpreted in or there will be amendments made to add it in when other bills are passed and no one will notice. Once government has complete control over healthcare it can use healthcare coverage to force you to do or not do just about anything and that really is the whole point. I.e. anyone with a gun does not get coverage or will have coverage revoked. if you are overweight and do not go on a weight loss program, coverage will be revoked or you will be fined. Stop eating meat, etc, etc.
October 30th, 2009 | 11:09 pm
Improved? Only way to improve it is to put a lit match to it or throw it into devouring flames.
Betsy McCoughey is an amazing person whom I very much admire, and, by the way, remember when you thought, SHS, that she was on the wrong track by saying “death panels”?
November 1st, 2009 | 1:50 am
Don’t forget, one of the key players, Center for Practical Bioethics in Kansas City, who I am sure wants to provide the counseling documents to be used, has an advance care directive that says one doesn’t want artificially provided food and water, unless you cross it out and initial. As the default position on the document, frail, sick, elderly will think this is normal, or what is expected. s
Plus, if talking to the doctor means their “wishes” turn into a doctor’s order via POLST (Physician’s Orders for Life Sustaining Treatment), it will follow them anywhere and if Rockefeller puts his end-of-life items back into the Senate bill, as expected, it will mean one cannot fail to follow a POLST order, no matter who objects, without giving up the right to be paid for services rendered to the Non-POLST-ed (still alive) patient.
November 1st, 2009 | 1:57 am
One more thing. CEO of Center for Practical Bioethics, Myra Christopher said during a speech Oct. 1 here that she would prefer that the patient get paid for having the counseling session with the doctor, eithe via an insurance benefit or a cash stipend. So be on the look for that. If this suggestion comes up, I hope people can realize that if your government is willing to give you CASH to have these counseling sessions, they are not doing it because they care about YOUR wishes as much as they care about you signing documents that could save THEM money in the long run and pay for this health care reform. — That speech is also where it says Rockefeller’s staff said he would be putting the end-of-life provisions back into the Senate Health Care Reform bill at the “11th hour.” The speech is can be heard at http://www.rotary13.org or read at (transcription from audio) at http://www.nrlc.org/HealthCareRationing/MyraChristopherspeech.html
November 19th, 2009 | 4:03 pm
[...] of a conference committee. More on that in the next post.) Recall that the House Bill prevented the promotion of assisted suicide in the end of life counseling. It’s missing altogether rom HR 3590. This is the only reference to assisted suicide in the [...]
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