And So I Go: Yesterday, Today and Tomorrow

The Death Panels are back as part of Obmacare

Posted on: December 26, 2010

Le·gal In·sur·rec·tion: I Don’t Care, But We All Sho

As I have mentioned on this site several times if you do not subscribe to Le·gal In·sur·rec·tion then you really should.  He stays on top of the most controversial issues and advises from an attorney’s point of view as well as a Conservatives.

Todays post is vitally important because from this point on what Obama can not get the Congress to agree to he will simply decree with his Presidential prerogatives.  These are dangerous we have over the years given to various presidents for various reasons but they stay in force unless repealed.  So  Presidential prerogatives given to Kennedy are still enforced and read to be used by Obama for something entirely different than was intended when given to Kennedy.  Obama WLL continue in his socialistic agenda to destroy our republic.  The only privilege he does not have is funding and it is the only weapon the Congress still has in it’s hands to use against him and his cadre of evil.  BB

Sunday, December 26, 2010

I Don’t Care, But We All Should

The Obama administration has instituted, via regulations, the end of life counseling which was taken out of the Obamacare legislation after many people objected to the government paying for such services.

As reported in The New York Times, the Obama administration took steps to conceal the change from the public.

Substantively, I don’t care.  I find nothing wrong with end of life counseling, and when my mother was terminally ill I was glad to have her instructions in writing.  Whether the government should be involved is a different matter, so I do not criticize those who want government to stay completely out of such decisions, even if only funding is involved.

Procedurally, we all should care.  This is a textbook example of what I have been warning.  Obamacare simply is the infrastructure.  The details and the demons will be worked out in regulations.

The fact that such a controversial change was kept quiet for so long, and that the Obama administration took steps to keep it quiet, is most troublesome of all.

Defunding is the only option at this point, because the regulators cannot be trusted.

Following is the article in the New York Times that explains what Obamanation has done to circumvent the wilol of We the People.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress.

In this case, the administration said research had shown the value of end-of-life planning.

“Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives,” the administration said in the preamble to the Medicare regulation, quoting research published this year in the British Medical Journal.

The administration also cited research by Dr. Stacy M. Fischer, an assistant professor at the University of Colorado School of Medicine, who found that “end-of-life discussions between doctor and patient help ensure that one gets the care one wants.” In this sense, Dr. Fischer said, such consultations “protect patient autonomy.”

Opponents said the Obama administration was bringing back a procedure that could be used to justify the premature withdrawal of life-sustaining treatment from people with severe illnesses and disabilities.

Section 1233 of the bill passed by the House in November 2009 — but not included in the final legislation — allowed Medicare to pay for consultations about advance care planning every five years. In contrast, the new rule allows annual discussions as part of the wellness visit.

Elizabeth D. Wickham, executive director of LifeTree, which describes itself as “a pro-life Christian educational ministry,” said she was concerned that end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death.

“The infamous Section 1233 is still alive and kicking,” Ms. Wickham said. “Patients will lose the ability to control treatments at the end of life.”

Several Democratic members of Congress, led by Representative Earl Blumenauer of Oregon and Senator John D. Rockefeller IV of West Virginia, had urged the administration to cover end-of-life planning as a service offered under the Medicare wellness benefit. A national organization of hospice care providers made the same recommendation.

Mr. Blumenauer, the author of the original end-of-life proposal, praised the rule as “a step in the right direction.”

“It will give people more control over the care they receive,” Mr. Blumenauer said in an interview. “It means that doctors and patients can have these conversations in the normal course of business, as part of our health care routine, not as something put off until we are forced to do it.”

After learning of the administration’s decision, Mr. Blumenauer’s office celebrated “a quiet victory,” but urged supporters not to crow about it.

“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”

I personally like the idea of a doctor explaining these end of life issues with the patient and did not agree with the “death panel” argument when such a fuss was made.  I could see both sides of the issue  and I could see where very ill patients could be converted into making the decision to stop care  on the doctor’s advise.  Being elderly myself I would personally want the doctor’s opinion  as to the efficacy of further care however.  That is assuming I am in my right mind; and if I wasn’t able to make this decision then I would most certainly want to be left to die  because if I am that sick what is there to live for?.  This is not the point here.

The real point is that Obama went over the heads of Congress and  used the regulatory process to get the provision put back in.

We the People  tend to believe that Congress passes a bill and that is that.  NO! NO! NO! Congress passes a bill and then it goes to those little people in those little cubicles to make up the rules only hinted at or outlined in the bills Congress had passed.  Here is where the real power is!  Here is where anything can be done whether we like it or not.  and you had better believe the Communist have spend the last decades packing their believers into these positions in the federal government. BB

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The e-mail continued: “Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”

In the interview, Mr. Blumenauer said, “Lies can go viral if people use them for political purposes.”

The proposal for Medicare coverage of advance care planning was omitted from the final health care bill because of the uproar over unsubstantiated claims that it would encourage euthanasia.

Sarah Palin, the 2008 Republican vice-presidential candidate, and Representative John A. Boehner of Ohio, the House Republican leader, led the criticism in the summer of 2009. Ms. Palin said “Obama’s death panel” would decide who was worthy of health care. Mr. Boehner, who is in line to become speaker, said, “This provision may start us down a treacherous path toward government-encouraged euthanasia.” Forced onto the defensive, Mr. Obama said that nothing in the bill would “pull the plug on grandma.”

A recent poll by the Kaiser Family Foundation suggests that the idea of death panels persists. In the September poll, 30 percent of Americans 65 and older said the new health care law allowed a government panel to make decisions about end-of-life care for people on Medicare. The law has no such provision.

The new policy is included in a huge Medicare regulation setting payment rates for thousands of services including arthroscopy, mastectomy and X-rays.

The rule was issued by Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services and a longtime advocate for better end-of-life care.

“Using unwanted procedures in terminal illness is a form of assault,” Dr. Berwick has said. “In economic terms, it is waste. Several techniques, including advance directives and involvement of patients and families in decision-making, have been shown to reduce inappropriate care at the end of life, leading to both lower cost and more humane care.”

Ellen B. Griffith, a spokeswoman for the Medicare agency, said, “The final health care reform law has no provision for voluntary advance care planning.” But Ms. Griffith added, under the new rule, such planning “may be included as an element in both the first and subsequent annual wellness visits, providing an opportunity to periodically review and update the beneficiary’s wishes and preferences for his or her medical care.”

Mr. Blumenauer and Mr. Rockefeller said that advance directives would help doctors and nurses provide care in keeping with patients’ wishes.

“Early advance care planning is important because a person’s ability to make decisions may diminish over time, and he or she may suddenly lose the capability to participate in health care decisions,” the lawmakers said in a letter to Dr. Berwick in August.

In a recent study of 3,700 people near the end of life, Dr. Maria J. Silveira of the University of Michigan found that many had “treatable, life-threatening conditions” but lacked decision-making capacity in their final days. With the new Medicare coverage, doctors can learn a patient’s wishes before a crisis occurs.

For example, Dr. Silveira said, she might ask a person with heart disease, “If you have another heart attack and your heart stops beating, would you want us to try to restart it?” A patient dying of emphysema might be asked, “Do you want to go on a breathing machine for the rest of your life?” And, she said, a patient with incurable cancer might be asked, “When the time comes, do you want us to use technology to try and delay your death?”

What I don’t understand is why this clause was even put in the Obamacare bill to begin with.  I have had several operation in the last few years and every time the hospital has offered me papers to read and sign telling them what to do in case of an emergency.  I could have asked my doctor or the nurses any questions I wanted about my illness and I feel I would have gotten answers.  I never asked about death except to say I wanted nothing done if by chance I died in the operating room or afterward before leaving the hospital.  So there was no need to put it in black and white since it was just a part of the procedure anyhow.  Also next of kin were asked if they wanted patients revived and told when asked  what the chances were.  Of course the next of kin did have to ask the doctors for specifics before they were given but that was okay too.  It all seemed like a big to do about something that didn’t need fixed or messed with as the system was working.  So by making a fuss and taking the provision out of the bill the Republicans and other critics really just made it impossible for doctors to answer normal questions of the patient and family.  It is only right then that this provision be put back in the bill.  It is wrong that it was done behind closed doors thru the rules and regulations process.! I don’t know how it should have been done since the politicians were playing politics with this serious issue but it should not have been placed in the hands of bureaucrats.


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