Medicare revives end-of-life planning

A new health regulation issued this month offers Medicare recipients voluntary end-of-life planning, which Democrats dropped from the monumental health care overhaul.

The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

But the practice was heavily criticized by former Alaska Gov. Sarah Palin and some other Republicans who have likened the counseling to "death panels."


The "voluntary advance care planning" is included in a Medicare regulation issued Dec. 3 that covers annual checkups, known as wellness visits. It goes into effect Jan. 1.

Source
NY Times article.

From the NY Times article linked above:

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.

So, don't put it in the bill, then regulate it elsewhere.
Sneaky little politicians in DC.

I suppose I should say that I'm on the fence about this.

Assuming this is only used to assist families in making decisions regarding end-of-life health care, which should the family choose to prolong life the system continues to pay for, and does not empower the gov't to make the choice for the family, I could be persuaded to endorse it. But to me that would mean doctors and advisers must be very sympathetic to the patients and their families and not the budgetary concerns, offer the options of experimental treatments and such, and not dissuade anyone from persuing extended life even if the outlook is less than optimal.

reply to post by abecedarian


Medical professionals: check out the practice of "Slow Code"s. Whether motivated by compassion or financial concerns ("taking up a bed") decisions are made about patient care all the time without consulting the families.

ganjoa

Originally posted by abecedarian
I suppose I should say that I'm on the fence about this.

Assuming this is only used to assist families in making decisions regarding end-of-life health care, which should the family choose to prolong life the system continues to pay for, and does not empower the gov't to make the choice for the family, I could be persuaded to endorse it. But to me that would mean doctors and advisers must be very sympathetic to the patients and their families and not the budgetary concerns, offer the options of experimental treatments and such, and not dissuade anyone from persuing extended life even if the outlook is less than optimal.

edit on 12/26/2010 by abecedarian because: (no reason given)

I would agree with you. But really, when won't it be about the ability to pay? If a wealthy family gets the same proposals as a poor family, then I'd agree. But I'm way too cynical to believe that'd be the case.

Looks like Sarah Palin was right. I mean (I'd have to look it up) but didn't Paul Krugman espouse the use of deth panels to lower costs?

Originally posted by beezzer

Originally posted by abecedarian
I suppose I should say that I'm on the fence about this.

Assuming this is only used to assist families in making decisions regarding end-of-life health care, which should the family choose to prolong life the system continues to pay for, and does not empower the gov't to make the choice for the family, I could be persuaded to endorse it. But to me that would mean doctors and advisers must be very sympathetic to the patients and their families and not the budgetary concerns, offer the options of experimental treatments and such, and not dissuade anyone from persuing extended life even if the outlook is less than optimal.

edit on 12/26/2010 by abecedarian because: (no reason given)

I would agree with you. But really, when won't it be about the ability to pay? If a wealthy family gets the same proposals as a poor family, then I'd agree. But I'm way too cynical to believe that'd be the case.

Looks like Sarah Palin was right. I mean (I'd have to look it up) but didn't Paul Krugman espouse the use of deth panels to lower costs?

That is my hangup accepting this.

A utopian society would care for everyone in spite of their ability to pay. But isn't that what the healthcare reform is about- providing overage, oops- meant coverage, irrespective of the ability to pay? Costs are, and should be, related to that. Maybe this could be a segue into fast-tracking, accelerating usage of experimental treatments?

Do I trust the government to take the high-road? Not in the least- gov't is always taking as much as they can then asking one to prove one's worth for recompense.

And if you want to bring in personal wealth, should the wealthiest pay more and receive less? The wealthiest could possibly pay costs out of pocket without involving the gov't.

Does a steelworker put more risk into their life than a secretary? Does the steelworker deserve the same risk assesment the secretary does? Should the secretary subsidize healthcare coverage for the steelworker?

When does "equal" not reflect equal?

And should government decide that?

Originally posted by ganjoa
reply to post by abecedarian

 

Medical professionals: check out the practice of "Slow Code"s. Whether motivated by compassion or financial concerns ("taking up a bed") decisions are made about patient care all the time without consulting the families.

ganjoa

By "slow code" I'm assuming a subtle reference to where one is under immediate threat, faced with immediate loss of live, i.e.heart attack, and the immediate, more viable patient is a "fast code" and the one setting over in some room and has been there 3 weeks is "slow code", correct?

Yeah, I can see where someone in ICU, recently admitted and under constant surveillance, has an arrhythmia and gets immediate attention while someone elsewhere, in a "stable", 2 month long coma has a heart attack and the crash cart goes to ICU instead. What's that?

reply to post by abecedarian

In the end, it's all going to be about money. Bean counters in an office somewhere won't care about the emotional affects/issues. It'l all be about cost. As for a secretary vs. a steel worker, why do we have to devalue a persons employment to a point where they are just values put into a spreadsheet? Does the steel worker have more kids than the secretary? Who is the major breadwinner in the family?

We've moved away from the debate about good coverage for all, and moved to a point system where based on who you are and what you do is more important than just curing what ails you.

Healthcare in this country needed an overhaul. But it's now transformed into a point system that scares me. Must I keep my value to the system in order to get care? Or if my value has lessened, do I just get my choice of red pill/blue pill and my choice of scenery and music (ala Soylent Green)?

Originally posted by beezzer
reply to post by abecedarian

 

Healthcare in this country needed an overhaul. But it's now transformed into a point system that scares me. Must I keep my value to the system in order to get care? Or if my value has lessened, do I just get my choice of red pill/blue pill and my choice of scenery and music (ala Soylent Green)?

Agreed, it needed an overhaul.

But EOL was taken out of the reform bill to appease Republican concerns/threats/truths, and now EOL is being added back in via "Executive" (presidential?) branch regulations, just as Democrats are leaving office.

In the end, it's all going to be about money. Bean counters in an office somewhere won't care about the emotional affects/issues. It'l all be about cost. As for a secretary vs. a steel worker, why do we have to devalue a persons employment to a point where they are just values put into a spreadsheet? Does the steel worker have more kids than the secretary? Who is the major breadwinner in the family?

So now, cost/benefit analysis is important?

We've moved away from the debate about good coverage for all, and moved to a point system where based on who you are and what you do is more important than just curing what ails you.

And if the steelworker lives a 40 year productive life on the job without incident or injury, the steelworker deserves to be penalized the same as the secretary who had 2 paper cuts a year for 40 years... each requiring tetanus shots and stitches?

Where's the balance point where fair=equal?
Tie fair to wages and injury?
Tie fair to risk and wages?

reply to post by abecedarian


All good points. Which is why a free-market system works best. Someone once said America is about equal oppourtunities, not equal outcomes. In making everything "equal" are we raising the bar, or lowering it?

And why does it have to be equal. Life isn't about equality. If I don't get cancer but my neighbor does, is that fair? Will the government penalize me for being healthy because now, we are no longer equal.

Originally posted by beezzer
reply to post by abecedarian

 

All good points. Which is why a free-market system works best. Someone once said America is about equal oppourtunities, not equal outcomes. In making everything "equal" are we raising the bar, or lowering it?

And why does it have to be equal. Life isn't about equality. If I don't get cancer but my neighbor does, is that fair? Will the government penalize me for being healthy because now, we are no longer equal.

Nothing of life is equal. Does one living a hunter's life deserve anything more than one living an urban life?
It could be argued that the hunter is being proactive, procuring food and such in order to survive.
Does the city dweller thus deserve meat (or vegan substitutes) on thier tabile in kind? In my mind, no.

We can't have "capitalist" this and "socialist" that. It won't work that way.

Another thread going on here:
www.abovetopsecret.com...

yeah, it started after mine but ... seems to have more fervor.

My husband has a disease which will probably lead to his death within a few years. He actively seeks out end-of-life counseling from doctors, psychologists, religious leaders, philosophers, etc. He has also talked extensively to me and to his family about what he would like to have happen if and when his early death should occur.

His complaint is that most doctors don't take the time to counsel their patients sufficiently after they deliver the bad news. Many simply give their medical opinion and leave the patient to work out the existential issues on their own.

Probably many doctors feel unqualified to counsel people in spiritual and philosophical subjects and decline on those grounds. Another reason, however, is that a doctor's time is money. Physicians are not reimbursed for the time taken to counsel their patients fully, and they do pay attention to the bottom line.

The Obama plan to reimburse physicians for taking the time to go over a patient's options carefully with them seems sound. Our concern is not that the people my husband consults are encouraging him to die -- none of them are -- but rather that they often don't seem equipped to deal with the subject at all.

My husband can't consult people who have had the experience of dying, obviously, so it seems right that physicians, who have had extensive experience with these matters, should be one of the resources a terminally ill person has available. It seems only right that counseling on these matters should be among the services they are paid to perform.

Originally posted by abecedarian
From the NY Times article linked above:

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.

So, don't put it in the bill, then regulate it elsewhere.
Sneaky little politicians in DC.

edit on 12/26/2010 by abecedarian because: (no reason given)

Sneaky little democrat politicians in this case.

I've been reading that obama would now try to get by decree what he couldn't get Congress and the American people to swallow.

In this case, these de facto beginnings of "death panels" were stripped out of the obamacare bill by Congress, but here is one of obama's toadies putting the regulations back in - by degree.



And for the "everyone should discuss end of life options" democrat supporters, These discussions, should take place, with family and then your doctor, but not with your doctor as mandated by the government. Only a total fool would think those were the same thing.

Plus, add that once the government tags you as "expendable" because your treatment is "too expensive", you really are at the end of your life. Compliments of the obama administration, of course.

reply to post by Sestias


Don't you see though, end of life care and consulting is just a way to make your husband want to die faster. Which is why you're supposed to be against it, here...let's start calling it a 'death panel'. If we allow this order to be implemented into medicare (thank goodness we got it out of Obamacare), then Americans will be facing these death panels on a regular basis if they're faced with a terminal illness.

We all know how much the -government- likes money, so the -government- will be a part of the panel and suggesting the most cost effective manor of any medical procedures...they'll have the greatest say because they'll be footing a majority of the bill. Anyway, if death costs less than the cost of the procedure, then death will most likely be the option given to you and your family. This is why you should oppose this measure. The -government- wants you to pay your -taxes- and then die, with as little compensation as possible.

/devils advocate

Now, everyone, read that same paragraph again replacing the following words:
Government=insurance company
Taxes=insurance payment and copayment

You're going to die. The sooner you realize that, the sooner you realize you don't want to leave your family with difficult decisions ontop of the pain of losing you.

Originally posted by Sestias
My husband has a disease which will probably lead to his death within a few years. He actively seeks out end-of-life counseling from doctors, psychologists, religious leaders, philosophers, etc. He has also talked extensively to me and to his family about what he would like to have happen if and when his early death should occur.

His complaint is that most doctors don't take the time to counsel their patients sufficiently after they deliver the bad news. Many simply give their medical opinion and leave the patient to work out the existential issues on their own.

Probably many doctors feel unqualified to counsel people in spiritual and philosophical subjects and decline on those grounds. Another reason, however, is that a doctor's time is money. Physicians are not reimbursed for the time taken to counsel their patients fully, and they do pay attention to the bottom line.

The Obama plan to reimburse physicians for taking the time to go over a patient's options carefully with them seems sound. Our concern is not that the people my husband consults are encouraging him to die -- none of them are -- but rather that they often don't seem equipped to deal with the subject at all.

My husband can't consult people who have had the experience of dying, obviously, so it seems right that physicians, who have had extensive experience with these matters, should be one of the resources a terminally ill person has available. It seems only right that counseling on these matters should be among the services they are paid to perform.

edit on 26-12-2010 by Sestias because: (no reason given)

My sympathies to you and yours.

Two of the issues I see with EOL counseling are that it doesn't involve just a doctor.
A lawyer, or at least good legal advice is necessary as well since a will/living will and trust should be established- and will Medicare going to cover that?
If gov't is involved, obviously religious preparations can't be endorsed, but if religion is involved in EOL decisions, who's paying that?

Originally posted by links234
reply to post by Sestias

 

Don't you see though, end of life care and consulting is just a way to make your husband want to die faster. Which is why you're supposed to be against it, here...let's start calling it a 'death panel'. If we allow this order to be implemented into medicare (thank goodness we got it out of Obamacare), then Americans will be facing these death panels on a regular basis if they're faced with a terminal illness.

We all know how much the -government- likes money, so the -government- will be a part of the panel and suggesting the most cost effective manor of any medical procedures...they'll have the greatest say because they'll be footing a majority of the bill. Anyway, if death costs less than the cost of the procedure, then death will most likely be the option given to you and your family. This is why you should oppose this measure. The -government- wants you to pay your -taxes- and then die, with as little compensation as possible.

/devils advocate

Now, everyone, read that same paragraph again replacing the following words:
Government=insurance company
Taxes=insurance payment and copayment

You're going to die. The sooner you realize that, the sooner you realize you don't want to leave your family with difficult decisions ontop of the pain of losing you.

left your whole quote there for a reason

Read the paragraph and replaced the words and whoowee, it reads mostly the same. Insurance companies were already regulated by the State and Federal governments.... Kaiser, Blue Cross, Blue Shield, Aetna, etc. have always provided EOL counseling... Medicare too.

So, what's changed?

Oh, I know.

Now government FORCES you to buy insurance. This is good, right? Now you can pay into the system and get some benefits you weren't going to get, right?

Government has already been forcing you to buy insurance via SDI, FICA, etc.

So, in spite of your intentions to portray something good coming out of the "Obamacare" legislation, the reality is most of it was already in place via Medicare; even EOL/hospice was covered under the existing system.

Originally posted by centurion1211
Sneaky little democrat politicians in this case.

...
>snip

reply to post by Sestias


MDMA-assisted psychotherapy

Search

Good luck with everything

reply to post by Dance4Life


And how is that supposed to help?
Or are you too bothered to explain?