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During the stormy debate over his healthcare plan, President Barack Obama promised his program would not "pull the plug on grandma" and Congress dropped plans for death panels and "end of life" counseling that would encourage aged patients from partaking in costly medical procedures.
But on December 3rd, the Obama administration seemingly flouted the will of Congress by issuing a new Medicare regulation detailing -- "voluntary advance care planning" that is to be included during patients' annual checkups. The regulation aimed at the aged "may include advance directives to forgo aggressive life-sustaining treatment,"
Before being tapped by Obama to his Medicare post, Berwick had long applauded Britain's National Health Service, which uses an algorithm to determine if the aged are worthy of additional expenditure for medical care and advanced treatments.
Berwick has argued that rationing will have to eventually be implemented in the U.S, stating, “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”
Seniors appear to be a major target for precious resources under the Obama healthcare plan. According to the Congressional Budget Office, the Obama plan cuts nearly $500 million in Medicare benefits to seniors as the federal government adds 30 million uninsured Americans to private and public health care systems.
The cost of caring for the elderly has not been lost on Berwick.
“The chronically ill and those towards the end of their lives are accounting for potentially 80 percent of the total health care bill out here… there is going to have to be a very difficult democratic conversation that takes place,” he said.
Last month, however, economist and New York Times columnist Paul Krugman told ABC News that rising Medicare costs could only be dealt with by "death panels and sales taxes."
He added: "Medicare is going to have to decide what it's going to pay for. And at least for starters, it's going to have to decide which medical procedures are not effective at all and should not be paid for at all. In other words, it should have endorsed the [death] panel that was part of the healthcare reform.’"
At some point people must realize the futility of trying to save the current bankrupt Social Security system.
More tinkering with the status quo won't help – Social Security is both financially and morally bankrupt – and soon this Ponzi scheme will collapse.
Completely ending Social Security and returning total control over retirement savings to individual workers will end the fraud and provide opportunities for them to earn a decent rate of return on their own hard-earned money. Moreover, it will protect their savings from rapacious politicians and ensure that their money is used productively rather than to disguise federal deficits. Reforms in places such as Chile suggest that the overall benefits to the economy could be substantial if government is removed from the equation.
Unfortunately, like the falling man, it is hard for most people to realize that things are not "fine" – until they hit the pavement. The sooner we end Social Security, the better for everyone concerned.
The sooner we end Social Security, the better for everyone concerned.
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.