This happened last Friday and I completely missed it:
Six years after legislation to encourage end-of-life planning touched off a furor over “death panels,” the Obama administration issued a final rule on Friday that authorizes Medicare to pay doctors for consultations with patients on how they would like to be cared for as they are dying.
The administration proposed the payments in July, touching off none of the rancor that first accompanied the idea during debate on the Affordable Care Act in 2009….“We received overwhelmingly positive comments about the importance of these conversations between physicians and patients,” Dr. Conway said. “We know that many patients and families want to have these discussions.”
Huh. It turns out that Republicans never really had any problem with this at all. I guess that whole “death panel” thing was just a big misunderstanding. The Wall Street Journal explains what happened:
Since 2010, legislation that would allow reimbursements to physicians for advance planning discussions has gained bipartisan support….The climate has changed in part because of lobbying and education campaigns by medical groups.
Yeah, that must be it. I’m glad we got that straightened out.
Except for Sarah Palin, of course, who offered her familiar common-sense take:
“Government needs to stay the hell out of our ‘end-of-life’ discussions,” she said in a long, um, commentary on Facebook. “I’m so angry at democrat and republican politicians who just rolled their eyes when I, and many others, rose up with warnings that each step forward taken by champions of this socialist program would jerk back two steps from every free American and our God-given rights.”
Blah, blah, blah.
Average life expectancy is one of two statistics commonly used to compare the health-care systems of different nations. (The other is infant mortality.)
One of the puzzles about the U.S. system is that we spend far and away the most money per capita for health care, but we rank 50th in average life expectancy — after Macau, Malta, and Turks and Caicos, among others.
We are all familiar with statistics about how much of health-care spending takes place in the last year of life, and with stories about old people who are tortured with costly treatments they don’t want and which prolong dying but don’t extend life in any meaningful sense.
Certainly, ailing old people should be allowed to die in peace, if that’s what they want, and not be subject to excruciatingly painful surgeries and drugs that will do nothing for them. These are more the fault of lawyers than doctors. In our experience, doctors can be all too cool and rational in their thinking about the end of life. It’s fear of lawsuits (or, in a few cases, trolling for customers) that prevents doctors from behaving rationally when prescribing treatment for the old and terminally ill…
So what do we do about old people who, on balance, would rather get even older — whatever that means in terms of “quality of life” — than give up? This is one of the indelicate, unmentionable questions in the health-care debate…
In short, all the Republican talk during the health-care- reform debate about “death panels” was melodramatic and unfair, but not ridiculous. One way or another, holding down health-care costs will require policies that deny treatment to people who want it. And want it because it will extend their lives.
This goes on already, all the time. Health insurance companies have been known to deny payment for treatments deemed unnecessary. Age limits for organ transplants are another example. All policies that involve denying care because of “quality of life” considerations are, in effect, “death panels.” But no society can afford to give every citizen every possible therapy…
How do you persuade fellow citizens to accept limits on their right to consume health-care resources? The trick, we think, is to ask them when they’re healthy, not when they’re sick. If you think a $200,000 operation is going to give you a few more years to live, it’s going to be hard to convince you that it’s not worth the cost. But before then, when your odds of needing that expensive operation are the same as everybody else’s, you might well choose a system that offers a higher life expectancy, even though it costs less. In fact, why wouldn’t you?
Bloomberg View articles don’t always try to answer the questions they ask. This is one that sort of suggests alternatives; but, the final resolution isn’t settled yet. We’re stuck with politicians, insurance companies, healthcare corporations and their own versions of “death panels” in charge of negotiating with us.
You already know who has the most power in that dialectic – and it ain’t us.
Ever see a teabagger at an anti-war demonstration?
A DNR, or do not resuscitate order, is a legal document that ensures that resuscitation efforts will not be attempted if someone suffers a cardiac or respiratory arrest. End-of-life, or advance care planning, is a subject that far too many families avoid discussing until it’s too late…
Advance directives provide instruction for your family and physician about the types of treatment you want at the end of your life. Sadly, most Americans don’t have them. A 2003 report by the U.S. Agency for Healthcare Quality and Research found that less than 50 percent of terminally ill patients studied had an advance care directive in their medical record. Of those who had directives, between 65 and 76 percent of their physicians were not aware it existed.
End-of-life planning, unfortunately, has emerged as a hot button political issue. In 2009, House Democrats included a provision in the health care reform bill that would have allowed Medicare to reimburse doctors for end-of-life discussions. Former Alaska Gov. Sarah Palin derided the proposal as “Obama’s death panel,” falsely asserting that the government would act as arbiter on who would receive health care. Then-Minority Leader John Boehner claimed that encouraging these discussions would be a step toward “government-sponsored euthanasia.” Ultimately, the provision ignited such intense vitriol that congressional leaders dropped the provision from the final bill that was signed by President Obama.
Many of the arguments against advance-care planning, however, lack merit. The point of the provision was to foster conversation about dying between doctors and patients as well as informed decision making. In an October 2008 study by the Journal of the American Medical Association, researchers found that patients who had these discussions were more likely to accept their prognosis and preferred to receive comfort care, rather than aggressive life-extending therapies. Many choose hospice care, which treats the entire person, both medically and spiritually…
April 16 is National Health Care Decisions Day — an invaluable opportunity for families across America to begin to make informed health-care decisions or revisit the decisions that have been made…Figure out what you want, document your wishes, inform your loved ones and urge them to do the same.
The religious phonies who call themselves conservatives should butt out of everyone else’s life. Those of us who choose – who demand the right to choose – dignity as an end draws near don’t need volunteer saviors telling us what we can and can’t do.
The Kongressional Klowns who get in the way of Medicare don’t wish to see us have professional advice – or aid in the cost of getting that advice. They should leave the corporate cabal that runs American politics and get an honest job.
Gummint pays for my healthcare
They’re known as the Arizona 98. All of them are in need of a life-saving transplant. On Saturday, with time running out for many of them, the “Dream of Life Intervention Coalition” staged a silent protest against the state’s move to trim Medicaid transplant funding in an effort to reduce the budget deficit. The Tucson demonstration began with one protestor, who was then joined by 19 others. A similar event was held in Phoenix Saturday.
In Tucson, instead of calling aloud for Governor Brewer to restore funding, Emily Cameron let her sign do the talking. 9 On Your Side asked Cameron why she would stage a silent demonstration when her life is on the line.
“I think that will come soon,” Cameron said. She was carrying a sign that read, “$5 Million to Sheriff Babeu, zero to dying citizens.” Cameron was referring to the amount recently provided to Pinal County Sheriff Paul Babeu to fight drug and human smugglers.
Time is not on Cameron’s side. She is one of the 98 patients who is being denied a transplant under the state’s version of Medicaid, which provides health care to some people living in poverty. Bone marrow is her only life-saver, she said…
Pat Roll, who received a new heart five years ago, came to the rally Saturday as a symbol of living proof that transplant recipients live long lives…
KGUN9 asked Roll what she would like to say to Gov. Brewer, who claims transplant recipients, on average, live only one year after receiving a new organ or tissue.
“I say to her, ‘Your facts are wrong. First of all, we live more than a year,'” said Roll…
Facts mean absolutely nothing to beancounters. There could care less if they’re counting people who will die soon – or used tyres in a junkyard.
“There’s an image that they try to put out there that all of the transplant patients are illegal or on welfare,” said Cameron, a nurse for 20 years. Because of her illness, she is no longer able to work. That is why she is on AHCCCS, Arizona’s Health Care Cost Containment System.
She says funding transplants would only cost the state $800,000 this year – and $1.4 million next year – not the $5 million Gov. Jan Brewer says it will cost.
“They just found $5 million for the sheriff of Pinal County…
Compassionate conservatives? What a laugh.
Any teabaggers ever join an anti-war demonstration?
After two years of struggling to balance the rights of patients against the beliefs of health-care workers, the Obama administration on Friday finally rescinded most of a federal regulation designed to protect those who refuse to provide care they find objectionable on moral or religious grounds.
The decision guts one of President George W. Bush’s most controversial legacies: a rule that was widely interpreted as shielding workers who refuse to participate in a range of medical services, such as providing birth control pills, caring for gay men with AIDS and performing in-vitro fertilization for lesbians or single women.
Friday’s move was seen as an important step in countering that trend, which in recent years had led pharmacists to refuse to fill prescriptions for the emergency contraceptive Plan B, doctors in California to reject a lesbian’s request for infertility treatment, and an ambulance driver in Chicago to turn away a woman who needed transportation for an abortion.
“Without the rescission of this regulation, we would see tremendous discrimination against patients based on their behavior and based just on who they are,” said Susan Berke Fogel of the National Health Law Program, an advocacy group based in the District. “We would see real people suffer, and more women could die.”
The new rule leaves intact only long-standing “conscience” protections for doctors and nurses who do not want to perform abortions or sterilizations. It also retains the process for allowing health workers whose rights are violated to file complaints.
You wouldn’t ask Republicans, teabaggers and other hypocrites to give up on the Death Panels they already support, would you?
Thinking about death can be frightening, no matter your age or medical condition. As we get older, the reality of our own mortality tends to come into clearer focus; this doesn’t make talking about death or life-sustaining treatments any less frightening though.
It was fear — stoked by certain politicians — that led to the inaccurate and misguided “death panel” rumors that surrounded health care reform proposals last year.
Beginning January 1, Medicare will reimburse physicians who advise patients, in voluntary discussions, about their preferences for end-of-life care treatment during their annual Medicare “wellness visit.” This is advance care planning, and it is a good thing for seniors, their families and health care professionals.
It’s not new. A law passed in 2008 allowed end-of-life planning to be part of a patient’s “welcome to Medicare” exam. Health care reform turned the welcome visit into an annual wellness visit. And now regulations clarify that these important discussions will be covered should the Medicare beneficiary wish to take advantage of this opportunity.
Advance care planning allows a person to make his or her wishes and care preferences known before being faced with a medical crisis. Advance care planning is simply smart life-planning.
RTFA. Many important details and suggestions about planning for the end of your future.
You can be smart. Or you can be stupid.
When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.
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 same dweebs who believed the agitprop back then will likely get their wedgies on, again.
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…
“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.
RTFA. Reflect on the fact that the average Tea Party nutball hasn’t gotten past 1611 when it comes to palliative care – much less understanding that terminally ill folk just might someone more than the parish shaman advising them on their legal and medical choices.
There are Republicans who know better; but, they are corrupt enough to let opportunism and vote-getting from the truly ignorant override anything approaching ethical standards.
First, it was distraught patients awaiting organ transplants who protested Arizona’s decision to no longer cover such operations under its Medicaid program.
Now, Arizonans who received such transplants, and are alive and well as a result of them, are questioning the data that lawmakers relied on to make their controversial benefit cuts…
When Arizona lawmakers voted last spring to cut some state-financed transplant coverage, they relied on data provided by state health officials showing that the procedures were rarely successful. But transplant experts and some patients who have undergone the now-discontinued procedures question the state’s numbers…
The cure rate for bone marrow transplants cited in the report to the Legislature was either zero or 7 percent, depending on whether that unidentified 14th patient lived. But transplant experts put the actual survival rate, based on national studies, at over 40 percent.
Dr. Jeffrey R. Schriber, medical director of the Blood and Marrow Transplant Program at Banner Good Samaritan Medical Center in Phoenix, has written to Gov. Jan Brewer and state lawmakers telling them that their decisions were based on incomplete data that gave the wrong picture. His data show the success rate for bone marrow transplants covered by Arizona’s Medicaid program at slightly higher than the national average. Of 20 operations performed at Banner in recent years, 9 patients have survived, he said…
Bone marrow transplants are not the only ones in which legislators used questionable data to make their decision, transplant experts say. The American Society of Transplant Surgeons called Arizona’s transplant cuts “decisions with no medical justification.”
Liver transplants for those with hepatitis C, which the state also discontinued, have a survival rate exceeding 80 percent after one year and 60 percent after five years, the transplant group said. Arizona’s study of such procedures was far more pessimistic, saying such transplants “do not significantly affect the diseases they are intended to cure.”
The same liars who invented “death panels” to prop up their opposition to extended healthcare – now, use their own version of death panels to cut off essential medical procedures to stiffen their lame beancounter backbone.
RTFA. Corrupt policies, deceitful, in line with neocon ideology all the way.
Seniors and the disabled “will have to stand in front of Obama’s ‘death panel‘ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care.”
Sarah Palin, Friday, August 7th, 2009.
RTFA. Long, detailed examination of this statement from our #1 favorite nutball.
UPDATE: And, now, she paints herself into a corner trying to explain how she’s right – and how she’s not wrong. WTF?
Thanks, Mr. Fusion