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| Name: |
GoneFishin
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| Subject: |
Time For The Truth
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Date:
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8/16/2009 9:32:01 PM
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The Right needs to stop spreading lies if they want to be part of the solution and so does the Left. The Right continues to state that the Living Will provision is mandatory. Well, guess what??????????
The government currently requires hospitals to ask adult patients if they have a living will, or "advance directive." If the patient doesn't have one, and wants one, the hospital has to provide assistance. The mandate on hospitals was instituted during a Republican administration, in 1992, under President George H.W. Bush.
There is NO requirement for a living will under the new plan according to Monsignor Charles Fahey, 76, a Catholic priest who is chairman of the board of the National Council on Aging, a nonprofit service and advocacy group.
Fahey said, "We have to make decisions that are deliberative about our health care at every moment . What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini — then let me go."
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| Name: |
JustAGuy
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| Subject: |
No Death Panels
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Date:
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8/16/2009 10:31:29 PM
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URL: No Death Panels
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| Name: |
Yankee06
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| Subject: |
No Death Panels
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Date:
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8/17/2009 1:04:17 AM
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-Most of teh posts on this subject are using secondary sources. Most of these secondary sources are interpreting the HR3200 to support a dem/liberal position or a Repub/conservative position. We should stop using secondary sources for this subject because most of them are too partisan.
-Go to the primary source: Here is a copy of the famouse page 425 from HR3200 that is suppose to talk about "mandatory" end of life consults....
HR3200, pgs 424-425 (the numbers on teh left are line numbers):
-Advance Care Planning Consultation
21- ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
22- term ‘advance care planning consultation’ means a con-
23 sultation between the individual and a practitioner de-
24 scribed in paragraph (2) regarding advance care planning,
25 if, subject to paragraph (3), the individual involved has
Page 425
1-not had such a consultation within the last 5 years. Such
2 -consultation shall include the following:
3- ‘‘(A) An explanation by the practitioner of ad
4-vance care planning, including key questions and
5 -considerations, important steps, and suggested peo
6-ple to talk to.
7 -‘‘(B) An explanation by the practitioner of ad
8-vance directives, including living wills and durable
9- powers of attorney, and their uses.
10-‘‘(C) An explanation by the practitioner of the
11- role and responsibilities of a health care proxy.
12- ‘‘(D) The provision by the practitioner of a list
13- of national and State-specific resources to assist con
14 -sumers and their families with advance care plan
15- ning, including the national toll-free hotline, the ad
16-vance care planning clearinghouses, and State legal
17- service organizations (including those funded
18 -through the Older Americans Act of 1965).
19- ‘‘(E) An explanation by the practitioner of the
20- continuum of end-of-life services and supports avail
21-able, including palliative care and hospice, and bene
22-its for such services and supports that are available
23- under this title.
-You can see from the above wording that neither the word "mandatory" or "volutary" appears in the document. Without either of these words being directly stated, then a lawyer would state that line 25 of page 424 through line 2 of page 425 means mandatory. However, if the "intent" is "voluntary" as the administration claims, then the easy fix is just add teh word "volutary" How hard is that? The trouble is very few prople have actually read the bill, so the arguing goes on.
-Now the term "Death panel" which has come up in discussions on teh bill has lately been used in relation to page 425. I believe this is because most of the TV pundits haven't read the bill or know the background on this issue ---or they just want to obfuscate the truth. The Brits first used this term to refer to the panels that decide who gets what; what we are calling in our bill the "Comparative effectiveness" panels. These are the people who will decide who gets what rationed care. Teh example most commonly used is the panel decides who gets the by-pass surgery, --the 65 year old retired senio citizen or the 30 year old working father of five. But it's stated in dollar allocation so it doesn't sound so heartless. In other words, medicare will be cut by $50 billion so increased insurance access can be supported with $50 billion.
-IF you want to know what's in the bill, read it. If you kinda want to know what's in the bill, listen to both sides of the discussion and then try to figure out who has the better logic. If you don't really want to "know" what's in the bill, but want to support one side, then just listen to one side.
-(of course if you decide to read the bill, be prepared to go nuts! :)
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| Name: |
JustAGuy
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| Subject: |
No Death Panels
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Date:
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8/17/2009 1:24:10 AM
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Yankee .. I usually applaud your posts and just add "yeah ... what Yankee said".
But I'm not clear on this one. So are you saying that the bill does indeed call for "death panels"? Or are you refuting that the bill calls for "death panels"?
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| Name: |
Yankee06
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| Subject: |
No Death Panels
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Date:
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8/17/2009 2:51:49 AM
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Justaguy,
-Sorry I wasn't clear in above posts , --too much ready of HR3200 legalese mumbo jumbo
-You asked in above post: " So are you saying that the bill does indeed call for "death panels"? Or are you refuting that the bill calls for "death panels"?"
-What I had tried to say was:
--1) that page 425 doesn't discuss death panels. That the term "death panels" has just in the last week or two been associated with page 425, probably asa result of teh Palin comment. Page 425 talks about end-of-life government consultations. Those that oppose these consultations say that these consultations are "mandatory" , but they shouldn't be, ... and that these government people will try to direct the elderly away from costly life-extending procedures in favor of hospice services, --in order to save the government money. Peole who suppor these consultations, per page 425, say that these consultations are "voluntary" and that the counsultants will talk about all options and not try to force any options. The present HR3200 wording would lead to a legal assessment that the visits are "mandatory" because the present wording does not in any way qualify through adjectives or phrases these consultations. Thus if the congress wants them to be voluntary then they must use some kind of limiting terminology like the word "voluntary"
-2)Now, the term death panels: The term death panels has been used by many Brits as a derogatory reference to their health care commissions. Because these commissions determine who gets what health care and how much and at what cost. HR 3200 was taken much from the British heath care system, to include its concept of managing commissions and committees. HR3200 calls for a Heath Benefits Administration Committee. This committee will decide how HR3200 is really executed. If it follows teh Brit model it will focus on costs and eventually rationing. In England this has lead to what many say is a short changing of senior citizens and the severely disabled. Thus the term death panels,because many believe the health care commissions would rather see old and disabled people dead rather than using costly health resources. The proponents for HR3200 are referring to these commissions and committees as "service-effectiveness" or "benefit effectiveness" groups. Service- or benefit- or cost-effectiveness equalling "rationing" in my judgement.
-So, 1) HR3200 on page 425 calls for those over 65 to have a mandatory consultation every 5 years with a government representative on end-of-life issues. 2) HR3200 call for numerous "panels" whose responsibilities are to determine the cost-effectiveness of benefits and I believe eventually the rationing of these benefits in favor of those who still have much to contribute to society to the disadvantage of those who are too disabled or too old.
-Hope that clears some of the fog.
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| Name: |
MartiniMan
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| Subject: |
Time For The Truth
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Date:
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8/17/2009 12:34:37 PM
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Yankee: Help me out here. When I read the pertinent sections it seems mandatory to me for this discussion to occur if it has been 5 years since the last consultation. I negotiate a lot of contracts and the word "shall" means you have to do it and I understand from your post that this is your interpretation as well. Further, the content of the conversation that is required seems to go way beyond a practitioner asking a patient if they want to discuss end of life options, which is common prior to surgery.
Secondly, people need to understand what actually happens with federal laws. What will happen is the appropriate agency created by the act will promulgate regulations that dictate exactly how the law will be implemented. This is where the rubber meets the road. We see this all the time in the environmental business. Congress passes a law and USEPA creates regulations from the law. These regulations are enforceable with criminal and civil penalties.
So is it hard to imagine this scenario? The Comparative Effectiveness Panel determines you don't fit into the right category for a procedure or treatment, the agency created by the law denies the claim for the procedure/treatment and the doctor is required by the law and subsequent regulations (which we have not seen as yet) to tell you about all your end of life options. Is this a "Death Panel"? Maybe the term is over the top but the result is the same. So I think GF's claim that the right is "lying" is probably overstated but we are caught up in debating terminology when the substance of the concern and criticism is in my view right on track.
I know the intent of the left is try to characterize those opposed to Obamacare as right-wing nuts, insurance company sycophants, etc. But the fact is this forum demonstrates that this is completely wrong. My sense is that Architect, Hound and others on the forum that voted for Obama have very real concerns about government control of health care. We all know our system needs some repair but government control is not the answer because it hasn't worked anywhere else.
BTW, interesting article in the Canadian Press today about the incoming head of the Canadian Medical Association saying their system is on the verge of collapse and she has called for a role of private entities in fixing the system.
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| Name: |
Yankee06
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| Subject: |
Time For The Truth
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Date:
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8/17/2009 2:42:32 PM
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Martini Man,
-1. Yes, I agree that the wording on pages 424-425 of HR3200 means that the consultations are mandatory. I believe that 99 out 100 lawyers would agree.
-I agree with most of what you said on how Fed laws are implementd by agencies. Depending on how tightly a law is worded, those who execute the law can have a signifiant effect on the impact of a law. That is why it is important for an administration to get as many people of its persuasion into government positions, either through political appointments or teh normal government hiring process. I have found that government agencies overtime tend to take on their own ethical code. This code is developed and protected by the long-term government professionals who often offer resistence to significant change by government appointees. Thus it is important for an administration that wants to begin an agency or institute new policies to pack the new agancy or poicy implimentation group with people who beleive as the administration believes. This goes for all administrations of both parties.
-No, the scenario you present is not hard to imagine. Given that the proposed bill is significantly based on teh Brit system which has a track record we can evaluate, and based on democratic party policies and proclivities that we can evaluate, and based on the kind of health advisors the administration has in the white house like Dr. Ezikial Emanual, and based on the words of the president himself, your scenario is not hard to imagine. However, other less drastic courses are also possible. This is why the bill has to be as clear and definitive as possible in its wording, and the American people should have an opportubity to read it, or at least have faith that their elected leaders have read it and believe that their leaders think it reflects teh ideals of th majority of their constituents, while at the same time protecting the rights of the minorities within their constituents like teh disabled and the elderly.
---As an aside, Oregon is a very liberal state that provides some instruction on where heath care may go. Oregon now allows its doctors to participate in assisted suicides, with more people taking the option every year. Most are cancer patients that just don't want to spend their endtime (whatever that may be) in pain or drain their monies for eventually ineffective treatments when that money could be given to their children.. That's all good and well and there are good arguments for and against these government-sanctioned suicides. But one of teh things that happens is that such deaths become more "normal" and eventually mainstream. Then something like the following happens: last year one cancer patient was not responding well to treaments. Her doctor recommended she try an experimental treatment. She was on federal and state aid, so she requested approval from teh state. The state denied her funding for the treatment because it was too costly for teh likely results for her particular case, but told her that the state would provide funding (about $500 was stated if I remember correctly) for hospice and other end-of-life treatments. In my view, this is the kind of stuff that happens when the state gets involved because its focus is on cost savings. The question that comes up is would a health insurance company have done the same to her? I guess it all depends on what kind of policy she had.
-The problem I find with all these dicussions about HR3200 is that it is apparent to me that most of the congressmen/women I see on TV, as well as the TV commentators have not read teh bill. These people are just yammering party talking points. In my mind there should be two trails of arguments: 1) on what's in the bill and the wording of what's in the bill, and 2) a more general discussion on the possible and probable impacts of the bill, the long-term administration goals for US health care, and the records and writings and speeches of Obama and his health advisors which one would think will significantly impact the future health care system. Most of teh discussions we get now have all these elements jumbled together with people talking past each other and going nowhere. I think teh American people have a "right" to know what's is being planned for them in detail, ---but more importantly, they have a "responsibility". True , lots of people don't care about the bill or won't read it, or can't read it; ...but these town halls show that there are also lots of people who do care, can read, and want answers.
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| Name: |
GoneFishin
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| Subject: |
Time For The Truth
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Date:
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8/17/2009 3:48:38 PM
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When the time comes for that "mandatory" Living Will, no one is mandating your wishes. They may suggest but be creative. Just agree to the following: "I want to receive all possible medical treatment regardless of cost to prolong my life until age 120".
Now, the "death penalty" is a seperate issue. It doesn't matter if you have that "mandatory" Living Will. HMOs already withhold treatment if they want to based on their criteria. Fortunately, you haven't faced it yet. There will always be treatment withheld based on cost to benefit irrespective of, or lack thereof, a public option.
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| Name: |
MartiniMan
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| Subject: |
Time For The Truth
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Date:
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8/17/2009 4:27:37 PM
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GF, you seem so fixated on HMO's denying care as if that makes it all right for the government to do the same thing. At least there are a lot of options for people in HMO's to go elsewhere for insurance (recognizing that me be difficult with pre-existing conditions, which is an area that has to be fixed). While some employers may only offer an HMO option you could try to go to work elsewhere and if they keep losing good employees because of the coverage they will make a change or go out of business. Simply put, if HMO's were such death machines the market will figure that out and go elsewhere for insurance. In fact, they are so unpopular that I haven't been offered an HMO as an alternative at my last three employers. Fortunately we have other options.
I know you need to see the word mandatory in the law but you totally ignored my point about how regulations can accomplish based on ambiguous laws what would never be palatable in the actual legislation. Rationing health care is the only way the government can save money and that is what the panels are for. Anyone can see it.
If Obama gets his way there will only be one option. Fortunately it appears that they may wave the white flag on the idea of the government plan but don't think for a minute he has given up on the concept. He will look for another way to get this done and he frankly underestimated the aversion the American people have toward government control of anything. I can't believe he is still out there making the UPS/FedEx argument. Not only is it a wildly flawed argument vis-a-vis the current legislation, every time he uses it people think of the long lines at the Post Office and want to run away even faster from Obamacare. The guy is really tone deaf on this issue for some reason.
GF, I think you are beginning to see that America is still a center-right country and the polls are showing that those in the middle are waking up to who Obama really is. I never believed his election was the watershed event that the majority of Americans are suddenly socially and fiscally liberal. If you go back and examine his campaign you will see a lot of center/center-right positions that he never intended to follow and the middle that elected him are beginning to understand it all too clearly. And while I think Obama can be called a socialist it is probably more accurate to call him a statist. This is really the term that best fits his philosophy. The left is getting very angry again because they realize they are still only 20% to 30% of the country.
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| Name: |
architect
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| Subject: |
Time For The Truth
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Date:
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8/17/2009 6:06:43 PM
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Well I'm no lawyer, thankfully, but English is my mother tongue and if what you posted is the actual language I don't see such consultation as mandatory. The word "shall" is in reference to what the consultation will include rather than to whether the consultation must take place. The changes to the medicare proposed in 2003 had a provision co-sponsered by Sen Issakson (R GA) which, according to what I've heard, would have been mandatory. It was defeated. Of course we now know Sarah Palin was advocating such a provision for Alaska a recently as spring of 2008.
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