4 Comments so far

1. on Monday - Aug 10th, 2009 at 3:25 pm Kevin Callahan wrote:

   You can listen to McCaughey’s lies and distortions or you can go to the actual text of the bill and read it for yourself. These Advance Care Planning consultations, paid for by the government, would be available, if desired, once every five years. They are not mandatory as McCaughey says. They would be initiated by the patient not by someone from the government. These consultations would be between a patient and their doctor or medical professional; not with someone from the government. There is nothing in this legislation that encourages or otherwise discusses euthanasia. The idea behind this section is to give patients an opportunity to make their wishes known in advance of an emergency or medical problem. Giving the patient the opportunity to let the doctor and their loved ones know what it is that they, the patient, want is a good thing.

   Read the bill and stop listening to someone like McCaughey whose agenda is to kill health care reform, just as she helped to do in 1994.

   Page 424, Line 15:

   SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

   (a) MEDICARE.—

   (1) IN GENERAL.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—

   (A) in subsection (s)(2)—

   (i) by striking “and” at the end of subparagraph (DD);

   (ii) by adding “and” at the end of subparagraph (EE); and

   (iii) by adding at the end the following new subparagraph:

   Page 425:

   “(FF) advance care planning consultation (as defined in subsection (hhh)(1));”; and

   (B) by adding at the end the following new subsection:

   “Advance Care Planning Consultation

   “(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

   “(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

   “(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

   “(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

   “(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline,

   Page 426:

   the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

   “(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

   “(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—

   “(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

   “(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

   “(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is

   Page 427:

   unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a healthcare proxy).

   “(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—

   “(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

   “(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

   “(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—

   “(I) ensures such orders are standardized and uniquely identifiable throughout the State;

   (II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;

   Page 428:

   “(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

   “(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physcians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

   “(2) A practitioner described in this paragraph is—

   “(A) a physician (as defined in subsection (r)(1)); and

   “(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.

   “(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

   Page 429:

   “(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

   “(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

   “(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—

   “(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals
   and providers across the continuum of care;

   Page 430:

   “(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

   “(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

   “(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

   “(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—

   “(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

   “(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;

   “(iii) the use of antibiotics; and

   “(iv) the use of artificially administered nutrition and hydration.”

2. on Monday - Aug 10th, 2009 at 9:08 pm ZZ Bachman wrote:

   What makes you think I did not read it? I have the full copy in PDF. Show me where it says it is voluntary when in fact it gives a 5 year time interval to do just the opposite? It doesn’t say it is compulsory either but that is not the issue. It opens the door for it to will be written into law. The compulsory part always comes after it is passed and on the books under separate legislation that will intend to foster the “spirit of the law”. Where are you getting YOUR facts from?? It is not from the language in this bill. The issue is that the language OPENS THE DOOR for an invasion of privacy by the federal government into the personal decisions of families and individuals!

   The essential fact is that the government wants to make sure they are “EDUCATING” us on how to “legally” withhold treatment. This is the first step before full blown regulation.

   For example… You liberals hate the NRA for protecting our rights as citizens (yours too) under the 2nd Amendment when the NRA takes the position that “when you give up some of your rights” you are on a slippery slope to loosing all of them. Well this includes the 1st Amendment rights too, both yours and mine. This administration is coming very close to saying out loud that only the LEFT can protest in this country. Yet ironically, the left who so often preach Freedom of Speech — seem to feel no concern at all about giving up their personal freedom of choice and speech as long as the government is controlled by the LEFT and has a socialist agenda that aligns with their particular point of view. In my book that’s the epitome of hypocrisy.

   Why was it necessary for our government to insert ANY language at all about “educating” its citizens when we already have the freedom to educate ourselves? Why??? Because once the language is in there, they can easily INSTITUTIONALIZE it. Health care is not a RIGHT protected under the constituion or bill of rights. FREEDOM of choice UNDER THE LAW is. When those who MAKE LAWS, (your legislatures) decide that personal freedoms of those that have need to be compromised for those that have not, we have moved from capitalism to socialism and the “failed communist experiment” (including the hippie communes of the 60′s. Since when did it become a crime in this country to be wealthy and that wealth needs to be re-distributed.

   If this had been proposed by a Republican Congress you guys would be protesting that it was a restriction of your personal freedom. Like wire tapping to find terrorists. Why is that despised but the left feels its fine to have government intrude upon our personal life when it comes from a leftist democratic legislature and leftist President? I guess the 1st Amendment only protects the right to the free speech of those on the political left.

   If left wing democrats in Congress like the Pelosi automatons really wanted to reduce HEALTH CARE COSTS (instead of driving their new age socialist agendas) they would be pushing for TORT REFORM and to CONSTRAIN FRIVOLOUS LAWSUITS which is one of the primary underlying causes of increased costs of insurance to both Physicians and Patients. They don’t because they are all mostly lawyers themselves and have too many special interest groups to please.

   The American people and the old “Silent Majority” are already fed up with the way this Congress feels it has an absolute right to ram anything down anybody’s throat. They’ll get their at the Mid Term elections. The polls are already pointing to it.

   When you let the fox in the hen house don’t be surprised when you find chicken lying dead eaten in the coop. Intrusive government was something the left used to despise, (note past tense) but it now seems they are good with it as long as it drives their new age socialist agenda. Shades of George Orwell.

   The first step on the slippery slope of a Big Brother in the future making decisions on who among us is worth keeping alive or not is predictably paved by those who were naive enough to not see the danger here in the present.

3. on Tuesday - Aug 11th, 2009 at 12:11 pm Kevin Callahan wrote:

   A few thoughts on some of your (ZZ Bachman) comments in response to my comment.

   1. McCaughey says the counseling is mandatory. It is not. You have to go back to what is being amended in order to get the context. What they are talking about is what services the government will pay for. In this proposed legislation the government would pay for Advanced Care Planning consultations between a covered individual and their medical professional only once every five years (unless the medical condition deteriorates in the time between allowed consultations) . Neither this nor what is being amended makes anything mandatory for the patient. And there is not any indication whatsoever in the proposed legislation or in the legislation that it amends that would indicate that it would become mandatory in the future. The assertion that it would become mandatory in the future has no basis in fact or legislation.

   2. The purpose of this section is to have the government pay for covered individuals to have the opportunity, if they desire it, to speak with their medical professional (physician, nurse practitioner, or physician assistant) about how they (the patient) want to be treated in an medical emergency, and, to get assistance in memorializing those wishes in a legally binding way (living will, durable power of attorney for health care, heath care proxies, etc.). This is a conversation between a patient and their medical professional. The proposed legislation does not mandate, encourage or recommend, in any way, shape or form, what advice the doctor should provide to the patient; only what minimum subjects should be included in order to be paid.

   3. Advanced Care Planning empowers the patient to have a say in their own care. It is just good, sound planning and something that most physicians would strongly recommend for their patients. What if someone gets in an accident and can’t tell their doctors what procedures for life sustaining care they want or don’t want. Who then decides? Their children or care givers? Why make them have to make these terrible decision when the patient, through such things as a living will or durable power of attorney, can state beforehand, exactly how they want to be treated. It’s better for the patient and it’s better for the care givers.

4. on Tuesday - Aug 11th, 2009 at 8:43 pm ZZ Bachman wrote:

   Thanks for the spirited debate… but you seem to be missing my point.

   1. Whether McCaughey says its mandatory or not is not even relevant from my point of view. Let’s say it is and always will be voluntary. Why does something like this NEED to be in a law even if it is voluntary ?

   2. Why does the opportunity we ALL have today to speak to a doctor about these alternative NEED to be put in a law?

   3. Again…. I agree with your perspectives on SOUND PLANNING…. there is nothing that prevents people from planning. Why does it NEED to be put into a law ??

   Ergo… does every freedom we have (which foods we eat) need to be written into a LAW ?? For instance… smoking is bad for your health, so is drinking, so is being overweight. If a person wants to SMOKE, DRINK and be FAT (as long as he doesn’t infringe on my rights as in DUI) why is it anybody’s business if that person decides to continue to be a fat smoker who drinks ??

   Its about being a LIBERTARIAN more than its about partisan REPUBLICAN / DEMOCRAT politics.

   The whole idea of the Government knows what’s best for you smacks of the thinking back in the 40′s that set into motion the biggest socialist program in the U.S. today (Social Security). A program by the way that everyone agrees isn’t worth much today. It was needed because our government back then believed people were too stupid to save money for their retirement. So…. they put it into a LAW. A LAW by the way that was supposed to be temporary to get the nation through the Great Depression. So much for best laid government plans. What was that about a “Lock Box”?

   I will take privatization and free capital markets over government programs any day. Wish I had accumulated all the SS dollars over the years and was allowed to invest it myself. Thank you.

   Bottom line, why is it that liberals feel that it is necessary to mandate and impose behaviors for everyone though governmental law just because they believe its the right thing to do? What ever happened to Freedom of the Individual to choose where we spend out money ??? (See — some of us conservative libertarians are pro choice !! )

   So again the issue is, if these are all voluntary, explain WHY these 3 items you highlight (mandatory or not) NEEDED to be put in the LAW ??? Could it be some FDR-think creeping back into the democratic agenda??