20 August 2009

Living will provision allowed to die

It's always such a shame when stupid wins out. And it looks increasingly like stupid will win in the battle whether the health care reform legislation will include a provision that pays doctors for helping patients devise their end of life plans. Similar provisions had been included, and overwhelmingly passed with bipartisan support, in previous health care legislation, but that was before the GOP decided the quickest way to kill Obama's health care reform objective was to scare the shit out of people. And if it look some flat out lying to scare them...well, so be it...

It's not a big surprise, then, that the Senate Finance Committees will likely eliminate a "living will" provision from their version of a health care reform bill . Too much trouble. Too much confusion. In other words, too many lies have successfully riled up the numbskulls who consider folks like Sarah Palin as fair arbiters.

It's not the end of the world. I do feel bad for folks who really would benefit from the provision, but the big objectives for health care reform stay the same; more coverage and less cost.

But it does seem especially tragic when national policy is developed on the basis of lies and misinformation.

The excerpt above is from a well-written commentary by Jay McDonough at Swimming Freestyle, with which I hearily concur. The proceedings to date do not eliminate living wills; they just remove an incentive for discussing them. I share Jay's disappointment that the provision was defeated not by reasoned discussion among rational lawmakers or by an informed public mandate, but by blatant fearmongering. It's a sad reflection of the frank ignorance of a vast number of Americans that they are so susceptible to such chicanery.


  1. Maybe it would have been more intelligent to avoid talking about government mandated end of life counseling and saving money on medicare in the same paragraph

  2. I hate to tell you this but people who check into the hospital are ALREADY offered assistance in getting advanced directives, living wills, etc.!!!

    Let me spell this out for you. I am a nurse. I admit patients every day into the hospital. As part of the admission process, I ask patients:

    1: If they already have an advanced directive or living will.

    2: If we already have a copy in our hospital's record, and if not, where we can get one.

    3: If they would like help from our case managers. If they say "yes," two of the case managers at the hospital will bring the forms, review them at length with the patient, and witness the patient signing them with their family/friends present if they so desire.

    Look. It would be a CONFLICT OF INTEREST for the same entity responsible for paying for the patient's continued care to also be the one responsible for talking to them about measures that could limit them.

    This does NOT mean that I (or anyone else against this ridiculous sham called "health care reform") am against living wills, advanced directives, etc. Believe me: as a nurse, I am ALL for them. We all are. It's just that the government shouldn't be responsible for them.

  3. I agree that the government should not be "responsible" for the consultations. The House bill had no provisions that would have made the government "responsible" for the consultations, only the reimbursement to the physician for their time during that session.

  4. The advance directive ensures that the person's wishes will be carried out, and takes the burden of deciding what to do from the family. It's irresponsible not to have one. Specifically including pay for assisting the patient in making these decisions is promulgating individual responsibility, which the Republicans seem to favor in other circumstances. Hypocrisy and stupidity have replaced decency and thought.

  5. All right. I'll go slower.

    The president seems to be very worried about doctors getting reimbursed too much for tonsillectomies and amputations.

    (See http://www.nbcphiladelphia.com/news/archive/Tonsil-Doctors-Fight-Obama-Smear.html and then http://www.healthleadersmedia.com/content/237492/topic/WS_HLM2_PHY/Obama-Missteps-on-Foot-Amputation-Pay-to-Surgeons.html

    He appears to worry that the doctors are engaging in processes and procedures that are not necessary simply because they are reimbursed more for it.

    So now, let's think about the whole advanced directive/living will issue. Again, patients CURRENTLY are offered assistance and information about making advanced directives and living wills EACH AND EVERY TIME THEY ARE ADMITTED TO THE HOSPITAL!!!

    And who does this?

    The doctors? Please.

    No. It's the case managers, who are (drum roll please) nurses by education and training.

    So just because the government will reimburse doctors each and every time they meet with a patient to discuss living wills, end of life planning, etc., it won't open the door in any possible way to abuse or pressure of any kind, riiiiight?????


    Then there is the other issue. Even if you think that the reform that Obama and the Dems are currently pushing is just the best thing since sliced bread, you need to remember that this is just the tip of the iceberg. Once passed, a massive, unwieldy federal government agency will be established (slowly) that will have to start creating regulation, after regulation, after regulation. Thousands of detailed regulations that will affect each of us in ways we can't even imagine right now will be passed that will delay treatment, reimbursement, processing, and patient care.

    Look. It doesn't matter. Whoever pays the bills is the one who will always hold the power. Go ahead and fantasize about being able to control your health care because you pay taxes. The government will control your health care in ways you can't even imagine.


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