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Sunday, August 09, 2009

The mandated hint to go gently into that good night ... brought to you by Democrats.

Saving money in medical care is easy if you can simply get people off of medical care. The secret to lowering medical costs dramatically is persuading people not to want to live. If you get sick and the doctor tells you the prognosis isn’t good, and then begins to discuss end of life issues, you may or may not want to agree. How about we pay doctors to encourage you to take that pill, ease the pain and slide into death quickly rather than cling to life?

The aged widow has seen many of her friends die and is in pain from arthritis and her eyesight’s failing. She contracts pneumonia and has to be taken to the hospital. How about some end of life counseling to make the doctor some money and save ObamaCare money?

Compassion? I guess it depends on how much you value life. Or whether you are in her will.

Even writers for the Washington Post are questioning the details of government run health care.

Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice -- even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs?

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they're in the meeting, the bill does permit "formulation" of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would "place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign," I don't think he's being realistic.

What's more, Section 1233 dictates, at some length, the content of the consultation. The doctor "shall" discuss "advanced care planning, including key questions and considerations, important steps, and suggested people to talk to"; "an explanation of . . . living wills and durable powers of attorney, and their uses" (even though these are legal, not medical, instruments); and "a list of national and State-specific resources to assist consumers and their families." The doctor "shall" explain that Medicare pays for hospice care (hint, hint).

Admittedly, this script is vague and possibly unenforceable. What are "key questions"? Who belongs on "a list" of helpful "resources"? The Roman Catholic Church? Jack Kevorkian?



The government (or any third party provider) - if they pay for your care - has an interest in paying the least for that care. That is the problem with third party payers. And when there is only one third party payer, the government, the threat to life is very much higher than with private insurance.

Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party -- the government -- recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don't have to be a right-wing wacko to question that approach.


Apparently SOME members of the media are starting to read the bills.

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