Monday, December 27, 2010

They're ba-aack...

After being dropped from text of ObamaCare, the controversial and supposed "death panels" section looks to be making a comeback via the regulations-writing process.

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.

"...achieve the same goal by regulation."

Yet another kick in the nuts for those Blue Dogs who voted for this monstrosity.

So, it's not actually part of ObamaCare but will be part of ObamaCare anyway. And don't let anyone know about it.

Back in August of last year, we sunk our teeth into the infamous Section 1233 to see if, in fact, there were any "death panels" lurking about. Here are a couple of salient bits from our analysis:

Executive summary: Although our review of Section 1233 does not turn up any “death panels”, the language in that section contains enough wiggle room for these “counseling” sessions to produce unsavory situations and outcomes because of the inevitable rationing that will come with government-managed healthcare.

and this:

Conclusion: First and foremost, this legislation, because of the Byzantine fashion in which it is written should be opposed on principle alone. Well, all legislation is written in that manner. Perhaps, but we all reserve the right to be smarter than we used to be and nothing this important should give someone a headache while trying to read it, let alone interpret it.

So while there does not appear to be a death panel, per se, the vague manner in which the language is crafted leaves plenty of wiggle room for physicians to steer patients towards decisions that would lead to a lessening of treatment(s), malnourishment, dehydration and a cutback on anti-biotics.

And if you believe, as we do, that government-managed healthcare will lead to shortages and thus the eventuality of rationing, one can connect the dots to see where this is all going.

And it's not just us down here in the fever swamps of the blogosphere who believe that O-Care will eventually lead to health care rationing. Dr. Donald Berwick, the HMFIC of Medicare and Medicaid not only believes it but appears to be a big fan:

"It's not a question of whether we will ration health care. It is whether we will ration with our eyes open."

And it's because of this, we found the following quite amusing:

Mr. Blumenauer, the author of the original end-of-life proposal, praised the rule as “a step in the right direction.”
Here's a portion of an email from Blumenauer to his peeps:
The e-mail continued: “Thus far, it seems that no press or blogs have discovered it (ed.: uh-oh), but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”

In the interview, Mr. Blumenauer said, “Lies can go viral if people use them for political purposes.”

While we (the royal "we") have been accused of spreading misinformation and lies regarding ObamaCare, we've taken a look back at our criticisms of ObamaCare and have concluded that our biggest guns, our strongest arguments against ObamaCare have come directly from the mouths of its biggest supporters and the very people charged with executing, er, administering ObamaCare - people like Berwick, the Secretary of Health and Human Services, Kathleen Sebelius, and the President himself.

And to think that they firmly believe the current unpopularity of ObamaCare is due to a "messaging" problem. Keep yakking, people, keep yakking.


steve said...

This was the best part of the original bill. I am glad to see it coming back. I sit here in my call room just having finished a case on a 90 y/o completely demented patient who is going to die after 4 hours of surgery. The only family available said to do everything. None of the family knew any of his medical history.

Few people plan for end of life situations. High end estimates put it at 1/3 of people. When integrated health services have made it policy to discuss end of life issues, they find that people are more functional for a longer period of time. Family is happier, and the care is cheaper. When people understand, and talk this over with family, they often opt to avoid expensive care that leaves them dying on a ventilator. Instead, they optimize functionality and time with family. Opposing this is pure partisan hackery.


B-Daddy said...

Why aren't doctors having this discussion without the bill?

Dean said...

Alternate headline for post: "'Suppose that's one way to keep the costs down."

Given what we know about Berwick, we can only hope for such benign results.

steve said...

"Why aren't doctors having this discussion without the bill?"

Some do. For some patients, this is a pretty easy discussion and takes only a few minutes. Others find this a difficult topic to handle. If you need to schedule a 30 minute or one hour time slot to discuss this w/o reimbursement, it just wont happen for those patients.

"Alternate headline for post: "'Suppose that's one way to keep the costs down."

Sigh. The real point is that patients and families will get the care that they would really want. If they show up at the hospital in extremis with no end of life plans, they will most likely get everything, and I do mean everything, done to them even if it was not what they wanted. These are mostly older people, under stress, making these decisions at 2:00 AM. That is not a rational way to approach this issue. I have seen this too many times. If they have not explicitly talked this over, by the time they get to me they nearly always say to just go ahead and do everything. Afterwards, they feel guilty for putting their spouse through the pain and suffering w/o any real hope for a good outcome. They never get to say goodbye in a meaningful way.

For less emergent situations, the hospice people, among others, are very good at maximizing the number of functional days one can have at the end of life. People are more open to these kind of options if they know about them and have considered them ahead of time.


Dean said...

Backing up for a moment:

"This was the best part of the original bill. I am glad to see it coming back."

It was cynically removed from the original bill in order to get it passed and now cynically added back into the regulations in the regs-writing process. Glad you're happy with that bit of transparency.

Now, staying on track: If this were only federally-mandated/sponsored best management practices, that would be one thing. Dubious still, but not on the level to which I hold it suspect now.

There has been nothing this administration has done in its nearly-two years in power to grant them the benefit of the doubt, especially with respect to how ObamaCare was fashioned and the running commentary provided by O-Care supporters from Berwick, Sebelius, the President and Congressmen and Senators on down.

It's a power grab.

I stand by my assertions made in the body of the post.

B-Daddy said...

Linked. Also, I have more a complete rebuttal to Steve's and other's arguments.

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