Maybe This Time Someone Will Call Her On It
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.
Before the grifters, charlatans, flim-flammers and political opportunists that make up the leadership of the conservative movement get a chance to crank out a million misleading words on this, here it is:
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.
Advanced directives are state law. Here’s Ohio, in plain language. This is from a hospital site:
Advance Directives are legal planning tools that help you make your wishes known. In Ohio, we have 5 Advance Directive tools:
· Living Will
· Durable Power or Attorney for Health Care
· Do-Not-Resuscitate (DNR) Comfort Care Order
· Mental Health Declarative
· Organ Donation
Advanced directives aren’t controversial. They aren’t new. Ohio’s law went in nineteen years ago. They aren’t frightening. There are provisions in all fifty states for anyone to draft an advanced directive, with or without a lawyer. All this rule change does is allow Medicare to pay doctors for a consult on the medical issues surrounding end of life care.
This rule change gives patients and prospective patients more information, not less. This rule change allows more autonomy and power for the individual to make decisions, not less.
That Sarah Palin was able to launch her celebrity career by misleading and terrifying millions of people is shameful. That conservatives and media went along and managed to completely muddle an issue that was debated and discussed and implemented at the state level 20 years ago is shameful. But it happened, and it will happen again.
“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”
I think they should shout if from the rooftops. Allowing conservatives to mislead people is just wrong.
If you could distill that post for a bumper sticker then we’d all be better off. Conservatives can never win an argument on the facts, kay, so misleading, sowing confusion and appealing to people’s ignorance is all they can do. Death Panels fits on a bumper sticker and in a Palin tweet, so conservatives, who are mindless authoritarians and don’t do nuance, will always have the advantage that simple lies confer. You know who else liked death panels.
@Cat Lady:
The Times article sucks. It’s classic “he said/she said”.
Someone needs to mention that this is state law in all fifty states and has been for years.
We’re talking about a payment mechanism for a physician’s consult on a settled issue. What astounds me is how commonplace this whole idea is in Ohio, and I’m not talking about people who do fancy estate planning (like, say, Sarah Palin). I’m talking about everyone who writes a will, or has any serious medical issue that requires a visit to a hospital.
Twenty years of education and thoughtful, careful discussion of a difficult issue down the freaking drain, with one Tweet from The Grifter. It’s obscene.
@Cat Lady:
There’s your bumper sticker. I LOL’ed on Christmas Eve when I saw a pickup truck with a bumper sticker that read ‘I DO NOT VOTE FOR REPUBLICANS’
During the original Death panel free for all, I had a memorable exchange with a patient. She interpreted the Fox BS as the government mandating that every 5 years she had to discuss her end of life wishes with some stranger. I guess she thought these people would be hired to sit in rooms and do only this. I told her no, it just meant that she, if she wanted, could come see me for a visit solely to discuss advanced directives etc and Medicare would pay me for the time to do that. She did a complete double take. “But that would be good! What’s wrong with that?”
@gbear:
That’s awesome. I’d prefer “I DO NOT BRAKE FOR REPUBLICANS”, but OK.
@Kay:
Asking a conservative not to lie is like asking a bird not to fly, but the FAIL that is our “liberal media” is why we can’t have nice things.
Allowing conservatives to mislead people is just wrong.
True, but it generates eyeballs for the SCLM. Nontroversy, ho!
Amongst us BJers, we can discuss this very well and to the point of what it really means. Out there across this land, the majority of the Medicare recipients will see it much differently if they are aware of it at all.
I spent a good portion of yesterday with our two 88 yr old relatives. I am sure they will pounce on this in the negative.
This whole controversy is just plain silly. My father was a physician for more than fifty years, and he provided these consultations on a regular basis. He billed the insurance company for an “extended office visit” with a diagnosis code of whatever he had been billing for that patient in the past, and they paid it every time. A consultation is a consultation, and the topic of that consultation is nobody’s business. “We discussed the treatment plan,” is all that ever needs to be disclosed. This whole thing about paying doctors for a specific type of consultation is nonsensical; the type of consultation should not even be known. That topic is confidential. Has no one ever heard of HIPAA?
@CA Doc:
I have no earthly idea why anyone would want a county probate judge to make this decision, which is where it would end up here without a directive, if there’s a challenge. I’m confident county probate judges really, really don’t want to do that, what with their scary black robes and reputation for legislating from the bench and all.
Who wants that decision? After Schiavo? Not a lot of hands are going up, I’d wager.
Kay,
You made Benen’s blog! Congrats. :)
On topic: My grandmother who was connected to a machine that kept her alive for 2 years (against her expressed will) was a lesson to me and the rest of my family about how crucial these laws are and how important it is to have the actual conversation with your doctor. These assholes are playing politics with people’s end of life dignity. Jerks.
The “Death Panel” lie wasn’t just a talking point. It was a deliberate effort, by the Terri Schiavo conservatives, to manufacture doubt about people’s end-of-life wishes, so as to more broadly impose their own beliefs about end-of-life care.
@Bill H.
Unfortunately everything can be audited by Medicare and the exam and history has to match up with the diagnosis and the way you coded the visit (simple, extended, complicated etc). Meaning that you have to have spent the time in the exam room to do that, leaving little or no time to get into these deep discussions that often involve other family members with conflicting concerns. It’s extemely important, but not expressly paid for currently.
@CA Doc:
Well, that creates a valid argument for “keep the government away from my healthcare,” doesn’t it. If the government is privy to the details of what occurs in the doctor’s office and what is discussed between me and my doctor, that is a powerful, powerful argument for preventing the government from playing any role in the administration of health care.
Perhaps the “tea party” has it right and this health care reform and Obama’s approach to things is a really, really bad idea. Certainly what you point out makes me thoroughly dread the day that I go on Medicare.
I think I’m also glad that my father died before he had to practice under Medicare.
I should additionally point out that my health care has already deteriorated seriously since “health care reform” was passed. My primary care physician now requires an annual fee of $1600 merely to remain as his patient. That is in addition to all of the usual office fees, which have not gone down. So I now have a new primary, who knows nothing whatever about me. My cardiologist discontinued annual visits, says they are not showing anything, which is a little wierd since he ran no tests this past year, and so my atrial fibrillation is not being monitored. My pulmanologist discontinued annual visits, said my lungs were stable, so my COPD and emphysema are no longer being monitored. Happily, my neuroligist still sees me every eight months, so my Parkinson’s Disease is being controlled, but he worries about additional small strokes (TIA’s) being caused by the heart condition, given that it is no longer being watched on a regular basis.
So who knows what might happen unnoticed with my heart or lungs, but money is not being wasted keeping an eye on them, and my primary doctor has one fewer patient, so the “cost of health care” is being reduced. I guess that makes “health care reform” a smashing success.
@Bill H.: I’m sorry for all that trouble you’re having, but what provisions of ACA are you pointing to that are responsible for these changes?
Bill H – you might want to determine if the fault lies with your insurance carrier. If you have serious heart and lung issuus, your doctor may be attempting to bill you for things your insurance won’t pay for. And is not performing the tests your insurance carrier won’t pay for.
Your problem speaks more to the need for more reform not less.
You know, you can have that end of life care discussion and still not choose Do Not Resuscitate status. I let all of my healthcare people know that I have no intentions of going without a fight and they seem to respect that.
IF, on the other hand, I develop some terrible condition, I can choose to have that conversation again and take another look at my options.
Which is what the medicare provision is talking about.
@Joey Maloney (#15):
None of ‘um, I’d wager, since most of the regulations have yet to kick in. In fact, insurance companies were continuing to raise rates and cut coverage, even before any of ACA kicked in after passage. As bcinaz @16 points out, he’s experiencing issues with either/or both his insurance carrier or his medical care providers.
@Bill H.:
Except it’s not, what is discussed is between you, your doctor and your insurance company. Who would you rather be in that conversation, someone trying to make a profit off you or someone who doesn’t need to?
@Kay:
Exactly. But where has the Democratic messaging been these past two years? Time and time and time again, they let the liars get the better of them.
@debbie (#20):
Um, no. Even were the Democrats in general, and the President and all his staff in particular, standing on the Capital steps shouting out their message daily, if the media are not recording, printing, and broadcasting said message, it never happened. And that’s the situation we’ve got today, and have had since the Obama administration came into power. Note, for contrast, all the mindless stupidity and outright lies being routinely published, broadcast, ‘analyzed’, and re-broadcast from conservatives in general and the Republican party, and their surrogates, in particular.
This “death panels” argument was treated as a laugh, but it’s really the purest, most nastily ad hominem attack of the past two years. Any journalist who actually asked Betsy McCaughey et al to actually show them where in the bill the death panels were (and a few did) were told “Well, they aren’t actually in the bill, but you just know that Those People will form them.”
@debbie:
I’m up for the bumpersticker.
@henqiguai:
True that.
All the more reason for a bumpersticker and short, memorable sentence approach.
Our media respects its corporate masters.
Somehow NYT managed to avoid mentioning Arizona Republicans’ actual Death Panels.
Ah, the “liberal” media.
@Elizabelle: How about “Friends don’t let friends swallow GOPaganda”?
@debbie:
Falling on deaf ears.
and let’s not forget who put the death panels into the bill in the first place… Johnny Isakson, Republican, of Georgia.
I was so outraged by all the lying and misinformation surrounding the “death panel” crap. My mother had dementia. She died two months ago. One of the most comforting things we had during this ordeal is we knew exactly what my mother wanted. And even then, some of the decisions were hard.
My mother had an advance directive and a living will. She was a nurse. She talked about end of life care long before it was a consideration for her.
You do an advance directive not for yourself, the medical profession or to contain costs. You do it for the people who will take care of you should the need arise. Keep that in mind.
My only disagreement is discussing this with your doctor. Doctors by and large suck at this. There should be specially trained social workers who work with people on these issues. Early in life – well before you perceive the need.
@Elizabelle:
@henqiguai:
@Nick:
Short, memorable sentences can also be spoken out loud and at every opportunity, whether it’s in front of Congress or back home, talking to a local tv station during the fall campaign (lord knows there were countless opportunities for sound bites). How’s this for short and sweet: “They lie.” It worked okay for that Wilson clown. Or let me repurpose Kurt Cobain’s music-writing rule to read, “Democrats: subject, verb, period.”
@George:
I too was outraged by the death panel crap, and yet Democrats protested about as vigorously as that kid Brick does in The Middle when he lowers his head and whispers into his chest. And when they did speak up, Democrats gave long-winded, Kerry-type responses.
Here’s yet another opportunity that will be missed by Democrats. They should be out everywhere, pointing out the irony that despite all the unsubstantiated claims that Democrats wanted to establish death panels, it turns out to be the Republicans, in the form of the state of Arizona, who have actually instituted them.
@debbie:
In order for that to work, people have to believe they actually DO lie.
This is a very smart move. Yes, we all want to live, but we also want a certain quality of life. Suffering with an illness is not a way to live.
So death panels are announced via fed regulations instead of a law and the usual suspect enablers of euthanasia say they’re not death panels. Why be surprised? Some leftie genocidal maniacs want to do it in hospitals rather than gulags.
Every time Congress passes a law and it is signed by the President, the next step is to send it to the appropriate federal agency, which is responsible for writing the regulations. Without regulations, the law could not be implemented. This is not a new process. It has been this way all along.
I’d put an “allowing conservatives” bumper sticker on my laptop cover.
(I’d leave out the “just” to allow other words to be bigger.)
Folks,
I don’t find either Dems or Reps having any advantage on the “honesty” scale.
Politics are opinion-based. Beliefs differing from your (or my) beliefs, are opinions…..neither better or worse.