End of Life: In or Out
Aug 13th, 2009 by Timothy Pancoast
http://finance.senate.gov/press/Gpress/ … 081309.pdf
M E M O R A N D U M
To: Reporters and Editors
Re: End-of-life care concerns, other concerns in House health care legislation
Da: Thursday, Aug. 13, 2009Sen. Chuck Grassley, ranking member of the Committee on Finance, today made the following comment on end-of-life concerns and other concerns prompted by the
House committee-passed health care legislation.“The bill passed by the House committees is so poorly cobbled together that it
will have all kinds of unintended consequences, including making taxpayers fund health care subsidies for illegal immigrants. On the end-of-life issue, there’s a big difference between a simple educational campaign, as some advocates want, and the way the House committee-passed bill pays physicians to advise patients about end of life care and rates physician quality of care based on the creation of and adherence to orders for end-of-life care, while at the same time creating a government-run program that is likely to lead to the rationing of care for everyone. On the Finance Committee, we are working very hard to avoid unintended consequences by methodically working through the complexities of
all of these issues and policy options. That methodical approach continues. We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly. Maybe others can defend a bill like the Pelosi bill that leaves major issues open to interpretation, but I can’t.”
The Hill is reporting that the end of life clauses, which are at best open to interpretation will be kept out of the Senate Finance Committee version of the bill. However, they are still subject to be reintroduced when the bill goes into conference between the two houses of congress.
I’ll believe that when I see it.
I would be holding my breath till after Labor Day, but I agree with you. There are still plenty of obsacles to removing the end of life clauses.
Anyone want to bet that if he does get it cut from the Senate Finance Committee’s version that President Obama, or at least some of his friends will say “look its not in the bill anymore, so stop complaining?” Then I am going to say, “wait, I thought there was no bill.”
Even if they take it out of the Senate version the House will put it back in.
I don’t see how the Whitehouse says what it does about it not being to the public good to treat terminally ill people even when they are in severe pain then tries to call this a myth. It came straight from the President’s mouth. He has appointed disciples of Peter Singer. This is a real and present danger.
I don’t see how the Whitehouse says what it does about it not being to the public good to treat terminally ill people even when they are in severe pain then tries to call this a myth. It came straight from the President’s mouth.
Where did you hear this? Do you have a link to a video or a transcript or something?
Well Obama IS saying he is not in favor of a single payer system….but in 2007 there is video of him saying he IS in favor of a single payer system. I’m sure there is plenty of evidence to back up David’s claim as well.
http://www.time.com/time/magazine/article/0,9171,1913746-2,00.html
http://johnrussell.newsvine.com/_news/2009/08/14/3152252-the-death-panel-brouha-is-obamas-own-doing-on-april-29-he-questioned-the-cost-effectiveness-of-his-own-grandmas-hip-surgery?commentId=8835408April 29 (Bloomberg) — “President Barack Obama said his grandmother’s hip-replacement surgery during the final weeks of her life made him wonder whether expensive procedures for the terminally ill reflect a “sustainable model” for health care.
Gee, where could the misinformed town hall crazies have gotten the idea that Obama was thinking about saving money by denying expensive procedures toward the end of life? … “
Enough with your links to commentary and secondary sources. Here is the original New York Times Magazine interview you are apparently talking about.
I will concede that a sufficiently twisted mind, one also with a limited vocabulary and inability to follow an English sentence, could construct denial of care out of Obama’s quote in that interview:
But for normal folks, we understand what “It’s not determinative” means.
And we understand that “It is very difficult to imagine the country making those decisions just through the normal political channels. means that end-of-life decisions will be left to the individual and not mandated in law.
And that is exactly what we see in the bill today.
noman – the only problem with your attacks and your “supposed” setting the record straight is that your NYT article is from May 3rd and points to an April 14th speech by Obama.
David’s link to newsvine points to a discussion by the President on April 29th………
His link to Time magazine took place on July 29th….
Sorry to burst your happy lying bubble……….
Thank you. The Time link is the original time link. The concern was there and the President was asked about it April 29 and gave that famous answer. He has been asked about it repeatedly including in the late July issue of Time. If Time is not reputable to you, then we have little to discuss on this subject.
You can not rebut my recent links with outdated ones. Have the courage to believe the truth. I happen to see the President’s statement with my own eyes and then he confirmed it in an interview in Time as well as a second speech July 24.
Speaking of lying:
I ignored the July Time interview because it contains nothing to back up this claim David made:
I don’t see how the Whitehouse says what it does about it not being to the public good to treat terminally ill people even when they are in severe pain then tries to call this a myth. It came straight from the President’s mouth.
Not the slightest shred.
So it’s not in the April NYT interview, it’s not in the July 28 Time article…
But you mentioned some July 24 speech, so now I have to go track that down too.
David,
No doubt the terms racist and bigot shall be flying very shortly now that in two threads noman has been proven to be just another left wing spin doctor and a REALLY bad one.
It’s almost comical now that the FACTS are coming out against this plan. It’s like watching dozens of Obi-wan Kenobe wannabes out there trying to use the force (remember Episode 4 “These aren’t droids you’re looking for…Move along”) to convince America that what we read, see and hear with our own eyes and ears is “Not in the bill”
noman – April 29th speech
“The ‘Death Panel’ Brouha Is Obama’s Own Doing, On April 29 He Questioned The Cost-Effectiveness Of His Own Grandma’s Hip Surgery” – title of newsvine article
Who are you going to believe me or my own eyes.–President Obama (sarcasm)
Evan, you are losing it, pal – you are trying to argue by repeating the same link David gave in his original false claim. Run around in circles much?
Anyway – he’s allowed to question his grandmother’s care. It’s his OWN GRANDMOTHER, not yours.
From the Time article:
Question: Well, you know, a few months ago, you brought up your own grandmother’s situation [choice to have an expensive hip replacement when she was terminally ill]. It was painful and personal because every family, if they haven’t hit some wrenching decision like this, is going to. As you think back on that, Was that the right decision?
Obama Answer: Is this the kind of thing that a reformed system, as you see it, would change the dynamic of that decision? You know, first of all, unlike my mother, who had a difficult time with her cancer in part because her insurance was a little bit unreliable and she had just taken a new job, my grandmother had been signed up under Kaiser Permanente for years. And it’s actually one of the models of high-quality, cost-efficient care that’s out there right now, partly because they maintain such a stable base of patients and they construct a whole team approach that has proven to be very effective. So my grandmother was generally very happy with her care, and if we could actually get our health-care system across the board to hit the efficiency levels of a Kaiser Permanente or a Cleveland Clinic or a Mayo or a Geisinger, we actually would have solved our problems. Now, even in those systems, there’s still going to be hard choices, right? But the fact of the matter is, ultimately, my grandmother was able to get that hip replacement even though she had terminal cancer and even though the operation was full of risks. And so from a purely economic point of view, there would be some who argued that wasn’t a good use of health-care dollars. I guess my point is that —
Question: Do you believe that was?
Obama Answer: Now you ask me, Do I think it’s worth it? Of course. It was my grandmother. So anything that would relieve her pain or her suffering or extend her life in a way that she wished is something I wanted to do, and I would have paid for it out of pocket if I had to. But not every family is going to make those same decisions.
noman – BUT HE CAN’T QUESTION MY GRANDMOTHERS CARE…and THAT my silly liberal friend is the problem with the current healthcare plans…..I cited that link because YOU got the date wrong. It wasn’t July 29th it was April 29th AS STATE IN THE TITLE OF THE ARTICLE…
There’s a lot flying back and forth, so I can’t fault you for being confused. In #10 David suggested there was a July 24 speech that might back up his claim. Lord knows I can’t find it anywhere else.
Can you or David find it here, in the Presidents official July 24 remarks? Perhaps it got left out somehow.
Your cut-and-paste crapflood didn’t put you any closer to proving your point. You still haven’t shown me where Obama suggested denying care to anyone.
All I see is Obama explicitly saying end-of-life decisions should be left to the patient and the family.
“April 29 (Bloomberg) — President Barack Obama said his grandmother’s hip-replacement surgery during the final weeks of her life made him wonder whether expensive procedures for the terminally ill reflect a “sustainable model” for health care.”
Still nothing to justify this characterization:
I don’t see how the Whitehouse says what it does about it not being to the public good to treat terminally ill people even when they are in severe pain then tries to call this a myth. It came straight from the President’s mouth.
You are the spin doctor, Evan.
The House Bill, the only one we have so far, enables those who wish to have a consultation with their doctor about end of life issues, covered by insurance.
Your quote above is an Obama statement about his own thoughts within his own family, and has no relationship whatsoever to the House Bill.
So who did you say was spinning?
Your quote above is an Obama statement about his own thoughts within his own family, and has no relationship whatsoever to the House Bill.
Well to be fair Perry, I was rebutting David’s claim about Obama’s opinion, not about what’s in the House bill. Rebutting fake claims about the House bill is in another thread.
Actually Obama’s NYT Mag quote was the most interesting to me, because I see how a careless or malicious reader could spin that into ACORN-led death panels.
Fake claims? Oddly enough I’m spending my early afternoon reading a healthcare bill that NONE of you liberal nuts have read yet. It’s rather interesting, like this provision starting on page 30 of H.R. 3200 which clearly states that an advisory committee will be created to decide what treatments are effective and what are not. This committee includes 9 members appointed by the President, 9 more appointed by the Comptroller General and up to 8 more appointed by the President. Oddly enough not a single mention of for instance state representation to ensure each state has a say….Not a single elected official that the citzens of the states can determine without turning CONTROL of this completely over to the government…It also lists “labor” which begs the question, do the labor unions now get to tell us how to run our healthcare? Please feel free to actually read this…
who are Federal employees and offi
11 SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.
12 (a) ESTABLISHMENT.—
13 (1) IN GENERAL.—There is established a pri
14 vate-public advisory committee which shall be a
15 panel of medical and other experts to be known as
16 the Health Benefits Advisory Committee to rec
17 ommend covered benefits and essential, enhanced,
18 and premium plans.
19 (2) CHAIR.—The Surgeon General shall be a
20 member and the chair of the Health Benefits Advi
21 sory Committee.
22 (3) MEMBERSHIP.—The Health Benefits Advi
23 sory Committee shall be composed of the following
24 members, in addition to the Surgeon General:
Page 31
1 (A) 9 members who are not Federal em
2 ployees or officers and who are appointed by
3 the President.
4 (B) 9 members who are not Federal em
5 ployees or officers and who are appointed by
6 the Comptroller General of the United States in
7 a manner similar to the manner in which the
8 Comptroller General appoints members to the
9 Medicare Payment Advisory Commission under
10 section 1805(c) of the Social Security Act.
11 (C) Such even number of members (not to
12 exceed
13 cers, as the President may appoint.
14 Such initial appointments shall be made not later
15 than 60 days after the date of the enactment of this
16 Act.
17 (4) TERMS.—Each member of the Health Bene
18 fits Advisory Committee shall serve a 3-year term on
19 the Committee, except that the terms of the initial
20 members shall be adjusted in order to provide for a
21 staggered term of appointment for all such mem
22 bers.
23 (5) PARTICIPATION.—The membership of the
24 Health Benefits Advisory Committee shall at least
25 reflect providers, consumer representatives, employ-
Page 32
1 ers, labor, health insurance issuers, experts in health
2 care financing and delivery, experts in racial and
3 ethnic disparities, experts in care for those with dis
4 abilities, representatives of relevant governmental
5 agencies. and at least one practicing physician or
6 other health professional and an expert on children’s
7 health and shall represent a balance among various
8 sectors of the health care system so that no single
9 sector unduly influences the recommendations of
10 such Committee.
11 (b) DUTIES.—
12 (1) RECOMMENDATIONS ON BENEFIT STAND
13 ARDS.—The Health Benefits Advisory Committee
14 shall recommend to the Secretary of Health and
15 Human Services (in this subtitle referred to as the
16 ‘‘Secretary’’) benefit standards (as defined in para
17 graph (4)), and periodic updates to such standards.
18 In developing such recommendations, the Committee
19 shall take into account innovation in health care and
20 consider how such standards could reduce health dis
21 parities.
22 (2) DEADLINE.—The Health Benefits Advisory
23 Committee shall recommend initial benefit standards
24 to the Secretary not later than 1 year after the date
25 of the enactment of this Act.
Page 33
1 (3) PUBLIC INPUT.—The Health Benefits Advi
2 sory Committee shall allow for public input as a part
3 of developing recommendations under this sub
4 section.
5 (4) BENEFIT STANDARDS DEFINED.—In this
6 subtitle, the term ‘‘benefit standards’’ means stand
7 ards respecting—
8 (A) the essential benefits package de
9 scribed in section 122, including categories of
10 covered treatments, items and services within
11 benefit classes, and cost-sharing; and
12 (B) the cost-sharing levels for enhanced
13 plans and premium plans (as provided under
14 section 203(c)) consistent with paragraph (5).
15 (5) LEVELS OF COST-SHARING FOR ENHANCED
16 AND PREMIUM PLANS.—
17 (A) ENHANCED PLAN.—The level of cost
18 sharing for enhanced plans shall be designed so
19 that such plans have benefits that are actuari
20 ally equivalent to approximately 85 percent of
21 the actuarial value of the benefits provided
22 under the reference benefits package described
23 in section 122(c)(3)(B).
24 (B) PREMIUM PLAN.—The level of cost
25 sharing for premium plans shall be designed so
Page 34
1 that such plans have benefits that are actuari
2 ally equivalent to approximately 95 percent of
3 the actuarial value of the benefits provided
4 under the reference benefits package described
5 in section 122(c)(3)(B).
I think Sen. Grassley has handled the matter fairly well. The end of life provisions, whether completely benign or potentially malignant, have bothered a lot of people. You can argue that they shouldn’t be, but they HAVE been opened up to several different interpretations. Some of those interpretations are quite scarry, perhaps overly so.
Government involvement in end of life counciling is not essential to the health care bill. Costs can be cut without it, and doctors can still talk to their patients and families about end of life choices without it. I know they did before both of my grandmothers, and my mother passed away.
Sheesh,,,,
That awful Perry person, who thinks it’s his job to get on this board and lie when he could over to the Daily Kos and lie all damn day, lies again about what’s in the house bill.
So let us clarify….the house bill will PAY physicians for referring patients to end of life counseling as appropriate. These physicians will also be judged on their performance by whether or not they do this referring.
If anybody but Perry thinks this won’t cause lots of referrels to the death panels, I got a bridge to sell them, cheap.
Lookit, these Death panels have killed this health care bill more than anything else about it whether the libs on this board like it or not.
It’s what will cause the unelection of Dems across the fruited plains, beginning with Corzine and Spector then a grand rout in 2010. If we’re lucky maybe that Perry person will go away.
It doesn’t matter how the Dems spin it. Americans don’t think the gubmint should be getting involved in any form or fashion in any kind of end of life counseling, no they don’t and it was the dumbest damn thing to put it in there although I’m glad.
Sarah Palin got it right…she called them Death Panels and that is what they are. They killed this bill pure and simple, put a fork in it.
We have common sense out here in la la land and they call it common for a reason….the common people got it.
NOT the political elites and definitely not that Perry personl.
Pat Fish: “That awful Perry person, who thinks it’s his job to get on this board and lie when he could over to the Daily Kos and lie all damn day, lies again about what’s in the house bill.
So let us clarify….the house bill will PAY physicians for referring patients to end of life counseling as appropriate. These physicians will also be judged on their performance by whether or not they do this referring.
If anybody but Perry thinks this won’t cause lots of referrels to the death panels, I got a bridge to sell them, cheap.”
The fact is, Pat, that the counseling is voluntary. Whatever the doctor or counselor advises need not be followed. There is nothing compulsory about it. Medicare would pay for the session for any interested senior. The idea of a “death panel” (Sarah Palen’s word), is false; there is no such a thing in the House Bill.
You are right about one thing, this provision was removed from the House Bill. I hope it gets put back in during reconciliation, because I think it is a great idea, for voluntary, paid for, counseling re end of life issues. Too many people do not think ahead, then it can become a burden on the family in the midst of a medical crisis.
The rest of it, Pat, I understand your sentiment. If an idea or position expressed is not in agreement with yours, then that person is “awful”. That’s fine with me, coming from you!
The funny thing is, I don’t care if the end of life counseling is in the bill or not. It is in the category of bells and whistles.
Sure, it is a good idea that everyone should have a living will stating their wishes, and it is a good idea to have counseling if you need it. But federally funded counseling for living wills is the last thing on my mind when I wish for universal health care.
But lying about the proposed health care plan, I will not stand for.
“The funny thing is, I don’t care if the end of life counseling is in the bill or not. It is in the category of bells and whistles.” – Noman
I can totally appreciate that.
I am against the actuall policy in the bill. Doctors know their job, and if they are failing to do it then the medical boards should take action. I have never had a problem with doctors failing to provide ample information and help when anyone in my family faced end of life decisions. None of the doctors needed a government pannel to tell them what the options were. They didn’t need the government to tell them that they should share those options with their patients either.
I agree lying about proposed legislation, doesn’t help any thing. Just remember to apply that evenly. I have worked pretty hard to combat some of the lies about the bill, because the truth is bad enough in my opinion.
I am sure you will still dissagree with where I fall on the issue though. I think it is wrong to lie about the actual text of the bill, but I don’t think it is wrong for citizens to question the potential ramifications of any piece of legislation.
As far as end of life provisions go, if they have been removed from any version of the bill I am not aware. Senator Grassley has only stated that he will not support it in the Senate Finance Committee’s version. Due to his position most likely it will not be included. However, I am not sure how it would have been removed from the House version since they have been on recess since before the issue finally came to a head.
Timothy, I believe you are misunderstanding the intent of this section of the proposed bill.
This is for people who are not deathly ill or in a crisis. The purpose is to have an optional session set up with a doctor to get his input on end of life options, long before any decision has to be made, while clear thinking can be had, the session to be covered by one’s health insurer.
I think it is a very wise thing to do. Many people don’t bother, until the crisis hits. This will encourage people to do so. And in the end, it may save families or insurance companies huge end of life medical bills that the ill family member would never have intended.
But lying about the proposed health care plan, I will not stand for.
Good for you! So call the White House.
No Hube, they already know. It is you who remains ignorant.
Mm-hmm. That must be why Obama can never get anything straight when he’s talking about the subject, eh?
But what do you care anyway — about what I think or anyone else here that debates this topic on from the other side? We’re all racists according to your very own criteria, right?
LOL … who’s ignorant again, putz?
I’m not the one with an archive full of posts about how white people are tired of being hassled by The Man.
Are you’re inferring that I do? Again, who’s ignorant again?
Do you “keep score” on all these? Do you sit there and high-five yourself when you think you “score a point?” LOL!!
Here’s our no-man in a nutshell.
Perry, my mother’s passing was indeed young and premature due to cancer. However, my grandmothers both had conversations with their doctors to remind them to get things squared away as they got older. Those conversations may not have been on a five year schedule and they might be a little different if they had taken place in today’s environment, but they still happened. It didn’t take extra time as it could easily be done durring the course of a regular check up.
I am not against people being prepared as they get older, but I think end of life counciling laid out by the bill is inefficient and out of place.
The problem is that some people don’t understand how much they want to live until they are in a situation which focuses their mind. You ask someone how they would feel in an hypothetical situation and get them to sign papers then, but when the time comes they have a different perspective. A lot of people may not get that second chance to recover if they aren’t resuscitated. This is a very bad idea and it is already starting. The stimulus bill made a downpayment on it.
On a side note I find it of interest that people routinely wait in lines to talk to a low level administrator about an end of life decision. It happens at the DMV when people are counceled on the end of life decision to become an organ donor. This counceling begins as early as age 15, and has a fairly important impact on the end of an individual’s life. An MD is not required to provide citizens with this counceling, and within a matter of minutes they have made an end of life choice without having their medical insurance billed.
… and so far, there have been no complaints from the organ donors.
Wow, people talking to virtual strangers without medical licenses about an important end of life choice, and there are no complaints. (Well, saying that there are no complaints isn’t exactly true. However, you are techinically correct, none of the donors have complained, what with being dead and all).
To me this says that the end of life provisions found in HR 3200 were over complicated, inefficent and costly. If the legislation’s goal was to insure that all citizens were made aware of end of life options, and had the option to prepare them ahead of time then there are more efficient ways to do so.
That being said I would still rather the government not be involved with the end of my life at all, and that includes the inheritance tax.
I think this is a GREAT time for private-sector entrepreneurs to start fly-by-night counseling services for living wills. You don’t need any qualifications, right?
Noman, you are a little behind the times aren’t you. There are already plenty of private companies that offer living will services. There has been quite the boom in that industry. You can even do it yourself online.
Oh, and what level of qualification does the person behind the counter at the DMV have to be doing organ donor counseling?
Here’s the pamphlet. Do you want to be an organ donor? Yes? Then here is the dot on your diver’s license. Congratulations, you have just made an important end of life decision!
Well technically it is a POST-end-of-life decision. Not really much bearing on one’s quality of life.
Several “end of life” decisions could fall into that category.
Also there has been some debate over the years about organ donation because in some cases the survivors feel that more would have been done to save the donor’s life if their organs were not being donated.
“That being said I would still rather the government not be involved with the end of my life at all, and that includes the inheritance tax.”
End of life counseling, Timothy, no problem, your choice.
Inheritance tax: What is the exclusion now, $2M? Most families could thrive for a lifetime on the income from $2M invested. So don’t worry, Timothy, you’re OK, and so are all the others who will inherit in excess of $2M and pay some taxes on it. What ever happened to the core value of working for your income instead of inheriting it? You should be contributing your inheritance to your church or to charity!
Thanks for being the dictates of my own concience Perry.
That is exactly what bothers so many people about massive government, and socialism. The American dream has never been about being OK, and it has never been about what the government will do for me and others with our own money. It has been about what people can do themselves.