End Of Life: A Better Way
We spend one third of our health dollars on the last three months of people’s lives. That is a fact, one that clearly needs to change. I support changing those statistics.
But politically, it has to be handled with kid gloves. Naturally, anything that makes the government look like its getting into the ‘let’s pull the plug’ business is a little creepy. And it is understandable that many people don’t want to allow government into their personal life-and-death decisions.
Charles Lane of the Washington Post asks a simple question: What is the now infamous Section 1233 going to do? Section 1233 imposes a requirement for end-of-life planning sessions every five years for Medicare patients — and immediately after patient gets a terminal diagnosis.
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.
Yeah, and that from a member of the mainstream media. Obama didn’t help matters. In his ABC informercial in July, he said this:
httpv://www.youtube.com/watch?v=U-dQfb8WQvo
The ‘take a pill instead’ line has resonated through out America…and not in a good way.
Frankly, this whole strategy on decreasing end of life costs is creepy. I don’t want government dictating ANYTHING about the end of my life.
That said, we have to reduce end of life costs. So it sounds like I am a hypocrite, right? Wrong. I propose another way. I propose that the government stay out of the decision making all together. Instead, decisions should be made by ethics panels Every hospital has ethics panels, primarily made up of doctors but also often including nurses and even clergy. Usually a patient representative is there as well. These committees, independent of any government oversight, help give families and doctors guidance on what the most ethical way forward is for complicated cases.
I would propose that ethics committees do the job they are doing today, with one caveat. I would allow the decision that the ethics committee makes to have some financial repercussions. If the ethics committee deems that care should be continued, then it will be. If they deem that the quality and length of the patient’s life is being artificially extended for no gain whatsoever, then there are choices that need to be made. The family can still continue the current care. However, the insurer (whether it be the government, i.e. Medicare, or a private insurer) would no longer be responsible for all of the costs. We can certainly regulate how much or little of the costs will be covered by insurance.
However, in this scenario, the government simply has NO ROLE in deciding the course of the patient’s illness. They are an outside regulator, and nothing more. The ethical decisions, the one determining if there is any ‘worth’ to extending the patient’s life, will be made by doctors, clergy, nurses, and even representatives of the patient’s family. And even then, if the ethics committee judges that the patient’s life is at an end, the family still has the option of paying out of pocket if they decide that. Admittedly, most families will not be able to pay.
Now, admittedly, most families will not be able to pay. But framkly, that is the reality we are facing in health care today. We cannot afford what we are currently doing. Patients should always have the right to do as they see fit…but just like in any other decision in our lives, we have to balance that with the costs involved.
Once again, Democrats have used overhanded measures to confront a cost issue that could be handled more elegantly, and more humanely.
UPDATE: The Senate Finance Committee is getting ready to drop the end of life provision…which is a mistake. What kind of reform bill will it be if we don’t confront costs in the final days of people’s lives? This is the cowardly way out.
I suppose this is one of the toughest of issues facing everyone. As time and technology has progressed conditions that were terminal are no longer. So, is this more of an age issue? Of course the life expectancy has also risen. Therefore people expect to live longer. Hopefully there is also quality with the extra time.
From a very personal point of view I know the conditions of life that for me make it worth living.
How does this fit with premature birth children and other high risk-low probability of survival scenarios? Would shark attack victims of moderate age have to be concerned that emergency procedures not be performed because the odds are against?
Don’t get me wrong, there are plenty of cases where keeping someone alive for the sake of existence seems less than inhumane. Yes, I agree kid gloves here indeed.
James, no kid gloves needed. Why do we pay into a system for our entire lives if not to be taken care of when we or our family are sick? Why is it that the money we pay into insurance goes towards treating others that pay nothing, that have never paid anything towards my care, my family’s care, or anyone elses? We’re going to change an entire system and take away things from people that play by the rules so that people who don’t pay or play by the rules will be covered? James, don’t be sucked in by letting them dictate the premise of the argument. If you want everyone to be covered then create a condition where they more than likely will procure a job and they and their employer can buy medical insurance. How often have old sickly citizens chosen to die instead of prolonging expensive medical procedures? Plenty! How about we all tell the politicians that we will have a “dialogue” as soon as they fix the tort situation? That, in and of itself would exponentially reduce costs from a single pill to expensive life support system, premiums and so on. That, in and of itself, would reduce the “cover your ass” system we have now that wastes manpower, resources, and time in the event they are sued. Money is being paid out, hundreds of millions of dollars, by Insurance companies because it is cheaper for them to pay out then to pay lawyers. If they really wanted to “reform” health care there are so many things they could have done, none of which they even addressed. It is a power grab to transform the country into a one-party system where voters become dependent and beholden to politicians and nothing more. They identified a small window of opportunity while they have super majorities and they’re going for it. It has absolutely nothing with actually reforming health care for their citizens and everything to do with an opportunity. That’s why they are doing everything that appears to intelligent people and economists to be putting us in a hole and breaking the bank. That creates an “emergency” where they can ram these things through while at the same time they add more voters completely dependent on them. How about making medical insurance 100% deductable? If you pay twenty thousand for insurance then the government deducts twenty thousand from your earned income. That’s a lot of coverage. Easy enough isn’t it? Oh, but wait! That doesn’t help the “takers” that vote them into office every couple of years. They couldn’t do something like that. Where’s the billions of dollars that we supposedly were going to saving by taxing tobacco and smokers at an almost tyrannical rate? It must be around somewhere, right? This has NOTHING to do with reforming health care and has EVERYTHING to do with a power grab.
Dave B I agree with you more than you can know and have posted similar here many times. However, my comment was simply regarding the end of life determination. Who would do it and how would it be made.
If I am still not being clear than let us try this: Except when one is dead and there is documentation; how can one anticipate an end to ones life with precision? Here I comment on the moral:financial equation that makes me so fear having anyone with a financial interest in cost savings being the plug pullers or deniers of care (choose your cases: over severe accidents; brutal attacks from sharks or other animals, people too old or children in jeaopardy too young).
Now I believe the post here on Avatar referenced as much regarding ethics panels for those cases with no or extreme little hope.
I am glad my grandparents and parents enjoyed Social Security but I don’t expect to be a recipient. I don’t want that or other care given to law breakers such as illegal aliens either. If they can receive these benefits while breaking our laws than why should I obey laws either?!?
We are on the same page my friend.
[...] End Of Life: A Better Way « NEOAVATARA [...]