The flap over Sarah Palin's reference to a "death panel" in the government health care plan has led to a debate on this very important aspect of the whole debate. It involves the question about "health care rationing". The Administration, the Democrats and the news media have pounced on her comment to illustrate that the protesters at the town hall meetings are acting on "false information". President Obama himself has jumped on this aspect to describe it as a false attack.
But is it?
At issue is section 1233 of the plan promoted by the President. Here are the points in section 1233 of the proposed health plan:
Section 1233. Advanced Care Planning Consultation
Subject to paragraphs (3) and (4), the term `advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--
`(I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes;
`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--
`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--
`(I) ensures such orders are standardized and uniquely identifiable throughout the State;
`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;
`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
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As I have discussed in a previous posting, these are legitimate issues and questions that patients, their families and their doctor face in the final years of life. As I have recently written, I recently went through this with my mother, who died in May.
My question is why the government-any government-should be involved in these decisions. Why should the government involve itself in providing tax-payer paid counseling sessions every five years? Does anyone seriously doubt that there is a government interest here in eliminating sick and elderly people in the interest of cost effectiveness?
Has not President Obama publicly stated that there is an interest in a government body advising health care providers as to the advisability of certain medical procedures for the sick and elderly?
Yes, he has. He also said in the same breath that it might be better to forego the operation and take the pain-killer.
I know from personal experience with my late mother that many old people do, indeed, reach that point. My point is that this is a decision that must be reached between a patient, family and doctor-not the government.
Does any sensible person really doubt that the government health care plan has such an intent to save costs by encouraging the sick and elderly to let go of life-especially when the government starts paying for medical expenses?
And what is the rebuttal from the President and the Democrats to the this issue?
"Insurance companies already ration health care."
Well perhaps. But that was not the case with my mother. During the last eight years of her life (age 80-88), she received several hospital visits, skilled nursing facility stays, cat scans, MRIs, a pace-maker, basically, everything she needed to the day she made the decision to let go-supported by myself, her doctor, and hospice. Nobody from the government was involved. Nothing was ever declined.
Sarah Palin's reference to a "death panel" may have been poorly-chosen. But the idea is valid. Government can never be allowed to get involved in end of life issues. To do so would destroy any claim we might have as a decent nation.
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