{"id":2992,"date":"2009-08-12T05:15:57","date_gmt":"2009-08-12T09:15:57","guid":{"rendered":"http:\/\/www.geneveith.com\/?p=2992"},"modified":"2009-08-12T05:15:57","modified_gmt":"2009-08-12T09:15:57","slug":"section-1233-of-the-health-care-bill","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/geneveith\/2009\/08\/section-1233-of-the-health-care-bill\/","title":{"rendered":"Section 1233 of the Health Care Bill"},"content":{"rendered":"\n<\/head>

Washington Post<\/em> editorial page staffer is not right-winger and he himself has a Living Will, but he has qualms about Section 1233 of the Health Care Bill that pays doctors to offer \u201cend of life\u201d counseling to seniors. He is afraid that the physician-as-authority-figure will unduly influence the elderly to request \u201cpulling the plug\u201d as an effort to save money. From House Health-Care Reform Bill Oversteps on End-of-Life Issues \u2013 washingtonpost.com<\/a>;<\/p>\n

Section 1233. . . addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they\u2019re just trying to facilitate choice \u2014 even if patients opt for expensive life-prolonging care. I think they protest too much: If it\u2019s all about obviating suffering, emotional or physical, what\u2019s it doing in a measure to \u201cbend the curve\u201d on health-care costs?<\/p>\n

\nThough not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren\u2019t quite \u201cpurely voluntary,\u201d as Rep. Sander M. Levin (D-Mich.) asserts. To me, \u201cpurely voluntary\u201d means \u201cnot unless the patient requests one.\u201d Section 1233, however, lets doctors initiate the chat and gives them an incentive \u2014 money \u2014 to do so. Indeed, that\u2019s an incentive to insist.\n

Patients may refuse without penalty, but many will bow to white-coated authority. Once they\u2019re in the meeting, the bill does permit \u201cformulation\u201d of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would \u201cplace senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,\u201d I don\u2019t think he\u2019s being realistic.<\/p>\n

What\u2019s more, Section 1233 dictates, at some length, the content of the consultation. The doctor \u201cshall\u201d discuss \u201cadvanced care planning, including key questions and considerations, important steps, and suggested people to talk to\u201d; \u201can explanation of . . . living wills and durable powers of attorney, and their uses\u201d (even though these are legal, not medical, instruments); and \u201ca list of national and State-specific resources to assist consumers and their families.\u201d The doctor \u201cshall\u201d explain that Medicare pays for hospice care (hint, hint).<\/p>\n

Admittedly, this script is vague and possibly unenforceable. What are \u201ckey questions\u201d? Who belongs on \u201ca list\u201d of helpful \u201cresources\u201d? The Roman Catholic Church? Jack Kevorkian?<\/p>\n

Ideally, the delicate decisions about how to manage life\u2019s end would be made in a setting that is neutral in both appearance and fact. Yes, it\u2019s good to have a doctor\u2019s perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party \u2014 the government \u2014 recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don\u2019t have to be a right-wing wacko to question that approach.<\/p>\n

As it happens, I have a living will and a durable power of attorney for health care. I\u2019m glad I do. I drew them up based on publicly available medical information, in consultation with my family and a lawyer. No authority figure got paid by federal bean-counters to influence me. I have a hunch I\u2019m not the only one who would rather do it that way. <\/p>\n

Notice that the issue is not the intent but the effect.<\/p><\/div>\n<\/blockquote><\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

Washington Post editorial page staffer is not right-winger and he himself has a Living Will, but he has qualms about Section 1233 of the Health Care Bill that pays doctors to offer \u201cend of life\u201d counseling to seniors. 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