End of Life: ObamaCare and the Elderly

The Washington Post has a new piece up, "Seniors Remain Wary of Health-Care Reform: Administration Aims to Reassure Older Americans Fearful of Losing Access to Care."

The report covers the big issues of debate on ObamaCare and medical treatment of the elderly.

On the one hand, there's the suggestion, stretching back to early this year, that President Obama favors the steep rationalization of elderly care, which has been described by some as "euthanasia." More recently, former Gov. Sarah Palin wrote a post on Facebook this week suggesting:

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

The Post's article responds, saying "There are no such "death panels" mentioned in any of the House bills." And of course, right on cue, leftists attacked Palin as wacko. But as both William Jacobson and Ann Althouse indicate, the former vice-presidential candidate is on solid ground. And Althouse, pointing to this video below, argues that Palin's conclusion is "cool-headed and manifestly sane."

There's also a second strand of debate on "end-of-life" counseling, which is sounds less dramatic than "euthanasia," but in some respects comes pretty close to it. Charles Lane addresses the issue in his piece, "Undue Influence: The House Bill Skews End-of-Life Counsel." Looking at the House bill, Lane argues:

Section 1233 ... addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice -- even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs?

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.

What's more, Section 1233 dictates, at some length, the content of the consultation. The doctor "shall" discuss "advanced care planning, including key questions and considerations, important steps, and suggested people to talk to"; "an explanation of . . . living wills and durable powers of attorney, and their uses" (even though these are legal, not medical, instruments); and "a list of national and State-specific resources to assist consumers and their families." The doctor "shall" explain that Medicare pays for hospice care (hint, hint).

Top administration officials have been developing a policy known as "The Complete Lives System." The model provides the theoretical basis for President Obama's plan for the rationaliztion of elderly care.

It's really awful, no matter how you look at it. Leftists will keep pulling their hair out over this, screaming that it's just a bunch of right-wing demagoguery. But all folks have to do is READ THE BILL itself. This first passage, from page 429, Lines 10-12, is particularly gruesome, and later sections indicate the "limitation" of treatment:

‘‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

‘‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—

‘‘(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in igning such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the in dividual and be followed by health care professionals and providers across the continuum of care;

‘‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, in cluding an indication of the treatment and care desired by the individual; ‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and ‘‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the in dividual.

‘‘(B) The level of treatment indicated under subpara12 graph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified 14 interventions. Such indicated levels of treatment may include indications respecting, among other items—

See also, "The HC Monstrosity-All 1,018 Pages."