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Kathleen Parker is one of America's most popular opinion columnists, addressing the country's mental health through her views on current national ...
Read more about Kathleen Parker.
Kathleen Parker is one of America's most popular opinion columnists, addressing the country's mental health through her views on current national ...
Read more about Kathleen Parker.
Sometimes Slopes Really Are Slippery
Kathleen Parker
WASHINGTON -- Sarah Palin was right, the second time.
We do need to turn down the rhetorical heat lest we miss important issues in the proposed House health care bill.
Unfortunately, Palin's more thoughtful comments followed a made-for-the-tabloids Facebook post suggesting that under President Obama's health care reform, a "death panel" would kill her elderly parents and her Down syndrome baby.
Once upon a time, radical reformers could only dream of such helpful enemies. Now that the world is chasing hyperbole, we indeed risk overlooking troublesome language in the end-of-life section of the House health bill, aka Section 1233 of HR 3200.
For purposes of civil discourse, let's assume that no one wants to kill off old people. Just as airline pilots have a primary interest in safely landing planes, even Nancy Pelosi, Harry Reid and Barack Obama will be elderly someday.
Meanwhile, we all know that America's health care system is in dire need of repair. We also know, though we're loath to admit, that we can't do all things for all people. Technology that enables us to prolong life far beyond what is natural or desirable also threatens to cripple us financially.
How do mere humans balance the immense powers of "can" against the humbling moral quandary of "should?" This is partly what the bill's end-of-life section aims to address.
Theoretically, rational people can dwell happily on the same page. Wouldn't we all rather voluntarily make end-of-life provisions while we're still healthy rather than burden family members, who would be reluctant (one hopes) to pull the plug on our darling selves?
Of course. In practice, however, the debate is over whether these consultations are conclusively voluntary -- and the bill, to the extent it is comprehensible at all, is vague enough to cause concern.
For instance, the bill makes end-of-life consultations reimbursable under Medicare every five years, but allows for more frequent Medicare-reimbursed sessions should a person's condition worsen. These consultations allow for the formulation of "an order regarding life-sustaining treatment."
We can all imagine a situation when we might not want any more life-sustaining treatments -- when death is imminent, for example. But we can also imagine a scenario when, feeble and ill, we might be subtly urged to forgo further life-sustaining treatment out of consideration for others. Given that "actionable medical orders" can be formulated from advance care consultations, the danger is that life-sustaining care would be precluded based on a checkmark on a document you signed five years earlier.
It would be nice to think that everything goes as intended by patients, but we can safely assume that when human error collides with bureaucratic efficiency, nightmarish enforcement scenarios could ensue. Likelihoods morph into certainties when, as this bill sets out, primary physicians aren't necessarily involved in the consultations. As proposed, a variety of health care practitioners would do.
Not least, the bill is an enabling document that leaves great discretion to the secretary of health and human services to develop guidelines that ultimately could change the character of what seems to be offered. In just one of dozens of examples, the bill leaves it to the secretary to develop "quality measures" on end-of- life care and advanced care planning.
What might such quality measures look like? Who knows? But other documents floating around hint at what the secretary might consider.
One is a 2008 Rand Corp. report, "Advance Directives and Advance Care Planning: Report to Congress," which suggests mechanisms by which poor "advance care planning" could be viewed as "medical error," otherwise known as malpractice. While it's unclear what direction "quality measures" might take, the bill could allow the government to require Medicare providers to encourage end-of-life consultations -- or risk being penalized in their compensation or in their ability to participate in the Medicare program.
Beyond the jargon, of course, the real issue is that people instinctively (and correctly) fear bureaucracy -- especially in matters of life and death. When it takes 1,017 pages of mostly incomprehensible language to MapQuest the way we live (and die), people have a right to demand clarity.
A simple amendment to HR 3200 would do much to cool tempers. All that's needed is specific language saying that these end-of-life consultations are not mandatory -- either for physicians or patients -- and that there would be no penalty, either in coverage or compensation, for declining to participate.
In the absence of such language, one may reasonably assume otherwise.
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Kathleen Parker's e-mail address is kathleenparker(at)washpost.com
(c) 2009, Washington Post Writers Group
This news arrived on: 08/12/2009
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Posted Comments:
08-17-2009 02:56
JCE wrote:
Thank God for another couple of voices of reason. The right wing terrorists want to have some more people killed, and then there will be martial law, and we will lose more of our freedoms. So we can talk reasonably, cooperate, and us the vote wisely, or act stupid, be partisan, buy into the lies, and throw it all away. I feel sorry for the young, with so many stupid old, especially racists, not wanting any change.
08-16-2009 22:38
WCM wrote:
Howard you are absolutely right.It's going to take educated voters from both sides, saying enough is enough, for our country to get back on the right page.The fanatics on the right and left are destroying our great country. WE THE PEOPLE, must hold them all accountable and put them in their rightful place.Every citizen in this country has a stake in our future and should be treated to the same equal opportunities under the law.We can no longer reward the wealthy ,just because they think their entitled.We can no longer reward those who are able but want work.We can no longer reward those who are here illegally.We can no longer support countries financially that would destroy us, if given the opportunity.WE THE PEOPLE, have been fleeced by self serving individuals far to long.The only way to stop this, is in the voting booth.We must fire them and send them packing.Maybe then they all will get the message.
08-16-2009 22:10
WCM wrote:
Truthful post JCE. It's funny how the people running the Republican Party can do the two step and nothing is ever said, yet they circle the wagons when anybody from the Democratic Party changes their position on an issue.Sen. Johnny Isackson from Georgia was pro-planning til his puppet masters told him he had to change his position.This issue has been totally taken out of its original context so as to keep the the voters from seeing the real issues. The RNC has pulled out all stops in spreading their lies and deceit here in Georgia.Congressman Paul Broun ,a doctor himself ,is traveling around the state with his medicine show telling total lies and almost starting riots.It amazes me that their having to double the security at their own shows. Something that I've also noticed is there are a lot of people from other states and counties showing up in these little town hall meetings.I find this to be more than coincidental.
08-15-2009 22:57
JCE wrote:
The right wing terrorists are using the same scare tactics that they used in the early 90s to stop reform, and the same tactics HItler used. I am waiting to see who the terrorists will pick as their Hitler to run against Obama.
Dick from Chaska, Goldenwren, Al, MarineMom, Ed O'Malley, Howard, Kathie, casey42 and Catharyne made some good posts, and have obviously been doing some research, reading, listening, and thinking for themselves. The others would do well to think about what they posted.
Last year, Palin, as with the bridge to nowhere, was for end of life planning before she was against it. Why are the republicans so against people making decisions about how they want to live or die, while they still can, saving their families the job, saving everyone some money, and so in favor of supporting the rich? The rich didn't elect them, they just bought them, body and soul, in order to have them sell out America.
One is either for law and order, the constitution, the people, freedom, justice and equality for all, and the truth, or one isn't. And the right and left wing extremists, and the right wing terrorists, and the terrorist tools, the baggers, deathers and birthers, are not for all of that. All they want is for the republicans do be destroying the country, and no one else.
Dick from Chaska, Goldenwren, Al, MarineMom, Ed O'Malley, Howard, Kathie, casey42 and Catharyne made some good posts, and have obviously been doing some research, reading, listening, and thinking for themselves. The others would do well to think about what they posted.
Last year, Palin, as with the bridge to nowhere, was for end of life planning before she was against it. Why are the republicans so against people making decisions about how they want to live or die, while they still can, saving their families the job, saving everyone some money, and so in favor of supporting the rich? The rich didn't elect them, they just bought them, body and soul, in order to have them sell out America.
One is either for law and order, the constitution, the people, freedom, justice and equality for all, and the truth, or one isn't. And the right and left wing extremists, and the right wing terrorists, and the terrorist tools, the baggers, deathers and birthers, are not for all of that. All they want is for the republicans do be destroying the country, and no one else.
08-13-2009 22:34
Kathie wrote:
Howard
I agree with everything you said. It's about time everyone takes the time to read this thing, especially the ones that are making up the lies, and the ones that will be voting on it. There is a definite need for reform, and if these elected knuckleheads can't get over their pettiness toward each other, it's time to get rid of them. Quit with the scare tactics, and work for the people who are paying your wages.(Not the lobbyists that are paying you extra).
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