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There has been a lot of discussion as of late about the so-called Mandatory End of Life Counseling provisions tucked away in the ‘‘America’s Affordable Health Choices Act of 2009’’.
Many Americans are concerned that this is a veiled way to lessen the burden on the health care system by eliminating extensive (and expensive) life extending procedures for the elderly, and the critically ill.
Others claim it is simply a way to insure that the government, through Medicare, covers the cost of making informed end of life decisions, such as legal paperwork regarding living wills and trusts, DNR (Do Not Resuscitate) forms, burial arrangements, and options for continuing care.
I have tried to do some research into this matter, and most of the information in the top spots on a web search leads to the conclusion that the former is the case. However, I am not one to succumb to the "consensus" method of decision making.
Here is the actual wording of the bill, from the first link, beginning page 424. To save space, I am only putting the parts I find questionable, not trying to use it out of context, as most of the separate sections are indeed separate.
‘‘(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.
‘‘(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 un-able to communicate those wishes, including requirements regarding the designation of a surrogate decision maker (also known as a health care proxy).
‘‘(IV) is guided by a coalition of stake
holders 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."
Now, the proponents of the bill claim that the End of Life issue is going to help the elderly get the proper care, but all that counseling has got to be expensive, and tacked onto the Medicare footprint to boot.
So I have a problem reconciling that to this statement by Speaker Nancy Pelosi, regarding the bills responsibility to the Congressional Budget Office, or CBO.
"We do have to be fiscally responsible. We will live by the rules of the CBO. But it's also true that the CBO doesn't count things that we know will save money, like prevention, wellness and end-of-life issues. You don't need to be a congressional accountant to know those will save money. We are very confident that this bill will have savings, and many of them will not be counted by the CBO. But they will save money. Outside groups can document them. We will live by the rules so we are fiscally sound and all the rest. But that doesn't mean we won't have other provisions that save money, but won't be scored."
Perhaps she is only speaking what she feels she needs to say to garner support from fiscally conservative democrats, as she basically reversed that sentiment two seconds later with this statement regarding government deals with the health and pharmaceuticals industry:
"We know we can squeeze more from the system. The minute the drug companies settled for $80 billion, we knew it was $160 billion. Right? If they're giving away 80? But in any event, they're supporting the bill and everybody likes that. But there could be more money. But when you want to squeeze more, you have to be careful about what you're squeezing. You have to make sure it's waste, fraud, and abuse. We don't have the capability of squeezing from the private sector. All we can squeeze is out of the public sector. And the president made the agreements he made. And maybe we'll be limited by that. But maybe not!"
Where does she think the public sector gets its money? From the private sector!! But I digress.
My question is, 'How can being more involved in "end of life issues" save money, when it is obviously going to cost the government more than what they spend now?", unless some of those "issues" involve convincing people to receive less care, effectively ending their life.
What do you think?