Just about everyone is talking about how the Dems and the Obama administration snuck the death panels back into Obamacare, and snuck really is the operative word:
“We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ — e-mails can too easily be forwarded.”
The e-mail from Rep. Blumenauer’s office continued: “Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”
Some folks are mostly bothered by the sneaking around, and some are more worried about where these end-of-life consultations will take us. You know: euthanasia, assisted-suicide, pulling-the-plug-on-Granny, or however you phrase it.
Out of all the debating, however, the Mad Conservative is the one that really nails down the issue. She does so by using a personal story. After all, when it comes down to it, this issue is very personal.
How are these healthcare regulations going to affect us personally?
Roxanna Danna’s story illustrates a very personal worry: what if your elderly mother has to decide whether she is strong enough to survive an emergency surgery, and you aren’t there to help her?
What if you can’t get a flight until tomorrow? Months before, a (well-meaning! I’m not a doc-hater like some people!) physician had already provided her with an advance care consultation. During this consult, she signed an advanced directive instructing that no life-extending surgery take place in circumstances just . . . like . . .this one. By the time you arrive, she is unconscious and unable to revoke this directive.
Roxanna was there to help her mother decide about the surgery, and so her story ends happily.
But, what if?
It’s a valid concern, the fear that these consults will unduly influence patients to make decisions that result in the revocation of lifesaving treatment or something as basic as food and water. Not everyone shares the concern, but that fact certainly does not invalidate it.
I wanted to decide for myself about this new regulation, so I went searching for it. All the articles I’ve linked discuss the regulation, but none of them link or quote it.
I couldn’t find it either. According to Breitbart.com, the “end-of-life” language has been changed to the less scary name “voluntary advance care planning,” and the reg was issued on December 3rd. The 3rd? The New York Times didn’t break the news until December 25th.
Boy, that secrecy really paid off. (“The longer this goes unnoticed, the better our chances of keeping it.”)
It wasn’t a complete secret, though. A post dated November 9th at the Social Work Hospice and Palliative Care Network blog is entitled:
“New Physician Payment Final Rule Includes Voluntary Advance Care Planning“
The author of that post openly discusses the fact that “A legislative provision to offer voluntary advance care planning every five years was dropped from the health care reform bill because of hysteria over government encouraged euthanasia.”
So it’s been out there, and we missed it.
But hey. Here I am, fully aware of this new regulation, and I still can’t locate it. That palliative care blogger very helpfully provided a direct link to the (then) proposed regulation, at The Office of the Federal Register:
Clicking on said link produces nothing but a 404 error. File not found.
My scan of the whole OFR website turned up nothing. Ditto on the Centers for Medicare and Medicaid Services. I hunted until my brain went numb from bureaucracy overload. Scanning the CMS website is like trying to digest the tax code in a day. (By the way, I tried to do that once. I don’t recommend it.)
I did find a link to a friendly new website called innovations.cms.gov.
The website’s introduction is penned by Dr. Berwick himself. He pontificates:
“None of this will be easy. Government cannot and should not do this alone. That’s why we are working with leaders in the private sector to come up with the best answers to the problems that face us all.
We hope that you will join us, too. What I ask for is your partnership and your input. I would like to help forge an unprecedented level of shared aim, shared vision, and synergy in action among the public and private stewards and leaders of health care.”
When it’s so difficult to find a regulation already promulgated, color me just a little skeptical about that whole “asking for your input” line. Uh-huh. Betcha don’t see girls like me in places like this either, do ya?
Input is important to you, Dr. Berwick? Really? Well, maybe not so much that old-fashioned, face-to-face doctor-patient input: “the health care encounter as a face-to-face visit is a dinosaur.”
Do they really need yet another government
propaganda information website like Innovations? Can’t Berwick just spout his nonsense on Healthcare.gov? You’d think the administration would want to capitalize on money spent putting Healthcare.gov on the top of Google searches.
Is this new regulation starting us down a slippery slope into euthanasia?
Well, it may be on the slippery slope, but it ain’t the start of it. Perhaps that slope began with this sort of advice: “You’ve gotta have a Living Will/Advanced Directive; you’ve gotta have one this instant!“
Like Althouse says, “It seems to me that the effort is to get people to commit in advance to death-hastening choices, by getting everyone to sign these documents.”
Say that reminds me. The National Right to Life Committee has a life-affirming alternative to those death-hastening documents: the Will To Live. You can use that template as a starting point for your own “Advanced Directive.” Tailor it to your own preference, and it is still a valid legal document if signed and witnessed properly.
When I get asked by a doctor whether I have a “Living Will,” I can honestly answer, “Yes. Yes I do.”
But. Instead of directing when treatment should be removed, my living will is stuffed with statements like:
“I direct that medical treatment and care be provided to me to preserve my life without discrimination based on my age or physical or mental disability or the ‘quality’ of my life. I reject any action or omission that is intended to cause or hasten my death.”
It’s good way to avoid the fear of getting the plug pulled too early.
This new “advance care” regulation doesn’t create the real death panel, anyway.
All it does is allow doctors to be paid for advising you about a difficult things. Ideally, this advice will ensure that future treatment is consistent with your wishes and moral values should you become too sick to decide for yourself. Ideally.
The really real death panel will be created by rationing of healthcare:
Under highly centralized national health care, the government inevitably makes cost-minded judgments about what types of care are “best” for society at large, and the standardized treatments it prescribes inevitably steal life-saving options from individual patients. This is precisely why many liberals like former White House budget director Peter Orszag support government-run health care to control costs: Technocrats in government can then decide who gets Avastin for cancer, say, and who doesn’t.
Even Paul Krugman knows it. Perhaps the “Independent Payment Advisory Board” will morph into a full-fledged death panel. Maybe one of the other Obamacare-created boards or commissions (filled with unelected, “independent” expert members, of course!) will do the dirty work. Probably, the work of various entities will, in conjunction with one another, produce a death-panel-like result.
The devil’s in the details.
But don’t worry. Leaders, stewards, and experts like Berwick and Sebelius will hammer out those details for us.
“The inability of democratic assemblies to carry out what seems to be a clear mandate of the people will inevitably cause dissatisfaction with democratic institutions. Parliaments come to be regarded as ineffective ‘talking shops,’ unable or incompetent to carry out the tasks for which they have been chosen. The conviction grows that if efficient planning is to be done, the direction must be ‘taken out of politics’ and placed in the hands of experts–permanent officials or independent autonomous bodies.”
Hayek, 1944, The Road To Serfdom, Chapter 5 (emphasis mine).
UPDATE: Matt Ross says so, too! “End of life planning” is not a death panel. A board which decides what medical care you get: that is a death panel. Big difference folks.