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Denounced As “Death Panels,” Funding For End Of Life Counseling Makes A Comeback

The provision of the Affordable Care Act that Sarah Palin, Newt Gingrich, Michelle Bachmann, and others demonized as “death panels” is about to make a comeback under a new series of Medicare regulations:

WASHINGTON — When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress.

This is essentially the same type of program that was included in Section 1233 of the bill that eventually became the ACA, and it became a focus of controversy when Sarah Palin took her Facebook page in June 2009 claiming that it would create government panels that would have mandated that her Down’s Syndrome baby should die:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. 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.

As it turned out, though, just wasn’t true:

According to the bill, “such consultation shall include the following: An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to; an explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses; an explanation by the practitioner of the role and responsibilities of a health care proxy.”

Medicare will cover one session every five years, the legislation states. If a patient becomes very ill in the interim, Medicare will cover additional sessions.

Jon Keyserling, general counsel and vice president of public policy for the National Hospice and Palliative Care Organization, which supports the provision, said the bill doesn’t encourage seniors to end their lives, it just allows some important counseling for decisions that take time and consideration.

“These are very serious conversations,” he said. “It needs to be an informative conversation from the medical side and it needs to be thought about carefully by the patient and their families.”

In no way would these sessions be designed to encourage patients to end their lives, said Jim Dau, national spokeman for AARP, a group that represents people over 50 that has lobbied in support of the advanced planning provision.

McCaughey’s comments are “not just wrong, they are cruel,” said Dau. “We want to make sure people are making the right decision. If some one wants to take every life-saving measure, that’s their call. Others will decide it’s not worth going through this trauma just for themselves and their families, and that’s their decision, too.”

Both Keyserling and Dau were particularly troubled that McCaughey insisted — three times, to be exact — that the sessions would be mandatory, which they are not.

For his part, Keyserling said he and outside counsel read the language carefully to make sure that was not the case.

“Neither of us can come to the conclusion that it’s mandatory.” he said. “This new consultation is just like all in Medicare: it’s voluntary.”

“The only thing mandatory is that Medicare will have to pay for the counseling,” said Dau.

Even more ironic was the fact that the provision was proposed by a Republican, Georgia Senator Johnny Isakkson who dismissed the “death panel” rhetoric in an interview with The Washington Post in 2009:

Is this bill going to euthanize my grandmother? What are we talking about here?

In the health-care debate mark-up, one of the things I talked about was that the most money spent on anyone is spent usually in the last 60 days of life and that’s because an individual is not in a capacity to make decisions for themselves. So rather than getting into a situation where the government makes those decisions, if everyone had an end-of-life directive or what we call in Georgia “durable power of attorney,” you could instruct at a time of sound mind and body what you want to happen in an event where you were in difficult circumstances where you’re unable to make those decisions.

This has been an issue for 35 years. All 50 states now have either durable powers of attorney or end-of-life directives and it’s to protect children or a spouse from being put into a situation where they have to make a terrible decision as well as physicians from being put into a position where they have to practice defensive medicine because of the trial lawyers. It’s just better for an individual to be able to clearly delineate what they want done in various sets of circumstances at the end of their life.

How did this become a question of euthanasia?

I have no idea. I understand — and you have to check this out — I just had a phone call where someone said Sarah Palin’s web site had talked about the House bill having death panels on it where people would be euthanized. How someone could take an end of life directive or a living will as that is nuts. You’re putting the authority in the individual rather than the government. I don’t know how that got so mixed up.

Isaakson goes on to explain the logic behind the idea:

I’ve seen the pain and suffering in families with a loved one with a traumatic brain injury or a crippling degenerative disease become incapacitated and be kept alive under very difficult circumstances when if they’d have had the chance to make the decision themself they’d have given another directive and I’ve seen the damage financially that’s been done to families and if there’s a way to prevent that by you giving advance directives it’s both for the sanity of the family and what savings the family has it’s the right decision, certainly more than turning it to the government or a trial lawyer.

Exhibit A, of course, is the Terry Schiavo case.

Because she never prepared a Living Will, Advance Medical Directive, or other document memorializing what she did and did not want to have done to her, it was left to the Courts to decide what should happen, which resulted in a battle that tore the Schiavo family apart and led some (insane) pro-life activists to claim that her husband and the judges who made the decisions were “murderers”. It also led to a completely inappropriate move by Congress to get involved in a matter that belonged in, and should have been left in, the State of Florida.

The point is that everyone should have a Living Will, regardless of their age, and all that Section 1233 was intended to do is make the preparation of such a document something that Medicare covers. That’s what the new regulations also seem to be aimed at.

Do I think government should be doing that ? Well, no, but that’s a different argument from claiming that the Obama Administration is about to set up “death panels.”

And I still think “death panel” would be a cool name for a rock band.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. floyd says:

    an explanation …of advance directives, including living wills and durable powers of attorney, and their uses; an explanation … of the role and responsibilities of a health care proxy.”
    “””””””””””””””””””””””””””””””””””””
    Sounds like legal advice from people who should be giving medical advice.

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  2. steve says:

    This is wonderful news if true. I am involved in a lot of end of life care. Few people really discuss this ahead of time. Most people do not know what options they have. They end up making these decisions late at night, under duress. All too often we end doing procedures on people for whom there is no chance of improvement when the family cannot be found or cannot make up their minds since they had no idea what was wanted by the patient. Existing medical literature suggests that those who engage in even minimal discussions about end of life issues ahead of time die with less pain, may actually live longer and families are much happier with the care their loved ones received.

    “Do I think government should be doing that ? Well, no, but that’s a different argument ”

    Government is not doing it. When I have these discussions now, no one from government is there telling me what to do. Under this proposal, the physician and patient will jointly decide on the best course of action for that patient. The only difference is that the patient’s insurer, Medicare, will pay for the consultation.

    Steve

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  3. Eric Florack says:

    And Steve; Medicare will only pay for the consultation… and eventually… mark this well… will only pay for whatever the consultation” dictates.

    And make no mistake, this is already written into Obamacare… specifically, section 1223.

    I point to a Washington Post article, written when all this first came up:

    Still, I was not reassured to read in an Aug. 1 Post article that “Democratic strategists” are “hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors.”

    If Section 1233 is innocuous, why would “strategists” want to tip-toe around the subject?

    Perhaps because, at least as I read it, Section 1233 is not totally innocuous.

    [SNIP]

    Section 1233, however, 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).

    So in reality, there’s no such thing as “death panels’ in Obamacare.. except for the…. ummmm… err… death panels. Nothing in this has changed, except for the worse.

    Well, I know I feel so much better about government and healthcare,don’t you?

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  4. Andy says:

    Steve,

    What is preventing you from doing this now? Isn’t discussion of end-of-life option part of a doctor’s professional and ethical responsibilities?

    Let’s call this measure what it really is – a pay raise for doctors by providing another billable expense for something most doctors do already. This is a perfect example of why the piece-work fee-for-service system needs to go. The incentives that promote cutting up care into ever more billable items is not a sustainable system.

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  5. michael reynolds says:

    Andy:

    I think that’s unfair in this case. If these consultations offer patients the opportunity to limit unwanted or pointless treatment they’ll likely pay for themselves.

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  6. anjin-san says:

    Perhaps we can get some “stupid panels” going, and all the Palin Parrots can be charter members. Bit is first in line.

    As someone who has lost a few relatives in the last few years, I can tell you that end of life planning can make an excruciating situation less painful, especially if you happen to have a loved one in a coma.

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  7. michael reynolds says:

    Eric:

    Would you mind posting a link to that Washington Post article? Because all I’m finding are right wing noise machine references to a column by Charles Lane. Do you have an actual article? Or you honestly unaware of the differences between “article” and “column?”

    Here’s the bio on Charles Lane from the WaPo:

    Charles M. Lane is an editorial writer for The Post, specializing in economic policy, trade, energy and globalization.

    Lane joined The Post in 2000, first as an editorial writer and then as a Supreme Court reporter. He rejoined the editorial board in 2007. He served as editor and senior editor of The New Republic from 1993 to 1999 and was a foreign correspondent for Newsweek from 1987 to 1993. He contributed to the book “Crimes of War: What the Public Should Know,” edited by Roy Gutmann and David Rieff and in 1992 was awarded a Citation for Excellence from the Overseas Press Club.

    Lane is a member of the Council on Foreign Relations.

    Mr. Lane does not appear to be acting as a reporter. Nor does he appear to have any particular background in health matters.

    And even then, his editorial doesn’t say what you seem to think it says.

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  8. Eric Florack says:

    Mr. Lane does not appear to be acting as a reporter. Nor does he appear to have any particular background in health matters.

    That’s OK, since most lawmakers similarly lack that experience. (chuckle)

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  9. Eric Florack says:

    As someone who has lost a few relatives in the last few years, I can tell you that end of life planning can make an excruciating situation less painful, especially if you happen to have a loved one in a coma.

    And government is required for this, right, anjin? (spit)

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  10. Eric Florack says:
  11. anjin-san says:

    > (spit)

    Aww. That’s so clever. Did you think of that all by yourself?

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  12. anjin-san says:

    Oh, and bit? If you take a close look at the linked page you sent, you will see:

    washingtonpost.com > Columns

    Thank you for proving Michael’s point. Very thoughtful of you.

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  13. steve says:

    @Andy- I am one of those expensive hospital based specialists. By the time I have the conversation, the patient is in big trouble. The patient often cannot talk, and the families are crying. What we need is to have the conversation before then. Ideally it will be with the patient’s primary care doc (PCP). The PCP does not have the financial incentives that a hospital doc would have. Currently, a PCP would not get reimbursed for this discussion, which often needs to be a long one. I am not in favor of dictating that a doc must do this and not pay them. FTR, many docs do this stuff anyway, but not enough.

    @Eric-What you posit is a drastic change in physician behavior. I dont know any docs who would suddenly start encouraging people to just die to save money. This is a slippery slope argument that does not fit. What does fit is that we need to cut costs. ALL plans will involve some decreased services somehow. Ryan’s plan does it by not paying for care. Other plans do it by cutting out care that does not work. Just different choices.

    “And government is required for this, right, anjin?”

    As this is a subject near and dear to my heart, I am open to other suggestions. Have any? What we do now does not work well.

    Steve

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  14. Pete says:

    What I can’t reconcile is the apparent acceptance by many civil libertarians and lefties of govt. intrusion into private lives made possible by this legislation. As becomes frighteningly obvious by this gambit, govt. need not pass legislation to worm itself into private lives of individuals. This makes the Patriot Act look tame by comparison. From a couple of righties:

    There is, however, something at least vaguely disturbing about a government incentivizing doctors to do so as part of an expansive regulatory program that has, as one of its primary goals, cost reduction. The process used by Obama and Kathleen Sebelius to get this into ObamaCare is more disturbing, and in a very specific way. Congress made it clear that it didn’t want this incentive as part of the new law. However, thanks to the miles and miles of ambiguity in the final version of ObamaCare, with its repetitive the Secretary shall determine language, Congress has more or less passed a blank check for regulatory growth to Obama and Sebelius.

    The most amazing part of the New York Times story is an email from Representative Earl Blumenauer (D-Oregon) to his accomplices back in early November, when these new regulations were being drafted:

    “While we are very happy with the result, we won’t be shouting it from the rooftops, because we aren’t out of the woods yet. This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth… We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ – emails can too easily be forwarded… Thus far, it seems that no press or blogs have discovered [the new Medicare regulations], 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.”

    In other words, you knuckle-dragging imbecile voters might get all riled up if you knew about their glorious triumph, so the Democrats wanted to keep it on the down-low. They were able to complete the process of putting these regulations together behind closed doors, untroubled by any concerned citizens who might have received an email that accidentally got forwarded outside of the conspiracy.

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  15. steve says:

    “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.”

    You know, I would bet that this A-hole has never sat with a family and talked about end of life decisions. I bet he has never been there at 2:00 AM when you tell the family they have 5 minutes to decide what to do. As to this happening at a meting with one’s PCP, he should feel free to cite examples of docs currently forcing patients and family to sign “plug pulling” orders given that we have numerous organizations like the Mayo Clinic where doing so would save them money. The dishonesty here just stinks.

    Steve

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  16. An Interested Party says:

    Who knew that incentivizing doctors to talk to patients about end-of-life planning was the same thing as the government trying to get doctors to kill people…ohhhhh, such a conspiracy! People like Pete and Eric must be quaking in their boots…

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  17. Pete says:

    IP, I don’t think the govt is trying to get doctors to kill people. I think the govt. is ill-equipped to assume the responsibilities inherent in trying to administer and manage 1/6 of our economy. After all, their record in matters economic doesn’t give me a warm fuzzy feeling.

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  18. anjin-san says:

    > I bet he has never been there at 2:00 AM when you tell the family they have 5 minutes to decide what to do

    I know that when I got the call telling me a relative was in a coma, I was very glad to have an end of life directive to refer to, especially since I would have been the one making decisions otherwise. According to the column bit refers to, only about a third of Americans have EOL directives, so clearly we need to do better as a society, especially when you consider the mind boggling costs associated with much of the care people receive in the last six month to a year of their lives.

    Based on what I have seen, much of our current system exists to bleed people dry financially in their declining days. When my grandfather had his second stroke, he was ressicated in spite of a standing DNR. I damn near threw the doctor out the window. He had 6 more months of painful, near zero quality life, and was very bitter that he had been put in that situation. Those last months cost over 100K, about half of which was an out of pocket expense for my family.

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  19. anjin-san says:

    > After all, their record in matters economic doesn’t give me a warm fuzzy feeling.

    True. The utter failure of the GM bailout pretty much proves that. Oh, wait…

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  20. Pete says:

    So, Anjin, how would this regulation have helped your Grandfather? My doctor is willing to discuss these options with me during routine checkups. I ask and he answers. Both my parents have DNR documentation. My father had a major stroke which left him lying in bed looking like a fish out of water gasping for air. The family had no problem with the DNR order and there was no exorbitant cost to let him lie there for a week before he died.

    Why do we need to incentivize doctors to discuss it? Because people are too stupid or afraid to discuss it on their own?

    If your answer is yes, then you would be in the camp of people who believe they are superior in intellect and therefore responsible to “help” the less fortunate with difficult decisions. Sort of like God, eh?

    I agree the current system stinks. If you believe govt. involvement to a much greater degree than already present is the answer, then I think you are hopelessly naive.

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  21. An Interested Party says:

    “I think the govt. is ill-equipped to assume the responsibilities inherent in trying to administer and manage 1/6 of our economy.”

    Such an silly strawman…a Medicare regulation is hardly the government taking over the entire health care sector of the economy…there are so many real things out there to get outraged about…it seems a bit ridiculous to get outraged over phantoms…by the way, anyone who is upset over the government being involved in the health care sector is going to simmer in impotence, as that ship (not the same thing as the government “taking over” anything) sailed a long time ago…

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  22. Pete says:

    True. The utter failure of the GM bailout pretty much proves that. Oh, wait…

    Anjin, anecdotal evidence is your favorite excuse to admit you might just be wrong. The government has its good points, but they are rarely associated with effective and efficient economic policy. Their economic policies are not designed for long term growth and wealth building, but more for short term corrections to problems they are usually complicit in causing.

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  23. anjin-san says:

    > Anjin, anecdotal evidence is your favorite excuse to admit you might just be wrong.

    As opposed to the no evidence at all that you offer?

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  24. michael reynolds says:

    Pete:

    Their economic policies are not designed for long term growth and wealth building, but more for short term corrections to problems they are usually complicit in causing.

    Actually that describes American business. It was Wall Street that decided to bundle big bunches of bad mortgages together, get their pet bond rating agencies to slap a Grade A Prime Cut label on them, then cleverly bet the ranch on their own bogus instruments and all but destroy the financial system of the western world.

    In case you’re wondering who rescued them and the rest of us from this monumentally short-sighted greed-fest? That would be the government.

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  25. Zelsdorf Ragshaft III says:

    Anjin, if there is a “stupid panel”, you much be a charter member. In good standing. No one is more qualified than you to sit on, no chair that panel.

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  26. Eric Florack says:

    As this is a subject near and dear to my heart, I am open to other suggestions. Have any? What we do now does not work well.

    Doesn’t work well in respect to what? Might I point out that when we’re doing now is tr result of government involvement in the process?

    @Eric-What you posit is a drastic change in physician behavior. I dont know any docs who would suddenly start encouraging people to just die to save money.

    Save who money? Do you mean to MAKE money? After all the government pays them for their involvement in the process, by virtue of 1223.

    What I can’t reconcile is the apparent acceptance by many civil libertarians and lefties of govt. intrusion into private lives made possible by this legislation.

    Rather makes one wonder about their motives, doesn’t it? Hint: Civil liberty isn’t in them.

    Oh, and… Anjin?
    Look at the url. Note the word “articles”

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  27. Eric Florack says:

    It was Wall Street that decided to bundle big bunches of bad mortgages together, get their pet bond rating agencies to slap a Grade A Prime Cut label on them, then cleverly bet the ranch on their own bogus instruments and all but destroy the financial system of the western world.

    But why would they do that?
    Oh, yeah… to allow folks who can’t afford homes of their own because of credit ratings…( A racist system, we’re told) to get loans they couldn’t afford… all accomplished under Clinton, with the help of Barney Frank and company.

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  28. anjin-san says:

    > Look at the url. Note the word “articles”

    Well, if something is in a URL, it is pretty much like a burning bush, right?

    You do know what the function of bread crumbs is on a website, don’t you? If you click on the “columns” in washingtonpost.com > Columns (not hard to find, directly above the title) it will take you to the outlook & opinion section of the Post.

    The “article” you reference, is an opinion piece. If you are too dense to see that, you are clearly hopeless.

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  29. michael reynolds says:

    Eric:

    Oh, yeah, I forgot, it was all the fault of Fanny and Freddie. Which totally explains why exactly the same thing has happened in the UK, Ireland, Spain and so on. Because Barney Frank doesn’t just run this country, he runs the entire planet, forcing bankers to exhibit greed and recklessness in pursuit of gigantic bonuses.

    Right.

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  30. michael reynolds says:

    Eric:

    It was an editorial. A column. Written by a columnist. You’re not even arguing at this point you’re just lying.

    You were suckered by the echo chamber, you didn’t bother to check your source, and now you’re flailing away trying to pretend you weren’t duped. Give up. It was a column, not an article, an opinion piece by a man with no particular expertise in the field. Once again — for the billionth time — you bought the echo.

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  31. anjin-san says:

    > Because Barney Frank doesn’t just run this country, he runs the entire planet,

    The man shoots lighting bolts from his fingertips.

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  32. wr says:

    Fascinating that all the usual crusaders for liberty are screaming about how the lefty government wants to kill us all by mandating Medicare pay for end of life counseling sessions but somehow neglect to notice that the very Republican government of Arizona is actively killing — one might say murdering — its own citizens by revoking payments for organ transplants. But I guess that’s okay, since it’s only poor people who are dying, and their agonizing death just proves the greatness of the free market.

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  33. section9 says:

    Well, no, look kids, it’s about control. I’m surprised that Mataconis hasn’t figured out that Palin was right all along about National Socialist Health Care.

    The people figured it out; which is why Democrats got such a boost from Health Care in November.

    Oh, wait….

    Health Care Reform, like the GM bailout, was a naked power grab by a political protection racket that runs around calling itself the Democratic Party. And the upshot was that there was no real long term solution.

    The money was looted, nay looted, from our kids and our grandkids. The seed money with which we are supposed to compete with the Chinese and the Indians was used to fund this ridiculously complex Rube Goldberg device.

    Conservatives can’t undermine this tribute to the memory of Juan Domingo Peron soon enough.

    I know it kills Mataconis that Palin was right all along, but she was. That’s why she the shrewdest Republican politician around today. The sly little Dems tried to get Death Panels in by the back door.

    I’m surprised the NYT actually reported it.

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  34. Andy says:

    Steve,

    I am one of those expensive hospital based specialists. By the time I have the conversation, the patient is in big trouble. The patient often cannot talk, and the families are crying. What we need is to have the conversation before then. Ideally it will be with the patient’s primary care doc (PCP). The PCP does not have the financial incentives that a hospital doc would have. Currently, a PCP would not get reimbursed for this discussion, which often needs to be a long one. I am not in favor of dictating that a doc must do this and not pay them. FTR, many docs do this stuff anyway, but not enough.

    That is exactly the problem I’m talking about. The current compensation system fails to align a doctor’s ethical responsibilities with financial incentives.

    Why do doctor’s need separate compensation schemes for different types of consultations? If we’re stuck with fee-for-service there should at least be a flat hourly fee for a doctor’s time and expertise similar to what lawyers have. A system which rewards certain types of consultations above others is not a system worth defending.

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  35. tom p says:

    >”but somehow neglect to notice that the very Republican government of Arizona is actively killing — one might say murdering — its own citizens by revoking payments for organ transplants.”

    nuff said…

    >”But I guess that’s okay, since it’s only poor people who are dying, and their agonizing death just proves the greatness of the free market.”

    wr, I feel the need to add that the only reason these people are so poor and desperate is because their illnesses caused them to lose their jobs, where upon they lost their health insurance, whereupon they lost all their savings paying for the care to keep them alive until they could receive a transplant, whereupon when that wasn’t enuf they sold everything they owned (including their homes) in the hopes of staying alive long enuf to get one, BUT….

    The state of AZ has decided via their infinitely wise “death panels” that you are not worth saving.

    It is the perfect Galtian enterprise: First we take all their money, property, (got any dreams? We want them too)… Then we let them die. God I wish I were a Republican, than I could gloat too.

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  36. Zelsdorf Ragshaft III says:

    Why don’t some of you brilliant lefies wonder on over the Patterico’s. I understand he is a real lawyer practicing law in a big city. He has a little different take on this issue than Mataconis or the rest of you for that matter. Something about end of life counseling on some issues are a legal matter not a medical one but then who cares. I hope any medical aid is denied each of you.

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  37. Zelsdorf Ragshaft III says:

    Anjin, you talk about the GM bailout like it did something. It did if you belonged to the union which should have taken a hit like investors did, but your buddy Obama bought off the unions with taxpayer dollars. I am pretty sure Obama operated outside the authority of his office. I can only hope he is held accountable for this and his union goon buddies get to spend time in some maximum security facility getting to know LeRoy.

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  38. An Interested Party says:

    “The money was looted, nay looted, from our kids and our grandkids.”

    Money has long been looted from future generations since Reagan was president, but it only seems to have become a problem for some people when the fella with the funny name with a D behind it became president…fancy that…

    “I hope any medical aid is denied each of you.”

    And to think that just yesterday you were wishing peace upon others…have you found a job yet? Or are you still feeding at the government trough? I guess sitting around waiting for a check gives you plenty of time to hurl repulsive comments like the one above at others…

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  39. Terrye says:

    I think Obamacare is a disaster…but I also think that Medicare is going to be making some new rules with or without it.

    Medicare is the government, tax payers pick up the bill. And the truth is that they often times say no. That is why people pay so much for additional insurance.

    A lot of these things are already being done, in and outside of the Medicare system and as the population continues to age and the costs continue to mount, I think it is inevitable that more attempts will be made to deal with these sorts of costs.

    I don’t much like government intrusion, but I think some of the reaction to this is a tad paranoid.

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  40. Terrye says:

    “Something about end of life counseling on some issues are a legal matter not a medical one but then who cares. I hope any medical aid is denied each of you.”

    Zelsdorf, no, it is not just a legal matter, it is about end of life, that is it is about your medical condition and I would rather discuss those options with a doctor, than with some lawyer. I doubt very much if conservatives would like it a lot better if the government mandated that you go talk to some lawyer. The truth is Medicare is controlled by the government right now and decisions like this are made every day anyway. People just choose to ignore it until or unless it effects them personally.

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  41. Eric Florack says:

    Oh, yeah, I forgot, it was all the fault of Fanny and Freddie. Which totally explains why exactly the same thing has happened in the UK, Ireland, Spain and so on.

    Do you really suppose our economies operate so independently?

    You were suckered by the echo chamber, you didn’t bother to check your source,

    and you have proof that what was said was wrong? Let’s see it

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  42. Stan says:

    In response to Zels, under the terms of the auto bailout the auto workers had to agree to a two-tier wage and benefits structure in which new hires come in with lower pay and fewer benefits. If this isn’t a sacrifice, what is? It’s another example of the death of the American dream.

    Regarding another kind of death, namely death panels, wr points out above that an Arizona commission decided on the basis of scanty and unreliable evidence that a number of transplant operations weren’t effective and would no longer be covered by Medicaid. As a result, over a hundred people will die in the next year or so unless Arizona decides to again cover transplants or private charities pick up the cost of the operations. This is a real instance of a death panel at work, and I haven’t heard one peep from Sarah Palin, John Boehner, or Charles Grassley, the three main purveyors of the death panel myth. I also haven’t heard much from network news about Arizona’s decision. I’ve had a lot of difficulty deciding whether Zelsdorf Ragshaft III and Eric Florack are real people. If they are, I think they owe us a comment about the Arizona death panels.

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  43. john personna says:

    Do you really suppose our economies operate so independently?

    The key is that real estate prices bubbled and popped around the world, even in those countries which did not get funding from Freddy and Fanny, even in countries which did not have Community Reinvestment Acts.

    It would be pretty spooky to believe Norwegian houses went to a million bucks because some bank in Detroit was forced to lend to minorities.

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  44. michael reynolds says:

    Eric:

    The editorial doesn’t say anything, Eric. It offers a vague opinion based on nothing, offering no proof, just a sort of inchoate sense of unease. There was nothing advanced that is capable of proof or disproof.

    I really don’t mean to offend you, but you’re just not generally worth the effort. You’re not entertainingly nutty, just hopelessly obtuse.

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  45. anjin-san says:

    > Do you really suppose our economies operate so independently?

    Is this really your idea of a deep though? Here how about this one?

    Do you really suppose our economies operate so interdependently?

    Hmm. Now, buy your own standards, I have shattered your “argument”, such as it is…

    The sad thing is that you seem to think these little quips you throw out equate to devastating counterpunching. You really ought to expand your intellectual circle beyond DavidL and “The American Thinker”.

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  46. anjin-san says:

    > and you have proof that what was said was wrong? Let’s see it

    Ah, that’s your standard?

    You have proof Obama is a non-citizen, communist, jihadist, Muslim – Let’s see it.

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  47. Enlightek says:

    Every time Congress passes a law and it is signed by the President, the next step is to send it to the appropriate federal agency, which is responsible for writing the regulations. Without regulations, the law could not be implemented. This is not a new process. It has been this way all along.

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  48. steve says:

    “Might I point out that when we’re doing now is tr result of government involvement in the process?”

    Nope. The government has nothing to do with end of life decision making right now. There are no govt regulations telling what to say or not say.

    “Save who money? Do you mean to MAKE money? ”

    Nope, make money. The current system encourages making money. If physicians talk with patients about the issue, studies have shown that people generally ask for less ineffective care and are more functional for a longer period of time.

    “What I can’t reconcile is the apparent acceptance by many civil libertarians and lefties of govt. intrusion into private lives made possible by this legislation.”

    This same level of intrusion happens about 1/3 of the time. Many docs go ahead and discuss the issues with patients, even though there will be no reimbursement. For many patients it is a pretty easy conversation. For others, it is likely to be a bit long and complicated. I fail to see how just asking people if they want to talk about end of life issues is an intrusion. Patients can say no.

    Steve

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  49. jwest says:

    This article and the comments that follow illustrate how the subject of government health care separate people into two distinct camps – those who understand what is happening and those who don’t. Doug and his liberal brethren fall decidedly into the latter category.

    Mired in minutia, liberals fail to acknowledge the primacy of purpose in any government health care system, which Sarah Palin brilliantly distilled into the phrase “Death Panels”. They are the essential ingredient by which all other portions of a government system flow. Although stark in brevity and clarity, the term Death Panel brings the entire reason for government control of health care into light.

    As an example, consider the case of an 82 year old male Medicaid recipient with two previous open heart procedures. Tests indicate that due to chronic alcoholism, a liver transplant is necessary. The transplant with follow-up care will cost an estimated $380,000 if no other complications arise, and will extend the life of the individual approximately 18 months. Is this a good expenditure of the taxpayer’s money? Should the man receive the operation, or should that money be spent on better pre-natal care and immunizations?

    Congratulations. You’ve just participated in a Death Panel.

    There is no argument that mild forms of Death Panels exist today (in one guise or another)and that all the government’s problems, from entitlement spending on Medicare and Medicaid, Social Security and by extension the deficit and national debt, could be solved if the government had sole control over where the lines of treatment are drawn. However, liberals refuse to accept the reality of the subject and openly discuss the ramifications of such a system.

    Until the left develops the capacity to understand what the fundamental issues are, it’s impossible to have an intelligent discussion on the subject.

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  50. An Interested Party says:

    It would be most helpful if you could provide evidence of a real “death panel” rather than the hypothetical example you gave above…otherwise, you are simply trafficking in the same lies as your heroine from Wasilla…

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  51. Stan says:

    An Interested Party didn’t ask me for an example of a death panel, but I’ll give one anyway. Recently the state of Arizona decided that certain forms of organ transplants aren’t effective enough for them to be paid for by the state’s Medicaid program. There have been allegations that the Arizona panel that made this decision didn’t consider all the evidence, and was overhasty in its decision. I haven’t seen enough in the press about this issue to know whether the panel was correct or not about the effectiveness of the operations. But there’s no doubt that roughly 100 Arizona residents who were slated to have such operations will have to soldier on as best they can until their malfunctioning organs fail, and that many if not all of these people will die as a result. So I think it’s fair to say that the group of people who decided their fate can be described as a death panel. The same description can be given to the Arizona legislators who eliminated support for the transplants in the state’s Medicaid program. And the governor of Arizona, Jan Brewer, who signed the bill the legislature passed, deserves mention as a one-woman death panel.

    A number of Republican politicians, Sarah Palin in particular, had a lot to say about death panels when the health reform bill was under consideration. They haven’t said a word about Arizona’s form of triage, and neither has most of our nation’s press. And neither has this blog.

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  52. An Interested Party says:

    “A number of Republican politicians, Sarah Palin in particular, had a lot to say about death panels when the health reform bill was under consideration. They haven’t said a word about Arizona’s form of triage, and neither has most of our nation’s press. And neither has this blog.”

    How utterly shocking! Of course, since the president has nothing to do with this, what good would it do to talk about these death panels? I mean, that certainly wouldn’t help people like Palin push their agendas at all…

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  53. [...] the inevitable hyperbolic reaction to last weeks report that new Medicare regulations would include provisions to fund end-of-life counseling, the Obama [...]

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  54. [...] Denounced As “Death Panels,” Funding For End Of Life Counseling Makes A Comeback (outsidethebeltway.com) [...]

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