White House Changes End-of-Life Medicare Rules
WASHINGTON - Reversing a potentially controversial decision, the Obama administration will drop references to end-of-life counseling from the ground rules for Medicare's new annual checkup, a White House official said Wednesday.
The latest shift on the sensitive subject comes ahead of a vote next week in the new GOP-led House to repeal President Barack Obama's landmark health care overhaul.
The decision is not likely to have much impact on patients and doctors already discussing options for care in the last stages of life. For example, voluntary end-of-life planning is already covered as part of the "Welcome to Medicare" doctor visit, available to seniors within the first year of joining the program.
The original House version of the overhaul legislation sought to expand coverage, allowing for discussions every few years. But the plan was dropped after Sarah Palin and other Republicans raised the specter of "death panels" deciding the fate of vulnerable seniors. Those charges were later debunked by several non-partisan fact-checking groups.
End-of-life counseling unexpectedly surfaced again late last year in a Medicare regulation that spelled out what would be covered in a new annual checkup, or wellness visit, authorized by the health care law. The regulation said such voluntary doctor-patient discussions could be part of the annual visit.
The White House official said the administration is now pulling back the language because there wasn't enough chance for all sides to comment on the change. The official spoke on condition of anonymity to discuss what has turned into an embarrassing episode for the administration.
End-of-life planning is already an accepted part of care for people facing terminal illness, and the administration's reversal is unlikely to have much impact on that. Longstanding federal rules require hospital patients to be informed of their right to spell out in a living will or similar document their wishes about being kept alive by machinery if there's no hope for a cure.
However, many doctors and public health advocates believe the government should take a more direct role in encouraging people to plan ahead. They say it would save families the ordeal of having to make agonizing decisions when a loved one is incapacitated.
Opponents counter that such decisions are highly personal, and government should stay out. They worry that explicitly including end-of-life counseling in Medicare rules could send an indirect message that people facing serious illness should be nudged toward hospice care, giving up on seeking a cure.
The new regulation was first reported by The New York Times.
AP The latest shift on the sensitive subject comes ahead of a vote next week in the new GOP-led House to repeal President Barack Obama's landmark health care overhaul.
The decision is not likely to have much impact on patients and doctors already discussing options for care in the last stages of life. For example, voluntary end-of-life planning is already covered as part of the "Welcome to Medicare" doctor visit, available to seniors within the first year of joining the program.
The original House version of the overhaul legislation sought to expand coverage, allowing for discussions every few years. But the plan was dropped after Sarah Palin and other Republicans raised the specter of "death panels" deciding the fate of vulnerable seniors. Those charges were later debunked by several non-partisan fact-checking groups.
End-of-life counseling unexpectedly surfaced again late last year in a Medicare regulation that spelled out what would be covered in a new annual checkup, or wellness visit, authorized by the health care law. The regulation said such voluntary doctor-patient discussions could be part of the annual visit.
The White House official said the administration is now pulling back the language because there wasn't enough chance for all sides to comment on the change. The official spoke on condition of anonymity to discuss what has turned into an embarrassing episode for the administration.
End-of-life planning is already an accepted part of care for people facing terminal illness, and the administration's reversal is unlikely to have much impact on that. Longstanding federal rules require hospital patients to be informed of their right to spell out in a living will or similar document their wishes about being kept alive by machinery if there's no hope for a cure.
However, many doctors and public health advocates believe the government should take a more direct role in encouraging people to plan ahead. They say it would save families the ordeal of having to make agonizing decisions when a loved one is incapacitated.
Opponents counter that such decisions are highly personal, and government should stay out. They worry that explicitly including end-of-life counseling in Medicare rules could send an indirect message that people facing serious illness should be nudged toward hospice care, giving up on seeking a cure.
The new regulation was first reported by The New York Times.
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This is a link to an article that supports Dr Emanuel's ideas, and says my above post is out of context.
What is ignored is that as all universal health care systems in the world currently do, rationing is inevitable. And under rationing, government bureaucrats will be making bioethics decisions that should be made between families and their doctors. While they try to say that Emanuel's complete lives system takes into account the disabled or handicapped, read carefully. With limited resources, the government will choose to treat a basically healthy teenager and withhold treatment from a handicapped individual of similar age, and ahead of a toddler or infant on whom the government has invested less $$ on education and are further away from being productive (read taxpaying) members of society. Bioethics is a very complex issue, but Mr Emanuel and I start from very different places.
One of President Obama's most proclaimed goals has always been healthcare "reform" and the reduction of costs and the spending of America's treasure on healthcare. That certainly implies that money - tax dollars or deficit dollars - will essentially be a medical resource. This could very easily create a manufactured scenario that could produce the kind of scarcity that would automatically invoke Dr. Emanuel's bio-ethical philosophies. Dr Emanuel, Special Advisor to the Director of the White House Office of Management and Budget for health policy and would undoubtedly be consulted on forced reductions in spending on healthcare.
It is all terribly frightening and not for the faint of heart. There are just too many ways that Dr. Emanuel's own personal type of eugenics; this evil form of rationing could be law very soon into the future.
The Complete Lives System In Dr. Ezekiel Emanuel's Own Word
Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an
alternative: the complete lives system. This system incorporates five principles (table 2): youngest-first, prognosis, save the most lives, lottery, and instrumental value. As such, it prioritizes younger people who have not yet lived a complete life and will be unlikely to do so without aid. Many thinkers have accepted complete lives as the appropriate focus of distributive justice: "individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate."1,75,76 Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system. Consideration of the importance of complete lives also supports modifying the youngest-first principle by prioritizing adolescents and young adults over infants (figure). Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfillment requires a complete life.77 As the legal philosopher Ronald Dworkin argues, "It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies and worse still when
an adolescent does";78 this argument is supported by empirical surveys.41,79 Importantly, the prioritization of adolescents and young adults considers the social and personal investment that people are morally entitled to have received at a particular age, rather than accepting the results of an unjust status quo. Consequently, poor adolescents should be treated the same as wealthy ones, even though they may have received less investment owing to social injustice.
The complete lives system also considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern that disproportionately large amounts of resources will be directed to young people with poor prognoses.42 When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable.1,30 Some small benefits, such as a few weeks of life, might also be intrinsically insignificant when compared with large benefits.8
Saving the most lives is also included in this system because enabling more people to live complete lives is better than enabling fewer.8,44 In a public health emergency, instrumental value could also be included to enable more
people to live complete lives. Lotteries could be used when making choices between roughly equal recipients, and also potentially to ensure that no individual-irrespective of age or prognosis-is seen as beyond saving.34,80 Thus, the
complete lives system is complete in another way: it incorporates each morally relevant simple principle. When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated (figure).78 It therefore superficially resembles the proposal made by DALY advocates; however, the complete lives system justifies preference to younger people because of priority to the worst-off rather than instrumental value. Additionally, the complete lives system assumes that, although life-years are equally valuable to all, justice requires the fair distribution of them. Conversely, DALY allocation treats life-years given to elderly or disabled people as objectively less valuable. This is the guy Obama has hired to determine priorities in our health care system.
jade84116, so you think trying to compete in the Global Economy with an Medical System like we had is going to work? Let me guess... YOU think Trickle Down Economics works too. Look man when you are DEAD LAST, on the BOTTOM, when you are paying TWICE what everyone else is paying you ACT.. IF and that is a MAJOR IF, the Republican's intend to do what they promised for THREE DECADES, let them put it on the table... let the American People compare the two and let's move on! This is just PLAIN Stupid...especially when we are faced with fixing THREE DECADES of Failed Policy...
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How is Globalization and the US medical system related, Sknk?
What possible relationship do they have?
chevyhotrod, This ISN'T rocket Science you poor uneducated human. The LAW is passed.. it's LAW. If you have provisions you wish to change you make that a piece of LEGISLATION, go to the other people there have them sign on to it. IF you can't get their help or you have NO IDEAS what so ever, drop it and move on! Conducting senseless Votes at a time when we are just beginning to pull out of the Worst Recession in modern history is just FLAT OUT STUPID!!
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Skyk, do you EVER get tired of telling folks how dumb, stupid, moronic, uneducated, and wrong they all are?
And do you know how dumb, stupid, moronic, uneducated, and wrong your posts make you look. For instance, the one above - You think that Congressmen can just take the healthplan around and have a change made here and there, perhaps initialed? and that is all it takes to change a piece of legislation? You have never held office in anything, have you, not even Micky Mouse Club. It is chaotic enought in Congress as it is, without every Congressman who doesn't like a part of a legislation running around with his/her own copy of a legislation wanting to point to every other Congressman the little individual "fix" they want.
I'd certainly NOT want to go to a doctor that didn't ask me if I wished to discuss the fact that I'm dying every year... it IS a reality that some have a hard time talking about.
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SkyK - See if I understand this correctly - You would like your doctor to discuss with you the fact that you are dying every year...I don't think many people are like you. I think most of us would rather discuss with our doctors that we'd like to stay alive for the next few years - in other words - How can I keep going? instead of How much longer do I have?
You sure see things in a different light? But, hey, to each his own....
It is all about using the correct buzzwords with those people.
You know nothing about Tri Care or the government employees insurance. It is no different then any civilian employers insurance. Those plans are all run by insurance companies and paid for by the government, just like any private employer. The government does not run those plans.