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The President, Medicare, and Planning for Dying

An unemotional evaluation of Medicare’s new “end-of-life” planning

Curtis Coleman, The New South Conservative: During the 2009-2010 national debate on Obamacare, one of the most controversial and emotionally debated components of the bill’s massive leap toward socialized medicine was the now infamous Section 1233, which included plans and compensation to physicians for “end-of-life” counseling. The proposal touched off a political firestorm over “death panels,” so Democrats dropped it from healthcare deformation legislation. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

According to Robert Pear of The New York Times, “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.”

What About “End of Life” Planning?

When conducted for the benefit of the patient first (and secondarily for the patient’s family), “end-of-life” counseling and planning is a valuable tool for patients, their families and their physicians.

According to the Family Caregiver Alliance, “The one area that most of us avoid planning is the end of our life. Yet, if we don’t plan, if we don’t at least think about it and share our ideas with those we love, others take over at the very time when we are most vulnerable, most in need of understanding and comfort, and most longing for dignity.

“Big issues confront us when we think about our own death or that of someone we love. Our attitudes and beliefs about religion, pain, suffering, loss of consciousness, and leaving behind those we love come into play. We can let things unfold as they may, and for some of us that’s exactly right. For others of us, it is good to plan.”

End of life planning can include such valuable documents as a living will, a legal document that a person can use to make known his or her wishes regarding life-prolonging medical treatments. It can also be referred to as an advance directive, health care directive, or a physician’s directive.

Although laws vary from state to state, generally a living will describes certain life-prolonging treatments. The document can be used to indicate which treatments you do or do not want applied to you in the event you either suffer from a terminal illness or are in a permanent vegetative state. A living will does not become effective unless you are incapacitated; until then you’ll be able to say what treatments you do or don’t want. They usually require a certification by your doctor and another doctor that you are either suffering from a terminal illness or permanently unconscious before they become effective as well. This means that if you suffer a heart attack, for example, but otherwise do not have any terminal illness and are not permanently unconscious, a living will does not have any effect. You would still be resuscitated, even if you had a living will indicating that you don’t want life prolonging procedures. A living will is only used when your ultimate recovery is hopeless.

End-of-life planning can also include a health care power of attorney or health care proxy. This document becomes valuable to your family and your health care providers when your health is not so dire that your living will becomes effective. A health care power of attorney is a legal document that gives someone else the authority to make health care decisions for you in the event you are incapacitated. The person you designate to make health care decisions on your behalf is supposed to consider what you would want, so be sure to talk with them about it. It may be a difficult conversation, but you’re asking someone to take on a great burden for you – letting him or her know what you want lessens that burden.

It is entirely appropriate and important for one’s physician to be involved in this planning process, and it is equally appropriate for Medicare to reimburse your physician for his or her participation in the planning process – if that is the limit of Medicare’s involvement.

So why the emotionally charged debate?

Are Conservatives Just Fear-mongering?

Are conservatives just fear-mongering (like the liberals and progressives in the recent mid-term elections when conservatives advocated eliminating the IRS and its tangled, mangled tax codes in favor of the Fair Tax, or when conservatives had the courage to talk about the obvious and unavoidable adjustments required for Social Security to continue to be viable)? Are conservatives doing “a despicable thing” by playing on the fragile emotions of seniors who are facing difficult discussions and decisions – and possibly fears – about the end of life?

Or is there a legitimate concern of which Americans must be aware? The answer is an unequivocal “yes!”

[Read full article]

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Curtis Coleman is the President of The Curtis Coleman Institute for Constitutional Policy and former conservative Republican candidate for US Senate.


Tags: Curtis Coleman, Health Care, Affordable Care Act, Obamacare, Death Panels, End of Life Care

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December 30, 2010 - Posted by | Health Care

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