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12/27/2010
Wrong to malign ‘death panels’

Well ok, death panels, whatever they might be, are probably horrific. Whatever they might be. However, doctors advising older patients on end-of-life care does not constitute a death panel.

The New York Times reported yesterday that Medicare will issue new regulations that will pay for “’voluntary advance care planning’ to discuss end-of-life treatment as part of [one’s] annual visit.”

Important stuff. Probably cost-saving stuff. Wise. Critical for families and their parents and other loved ones to consider. Have you completed your living will? Have you encouraged your parents to complete their living wills?

It’s not an easy or straightforward process. (Mayo Clinic’s advice is helpful. So is the more expansive – but still in layman’s language – help from the American Bar Association) I've done it for myself and my husband - and for my dad. The conversations and decisions were tough. Make it a New Year’s resolution to get it done (or updated) for your parents – and then for yourself.

Ed Morrissey over at Hot Air acknowledges the import of advance directives – but points out his real concerns.

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.

Conservatives are wrong to oppose the measure. First of all, voluntary end-of-life counseling, funded by Medicare will absolutely reduce costs. In this instance, I wholly support the controversial administrator of the Centers for Medicare and Medicaid Services, Dr. Donald Berwick, in his quest for better, wiser end-of-life care.(From the NY Times article...)

“Using unwanted procedures in terminal illness is a form of assault,” Dr. Berwick has said. “In economic terms, it is waste. Several techniques, including advance directives and involvement of patients and families in decision-making, have been shown to reduce inappropriate care at the end of life, leading to both lower cost and more humane care.”

At the same time, Morrissey is right – we must absolutely be vigilant over the “blank check for regulatory growth” written out to President Obama and HHS Secretary Sebelius.

Conservatives, beware and be informed – ‘death panels’ aren’t all they’re cracked up to be.

Jo Egelhoff, FoxPolitics.net

COMMENTS

I agree, and to oppose assisted suicide is actually very cruel. I have seen elderly family members who were totally out of it being forced to endure months of painful or drug-induced stupor because the law say we cannot allow them an easier way out.

Jack Lohman (Mon Dec 27 07:57:50 2010)

I hope someone, then, can tell me where to draw the line? Who will play God? That is the concern of many religions and citizens. Perhaps impossible!

John Hyland (Mon Dec 27 08:32:13 2010)

John, the line should be drawn by the person themselves, if they are still able. It's called personal choice, and to hell with the outsider views.

Jack Lohman (Mon Dec 27 08:43:35 2010)

The government isn't regulating anything here. This is simply allowing Medicare to pay for already available end-of-life planning should a person elect to do it.

The fact that Medicare pays for heart surgery doesn't mean the government is forcing everyone to have a bypass. Honestly, take off the tinfoil hats.

pjmad (Mon Dec 27 11:13:33 2010)

Yes I do think people should have written end-of-life information. No, I do not think government should have one thing to do with it!

Government is intrusive and ALWAYS pushes forward. If you allow them to they'll take over every phase of our lives even more than they already have!

Jo, I have to say, I'm rather surprised at your easy stance on this. You took care of your family but now you want the government to force everyone else to do what you did? Using the government's past and projecting into the future, what penalty will government use against those who do not observe its directive to have end-of-life planning? IRS came immediately to mind. Where does it end?

And Jack, if your relative is unable to give you any kind of information about their wishes (perhaps after a car accident in which they were badly injured and still young) will you simply have them killed?

First, no one should be forced to make that decision for another person.

Second, those who insist on the right to do so, may have an ulterior motive, such as an inheritance.

As to Dr. Donald Berwick, I've found a few interesting things about him.

The Boston Globe:

“I am romantic about the National Health Service,’’ Berwick told a British audience in 2008. “I love it.’’ He not only loves the National Health Service, he extols it as “an example for the whole world — an example . . . that the United States needs now.’’

...But if Berwick’s credentials cannot be doubted, neither can his ideological commitment to centralized state power over health care, or his disdain for the ability of markets and competition to improve the quality and lower the cost of medical services.

He has publicly saluted Britain’s socialized National Health Service for rejecting the “immoral’’ American system and “the darkness of private enterprise.’’ He declares that “the Holy Grail of universal coverage’’ cannot be achieved with consumer-centered health care, but only through “collective action overriding some individual self-interest.’’

And he embraces government health care rationing. “The decision is not whether or not we will ration care,’’ he said in a 2009 interview, “the decision is whether we will ration with our eyes open.’’

A quote from Berwick's book as cited by Dr. Hal Scherz:

There is no ambiguity about how Berwick feels about the sanctity of the doctor patient relationship. In his book "New Rules" he writes: "Today, this isolated relationship (between doctor and patient) is no longer tenable or possible... Traditional medical ethics, based on the doctor- patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority... Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized decision making."

Quotes by Dr. Berwick captured on YouTube:

"I cannot believe that the individual healthcare consumer can enforce through choice the proper configurations of a system as massive and complex as healthcare. That is for leaders to do."

"Please don't put your faith in market forces. It's a popular idea: that Adam Smith's invisible hand would do a better job of designing care than leaders with plans can."

"The U.K. has people in charge of its health care- people with the clear duty and much of the authority to take on the challenge of changing the system as a whole. The U.S. does not"

IMO, Dr. Berwick is an arrogant elitist who thinks he knows better than anyone else what people need or want in their lifetimes.

He admits, or should I say, proudly says, he believes in redistribution of wealth and believes socialized medicine will do the trick (paraphrased).

Dr. Hal Scherz, a pediatric urological surgeon at Georgia Urology and Children's Healthcare of Atlanta, serves on the faculty of Emory University Medical School and is president and cofounder of Docs4PatientCare in an article, says this:

Dr. Berwick's appointment was a final episode in the story of tawdry, backroom dealing and the-people- be- damned politics that rammed Obamacare through Congress and on Election Day cost so many members of Congress their jobs. Dr Berwick's role in this episode and the disdain he has shown for the prerogatives of the US Senate speak to the same problem his views on health care show - an avarice for personal power that is deeply at odds with a system of government that places that power in the hands of elected representatives and ultimately in the people themselves.

Dr. Scherz also said that by all accounts Dr. Berwick is good at his specialty, pediatric medicine.

C. R. Stevenson (Mon Dec 27 11:52:42 2010)

Nice post Jo.

CR;
>>>IMO, Dr. Berwick is an arrogant elitist who thinks he knows better than anyone else what people need or want in their lifetimes.<<<
But of couse, you know better than he does.

Dean Weichmann (Mon Dec 27 13:04:48 2010)

C.R., please give me at least some credit for having heart. Under ALL cases I'd listen to the expert physicians (and probably more so, the nurses). If all odds are against recovery I'd make the best decision I could muster. But it would NOT be a selfish one. It would be my decision and not my pastor's.

You have a real hate for government, which for the most part are people also trying to do the right thing. Except for the politicians that have cash on the line and their corporate buddies that have profit as their motive. Who if left to them would keep your loved one alive as long as the cash kept coming in. Good luck.

Jack Lohman (Mon Dec 27 14:45:30 2010)

I think we need to have a serious discussion in this country regarding end of life care. Should we spend large amounts of money to prolong someones life by 2-3 weeks, when there is no hope? With limited medical resources, we cannot pay for everything. Here is a good article regarding end of life care, that everyone should read.

John P (Mon Dec 27 14:50:28 2010)

C.R., the government is not forcing anyone to do anything. The government, as I understand the upcoming reg, is allowing, again, not forcing, Medicare to pay for end-of-life consulting with one's doctor. And everyone should consider doing end-of-life planning and attempt to finalize advance directives. It's not an easy process - but many who have been through terminal illness with loved ones know it's a much more difficult process when advance directives are not in place.

Jo (Mon Dec 27 14:54:54 2010)

I am a conservative, but I have no issue with this. I think that we need to have as a country end of life discussions with people. My wife is an Internal Medicine physician, and she is surprised by how many people have never given end of life care directives any thought or if they have thought about it, they never tell anyone their wishes, or they want to have every life prolonging procedure done, no matter what state they are in. In a previous post I linked to an article in the New Yorker regarding end of life and hospice.

John P (Mon Dec 27 15:58:53 2010)

You're correct, Jack. I do have a hate on for government because normal, so far as most can ascertain, people go into it promising to ease restrictions on our lives and within a short period of time most are of the opinion they know better than anyone else what is best for the country and each individual in it.

Berwick will not change his spots as leopards never do without an epiphany. Nothing I've read tells me that has occurred.

Please read my post even though it is lengthy. I am not against end-of-life counseling! I simply don't want government to have anything to do with it because government does not know how to stop itself once it gets going. First it will have recommendations available and then it will have mandatory "recommendations"!!

C. R. Stevenson (Tue Dec 28 10:16:24 2010)

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