So now the narrative has changed again, and Sarah Palin is being accused of being hypocritical on “death panels.” The problem is she’s not only not hypocritical, but yet again the media is slinging pitchforks and torches at “the stupid one” to discredit her. Here’s the rub: it isn’t working.
Here’s what she had to say on her Facebook account about her “death panels.”
Our senior citizens are right to be wary of this health care bill. Medical care at the end of life accounts for 80 percent of all health care. When care is rationed, that is naturally where the cuts will be felt first. The “end-of-life” consultations authorized in Section 1233 of HR 3200 were an obvious and heavy handed attempt at pressuring people to reduce the financial burden on the system by minimizing their own care. Worst still, it actually provided a financial incentive to doctors to initiate these consultations. People are right to point out that such a provision doesn’t sound “purely voluntary.”
In an article I noted yesterday, Charles Lane wrote:
“Ideally, the delicate decisions about how to manage life’s end would be made in a setting that is neutral in both appearance and fact. Yes, it’s good to have a doctor’s perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party — the government — recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don’t have to be a right-wing wacko to question that approach.” [5]
I agree. Last year, I issued a proclamation for “Healthcare Decisions Day.” [6] The proclamation sought to increase the public’s knowledge about creating living wills and establishing powers of attorney. There was no incentive to choose one option over another. There was certainly no financial incentive for physicians to push anything. In fact, the proclamation explicitly called on medical professionals and lawyers “to volunteer their time and efforts” to provide information to the public.
Comparing the “Healthcare Decisions Day” proclamation to Section 1233 of HR 3200 is ridiculous. The two are like apples and oranges. The attempt to link the two shows how desperate the proponents of nationalized health care are to shift the debate away from the disturbing details of their bill.
Here’s a bit more of Lane’s piece.
Until now, federal law has encouraged end-of-life planning — gently. In 1990, Congress required health-care institutions (not individual doctors) to give new patients written notice of their rights to make living wills, advance directives and the like — but also required them to treat patients regardless of whether they have such documents.
The 1997 ban on assisted-suicide support specifically allowed doctors to honor advance directives. And last year, Congress told doctors to offer a brief chat on end-of-life documents to consenting patients during their initial “Welcome to Medicare” physical exam. That mandate took effect this year.
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).
Admittedly, this script is vague and possibly unenforceable. What are “key questions”? Who belongs on “a list” of helpful “resources”? The Roman Catholic Church? Jack Kevorkian?
Ideally, the delicate decisions about how to manage life’s end would be made in a setting that is neutral in both appearance and fact. Yes, it’s good to have a doctor’s perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party — the government — recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don’t have to be a right-wing wacko to question that approach.
There’s an obvious and apparent difference between a proclamation on responsible end of life planning and a government mandated sit down every few years (then later every year) at a doctor’s office. That is, if you want to see it. Of course, if you’re just out to discredit your opponents, the differences utterly disappear.