Any thoughts on the new 23 trillion cost of free healthcare?

[letsrock]

Doesnt look like they will have the votes.

[letsrock]

Guess they will find something new to tax us to death on.

[Angel]

Posted by a Canadian at Democratic Underground



Would any of our Hoser friends like to add anything to his comments?

He pretty much covered it all there, FORD. The misconceptions regarding our health plan down there blow our minds! All I can say is - if I was in the States, I'd be dead.

I have a "pre-existing condition" (pacemaker). Nobody would give me insurance down there, and if they did, the premiums would probably be at least $1000/mo.

I choose which doctor I go to. Yeah, I might have to wait a long time for that knee or hip surgery, but I get my new pacemaker when I need it, and I've known numerous people who have gone to emergency for something, and had their surgery within the next 3 days.

A HUGE difference is that we practice preventive medicine, because we don't have to worry about paying for doctors/lab fees, etc. Many cancers are caught in the early stage, when they are still treatable... and your government spends a hell of a lot more on health care per capita than ours does.

[FORD]

Hey, look how long Eddie Van Halen had to wait for hip surgery, and he's a rich guy in the US!

[ELVIS]

Yeah...

Obama's leadership in healthcare reform, although he admittedly has not read the bill...

[ZahZoo]

Was on a road trip last weekend and listened to quite a bit of talk radio to kill the boredom. There was some woman on an NPR program discussing one of the Medicare/Medicaid modification provisions.

It's on page 425 of the house bill... it provides guidelines for mandatory counseling for the "elderly" with their physicians, family, attornies, etc... regarding End of Life provisions and stipulations for life threatening medical conditions.

The bill covers most of the standard stuff regarding patient wishes for a living will, do not resucitate instructions and common treatment provisions and discussion of options for extended care, rest homes, home hospice, assisted living, etc...

The main focus of the discussion was inclusions in the bill to include mandatory counseling with considerations leaning towards self induced euthanasia when a life threatening illness or disease is diagnosed. Methods of nutrition or hydration reductions to facilitate death at a more rapid rate than what would naturally occur.

Interesting subject matter... the NPR person was focusing only on if the mandatory counseling would be primarily focused on pressuring the elderly to chose taking them sleves out rather than expensive medical interventions for life threatening illnesses.

I personally don't have a problem with counseling and presenting all possible options. Having dealt with elder care the last several years it's a tough arena... especially difficult when the older person hasn't given consideration to their wishes before their mental capacity has deteriorated beyond being able to effectively participate in the decision process.

How far do y'all think such mandatory counseling should go?

[ELVIS]

Thank you Zah...couldn't have said it better...

I heard the exact same show and the only part you left out is that the NPR host seemed to be glorifying the whole thing...

But it was scary to listen to, and most people have no idea that these things are indicated in the bill...

[ZahZoo]

Agreed the NPR person was solely focused on the self euthanasia aspects... which was somewhat over the top in the way it was presented.

It did prompt me to go read that sub-section... which only contains one mention of artificial nutrition/hydration considerations. The primary focus in the bill was living will and health care/assisted care considerations.

[ELVIS]

Which will be reduced in unimaginable proportions...

Thank you again...

[FORD]

You guys realize that you're talking about hospice care for the terminally ill here, not some sort of neo-Hitlerian extermination program from a bad sci-fi movie.

Elvis (as a nurse) should certainly know better.

[ELVIS]

I do...

That's why i'm entirely against this...

[ELVIS]

And you can compare it to a "sort of neo-Hitlerian extermination program from a bad sci-fi movie."

[ZahZoo]

You guys realize that you're talking about hospice care for the terminally ill here, not some sort of neo-Hitlerian extermination program from a bad sci-fi movie.

Elvis (as a nurse) should certainly know better.

I wouldn't say that the case Ford... It's much more comprehensive. Have you read the section 1233?

The PDF format doesn't copy well but here's the main portion of the section.

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
16 (a) MEDICARE.—
17 (1) IN GENERAL.—Section 1861 of the Social
18 Security Act (42 U.S.C. 1395x) is amended—
19 (A) in subsection (s)(2)—
20 (i) by striking ‘‘and’’ at the end of
21 subparagraph (DD);
22 (ii) by adding ‘‘and’’ at the end of
23 subparagraph (EE); and
24 (iii) by adding at the end the fol25
lowing new subparagraph:
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425
1 ‘‘(FF) advance care planning consultation (as
2 defined in subsection (hhh)(1));’’; and
3 (B) by adding at the end the following new
4 subsection:
5 ‘‘Advance Care Planning Consultation
6 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
7 term ‘advance care planning consultation’ means a con8
sultation between the individual and a practitioner de9
scribed in paragraph (2) regarding advance care planning,
10 if, subject to paragraph (3), the individual involved has
11 not had such a consultation within the last 5 years. Such
12 consultation shall include the following:
13 ‘‘(A) An explanation by the practitioner of ad14
vance care planning, including key questions and
15 considerations, important steps, and suggested peo16
ple to talk to.
17 ‘‘(B) An explanation by the practitioner of ad18
vance directives, including living wills and durable
19 powers of attorney, and their uses.
20 ‘‘(C) An explanation by the practitioner of the
21 role and responsibilities of a health care proxy.
22 ‘‘(D) The provision by the practitioner of a list
23 of national and State-specific resources to assist con24
sumers and their families with advance care plan25
ning, including the national toll-free hotline, the ad-
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426
1 vance care planning clearinghouses, and State legal
2 service organizations (including those funded
3 through the Older Americans Act of 1965).
4 ‘‘(E) An explanation by the practitioner of the
5 continuum of end-of-life services and supports avail6
able, including palliative care and hospice, and bene7
fits for such services and supports that are available
8 under this title.
9 ‘‘(F)(i) Subject to clause (ii), an explanation of
10 orders regarding life sustaining treatment or similar
11 orders, which shall include—
12 ‘‘(I) the reasons why the development of
13 such an order is beneficial to the individual and
14 the individual’s family and the reasons why
15 such an order should be updated periodically as
16 the health of the individual changes;
17 ‘‘(II) the information needed for an indi18
vidual or legal surrogate to make informed deci19
sions regarding the completion of such an
20 order; and
21 ‘‘(III) the identification of resources that
22 an individual may use to determine the require23
ments of the State in which such individual re24
sides so that the treatment wishes of that indi25
vidual will be carried out if the individual is un-
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427
1 able to communicate those wishes, including re2
quirements regarding the designation of a sur3
rogate decisionmaker (also known as a health
4 care proxy).
5 ‘‘(ii) The Secretary shall limit the requirement
6 for explanations under clause (i) to consultations
7 furnished in a State—
8 ‘‘(I) in which all legal barriers have been
9 addressed for enabling orders for life sustaining
10 treatment to constitute a set of medical orders
11 respected across all care settings; and
12 ‘‘(II) that has in effect a program for or13
ders for life sustaining treatment described in
14 clause (iii).
15 ‘‘(iii) A program for orders for life sustaining
16 treatment for a States described in this clause is a
17 program that—
18 ‘‘(I) ensures such orders are standardized
19 and uniquely identifiable throughout the State;
20 ‘‘(II) distributes or makes accessible such
21 orders to physicians and other health profes22
sionals that (acting within the scope of the pro23
fessional’s authority under State law) may sign
24 orders for life sustaining treatment;
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428
1 ‘‘(III) provides training for health care
2 professionals across the continuum of care
3 about the goals and use of orders for life sus4
taining treatment; and
5 ‘‘(IV) is guided by a coalition of stake6
holders includes representatives from emergency
7 medical services, emergency department physi8
cians or nurses, state long-term care associa9
tion, state medical association, state surveyors,
10 agency responsible for senior services, state de11
partment of health, state hospital association,
12 home health association, state bar association,
13 and state hospice association.
14 ‘‘(2) A practitioner described in this paragraph is—
15 ‘‘(A) a physician (as defined in subsection
16 (r)(1)); and
17 ‘‘(B) a nurse practitioner or physician’s assist18
ant who has the authority under State law to sign
19 orders for life sustaining treatments.
20 ‘‘(3)(A) An initial preventive physical examination
21 under subsection (WW), including any related discussion
22 during such examination, shall not be considered an ad23
vance care planning consultation for purposes of applying
24 the 5-year limitation under paragraph (1).
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1 ‘‘(B) An advance care planning consultation with re2
spect to an individual may be conducted more frequently
3 than provided under paragraph (1) if there is a significant
4 change in the health condition of the individual, including
5 diagnosis of a chronic, progressive, life-limiting disease, a
6 life-threatening or terminal diagnosis or life-threatening
7 injury, or upon admission to a skilled nursing facility, a
8 long-term care facility (as defined by the Secretary), or
9 a hospice program.
10 ‘‘(4) A consultation under this subsection may in11
clude the formulation of an order regarding life sustaining
12 treatment or a similar order.
13 ‘‘(5)(A) For purposes of this section, the term ‘order
14 regarding life sustaining treatment’ means, with respect
15 to an individual, an actionable medical order relating to
16 the treatment of that individual that—
17 ‘‘(i) is signed and dated by a physician (as de18
fined in subsection (r)(1)) or another health care
19 professional (as specified by the Secretary and who
20 is acting within the scope of the professional’s au21
thority under State law in signing such an order, in22
cluding a nurse practitioner or physician assistant)
23 and is in a form that permits it to stay with the in24
dividual and be followed by health care professionals
25 and providers across the continuum of care;
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430
1 ‘‘(ii) effectively communicates the individual’s
2 preferences regarding life sustaining treatment, in3
cluding an indication of the treatment and care de4
sired by the individual;
5 ‘‘(iii) is uniquely identifiable and standardized
6 within a given locality, region, or State (as identified
7 by the Secretary); and
8 ‘‘(iv) may incorporate any advance directive (as
9 defined in section 1866(f)(3)) if executed by the in10
dividual.
11 ‘‘(B) The level of treatment indicated under subpara12
graph (A)(ii) may range from an indication for full treat13
ment to an indication to limit some or all or specified
14 interventions. Such indicated levels of treatment may in15
clude indications respecting, among other items—
16 ‘‘(i) the intensity of medical intervention if the
17 patient is pulse less, apneic, or has serious cardiac
18 or pulmonary problems;
19 ‘‘(ii) the individual’s desire regarding transfer
20 to a hospital or remaining at the current care set21
ting;
22 ‘‘(iii) the use of antibiotics; and
23 ‘‘(iv) the use of artificially administered nutri24
tion and hydration.’’.
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1 (2) PAYMENT.—Section 1848(j)(3) of such Act
2 (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
3 ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’.
4 (3) FREQUENCY LIMITATION.—Section 1862(a)
5 of such Act (42 U.S.C. 1395y(a)) is amended—
6 (A) in paragraph (1)—
7 (i) in subparagraph (N), by striking
8 ‘‘and’’ at the end;
9 (ii) in subparagraph (O) by striking
10 the semicolon at the end and inserting ‘‘,
11 and’’; and
12 (iii) by adding at the end the fol13
lowing new subparagraph:
14 ‘‘(P) in the case of advance care planning
15 consultations (as defined in section
16 1861(hhh)(1)), which are performed more fre17
quently than is covered under such section;’’;
18 and
19 (B) in paragraph (7), by striking ‘‘or (K)’’
20 and inserting ‘‘(K), or (P)’’.
21 (4) EFFECTIVE DATE.—The amendments made
22 by this subsection shall apply to consultations fur23
nished on or after January 1, 2011.
24 (b) EXPANSION OF PHYSICIAN QUALITY REPORTING
25 INITIATIVE FOR END OF LIFE CARE.—
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[ELVIS]

I'm glad i'm not a family practitioner MD, because i'd probably give it up...

My guess is, many MD's will throw in the towell if this crap passes...but it wont...it can't!

[FORD]

Here's a case for you, Nurse Presley......

87 year old woman in complete renal failure. The kidney damage was directly caused by heart medication, so obviously there's another organ going down hill fast.

Patient is suffering in extreme pain and rarely conscious. Maybe due to the physical condition or the pain meds she's on (probably morphine)

Do you attempt dialysis and prolong her suffering, or do you let nature take its course?