Here's what I've come up with regarding the health care legislation "death panels":
The fear that the health care legislation would include provisions for 'death panels' seems to have started (or at least publicly acknowledged in the mainstream media) by a statement made by Sarah Palin, expressing concern that Obama would have a death care panel, and using her own son as an example of a child that may not pass the criteria for getting health care, due to his Downs Syndrome.The 'death panel' references were removed from the health care legislation before it passed.
There is no reference to it in the current bill, now law.
However, the debate continues, and as we have seen before, instead of getting this through with legislation, the Obama administration will try to get the same results by using regulations. Here's a review of the state of death panels as it stands now. Watch for 'regulations' in the coming weeks...
The Republican death panel meme was first raised by Sarah Palin.
Palin had claimed that the Democratic plan would ration care and wrote that "my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care.
Politifact.com said that "Palin's statement sounds more like a science fiction movie .. than part of an actual bill before Congress." They rated her statement as "Pants on Fire!" on their "truthometer" and said that similar claims by other conservatives that the health care bill encourages euthanasia were false and that there was no "death board" to determine the worthiness of individuals to receive care. Later Palin said her original comments concerned statements made by Dr. Ezekiel Emanuel (See below for Emanuel's article), a health policy advisor to President Obama and the brother of the President’s chief of staff.
 but the adviser concerned was "outraged" by Palin's accusations.
============================Palin's comments were sparked by Dr. Ezekiel Emanuel's article...
Dr. Ezekiel Emanuel, who was the health-policy adviser at the White House’s Office of Management and Budget
at the time said “there’s no basis for that claim either in any of my writings or the legislation. It has no grounds in reality. It’s surreal and Orwellian, the idea that this legislation or my writings suggest that her son Trig shouldn’t get health care.”
He noted that his sister has Cerebral Palsy and he is not without personal sympathy for those with disabilities. He is an opponent of euthanasia, and abhors people cavalierly distorting his writings and the work that he had done over 25 years helping to improve medical care in America for vulnerable people who often have no voice. The disputed legislative proposal was based on a clause in a House bill that did not pass into law concerning reimbursement for counseling about living wills.
So the concern was with a version of the healthcare legislation that included this clause for reimbursement for counseling about living wills; documents the patient signs which enable others to make life and death decisions in the event the patient is unable to do so himself.
The issue of death panels was 'closed' by having the living will reimbursement clause removed from the bill before it passed.However, the issue is still alive: the administration/insurance companies seek to implement this by regulation instead of by law.
This is happening now, JANUARY of 2011:
Payment to doctors for voluntary end-of-life consultation on advance directives is to be revived by regulation as of January 1, 2011 but could be modified or reversed if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.
The regulation is similar to end-of-life counseling that became law when George W. Bush was president
, expanding the benefit from a welcome visit to part of an annual wellness visit. Betsy McCaughey, who inspired Palin's "death panel" statement, said, “If they make advance-care planning a protocol … it’s not voluntary, despite the use of the word.“
(Note the 'similar' law put in place when Bush was in office; supported by Republicans - is now rejected by Republicans when Democrats sought to add it to the healthcare bill. There is no difference between left and right: the insurance companies are calling the shots, and congress, the puppets on the stage, are playing their roles.)On the January 2011 incarnation of this 'living will' clause...
============================From an interview that McCaughey did on the O'Reilly Report on Fox: (with a guy named Eric Bolling filling in for O'Reilly.)http://www6.lexisnexis.com/publisher/EndUser?Action=UserDisplayFullDocument&orgId=574&topicId=100007214&docId=l:1330147647&start=4SHOW: THE O'REILLY FACTOR 8:00 PM ESTDecember 27, 2010 MondayBOLLING
: But now there are reports that President Obama is bringing back end-of-life planning with the Medicare regulation set to go into effect next week
. The White House says, no, that's not true -- issuing a statement blaming a law signed by President Bush. So, what's really going on?
With us now: Dr. Betsy McCaughey, author of "Obama Health Law: What It Says and How to Overturn It"; and joining us from New Orleans, Dr. Caroline Heldman, professor of politics at Occidental College.
Dr. McCaughey, let's start with you. I thought we were done with this. I thought we went through this, spent a lot of time talking about death panels. They weren't included in the health care bill that became law that you have right here, but they are back. Are they back?BETSY MCCAUGHEY, PH.D., AUTHOR, "OBAMA HEALTH LAW"
: That's right. It appears that the administration is trying to achieve by regulation what they could not achieve by legislation
. And, of course, it's a good idea to pay doctors to spend time helping patients through the tough decisions, wrenching decisions they may face toward the end of their life.
But governments should not be scripting what doctors tell patients.BOLLING
: Doctor, take our viewers through exactly what this regulation says it allows or asks doctors, incentivizes them to discuss end-of-life issues, right?MCCAUGHEY
: Well, there's a new benefit called the once yearly "well visit" with your doctor or nurse practitioner or physician's assistant, not necessarily a doctor. And among the things that will be included, assessment of your weight and body weight, your mental capacities, whether you are at risk at depression, et cetera, et cetera, and advanced planning or end-of-life counseling.BOLLING
: Professor Heldman, do we really need to incentivize doctors to ask grandma whether she wants to pull the plug year after year after year? Isn't once enough?CAROLINE HELDMAN, PH.D., OCCIDENTAL COLLEGE PROFESSOR
: Well, as you - - as you bring up, Eric, it's part of the regulation passed during the Bush administration to do it when folks join Medicare. So, this is simply offering it more consistently. And, yes, I do think end-of-life counseling is incredibly important.BOLLING
: Professor, why do you need to offer it more consistently? Don't you make a decision whether, you know, you're on life support, whether you want the doctor to pull the plug once? Or -- you know, what's really troubling is that they are going to incentivize doctors, pay doctors to do this counseling.HELDMAN
: Right. To do the counseling, not the outcome, and it's voluntary on the part of the patient. It something benefits families. It benefits individuals. You get to choose how you want to die. It's a wonderful benefit. And I don't know how it's possible that we're having a debate about this.(Note: Heldman, in support of incentivizing Doctors to ask patients if they want to 'check out', considers it a benefit to families. This could create a scenario where families, burdened with health care costs of the patient, are put into a position of advocating for the patient to make the 'right' choice. Perhaps 'nudge' them into a decision. Brings up all kinds of opportunities for intra-family fighting - guaranteed to pull families apart at a time when they should be united. Perfect NWO plan; reduce population, destroy a family, blame the victims all rolled up into one.)(CROSSTALK)MCCAUGHEY
: The reason we're having a debate it is that it's not simply being offered. First of all, it's being scripted. If you look in the Obama health law section 936, the government is actually going to be creating brochures and videos.HELDMAN
: Education. They are going to be educating individuals about options?MCCAUGHEY
: Making brochures and videos about these decisions. Those decisions belongs --HELDMAN
: They shouldn't offer education?MCCAUGHEY
: -- to others.
And -- and, voluntary -- it's only voluntary if your doctor is not going to be paid less or penalized in some way if you choose not to go through that counseling or choose not to engage in advanced planning.
And the fact is that Medicare has protocols and it grades doctors and pays them based on compliance with those protocols
. So, what we need to know right now is: is the Obama administration going to pay doctors less if they don't offer this counseling and if they don't get their --BOLLING
: Professor, if at some point if you keep asking a patient, are you sure you don't want to pull the plug? Are you sure you don't want to pull the plug? Eventually, you're going to say, all right, already enough, pull the plug.HELDMAN
: That's not what this is. That's not what this is. It's simply offering it more often so that if people change their mind and want to plan for their end-of-life, they have that option. It's giving choice to customers.MCCAUGHEY
: It's a drum beat -- it's a drum beat of spend less on your care, let's let you die sooner.HELDMAN
: No. It's death with signature any at this. It's allowing consumers a choice.MCCAUGHEY
: That's your opinion, but not everybody who is enrolled in Medicare should interest to go through about hearing about that every year.HELDMAN
: They don't have to. It's voluntary. That's what voluntary means.MCCAUGHEY
: I want to know whether doctors will have to comply with this protocol in order to receive full Medicare payments, first of all. And secondly, why is the government making these videos and brochures? This should be done by churches and private groups and not the government. The government is not the expert on when or how we die.HELDMAN
: No. Doctors are.BOLLING
: Go ahead, Professor. But let me turn the subject a little bit, just a touch here. Representative Blumenauer from Oregon, Democrat, also, he put an email on. This is very, very troubling. I want you to weigh in on this.
The email says and he wrote this to constituents and to friends. "We would ask that you not broadcast this accomplishment." Meaning that this became a regulation, and he also says he goes on to say, "The longer this goes unnoticed -- the longer this goes unnoticed, the better our chances are of keeping it."
Is this the way we want to govern in this country?HELDMAN
: Well, unfortunately, Eric, that's what people like Dr. McCaughey and others who call these death panels and mislead the American public have left us with. It's rhetoric. It's not reality.
The fact of the matter is, this is what is good for patients. It's good for taxpayer
s. I want to die with dignity. Others should have that choice as well.(CROSSTALK)MCCAUGHEY
: This is the most deplorable case of Washington knows best. This isn't supposed to be the job of our federal government to dictate what decisions we make toward the end our life.HELDMAN
: They are not dictating anything.(CROSSTALK)MCCAUGHEY
: Yes, they were making brochures right here in the law. Oh, but then leave it to the doctor and patient to decide what's discussed. Don't provide federally sponsored brochures and videos.BOLLING
: Professor --(CROSSTALK)HELDMAN
: -- educational materials.BOLLING
: Hold on. Professor, whether or not this was originally brought up during the Bush administration, who cares? We spent a lot of time, a lot of effort discussing the health care law when we voted on it. We went through all the hashings, we slugged it out. You got to pass. It went through.But death panels and that end-of-life advisory board was removed from it,
the discussion was off the table. All of a sudden, it's creeping back in.HELDMAN
: Well, Eric, isn't it sad it was already law and yet rhetoric caused Democrats to be so fearful that they had to take it out of the health care bill, even though it was available to seniors. That should tell you something about how Republicans and others have been using fear tactics to scare the American public.(CROSSTALK)MCCAUGHEY
: -- agenda. This law drastically expands Medicaid 85 million people to pay for it. It's eviscerating Medicare. It's robbing Peter to pay Paul, or in this cases, robbing grandma and grandpa. And that's why --BOLLING
: We're going to have to leave it there. Doctors, we appreciate your time, both of you.
Here's the article by Dr. Ezekiel Emmanuel:
===================================WHAT ARE THE POTENTIAL COST SAVINGS
FROM LEGALIZING PHYSICIAN-ASSISTED SUICIDE?
Volume 339, Number 3·167
EZEKIEL J. EMANUEL , M.D., PH .D.,AND MARGARET P. BATTIN , PH .D.
From the Center for Outcomes and Policy Research, Division of Cancer Epidemiology and Control,
Dana–Farber Cancer Institute, and the Division of Medical Ethics, Harvard Medical School, Boston (E.J.E.);
and the Department of Philosophy, University of Utah, and the Division of Medical Ethics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (M.P.B.). http://www.scribd.com/doc/18428440/What-Are-the-Potential-Cost-Savings-From-Legalizing-Physician-Assisted-Suicide
Address reprint requests to Dr. Emanuel at the Center for Outcomes and Policy Research, Division of Cancer Epidemiology and Control, Dana–Farber Cancer Institute, 44 Binney St., Boston, MA 02115.
©1998, Massachusetts Medical Society.
In the Washington v. Glucksberg and Vacco v. Quill decision rejecting a constitutional right to physician-assisted suicide, the Supreme Court allowed each state to decide whether to legalize the intervention.1
In state legislatures rather than courtrooms, factual claims about the probable extent and implications of permitting physician-assisted suicide assume a preeminent role in the debate about legalization.2
Particularly sensitive in these discussions will be the issue of the potential cost savings from legalizing physician-assisted suicide, and how the savings might influence decision making by health care institutions, physicians, families, and terminally ill patients.3-6
Although we do not agree with each other about the ethics or optimal social policy regarding physician-assisted suicide and euthanasia, we do agree that the claims of cost savings distort the debate. Within the limits of available data, we offer an assessment of the potential cost savings from legalizing physician-assisted suicide, demonstrating that the savings can be predicted to be very small — less than 0.1 percent of both total health care spending in the United States and an individual managed-care plan’s budget. SPECULATING ABOUT COST SAVINGS FROM PHYSICIAN-ASSISTED SUICIDE
There is a widespread perception that the United States spends an excessive amount on high-technology health care for dying patients. 7-20
Many commentators note that 27 to 30 percent of the Medicare budget is spent on the 5 percent of Medicare patients who die each year.21
They also note that the expenditures increase exponentially as death approaches, so that the last month of life accounts for 30 to 40 percent of the medical care expenditures in the last year of life.
To many, savings from reduced use of expensive technological interventions at the end of life are both necessary and desirable.11,12,18,19
Many have linked the effort to reduce the high cost of death with the legalization of physician-assisted suicide. One commentator observed: “Managed care and managed death [through physician-assisted suicide] are less expensive than fee-for-service care and extended survival. Less expensive is better.”22
Some of the amicus curiae briefs submitted to the Supreme Court expressed the same logic: “Decreasing availability and increasing expense in health care and the uncertain impact of managed care may intensify pressure to choose physician-assisted suicide”23
and “the cost effectiveness of hastened death is as undeniable as gravity. The earlier a patient dies, the less costly is his or her care.”24
Indeed, the Supreme Court noted the potential for cost-saving motives to influence the legalization and use of physician-assisted suicide, speculating that “if physician-assisted suicide were permitted, many might resort to it to spare their families the substantial financial burden of end- of-life health care costs.”1 FACTORS DETERMINING SAVINGS FROM PHYSICIAN-ASSISTED SUICIDE
Computing the likely cost savings from legalizing physician-assisted suicide is based on three factors: (1) the number of patients who might commit suicide with the assistance of a physician if it is legalized; (2) the proportion of medical costs that might be saved by the use of physician-assisted suicide, which is related to the amount of time that a patient’s life might be shortened; and (3) the total cost of medical care for patients who die.
Each of these factors is uncertain. Although available data indicate that physicians in the United States currently provide euthanasia and assistance with suicide to some patients,25,26
it is impossible to determine how many additional Americans would die as a result of physician-assisted suicide if it were legalized. The savings from legalization would depend on the additional number of physician-assisted suicides beyond the current number. Since predictions about any patient’s precise date of death are inherently uncertain, it is impossible to determine how much life would be forgone. Finally, only limited data are available on the costs of care near the end of life in the United States.15,16,21
However, by combining data on physician-assisted suicide and euthanasia in the Netherlands, where these interventions are openly performed27,28
and have been studied,2 9 -31
and available U.S. data on costs at the end of life, we can estimate the cost savings that would be realized in the United States if physician-assisted suicide were legalized. Although such an estimate is very crude, sensitivity analysis can minimize the effect of the uncertainty by providing the range of savings under reasonable conditions. THE NUMBER OF PATIENTS WHO MIGHT CHOOSE PHYSICIAN-ASSISTED SUICIDE
In the Netherlands, approximately 3100 cases of euthanasia and 550 cases of physician-assisted suicide occur annually, representing 2.3 percent and 0.4 percent, respectively, of all deaths.31
(There are an additional 1000 cases [0.7 percent] in which euthanasia is performed without the patients’ explicit, current consent.31
Such cases are neither sanctioned in the Netherlands nor permitted by the current proposals for legalization of physician-assisted suicide in the United States
About 80 percent of deaths by physician-assisted suicide or euthanasia in the Netherlands involve patients with cancer, representing 6 percent of all deaths from cancer.30,31
Extrapolating the Dutch rates to the United States suggests that approximately 62,000 Americans (2.7 percent of the 2.3 million who die in the United States each year) might choose physician-assisted suicide if it were legalized and carried out with the explicit, current consent of the patients.
Patients with cancer are also likely to be the primary users of physician-assisted suicide in the United States.25,26 PROPORTION OF LIFE SHORTENED BY PHYSICIAN-ASSISTED SUICIDE
Although predicting the exact date on which an individual patient will die is impossible, physicians are fairly accurate in predicting the time of death on a population basis, especially for patients who die of cancer.16,32
Dutch physicians estimate that 17 percent of patients receiving euthanasia or a physician’s assistance with suicide at the patients’ explicit request had their lives shortened by less than one day, 42 percent by one day to one week, 32 percent by more than one week to four weeks
, and 9 percent by more than one month.30,31
Thus, more than 90 percent of Dutch patients who died as a result of physician- assisted suicide or euthanasia at their own explicit request had their lives shortened by 4 weeks or less, with an average life reduction of less than 3.3 weeks. THE COSTS OF MEDICAL CARE FOR DYING PATIENTS
Determining the costs of medical care at the end of life and how much would be saved by legalizing physician-assisted suicide is made difficult by several problems with the available data. It is speculative to assume that patients who might commit physician-assisted suicide would consume resources at a rate similar to that of patients who do not; such patients may be considerably different from average decedents in terms of health status, psychology, and sociodemographic characteristics, using more (or fewer) health care resources at the end of life.25
Also, the best data available in the United States on the cost of medical care at the end of life come from Medicare, which provides mainly acute care for the elderly and disabled. 33, 34
Studies have come to various conclusions about whether these Medicare data can be extrapolated to decedents under 65 years old.35 -38
According to recent Medicare data, for a beneficiary who dies of cancer after receiving conventional care, $30,397 (in 1995 dollars) is spent on medical care in the last year of life.39,40
Fully 33 percent of the last year’s costs ($10,118 in 1995 dollars) are spent in the last month of life, and 48 percent ($14,507 in 1995 dollars) in the last two months of life. (The available data do not define costs in any smaller increments of time.)
Article continues here: http://www.scribd.com/doc/18428440/What-Are-the-Potential-Cost-Savings-From-Legalizing-Physician-Assisted-Suicide