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Here We Go Again:
ObamaCare Regulations "Nudge" Elderly to Reject Lifesaving
Treatment Part One of Three By Dave Andrusko Good evening. I trust you had a wonderful Christmas. Part Two today talks about a wonderful pro-life Christmas message delivered by President Ronald Reagan. Part Three looks at the "60/30/10" principle. Over at National Right to Life News Today (www.nationalrighttolifenews.org), we find even more opposition to ObamaCare while Wesley Smith updates us on another anti-life scam. Please send your comments on Today's News & Views and National Right to Life News Today to daveandrusko@gmail.com. If you like, join those who are following me on Twitter at http://twitter.com/daveha. A story over the weekend in the New York Times reveals that the Obama Administration is using a surreptitious change in a Medicare regulation to fund "end-of-life planning," a proposal so controversial that it was dropped from the already controversy-laden ObamaCare in 2010. Writing in a story that appeared online on Christmas day, reporter Robert Pear explained that under the new policy, "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." To his credit, Pear puts the Medicare change in both the immediate and long-term contexts. "While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress." The final statutory version of ObamaCare authorizes Medicare coverage of a yearly "wellness visit." But under the new regulation, which had gone undetected, as of January 1, the annual visit will now cover "voluntary advance care planning" to discuss end-of-life treatment. "The danger is that subsidized advance care planning will not just discover and implement patient treatment preferences but rather be used to nudge or pressure older people to agree to less treatment because that is less expensive," warns Burke Balch, director of NRLC's Robert Powell Center for Medical Ethics. Indeed, the New York Times story noted that Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services, which issued the rule, has said, "Using unwanted procedures in terminal illness is a form of assault. 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." NRLC strongly opposed Berwick's selection. In a foreshadowing of what is coming to pass, he took office courtesy of a recess appointment, rather than be grilled by the Senate. At the time NRLC described Berwick as a "one-man death panel." Holly Prigerson of Boston's Dana Farber Cancer Institute has been quoted as saying, "We refer to the end-of-life discussion as the multimillion-dollar conversation because it is associated with shifting costs away from expensive . . . care like being on a ventilator in an ICU, to less costly comfort care…."[1] Indeed, a medical journal article of which Priegerson was lead author concluded that the mean cost of care was 35.7% less for patients who reported having end-of-life discussions, compared with patients who did not. [2] Myra Christopher heads a major "bioethics" think tank--the Center for Practical Bioethics--that has long pushed for advance directives. In an October 2009 speech, she left no doubt of the economic motive for promoting advance care consultations. In the context of advocating them, she said, "The reality is that 9% to 11% of the entire health care budget is spent on end of life care – nearly 27 to 30% depending on whose data you want to believe of the Medicare budget is spent on end of life care. Conservatively, conservatively, $6.1 billion every year of Medicare is wasted on what we refer to as futile care . . . ."[3] While the provision dropped from the statute but now reinstated by the Obama Administration regulation was being fiercely debated in Summer 2009, author and blogger Lee Siegel, in general a strong advocate of President Obama's approach to health care restructuring, wrote: [O]n one point the plan's critics are absolutely correct. One of the key ideas under end-of-life care is morally revolting. . . . . The section, on page 425 of the [ original House] bill, offers to pay once every five years for a voluntary, not mandatory, consultation with a doctor, who will not blatantly tell the patient how to end his or her life sooner, but will explain to the patient the set of options available at the end of life, including living wills, palliative care and hospice, life sustaining treatment, and all aspects of advance care planning, including, presumably, the decision to end one's life. The shading in of human particulars is what makes this so unsettling. A doctor guided by a panel of experts who have decided that some treatments are futile will, in subtle ways, advance that point of view. Cass Sunstein, Obama's regulatory czar, calls this "nudging," which he characterizes as using various types of reinforcement techniques to "nudge" people's behavior in one direction or another. An elderly or sick person would be especially vulnerable to the sophisticated nudging of an authority figure like a doctor. Bad enough for such people who are lucky enough to be supported by family and friends. But what about the dying person who is all alone in the world and who has only the "consultant" to turn to and rely on? The heartlessness of such a scene is chilling.[4] Pear's story documents that proponents fully understood how politically radioactive it is to use the bureaucracy to accomplish a much resisted proposal. For example, "Several Democratic members of Congress, led by Representative Earl Blumenauer of Oregon and Senator John D. Rockefeller IV of West Virginia, had urged the administration to cover end-of-life planning as a service offered under the Medicare wellness benefit," according to Pear. Mr. Blumenauer, who authored the original end-of-life proposal (Section 1233), praised the rule as "a step in the right direction." But not enough to actually alert the public, according to the Times'' story. Evidently, Blumenauer and others learned of the Obama Administration's plans back in November. In an email sent out to other like-minded folks at the time, Blumenauer wrote, "While we are very happy with the result, we won't be shouting it from the rooftops because we aren't out of the woods yet." Why? "This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the 'death panel' myth." According to Pear, the e-mail continued: "Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it." Further into Pear's story, we read a quote from a spokeswoman for the Medicare agency. Ellen B. Griffith acknowledged, "The final health care reform law has no provision for voluntary advance care planning," but added that under the new rule, such planning "may be included as an element in both the first and subsequent annual wellness visits, providing an opportunity to periodically review and update the beneficiary's wishes and preferences for his or her medical care." This actually goes beyond the dropped statutory provision, which had authorized payment for advance care planning every five years, while the regulation makes it a part of every annual checkup. "The Obama Administration end run around Congress, risking public outrage at the revival of a provision that provoked such strong fears among older Americans on Medicare," Balch said, "demonstrates just how committed the President is to use every means at his disposal to constrain the resources Americans devote to health care. It is a bad omen for how the Obama Administration, if still in office, will use authority that kicks in after the next presidential election to impose so-called 'quality and efficiency' measures on health care providers as a means of limiting the health care Americans of any age are permitted to receive–even when they pay for it with private, nongovernmental funds." For more complete
documentation of the rationing in the Obama Healthcare Law,
visit
http://www.nrlc.org/HealthCareRationing/Index.html. |