Obama Returns to End-of-Life Plan That Caused Stir

[NYcarbineer]

I'm just curious, what sorts of medical treatments and procedures do Republicans plan to deny patients when they submit their big cuts in Medicare and Medicaid in their upcoming budget?

 

[geauxtohell]

Compensating doctors for their expert medical opinion on end of life matters (which they deal with as a matter of course in their profession) so that people can think about these matters and make their wishes known is just good sense.

You guys act like people aren't going to die but for this conversation, which is now considered to be a standard of care.

Guess what? You are wrong. Whether you plan for it or not, you are going to die someday.

I swear, I think half of the knee jerk stupidity that surrounds this issue is really just baby boomers struggling to come to grips with their own mortality.

 

[SFC Ollie]

Compensating doctors for their expert medical opinion on end of life matters (which they deal with as a matter of course in their profession) so that people can think about these matters and make their wishes known is just good sense.

You guys act like people aren't going to die but for this conversation, which is now considered to be a standard of care.

Guess what? You are wrong. Whether you plan for it or not, you are going to die someday.

I swear, I think half of the knee jerk stupidity that surrounds this issue is really just baby boomers struggling to come to grips with their own mortality.

Seems to me that this "counseling" is little more than the Doctor giving you your treatment options. Which he is already paid to do. Do you go see your doctor just to talk about dying?

 

[bigrebnc1775]

I'm just curious, what sorts of medical treatments and procedures do Republicans plan to deny patients when they submit their big cuts in Medicare and Medicaid in their upcoming budget?

Doesn't it get old defending a lie?

 

[geauxtohell]

Seems to me that this "counseling" is little more than the Doctor giving you your treatment options. Which he is already paid to do. Do you go see your doctor just to talk about dying?

First: discussing Advanced Directives is not discussing "treatment options". Unless you are at the end of life and the pathology is known, there is no way to know what your treatment options are. It's more basic (i.e. would you want to be intubated? How long would you want your life to be prolonged?). Discussing this topic with patients is part of good medical care. Guess what? Death is a medical issue that every person will face and Physicians will be the ones who see you to the end in the vast majority of cases.

Second: Patients still maintain the autonomy (rightfully) to change their mind, even if it is up to the last days of their life. The verbal directive from a patient trumps all previous documentation.

As a medical student, I see it from the other end. Ever walk through an ICU? What about hospice?

There is absolutely nothing wrong (short of the histrionics of people who are scared to frigging death about their own mortality) with coming up with a pragmatic plan so that, when the time comes, your wishes are articulated and respected.

As, I said, this is becoming a standard of care. Furthermore, since it will be a primary care doctor that does this, it is doubtful that it will be the same Doctor that sees that your wishes are executed.

Either way, whether you choose to die on your own terms or not, it won't matter in the end. If you refuse to put your decisions down on paper, then someone else will decide for you. Either way, you aren't going to cheat death by utilizing the defense mechanism of denial.

To make things even worse, if someone else makes that decision for you, it's either going to be a physician who may not be acting in what you would truly want to happen or your family members who are trying to act in what they think your wishes would be (and this usually results in inter-family fighting).

You would think that after Quinlin, Cruzan, and now Schiavo, we would realize how devastating this issue can be for families and move beyond the idiotic hyperbole and have a rational debate about it.

However, the outrage pimps (I am talking about the politicians and pundits here) are more interested in seeing the matter turn into a food fight so they can gin up votes. In the end, they aren't going to be the ones that make the decision to pull the plug. Your health is just a cynical campaign issue for them.

Wake up guys. Seriously.

 

[Modbert]

Everyone after a certain age (18 or 21) would be smart enough to make out a will of some sort as to what happens with their body in case of a terrible accident where they are put into a coma, on a feeding tube, etc.

Edit: GTH is completely right and articulates the right answer in the post above mine.

 

[geauxtohell]

And you think putting the government in charge is not terminal stupidity in itself?

I may have to knock you down a peg or 2 on my "who is smart and reasonable on the forum" ladder you were up near the top....... .

The government is not "in charge". The patient has autonomy over their own health care decisions.

The government is just going to reimburse physicians for their time and expert medical opinion.

I thought you free marketers were all for people being fairly paid for their work?

 

[SFC Ollie]

Again, this may all be for nothing as the lawsuits stack up and the bill is dismantled piece by piece.

 

[geauxtohell]

Again, this may all be for nothing as the lawsuits stack up and the bill is dismantled piece by piece.

Here is the irony.

Regardless of what happens to this bill, the issue is still there.

Everyone of us is going to die someday.

You can either do it on your terms or not. Either way, it's going to happen and if you fail to act on your own behalf, someone else will do that for you.

Look past the politics of the Sciavo matter for a second and assume that everyone was acting in good faith, both her husband and the Schindlers (I realize that may not have been the case, but let's just assume for hypothetical reasons that is a true statement).

Now look at the result.

Now imagine you in that position. Would you want to lay in a bed and be fed by a tube for ten years?

The answer to that is actually irrelevant. If that is what you want, you'd had better make sure you have articulated that wish. If that is not what you want, then you'd better make sure you've articulated that wish as well.

Because, the Schiavo case is an example of just how bad it can get.

 

[SFC Ollie]

Again, this may all be for nothing as the lawsuits stack up and the bill is dismantled piece by piece.

Here is the irony.

Regardless of what happens to this bill, the issue is still there.

Everyone of us is going to die someday.

You can either do it on your terms or not. Either way, it's going to happen and if you fail to act on your own behalf, someone else will do that for you.

Look past the politics of the Sciavo matter for a second and assume that everyone was acting in good faith, both her husband and the Schindlers (I realize that may not have been the case, but let's just assume for hypothetical reasons that is a true statement).

Now look at the result.

Now imagine you in that position. Would you want to lay in a bed and be fed by a tube for ten years?

The answer to that is actually irrelevant. If that is what you want, you'd had better make sure you have articulated that wish. If that is not what you want, then you'd better make sure you've articulated that wish as well.

Because, the Schiavo case is an example of just how bad it can get.

Her parents were idiots. Still it is not something the Government should be involved in in any way shape or form.

 

[geauxtohell]

Again, this may all be for nothing as the lawsuits stack up and the bill is dismantled piece by piece.

Here is the irony.

Regardless of what happens to this bill, the issue is still there.

Everyone of us is going to die someday.

You can either do it on your terms or not. Either way, it's going to happen and if you fail to act on your own behalf, someone else will do that for you.

Look past the politics of the Sciavo matter for a second and assume that everyone was acting in good faith, both her husband and the Schindlers (I realize that may not have been the case, but let's just assume for hypothetical reasons that is a true statement).

Now look at the result.

Now imagine you in that position. Would you want to lay in a bed and be fed by a tube for ten years?

The answer to that is actually irrelevant. If that is what you want, you'd had better make sure you have articulated that wish. If that is not what you want, then you'd better make sure you've articulated that wish as well.

Because, the Schiavo case is an example of just how bad it can get.

Her parents were idiots. Still it is not something the Government should be involved in in any way shape or form.

Pragmatically, re-imbursing Doctors for this simple conversation (and that is all that is being proposed) is the best way to see that every patient is allowed to consider their options (and in the end, believe it or not, this is in the patient's best wishes). In a primary care visit, there is just so much going on that it will get pushed to the periphery.

Here's a good example of it. A "Review of systems":

Review of systems - Wikipedia, the free encyclopedia

For a clinic visit is just good care that allows you to practice preventative medicine and catch problems the patient (or you) might have missed. In our state, if you don't do at least five of them and document that you've asked, it affects reimbursement. If this were not the case, a "Review of Systems" would become one of those "nice to do things".

Re-imbursing physicians for their efforts is the best way to ensure something get's done.

It's only fair too. Drs. "sell" their knowledge and this discussion is part of that "product".

 

[PLYMCO_PILGRIM]

Seems to me that this "counseling" is little more than the Doctor giving you your treatment options. Which he is already paid to do. Do you go see your doctor just to talk about dying?

First: discussing Advanced Directives is not discussing "treatment options". Unless you are at the end of life and the pathology is known, there is no way to know what your treatment options are. It's more basic (i.e. would you want to be intubated? How long would you want your life to be prolonged?). Discussing this topic with patients is part of good medical care. Guess what? Death is a medical issue that every person will face and Physicians will be the ones who see you to the end in the vast majority of cases.

Second: Patients still maintain the autonomy (rightfully) to change their mind, even if it is up to the last days of their life. The verbal directive from a patient trumps all previous documentation.

As a medical student, I see it from the other end. Ever walk through an ICU? What about hospice?

There is absolutely nothing wrong (short of the histrionics of people who are scared to frigging death about their own mortality) with coming up with a pragmatic plan so that, when the time comes, your wishes are articulated and respected.

As, I said, this is becoming a standard of care. Furthermore, since it will be a primary care doctor that does this, it is doubtful that it will be the same Doctor that sees that your wishes are executed.

Either way, whether you choose to die on your own terms or not, it won't matter in the end. If you refuse to put your decisions down on paper, then someone else will decide for you. Either way, you aren't going to cheat death by utilizing the defense mechanism of denial.

To make things even worse, if someone else makes that decision for you, it's either going to be a physician who may not be acting in what you would truly want to happen or your family members who are trying to act in what they think your wishes would be (and this usually results in inter-family fighting).

You would think that after Quinlin, Cruzan, and now Schiavo, we would realize how devastating this issue can be for families and move beyond the idiotic hyperbole and have a rational debate about it.

However, the outrage pimps (I am talking about the politicians and pundits here) are more interested in seeing the matter turn into a food fight so they can gin up votes. In the end, they aren't going to be the ones that make the decision to pull the plug. Your health is just a cynical campaign issue for them.

Wake up guys. Seriously.

All that is well and good until you change your mind and decide you want a treatment and a government bureaucrat decides you don't have enough "intrinsic value to society" for them to perform said treatment.

Thats the part your ignoring. You are talking about something very similar, but not the same, as the issue most have with this. That issue being a government official will be the one deciding what treatments are and are not available based on your societal worth.

 

[Greenbeard]

All that is well and good until you change your mind and decide you want a treatment and a government bureaucrat decides you don't have enough "intrinsic value to society" for them to perform said treatment.

Thats the part your ignoring.

Actually, that's the part you're making up.

 

[jillian]

All that is well and good until you change your mind and decide you want a treatment and a government bureaucrat decides you don't have enough "intrinsic value to society" for them to perform said treatment.

Thats the part your ignoring. You are talking about something very similar, but not the same, as the issue most have with this. That issue being a government official will be the one deciding what treatments are and are not available based on your societal worth.

is the quote "intrinsic value to society" in the statute? or is that your slant on the subject?

perhaps you would rather a claims adjuster from an insurance company with a financial interest in cutting off your medical care make those assessments as to what is cost beneficial since that is the status quo.

and claims adjusters are instructed to deny as many claims as possible. so i'm afraid the reasons for the hysteria aren't resonating for me.

 

[PLYMCO_PILGRIM]

All that is well and good until you change your mind and decide you want a treatment and a government bureaucrat decides you don't have enough "intrinsic value to society" for them to perform said treatment.

Thats the part your ignoring.

Actually, that's the part you're making up.

Not exactly

Medicare - Health - The New York Times
http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=3&ref=robertpear

Right there the government is getting involved, monetarily, with end of life care.

Read the 2 links from a liberal source you might be interested. If you want balance I'll posts something from a conservative source but I know you dont believe those sites.

 

[jillian]

All that is well and good until you change your mind and decide you want a treatment and a government bureaucrat decides you don't have enough "intrinsic value to society" for them to perform said treatment.

Thats the part your ignoring.

Actually, that's the part you're making up.

Not exactly

Medicare - Health - The New York Times
http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=3&ref=robertpear

Right there the government is getting involved, monetarily, with end of life care.

Read the 2 links from a liberal source you might be interested. If you want balance I'll posts something from a conservative source but I know you dont believe those sites.

well, yes, exactly.... all it says is that they want to go back to paying for end of life counseling.

why do you have a problem with people doing living wills?

 

[PLYMCO_PILGRIM]

Actually, that's the part you're making up.

Not exactly

Medicare - Health - The New York Times
http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=3&ref=robertpear

Right there the government is getting involved, monetarily, with end of life care.

Read the 2 links from a liberal source you might be interested. If you want balance I'll posts something from a conservative source but I know you dont believe those sites.

well, yes, exactly.... all it says is that they want to go back to paying for end of life counseling.

why do you have a problem with people doing living wills?

When were we discussing living wills again? Lets try and not throw strawmen at each other.

Read both links, along with the HC bill and the parts of the stimulus bill that have HC in them, and you will see that the doctors only get paid if they give the advice the government official reccomends.

 

[Zoom-boing]

Government is interested in cost reduction. Insurance companies are interested in profit. Is there really a difference? Probably not. Still, government has become too involved in too many facets of . . . . everything.

Ah well, someday we will all be dead. That there is a fact, Jack. Off to the mall!

 

[PLYMCO_PILGRIM]

Government is interested in cost reduction. Insurance companies are interested in profit. Is there really a difference? Probably not. Still, government has become too involved in too many facets of . . . . everything.

Ah well, someday we will all be dead. That there is a fact, Jack. Off to the mall!

Not really zoom, they are basically the same thing.

Where the difference is comes in efficiency. What is more efficient a private company or the federal government? With all the inherent waste that comes with government, in the end, we will have less money available for care and more going to waste.

 

[jillian]

Not exactly

Medicare - Health - The New York Times
http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=3&ref=robertpear

Right there the government is getting involved, monetarily, with end of life care.

Read the 2 links from a liberal source you might be interested. If you want balance I'll posts something from a conservative source but I know you dont believe those sites.

well, yes, exactly.... all it says is that they want to go back to paying for end of life counseling.

why do you have a problem with people doing living wills?

When were we discussing living wills again? Lets try and not throw strawmen at each other.

Read both links, along with the HC bill and the parts of the stimulus bill that have HC in them, and you will see that the doctors only get paid if they give the advice the government official reccomends.

you need to start reading with some understanding. end of life counseling is about how people should plan their medical care at the end. the PURPOSE is for them to prepare living wills to state their intent.

a lot of loons are running around calling that death panels.

that's what.

doctors NOW don't get paid if the insurance company tells them not to perform a procedure. i'm not quite sure what is so difficult about this.

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