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

[Revere]

Is it a representative republic when Congress explicitly strips or votes down provisions like death panels or legislation like cap and tax, and unelected bureucrats implement them anyway?

No, that is not representative government.

 

[Trajan]

Any agency that can write a regulation like this without the oversight of a real representative goverment needs to be de-funded.

I realize American Government isn't covered well in schools anymore but this is how your government works. Congress explicitly delegates implementation responsibilities to the executive branch in its legislation. HHS was given authority in the law to do this.

`Annual Wellness Visit

`(hhh)
(1) The term `personalized prevention plan services' means the creation of a plan for an individual--

`(A) that includes a health risk assessment (that meets the guidelines established by the Secretary under paragraph (4)(A)) of the individual that is completed prior to or as part of the same visit with a health professional described in paragraph (3); and
`(B) that--

`(i) takes into account the results of the health risk assessment; and
`(ii) may contain the elements described in paragraph (2).​

`(2) Subject to paragraph (4)(H), the elements described in this paragraph are the following:

`(A) The establishment of, or an update to, the individual's medical and family history.
`(B) A list of current providers and suppliers that are regularly involved in providing medical care to the individual (including a list of all prescribed medications).
`(C) A measurement of height, weight, body mass index (or waist circumference, if appropriate), blood pressure, and other routine measurements.
`(D) Detection of any cognitive impairment.
`(E) The establishment of, or an update to, the following:

`(i) A screening schedule for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices, and the individual's health status, screening history, and age-appropriate preventive services covered under this title.
`(ii) A list of risk factors and conditions for which primary, secondary, or tertiary prevention interventions are recommended or are underway, including any mental health conditions or any such risk factors or conditions that have been identified through an initial preventive physical examination (as described under subsection (ww)(1)), and a list of treatment options and their associated risks and benefits.​

`(F) The furnishing of personalized health advice and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
`(G) Any other element determined appropriate by the Secretary.​

.
.
.
`(4) (H) The Secretary shall issue guidance that--

`(i) identifies elements under paragraph (2) that are required to be provided to a beneficiary as part of their first visit for personalized prevention plan services; and
`(ii) establishes a yearly schedule for appropriate provision of such elements thereafter.'.​

The bolded bits are the source of the authority (granted by Congress) for CMS (inside HHS) to decide what the components of the annual wellness visit will be. Indeed, that guidance ordered by the law is what this regulation is. And regs are subject to Congressional oversight.

did the democrats strip the provision out, or not when it became the topic du jour during the bills run up etc.?

 

[Greenbeard]

did the democrats strip the provision out, or not when it became the topic du jour during the bills run up etc.?

It was never in the ACA.

 

[SFC Ollie]

Any agency that can write a regulation like this without the oversight of a real representative goverment needs to be de-funded.

I realize American Government isn't covered well in schools anymore but this is how your government works. Congress explicitly delegates implementation responsibilities to the executive branch in its legislation. HHS was given authority in the law to do this.

`Annual Wellness Visit

`(hhh)
(1) The term `personalized prevention plan services' means the creation of a plan for an individual--

`(A) that includes a health risk assessment (that meets the guidelines established by the Secretary under paragraph (4)(A)) of the individual that is completed prior to or as part of the same visit with a health professional described in paragraph (3); and
`(B) that--

`(i) takes into account the results of the health risk assessment; and
`(ii) may contain the elements described in paragraph (2).​

`(2) Subject to paragraph (4)(H), the elements described in this paragraph are the following:

`(A) The establishment of, or an update to, the individual's medical and family history.
`(B) A list of current providers and suppliers that are regularly involved in providing medical care to the individual (including a list of all prescribed medications).
`(C) A measurement of height, weight, body mass index (or waist circumference, if appropriate), blood pressure, and other routine measurements.
`(D) Detection of any cognitive impairment.
`(E) The establishment of, or an update to, the following:

`(i) A screening schedule for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices, and the individual's health status, screening history, and age-appropriate preventive services covered under this title.
`(ii) A list of risk factors and conditions for which primary, secondary, or tertiary prevention interventions are recommended or are underway, including any mental health conditions or any such risk factors or conditions that have been identified through an initial preventive physical examination (as described under subsection (ww)(1)), and a list of treatment options and their associated risks and benefits.​

`(F) The furnishing of personalized health advice and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
`(G) Any other element determined appropriate by the Secretary.​

.
.
.
`(4) (H) The Secretary shall issue guidance that--

`(i) identifies elements under paragraph (2) that are required to be provided to a beneficiary as part of their first visit for personalized prevention plan services; and
`(ii) establishes a yearly schedule for appropriate provision of such elements thereafter.'.​

The bolded bits are the source of the authority (granted by Congress) for CMS (inside HHS) to decide what the components of the annual wellness visit will be. Indeed, that guidance ordered by the law is what this regulation is. And regs are subject to Congressional oversight.

I do believe that if Obama shit on your dinner you would believe it was good for you.

 

[TossObama]

Is it a representative republic when Congress explicitly strips or votes down provisions like death panels or legislation like cap and tax, and unelected bureucrats implement them anyway?

No, that is not representative government.

***How about the unspoken part of this mess that forces us to accommodate their dope addictions by making dope "legal", rampant and deadly psychosis in what was once actually Medical Care and stripping away any and all protections that once kept all of us safe from scumbags like the Netherlands mentality? Normal decent people suddenly find themselves in violation of the "law" when they protest this garbage.

How about that "Christmas Gift" Planned Parenthood handed out this year -- a pre-paid Abortion card.

What we've got in positions of authority now seem to have serious Frontal Lobe damage to their brains FROM CHRONIC DRUG ABUSE. Nothing about ANYTHING that's being done is FOR the benefit of the American people, and we are being dragged around by the tail by a bunch of crazies.

I'll tell you one thing, Texas is Ticked Off. We've had enough and we are going to send Rick Perry to D.C. to clean this stinking mess up. And I guarantee you he ain't nobody a scumbag wants to deal with. This country is in such a mess Rick Perry is the only person in the country who can clean it up. And watch 'em duck and run when he shows up.

 

[TossObama]

End of life decisions are tough. We have some sense of this complex issue as our parents are still living, but all are in their eighties or above. My mom recently told the doctors she wants not another test or scan or drug or anything. She is 90 and while she can get around realizes they ain't gonna make her 35 again. Doctors are interested in prolonging life even against the wishes of the person and family, and sadly they are into money too, as hospitals do one expensive test after another. One fact of life that conservatives somehow fail to realize is without some regulatory structure life would be chaos. Dignity lost as the body exists, but the person is gone. There is nothing wrong with having these talks before that final breath and eternity.

"The new Medicare regulation covering physicians’ discussions with their patients about end-of-life issues is once again under attack by right-wing ideologues. The new rule is specifically designed to give patients the opportunity to explain their wishes about end-of-life care to their personal physicians. It represents a thoughtful and valuable step toward allowing patients to control decisions about their own health care." http://www.nytimes.com/2010/12/29/opinion/l29medicare.html


Why end-of-life planning is smart, necessary - CNN.com

I don't know what 3rd world country you spewed from, but in this country our Doctors have NEVER been confined by any law that forces them or their Patients into any type of medical care. Furthermore, every Doctor that's worth his/her salt WANTS the Patient and the Family involved in the care.

So you tell me what this "end of life" crap is all about. It's about legalizing medical murder.

 

[TossObama]

For reference, the offending piece of the regulation (p. 238), regarding components of the new Medicare annual wellness visit.

Comment: We received a number of comments from physicians, health care providers, and others urging us to add voluntary advance care planning as an element to the definitions of both the ‘‘first annual wellness visit’’ and the ‘‘subsequent annual wellness visit.’’

*** Did anyone actually check out the "physicians, and health care providers" who were making those demands??

I did.

Every single one of them wanted (1) medical murder, (2) the right to experiment on the patient without their knowledge or consent and, (3) wanted the right to "harvest" the dead body without consent after they were medically murdered or died under any condition.

As a matter of fact, every single photo of distressed and so-called "anxious and suffering" patient AND FAMILY they presented happened to be a Patient who was a mess because of very poor Nursing care.

They know it, I know it, and I'm sure as hell not going to shut up and go away about this matter.

 

[TossObama]

I realize American Government isn't covered well in schools anymore but this is how your government works. Congress explicitly delegates implementation responsibilities to the executive branch in its legislation. HHS was given authority in the law to do this.

`Annual Wellness Visit

`(hhh)
(1) The term `personalized prevention plan services' means the creation of a plan for an individual--

`(A) that includes a health risk assessment (that meets the guidelines established by the Secretary under paragraph (4)(A)) of the individual that is completed prior to or as part of the same visit with a health professional described in paragraph (3); and
`(B) that--

`(i) takes into account the results of the health risk assessment; and
`(ii) may contain the elements described in paragraph (2).​

`(2) Subject to paragraph (4)(H), the elements described in this paragraph are the following:

`(A) The establishment of, or an update to, the individual's medical and family history.
`(B) A list of current providers and suppliers that are regularly involved in providing medical care to the individual (including a list of all prescribed medications).
`(C) A measurement of height, weight, body mass index (or waist circumference, if appropriate), blood pressure, and other routine measurements.
`(D) Detection of any cognitive impairment.
`(E) The establishment of, or an update to, the following:

`(i) A screening schedule for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices, and the individual's health status, screening history, and age-appropriate preventive services covered under this title.
`(ii) A list of risk factors and conditions for which primary, secondary, or tertiary prevention interventions are recommended or are underway, including any mental health conditions or any such risk factors or conditions that have been identified through an initial preventive physical examination (as described under subsection (ww)(1)), and a list of treatment options and their associated risks and benefits.​

`(F) The furnishing of personalized health advice and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
`(G) Any other element determined appropriate by the Secretary.​

.
.
.
`(4) (H) The Secretary shall issue guidance that--

`(i) identifies elements under paragraph (2) that are required to be provided to a beneficiary as part of their first visit for personalized prevention plan services; and
`(ii) establishes a yearly schedule for appropriate provision of such elements thereafter.'.​

The bolded bits are the source of the authority (granted by Congress) for CMS (inside HHS) to decide what the components of the annual wellness visit will be. Indeed, that guidance ordered by the law is what this regulation is. And regs are subject to Congressional oversight.

I do believe that if Obama shit on your dinner you would believe it was good for you.

He's a paid goon, Ollie. He's just doing his job.

*** Excuse me. Patients are being advised NOT to go in for the "Welcome to Medicare" visit and there are valid reasons why.

All that info goes into a central data base, and if the Patient records show there are no diseases to prevent harvesting, guess what -- upon expiration, that Patient gets harvested.

I have never seen a more dangerous and deadly "law" aimed at the American people, and it should not be tolerated.

 

[Trajan]

did the democrats strip the provision out, or not when it became the topic du jour during the bills run up etc.?

It was never in the ACA.

I see, so I'll ask the Q 2 different ways;

it was never considered as part of the bill before it was voted upon, at any time?

or-

did the dems not go through with putting it the final bill for vote, when it became a question that garnered public review and became rightly or wrongly a source of consternation?

 

[geauxtohell]

Real Nurses have been rescuing Patients from scum like you in so-called "hospice". And golly, isn't it amazing that once a Patient is taken care of properly BY NURSES, they are no longer targets for medical murder.

You consider hospice care to be "medical murder"?

That's stupid.

I take it you are involved the medical profession to some extent. Have you ever visited a hospice and talked to hospice patients?

You apparently wanted to attack another poster in your rant, you came off looking stupid in the process.

And this:

Folks, what Luissa doesn't want you to know is this: If you or your loved one has been forced into Medicare, you are not considered anything but government property. You and your family cannot refuse or stop the harvesting of your body, nor can you refuse medical experimentation. You cannot even refuse the "free" Medicare, nor can you send your Medicare card back.

Is beyond stupid.

 

[geauxtohell]

I'm sorry, but my father spent a week in a hospice where he was cared for as a human being should be. He actually improved enough that they told us he should go back to a constant care facility as it wasn't his time yet. I saw nothing from the staff but caring and understanding.

I have no idea what T.O.B. does in the medical profession (though I am sure they will tell us), but I haven't encountered anyone in healthcare who has such a low regard for hospice care. It seems to be more in line of the "old school" mentality from the late 70's that made it so hard for hospice to gain credibility in the medical industry. We are now decades away from that debate.

God forbid we try and alleviate suffering in a terminal patient. They should just suffer excruciating pain until they die. That's the way God would have wanted it.

I am glad your father had access to hospice care. I've spent some time in our local hospice talking with the patients. I haven't met any of them (or their families) that weren't thankful for hospice. That makes sense, as with any care, patients can refuse hospice if they want. It's not forced on anyone.

 

[Greenbeard]

Any agency that can write a regulation like this without the oversight of a real representative goverment needs to be de-funded.

I realize American Government isn't covered well in schools anymore but this is how your government works. Congress explicitly delegates implementation responsibilities to the executive branch in its legislation. HHS was given authority in the law to do this.

`Annual Wellness Visit

`(hhh)
(1) The term `personalized prevention plan services' means the creation of a plan for an individual--

`(A) that includes a health risk assessment (that meets the guidelines established by the Secretary under paragraph (4)(A)) of the individual that is completed prior to or as part of the same visit with a health professional described in paragraph (3); and
`(B) that--

`(i) takes into account the results of the health risk assessment; and
`(ii) may contain the elements described in paragraph (2).​

`(2) Subject to paragraph (4)(H), the elements described in this paragraph are the following:

`(A) The establishment of, or an update to, the individual's medical and family history.
`(B) A list of current providers and suppliers that are regularly involved in providing medical care to the individual (including a list of all prescribed medications).
`(C) A measurement of height, weight, body mass index (or waist circumference, if appropriate), blood pressure, and other routine measurements.
`(D) Detection of any cognitive impairment.
`(E) The establishment of, or an update to, the following:

`(i) A screening schedule for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices, and the individual's health status, screening history, and age-appropriate preventive services covered under this title.
`(ii) A list of risk factors and conditions for which primary, secondary, or tertiary prevention interventions are recommended or are underway, including any mental health conditions or any such risk factors or conditions that have been identified through an initial preventive physical examination (as described under subsection (ww)(1)), and a list of treatment options and their associated risks and benefits.​

`(F) The furnishing of personalized health advice and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
`(G) Any other element determined appropriate by the Secretary.​

.
.
.
`(4) (H) The Secretary shall issue guidance that--

`(i) identifies elements under paragraph (2) that are required to be provided to a beneficiary as part of their first visit for personalized prevention plan services; and
`(ii) establishes a yearly schedule for appropriate provision of such elements thereafter.'.​

The bolded bits are the source of the authority (granted by Congress) for CMS (inside HHS) to decide what the components of the annual wellness visit will be. Indeed, that guidance ordered by the law is what this regulation is. And regs are subject to Congressional oversight.

I do believe that if Obama shit on your dinner you would believe it was good for you.

Are you suggesting I'm giving Obama credit for the invention of the executive branch? Really, I'm not.

 

[boedicca]

Here's a good example of the rationing employed by the NHS which their biggest fan, Dr. Berwick, will likely emulate.

The NHS will pay for the treatment of macular degeneration in only one eye of an elderly patient in order to save £1,500.

Thousands of patients will be condemned to blindness because of a decision to ration the NHS treatment which could save their sight, leading charities warned last night.

They said that patients with macular degeneration, the most common cause of blindness in the elderly, would effectively have to lose the use of an eye before qualifying for therapy to save their remaining vision.

Their condemnation came as the NHS drug rationing body, the National Institute for Clinical Excellence (NICE), recommended restrictions on funding a treatment for the condition.

Macular degeneration affects two million people in Britain. One version, wet age-related macular degeneration (AMD), can mean loss of sight in the affected eye within three to five months of diagnosis.

It is the principal cause of irreversible blindness in Britain but the sight of many sufferers can be saved at a cost of around £1,500 per patient if treated early enough.

AMD is caused by blood vessels growing under the central part of the retina. When they leak fluid, scar tissue forms and vision can be destroyed. Photodynamic-therapy (PDT) uses laser light to activate a drug, Visudyne, which seals the blood vessels and stops further damage.

It is routinely available in most European Union countries and in North America.

The treatment has been available in Britain for 18 months at 100 hospitals and 500 patients have been treated.

But now NICE's ruling says Visudyne should be used to maintain vision in only one eye in cases of age-related macular degeneration - either the better seeing one or the remaining functioning one where sight has been lost in the other....

You must go blind in one eye before NHS will treat you | Mail Online



So after years of working and paying taxes, one's reward is half blindness in order to save the NHS £1,500. If that's the government's attitude over a small amount of money, just think about how they will treat very expensive protocols.

 

[Revere]

What is the Constitutional authority of the exectuve branch to order agencies to write rules which were explicitly voted down by the Legislative branch?

 

[logical4u]

You are talking about the way it is now.

Under ObamaCare, there are dozens of agencies that will decide what is covered. It's quite clear that where this is headed is that certain procedures will be denied to people over a certain age.

It's happened in the UK.
It's happened in Canada.
It will happen here.

Read up on Dr. Berwick. His philosophical bias is apparent.

That is the point.

Every time the government is given the power to control something that was controlled by the market, it messes it up. It doesn't make it better. It doesn't make it less expensive. It ruins it. All we are asking is that you take a serious look at the history of government-run or any other health-care that is administered by people that can subvert medical funds to another place and see what has happened.

When Hitler took office, everyone said that it was great. He "fooled" the majority of the people. After they continued to "give him" power and he showed his "real intentions", it was too late to stop him. This "healthcare bill" is Hitler in the beginning stages. If you stomp all over it now, and make sure the "power" is "limited", then we will not re-live history. If you continue to support the government being able to tell you what you "must buy" and what you "must accept" for health care, you are welcoming that attitude into EVERY aspect of citizens' lives. Personally, no thank you, I do not want some political hack that owes a hospital in my area a favor, so it directs all citizens within a 100 mile radius to "use" that hospital. I do not want my care to be "earmarked" by any in congress.

 

[geauxtohell]

I'll tell you one thing, Texas is Ticked Off. We've had enough and we are going to send Rick Perry to D.C. to clean this stinking mess up. And I guarantee you he ain't nobody a scumbag wants to deal with. This country is in such a mess Rick Perry is the only person in the country who can clean it up. And watch 'em duck and run when he shows up.

Oh, yeah. That's just what America needs. Another fucking president from Texas, because the last two were so great for our country.

I am continually amused by the delusions of grandeur that some Texans have about their state.

 

[Trajan]

Here's a good example of the rationing employed by the NHS which their biggest fan, Dr. Berwick, will likely emulate.

The NHS will pay for the treatment of macular degeneration in only one eye of an elderly patient in order to save £1,500.

Thousands of patients will be condemned to blindness because of a decision to ration the NHS treatment which could save their sight, leading charities warned last night.

They said that patients with macular degeneration, the most common cause of blindness in the elderly, would effectively have to lose the use of an eye before qualifying for therapy to save their remaining vision.

Their condemnation came as the NHS drug rationing body, the National Institute for Clinical Excellence (NICE), recommended restrictions on funding a treatment for the condition.

Macular degeneration affects two million people in Britain. One version, wet age-related macular degeneration (AMD), can mean loss of sight in the affected eye within three to five months of diagnosis.

It is the principal cause of irreversible blindness in Britain but the sight of many sufferers can be saved at a cost of around £1,500 per patient if treated early enough.

AMD is caused by blood vessels growing under the central part of the retina. When they leak fluid, scar tissue forms and vision can be destroyed. Photodynamic-therapy (PDT) uses laser light to activate a drug, Visudyne, which seals the blood vessels and stops further damage.

It is routinely available in most European Union countries and in North America.

The treatment has been available in Britain for 18 months at 100 hospitals and 500 patients have been treated.

But now NICE's ruling says Visudyne should be used to maintain vision in only one eye in cases of age-related macular degeneration - either the better seeing one or the remaining functioning one where sight has been lost in the other....

You must go blind in one eye before NHS will treat you | Mail Online



So after years of working and paying taxes, one's reward is half blindness in order to save the NHS £1,500. If that's the government's attitude over a small amount of money, just think about how they will treat very expensive protocols.

Thats an apocalyptic and marginal example.

and, : "in the land of the blind" and all that

 

[logical4u]

You are talking about the way it is now.

Under ObamaCare, there are dozens of agencies that will decide what is covered. It's quite clear that where this is headed is that certain procedures will be denied to people over a certain age.

It's happened in the UK.
It's happened in Canada.
It will happen here.

Read up on Dr. Berwick. His philosophical bias is apparent.

Again, I won't try and argue hypotheticals with you guys.

As it stands, this is a damn smart policy issue.

That is great, can we list you as one of the great "heroes" that condemned us into servitude, instead of citizenry.

 

[Greenbeard]

What is the Constitutional authority of the exectuve branch to order agencies to write rules which were explicitly voted down by the Legislative branch?

What was voted down?

 

[logical4u]

And who was that?

Most Republicans and some democrats. Since so much was done behind closed doors who knows? This is one thing I believe the people voted against last month. You know the secret deals and special deals for votes. All the back room meetings, Generally the dirty politics. But hey, I could be wrong, maybe there was another reason the republicans picked up over 60 seats......

Oh. As I wouldn't trust the GOP to pick up trash in my neighborhood, I see that I am not among the "we".

Would you trust the "GOP" to run "your" health care?