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

[geauxtohell]

And above all else; dirty politics and a stab in the back to those who fought against it.

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".

 

[SFC Ollie]

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".

Did I say "we"?

 

[geauxtohell]

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".

Did I say "we"?

Apologies. "Those".

 

[theDoctorisIn]

Just because something is personally smart for a person to do doesn't justify the government wielding power over the individual to do it.

I agree completely.

It's a shame that the legislation in question has nothing to do with your statement.

It doesn't "wield power over the individual". It "wields power" over Medicare to make sure it pays for it.

 

[jillian]

And above all else; dirty politics and a stab in the back to those who fought against it.

things get brought up again all the time. calling this 'dirty politics' seems to miss the point of how things get done. sometimes there are wording changes; sometimes it's taken off of another bill; or put on another bill.

in this case, i don't actually think it *was* ever voted on. i think it got pulled because of the propagandists calling it 'death panels'.

now which would you say is dirty politics? people lying about what the bill says? or actually bringing it up for a vote? or even bringing it up AGAIN for a vote.

 

[midcan5]

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

 

[Zoom-boing]

Question . . . . if my mom or dad (83 and 88) went to the doctor for whatever and in the course of that appointment discussed end-of-life plans, Medicare wouldn't pay for that (pre any of this)?

 

[Samson]

My Father had a living will. He insisted that he was not to be a burden to any of us and that he was to have no artificial prolonged life. When he decided not to eat (he was conscious and speaking) And the Hospital wanted to place him on life support and force feed him through a tube, we moved him from the Hospital to a Hospice. A week later he was eating and doing so much better we had to move him back to a full service assisted living. He died a week later from a blood clot. But the Government had no bearing on what actions we took or the decisions he had earlier made.

What is so hard to get? The government will have no bearing on your decisions.

Actually, discussing this new "Obamacare" with my family doctor (and good friend) he made one statement that you have to wonder about. When the subject of rationed health care came up he said " That's already being done."

So, is he holding up your Viagra refills?

 

[SFC Ollie]

What is so hard to get? The government will have no bearing on your decisions.

Actually, discussing this new "Obamacare" with my family doctor (and good friend) he made one statement that you have to wonder about. When the subject of rationed health care came up he said " That's already being done."

So, is he holding up your Viagra refills?

Nope, he has strict instructions that should I ever need viagra to take me out back and shoot me.

 

[SFC Ollie]

And above all else; dirty politics and a stab in the back to those who fought against it.

things get brought up again all the time. calling this 'dirty politics' seems to miss the point of how things get done. sometimes there are wording changes; sometimes it's taken off of another bill; or put on another bill.

in this case, i don't actually think it *was* ever voted on. i think it got pulled because of the propagandists calling it 'death panels'.

now which would you say is dirty politics? people lying about what the bill says? or actually bringing it up for a vote? or even bringing it up AGAIN for a vote.

Well, that's interesting. I suppose it's all dirty politics, and it needs to end (we know it won't). But then again How can one lie about what's in it when "We have to pass it to see what's in it."

It's a bad bill.

 

[Samson]

Actually, discussing this new "Obamacare" with my family doctor (and good friend) he made one statement that you have to wonder about. When the subject of rationed health care came up he said " That's already being done."

So, is he holding up your Viagra refills?

Nope, he has strict instructions that should I ever need viagra to take me out back and shoot me.

I wonder if Medicare or Obamacare will cover that.

 

[Greenbeard]

Question . . . . if my mom or dad (83 and 88) went to the doctor for whatever and in the course of that appointment discussed end-of-life plans, Medicare wouldn't pay for that (pre any of this)?

Medicare pays for it now as part of the "Welcome" visit. That's the one-time wellness visit Medicare beneficiaries get when they first become eligible for Medicare. Before health care reform, Medicare didn't pay for an annual wellness visit. Now it will. The regulation this thread is about just ensures that end-of-life planning is offered as part of that visit, if the beneficiary wants it.

 

[TossObama]

"WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives."

Doesn't sound exactly like (and this is from memory so I could get a few words wrong)

"Maybe Grandma doesn't need a pacemaker or an operation, maybe she only needs a pill."

If grandma is going to die in six months anyways, and is already on hospice, she probably only needs a pill. This plan, doesn't mean she can't get a pacemaker if she wants one. It just means the doctor will inform her of her options, and what would be her best option.

*******All right Luissa, I've read all your postings I can stomach. Now I'm commenting.

You are the very LAST person I'd ever want taking care of my loved one or me, in any situation. You obviously think nobody can see through the smoke and whistles in your postings. Kiddo, you are no Nurse. 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. Real Nurses actually protect their Patients from people like Luissa.

To the rest of you, let me explain what Luissa appears to be. Luissa is what real Nurses call a "Certified Tootsie Girl". What is that? She/he is likely "certified", not educated.

Their job is simply to murder patients.

Those "certified" murderers are usually psychological sickies, by the way, and this alone prevents them from participating in valid Patient Care. They are considered "unemployable" in any level of valid Nursing. Why? They kill Patients. It's "hospice" who sniffs those sickies out for employment.

And Luissa, what's that you said about little chats about "end of life"???? Do you really want me to go there, Luissa?????????? Well, to hell with what you want. I'm goin there.

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.

This trash that's in office will force you to pay back all the Social Security monies you've received if you send back your Medicare card. You are allowed to refuse the Medicare you have to pay additionally for.

They don't consider that all those forced salary withdrawals from your paychecks were "payments" for the Medicare card you are forced to accept. Anyway, that Medicare card is actually akin to what the nazis forced the Jews and Jehova Witnesses to sew on their coats. It is NOT medical insurance, it is not medical care. Our own government regards it as ownership of your body.

Luissa and psychotics who get their kicks murdering patients, aren't found anywhere in a hospital EXCEPT the Chaplains office. Do What?? Tootsie girls aren't medical personnel, remember? The god-guy is who comes in with his "spiritual" b.s., gets the patient to sign the end of life document, and 15 minutes later in prances the Tootsie Girl with the kill meds.

There is absolutely no verbage whatsoever in those documents that would give any clue whatsoever to any patient, that they just gave permission for the Tootsie Girl to kill them. It's what the "democrats" (particularly the Netherlands pod of crazies) call "interpretation".

What this means, folks, is someone has to pay the god-guy for getting you to sign that paper. It isn't about paying a Medical Doctor to explain medical issues to you. The dang "doctor" in this picture is a DOCTOR OF DIVINITY, a god-guy with a Tootsie Girl in tow.

I can't wait for your responses to me Luissa. I can't wait.

By the way folks, there's a LOT more to this issue. A LOT MORE.

I'm waiting for your response, Luissa.

 

[Greenbeard]

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.’’ They base their recommendation upon a number of recent research studies, and the inclusion by statute of a similar element in the existing initial preventive physical examination (IPPE) benefit. One commenter noted that ‘‘the new wellness visit was wisely designed to build on the initial preventive physical exam, providing an ongoing, systematic focus on wellness and prevention by harmonizing Medicare services into a coordinated benefit.’’ Another commenter stated that ‘‘the AWV provides an appropriate setting for providers to initiate voluntary conversations about future care wishes, as they counsel beneficiaries on other aspects of their health and achieving their personal health goals.’’ The commenter added that the ‘‘care plans discussed in the ’Welcome to Medicare visit’ should not be frozen in time, but revisited as an important component of patient wellness.’’

Response: We agree that voluntary advance care planning should be added as an element of the definitions of both the ‘‘first annual wellness visit’’ and the ‘‘subsequent annual wellness visit’’ based on the evidence described below, and the inclusion of a similar element in the IPPE benefit (also referred to as the Welcome to Medicare visit), since January 1, 2009. We believe that this will help the physician to better align the personal prevention plan services with the patient’s personal priorities and goals.

Recently, Detering and colleagues (British Medical Journal 2010; 340:c1345) reported that ‘‘advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives.’’ Silveira and colleagues (New England Journal of Medicine 2010; 362:1211–8) reported that ‘‘data suggest that most elderly patients would welcome these discussions.’’ Lastly, a study by Fischer and colleagues (Journal of the American Geriatric Society 2010; 58:400–401) found ‘‘no evidence that these (advance directive) discussions or completing an advance directive lead to harm.’’

Based on the available evidence and other relevant information, we are adding to the final regulation a definition of the term ‘‘voluntary advance care planning’’ to read as
follows:

‘‘Voluntary advance care planning’’ means, for purposes of this section, verbal or written information regarding the following areas:

(1) An individual’s ability to prepare an advance directive in the case where an injury or illness causes the individual to be unable to make health care decisions.
(2) Whether or not the physician is willing to follow the individual’s wishes as expressed in an advance directive.

This definition is based on the definition of ‘‘end-of-life planning’’, which is included as an element of the IPPE as described in section 1861(ww)(3) of the Act. Thus, the addition of ‘‘voluntary advance care planning’’ to the AWVs extends to those visits a similar element to the one already in the one-time IPPE.

We are also revising the definitions of the terms ‘‘First annual wellness visit’’ and ‘‘Subsequent annual wellness visit’’ by inserting a new element (ix) to the definition of the term ‘‘first annual wellness visit’’ and a new element (vii) to the definition of the term ‘‘subsequent annual wellness visit’’ in § 410.15 (a) of the final regulation text that would read as follows: ‘‘Voluntary advance care planning as that term is defined in this section upon agreement with the individual.’’

 

[Revere]

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

 

[SFC Ollie]

"WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives."

Doesn't sound exactly like (and this is from memory so I could get a few words wrong)

"Maybe Grandma doesn't need a pacemaker or an operation, maybe she only needs a pill."

If grandma is going to die in six months anyways, and is already on hospice, she probably only needs a pill. This plan, doesn't mean she can't get a pacemaker if she wants one. It just means the doctor will inform her of her options, and what would be her best option.

*******All right Luissa, I've read all your postings I can stomach. Now I'm commenting.

You are the very LAST person I'd ever want taking care of my loved one or me, in any situation. You obviously think nobody can see through the smoke and whistles in your postings. Kiddo, you are no Nurse. 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. Real Nurses actually protect their Patients from people like Luissa.

To the rest of you, let me explain what Luissa appears to be. Luissa is what real Nurses call a "Certified Tootsie Girl". What is that? She/he is likely "certified", not educated.

Their job is simply to murder patients.

Those "certified" murderers are usually psychological sickies, by the way, and this alone prevents them from participating in valid Patient Care. They are considered "unemployable" in any level of valid Nursing. Why? They kill Patients. It's "hospice" who sniffs those sickies out for employment.

And Luissa, what's that you said about little chats about "end of life"???? Do you really want me to go there, Luissa?????????? Well, to hell with what you want. I'm goin there.

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.

This trash that's in office will force you to pay back all the Social Security monies you've received if you send back your Medicare card. You are allowed to refuse the Medicare you have to pay additionally for.

They don't consider that all those forced salary withdrawals from your paychecks were "payments" for the Medicare card you are forced to accept. Anyway, that Medicare card is actually akin to what the nazis forced the Jews and Jehova Witnesses to sew on their coats. It is NOT medical insurance, it is not medical care. Our own government regards it as ownership of your body.

Luissa and psychotics who get their kicks murdering patients, aren't found anywhere in a hospital EXCEPT the Chaplains office. Do What?? Tootsie girls aren't medical personnel, remember? The god-guy is who comes in with his "spiritual" b.s., gets the patient to sign the end of life document, and 15 minutes later in prances the Tootsie Girl with the kill meds.

There is absolutely no verbage whatsoever in those documents that would give any clue whatsoever to any patient, that they just gave permission for the Tootsie Girl to kill them. It's what the "democrats" (particularly the Netherlands pod of crazies) call "interpretation".

What this means, folks, is someone has to pay the god-guy for getting you to sign that paper. It isn't about paying a Medical Doctor to explain medical issues to you. The dang "doctor" in this picture is a DOCTOR OF DIVINITY, a god-guy with a Tootsie Girl in tow.

I can't wait for your responses to me Luissa. I can't wait.

By the way folks, there's a LOT more to this issue. A LOT MORE.

I'm waiting for your response, Luissa.

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.

 

[Ropey]

And above all else; dirty politics and a stab in the back to those who fought against it.

things get brought up again all the time. calling this 'dirty politics' seems to miss the point of how things get done. sometimes there are wording changes; sometimes it's taken off of another bill; or put on another bill.

in this case, i don't actually think it *was* ever voted on. i think it got pulled because of the propagandists calling it 'death panels'.

now which would you say is dirty politics? people lying about what the bill says? or actually bringing it up for a vote? or even bringing it up AGAIN for a vote.

There's the reality. With highly reworked material often what is left out or modified shows more about the drafting intentions than what is left in.

 

[Revere]

The dirty politics is removing it from a bill, only to have unelected bureaucrats write it back in as agency rules.

 

[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.

 

[Revere]

Congress should not so delegate.

The authority needs to be taken away.