WASHINGTON — When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1. Under the new policy, outlined in a Medicare regulation, 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. (1)
Put another way after resistance from a large portion of the citizens that elected them, Congress removed payments for “end of life planning” and then passed the health care reform bill. Then a non-elected bureaucrat reinstates the very same thing as a new Medicaid rule.
Here are the details: the “Americans Affordable Health Choices Act of 2009” was passed by the House in November 2009. But not included in the final legislation was Section 1233, — that section allowed Medicare to pay for doctor/patient consultations about “advance care planning. Section 1233 was removed under withering criticism by Conservatives who feared the Government, who was paying for the health care, might have a vested interest in withholding that health care from senior citizens as a way to save money (the Sarah Palin “death panels”). This view was not without merit after reading comments from Dr. Berwick, the author of the new regulations.
” Dr. Berwick has said “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.” (Italics are mine). The key words here “inappropriate care” and “lower cost”! Personally I am not comfortable someone in Washington deciding care is inappropriate!
Dr. Berwick a fan of the British National Health Service and has argued strongly for rationing health care to the elderly. The President Obama recently said “The chronically ill and those towards the end of their lives are accounting for potentially 80 percent of the total health care bill out here . . . there is going to have to be a very difficult democratic conversation that takes place”.(2)
Does the phrase and "toward the end of their lives” make anyone else a little uneasy? Who will determine when you are “toward the end of your life”? The government? Dr. Berwick?
Dr. Berwick himself has said “The Decision Is Not Whether Or Not We Will Ration Care—The Decision Is Whether We Will Ration With Our Eyes Open.” (3)
Do you want someone sitting in Washington to decide what inappropriate care is when you are toward the end of your life? We might have an idea what the future of the government health care might look like in this country by looking at Dr. Berwick’s beloved UK health care system where they have an elaborate formula to determine your “quality” and length of life and how and what care you receive.
One other interesting fact of this whole story is Berwick was appointed with a recess appointment because the President feared he could not get enough votes in congress to get such a radical figure confirmed as required for a cabinet position. (A recess appointment is an option that the President has to appoint a cabinet member when such appointment is necessary and Congress is not in session, most often used to appoint someone who would not have the votes in congress be approved for the appointment. This appointment does not have to be voted on by Congress until the end of the next congressional session)
So we have Congress passing a hugely unpopular 2600 page heath insurance law that congressional members admit no one read. Congress did omit one of the most unpopular sections of that bill. Only then to have a White House appoints a man to oversee large portions of this law. This appointment is so unpopular the President does an end run around Congress with a recess appointment. Then this appointee immediately reinstating that same section congress rejected using his bureaucratic power granted to him by his new position.
The continuing and increasingly popular end runs around the Constitution not only by the courts but now by the White House are slowly chipping away at the constitutional power of the citizens of this country. It is that constitutional power that we use to control the workings of the federal government through our elected officials.
It’s hard to decide which is the biggest threat to our Liberty: the unconstitutional and overbearing laws and rules, or the method with which they are enacted.
(1)New York times Dec 25 2010
(2)NYT Magazine interview April 28 2009
(3) June 2009 interview for the magazine, Biotechnology Healthcare:
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