President Obama at children's hospital. AP Photo J. Scott Applewhite
It seems Republicans are sinking to a new low in their all-out attempts to stop health care reform from happening. First Republicans called it socialism, then they said it would raise costs, now they say it will force the elderly to have end of life consultations. In a recent interview with between Fred Thompson and Dr. Betsy McCaughey claims are made that the elderly on Medicare will be "forced" into a consultation every five years to decline services and basically end their life. So basically Republicans are making HR 3200 out to be and enactment of euthanasia for the elderly.
The Republican claims are of course false. Page 425 can be found in Section 1233 of the full text of HR 3200 here. The Republicans chose to misconstrue the section and focus in on only that section but a broader reading is key to understanding statutes. You will notice that Section 1233 is actually under the larger category of "Miscellaneous Improvements" to Medicare Beneficiaries. There is a simple explanation for this. Section 1233 actually provides more benefits for seniors rather than denying any benefits.
You can read the full section for yourself but nowhere in the language of the bill does it say seniors are forced to undergo end of life consultations. In reality, what the section does is expand benefits to include advanced care planning so that if seniors want to see a doctor or nurse to, for example, be consulted on how to make a living will they can do so but are not forced to do so. The bill expands Medicare benefits to include such consultations. So in reality HR 3200 lets seniors, by their own choice, go to practitioner to find out about living wills, power of attorney, or health care proxies and have such visits covered by Medicare. Does that sound controversial to you? To me it sounds entirely practical that someone the age of 75 would want to see a doctor or nurse so they could let their wishes be known about end-of-life care. However, in order to scare people from reform the Republicans are twisting and torturing the language of this section to mean something it does not.
Comments
I'll buy into healthcare changes when Congress puts their coverage into the same hat as everyone elses'
I just received the email and it really made me made. I knew it wasn't true but the elderly will believe it. Need to get the word out that it is not true.
I'm with Larry. If this is such a great plan - then Congress, the Obama family, the Federal Government and the Labor Unions will be on THE EXACT SAME PLAN
seniors need to be aware.
I would encourage everyone to forward the link to this article or another article on to someone via email. If there is another article out there which explains the section better use that I am not really concerned about getting increased viewership I just want people to know the truth about the bill. I know the opposition to reform is emailing their spin on page 425 to everyone and it is spreading like crazy. Some counter balance needs to be added to the argument.
Accepting something as positive just because it's included in a section entitled, "Miscellaneous Improvements" to medicare beneficiaries, is as ludicrous as believing the government's motives in enacting the healthcare bill are well-intentioned. My reading of section #1233 certainly leaves me wondering what the government has in mind.
The bill is written by lawyers, and written in a way to make it difficult to interpret--that's why we have opposing opinions of the meaning. To assume that this bill will magically bring about improvements in heal care is both unwise and without basis in fact--based upon the performance of other government programs.
To John: Read the language yourself. Can you find ANYWHERE that it says seniors will be FORCED to have consultations? All the language points to these consultations being covered under the new reform but not being forced on these seniors. As it is now seniors have to pay for a lawyer to have a living will or advanced health directive drawn up. Under the reform they can go see a nurse or doctor for free to have one setup and it is covered under Medicare.
After reading the short bill, by Ryan I feel he is making his comments based on the wording no one can understand. After passing it would be said thats not what we said. They say what they want it to mean after it passes in to law
President Obama today at AARP town hall as well as Congress members have said the provision is meant to expand services and not to force consultations on anyone. The language is tricky I will give you that but if you dissect it carefully the intent is clear that services are to be provided but not forced upon anyone. Especially when you take the provision in context of where it is located in the bill. In analyzing the provision courts would look to: (1) The plain language (2) the legislative history such as statement by Obama and sponsors and (3) The spirit of the law. All three point toward expanding coverage for these consultations but not forcing them on anyone. Bottom line, if you want to read the provision as forcing consultation you have to invent things not there. If you read the bill to expand coverage to allow for consultations you just need to be able to read complex statutory language. Not all bills can be simply worded, particularly when they reform a huge system.
Don't change the subject. The writer is correct and has exposed the right wing liars in Washington. Typical evasion....
What has happened to the Republican Party? They have a chance of a lifetime to put in constructive criticism and offer their own solutions to one of the most important problems of our lifetime.
Instead they choose to whine ane undermine President Obama at every turn.
I suppose they believe in the adage, "if you say a lie often enough it becomes a truth to the listener"
Haven't they done enough damage already?
It does so say that advance care planning consultation ‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following: *****Just so you know Shall=MUST
not only that, there is a 5,000 deductible per individual and 10,000 per family per year. Read the link yourself
also, the addition of community based medical homes that will be paid per benificiary, per month. Can you say ACORN?
The deductible limits are for all care and do not apply to the elderly and poor. As for the "shall=must" argument, that is simply not true. The section you are quoting is defining advanced care. So if I define what a car is and say a car shall include an engine does that mean you MUST have a car...no it does not. The statute is defining what advanced care planning is not saying that every person must have advanced planning.
no, but a car MUST have an engine.
so, a 5,000 deductible for a single person who is not elderly or poor? what is elderly , what is poor? I know that I can't afford a 5,000 deductible
what part of Consultation "shall" have, don't you understand? Shall means MUST
Obama is lying again people open your eyes.
Page 425 of Health Care Bill
Health Care for ALL???
On page 425 it says in black and white that EVERYONE on Social Security, (will include all Senior Citizens and SSI people) will go to MANDATORY counseling every 5 years to learn and to choose from ways to end your suffering (*and your life*). Health care will be denied based on age. 500 Billion will be cut from Seniors health care. The only way for that to happen is to drastically cut health care, the oldest and the sickest will be cut first. Paying for your own care will not be an option.
Do you want Ritual Suicide ?
This is immoral !
As to deductibles, almost every private plan has deductibles along the same lines if not worse limits than that of the health reform bill. Poor is defined based on the poverty line. People with incomes up to 400% of the poverty line would receive subsidies. Elderly is defined by current Medicare standards.
As to the "shall" debate I am not sure how else I can explain it. Never does the statute say that every senior "shall" have a MANDATORY consultation. It says, instead an advanced planning consultation "shall" consist of advice on getting a living will, etc. Again, if I say a bird shall fly does that mean you will fly? No. You are making a logical jump that is just not there in the language of the statute. It is ironic that the statute actually allows get a living will or advanced directive for free but Republicans are trying to convince people they must get them. That is like saying Medicare forces people to get health care. It does not, it ALLOWS people to have care.
Pass it quick! Then we can tell you what's in it.
Trust me! I'm a politician from Chicago.
BO
So if sec. 1233 is not a federal mandate then why put it in at all? We don't need the Federal Govt to grant rights to us that we already have. Sec. 1233 is clearly preparatory to assumption of additional regulatory powers by the Feds. The writer of this blog has no problem with this. On what does he base his faith in the mgmt prowess of centralized govt? Social Security? Medicare? US Post Office? Deficit mgmt? Secondly, it is not Republican fear mongers that are saying this bill will increase costs; it is the politically neutral CBO that has stated this.
Every cause needs its useful fools and Ryan and the like are Obama's useful fools.
To not have a health care directive is stupid. We all have to die, but we can make choices as to what procedures are acceptable under certain conditions. I thank God that my parents completed a directive so that I felt more confident it upholding their wishes plus what I believed they would want to happen. Drs. do not seem to want to spend the time discussing all of the information that one needs to decide what to do in certain crisis situations, so advanced knowledge and decision making, coupled with assigning health care representatives that can speak for you in the event that you cannot speak for yourself, is essential. ex. When a persons organs start shutting down, should the Dr coninue to administer hydration with an I.V.? Will that at some point cause you to drown? Is it painful or uncomfortable when the fluids are backing up in your system and your body swelling up because the kidneys are failing?
The public needs this option desparately!
The president has a habit of sticking a foot in the door fully aware that he intends to open it wide. This suggestion of death counseling is a foot in the door to push assisted suicide as much as possible. Counselors on the government till will surely push this idea to the hilt!
Ryan, what you do not to recognize is the President by his own words wants to eliminate the cost of Senior Advantage insurance through Medicare. That will put all but MINIMAL health care out of reach for most Seniors currently retired. A cost savings at our expense so you can have better care.
It may be that Mr. Ryan has not investigated Rahm Emanuel's brother Ezekiel......an MD from California, whose papers espoused Eskimo care (Put Grandma on the ice flow and walk back to the village.) His credibility is top notch now.....he authored some of this crap into the Bill.
This new Mengele is a socialist and West hater, as are the others in the Obamanistas. Many of my generational peers were as well.
25% of Senior Care costs occur in the LAST YEAR of life.
The Gang has promised to cut Medicare by 3-5 billion dollars.
Anyone see the cost savings here?
And Mr Ryan......this needs to spread like wildfire......if the blaze only serves to slow this thing down.
Why, if it doesn't take effect for years, must it be passed in two weeks?
Mr. Ryan, I do not assume that you are part of the state run media (CNN et al) but page 425 of section 1233 is differently viewed when mixed with the "sheets" on his associates, Ayres,Wright,Emanuel, etc. This one walks like a
These rich insurance companies are making "obscene" profits (Pelosi)
These insurance companies need competition. They wont go out of business. (Obama)
Lets see......private companies must at least break even to survive. The Federal Government has never run anything at a profit....it runs deficits.....obscene ones.
Who will survive? Government....single payer....and voila! Everone is in the net.
As I said, this "thing" must be digested with the appetizers this administration is serving. Trying to interpret something that has ANY room for the negatives is dangerous...especially if it has to be done RIGHT NOW. (Can we say Immigration Reform, back rooms, and overnight passage attempts?
I respect Ryan for providing a forum based on his article.....its a good debate. And I respect him more for taking part.
I just have seen too much already.
Obama in January said....The Stimulus bill will have an immediate effect.
Obama in June.....the Stimulus bill was never intended to have an immediate effect.
Who's lying......Obama then, or Obama now?
Thanks, Ryan....enjoyed it.
Ryan....You just want the truth? That is why you started your article stating "It seems Republicans are sinking to a new low in their all-out attempts to stop health care reform from happening." Is this statement the truth or Democrat's Propagandist statement?
Yes as Jack Nicholson would say "I want the truth." And I truly believe the truth is SOME but not ALL Republicans are using this provision to try and scare seniors when they know exactly what the provision actually does. They are playing on the fears of people about rationing and euthanasia and they found the one part of the bill which could be twisted and tortured to mean something it does not in order to start a fear campaign. Some of them know they are wrong about the bill but continue to spread disinformation as part of an effort to kill the bill. Others I think do really believe the provision provides forced consultation or euthanasia and I believe those people are just sincerely mistaken in their beliefs. Just because you take sides it does not mean you do not seek the truth. Abolitionists took sides it does not automatically follow that they were a propaganda machine.
Ryan, It is not the Republicans or the Blue Dog Democrats that will kill this bill. It is the bill itself. It was written in a hurry with no long range thought. The current administration is totally out of control. I believe the Obama we are seeing and hearing is a real eye opener to those who thought he would be something fresh. He is business as usual only worse.
Our current health care system is one of the best in the world and needs only to be tweaked in three areas; pharmceuticals, medicare system fraud and tort reform. You never hear that because of the BIG BUCKS the Drug Companies and Legal Organizations spread around D.C. Our medical cost could be cut by at least 30% with positive action in those three areas. Why is it never mentioned?
If we survive until election time in 2010, I hope the voters will get these "NUTS CASES" out of Washington. I don't know how some of them got there, in the first place. They are liars, cheats, idiots, tax evaders and every other slimeball you can name. The Health Care Bill shows that very plainly. After you read it, they call you liars, when you tell others, what's in it.
I don't need anyone explaining it to me as you have suggested above, "simple explanation." Only the ignorant and poorly educated people need that. I do not. Obama is smart. He knows how to win over uneducated people. That's the problem here. I know many families who think he is next to God. They are very ignorant and still believe he will pay their mortgages and give them free laptops and gasoline. These are the people who he targets. You are doing his dirty work along with millions of other idiots.
Thank you for getting this information out. I've read page 425 and do not see evidence of forced suicide. I hope people on the right will please give this another read. Each year our health care either decreases or costs more. In the case of a serious illness there is a real possiblilty that you can loose you home and any savings you may have accumulated to pay medical bills. I hope there is a solution but I'm sure it doesn't start by lying about what our legislators are trying to do. Some of these people are so angry with this administration that they will fight anything they try to accomplish whether good or bad. Please stop. You are ruining this country.
This Bill dumps end-of-life decisions exclusively on employees of organizations feeding at the federal trough. Consequently, a bias to cut costs is built into the system. Nowhere does it encourage the spiritual, ethical, moral, and philosophical members of a community as part of the decision making team as is the practice now.
This Bill repeatedly at the end of each section authorizes the Secretary to exercise his discretion. That's bad news when further in the Bill incentives are offered for efficient health care providers who are getting a cut in pay to begin with.
Interestingly, at the other end of the life spectrum, no one has mentioned the school based health clinics. Sounds like Planned Parenthood will have an abortuary next to each school in the inner-city. Eugenics anyone?
Anton: Right now such decision are made by insurance companies to a large degree. Do you really think there is no cost-cutting bias there?
I am sorry the bill does not advocate having the local Southern Baptist preacher come in to do the end-of-life consultations but there may be a problem with the separation of church and state in such cases don't you think?
How you make the jump to Eugenics without citing a single provision of the bill is amazing. Are you saying any government health influence on schools=eugenics? So why our are current government paid school nurses not bringing about eugenics?
I don't see how the author of this piece can say that this is not mandatory. "Such consultation SHALL include the following" (emphasis mine). A mother says to her child: "You shall go to the store and get me some milk." A teacher says to a student: "You shall complete 1-8 on page 300." The word "shall" signifies that this consultation WILL include the following, including the inevitable push to convince the elderly that they should consider the end of their lives neigh. The section does not even broach a discussion of possibilities of other treatments, such as alternative options. It simply focuses on end-of-life procedures.
Beth: When the law says "shall" it is defining what an end of life consultation is not saying everyone must have them. For example, if I say a book SHALL have pages does that mean you MUST have a book, or that you MUST have pages? No. In the same way when the statute says an end of life consultation shall consists of blah blah blah it is not saying you MUST have that consultation it is defining what a consultation is.
To extend further. Right now medicare regulations define what a doctor's SHALL consist of and what a hip replacement SHALL constitute. Does that mean all seniors right now are forced to have doctor's visits or hip replacements? No.
Look at the terminoloty: It's an "end of life" consultation and not a "treatment options" consultation.
Here goes another scare tactic. Will it ever end? After 8 years of Republican control which brought this country to the brink, they have no credibility left. No matter what Prsident Obama tries to do to fix their messes, not only are they against it they also spew lies after lies. I have read this page 425 and no where does it support what the lunatic fringe wants us to believe. As a senior, I will not be scared into believing this crap.
I agree wholeheartedly with Ninetta’s comments. I, too, am a senior citizen and will not be swayed by the outright lies and scare tactics the lunatic fringe is trying to spread.
I, for one, fully support health care reform.
p.s. Do you really think the health care industries, K Street lobbyists and the pharmaceutical companies have YOUR best interest at heart? NOT. It's the billions of dollar profits they're interested in, not you.
Remember: insurance companies do not want competition (from the public option), and the pharmaceutical companies do not want to negotiate lower prices for all the medicines that we, as senior citizens, need or will need. It's all about the money. Have you ever wondered why we pay the highest costs for medicines that other countries do not...same meds, from the same companies?
Why is it that Obama, Pelosi and all their cronies do not see shades of horrific medical care, or Socialized Medicine at it worst.
NO ONE WANTS SOCIALIZED MEDICINE IN THE UNITED STATE OF AMERICA.
Yet, the big push is on to make the nightmare a reality.
I wonder why people do not understand that Medicare is run by the Federal Government. Yet, do you ever hear anyone say "let's get rid of Medicare" ? ? ?
Are you aware that profits of the 10 biggest insurance companies soared from $2.4 billion in 2000 to $12.7 billion in 2007? That’s an increase of more than 400 percent! In 2000, the number of uninsured Americans was 38.4 million. In 2007, the number jumped to 45.7 million of Americans uninsured—an increase of more than 19 percent. Does this tell you anything??? How do you think the huge increase in profits was attained? By dropping people from their insurance rolls, that's how. Wake up folks. And think. Think for yourself. Don’t listen to all the noise. And do not be swayed by misinformation and scare tactics.
My understanding of the Constitution is that the Federal Gov't has powers limited to what is specifically dictated it in the Constitution, not that the government may do whatever is not forbidden to it by our most important document. To my knowledge government takeover of the healthcare system is not among the former, so, this whole argument SHOULD be moot. But government bureaucracies are almost always (99.99%) of the time self promoting but never (99.99%) self-sufficient. Our government can't even run Medicare, Medicaid, or even Social Security with any degree of efficiency (and for you socialists out there, the Feds do not pay for Social Security, or even medicare...WE DO!) so what fool would think they have the ability to even attempt to run the entire nation's healthcare? To my knowledge socialism/communism has never worked in any country anywhere.
Doug: So then you think we should end Medicare? Because that is government run health care right now. If you are saying we should end Medicare I give you points for consistency but nearly every senior in the country would disagree with you. Would you also be in favor of ending farm subsidies because those are not specifically mentioned in the Constitution either? Again if you say yes you are consistent but now you have seniors and farmers opposing you.
Article 1 Section 8 states the federal government has the power to regulate commerce between the states. If health care, which constitutes 1/6 of our economy, does not count as part of commerce between the states then I am not sure what does.
Penny Curry says:
NO ONE WANTS SOCIALIZED MEDICINE IN THE UNITED STATE OF AMERICA
That is not entirely true. There are LOTS of people who want socialized medicine in the US. People who DON'T want to work. People who are lazy and think the government should provide everything for them (basically communists, socialists and democrats, all the same thing.) The people who actually make this country work don't want socialized medicine. Just ask people who come HERE for treatment from countries that have government healthcare how well it works. They will be happy to tell you why they came to the United States for their healthcare. (and there are ALOT of them.)
I'm very concerned when Pres. Obama is on record saying "I believe and support a single payer system." I watched Obama's town hall meeting this week and it was scary. There where no real questions. Obama will end up being the worst U.S. President in modern history because he reminds me of the movie "The Manchurian Candidate".
Let me see if i got this right: no one wants socialized medicine in the USA; those that do are people that don't want to work; they are lazy and basically they are communists, socialists, and (God Forbid] they are Democrats. So in essence, seniors who are retired and receive Medicare and Social Security are lazy, don't want to work are either communists, socialists, and God Forbid are Democrats. And let us not forget our veterans who get their medical care from the VA are also lazy, don't want to work, etc. etc. One more thing just to correct the record, President Obama never endorsed a single payor system. He has advocated a public option. And by the way, the title of WORST PRESIDENT has already been earned by BUSH 2--you know the one who violated our Constitution on so many levels. I am grateful to have participated in a civil discussion on this important subject.
Quoted is Section 1233, b3:
‘(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.CommentsClose CommentsPermalink
‘(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A). ...."
So it is the "apparachiks" who will determine what end-of-life procedures are "appropriate." To be determined by a Secretary of HEW who agrees with "assisted suicide." I don't trust bureaucrats" to make my life/death decision
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