August 3, 2009

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The Latest Healthcare Reform Scaremongering

If you haven’t heard it by now, here it is: The Federal Government is going to require that all seniors have counseling about end-of-life decisions. Another version of the same scare is that the federal government is going to force senior citizens to choose an early (rather than a prolonged) death. Here is what HR 3200 actually says in regard to counseling on end-of-life issues for Medicare patients:

“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:  (A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to. (B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses. (C) An explanation by the practitioner of the role and responsibilities of a health care proxy. (D) The provision by the practitioner of a list of national and state-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and state legal service organizations (including those funded through the Older Americans Act of 1965). (E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.” (excerpted from pages 424 and 425 of HR 3200)

However well intentioned this bit of Washington doublespeak may be, if ever this legislation is to pass, DROP this little bit of moralizing. Consultation already is given, and I am sure that doctors manage to get paid for it—so let it GO so things can move ahead!

Admittedly, legislators speak their own special language—and it is universally confusing if not downright incomprehensible. Consider this little gem from page 174 of the same House Bill,

“The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter….” Or this one on page 192: “All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 shall be treated as 1 employer.” And hospitals surely will be enlightened by this statement on page 281: “The term ‘base operating DRG payment amount’ means, with respect to a hospital for a fiscal year, the payment amount that would otherwise be made under subsection (d) for a discharge if this subsection did not apply, reduced by any portion of such amount that is attributable to payments under subparagraphs (B) and (F) of paragraph (5)….”

House Bill 3200 is long, tedious, and full of obfuscations. It is horrible language—and there are more than 1,000 pages of it. And we cannot eliminate all of it, but absolutely and for sure, we should insist that the bit about ‘counseling’ senior citizens should be dropped. If we don’t, nothing ultimately will be done!

Just as a reality check, Medicare, signed into law more than 40 years ago—and by all reports, one of the most successful pieces of legislation—was a mere 53 pages long.

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