Advance Care Planning

I just read an interesting section of the proposed health care bill that refers to Advance Care Planning Consultation. Now what the h e double toothpicks is that? Go to page 425 and read a ways and you come to:

4 ''(E) An explanation by the practitioner of the
5 continuum of end-of-life services and supports avail
6 able, including palliative care and hospice, and bene
7 fits for such services and supports that are available
8 under this title.
9 ''(F)(i) Subject to clause (ii), an explanation of
10 orders regarding life sustaining treatment or similar
11 orders, which shall include--
12 ''(I) the reasons why the development of
13 such an order is beneficial to the individual and
14 the individual's family and the reasons why
15 such an order should be updated periodically as
16 the health of the individual changes;
17 ''(II) the information needed for an indi
18 vidual or legal surrogate to make informed deci
19 sions regarding the completion of such an
20 order; and
21 ''(III) the identification of resources that
22 an individual may use to determine the require
23 ments of the State in which such individual re
24 sides so that the treatment wishes of that indi
25 vidual will be carried out if the individual is un
1 able to communicate those wishes, including re
2 quirements regarding the designation of a sur
3 rogate decisionmaker (also known as a health
4 care proxy).
Translation: you will be encouraged to give it up (DNR - do not resuscitate) fur da grater god duvall. i.e. "you are going to die - would you care to speed things along?" And now you know where the cost savings will come from. No doubt Obama's Science Adviser John Holdren had some inputs on that section.

Cross Posted at Power and Control

posted by Simon on 07.18.09 at 07:02 PM


I read the section, but I can't say I see anything besides, at most, encouraging someone to think through and set down their 'druthers. Where does it say they're plumping for DNR? I've already been through the mill where, in the absence of such documentation, control essentially passed from the family to the hospital. If you don't have a living will yet, do your family a favor and get one.

HMI   ·  July 18, 2009 9:42 PM

It is not the government's job to deal with my end of life issues.

And I'm not interested in mandatory counseling every 5 years.

And I'm not interested in being forced into any health care plan.

M. Simon   ·  July 18, 2009 10:31 PM

I'm not going to read more than you've posted... as that's probably more than the people who are actually voting on it have personally read.

But... while I understand that it is not the government's job to deal with anyone's end of life issues, I certainly think you have a responsibility to deal with them yourself.

Mandatory counseling is never going to work for anything anytime anywhere... and I don't like being forced into anything any more than you do.

BUT... if this is the worst you can come up with in the health care reform bill, I wouldn't be opposed to it. (Please note again that I didn't follow the link.)

The main problem I have with the bill is the assumption that we have a health care crisis to begin with. Call me callous or whatever, I just don't see it.

Donna B.   ·  July 19, 2009 12:38 AM


The deal is that it only starts there. What happens when the Powers decide that health care costs are going through the roof and cutting back on doctor's salaries is not enough? Old folks will be denied care based on government policy. Because you have no enforceable contract with the government.

I dread the day - coming in months - when I will be FORCED into Medicare. Since I have no regular doctor my chances of getting one then will be slim and none.

Fortunately I think this bill has little chance of passing.

M. Simon   ·  July 19, 2009 2:08 AM

I read the first 100 pages and found the following:

Exemption for unions (Sec 154).

No disparity of benefits. You can't for example buy 'premium' coverage - regardless of price - unless it is specifically approved by the Commissioner (Sec 203(c)(5)). Except for unions and other favored groups.

Report of your private health information to the government (Sec 204(b)(2)), the scope of which to be determined by the Commissioner.

Mandatory enrollment. If you don't pick a plan the government will randomly put you in one (Sec 205(b)(3)(A)).

Grant the IRS the right to impose punitive taxes if you aren't in one (Sec 207(c)(1)(A)).

I stopped reading after that. There are at least 1000 pages in this thing.

Gideon7   ·  July 19, 2009 3:50 AM


HR 32000 mandates a punitive tax of 8% on small businesses with payrolls over
$400,000 if they don't offer one of the govt-approved plans; the punitive
tax is 2-6% for payrolls between $250,000-$400,000 (Sec 313(b)(1)).

Note that income or profitability aren't considered - just payroll.

Gideon7   ·  July 19, 2009 4:43 AM

My DH & I recently went to a meeting on Advance Care Planning at our (RC) church. The doctor/speaker is responsible for the local Hospice and is a palliative care specialist.

We discussed issues the medical community must deal with when faced with a crisis where the actions they could take are not clear-cut, the patient does not have a written outline for his/her wishes and spouse or children aren't reachable... (happens all the time)

This was a thoughtful presentation done within the context of our religious beliefs and was very helpful.

Susan Lee

Susan Lee   ·  July 19, 2009 10:02 AM

I work in long term care, and have worked in hospice care (much of which is currently covered under Medicare.)

I also absolutely loathe Obamacare and it's backdoor attempt to create a single payer government controlled system of health care rationing.

That said, what you cited is typical government speak, similar mandates already exist within the nursing home and hospice regulatory schema. But the opacity of the verbiage certainly doesn't help to dispel a layman's concerns.

The real problem is that this is just the legislation and it wouldn't even matter if it sounded nice and benign. After enactment what follows is that some executive governmental body then takes that law and turns it into regulation - and that is where things go horribly awry.

ThomasD   ·  July 19, 2009 2:10 PM

"Czar" is a misnomer for "Commissar."

Brett   ·  July 20, 2009 8:16 AM

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