Obama to bring "end of life" planning in through the back door

The idea that "end of life planning" paid for once every 5 years by Medicare will morph into euthanasia counseling was one of the more bizarre arguments against Obamacare when it was proposed two years ago. People have to make informed decisions about how they want their doctor to treat them if they sicken and are unable to make choices about resuscitation and other important end of life issues.

Everyone should have a Living Will that spells out for their family where to draw the line about extraordinary measures that could keep one alive. If you wish to remain in a vegetative state, that should be your choice and should be reflected in the body of the Living Will. With the force of law, no one - not family or government - can alter that decision. As long as it is clear you were of sound mind when you made that decision, your wishes must be respected.

The question isn't whether Living Wills are necessary. The question is should Medicare be paying for such consultations?

Conflating euthanasia with Living Wills is silly, but Obama has decided to bring the issue through the back door through regulation - a dangerous precedent that the president apparently feels will be necessary with other Obamacare issues that never made it past the finish line in Congress:

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.Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats' bill would allow the government to cut off care for the critically ill.

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover "voluntary advance care planning," to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an "advance directive," stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress.

It would probably be better if the government was totally out of the loop on making these decisions but most people who take advantage of such counseling will be seeing their family doctor - someone they trust to advise them with their interests at heart. I doubt whether a family physician will be pushing old people to end their own lives rather than receive critical care according to their wishes.

However, the principle of bringing this in by stealth, through back door regulation is abhorrent and should be stopped in its tracks. The issue was withdrawn because it was politically impossible to leave in the original legislation. To sneak it in by this manner just shows how little respect Obama has for constitutional niceties.





The idea that "end of life planning" paid for once every 5 years by Medicare will morph into euthanasia counseling was one of the more bizarre arguments against Obamacare when it was proposed two years ago. People have to make informed decisions about how they want their doctor to treat them if they sicken and are unable to make choices about resuscitation and other important end of life issues.

Everyone should have a Living Will that spells out for their family where to draw the line about extraordinary measures that could keep one alive. If you wish to remain in a vegetative state, that should be your choice and should be reflected in the body of the Living Will. With the force of law, no one - not family or government - can alter that decision. As long as it is clear you were of sound mind when you made that decision, your wishes must be respected.

The question isn't whether Living Wills are necessary. The question is should Medicare be paying for such consultations?

Conflating euthanasia with Living Wills is silly, but Obama has decided to bring the issue through the back door through regulation - a dangerous precedent that the president apparently feels will be necessary with other Obamacare issues that never made it past the finish line in Congress:

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.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats' bill would allow the government to cut off care for the critically ill.

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover "voluntary advance care planning," to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an "advance directive," stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress.

It would probably be better if the government was totally out of the loop on making these decisions but most people who take advantage of such counseling will be seeing their family doctor - someone they trust to advise them with their interests at heart. I doubt whether a family physician will be pushing old people to end their own lives rather than receive critical care according to their wishes.

However, the principle of bringing this in by stealth, through back door regulation is abhorrent and should be stopped in its tracks. The issue was withdrawn because it was politically impossible to leave in the original legislation. To sneak it in by this manner just shows how little respect Obama has for constitutional niceties.





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