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New York, 6:59 PM
Mon Nov 30
56 posts in the last 24 hours
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10/21/09
#groupthink
10/21/09
[www.thedailyshow.com]
It cracks me up eeeevery single time.
#thedailyshow
08/24/09
Just wanted to update these comments by letting anyone that stumbles across this in the future know that Betsy McCaughey got fired because of this appearance, so, y'know, happy ending
08/21/09
I hope you all take this opportunity to
1)communicate both verbally and in writing to your loved ones what you would like done medically if you cannot speak for yourself (advance directives not just for old people - think Terry Schiavo)
2) appoint a health care proxy who knows and respects your wishes. This can be any adult except a healthcare provider providing your care. HCPs are legally binding in every state. Otherwise you risk having your next of kin making the decisions. Google '>your state, health care proxy form'. most states have the fill in forms on line - print'em sign'em and give 'em to your health care proxy and your health care provider. (make sure you comply with state laws regarding notarizing and all that crap).
also google 'five wishes' document - it's a good starting point to discuss and think about these issues.
Goddess speed, my sisters.
08/21/09
08/21/09
The idea that the elderly (and everyone) should have end-of-life counseling seems to me a win-win situation: for the patient, who is able to make decisions based on rational thinking outside a moment of crisis, and for the hospital, which in times of crises may end up erring on the side of life support, which once instituted may be difficult for a family to turn off (either emotionally or legally).
08/21/09
08/21/09
08/21/09
08/24/09
08/21/09
08/21/09
Instead, it only provided doctors with reimbursement should any of their Medicare pateints *want* to discuss end-of-life issues. Otherwise, if grandma tried to ask questions about it, she'd most likely be cut off by her physician, who needs to keep a regular appointment to 7 minutes long if he or she has any hope of trying to even break even under Medicare's current reimbursement rates.
Also, end-of-life planning does *not* mean encouraging no treatment. It means choosing however you want to be treated at the end of life. Want aggressive intervention, ventilators, resucitation, the works? That's an end-of-life plan. Want no resucitation, no ventilators, hospice instead of hospital, or home care? Also an end-of-life plan.
08/21/09
08/21/09
08/21/09
Actually, I believe it means that the DOCTOR has to adhere to the patient's plan, instead of simply doing whatever he or she feels is best for the patient (or his or her billing). However, the fact that the bill doesn't actually specify whether the patient or doctor is the one who has to do the adhering is vague and should be fixed, tout de suite.
08/21/09
Initial end of life plans? No, the plan says nothing about that. The point is to incentivize doctors to abide by their patients' wishes—and there is nothing in the plan either forbidding patients from changing their minds, or rewarding doctors who ignore what the patient wants. If McCaughey studied the plan as closely as she claims she's either deliberately misrepresenting its content, or she's dumb as a post.
08/21/09
08/21/09
08/21/09
08/21/09
@all: I understand that a living will can be modified as long as one is competent. My fear is that, to use myself as an example, while I am healthy I may say "I never want to be on life support," and then, when I see that the end is nigh, I may turn to my husband and say, "I'm scared, I don't want to do this, whatever it takes don't pull the plug on me," but there may not be time to modify the official plans. And then if the doctor listens to my husband, and not my living will, he will be penalized.
Of course, I understand the inverse of this fear, which is that my wishes will be overridden by a doctor's opinion. I think this should be addressed, but I, personally, do not think that this legislation is the best forum for addressing it.
Also, thanks everyone for your thoughtful and helpful comments.
08/21/09
08/21/09
If you are still able to say something like that, you will still have time to modify your plans. These plans only go into effect after a patient is no longer able to express their own wishes. Although it's best to have a lawyer draw up a living will, if you were stuck in a hospital and dying, you could just have anyone write down what you want and give you the pen to sign it, just like writing your own will. It's not quite as good as a notarized form, but it'll do in a life-ending situation.
08/21/09
08/21/09
@queenjulie: I realize that there are ways to protect myself, like making my husband my guardian. My point is that I don't think it is clearly worded in this bill, nor do I think that this bill is the appropriate place to legislate on this issue. And in that regard, the Repubs have a valid critique of the bill, in my view. Clearly, their methods of objection are like, SO inappropriate, and muddy their point, and do them a disservice in the long run. But I think they may actually have a point.
08/21/09
I don't think Jon needed to do anything to "make" her look like an idiot. Her position is false, it's willfully ignorant, hyperbolic, and based in no facts whatsoever. If you can't back up an opinion, especially with relevant examples and facts, then it is not a particularly well constructed opinion.
While you seem genuinely concerned about the wording, I don't think she is. Nor do I believe any of the Repub's parroting this stuff have anyone's best interest in mind. There are no death panels (unless you count the fact that insurance companies already decide who will and will not get treatment now), this is not going to effect anyone's ability to make, or change their mind, about end of life decisions. As an example, when my Nana was dying, every single family member ended up signing the DNR at some point during a visit because hospitals are so anal about that, and those were her wishes. There's nothing about this part of the bill that's suggesting that you can't change your mind, or that your doctor should convince you to.
At this point, that should have been the end of it, really. But this woman is clearly trying to misrepresent this, and I frankly find it appalling.
08/22/09
Also, legislation can only be so precise and is meant to be fairly general. It's the courts who are to interpret specific situations based on the legislative intent and case law.
08/22/09
[jamesfallows.theatlantic.com]
08/21/09
2. Why would a medical professional be forced to count and report every end of life/ life sustaining discussion?
3. Why would anyone be penalized for discussing end of life procedures?
4. Are living wills (as I understand them) legal in the States?
5. If you have (an equivalent) a POA should that not take of a doctors liability in the event of death?
6. In legal matters the government should be involved and create laws to protect all parties. So why should this be an issue for anyone that the gov't prescribes the procedure?
08/21/09
We have a similar set-up in the States. My husband and I set up Trusts, Living Will and Advanced Health Care Directive after our first child was born. It was no big deal, cost us about $3k for the lawyer.
08/21/09
It varies by state, but is largely similar to what you describe.
2. Why would a medical professional be forced to count and report every end of life/ life sustaining discussion?
They wouldn't be forced to, but right now doctors are only paid by procedure and visit codes under Medicare and FFS private insurance. So talking to patient isn't reimbursed, and they lose money the longer they spend with each patient.
Under the provision in the bill, doctors *could* get paid for discussing end-of-life planning with their patients if the patients want to, so they would count and report this so they could spend the time with the patient and not lose money.
3. Why would anyone be penalized for discussing end of life procedures?
They don't currently get penalized, they just don't get paid for the time spent.
4. Are living wills (as I understand them) legal in the States?
Yes, thought state laws vary I believe.
5. If you have (an equivalent) a POA should that not take of a doctors liability in the event of death?
It should, but I'm not familiar enough with malpractice law to know how often it doesn't.
6. In legal matters the government should be involved and create laws to protect all parties. So why should this be an issue for anyone that the gov't prescribes the procedure?
They're not even prescribing the procedure, just offering reimbursement for it.
08/21/09
The first part of this statement and the last part of this statement contradict each other.
08/21/09
2. Ahhh...so a doctor might be encouraged to discuss end of life procedures with the patient because they could paid for it. That is a good thing, I should think.
3.Thanks for the clarification.
4. Sounds logical.
5. Okay.
6. That lady is nuts then.
Thank you for your answers I am now much smarter than I began. All I can say is that the woman's argument is rather moot. This is a postive intiative and will help many people.
08/21/09
08/21/09
08/21/09
08/21/09
08/21/09
[waysandmeans.house.gov]
Also, The Examiner wrote a good piece on the alleged Page 425 (sound to me like the Magic Bullet of the Health Care Bill) which says the following:
"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...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."
08/21/09
08/21/09
08/21/09
08/21/09
08/21/09
08/21/09
And the classic Repugnican tactic: repeat "they're going to take seniors' benefits!" enough times and no one will bother researching the truth on their own. Whose party dipped into Social Security the most in the last 30 years??? Gimmie a fkn break.
08/21/09
08/21/09
08/21/09
I think a big part of the problem here is that American culture is so youth-focused that to prepare consciously for death, and therefore to acknowledge the existence of it, is somehow surrendering, and so many people are so afraid of death that they just stick their fingers in their ears and refuse to think about or talk about it.
I thought one of the main reasons people have religion is so they're assured there's something after this life, and that it's not something to fear. I haven't had to be in a situation of making end-of-life decisions for myself or anyone I love, but I'd like to think that I would be confident in having lead a good life and when it's time to go, I'll go.