Obama ought to read section 1233 of HR 3200

Does anyone imagine that Barack Obama has sat down with HR 3200 and studied Section 1233 which concerns advanced care planning consultations? Has he seriously considered the implications of the language? Has he, or any supporters of his reforms, even attempted to refute these concerns by referring to the text of the provisions in question? He's a brilliant Harvard lawyer and U of C law professor. Why doesn't he go through the troubling language and show us why we shouldn't be concerned? This is right up his alley. Instead we get this:

The rumor that's been circulating a lot lately is this idea that somehow the House of Representatives voted for "death panels" that will basically pull the plug on grandma because we've decided that we don't -- it's too expensive to let her live anymore. (Laughter.) And there are various -- there are some variations on this theme.

He goes on to speculate about the intentions of the writers of the provisions and the sources of the "rumors." None of this addresses the language of the bill.

The following people, some of them liberals, have studied or at least read the provisions and are unable to dismiss them in the manner of Obama and company. And their concerns are based on what is written in HR 3200. Among them:

Charles Lane:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist.

Wesley Smith, who has studied the language closely and offered revisions that would absolutely rule out a mandatory interpretation. The section was revised but the ambiguity remains. Mr. Smith has written extensively on section 1233 and is the source for factual information and analysis on this subject.

Eugene Robinson:

If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.

Charles Grassley:

“In the House bill, there is counseling for end of life,” Grassley said. “You have every right to fear. You shouldn’t have counseling at the end of life, you should have done that 20 years before. Should not have a government run plan to decide when to pull the plug on grandma”

Sandy Szwarc:

More importantly, it is clearly an effort to coerce seniors to sign such an order. There are multiple loopholes that open doors for its misuse, and abuse of the elderly, while also including no protections for these patients.

Betsy McCaughey:

“In so many words, it is [mandatory] — because although it is presented in the bill as a Medicare service, when a doctor or a nurse approaches an elderly person who is in poor health, facing a decline in health, and raises these issues, it is not offering a service. It is pressuring them,” McCaughey said Monday. “I would not want that to occur when I am not at my parents’ bedside.”

Lee Siegel:

This reeks of the Big Brother nightmare of oppressive government that the shrewd propagandists on the right are always blathering on about. Except that this time, they could not be more right.

Herbert London:

Although it does not make reference to euthanasia, it is easy to draw the conclusion that counseling by someone, who is not necessarily equipped to make medical decisions, could be interpreted as euthanasia guidance. Suppose someone of 80 has cancer, a condition that may require aggressive and expensive treatment. What will a counselor suggest? My guess is he will point out that the treatment is discomforting and is unlikely to extend life expectancy significantly. Perhaps the best thing to do is let nature take its course. Is this euthanasia? That depends on perspective, but that conclusion cannot be ruled out.

Armstrong Williams:

You can’t control costs without telling someone they will have to either wait or go without. There’s no getting around that fact. Look to European countries and how they’re assigning “value” to human life and procedures. As morbid as it sounds, how else can you quantify access and enumerate costs? Obama and his staff started this. Democrats just codified it in language that offers Medicare coverage for doctors who want to counsel seniors on end-of-life decisions. Has it been blown out of proportion? Yes, but they’re very real concerns. Conservatives shouldn’t get the blame for what frightens constituents, particularly senior citizens.

Tom McClusky:

The biggest question mark comes from who wrote Section 1233 of the House health care overhaul bill. The original language was written by assisted suicide supporter Rep. Earl Blumenauer (D-Ore.) alongside a group that once was called the Hemlock Society – the nation’s biggest advocates of euthanasia and assisted suicide. The Hemlock Society helped draft Oregon’s assisted suicide law – legislation that has led some afflicted people in Oregon getting letters “consulting” them that, while the state run plan would not pay for their cancer treatments, the state would be happy to pay for assisted suicide if they choose that option.

Additionally, Section 1401 establishes the Center for Comparative Effectiveness Research. A similar center was established in the economic stimulus bill passed in February. The report issued by the House Appropriations Committee at that time explained what they hoped to accomplish with this “research.”:

“By knowing what works best and presenting this information more broadly to patients and healthcare professionals, those items, procedures and interventions that are most effective to prevent, control and treat health conditions will be utilized¸ while those that are found to be less effective and in some cases, more expensive, will no longer be prescribed. (Emphasis added).”

Five times in various committees there were attempts to ensure that “comparative effectiveness research” is not used for rationing purposes. Each time the Democrats on the committees voted the amendments down.

Additionally, the Obama plan relies heavily on cuts to Medicare to pay for the new benefits. Despite these cuts he fails to address the solvency issue of Medicare, inevitably leading to reduction of benefits to participants.

Couple these with public comments of supporters of the leading bills in Congress, like President Obama and Senator Ted Kennedy (D-Mass.), that the federal government would be making decisions that usually are left up to patients and doctors the onus should be on supporters of the bill to prove beyond a shadow of a doubt that their legislation would not lead to rationing of care.

And Sarah Palin. She quotes Charles Lane and Eugene Robinson, and the bill, in her FB follow-up to Obama's dismissal of this issue in Portsmouth on Tuesday:

With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.

Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program." [3] During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services. [4]

Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” [5] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones.... If it’s all about alleviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” [6]

Read the rest. For a wild-eyed trailer-trash hillbilly breeder, she sure makes a lot of sense.

More and varied opinions from The Hill Congressional Blog here. Opinions backed up with references to the texts being discussed are worthier of respect. Off-the-cuff ad hominem attacks, less so.

Comments welcome.

Cross-posted in the Green Room.

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