A hidden danger in Government health care

Old NFO has discovered a little-discussed provision in the omnibus health bill now being argued over in Congress and the Senate. It involves medical care at the end of life. You can read his whole post here, and the full Bill is online here in Adobe Acrobat (.pdf) format. Pages 425-430 are the important part. They're worth reading.

In brief, shrouded in legalese and wordiness, the Government will require - yes, require - that you have an "Advance Care Planning Consultation" every five years concerning the end of your life. During that consultation, you'll be informed by your physician (or physician assistant) about all relevant issues (there's a long list), and the practitioner will make 'suggestions' and 'recommendations' as to which would be appropriate in your situation. Furthermore, such a consultation "may include the formulation of an order regarding life sustaining treatment or a similar order" (quoting verbatim from the Bill, page 429).

As the Bill stands at present, the wording is pretty innocuous. However, what the practitioner can or will tell you about end-of-life options can, at any time, at the stroke of a pen, be restricted to those choices that the State is prepared to make available to you, or pay for. The Bill doesn't spell this out, of course, but if you read between the lines, the law would not have to be changed to permit that, once it's passed. It would be a purely administrative and/or regulatory decision. If there are options that might cost too much, or which the State decrees are not 'appropriate' for some reason, then the State - i.e. the bureaucrats running State-controlled health care - can simply order practitioners to exclude them from the options discussed, or eliminate them from the care order they prepare and sign.

Think that's far-fetched? Think that's Orwellian? Think again. On Page 432 of the Bill, we read the following:

IN GENERAL. — for purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life sustaining treatment.

Yep. Practitioners will be required to report annually on what measures they're recommending and/or providing for end-of-life care. Are you willing to bet that some, but not all, of those measures will end up on an "approved" list, and others on a "not approved" list? The State can very easily decide what it will, and will not, pay for, just as your medical insurance or HMO does now. If you happen to need a very expensive end-of-life care option to extend your life for a few months, or alleviate chronic pain, or whatever . . . are you sure the State will fund it? Or will the response be, "Sorry, but we need those funds to pay for toe fungus treatments. You'll just have to die early. Here, have an aspirin. Now go away and stop bothering us."

What about your doctor? If a practitioner persists in recommending or ordering treatments that the State doesn't want to provide, how regularly are his payments going to come through? Administrative delays? Bungled paperwork?

"Oh, we're sorry, Texas Doctor - your payment was misdirected to a clinic in Alaska by mistake. As soon as we recover the money from them, we'll send you another check. You should get it within six months, I'm sure."

"But how am I supposed to pay my staff, and the rent on my offices, until then?"

"I'm afraid we don't have any spare funds for that sort of thing. Of course, if you stopped prescribing such expensive interventions for your patients, that would free up funds. It's in your hands, really."

"But - but - even if I start doing so now, I'm still out a whole quarter's payments! What will I do until they arrive?"

"We all have to make sacrifices for the greater good, Doctor. It's for the children, you know. May I suggest you talk to your bank manager about extending your overdraft? Oh - and while you're talking to him, would you please ask for a larger overdraft, so you can pay back your medical study loans as well? Our records show you still owe us $80,000 or more, and we're having to recover those debts faster to pay for training new doctors. You'll be getting a note in the mail with your new repayment schedule. I'm sure you understand."

Yes, there are ways and means to ensure compliance . . .

Another absolute no-no for me, from a moral perspective, is that the Bill would not exclude abortion (in the sense of using abortion as 'after-the-fact contraception') from State-funded medical care. This is a non-starter for me, and for those who believe, as I do, that human life begins at conception. I will not - repeat, will not - permit my taxes to be used for what I regard, from my moral perspective, as legalized murder. I know there are millions of Americans who feel as I do on this issue. I can see a monumental Constitutional lawsuit brewing right now over this, and a tax revolt as well.

I'm slowly reading my way through the whole Bill. All I can say is that it's a nightmare of verbiage and bureaucratic phraseology. I've actually resorted to re-typing some sections in their entirety, using correct indentation, so that I can be sure what sub-sections fall under what super-sections. It's that bad. Suffice it to say that quite apart from what one may feel about 'socialized medicine', and even knowing that our present system is broken and must be fixed, I believe that this particular Bill will only make matters worse. It's poorly thought out, a bureaucratic nightmare.

What's even worse is that this Bill is so overarching in its implications that volumes and volumes of regulations will have to be written to implement its measures. Those regulations will not - I repeat, WILL NOT - have to be passed by Congress and the Senate. They'll be written by faceless bureaucrats, and take on the force of law. We'll likely have little or no input to them; but political, social and economic pressure groups will make sure they do. Once the regulations are in place, we''ll be stuck with them.

This is no way to treat a free people - and no free person should be willing to accept it.

Peter