OK, let's stipulate that anyone who passionately opposes America's
Health Choices Act is an easily manipulated blockhead.
that we've got the name-calling out of the way, maybe we can look at
what the legislation -- House Bill 3200 -- actually says about those
"death panels" that supposedly will be sending Grandma packing before
her time. Nothing, as far as I can find.
But that doesn't mean that there's no room for discussion about what the Democrats'
big health-care reform bill calls "Advance Care Planning Consultation."
There are 10 pages detailing new rules governing doctor-patient
relationships on the matter, including requirements for "end-of-life"
care. Several things can be said about these highly specific
They were not a part of the list of public demands for health-care
reform. People want an end to health-insurance exclusions for
pre-existing conditions, greater access to coverage for the uninsured
and the like. Few, if any, Americans are banging the drums to be told
how to die.
The end-of-life advice that the physicians are required to give their
patients include "advance care planning and advance directives ...
living wills, durable power of attorney, orders of life-sustaining
treatment and health-care proxies." With all due respect to physicians,
they're not the ones to be giving this advice. This job belongs to
lawyers. Would the bill require that physicians be trained as lawyers?
Would physicians be held legally accountable for bad advice given?
Would physicians be reimbursed for necessary extra training? How much
more would this increase the cost of this horrendously expensive bill?
Private sector managed-care groups already press physicians hard enough
to hold down costs, including the amount of time they spend with each
patient. So, how much more time will end-of-life consultations take
away from what physicians now have? The time my wife and I spent with
our lawyer having all this explained to us was measured in hours. Of
course, since a physician can't legally execute these end-of-life
documents, patients -- after spending time with physicians -- would
still have to consult with lawyers and pay for the service. Which
raises the question: If end-of-life consultations are so important --
and they are -- can't the argument be made that the bill should require
that lawyers give this advice, so that it's done right?
This end-of-life consultation requirement "interferes with the very
private patient-physician relationship." I put this in quotes, because
this is exactly the objection that pro-choicers raise when they oppose
any legislation that would require a doctor to counsel his patient
about the details and dangers of abortion. I'm in favor of that kind of
counseling -- the government is in the business, we're told, of
protecting consumers -- because of a woman's right to be fully informed
by competent authority of the risks of any medical procedure. It is not
in the financial interests of abortion providers to give women any
discouraging information. Of course, we hear no such objections to
interfering with the patient-physician relationship in the
Mind you, these are just a few of
the questions that can be legitimately asked
about only 10 pages of a
1,017-page bill. Similar questions can be asked of the other 1,007
pages, about each of its titles: "Protections and Standards for
Qualified Health Benefits Plans"; "Health Insurance Exchange and
Related Provisions"; amendments to "Internal Revenue Code Of 1986";
"Medicaid and Chip; Community Health Centers"; "Prevention and
Wellness; Quality and Surveillance" -- to name a few. In total, this is
a cosmic-size bill, a classic case of America leaping into the unknown
I highly recommend end-of-life consultations,
done properly. But as part of a cosmic bill that reconstructs the
entire health-care system, it and other issues are not getting the
debate they deserve. The reasonable path to reform is incremental. Why
do we have to try to swallow whole this cosmos of health-care
commissioners, health-insurance exchanges, health benefit advisory
committees and the rest of it? Agreement can be reached now, for
example, on prohibiting exclusions for pre-existing conditions. Let's
try that, see how it goes and tackle what comes next. Better than this
pig in a poke.
This column also appeared in the Chicago Tribune