Category: health care

Fact checking the death panel scare

One thing I have learned in the culture wars is to check the specifics of breathless claims from both left and right. So here is a claim from the Liberty Counsel that is making its way around the echo chamber:

Medicare Regulations Revive “Death Panels” of ObamaCare Bill

Is this true? Is Medicare about to unleash a panel of Dr. Deaths on the nation’s elderly? Not at all. This Wall Street Journal article has it about right, describing what Medicare is about to implement via their rule making process:

Advance care planning lays out the options and allows patients, in consultation with their providers and family members, to ensure that their future treatment is consistent with their wishes and moral values should they become too sick to decide for themselves.

To their credit, Liberty Counsel links to the Federal Register issue containing the new regulation, but unfortunately then misrepresents what it says. As noted by the WSJ, discussing advanced directives is something patients should do.

Called “voluntary advance care planning” in the Medicare regulation, this new rule allows physicians to be reimbursed for this consultation during the annual wellness visit, a service allowed by Medicare which covers all sorts of preventive care. The service is defined in the Federal Register:

Voluntary advance care planning means, for purposes of this section, verbal or written information regarding the following areas:

(i) An individual’s ability to prepare an advance directive in the case where an injury or illness causes the individual to be unable to make health care decisions.

(ii) Whether or not the physician is willing to follow the individual’s wishes as expressed in an advance directive. (p. 73406 & 73614).

No death panel there; just the patient, perhaps family, and the physician. Since the conversation is voluntary, a patient can avoid the whole thing. Physicians are allowed to provide written information about how to construct an advanced directive and what individual physicians will do under certain conditions. Physicians must provide informed consent to care and letting patients know what they will do is good practice. If a patient doesn’t like the approach of that doctor, then another doctor can be pursued. I like this approach much better than just waiting around for something to happen and then trying to figure out what the patient would have wanted.

These are important and necessary conversations, even though they can be emotionally difficult. The Federal Register cites studies which suggest that patients appreciate the opportunity to express their wishes and are not harmed by doing so.  

Back to the current flap. Where WSJ gets a little misty is when they let Sarah Palin and by extension other fear mongers off the hook a bit by saying that Palin really wants to talk about rationing of care when she writes about “death panels” (as she does here – note the title of the column).

Now I have a whole page on this blog devoted to debunking myths about Sarah Palin so I think it is fair to comment when she is stretching things. If you want to talk about rationing of care, then talk about rationing of care. Voluntarily discussing advanced directives with a personal physician is not a “death panel” nor is it of necessity rationing of care.

Lifenews.com is running a headline claiming that pro-life leaders want the new Congress to overturn the regulation. I am pro-life and I hope the new Congress does not overturn the regulation. I believe physicians should be reimbursed for bringing up the difficult topic and making adequate preparations for the inevitable. Conversations about end-of-life care will happen with or without the regulation. The question is: Will they happen with the patient’s wishes known or not?

UPDATE: Here are some Christian and pro-life groups which advocate advance directives. All the Medicare regulation does is include such planning in annual wellness visits if the patient agrees. Medicare patients could use any of these resources in conversation with their physicians.

Focus on the Family

Anglicans for Life

Physicians for Life 

National Right to Life

Aquinas Institute

Center for Bioethics and Human Dignity

This list was generated after about 5 minutes of searching. I suspect there are other groups with similar recommendations. There is nothing in the Medicare regulations which requires patients to accept a physician’s views if at odds with the patient’s views (although some state laws may allow a physician to ignore advanced directives). Nothing I can find in the Medicare regulation prohibits a patient from drawing on faith based resources to inform these conversations.

Added on Jan 3, 2011: I think it is important to note the voluntary element of these conversations from the Medicare regulations. Advanced care planning may be conducted at the initial Medicare visit and at the annual wellness visit, if the patient agrees. Here is how the Medicare regulation includes the procedure in these visits:

Voluntary advance care planning as that term is defined in this section upon agreement with the individual.

Paul Kengor: God Gets His Healthcare Bill

Note: The recent healthcare reform certainly is historic, in the sense that it most likely will be considered an important, perhaps defining, event in the Obama Presidency. Whatever eventually happens politically as a result, there are important elements of public discourse which marked the debate. One of those elements –religious rhetoric– is the subject of Dr. Kengor’s column.  

God Gets His Healthcare Bill

By Dr. Paul Kengor 

The most frustrating thing I’ve dealt with in professional life was eight years of outrageous, baseless charges against President George W. Bush on matters of faith. Even when Bush was simply asked about his faith, and responded with utterly benign statements, like saying he couldn’t imagine surviving the presidency “without faith in the Lord,” or noting he prayed before committing troops, echoing every president from Washington to Lincoln to Wilson to Carter to Clinton, he was viciously assaulted.

“We are dealing with a messianic militarist!” thundered Ralph Nader.

“He should not be praying,” intoned Lawrence O’Donnell to the MSNBC faithful.

Repeatedly, I was called to respond to this nonsense. My retort was agonizingly simple: I merely ran through example after example of American founders, presidents—Democrats and Republicans—saying either precisely what Bush said or something far more extreme, like Woodrow Wilson claiming God called upon him to found the League of Nations, or FDR mounting a battleship leading troops in a rendition of “Onward Christian Soldiers.”

What I said rarely mattered. Every Bush mention of God was a signal, somehow, that this Bible-quoting “simpleton” was trying to transform America into a “theocracy.”

Alas, there was another tactic I used: I quoted current Democrats on the campaign trail, from Hillary Clinton to Barack Obama, invoking the Almighty. I knew that if these politicians reached the White House, they’d say the same as Bush, or much worse—with no backlash from the secular media. Quite the contrary, liberals would roll out the red carpet, enthusiastically welcoming faith into the public square.

All of that is prelude to my point here today:

The Religious Left, from “social justice” Catholic nuns and Protestant ministers to the Democratic Speaker of the House and president of the United States, have been incessantly claiming God’s advocacy of their healthcare reform. That’s no surprise, just as it’s no surprise that the press is not only not outraged but silently supportive. There’s nary a whimper, let alone howls, of “separation of church and state!”

Consider a few examples, most telling in light of passage of the healthcare bill:

Last August, President Obama addressed a virtual gathering of 140,000 Religious Left individuals. He told them he was “going to need your help” in passing healthcare. Obama penitently invoked a period of “40 Days,” a trial of deliverance from conservative tormentors, from temptation by evildoers. He lifted up the brethren, assuring them, “We are God’s partner in matters of life and death.”

Like a great commissioning, in the 40 Days that followed the Religious Left was filled with the spirit, confidently spreading the word, pushing for—among other things—abortion funding as part of an eternally widening “social justice” agenda. The Religious Institute, which represents 4,800 clergy, urged Congress to include abortion funding in “healthcare” reform, adamantly rejecting amendments that prohibited funding. To not help poor women secure their reproductive rights was unjust, declared the progressive pastors. As the Rev. Debra Hafner, executive director of the Religious Institute, complained, federal policy already “unfairly prevents low-income women and federal employees from receiving subsidized” abortions.

Here we see the Religious Left’s continued perversion of “social justice.” Behold: social justice abortions.

Early last week, a group of 59 nuns sent Congress a letter urging passage of the healthcare bill. This came in direct defiance of the United States Conference of Catholic Bishops, which insisted the bill “must be opposed” because of its refusal to explicitly ban abortion funding. What the bishops said didn’t matter, one nun told Fox’s Neil Cavuto—supporting the bill is what “Jesus would do.”

The liberal media cheered on the nuns, gleefully exaggerating the sisters’ influence. In a breathtaking display, the Los Angeles Times beamed, “Nuns’ support for health-care bill shows [Catholic] Church split.” Quoting the nuns, the Times reported that the letter represented not more than 50 nuns but over 50,000. (I’m not kidding, click here.) Like Jesus with the loaves, the militantly secular/liberal Times had displayed miraculous powers of multiplication.

Finally, last Friday, Speaker of the House Nancy Pelosi, a Roman Catholic, invoked the Solemnity of the Feast of St. Joseph on behalf of the healthcare bill. She urged American Catholics to “pray to St. Joseph”—earthly guardian of the unborn son of God. Such overtures are hardly new for Pelosi, who routinely exhorts Democratic disciples to vote the liberal/progressive agenda as an “act of worship.”

All of that is prelude, of course, to what happened the evening of March 21, 2010, A.D., with a rare vote not merely on a Sunday—God’s day—but the final Sunday in Lent, the week before Palm Sunday that initiates the Lord’s Passion. To President Obama, Speaker Pelosi, and the Religious Left faithful, Jesus, presumably, has gotten his healthcare package.

Amid that process, secular liberals got religion, as their political soul-mates spearheaded this “change” in the name of Jesus Christ. It’s a quite radical departure from eight years of scourging George W. Bush every time he confessed he prayed. At long last, there is room for Jesus in the inn, so long as the Savior “supports” a certain agenda. Who says conversions don’t happen?

— Dr. Paul Kengor is professor of political science and executive director of The Center for Vision & Values at Grove City College. His books include “God and George W. Bush,” “God and Ronald Reagan,” and“God and Hillary Clinton.” The topic of this op-ed will be discussed at length by several speakers at our coming April 15-16 conference on “The Progressives.” Click here for more information.

Health care reform: Who must buy insurance?

The Christian Science Monitor takes a simple stab at this question here.

But here’s a key thing to remember: There is a simple concept at the center of this rambling, Rube Goldbergian machine. Democratic healthcare reform would expand insurance coverage in America by requiring people to obtain it.

That’s right. The healthcare reform bill would mandate that most US citizens and legal residents purchase “minimal essential coverage” for themselves and their dependents. They can get this either through their employer, or, if their employer doesn’t offer health insurance, they can buy it through new marketplaces that will sell policies to individuals.

Those marketplaces would be called “exchanges.” We’ll talk more about them in a later story. (We’ll also cover subsidies for health insurance, when it all would take effect, how it would be paid for, and what it means for businesses.)

I feel sure that the requirement to purchase health insurance will be challenged in court. Forcing a purchase with the penalty of fines seems to compel associations which could give rise to constitutional challenges.  The forced purchases, however, are key to the provision which is attractive to most people: elimination of pre-existing conditions as a reason to refuse coverage.

Why is Congress doing this? It’s a pretty obvious way to expand coverage, for one thing. Also, it will help bring in a flood of new customers for health insurance firms, including healthy young people who might not need much healthcare.

For insurance firms, those new customers could balance out the losses they might incur if they can no longer deny coverage to people with preexisting conditions. (Yes, that’s another change the bill makes.)

And remember, many people will not be buying this coverage purely on their own. Uncle Sam will be helping them. The bookend to the individual mandate is federal subsidies for insurance purchases, which reach deep into the middle class. We’ll talk about those next.

In essence, you and I (via taxes) will be providing coverage for people who may not want it so that people who need coverage for serious conditions will have it. Insurers may still benefit by virtue of the millions of new subscribers. I suspect there will be severe fines for insurers who attempt to limit coverage or benefits. But I don’t know. And the lack of knowledge is what is politically troubling. There will be legislators who approve this bill over the weekend that have not read it.

According to the NY Times, key votes are still in play approaching a Sunday vote.

Uganda’s Anti-Homosexuality Bill: Is CNSNews trying to change the subject?

This morning the conservative CNSNews reported on Tom Lantos Human Rights Committee Hearing on Uganda’s Anti-Homosexuality Bill. As I read the piece, I wondered if the reporter was trying to change the subject of the bill. The article seems quite focused on the following section of the Anti-Homosexuality bill pertaining to HIV positive persons:

3. Aggravated homosexuality.

(1) A person commits the offense of aggravated homosexuality where the

(b) offender is a person living with HIV

Offender is not defined in the bill but homosexuality is defined quite broadly and includes touching someone of the same-sex in a sexual manner. Touching is defined as

“touching” includes touching—

(a) with any part of the body;

(b) with anything else;

(c) through anything; and in particular includes touching amounting to penetration of any sexual organ. anus or mouth.

Touching in this manner can get you life in prison. If an HIV positive person touches in this manner, the action is considered “aggravated homosexuality” with death the penalty.

The CNSNews report makes a point to ask those at the Human Rights Committee hearing what they believe should happen with HIV persons who engage in homosexual sex. Here is the specific question:

CNSNews.com:  “It was mentioned today that the death penalty and long prison terms or life imprisonment are absolutely unacceptable and terrible for people who engage in homosexual acts.  And I was wondering if I could get your opinion on something.  Like, what would you—what do you think would be the appropriate way to address someone who knows they are HIV-positive and engages in homosexual relations anyway?  Like, what would be an appropriate penalty or a correct way to address that in your opinion?”

The question seems to assume that HIV-positive people who have sex set out to infect their partners with the virus. Rep. Baldwin gives a reasonable answer to the question.

Rep. Tammy Baldwin (D-Wis.):  “I think that—if there is—well first of all, in many parts of the globe, diagnostic tools aren’t necessarily available and so knowledge of one’s own HIV and its status is not uniformly as high in other places where health care is harder to come by than it is in the U.S.  When somebody has a communicable disease whether it be H1N1 flu, and they go about the public without, you know—potentially doing harm, or a sexually transmitted disease with calculation, tries to expose others, that is something that I think should be punishable and that it’s up to the legislatures of each country to decide what the appropriate penalty level is—how to deter such purposeful, harmful activity as well as protect others if there’s thought that that behavior might continue.”

 

Baldwin: “We’ve tackled that here in the U.S.  I would tell you that it varies from state to state what those criminal penalties or other penalties might be.  We’ve dealt with it not only with regard to sexually-transmitted disease, but diseases like tuberculosis.  And we’ve dealt with it at different times in different ways.  But I don’t think there’s one sort of boiler- plate way.  But again, I want to acknowledge this issue that health care systems are not the same in every country, and in order for this to be intentional, somebody has to know their HIV status.”

Rep. Baldwin makes clear that the actionable offense is intent to harm. However, the CNSNews reporter does not seem to get the crucial distinction – a distinction not made in the Anti-Homosexuality Bill. In the bill, there is no language that requires the offender to have harmful intent. The clear intent of the bill, as was recently confirmed to me by a researcher in the Ugandan Parliament Research Service is “to outlaw all same-sex sexual conduct.” Being HIV-positive gets the strongest penalty. In the bill, intent to harm is not relevant. The CNSNews reporter ignores Rep. Baldwin’s response.

 

CNSNews.com:  “Okay.  So in the case of somebody who does know that they are HIV-positive, are you saying that there should be a penalty then for continuing to engage in homosexual acts?”

Baldwin then tries to get back to the important distinctions involving awareness and intent.

Baldwin:  “Unprotected? I mean, there’s obviously ways to make sure that, you know, there are precautions—there are also universal precautions in medical settings as well as, you know, for those who engage in consensual activity.  But certainly if there is somebody who is using their, you know, their status as a weapon, you know, particularly to do harm, there should be, there should be appropriate penalties for that.  And I’m not going to advise any particular jurisdiction what it should be, but they should grapple with that in a democratic way.”

Even though the title of the article notes that Baldwin addressed purposeful spreading of HIV, the body of the article failed to make the important distinction:

But Baldwin did not say what specific punishment was warranted, particularly in the country of Uganda, which currently is considering legislation that would impose the death penalty on any HIV-positive person who willfully and knowingly engages in homosexual relations.

“Willfully and knowingly” engaging in homosexual relations should not be penalized according to Baldwin; doing so with the intent to spread HIV is what she addressed.  HIV-positive people may engage intimacy with appropriate precautions. Failing to make this distinction might be an oversight on the part of CNSNews or it might be an attempt to change the subject from what the bill says to focus on something that many readers would want to see addressed in law.

However, it is important to note that the bill as written intends “to outlaw all same-sex sexual conduct” and to impose the death penalty on same-sex intimacy, including touching, where one or both parties are HIV-positive, even if the touching is with mutual consent.

Brown wins; Dems look to nuclear option as means to get health care passed

Whether you support health care reform or not, wouldn’t the election of Republican Scott Brown in MA seem like a signal to slow things down?

Apparently Senate Democrats don’t think so. Senator Dick Durbin wants to get the bill signed before Brown can get into town and laid out a couple of ways to do it.

I suspect GOP strategists are torn. They don’t like the health care options but if the Dems ram something through, prospects for the midterm election should improve to an even more optimistic level.