Hole Big Enough To Drive A Bus Through

Charles Lane has an oped in the Washington Post which to my eye seeks to push the euthaniasia cannard in health care reform but just put a sunnier more intellectual and in fact a somewhat more honest face on it. Check him out:

Still, I was not reassured to read in an Aug. 1 Post article that "Democratic strategists" are "hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors."

If Section 1233 is innocuous, why would "strategists" want to tip-toe around the subject?
Perhaps because, at least as I read it, Section 1233 is not totally innocuous.

Until now, federal law has encouraged end-of-life planning -- gently. In 1990, Congress required health-care institutions (not individual doctors) to give new patients written notice of their rights to make living wills, advance directives and the like -- but also required them to treat patients regardless of whether they have such documents.

The 1997 ban on assisted-suicide support specifically allowed doctors to honor advance directives. And last year, Congress told doctors to offer a brief chat on end-of-life documents to consenting patients during their initial "Welcome to Medicare" physical exam. That mandate took effect this year.

Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice -- even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs?
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.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they're in the meeting, the bill does permit "formulation" of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would "place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign," I don't think he's being realistic.

What's more, Section 1233 dictates, at some length, the content of the consultation. The doctor "shall" discuss "advanced care planning, including key questions and considerations, important steps, and suggested people to talk to"; "an explanation of . . . living wills and durable powers of attorney, and their uses" (even though these are legal, not medical, instruments); and "a list of national and State-specific resources to assist consumers and their families." The doctor "shall" explain that Medicare pays for hospice care (hint, hint).

Admittedly, this script is vague and possibly unenforceable. What are "key questions"? Who belongs on "a list" of helpful "resources"? The Roman Catholic Church? Jack Kevorkian?

There is just one big fat hairy problem with this line of thinking. The ONLY group of people with a profit margin that depends on the elderly staying alive are doctors and hospitals. Mr. Lane would have been much better off if he had stuck to the usual fear mongering over "gubmint bureaucrats" or Sarah Palin's "death panels". As long as the elderly stay alive, even on life support, doctors and hospitals can continue to bill their health insurance, whether its from the private sector or a public option. Not only that, every 5 years a doctor would now get paid for having the consultation with his patient so if there is an incentive at all in this bill for he doctor, its for him to make sure the patient is living 5 years from the first consultation.

This is just common sense people, I can't really understand how his op ed merited being published in a major newspaper. Then I remembered it was in the Washington Post.

It is what it is.