John Fanning: Don’t throw out the good parts of the new health care law
The Affordable Heath Care for America Act creates a massive new entitlement at a time when the budget is already buckling under the weight of existing entitlements. In my opinion, it is repressive rather than progressive. There is no question our health care system needs a fix, however, insurance is not the cause, and bigger government is not the answer. As one pundit put it, it is health care being delivered by the U.S. Postal Service and administered by the IRS.
With that being said, there has been way too much demagoguery and fear mongering related to the bill, its passage and repeal. I would caution not to “throw out the baby with the bath water” but take a judicious look at each part of the legislation and fix it, if it is fixable, and more importantly, if it is affordable. All of this, unfortunately, might be in vain when the Supreme Court makes a ruling on its constitutionality. A recent ruling by a Florida judge puts into question not only its constitutionality, but its very existence. As an aside, it is interesting how the liberals vilified this judge for his decision and called him an activist, outlier, and out of the mainstream. They had no problem with the two judges who upheld the law and were appointed by Democrats. We need to tone down the rhetoric. In any event, let me share with you an example of what I mean by “tossing the baby out!”
When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” it was dropped from the legislation to overhaul the health care system. There was fear among Democratic leadership that Republicans would seize on the idea of end-of-life counseling to argue that the bill would allow the government to cut off care for the critically ill.
The final version of the health care legislation signed into law by President Obama in March of 2010 authorized Medicare coverage for yearly physical examinations, or wellness visits. The new rule would cover voluntary advance care planning to discuss end-of-life treatment as part of the annual visit.
Under the rule, doctors could provide information to patients on how to prepare an “advance directive” stating how aggressively they wished to be treated if they are so sick they cannot make heath care decisions for themselves.
Research by the British Medical Journal published this year states “advance care planning improves end-of-life care and patient and family satisfaction, and reduces stress, anxiety and depression in surviving relatives.” Dr. Stacy M Fischer, an assistant professor at the University of Colorado School of Medicine, found that end-of-life discussions between doctor and patient help ensure one gets the care one wants. In a sense, Dr. Fischer said, such consultations “protect patient autonomy.”
Opponents said this part of the bill would bring back a procedure that could be used to justify the premature withdrawal of life-sustaining treatment from people with severe illnesses and disabilities. Sarah Palin led the criticism referring to “Obama’s death panel” and that the panel would decide who was worthy of health care. Others said this provision may start us down the path toward government-encouraged euthanasia. As a rebuttal to this, Mr. Obama said that nothing in the bill would “pull the plug on grandma.” Still the idea of death panels persists. Many still think the new health care law allows a government panel to make decisions about end-of-life care for people on Medicare.
The administration eliminated Medicare payments for doctors to discuss advanced directives three days after it was implemented. A baby was thrown out with the bathwater.
In a recent study of 3,700 people near the end of life, Dr. Maria J. Silveira of the University of Michigan found that many had “treatable life-threatening conditions” but lacked decision-making capacity in their final days. With the new Medicare coverage, doctors can learn a patient’s wishes before a crisis occurs.
People are very reluctant to discuss or confront the prospect of their eventual death. However, there is nothing wicked or evil about giving Medicare patients the option to talk about end-of-life issues with their doctors in private. Advance-care planning is important because a person’s ability to make decisions may diminish over time, and he or she may suddenly lose the capability to participate in health care decisions. With coverage by Medicare, doctors can learn about a patient’s wishes before a crisis occurs. We should not let fear-mongering, “death panel” hysteria, and talk about government encouraged euthanasia prevent us from doing the humane thing.
John Fanning lives in Dillon and Green Valley, Ariz.
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