Be Ever Vigilant

In 2009’s various versions of the health care reform bill, one section that received much attention was the section that called for annual “end-of-life planning” sessions for everyone who was covered by government-approved health insurance (that would have been you and me). I’ve written about it previously here, you can read about it in Health Plans Forced to Provide Assisted Suicide Counseling.

The final version of the bill that was ultimately passed and signed into law did not include separate sections detailing these mandatory annual planning sessions. Instead, the planning sessions were folded surreptitiously into sections that altered Medicare. On January 1, the new regulation, which allows Medicare to pay for end-of-life planning went into effect. Here is an excerpt from a New York Times article:

When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ 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, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Do you see the two-step process that was used to circumvent the public’s distaste for this kind of “counseling”? First, the health care legislation allowed for “coverage of yearly physical examinations.” That’s well and good and people on Medicare should have that kind of coverage. But the second step is what is disturbing: an administration official decided, contrary to what the people wanted, that counseling on end-of-life decisions should be part of wellness visits, and included it in the regulations that govern Medicare.

I am a proponent of discussions regarding care in end-of-life situations–that’s not the concern here. The problem  is who is giving this counseling and what resources are used. One example of a government resource would be the Department of Veteran’s Affairs document, “Your Life, Your Choices.” I’ve written previously about the problems with this document in The VA’s “Your Life, Your Choices” Document.

After the news of the new regulation was released, and pro-life bloggers and commentators started pointing this out, the Obama administration had a sudden reversal regarding this regulation and deleted it from the Medicare regulation; from a New York Time article:

The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday. …

While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House. …

Although the health care bill signed into law in March did not mention end-of-life planning, the topic was included in a huge Medicare regulation setting payment rates for thousands of physician services. The final regulation was published in the Federal Register in late November. The proposed rule, published for public comment in July, did not include advance care planning.

An administration official, authorized by the White House to explain the mix-up, said Tuesday, “We realize that this should have been included in the proposed rule, so more people could have commented on it specifically.”

“We will amend the regulation to take out voluntary advance care planning,” the official said. “This should not affect beneficiaries’ ability to have these voluntary conversations with their doctors.”

Did the Obama administration get caught with its hand in the cookie jar? The section in the 2009 health care reform bill that mentioned these mandatory visits were removed and provisions which would open the way for it were quietly hidden  in other sections. Then the proposed rule published for public comment last July did not include this regulation, once again hiding it from view. Is this the kind of “transparent government” that then-candidate Obama promised voters in 2008?

Folks, this is just one more reminder that those who are defending the sanctity of human life need to be ever vigilant. Those who want to devalue human life are constantly probing for weaknesses in our defense and will do anything to further advance their agenda where the sanctity of human life takes a back-seat to political expediency.

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