Palin Bad for Dialogue

I wonder if she has ever talked with anyone who has a child with down syndrome who tried to get insurance? It is darn near impossible...

Re Euthanasia an interview:
http://voices.washingtonpost.com/ezra-klein/200...

From another blog:
Sen. Johnny Isakson (R-GA), the actual author of Section 1233, says that the interpretation of that section as encouraging euthanasia is "nuts." Question to be asked to every Republican officeholder and talking head: "Sen. Isakson says that Gov. Palin is nuts. Do you agree?"

I wonder if Mr Wallis has read HR 3200.

I agree with Paul and in a respectful way, yes, we need to let people know that there are "dirty little secrets" in this health care bill and it is very dangerous for this country and generations to come. The pattern seems to be that when the truth is pointed out, it is demonized, along with the people who pointed it out.

Right on, Jim! I have wondered for a long time why Sojourners has not been talking tough enough about the demagogues that populate the Republican right and continually deceive those of us who are trying to occupy the middle ground. Now the truth is out. These are really evil people and we must stand against them or we will lose what freedoms we as Americans have left. Do not yield an inch to those mouthpieces of the far right who will attack you for speaking out.

As a minister who has been on staff with a hospice organization, it seems to me that both these responses misunderstand (or mis-characterize) the language in the bill. Advance care planning, and physicians orders growing out of such conversations, are a GOOD thing, which need to be understood as a necessary part of treatment planning conversations between patients and their health care providers. Unfortunately, due to the human propensity for denial and avoidance (on both sides of the conversation), such planning still mostly doesn't take place.
As I understand the language in the bill, this is what is being provided for - without mandating any particular approach or choice (which I would certainly be against), but just insuring that the conversation take place. In my opinion, Rev. Wallis is right - to characterize this as any sort of "death panel," as Mrs. Palin does, is nothing short of demagoguery of the worst sort.

Here's what Wesley Smith wrote about the issue:

Palin's language was, in my view, amateurish and hyperbolic. The Third Reich was an evil system. The Soviet Gulag also qualified. Taliban-style oppression of women, gays, and others, ditto. But the admittedly awful health-care reform bills currently being debated don't come near to earning that opprobrium. As for "death boards," that term is an overly provocative attempt to describe a key feature of the pending legislation about which there is very real cause for concern.

We don't yet know what the final health-care reform bill will look like. But it appears certain that President Obama and his congressional allies hope to establish a centralized board or boards that would be charged with limiting costs by deciding which procedures and drugs would be covered, under what circumstances. The legitimate fear is that such boards, regardless of their benefits, would impose rationing based on invidious categories - such as age, disability, or other "quality of life" measurements. In other words, the boards would deny certain categories of patients treatment available to other categories of patients...

(He goes on to reference his writing about Dr. Ezekiel Emanuel, the head bioethicist at NIH and Rahm's brother:
http://www.firstthings.com/blogs/secondhandsmok...)

True, Palin would be a more effective critic of Obamacare if she didn't write like a college-student blogger. But her concerns are legitimate and substantive. And that shouldn't be lost in the criticism of her lexicon.

I have to say that I don't like the sound of the "counselling" provisions in the health care bill, but to call it a "death panel" is way over the top. I liked Sarah Palin when she was nominated for VP. I'm liking her a lot less now.

LV

While I agree that we should communicate our end of life wishes, I do not believe that the government should mandate it. And the following section does lend credence to Palin's comments:

THANK YOU Jim Wallis! This needed to be said.

"You are speaking like a demagogue..."

Said Mr. Pot to Mrs. Kettle. It's like the French Laundry on this blog lately.

The term "death panels" is a bit much. However, it's worth noting that the bill, as written, does not preclude the possibility of government making decisions for parents of special needs children and for the elderly.

Europe has been cited as, essentially, a health care panacea, for it's ability to extend health care to the vast majority of citizens on a budget. They are able to do so, in part, by virtue of a more, let's call it nuanced, attitude toward bio-ethics.

15,000 elderly people died during a recent French heat wave, the equivalent of about 75,000 here in America. This did not lead to a major overhaul of the French system, which (obviously) does not favor the elderly. It certainly would have here. We have a different ethos from France that makes health care reform a bit tricky.

If government panels are going to keep costs down by making decisions about coverage, how are they going to do so? Cheaper prescription drugs are off the table. Tort reform is off the table. What's left?

It is certainly hyperbolic and demagogic to call for Americans to oppose death panels, but it is no further from the core of the debate than anything I have seen here.

And Jesus said to them:

Love your enemies, bless them that curse you and pray for them which despitefully use you. Unless of course they disagree with you strongly on matters of public policy, in which case you shouldn't bless them at all.

In fact, you would bring honor upon me and yourself by maligning your enemies, along with their intelligence, character and Christian commitment. Better yet, pray for them to fail along with their political career. I'll do what I can to thwart them, because if you hate them, I probably hate them, too. In fact, I'll just follow your lead on this and other important issues.

Let's leave peacemaking to the people who aren't in a position to influence public policy.

The Gospel According to Jim 5:44

My goodness, Mr. Quillman, you are so naive! Why do you assume that a person forming advance directives (establishing a Health Care Power of Attorney and/or a Living Will) is a bad thing? It's basic common sense.

As a professional hospital chaplain I have been involved in hundreds of conversations with patients and people out in the community in consultations of this nature - helping people complete these sorts of directives and having discussions about how people want to be cared for in the end stages of life. These consultations are always voluntary and under this legislation they would remain so.

Death is something we all have to go through, you know. But there are good deaths and there are bad, painful traumatic ways to die - even in hospitals! Lack of good personal planning often results in the later. It always amazes me how many people resist the notion of palliative care.

I have a lot of first hand experience in ICU and ER situations, observing the negative effects on patients and families from a person NOT documenting their wishes ahead of time, and thus not having their true wishes respected as a result. Avoiding making advance medical directives makes about as much sense as not having a regular will. HR3200 simply provides for voluntary free consultations of this nature, at government expense. It has absolutely NOTHING to do with euthanasia! (A person can also file an advance directive stating that they want "everything done at all costs." Did you know that?)

You would do well to read that bill carefully for yourself (I have) and I also refer you to neutral arbiters who have rightly demolished such misinformation. FactCheck.org labels the claim "nonsense" and says calling this forced euthanasia is like saying "a bill making retirement planning easier would force Americans to quit their jobs." Terrifying seniors over this provision is shameless.

And take a look at this other bi-partisan site for a good summary of FACTS about health insurance reform legislation being proposed: http://www.politifact.com/truth-o-meter/subject...

Mr. Quillman, why are you making comments/commentary that DO NOT fit the citations you are making above? Read them again! I don't respect this sort of misquoting.

Nath4U...How dare you! Whose interests are truly served by exposing Mr. Wallis? Certainly not Sojourners and even less its readers! What does it matter? Will it change a single opinion? I encourage my fellow sojourners not to reflect upon your comments. You clearly have sympathies for political positions to which we do not subscribe. How slowly would our positions develop if we left their evaluation and approval to a collection of writings and tradition from which we have obviously progressed? What certainty would be lossed? And what would be gained?

I don't think that there are real "neutral arbiters" in any political debates, espicially heated ones like this. I also am very distrustful of most things"bi-partisan", as they usually never really are. I am pretty sure that I can read this bill as well as anyone else.

That being said, I did say that "While I agree that we should communicate our end of life wishes, I do not believe that the government should mandate it." This bill mandates end of life conversations with doctors every 5 years starting at age 65, I believe. I think it is a good and necessary thing to think through end of life decisions well before the end of life, but the government should not mandate this.

Sadly, none of this discussion really matters. It is a done deal, the fix is in, and Obama and the democrats will get what they want. Not enough conservatives to stop it.

I al sorry but yoAdvance Care Planning Consultation

`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--

`(I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes;

`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--

`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--

`(I) ensures such orders are standardized and uniquely identifiable throughout the State;

`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;

`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

`(2) A practitioner described in this paragraph is--

`(A) a physician (as defined in subsection (r)(1)); and

`(B) a nurse practitioner or physician's assistant who has the authority under State law to sign orders for life sustaining treatments.

`(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

`(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

`(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

`(5)(A) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--

`(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional's authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;

`(ii) effectively communicates the individual's preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

`(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items--

`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

`(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;

`(iii) the use of antibiotics; and

`(iv) the use of artificially administered nutrition and hydration.'.

(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(FF),' after `(2)(EE),'.

(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--

(A) in paragraph (1)--

(i) in subparagraph (N), by striking `and' at the end;

(ii) in subparagraph (O) by striking the semicolon at the end and inserting `, and'; and

(iii) by adding at the end the following new subparagraph:

`(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;'; and

(B) in paragraph (7), by striking `or (K)' and inserting `(K), or (P)'.

(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.

(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-

(1) Physician'S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:

`(3) Physician'S QUALITY REPORTING INITIATIVE-

`(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

`(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.'.

(c) Inclusion of Information in Medicare & You Handbook-

(1) MEDICARE & YOU HANDBOOK-

(A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:

(i) An explanation of advance care planning and advance directives, including--

(I) living wills;

(II) durable power of attorney;

(III) orders of life-sustaining treatment; and

(IV) health care proxies.

(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--

(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);

(II) website links or addresses for State-specific advance directive forms; and

(III) any additional information, as determined by the Secretary.

(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.
ur assumptions are incorrect. Here is the text of the bill.

Where does it say mandate every five years?

I have put the text of the bill below.

Have you read this in the actual 3200 Bill or just from some forward published by Jerry Falwell's liberty institution.

This is NOT MANDATORY. If it was, every single person minus a few freakjobs would protest this. It is simply there if you need it. I wish my grandmother would have had end of life counseling to establish a living will, and power of attorney. This would simply allow participation in the advanced planning program. It's there if you want it. That's all. YOU decide if you need it.

Also, When has anyone in the Administration discussed "rationing" care for the elderly? And where does it say that in this bill? It doesn't.

IThe thought here is that God blessed us with an enquiring mind. It is only when we let others do the enquiring for us that we begin to listen to the "false prophets" of any subject. There are those who believe you have to go the way of the church, at any cost, and there are those who believe God imbued them with minds able to come to rational decisions independent of churches, politicians, or the next-door neighbor they admire. God gave us good sense. It may be a sin not to use that gift.

"This is NOT MANDATORY. "

Then why is it in the bill? At best, this is evidence of bloat; legislation as prose.

"Also, When has anyone in the Administration discussed "rationing" care for the elderly?"

The cost for this bill has to come from somewhere. Higher taxes (likely), rationing (less likely, but not unlikely), abortion consulting (somewhat likely), salary caps (have fun with that one, Dems). Pick your poison.

The administration has not discussed ANY of these costs. This does not mean we are obligated to pretend there are no costs.

Read the interview with Johnny Izakson (GOP) who initiated the "end-of-life-counseling" amendment.

http://voices.washingtonpost.com/ezra-klein/200...

granted, like a good republican lackey, his office now rejects his involvement, but he had co-sponsored an almost identical "end-of-life counseling" bill back in 2007.

http://www.govtrack.us/congress/billtext.xpd?bi...

cut the abortion crap. it's not in the bill. and again, I don't like the bill, but I'd rather discuss those things that are there or should be there, than chasing boogeymen.

I cannot seem to read all the comments that have been posted.

Sojourners is censoring comments that disagree with Jim's perspective.

Sojourners allows commenters to argue and debate with each other, but strangely, the comments that severly and accurately critique Jim seem to disappear.

If you can't stand the criticism, Jim, then don't put your ideas in the public domain.

I am sitting here with the bill open before me: