Rationing Health Care for Seniors

UKRNinUSA, RN · Aug 8, 2009

HYANNIS – Eunice Kennedy Shriver remains in critical condition today at Cape Cod Hospital....
If this were any 'regular' 88 year old woman on Cape Cod, she would already have been sent to a local SNF to die..not kept in the ICU. I am truly sorry for the Kennedy family, but this is just one example of how health care is being rationed already. It'll get even worse if Obama's plan goes through.

I believe that would depend on her advance directive. While we are on the subject, I would like to clear up any misinformation you may have received

Myth vs. Fact: Advance Planning Consultations in H.R. 3200

Few areas are more vital for honest discussion and careful consideration than end-of-life care for America’s seniors. Unfortunately, families often do not know their loved ones’ preference for end of life care and are not confronted with these difficult decisions until an emergency arises. This leaves spouses, sons, daughters and grandchildren unprepared; as a result families struggle to make decisions in the midst of turmoil.

The House health care legislation includes a provision (Sec. 1233) that provides seniors with better care as they grapple with these hard questions. This provision extends Medicare coverage to cover the cost of patients voluntarily speaking with their doctors about their values and preferences regarding end-of-life care. These are deeply personal decisions that take thoughtful consideration, and it is only appropriate that doctors be compensated for their time.

Myth: Patients will be forced to have this consultation once every five years.

Fact: Advance planning consultations are not mandatory; this benefit is completely

voluntary. The provision merely provides coverage under Medicare to have a conversation once every five years if – and only if – a patient wants to make his or her wishes known to a doctor. If desired, patients may have consultations more frequently if they are chronically ill or if their health status changes.

Myth: Patients will be forced to sign an advance care directive (or living will).

Fact: There is no mandate in the bill to complete an advance care directive or living

will. If a patient chooses to complete an advance directive or order for life sustaining

treatment, these documents will help articulate a full range of treatment preferences, from full and aggressive treatment to limited, comfort care only. Patients that choose to have these documents and can customize them so that their wishes are appropriately reflected.

Myth: Patients will have to see a health care professional chosen by the government.

Fact: There are no government-chosen professionals involved. The legislation simply

allows Medicare to pay for a conversation between patient and their doctors if patients wish to talk with their doctor about end of life care preferences.

Provision Endorsed By: AARP, American Academy of Hospice and Palliative Medicine,

American College of Physicians, American Hospice Foundation, Center to Advance Palliative Care, Consumers Union, Gundersen Lutheran Health System, Hospice and Palliative Nursing Association,Medicare Rights Center, National Hospice and Palliative Care Organization, National Palliative Care Research Center, Providence Health and Services, and Supportive Care Coalition

http://blumenauer.house.gov/images/stories/documents/advance%20care%20planning%20myths%20vs%20facts.pdf

Glad to be of assistance, you're more than welcome.

HM2VikingRN, RN · Aug 8, 2009

Thanks for debunking yet another delusion of the right......

Ginger's Mom, MSN, RN · Aug 8, 2009

HYANNIS - Eunice Kennedy Shriver remains in critical condition today at Cape Cod Hospital.
Shriver, the 88-year-old sister of Sen. Edward Kennedy, has been in the intensive care unit of the hospital for about a week. Her family, including California Gov. Arnold Schwarzenegger, the husband of Shriver's daughter, Maria, is among those who traveled to the Cape to be with her.
More Times Breaking News
There are no updates on Shriver's condition, according to a Special Olympics spokeswoman. She was last said to be in "critical but stable condition".
Shriver was admitted to the hospital after suffering a series of strokes, the Associated Press reported early this morning. The Special Olympics spokeswoman would not confirm that report.
If this were any 'regular' 88 year old woman on Cape Cod, she would already have been sent to a local SNF to die..not kept in the ICU. I am truly sorry for the Kennedy family, but this is just one example of how health care is being rationed already. It'll get even worse if Obama's plan goes through.

That is so true, but I am surprised she wasn't airlifted to MGH like other members of her family.

Ginger's Mom, MSN, RN · Aug 8, 2009

I believe that would depend on her advance directive. While we are on the subject, I would like to clear up any misinformation you may have received
Myth vs. Fact: Advance Planning Consultations in H.R. 3200
Few areas are more vital for honest discussion and careful consideration than end-of-life care for America's seniors. Unfortunately, families often do not know their loved ones' preference for end of life care and are not confronted with these difficult decisions until an emergency arises. This leaves spouses, sons, daughters and grandchildren unprepared; as a result families struggle to make decisions in the midst of turmoil.
The House health care legislation includes a provision (Sec. 1233) that provides seniors with better care as they grapple with these hard questions. This provision extends Medicare coverage to cover the cost of patients voluntarily speaking with their doctors about their values and preferences regarding end-of-life care. These are deeply personal decisions that take thoughtful consideration, and it is only appropriate that doctors be compensated for their time.

Myth: Patients will be forced to have this consultation once every five years.

Fact: Advance planning consultations are not mandatory; this benefit is completely
voluntary. The provision merely provides coverage under Medicare to have a conversation once every five years if - and only if - a patient wants to make his or her wishes known to a doctor. If desired, patients may have consultations more frequently if they are chronically ill or if their health status changes.

Myth: Patients will be forced to sign an advance care directive (or living will).

Fact: There is no mandate in the bill to complete an advance care directive or living
will. If a patient chooses to complete an advance directive or order for life sustaining
treatment, these documents will help articulate a full range of treatment preferences, from full and aggressive treatment to limited, comfort care only. Patients that choose to have these documents and can customize them so that their wishes are appropriately reflected.

Myth: Patients will have to see a health care professional chosen by the government.

Fact: There are no government-chosen professionals involved. The legislation simply
allows Medicare to pay for a conversation between patient and their doctors if patients wish to talk with their doctor about end of life care preferences.

Provision Endorsed By: AARP, American Academy of Hospice and Palliative Medicine,
American College of Physicians, American Hospice Foundation, Center to Advance Palliative Care, Consumers Union, Gundersen Lutheran Health System, Hospice and Palliative Nursing Association,Medicare Rights Center, National Hospice and Palliative Care Organization, National Palliative Care Research Center, Providence Health and Services, and Supportive Care Coalition
http://blumenauer.house.gov/images/stories/documents/advance%20care%20planning%20myths%20vs%20facts.pdf
Glad to be of assistance, you're more than welcome.

I am skeptical, all have to report AMI, CHF, pneumonia, and surgical rates. We are told these measures are voluntary . This is very true, but if you do not follow there rules to the letter you will have 2% of Medicare and Medicaid funding removed.

So I wonder how voluntary these rules we be. Bigger issue is that the Federal Government will be requesting your medical record to see if this counseling was done. In the new regulations Medicare in now requesting direct access to hospital systems, the next level will be your medical record.

UKRNinUSA, RN · Aug 8, 2009

Bigger issue is that the Federal Government will be requesting your medical record to see if this counseling was done.

and again

"There is no mandate in the bill to complete an advance care directive or living

will."

Ginger's Mom, MSN, RN · Aug 8, 2009

You don't get it, right now everything is voluntary. A hospital does not have to submit any data. It is "voluntary", but if you don't you will loose 2% of your income. Also Joint Commission and other agencies use this "voluntary" data to accredit the hospital.

I can for see a provider loss 2% of their medicare fee and that data goes to the Board of Medicine who will not grant a license.

HM2VikingRN, RN · Aug 9, 2009

For a debunking about rationing:

Under Obamacare there will be rationing of healthcare, which we don't have now.

or, in another form: YOUR HEALTHCARE IS RATIONED!!!

Fact
Healthcare is rationed now. Insurance companies determine what procedures they will cover, and at what price. They deny payment on certain procedures, which means thay patients either go without, or they pay themselves. This is how rationing works in a capitalistic system.
Also: Referencing Pg 29, HR 3200, from Viral Emails Page 29 refers to co-payments and caps on out-of-pocket expenses as part of the minimum benefits package. It is not addressing treatment or approvals or anything of the sort.Ref.US Health Crisis
br>Private insurance companies ration care to Americans every single day. They reject applications based on pre-existing conditions and family history. They rescind coverage after an illness has been diagnosed. Their premiums and deductibles are so high that millions of Americans are forced to delay care or declare bankruptcy due to high costs. Ref.Media Matters Fact Check
As Ezra Klein points out on his blog: "If you look at waiting times, you'll see that relatively few Americans wait more than four months for surgery, which helps folks claim that America doesn't ration care, and makes our system look pretty good on the waiting times metric. Here's what they don't tell you: When you look at who foregoes care, the international comparisons reverse themselves. About 23% of Americans report that they didn't receive care, or get a test due to cost. In Canada, that number is 5.5%."
Rather Than Waiting In Line, Americans Simply Do Not Get Care. As Ezra Klein argues in the Los Angeles Times, "although Britain and Canada have decided that no one will go without, even if some must occasionally wait, the U.S. has decided that most of us who can't afford care simply won't get it.

http://healthcarereformmyths.org/HealthcareReformMyths.php#A25

CapeCodMermaid, RN · Aug 9, 2009

1. I do NOT appreciate your condescending tone. I do not need YOU to explain anything to me.

2. I am not on the 'right' politically speaking.

3. I spoke personally to Senator Tom Daschle. When asked if health care would be rationed, he told a joke and would not answer.

MY health care decisions are mine alone. Mine and my doctor and my insurance company. I trust either one of them far more than I do the government.

My point was more about preferential treatment given to celebrities.

HM2VikingRN, RN · Aug 9, 2009

from please cut the crap:

the rest are pure paranoia. the advance care planning consultation system has also been around for years, and i'm unaware of a spate of senior suicides or euthanasia as a result. it simply encourages people to consult with their doctors, and get all of the options available for either planning for the end, or working to create a higher quality of life. i'm sure almost everyone knows someone with a debilitating disease, such as multiple sclerosis or diabetes; advance care planning reduces the likelihood that these people will constantly show up at urgent care or the er for minor problems that they themselves can take care of.

elkpark · Aug 9, 2009

I've seen plenty of hopeless, futile cases maintained in ICUs for weeks or more -- "regular" people. I don't think the scenario in the OP is that out of the ordinary, or represents any kind of remarkable treatment.

I didn't realize it's routine treatment to ship (even) 88 year olds to a SNF "to die" within a week of having one or more CVAs ...

HM2VikingRN, RN · Aug 9, 2009

my health care decisions are mine alone. mine and my doctor and my insurance company. i trust either one of them far more than i do the government.
my point was more about preferential treatment given to celebrities.

no one is being condescending or intending to be that way towards you as a person. one of the goals of pnhp is to preserve the patient doctor relationship. doctors are spending 8+ hours per week dealing with denial of service issues which is a real concern. evidence based reimbursement practice guidelines should result in improved care and reduced bureaucracy. i agree with our concerns about rationing care based on ability to pay which is really driven by a profit driven health care system.

i encourage you to read the material available from pnhp.

no. socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. doctors in the veterans administration and the armed services are paid this way. the health systems in great britain and spain are other examples. but in most european countries, canada, australia and japan they have socialized health insurance, not socialized medicine. the government pays for care that is delivered in the private (mostly not-for-profit) sector. this is similar to how medicare works in this country. doctors are in private practice and are paid on a fee-for-service basis from government funds. the government does not own or manage medical practices or hospitals.
the term socialized medicine is often used to conjure up images of government bureaucratic interference in medical care. that does not describe what happens in countries with national health insurance where doctors and patients often have more clinical freedom than in the u.s., where bureaucrats attempt to direct care.

http://www.pnhp.org/facts/singlepayer_faq.php#run_system