Time For Thursday Health Care Hackery (And More)

If you’re thinking that all I ever do is post about health care anymore, I should tell you that that’s not correct, though you are close to the truth.

In today’s Philadelphia Inquirer, Former Senator Man-On-Dog laments the cost of the health care reform legislation here (as a former U.S. Senator, I’m sure he has no coverage issues concerning his own health care) and tells us the following…

Even after all this new spending, almost half a million Pennsylvanians would still be uninsured, according to the Lewin Group, a health-care consulting firm. And if a government plan modeled after Medicare became available to everyone, the firm predicts that a majority of privately insured Pennsylvanians would move to the government plan.

Oh, by the way, as Media Matters notes here, the Lewin Group is owned by United Healthcare, so don’t expect anything approximating a “fair and balanced” point of view (the Media Matters post also tells us of another sky high – and incorrect – enrollment estimate from Lewin…I would say there’s quite a difference between 88 million and 2 million.)

And here’s more from our former “family values” senator…

The health-care proposals could be financed partly through cuts in Medicare reimbursements to health-care providers. Pennsylvania ranks third, behind West Virginia and Maine, in the share of the population on Medicare. So not only would our doctors and hospitals be hurt disproportionately, but other insurance rates would go up as costs are shifted to the private sector.

Philadelphia also would feel a disproportionate impact. A proposed surtax on the “rich” to pay for expanded coverage would disproportionately strike higher incomes in the region. But the biggest hit would be to the region’s bioscience industry.

American health care was born in Philadelphia. The city boasts a list of national health-care firsts: first hospital, children’s hospital, medical school, cancer center, and more. Not surprisingly, those institutions are also among the nation’s best. This region leads the country, and our country leads the world in innovative medicine.

Why? Because private markets reward excellence and innovation. Government-managed systems won’t pay for either. With more than 40,000 people employed in bioscience jobs in the Philadelphia area, a shift away from quality and innovation would disproportionately penalize the region.

As noted here, the Philadelphia life sciences industry is funded also by the city and the state (I have no information on federal funding, and Santorum’s argument that enrollment in a government-funded public option could mean less for the life sciences industry from Uncle Sam is nothing more than typical propaganda).

But wait, there’s more!…

As to the climate bill, it would make coal Public Enemy No. 1, slapping enormous taxes on states that produce it and burn it for electricity. Pennsylvania is among the top five coal-producing states. More than 900 active mines employ more than 20,000 workers in the Commonwealth, in addition to almost 60,000 other jobs related to mining.

Taxing poor people in Appalachia for the benefit of California, New York, Connecticut, and New Jersey may be politically appealing to Democrats.

But is it change Pennsylvanians can believe in?

Demagoguery aside, Santorum actually has a point, shockingly enough. And that’s why ten Democratic senators, including PA’s Bob Casey and Arlen Specter, signed off on a letter that stated as follows (here)…

In a letter to Obama, the senators asked for a strong “border adjustment mechanism” to help U.S. industries adjustment to higher energy costs. Such a “mechanism” might include a tax or tariff against foreign manufacturers whose costs aren’t affected by the legislation.

“Any climate change legislation must prevent the export of jobs and related greenhouse gas emissions to countries that fail to take actions to combat the threat of global warming comparable to those taken by the United States,” the senators write.

And as long as I’m taking note of Little Ricky, this tells us that he’s been “making the stops” in Iowa. To do some ground work. For three years from now. Contemplating the “big chair” at 1600 Pennsylvania Avenue.

It’s almost too scary for words.

JDMullaneOh, and since it is Thursday, that means that it’s time once more for J.D. Mullane of the Bucks County Courier Times to inflict more nonsense on our public deliberation on health care reform (here…and by the way, read commenter “my2cents” for the reality-based perspective).

And today, that means attacking something else in the House version of the bill, and that would be Section 1233 (and in so doing, Mullane singles out Dem Congressman Earl Blumenauer of Oregon)…

Blumenauer, a lawyer, insists that Section 1233 is “carefully crafted” and “bipartisan” and that the “advance planning” it promotes is “voluntary.”

Yet, the word “voluntary” does not appear in the law. To be fair, neither does the word “mandatory.” This leaves the legal intent vague.

Blumenauer has denounced critics as “unhinged.” He has issued a “myth vs. fact” paper, insisting that Section 1233 “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.”

In fact, Section 1233 says more than that. A patient’s wishes may be “known” and “respected,” but the treatment a patient receives will be “guided by a coalition of stakeholders.” These include doctors, nurses, emergency medical technicians, long-term care facility managers, lawyers, hospice caregivers and state departments of health.

I read through Section 1233 from the bill (here), and I can’t find evidence of what Mullane is talking about. But in case I missed something, here is Section 1233 of the bill…

6 (a) MEDICARE.—
7 (1) IN GENERAL.—Section 1861 of the Social
8 Security Act (42 U.S.C. 1395x) is amended—
9 (A) in subsection (s)(2)—
10 (i) by striking ‘‘and’’ at the end of
11 subparagraph (DD);
12 (ii) by adding ‘‘and’’ at the end of
13 subparagraph (EE); and
14 (iii) by adding at the end the fol15
lowing new subparagraph:
16 ‘‘(FF) advance care planning consultation (as
17 defined in subsection (hhh)(1));’’; and
18 (B) by adding at the end the following new
19 subsection:
20 ‘‘Advance Care Planning Consultation
21 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
22 term ‘advance care planning consultation’ means a con23
sultation between the individual and a practitioner de24
scribed in paragraph (2) regarding advance care planning,
25 if, subject to paragraph (3), the individual involved has
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1 not had such a consultation within the last 5 years. Such
2 consultation shall include the following:
3 ‘‘(A) An explanation by the practitioner of ad4
vance care planning, including key questions and
5 considerations, important steps, and suggested peo6
ple to talk to.
7 ‘‘(B) An explanation by the practitioner of ad8
vance directives, including living wills and durable
9 powers of attorney, and their uses.
10 ‘‘(C) An explanation by the practitioner of the
11 role and responsibilities of a health care proxy.
12 ‘‘(D) The provision by the practitioner of a list
13 of national and State-specific resources to assist con14
sumers and their families with advance care plan15
ning, including the national toll-free hotline, the ad16
vance care planning clearinghouses, and State legal
17 service organizations (including those funded
18 through the Older Americans Act of 1965).
19 ‘‘(E) An explanation by the practitioner of the
20 continuum of end-of-life services and supports avail21
able, including palliative care and hospice, and bene22
fits for such services and supports that are available
23 under this title.
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1 ‘‘(F)(i) Subject to clause (ii), an explanation of
2 orders regarding life sustaining treatment or similar
3 orders, which shall include—
4 ‘‘(I) the reasons why the development of
5 such an order is beneficial to the individual and
6 the individual’s family and the reasons why
7 such an order should be updated periodically as
8 the health of the individual changes;
9 ‘‘(II) the information needed for an indi10
vidual or legal surrogate to make informed deci11
sions regarding the completion of such an
12 order; and
13 ‘‘(III) the identification of resources that
14 an individual may use to determine the require15
ments of the State in which such individual re16
sides so that the treatment wishes of that indi17
vidual will be carried out if the individual is un18
able to communicate those wishes, including re19
quirements regarding the designation of a sur20
rogate decisionmaker (also known as a health
21 care proxy).
22 ‘‘(ii) The Secretary shall limit the requirement
23 for explanations under clause (i) to consultations
24 furnished in a State—
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1 ‘‘(I) in which all legal barriers have been
2 addressed for enabling orders for life sustaining
3 treatment to constitute a set of medical orders
4 respected across all care settings; and
5 ‘‘(II) that has in effect a program for or6
ders for life sustaining treatment described in
7 clause (iii).
8 ‘‘(iii) A program for orders for life sustaining
9 treatment for a States described in this clause is a
10 program that—
11 ‘‘(I) ensures such orders are standardized
12 and uniquely identifiable throughout the State;
13 ‘‘(II) distributes or makes accessible such
14 orders to physicians and other health profes15
sionals that (acting within the scope of the pro16
fessional’s authority under State law) may sign
17 orders for life sustaining treatment;
18 ‘‘(III) provides training for health care
19 professionals across the continuum of care
20 about the goals and use of orders for life sus21
taining treatment; and
22 ‘‘(IV) is guided by a coalition of stake23
holders includes representatives from emergency
24 medical services, emergency department physi25
cians or nurses, state long-term care associa-
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1 tion, state medical association, state surveyors,
2 agency responsible for senior services, state de3
partment of health, state hospital association,
4 home health association, state bar association,
5 and state hospice association.
6 ‘‘(2) A practitioner described in this paragraph is—
7 ‘‘(A) a physician (as defined in subsection
8 (r)(1)); and
9 ‘‘(B) a nurse practitioner or physician’s assist10
ant who has the authority under State law to sign
11 orders for life sustaining treatments.
12 ‘‘(3)(A) An initial preventive physical examination
13 under subsection (WW), including any related discussion
14 during such examination, shall not be considered an ad15
vance care planning consultation for purposes of applying
16 the 5-year limitation under paragraph (1).
17 ‘‘(B) An advance care planning consultation with re18
spect to an individual may be conducted more frequently
19 than provided under paragraph (1) if there is a significant
20 change in the health condition of the individual, including
21 diagnosis of a chronic, progressive, life-limiting disease, a
22 life-threatening or terminal diagnosis or life-threatening
23 injury, or upon admission to a skilled nursing facility, a
24 long-term care facility (as defined by the Secretary), or
25 a hospice program.
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1 ‘‘(4) A consultation under this subsection may in2
clude the formulation of an order regarding life sustaining
3 treatment or a similar order.
4 ‘‘(5)(A) For purposes of this section, the term ‘order
5 regarding life sustaining treatment’ means, with respect
6 to an individual, an actionable medical order relating to
7 the treatment of that individual that—
8 ‘‘(i) is signed and dated by a physician (as de9
fined in subsection (r)(1)) or another health care
10 professional (as specified by the Secretary and who
11 is acting within the scope of the professional’s au12
thority under State law in signing such an order, in13
cluding a nurse practitioner or physician assistant)
14 and is in a form that permits it to stay with the in15
dividual and be followed by health care professionals
16 and providers across the continuum of care;
17 ‘‘(ii) effectively communicates the individual’s
18 preferences regarding life sustaining treatment, in19
cluding an indication of the treatment and care de20
sired by the individual;
21 ‘‘(iii) is uniquely identifiable and standardized
22 within a given locality, region, or State (as identified
23 by the Secretary); and
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1 ‘‘(iv) may incorporate any advance directive (as
2 defined in section 1866(f)(3)) if executed by the in3
4 ‘‘(B) The level of treatment indicated under subpara5
graph (A)(ii) may range from an indication for full treat6
ment to an indication to limit some or all or specified
7 interventions. Such indicated levels of treatment may in8
clude indications respecting, among other items—
9 ‘‘(i) the intensity of medical intervention if the
10 patient is pulse less, apneic, or has serious cardiac
11 or pulmonary problems;
12 ‘‘(ii) the individual’s desire regarding transfer
13 to a hospital or remaining at the current care set14
15 ‘‘(iii) the use of antibiotics; and
16 ‘‘(iv) the use of artificially administered nutri17
tion and hydration.’’.
18 (2) PAYMENT.—Section 1848(j)(3) of such Act
19 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting
20 ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’.
21 (3) FREQUENCY LIMITATION.—Section 1862(a)
22 of such Act (42 U.S.C. 1395y(a)) is amended—
23 (A) in paragraph (1)—
24 (i) in subparagraph (N), by striking
25 ‘‘and’’ at the end;
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1 (ii) in subparagraph (O) by striking
2 the semicolon at the end and inserting ‘‘,
3 and’’; and
4 (iii) by adding at the end the fol5
lowing new subparagraph:
6 ‘‘(P) in the case of advance care planning
7 consultations (as defined in section
8 1861(hhh)(1)), which are performed more fre9
quently than is covered under such section;’’;
10 and
11 (B) in paragraph (7), by striking ‘‘or (K)’’
12 and inserting ‘‘(K), or (P)’’.
13 (4) EFFECTIVE DATE.—The amendments made
14 by this subsection shall apply to consultations fur15
nished on or after January 1, 2011.
TIVE.—Section 1848(k)(2) of the Social Security Act
20 (42 U.S.C. 1395w–4(k)(2)) is amended by adding at
21 the end the following new paragraphs:
24 ‘‘(A) IN GENERAL.—For purposes of re25
porting data on quality measures for covered
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1 professional services furnished during 2011 and
2 any subsequent year, to the extent that meas3
ures are available, the Secretary shall include
4 quality measures on end of life care and ad5
vanced care planning that have been adopted or
6 endorsed by a consensus-based organization, if
7 appropriate. Such measures shall measure both
8 the creation of and adherence to orders for life9
sustaining treatment.
11 Secretary shall publish in the Federal Register
12 proposed quality measures on end of life care
13 and advanced care planning that the Secretary
14 determines are described in subparagraph (A)
15 and would be appropriate for eligible profes16
sionals to use to submit data to the Secretary.
17 The Secretary shall provide for a period of pub18
lic comment on such set of measures before fi19
nalizing such proposed measures.’’.
23 (A) IN GENERAL.—Not later than 1 year
24 after the date of the enactment of this Act, the
25 Secretary of Health and Human Services shall
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1 update the online version of the Medicare &
2 You Handbook to include the following:
3 (i) An explanation of advance care
4 planning and advance directives, includ5
6 (I) living wills;
7 (II) durable power of attorney;
8 (III) orders of life-sustaining
9 treatment; and
10 (IV) health care proxies.
11 (ii) A description of Federal and State
12 resources available to assist individuals
13 and their families with advance care plan14
ning and advance directives, including—
15 (I) available State legal service
16 organizations to assist individuals
17 with advance care planning, including
18 those organizations that receive fund19
ing pursuant to the Older Americans
20 Act of 1965 (42 U.S.C. 93001 et
21 seq.);
22 (II) website links or addresses for
23 State-specific advance directive forms;
24 and
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1 (III) any additional information,
2 as determined by the Secretary.
4 VERSIONS.—The Secretary shall include the in5
formation described in subparagraph (A) in all
6 paper and electronic versions of the Medicare &
7 You Handbook that are published on or after
8 the date that is 1 year after the date of the en9
actment of this Act.

Everybody got that? Good.

And as noted here…

Many observers now today write in the media that erroneous interpretations of Section 1233 of Health Care Reform Bill is (sic)very “egregious,” as it involves the lives of our senior citizens. The erroneous interpretation is that the government will counsel the senior citizens every five years on how to end their lives early. This is outrageous interpretation of end of life planning.

What the Section 1233 of the Health Care Reform Bill really reads is that “Medicare will pay for an “advance care planning consultation” once every five years. Section 1233 is actually creating a new benefit for seniors that will be paid for by Medicare. It will only pay for one consultation every five years unless the patient’s health changes. If that happens, the provision then calls for Medicare to pay for a new consultation when the change in health occurs,” explains SV Herald.

(More information is available here.)

By the way, I actually visited J.D. Mullane’s blog yesterday (where common sense goes home to die) and found out that his column will, according to Mullane, now “run…in the Burlington County Times, our sister newspaper across the river, beginning September. I’m looking forward to covering the governor’s race, one of the highest profile matchup’s in the country. With the Courier, the Intel in Doylestown and the Burlington paper, the audience expands to more than 100,000 readers.”

I just thought anyone out there who was thinking of renewing their subscription to the Courier Times (and who may be reading this) should know that Mullane’s publisher thinks rank propaganda should be rewarded instead of punished.

And newspapers wonder why they’re losing circulation…


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