# Section 1233, HR 3200  "End of Life Council/Euthenasia talk origins"



## PLYMCO_PILGRIM (Aug 11, 2009)

Read for yourself and decide. Taken from http://www.opencongress.org/bill/111-h3200/text?version=ih&nid=t0:ih:2834

&#8216;Advance Care Planning Consultation

&#8216;(hhh)(1) Subject to paragraphs (3) and (4), the term &#8216;advance care planning consultation&#8217; 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:CommentsClose CommentsPermalink

&#8216;(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.CommentsClose CommentsPermalink

&#8216;(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.CommentsClose CommentsPermalink

&#8216;(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.CommentsClose CommentsPermalink

&#8216;(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).CommentsClose CommentsPermalink

&#8216;(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.CommentsClose CommentsPermalink

&#8216;(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--CommentsClose CommentsPermalink

&#8216;(I) the reasons why the development of such an order is beneficial to the individual and the individual&#8217;s family and the reasons why such an order should be updated periodically as the health of the individual changes;CommentsClose CommentsPermalink

&#8216;(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; andCommentsClose CommentsPermalink

&#8216;(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).CommentsClose CommentsPermalink

&#8216;(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--CommentsClose CommentsPermalink

&#8216;(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; andCommentsClose CommentsPermalink

&#8216;(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).CommentsClose CommentsPermalink

&#8216;(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--CommentsClose CommentsPermalink

&#8216;(I) ensures such orders are standardized and uniquely identifiable throughout the State;CommentsClose CommentsPermalink

&#8216;(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional&#8217;s authority under State law) may sign orders for life sustaining treatment;CommentsClose CommentsPermalink

&#8216;(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; andCommentsClose CommentsPermalink

&#8216;(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.CommentsClose CommentsPermalink

&#8216;(2) A practitioner described in this paragraph is--CommentsClose CommentsPermalink

&#8216;(A) a physician (as defined in subsection (r)(1)); andCommentsClose CommentsPermalink

&#8216;(B) a nurse practitioner or physician&#8217;s assistant who has the authority under State law to sign orders for life sustaining treatments.CommentsClose CommentsPermalink

&#8216;(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).CommentsClose CommentsPermalink

&#8216;(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.CommentsClose CommentsPermalink

&#8216;(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.CommentsClose CommentsPermalink

&#8216;(5)(A) For purposes of this section, the term &#8216;order regarding life sustaining treatment&#8217; means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--CommentsClose CommentsPermalink

&#8216;(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&#8217;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;CommentsClose CommentsPermalink

&#8216;(ii) effectively communicates the individual&#8217;s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;CommentsClose CommentsPermalink

&#8216;(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); andCommentsClose CommentsPermalink

&#8216;(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.CommentsClose CommentsPermalink

&#8216;(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--CommentsClose CommentsPermalink

&#8216;(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;CommentsClose CommentsPermalink

&#8216;(ii) the individual&#8217;s desire regarding transfer to a hospital or remaining at the current care setting;CommentsClose CommentsPermalink

&#8216;(iii) the use of antibiotics; andCommentsClose CommentsPermalink

&#8216;(iv) the use of artificially administered nutrition and hydration.&#8217;.CommentsClose CommentsPermalink

(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting &#8216;(2)(FF),&#8217; after &#8216;(2)(EE),&#8217;.CommentsClose CommentsPermalink

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

(A) in paragraph (1)--CommentsClose CommentsPermalink

(i) in subparagraph (N), by striking &#8216;and&#8217; at the end;CommentsClose CommentsPermalink

(ii) in subparagraph (O) by striking the semicolon at the end and inserting &#8216;, and&#8217;; andCommentsClose CommentsPermalink

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

&#8216;(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;&#8217;; andCommentsClose CommentsPermalink

(B) in paragraph (7), by striking &#8216;or (K)&#8217; and inserting &#8216;(K), or (P)&#8217;.CommentsClose CommentsPermalink

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

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

(1) Physician&#8217;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:CommentsClose CommentsPermalink

&#8216;(3) Physician&#8217;S QUALITY REPORTING INITIATIVE-CommentsClose CommentsPermalink

&#8216;(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.CommentsClose CommentsPermalink

&#8216;(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.&#8217;.CommentsClose CommentsPermalink

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

(1) MEDICARE & YOU HANDBOOK-CommentsClose CommentsPermalink

(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:CommentsClose CommentsPermalink

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

(I) living wills;CommentsClose CommentsPermalink

(II) durable power of attorney;CommentsClose CommentsPermalink

(III) orders of life-sustaining treatment; andCommentsClose CommentsPermalink

(IV) health care proxies.CommentsClose CommentsPermalink

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

(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.);CommentsClose CommentsPermalink

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

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

(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


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## jillian (Aug 11, 2009)

if you think that's about euthenasia, you're an idiot. 

and you loons need to stop spewing that garbage....


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## PLYMCO_PILGRIM (Aug 11, 2009)

I already wrote up my interpretation but want to see what the pro-govt health care and the anti-govt health care people in here think first.


This is one section of the bill where people get the "this bill will deny care to seniors" from


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## PLYMCO_PILGRIM (Aug 11, 2009)

So can anyone tell me where it shows the claims some people say are in the bill?

Or how about show where it disproves the claims of end of life counciling?

Anyone?

Someone in here must have actually read the stuff you're all debating in a few other threads.


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## deaddude (Aug 11, 2009)

If you are referring to the death panel nonsense, then of course I can't show you where it is because it isn't there. The entire thing was made up to scare the elderly.


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## veritas (Aug 11, 2009)

deaddude said:


> If you are referring to the death panel nonsense, then of course I can't show you where it is because it isn't there. The entire thing was made up to scare the elderly.



IOW it's a wacko lie talking point that's to be repeated by republidrones.


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## PLYMCO_PILGRIM (Aug 12, 2009)

deaddude said:


> If you are referring to the death panel nonsense, then of course I can't show you where it is because it isn't there. The entire thing was made up to scare the elderly.



I am referring to the actual term "death panel" and its lack of being in the language of the bill.

I in no way support the bill as currently written but I also don't support bogus claims being used to make the bill less popular...when the truth comes out it hurts my chances of them changing the bill drastically so I can find it acceptable.


However, there are some points in the language above that make it sound as if the govt will make a cutoff point for coverage based on "value"


I'm still waiting for someone to find it on their own...i put the language up now people be good political activists and find it on their own  .


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## Emma (Aug 12, 2009)

It's not about 'death panels' or offing grandma. It's amending current law so that Medicare will reimburse for advance care planning. Which, by the way, can mean go all out as well as comfort measures only ... and everything in between.


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## Zoom-boing (Aug 12, 2009)

> &#8216;(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.CommentsClose CommentsPermalink
> 
> &#8216;(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.&#8217;.CommentsClose CommentsPermalink



Who makes up this 'consensus-based organization'?


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## PLYMCO_PILGRIM (Aug 12, 2009)

Zoom-boing said:


> > (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.CommentsClose CommentsPermalink
> >
> > (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..CommentsClose CommentsPermalink
> 
> ...



thats answered in section 122

 Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans. This will be chaired by the Surgeon General and will have 9 members who are not Federal employees or officers and who are appointed by the President, 9 members who are not Federal employees or officers and who are appointed by the Comptroller General, and an even number of members (not to exceed 8 ) who are Federal employees and officers, as the President may appoint. A committe with up to 27 members, 18 of whom are picked by the President. The bill says these people will reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies, and at least one practicing physician or other health professional and an expert on childrens health. But with no checks and balances on the selection of this group, you can only hope that absolute power does not corrupt absolutely.


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## AllieBaba (Aug 12, 2009)

jillian said:


> if you think that's about euthenasia, you're an idiot.
> 
> and you loons need to stop spewing that garbage....



You have to have an order for enabling life supporting treatment, Jillie. 

Do you read at all?

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

(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*; andCommentsClose CommentsPermalink

(II) _that has in effect a program for orders for life sustaining treatment described in clause _(iii).CommentsClose CommentsPermalink

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

(I) ensures such orders are standardized and uniquely identifiable throughout the State;CommentsClose CommentsPermalink

(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;CommentsClose CommentsPermalink

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

(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.CommentsClose CommentsPermalink*


You know what that says, Jillian? A group of people including ATTORNEYS will determine how LIFE SUPPORTING ORDERS are defined, and when to put them in place.

You're the lawyer. Do we currently have to have ORDERS defining whether or not we can opt for life saving treatments?


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## AllieBaba (Aug 12, 2009)

Crickets. Imagine.


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## AllieBaba (Aug 12, 2009)

*"Federal employees and officers, as the President may appoint."*

Gosh, abortion is between a woman and her dr...but apparently if you want to live, you'll have to be approved by a bunch of beaurocrats picked by the pres.

Imagine THAT line.


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## Emma (Aug 12, 2009)

AllieBaba said:


> You're the lawyer. Do we currently have to have ORDERS defining whether or not we can opt for life saving treatments?


All "life sustaining treatment" requires a physician order. 

Do you have a link to the section you quoted? So I can read it all in context. Thanks.


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## Sinatra (Aug 12, 2009)

AllieBaba said:


> jillian said:
> 
> 
> > if you think that's about euthenasia, you're an idiot.
> ...




You beat me to it.

It is so laughable when a few drones go around stating the term 'Death Panel" is not in the bill.  Of course not!  I don't know of anyone who stated it is!  The term death panel is descriptive, not actual, and as such, if anyone actually takes the time to read the material, could be quite applicable.

This Democrat House bill is rampant with broad stroke powers legislated to the federal government, and when combined with the stimulus bill additions regarding cost control measures in health care, paints a most ominous potential that some appear unwilling to consider.

How is that these same individuals who were for so long so suspicious of their government, are now willing to concede to it some of the most intimate and far-reaching powers possible simply because the individual residing at 1600 Pennsylvania Ave has a (D) after his name?

Don't simply consider yourself a Republican or a Democrat - consider yourself an American - and as such, educate yourself.

Read the bill - it is frightening the attempted scope of authorities being granted the federal government...


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## AllieBaba (Aug 13, 2009)

Emma said:


> AllieBaba said:
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> 
> > You're the lawyer. Do we currently have to have ORDERS defining whether or not we can opt for life saving treatments?
> ...



However, there's never been a "panel" picked by the president to approve what procedures are paid for. Nor has there ever been a requirement that if older ppl want any of their medical care paid for, they have to sit through end of life counseling every 5 years.


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## Emma (Aug 13, 2009)

AllieBaba said:


> Emma said:
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> > AllieBaba said:
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There's no requirement in this bill that older people have to sit through end of life counseling every 5 years, either. The only requirement is that Medicare reimburses IF the counseling occurs, but their limit on how often it will be reimbursed is every 5 years.  

Link to "'panel' picked by the president to approve what procedures are paid for" ?


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## jillian (Aug 13, 2009)

AllieBaba said:


> Crickets. Imagine.



that's cause some of us are working, living life, going to broadway shows with family and friends, yadda, yadda, yadda.... i don't sit at the computer all day

and the purpose of the section has already been explained to you by someone in the health field.

i can't help it if you can't read with comprehension.

oh...and i'm going back to work now... so i may or may not think about this thread again.... and may or may not bother answering you if i do think about it, depending on how ignorant and nasty your answer is. Farshtey?

and perhaps this, from another thread on this board, which you've clearly ignored, will be in simple enough english for you to follow:

http://news.yahoo.com/s/ap/20090811...uYXRlX3N1bW1hcnlfbGlzdARzbGsDZmFjdGNoZWNrbm9k


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## Navy1960 (Aug 13, 2009)

When this bill was first introduced  it was my impression that the section in question while not mandatory had the implied message to Seniors that it was more cost effective for them to consider methods of ending life rather than seeking any and all means available  to them that might extend their lives. After much consideration on this matter, and reading the section over and over I have come to two conclusions , first  that to make a blanket statement that there is a  requirement  in the bill as  written that Seniors  are required to appear before a panel i.e. "death panel" is a little bit of a stretch and can be considered somewhat more of a political intrepretation more so than an actual one.  The second thing however is the implied meaning  of the section, while perhaps not intentional does send the message as it applies to cost factors to providers and to Seniors by encouraging end of life counsel every 5 years.  The message it sends is one that on a cost savings basis it would  be easier to counsel Seniors on dignified ways to end their lives rather than seek out perhaps expensive medical care that would  perhaps  cost the taxpayers more than they had planned on. 

One more thing to consider here too is that end of life counsel and  living wills, etc. are  very private family matters and  should NEVER be legislated in any manner by any branch of any Govt.  other than the legal aspects that apply to the estates themselves.  What people need to consider here, that like it or not, in our society there is a rather large segment that values life in all it forms  and see's any encouragement to end it as repulsive. While there are still other segments of our society that see this issue as one of more to do with dignity and respect  and wish to encourage it as much as possible and  IMO that was the prupose of this section. While, again I think it a little bit of a stretch to just up claim this is a so called  section that requires "death panels" I do think that we  as a nation must in the end see this matter as a very private  family matter that can be done respectfully  and without the need for legislation that applies to a healthcare bill.


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## Emma (Aug 13, 2009)

AllieBaba said:


> Emma said:
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_And there's no requirement for that in this bill, either._ 

Are you arguing just to argue, being intentionally obtuse?


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## PLYMCO_PILGRIM (Aug 13, 2009)

I'm glad to see you guys are reading the language of the bill and debating over that instead of running wild with all the democrat and republican talking points.  


The more I read the more overbearing this bill is on our individual freedoms.

There is another thread I made with page numbers and sections too if you're all interested.   

The one I hate the most is where the govt will have the right to electronically remove funds from your bank account to cover the required co-pays under the proposed public option.


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## Emma (Aug 13, 2009)

PLYMCO_PILGRIM said:


> I'm glad to see you guys are reading the language of the bill and debating over that instead of running wild with all the democrat and republican talking points.
> 
> 
> The more I read the more overbearing this bill is on our individual freedoms.
> ...



Can you link to that please? I don't recall seeing anything about that, only electronic transfer of funds to and from _providers_.


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## Zoom-boing (Aug 13, 2009)

Emma said:


> AllieBaba said:
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> > Emma said:
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Yes there is:



PLYMCO_PILGRIM said:


> Zoom-boing said:
> 
> 
> > > (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.CommentsClose CommentsPermalink
> ...


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## veritas (Aug 13, 2009)

> (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.



I take that to mean, that as new advances are made and more data becomes available, they will be added to the mix and subsequently covered. This seems to be a _pendente lite _clause which makes the law more facile to add more features and make changes when necessary. If the bill passes and the new database is installed, then what may be an "experimental" treatment could be shown to be effective and then added as a covered procedure/drug/etc. This includes the "end of life" coverage as well. If perhaps we discover/develop better more effective palliative measures they can be added as well.


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## PLYMCO_PILGRIM (Aug 13, 2009)

Emma said:


> PLYMCO_PILGRIM said:
> 
> 
> > I'm glad to see you guys are reading the language of the bill and debating over that instead of running wild with all the democrat and republican talking points.
> ...



Page 59  Text of H.R.3200 as Introduced in House: America's Affordable Health Choices Act of 2009 - U.S. Congress - OpenCongress


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## Emma (Aug 13, 2009)

Zoom-boing said:


> Emma said:
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> 
> > AllieBaba said:
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Section 122 _where_?

That appears to be referring to something else, not the "consensus-based organization" in the above quote.


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## veritas (Aug 13, 2009)

PLYMCO_PILGRIM said:


> Emma said:
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> > PLYMCO_PILGRIM said:
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How do I get to page 59? I don't see it arranged by page in that format in your link.


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## PLYMCO_PILGRIM (Aug 13, 2009)

veritas said:


> PLYMCO_PILGRIM said:
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> > Emma said:
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sorry i downloaded the pdf.

Here is a site that has page numers...i'll check and see if the are the same as the pdf

HR 3200

EDIT:  Use google man, damn


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## Emma (Aug 13, 2009)

PLYMCO_PILGRIM said:


> Emma said:
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> > PLYMCO_PILGRIM said:
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Thanks. Your link didn't have page numbers, but I found it on mine. That is related to electronic transfers (funds and data) to and from providers, not consumers. 



> Any standard adopted under this part shall apply, in whole or in part, to the following persons:
> 
> (1) A health plan.
> 
> ...



US CODE: Title 42,1320d&ndash;1. General requirements for adoption of standards


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## veritas (Aug 13, 2009)

Title 42 is existing US Code.



Pilgrim, c&p me a subtitle from your pdf file, wouldja?


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## PLYMCO_PILGRIM (Aug 13, 2009)

veritas said:


> Title 42 is existing US Code.
> 
> 
> 
> Pilgrim, c&p me a subtitle from your pdf file, wouldja?



ok what one?

page 59
&#8216;&#8216;(C) enable electronic funds transfers, in
22 order to allow automated reconciliation with the
23 related health care payment and remittance ad24
vice;


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## veritas (Aug 13, 2009)

PLYMCO_PILGRIM said:


> veritas said:
> 
> 
> > Title 42 is existing US Code.
> ...




The part above the (C) which indicates the Section, subsection, title, subtitle etc......

Laws aren't usually arranged by page # because stuff is added and citations are inserted and stuff is redacted all the time.


Emma's link is from existing US Code for Social Security, not HR 3200.


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## PLYMCO_PILGRIM (Aug 13, 2009)

Subtitle GEarly Investments

3 SEC. 163. ADMINISTRATIVE SIMPLIFICATION.


Hey i wasn't caps locking that it was just cut/paste


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## veritas (Aug 13, 2009)

This is how you would cite the specific section you are referring to:

HR 3200
TITLE I--PROTECTIONS AND STANDARDS FOR QUALIFIED HEALTH BENEFITS PLANS
Subtitle G; Early Investments.
Section 163; Administrative simplification.


Replaces the Social Security Code Emma posted with:



> &#8216;*SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS.
> *
> &#8216;(a) Standards for Financial and Administrative Transactions-
> 
> ...




The applicability section has to do with providers, not individuals.


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## veritas (Aug 13, 2009)

ok since I see you are malleable with crap you find on the net.......I'll explain what is going on with the section you cited.........


A system will be set up whereby: both Social Security providers AND add ons to SS and private insurers will promulgate a move to implement a computerized system that can instantly indicate what coverage you have, [with a computer data card, like a credit card] IOW, it will know what your insurance is and what coverage you have. This will assist in billing. It will also streamline the claims process.

This section would change the indicated section in Title 42 so it would automatically apply to Medicare [Title 42 would be amended to reflect this] as well as the applicable providers in the section named in HR 3200. It proposes to eliminate ambiguity due to language constraints and strives to simplify and standardize nomenclature.

It does not set up an open conduit to your bank account.


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## Emma (Aug 13, 2009)

veritas said:


> PLYMCO_PILGRIM said:
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> ...



I'm linking what is being amended: 

(starts on page 57 of this link: http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf )

SEC. 163. ADMINISTRATIVE SIMPLIFICATION.
(a) STANDARDIZING ELECTRONIC ADMINISTRATIVE TRANSACTIONS.

(1) IN GENERAL.Part C of title XI of the Social Security Act (42 U.S.C. 1320d et seq.) is amended by inserting after section 1173 the following new section:

SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS.

US CODE: Title 42,Part C&mdash;Administrative Simplification


----------



## veritas (Aug 13, 2009)

Sorry for being snarky Pilgrim.

It's just that it's not hard for me to decipher this legal speak because I am used to doing it and it is easy for me because I like it.

Half the Senate are lawyers anyway. So.....they must be stupid lawyers [there are a lot of those] or liars [even more of those]. Anybody can run for the House, look at the gaggle of defectives in there.

Anyway, tracking down legal stuff is quite easy once you know how to do it. The interwebs make it even easier and cheaper too, free in most cases. Lawyers don't want you to know how easy it is because most of them don't have a handle on it because they are lazy fucks and they make money acting like you have to go to Hogwarts just to do what they do.


----------



## veritas (Aug 13, 2009)

> I'm linking what is being amended:



I got your six Emma and am trying to explain what it means and how it works to  pilgrim.


----------



## Emma (Aug 13, 2009)

veritas said:


> > I'm linking what is being amended:
> 
> 
> 
> I got your six Emma and am trying to explain what it means and how it works to  pilgrim.



I should have made it clear in my post why I was linking to that. Sorry.


----------



## veritas (Aug 13, 2009)

no apologies necessary.......we all learned something.

like why page #s aren't good for pointing people in the right direction for one......


----------



## Emma (Aug 13, 2009)

veritas said:


> no apologies necessary.......we all learned something.
> 
> like why page #s aren't good for pointing people in the right direction for one......



Something I've noticed in many of the misconceptions about what this bill proposes is too many are taking a line or two or a paragraph here and there out of context. You really need to read from the start of the section (at least) and refer to the current code that is being amended.


----------



## rdean (Aug 13, 2009)

Healthcare Decisions Day 

WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. WHEREAS, in Alaska, Alaska Statute 13.52 provides the specifics of the advance directives law and offers a model form for patient use. 
WHEREAS, it is estimated that only about 20 percent of people in Alaska have executed an advance directive. Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive. 
WHEREAS, it is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about Advance Directives. 
WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaska&#8217;s citizens with advance directives. 
WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives.
WHEREAS, as a result of April 16, 2008, being recognized as Healthcare Decisions Day in Alaska, more citizens will have conversations about their healthcare decisions; more citizens will execute advance directives to make their wishes known; and fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient.
NOW, THEREFORE, I, Sarah Palin, Governor of the state of Alaska, do hereby proclaim April 16, 2008, as:
Healthcare Decisions Day in Alaska, and I call this observance to the attention of all our citizens.


----------



## veritas (Aug 13, 2009)

Emma said:


> veritas said:
> 
> 
> > no apologies necessary.......we all learned something.
> ...




That and average reading comprehension is realllllllllllly dismal.

Also referencing and/or incorporation/redaction/replacement of existing code is not something people are used to. You have to jump around and back and forth to do it. Most are unwilling or confused by this.


----------



## veritas (Aug 13, 2009)

rdean said:


> Healthcare Decisions Day
> 
> WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. WHEREAS, in Alaska, Alaska Statute 13.52 provides the specifics of the advance directives law and offers a model form for patient use.
> WHEREAS, it is estimated that only about 20 percent of people in Alaska have executed an advance directive. Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive.
> ...




Have you plastered that in all the appropriate threads, rdean? Should make some heads explode.


----------



## Emma (Aug 13, 2009)

veritas said:


> Emma said:
> 
> 
> > veritas said:
> ...



Part of it is reading into it what they _want_ to believe is there (not referring to pilgrim, just in general), but yeah. It can be a daunting task. 

Someone else had suggested that each section of a bill that amends or adds to current law contain a summary (in plain English) what that section is intended to do. Something like that would put a stop to a lot of these rumors.


----------



## Emma (Aug 13, 2009)

veritas said:


> rdean said:
> 
> 
> > Healthcare Decisions Day
> ...



Awesome 



> WHEREAS, it is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about Advance Directives.





> WHEREAS, as a result of April 16, 2008, being recognized as Healthcare Decisions Day in Alaska, more citizens will have conversations about their healthcare decisions; more citizens will execute advance directives to make their wishes known; and fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient.



Heh.


----------



## veritas (Aug 13, 2009)

> Someone else had suggested that each section of a bill that amends or adds to current law contain a summary (in plain English) what that section is intended to do. Something like that would put a stop to a lot of these rumors.




That would be a good idea. The technical term for this is called: "Legislative Intent" and it usually heads each proposed bill in brief, but in this case, or in all cases really, until more of the population has a familiarity with legalese, it should be utilized heavily.


----------



## rdean (Aug 13, 2009)

veritas said:


> rdean said:
> 
> 
> > Healthcare Decisions Day
> ...



I was and someone wrote me a note to stop spamming the boards.  Perhaps they didn't like that fact that Sarah was for health care before she was against it.


----------



## veritas (Aug 13, 2009)

Oh do tell who wrote said note........


----------



## Emma (Aug 13, 2009)

rdean said:


> I was and someone wrote me a note to stop spamming the boards.  Perhaps they didn't like that fact that Sarah was for health care before she was against it.



Too bad you didn't post it with Palin's name and references to Alaska edited out. I'd love to see the egg on their faces after they screamed it was penned by a socialistic, nazi-lovin' lib


----------



## veritas (Aug 13, 2009)

make it your sig.........muahhaaaaaa


----------



## Emma (Aug 13, 2009)

veritas said:


> > Someone else had suggested that each section of a bill that amends or adds to current law contain a summary (in plain English) what that section is intended to do. Something like that would put a stop to a lot of these rumors.
> 
> 
> 
> ...


I think it _would_ be a good idea and not just with the health care bills but any of them. That would certainly put a stop to these ignorant scare tactics the right is pulling.


----------



## Cecilie1200 (Aug 13, 2009)

jillian said:


> AllieBaba said:
> 
> 
> > Crickets. Imagine.
> ...



So you had time to come in here, read the posts, and type in a response telling us . . . that you didn't have time to read the posts and respond?


----------



## AllieBaba (Aug 13, 2009)

Educating the public is a whole world different from a directive which subjects clients to forced counseling, and even further from a directive which sets up a panel of attorneys and beaurocrats to determine whose medical expenses will be paid for..in  a system that the people are forcibly herded into.


----------



## Old Rocks (Aug 13, 2009)

Navy1960 said:


> When this bill was first introduced  it was my impression that the section in question while not mandatory had the implied message to Seniors that it was more cost effective for them to consider methods of ending life rather than seeking any and all means available  to them that might extend their lives. After much consideration on this matter, and reading the section over and over I have come to two conclusions , first  that to make a blanket statement that there is a  requirement  in the bill as  written that Seniors  are required to appear before a panel i.e. "death panel" is a little bit of a stretch and can be considered somewhat more of a political intrepretation more so than an actual one.  The second thing however is the implied meaning  of the section, while perhaps not intentional does send the message as it applies to cost factors to providers and to Seniors by encouraging end of life counsel every 5 years.  The message it sends is one that on a cost savings basis it would  be easier to counsel Seniors on dignified ways to end their lives rather than seek out perhaps expensive medical care that would  perhaps  cost the taxpayers more than they had planned on.
> 
> One more thing to consider here too is that end of life counsel and  living wills, etc. are  very private family matters and  should NEVER be legislated in any manner by any branch of any Govt.  other than the legal aspects that apply to the estates themselves.  What people need to consider here, that like it or not, in our society there is a rather large segment that values life in all it forms  and see's any encouragement to end it as repulsive. While there are still other segments of our society that see this issue as one of more to do with dignity and respect  and wish to encourage it as much as possible and  IMO that was the prupose of this section. While, again I think it a little bit of a stretch to just up claim this is a so called  section that requires "death panels" I do think that we  as a nation must in the end see this matter as a very private  family matter that can be done respectfully  and without the need for legislation that applies to a healthcare bill.



I am in "disgustingly good health for a man my age" as my doctor put it. But should I start seeing signs of failing health, I will see such counsel, whether or not Medicare pays for it. I do not want to put the responsibility for the "pull the plug" decision on my wife or children.

All I see in the wording of this bill is removing the cost of that counsel from my budget. By the way, my mother-in-law recieved just such counseling, and was much happier in facing her last days for it, knowing her exact wishes would be followed.


----------



## Old Rocks (Aug 13, 2009)

AllieBaba said:


> Educating the public is a whole world different from a directive which subjects clients to forced counseling, and even further from a directive which sets up a panel of attorneys and beaurocrats to determine whose medical expenses will be paid for..in  a system that the people are forcibly herded into.



Cannot stop repeating the lie, even when it is plainly shown to you.


----------



## AllieBaba (Aug 13, 2009)

Cecilie1200 said:


> jillian said:
> 
> 
> > AllieBaba said:
> ...



Jill's just a troll who plays a lawyer on the internet.


----------



## Old Rocks (Aug 13, 2009)

AllieBaba is just a troll who plays a troll on the internet


----------



## Navy1960 (Aug 13, 2009)

Old Rocks said:


> Navy1960 said:
> 
> 
> > When this bill was first introduced  it was my impression that the section in question while not mandatory had the implied message to Seniors that it was more cost effective for them to consider methods of ending life rather than seeking any and all means available  to them that might extend their lives. After much consideration on this matter, and reading the section over and over I have come to two conclusions , first  that to make a blanket statement that there is a  requirement  in the bill as  written that Seniors  are required to appear before a panel i.e. "death panel" is a little bit of a stretch and can be considered somewhat more of a political intrepretation more so than an actual one.  The second thing however is the implied meaning  of the section, while perhaps not intentional does send the message as it applies to cost factors to providers and to Seniors by encouraging end of life counsel every 5 years.  The message it sends is one that on a cost savings basis it would  be easier to counsel Seniors on dignified ways to end their lives rather than seek out perhaps expensive medical care that would  perhaps  cost the taxpayers more than they had planned on.
> ...




While I don't see a provision in the bill that requires anything remotly close to a "death  counsel" or anything that would  require end of life counsel, as I stated eariler I do think this section of the bill does send a message and treads on an aspect of  family matters that is  uniquely private  and while I respect peoples opinions and even can understand to some degree why an advocate would call for it's inclusion into a bill. However, as stated eariler I do tend to believe that it sends a message  on value of life issues  vs. costs that need not be in this bill at all, and can be funded  by other means  if congress so chooses. I have absolutly no problem with anyone who wishes to end life with dignity and in fact think people should  express their wishes to their family in some way.  I find it , a little repulsive though that Govt. would  somehow see the need to include this very private matter into a healthcare bill however.


----------



## jillian (Aug 13, 2009)

Cecilie1200 said:


> jillian said:
> 
> 
> > AllieBaba said:
> ...



uh...try reading,dearie... my response was for allie ijit who was whining that I didn't respond to her quickly enough.


----------



## jillian (Aug 13, 2009)

AllieBaba said:


> Cecilie1200 said:
> 
> 
> > jillian said:
> ...



RAFLMAO!! And once again, allie squeals like a pig because she got her butt kicked.


----------



## Zoom-boing (Aug 13, 2009)

Read Sarah Palin's Facebook Notes on this.  She does an excellent job of explaining how 'end of life counseling' will lead to rationing and that seniors have every right to be concerned about all of this.

http://www.new.facebook.com/home.php?ref=home#/sarahpalin?v=app_2347471856&viewas=1429924401&ref=nf

This 'end of life counseling' is a moot point now.  They dropped this provision.

Sens. Drop End-of-Life Provision from Bill - CBS News


----------



## veritas (Aug 13, 2009)

> as I stated eariler I do think this section of the bill does send a message and treads on an aspect of family matters that is uniquely private



How so? It doesn't. It's part of what one intends, is not mandated and it is offered as part of the coverage. How does this differ from agreeing to be an organ donor on your driver's license? What if you have no family? Maybe you want to talk to your doctor about how you want to handle things or what options are available. Maybe you want counseling so you can talk to your family and let them know what you have decided.


----------



## veritas (Aug 13, 2009)

Zoom-boing said:


> Read Sarah Palin's Facebook Notes on this.  She does an excellent job of explaining how 'end of life counseling' will lead to rationing and that seniors have every right to be concerned about all of this.
> 
> Login | Facebook
> 
> ...




Sarah Palin does an excellent job on nothing except whipping the trog base into a foaming frenzy.


----------



## Cecilie1200 (Aug 13, 2009)

jillian said:


> Cecilie1200 said:
> 
> 
> > jillian said:
> ...



I did read, "dearie".  You clearly read the thread, but you picked only one post to respond to - which had to have taken time, since included links - and that one was merely so you could say, "I'm a busy woman and don't have time to respond to posts.  In fact, I'm going back to work now, and can't answer anything else."  So why is it, if you're SO pressed for time, THAT was the post you took the time to answer, instead of something more substantive?


----------



## rdean (Aug 13, 2009)

Zoom-boing said:


> Read Sarah Palin's Facebook Notes on this.  She does an excellent job of explaining how 'end of life counseling' will lead to rationing and that seniors have every right to be concerned about all of this.
> 
> Login | Facebook
> 
> ...



Don't forget, she was for it before she was against it.

Healthcare Decisions Day 

WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. WHEREAS, in Alaska, Alaska Statute 13.52 provides the specifics of the advance directives law and offers a model form for patient use. 
WHEREAS, it is estimated that only about 20 percent of people in Alaska have executed an advance directive. Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive. 
WHEREAS, it is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about Advance Directives. 
WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaskas citizens with advance directives. 
WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives.
WHEREAS, as a result of April 16, 2008, being recognized as Healthcare Decisions Day in Alaska, more citizens will have conversations about their healthcare decisions; more citizens will execute advance directives to make their wishes known; and fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient.
NOW, THEREFORE, I, Sarah Palin, Governor of the state of Alaska, do hereby proclaim April 16, 2008, as:
Healthcare Decisions Day in Alaska, and I call this observance to the attention of all our citizens.


----------



## veritas (Aug 13, 2009)

> Healthcare Decisions Day
> 
> WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. WHEREAS, in Alaska, Alaska Statute 13.52 provides the specifics of the advance directives law and offers a model form for patient use.
> WHEREAS, it is estimated that only about 20 percent of people in Alaska have executed an advance directive. Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive.
> ...



99 bottles of beer on the wall, 99 bottles of beer, take one down.........pass it around it'll take 99 million bottles of beer to sink in if ever it does........


----------



## Navy1960 (Aug 13, 2009)

veritas said:


> > as I stated eariler I do think this section of the bill does send a message and treads on an aspect of family matters that is uniquely private
> 
> 
> 
> How so? It doesn't. It's part of what one intends, is not mandated and it is offered as part of the coverage. How does this differ from agreeing to be an organ donor on your driver's license? What if you have no family? Maybe you want to talk to your doctor about how you want to handle things or what options are available. Maybe you want counseling so you can talk to your family and let them know what you have decided.



You do realize that almost everything you posted are matters of a personal nature  that involve decisions that between yourself,family,Doctor, etc. So why then would the Govt. see it as a repsonsiblity to legislate such issues that clearly are matters that belong in your hands.  In fact on organ donation you do realize that even by signing you DL that only expresses your wishes and does not automatically make you an organ donor. Again that is a matter between your loved ones and  Doctors. While the promotional aspect of it  i.e. DL is done by the state and you may see the provision as akin to that and you might be correct, however I tend to disagree because  just by encouraging end of life counsel to some that implies  several things to groups that may not see that a positive thing. Thus the reason why this matter needs to remain in private hands, much the same with abortion , to me it would be rather like the Govt, adding a provision in the healthcare bill that would advocate  abortion counsel for young women every 5 years. While not mandatory it is a matter that belongs in private hands. I respect the nature of this though deeply don't get me wrong IMHO the Govt. involved in this matter seems to me to send a very wrong message that can be better sent through funding  programs that already do this in local communties as not part of an overall healthcare bill.


----------



## Care4all (Aug 13, 2009)

AllieBaba said:


> Emma said:
> 
> 
> > AllieBaba said:
> ...


allie...geez louise! you and others are being played a fool...

hint....do a little reading instead of accepting the word of who you politically parrot!!! *google* what *life sustaining orders or POLST or MOLST* are...and the laws now, already in 27 plus states on life sustaining orders and their boards....this is nothing new, created by Democrats to kill you BULL CRAP silly!!!

POLST.ORG - Physicians Orders for Life-Sustaining Treatment Paradigm


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## veritas (Aug 13, 2009)

Your end matters are not personal if people have to know what you want. What if you wanted to refuse another round of chemo, but had a stroke in the meantime and couldn't say you didn't want it and just wanted to be let go? How is anybody going to know? What if you have alzheimers? 

It can't be that personal, it has to be documented and verified should the need arise if there is any contention. Your concerns are groundless. Death is a public happenstance. It's recorded. People are responsible for keeping track of these things. Not personal at all.


----------



## Zoom-boing (Aug 13, 2009)

> Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice -- even if patients opt for expensive life-prolonging care. I think they protest too much: *If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs*?
> 
> Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." *Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist*.



http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html


----------



## Care4all (Aug 13, 2009)

life sustaining orders - Google Search

POLST.ORG - Physicians Orders for Life-Sustaining Treatment Paradigm

please, please educate yourselves!


----------



## Cecilie1200 (Aug 13, 2009)

veritas said:


> Your end matters are not personal if people have to know what you want. What if you wanted to refuse another round of chemo, but had a stroke in the meantime and couldn't say you didn't want it and just wanted to be let go? How is anybody going to know? What if you have alzheimers?
> 
> It can't be that personal, it has to be documented and verified should the need arise if there is any contention. Your concerns are groundless. Death is a public happenstance. It's recorded. People are responsible for keeping track of these things. Not personal at all.



Actually, it doesn't.  You run the risk of having your next-of-kin deciding something other than what you wanted, but you don't HAVE to have a living will or DNR order or medical power of attorney or any of that if you don't want to.

You're right about one thing.  PEOPLE are responsible for it.  They're responsible for deciding whether or not they want to be responsible.  The government has no business stepping in and trying to legislate whether or not they do it.

Just because it's a good idea to do something doesn't necessarily mean it's a good idea for the government to make you do it.


----------



## veritas (Aug 13, 2009)

> Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist.



Once every 5 years.......what a profit center that's going to be...NOT.

Should we burden health care providers with sleuthing to find out what you might want? While keeping you alive to find out? When you don't want it? Track down all of your relatives? Find out you have no relatives?

I don't see any incentives other than knowing what you want.


----------



## veritas (Aug 13, 2009)

> You're right about one thing. PEOPLE are responsible for it.



I wasn't referring to the individuals who make the choices, I was referring to the individuals with the government that record these things, and provide the appropriate information to whomever is entitled to it....like coroners and courts and records clerks.


----------



## veritas (Aug 13, 2009)

> you don't HAVE to have a living will or DNR order or medical power of attorney or any of that if you don't want to.



No you don't. This bill isn't making it mandatory either.


----------



## Cecilie1200 (Aug 13, 2009)

I can't help thinking this "end of life counseling" is going to end up being a lot like the "genetic counseling" I was given when I became pregnant at the age of 39.  What it basically came down to was this woman sitting in a room, doing her best to scare the bejesus out of me about all the things that could be wrong with my baby and how difficult it would be to take care of a special-needs child, and trying to convince me to have an abortion should there be a problem.  I would much have preferred to have waived the consultation, but the clinic refused to give me an amniocentesis unless I let them "counsel" me.

Maybe I'm cynical, but I see "end of life counseling" turning out to be some doctor trying to scare the bejesus out of old/sick people about how awful a lingering illness might be, how horrible for their families, how expensive, etc. and trying to convince them to "die with dignity" instead.  As with the decision about keeping my baby (who was perfect in any case), I would prefer to make that decision with my husband and forego anyone else's "helpful" input unless I have a specific question.


----------



## Cecilie1200 (Aug 13, 2009)

veritas said:


> > You're right about one thing. PEOPLE are responsible for it.
> 
> 
> 
> I wasn't referring to the individuals who make the choices, I was referring to the individuals with the government that record these things, and provide the appropriate information to whomever is entitled to it....like coroners and courts and records clerks.



It's for them to record any official decision you choose to make.  It's not for them to have any input in the decision, or to even have any input in the decision to make an official decision or not.


----------



## Cecilie1200 (Aug 13, 2009)

veritas said:


> > you don't HAVE to have a living will or DNR order or medical power of attorney or any of that if you don't want to.
> 
> 
> 
> No you don't. This bill isn't making it mandatory either.



Uh huh.  You'll excuse me if I've seen leftist incrementalism too many times to be all that trusting of it remaining that way.  I'd prefer it if you folks just minded your own business on that topic entirely, thanks.


----------



## veritas (Aug 13, 2009)

> It's for them to record any official decision you choose to make. It's not for them to have any input in the decision, or to even have any input in the decision to make an official decision or not.



How'd you make that leap? Got your super sneakers on there, Sonic?


----------



## Cecilie1200 (Aug 13, 2009)

veritas said:


> > It's for them to record any official decision you choose to make. It's not for them to have any input in the decision, or to even have any input in the decision to make an official decision or not.
> 
> 
> 
> How'd you make that leap? Got your super sneakers on there, Sonic?



Make what leap?  The government encouraging "end of life counseling" with a doctor?  My doctor has no business having any input in my decision, beyond providing any information I ask him for, and the government has no business "encouraging" me to talk to him about it.


----------



## veritas (Aug 13, 2009)

You're bootstrapping. I said end of life decisions, and deaths, have to be documented and recorded so therefore they are not personal issues.

I don't know who you're arguing with. Yourself maybe?


----------



## AllieBaba (Aug 13, 2009)

veritas said:


> > you don't HAVE to have a living will or DNR order or medical power of attorney or any of that if you don't want to.
> 
> 
> 
> No you don't. This bill isn't making it mandatory either.



Yes it is. By making it mandatory to enroll, it's making it mandatory.

Figure it out.


----------



## veritas (Aug 13, 2009)

AllieBaba said:


> veritas said:
> 
> 
> > > you don't HAVE to have a living will or DNR order or medical power of attorney or any of that if you don't want to.
> ...





You are systemically illogical. It's not mandatory. It's covered.


----------



## Care4all (Aug 13, 2009)

Cecilie1200 said:


> veritas said:
> 
> 
> > > It's for them to record any official decision you choose to make. It's not for them to have any input in the decision, or to even have any input in the decision to make an official decision or not.
> ...



you are being an ignoramus!!!  

FIRST 
IT IS NOT MANDATORY that we have this counceling....it was an OPTION for people like me, who would have wanted ALL OF THE INFORMATION on living wills and medical order forms that could have been useful to me and my husband in making OUR DECISIONS on ourselves....

SECOND
the bill was to make certain my insurance covered my counceling on my PERSONAL FRICKING WISHES for MY fricking medical care that I decided through my professional counseling and research decided to do FOR ME, once every 5 years!

To make this out as something else is nothing less than being intellectually DISHONEST.

you all, are really acting like the girl who cried wolf on ONE TOO MANY meaningless things in this bill, and when there REALLY IS, an issue in it that could be of REAL concern, NO ONE....and I mean NO ONE (other than maybe yourselves) will ever listen to you or believe you...and THAT could be a REAL problem down the road.

I have never in my life seen a bunch of over reacting, over absolutely nothing, nimrods!

does ANYONE ever really take the time to research what they are arguing over other than researching your own political leaning sites of your own favor...

Just the mention of "Life sustaining orders" in the bill MADE ME, say to myself immediately, "What does life sustaining orders mean?" before I could even go on with this thread, so I googled it, got my answer immediately, and realized you all have totally misrepresented what the term actually means and how each state has gyuidelines ALREADY on life sustaining orders and how to handle such, and a board that determines such...  BUT NOOOOOOOO, YOU all have to make it out like this is OBAMA trying to KILL YOU...

WHAT A BUNCH OF LOONEY TOONS.

I truly do not understand WHY you wouldn't want to know the truth about each and every item you question and do some ACTUAL RESEARCH on it to find out precisely all about it and what it means?



Care


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## veritas (Aug 14, 2009)

> you are being an ignoramus!!!



At least she is consistent.


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## Emma (Aug 14, 2009)

Zoom-boing said:


> Read Sarah Palin's Facebook Notes on this.  She does an excellent job of explaining how 'end of life counseling' will lead to rationing and that seniors have every right to be concerned about all of this.
> 
> Login | Facebook
> 
> ...



It's dropped from one of the _Senate_ bills. 



> A health care bill passed by three House committees allows Medicare to reimburse doctors for voluntary counseling sessions about end-of-life decisions.



Too bad the Senators were pussies. 

I wonder why they feel providers shouldn't be reimbursed for their services?


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## Emma (Aug 14, 2009)

Cecilie1200 said:


> Actually, it doesn't.  You run the risk of having your next-of-kin deciding something other than what you wanted, but you don't HAVE to have a living will or DNR order or medical power of attorney or any of that if you don't want to.
> 
> You're right about one thing.  PEOPLE are responsible for it.  They're responsible for deciding whether or not they want to be responsible.  The government has no business stepping in and trying to legislate whether or not they do it.
> 
> Just because it's a good idea to do something doesn't necessarily mean it's a good idea for the government to make you do it.



There is NOTHING in the House bill that forces anyone to do anything. 

Dear God. 

As far as advance directives...

An advance directive can instruct your caregivers to do _everything_ to keep you alive; it can instruct them to provide certain levels of care (tube feedings and antibiotics, for example). It doesn't even have to include a 'living will' portion at all. That's why it's called a *directive*. 

And even if there _is_ a living will declining CPR and life-support, that does NOT automatically make you a do-not-resuscitate. That ONLY happens upon the order of a physician. And it's all reversible, in part or in whole. Neither the advance directive NOR a DNR order is written in stone.


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## Emma (Aug 14, 2009)

Cecilie1200 said:


> I can't help thinking this "end of life counseling" is going to end up being a lot like the "genetic counseling" I was given when I became pregnant at the age of 39.  What it basically came down to was this woman sitting in a room, doing her best to scare the bejesus out of me about all the things that could be wrong with my baby and how difficult it would be to take care of a special-needs child, and trying to convince me to have an abortion should there be a problem.  I would much have preferred to have waived the consultation, but the clinic refused to give me an amniocentesis unless I let them "counsel" me.
> 
> Maybe I'm cynical, but I see "end of life counseling" turning out to be some doctor trying to scare the bejesus out of old/sick people about how awful a lingering illness might be, how horrible for their families, how expensive, etc. and trying to convince them to "die with dignity" instead.  As with the decision about keeping my baby (who was perfect in any case), I would prefer to make that decision with my husband and forego anyone else's "helpful" input unless I have a specific question.



That is why the bill includes specific guidelines as to what constitutes "advance care planning".


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## Emma (Aug 14, 2009)

Cecilie1200 said:


> Make what leap?  The government encouraging "end of life counseling" with a doctor?  *My doctor has no business having any input in my decision*, beyond providing any information I ask him for, and the government has no business "encouraging" me to talk to him about it.



1. No one is _encouraging_ anything. 

2. Every health care provider has a plan of care for every patient.


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## Emma (Aug 14, 2009)

Just a question for those opposed to this...

Why do you not want providers reimbursed for their services?


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## PLYMCO_PILGRIM (Aug 14, 2009)

veritas said:


> This is how you would cite the specific section you are referring to:
> 
> HR 3200
> TITLE I--PROTECTIONS AND STANDARDS FOR QUALIFIED HEALTH BENEFITS PLANS
> ...



Oh thats freaking good!!!!!!!!.

I have another thread now that I have to edit that claim off of.

Thank you VERY much for pointing that out.


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## Navy1960 (Aug 14, 2009)

veritas said:


> Your end matters are not personal if people have to know what you want. What if you wanted to refuse another round of chemo, but had a stroke in the meantime and couldn't say you didn't want it and just wanted to be let go? How is anybody going to know? What if you have alzheimers?
> 
> It can't be that personal, it has to be documented and verified should the need arise if there is any contention. Your concerns are groundless. Death is a public happenstance. It's recorded. People are responsible for keeping track of these things. Not personal at all.



If a person get's into an accident, and has on their DL a listing that say's organ donor the Docotrs  before harvesting that organ must seek permission from the family members  to harvest that organ.  If a family member  has a stroke while having chemo  those treating them will then get permission from family members as how to proceed with that person(s) treatement.  If you had a long term condition like ALZ the same thing would apply. while death is a very personal matter, the estate side of death is a public matter, and  I submit that to dismiss concerns as groundless  is to catagorize death matters  as  simple matters of  accounting that can be administered on a Governmental spreadsheet  and I will continue to see this issue as very private matter that is supported by the fact that if death were as public as you say it were then the Govt. would be funding  funerals and legislating  the disposal,  time, and place of mortal remains.  If fact, perhaps this issue is both a public one when it comes to estate issues, and a private one when it comes to end of life issues, and at some point there is a little crossover as to how best to dispose of ones  estate, I will grant you that. Still, if this matter is  a state issue and no state lines are to be crossed, agian I see  on this minor portion of the end of life matters where the Federal Govt., even has  power to regulate , unless the  estate crosses state lines.  As for  the planning itself, to dismiss this concern out of hand is not recognize the varied  opinions , especially when it comes to end of life matters.


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## veritas (Aug 14, 2009)

It has nothing to do with the estate. I don't know where you are getting this. It's about what one wants and if it is carried out. It's not about the funeral. It's about the people that are responsible for seeing that your wishes are carried out, the doctors, the nurses and the administrators, it's a very public, on the record sort of thing.


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## Navy1960 (Aug 14, 2009)

End-of-life *self-medication* ok; euthanasia by others not ok. (Apr 2008)  Barack Obama;


Arizona:

36-3201 et seq. Living Wills and Health Care Directives 
Life-Prolonging Acts Does not include comfort care or alleviation of pain but may include life-sustaining treatment artificially delaying the moment of death, CPR, drugs, electric shock, artificial breathing, artificially administered food and fluids 
Legal Requirements for Valid Living Will (*1) Adult; (2) in writing; (3) language clearly indicating intent to create a living will; (4) dated; (5) signed; (6) witnessed by at least one adult or a notary public *
Revocation of Living Will Person may revoke health care directive or disqualify a surrogate by (1) written revocation; (2) orally notifying surrogate or health care provider; (3) making new health care directive; (4) any other act demonstrating specific intent to revoke 
Validity from State-to-State Health care directive prepared in another state is valid in this state if it was valid where and at the time it was adopted to the extent it does not conflict with the criminal laws of Arizona 
If Physician Unwilling to Follow Living Will Physician must effect prompt transfer to a physician willing to comply 
Immunity for Attending Physician Health care provider making good faith decisions in reliance on apparently genuine health care directive or decision of a surrogate or living will is immune from criminal, civil, and professional discipline for that reliance (unless negligent) 

Living wills are clearly state matters and are clearly  matters  of privacy and  that are decisions that between a family member and their appointed surrogate. It is NOT a public matter. In fact if it were, a public matter other than on the estate side of the issue and that include the disposition of  financial matters, then you would see a Federal Govt. standard applied to treating Doctors and not allowing them to deny  end of life  directives as in the Arizona law.  Your  correct in your assesment that htis issue impacts Doctors, nurses, and treatment professionals, however it has nothing at all to do with the Federal Govt. when it comes to end of life planning and Advanced Directives.  If the Federal Govt. wished to promote these things then perhaps then , they should be in the business of promtion of Abortions, types of  haircuts you should have,  the list is endles. but they all have one thing in common they are all private matters that belong in the hands of an individual and need not be  promoted by the Federal Govt.  In fact the legal implementation and legislation living wills are a state issue and literally have nothing at all to do with the Federal Govt.  and even the Federal Govt. has  stated this in the PSDA 

On November 5, 1990, Congress passed this measure as an amendment to the Omnibus Budget Reconciliation Act of 1990. It became effective on December 1, 1991. The PSDA requires many Medicare and Medicaid providers (hospitals, nursing homes, hospice programs, home health agencies, and HMO&#8217;s) to give adult individuals, at the time of inpatient admission or enrollment, certain information about *their rights under state laws governing advance directives*, 
, 

While the PSDA clearly shows any part of  living wills as it applies to legislation belongs to to states the exectution of those belong to private hands of  individuals and not the Federal Govt.


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## PLYMCO_PILGRIM (Aug 15, 2009)

I just dont get why the govt wants to get involved in more than just coverage.

Coverage is the issue, not the quality of service or types of services.


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## veritas (Aug 15, 2009)

> Coverage is the issue, not the quality of service or types of services.




Types of services ARE coverage. Quality is less quantifiable except with respect to what is covered. The end of life counseling would be considered a _consultation_ whereby you are informed of your situation and what options are available to you, just like any other information you would receive from your doctor about other things like diet and exercise and medications and potential procedures.


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## Emma (Aug 15, 2009)

veritas said:


> > Coverage is the issue, not the quality of service or types of services.
> 
> 
> 
> ...


Exactly. And again, this can also clarify that you want _everything_ done, or specifically _what_ you want done.


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## Navy1960 (Aug 15, 2009)

Emma said:


> veritas said:
> 
> 
> > > Coverage is the issue, not the quality of service or types of services.
> ...



So given that then why not  offer taxpayer funded cousel on abortion, or perhaps taxpayer funding on botox, or breast enhancements, because if you open the door under a healthcare bill to fund  counsel matters for personal preference then you must open it for everything.  The fact remains that this issue at best when legislation is invloved  belongs in the hands of the states and the people that make it and not in the hands of the Federal govt. and especially not in a healthcare reform bill.


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## veritas (Aug 15, 2009)

Navy1960 said:


> Emma said:
> 
> 
> > veritas said:
> ...




MANDATORY "counseling" is already in place for abortions. Which, since Bush and the fundies took office, includes all sorts of religious BS and less medical info and should be redacted and amended. Abortions, botox and breast enhancements are all elective procedures. Death is not elective, we're all getting that condition at one point or another, so your argument is not logical.

Whenever you get _any_ procedure, necessary or elective, the doctor is required to tell you what the possible risks and outcomes are and provide you with choices at the point  *before* the service takes place. The "end of life" nonsense is just noise and it is getting tiresome belaboring the point that it is a non starter and only brain donors wish to make further issue of it.


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## Old Rocks (Aug 15, 2009)

Navy1960 said:


> Emma said:
> 
> 
> > veritas said:
> ...



You have a choice as to whether or not you have an abortion, botox, ect. For each and every one of us, death is not a choice. It is what we all will experiance eventually. Given the medical communities abilities to keep the body alive far after the psyche has died, there are many of us that wish no part of that. Nor do we wish to have extroidinery measures taken to bring us back to live completely crippled after a stroke. 

There are many on Social Security and Medicare that recieve so little that the cost, out of pocket, for the advice on how to put their wishes into legally binding means lack of medicine, food, or heat.

Each and every one of us, as we approach our final years, should put what we want down in legally binding terms, whether it is no extroidinery measures taken, or all measure taken, to ease the burden on our loved ones.


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## Navy1960 (Aug 15, 2009)

So your saying that a person does not have a choice on the decision when or if they wish to have a living will? Of course it it's elective, as much so as your decision is to have your hair cut.  So while you may think it's not logical to argue because it does not fall into the catagory of being elective is completely false, Yes death is not elective, however the  decision to have an advance directive is and is that not what we are talking about here adavance directives?

BACKGROUND: Every state requires that a patient consent before undergoing medical treatment and that the consent be &#8220;informed.&#8221; Three interrelated elements underlie the long-standing tradition of informed consent: Patients must possess the capacity to make decisions about their care; their participation in these decisions must be voluntary; and they must be provided adequate and appropriate information. However, abortion counseling requirements sometimes run afoul of these principles by requiring information that is irrelevant or misleading.
In addition to abortion counseling requirements, many states require that at least 24 hours elapse between the counseling and the abortion. In states in which the counseling must be obtained in person (rather than via mail, fax, Internet or phone) and the woman must then wait a specified time period, most often 24 hours, between the counseling and the procedure, the woman is effectively required to make two trips to the health care provider in order to obtain an abortion, a requirement that could constitute a hardship for some women.
http://www.guttmacher.org/statecenter/spibs/spib_MWPA.pdf

I completely agree that mandatory counsel should be  abolished in these states and as I have stated in my other posts  I do not see a mandatory provision in this section in the healthcare bill. It's my opinion that funding, like it or not for  living wills, and end of life services  while well meaning, are private matters , and state matters and has clearly been shown that in the past  in federal legislation , so it has not business in this healthcare bill.  As you your informed consent  statement, that means what exactly?  I'm not advocating that this section means anything near the outlandish claim of a "death panel" however to some Seniors from a cost vs. life standpoint I can see how it can be taken that way.


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## veritas (Aug 15, 2009)

> So your saying that a person does not have a choice on the decision when or if they wish to have a living will?




Who said? Where? What are you talking about?


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