House Health Care Bill – H.R.3200: America’s Affordable Health Choices Act of 2009 – U.S. Congress – OpenCongress
by Melanie on 23/08/09 at 12:06 pm
Here it is: the actual text of the much maligned House health care bill, provided by OpenCongress.org. No, there are no death panels; Betsy McCaughey made those up out of a real doozy of an extrapolation. She concludes that because the bill calls for doctors to provide empirical data on whether patients take advantage of living wills and how they are utilized, or not, that doctors will be judged under the Physicians’ Quality Reporting Initiative, found elsewhere in the bill, and lose money if their patients change their minds and end up not wanting to be taken off a ventilator. Those are absurd claims. Even allowing for ambiguity, the bill can’t be interpreted like that. I’m glad she lost her job.
Incidentally, collecting the sort of data asked for in the bill is how evidence-based medicine is practiced—scientists gather data and determine whether a treatment or protocol is working or not. Finding out whether patients are adhering to their living wills would be good to know, if only so that doctors and hospitals can be prepared if, in fact, a large number do change their minds and would prefer more or less treatment at the end.
Here’s a link to the Jon Stewart segments in which Betsy McCaughey appeared and Open Congress’ links to the sections she cites.
But let’s be clear: It is in the best interests of everyone to encourage living wills, except possibly doctors, hospitals and companies that make money selling medical services and equipment. Most health insurance dollars are spent in the last few months of a person’s life, which is incredibly wasteful. The default position is to “do everything,” including keeping someone alive via tubes and ventilators, no matter how old, no matter how sick and no matter the cost. Health care has to be rationed. Living wills, which put the patient in the driver’s seat (I don’t want to be packed in an ambulance and plugged with tubes when I’m 99) are a good way to effectively “ration” but still maintain patient choice and options.
In general, rationing needs to occur based on benefit to the patient, not cost, according to Maggie Mahar, author of Money-Driven Medicine, a book and film, which aired on Bil Moyers Journal. That might sound illogical, but it’s really not. There’s little benefit—and in fact a negative effect—to provide expensive hospitalization and invasive testing in terminal patients who would be better served by hospice care, for example. This is not “pulling the plug on grandma!” I am only promoting dying with dignity, not refusal of treatment. There may also be little benefit in a expensive drug over a generic drug, but if there is benefit and medication would be life-saving , as well as prevent hospitalization and suffering, then the higher priced drug must be made available.
For a sobering look at what can happen when patients are not given the medicine and treatment they need in a timely manner, please view the documentary “Critical Condition,” which also aired on Bill Moyers Journal.
Here’s a PDF of H.R. 3200, downloaded from the Library of Congress.
Just sayin’ …
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