Senator Reverend Ruben Diaz
Chair, New York Senate Aging Committee
Legislative Office Building
Albany, NY 12247
Transmitted via email to: email@example.com
September 8, 2009
RE: H.R. 3200: America’s Affordable Health Choices Act of 2009 and Its Impact on Senior Citizens
Dear Senator Diaz,
Thank you for asking me to participate in the New York State Senate Aging Committee’s hearing regarding H.R. 3200, “America’s Affordable Health Choices Act of 2009.” You and I share a commitment to ensuring that our health care system is not “reformed” at the expense of America’s senior citizens.
I have been vocal in my opposition to Section 1233 of H.R.3200, entitled “Advance Care Planning Consultation.” Proponents of the bill have described this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. That is misleading. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.
Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual … or upon admission to a skilled nursing facility, a long-term care facility… or a hospice program.” During those consultations, practitioners are to explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services.
To understand this provision fully, it must be read in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As one commentator has noted, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones…. 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?”
As you stated in your letter to Congressman Henry Waxman of California:
Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives…. It is egregious to consider that any senior citizen … should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign.
It is unclear whether section 1233 or a provision like it will remain part of any final health care bill. Regardless of its fate, the larger issue of rationed health care remains.
A great deal of attention was given to my use of the phrase “death panel” in discussing such rationing. Despite repeated attempts by many in the media to dismiss this phrase as a “myth”, its accuracy has been vindicated. In the face of a nationwide public outcry, the Senate Finance Committee agreed to “drop end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly.” Jim Towey, the former head of the White House Office of Faith-Based Initiatives, then called attention to what’s already occurring at the Department of Veteran’s Affairs, where “government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care.” Even Washington Post columnist Eugene Robinson, a strong supporter of President Obama, agreed that “if the government says it has to control health care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.” And of course President Obama has not backed away from his support for the creation of an unelected, largely unaccountable Independent Medicare Advisory Council to help control Medicare costs; he had previously suggested that such a group should guide decisions regarding “that huge driver of cost . . . the chronically ill and those toward the end of their lives….”
The fact is that any group of government bureaucrats that makes decisions affecting life or death is essentially a “death panel.” The work of Dr. Ezekiel Emanuel, President Obama’s health policy advisor and the brother of his chief of staff, is particularly disturbing on this score. Dr. Emanuel has written extensively on the topic of rationed health care, describing a “Complete Lives System” for allotting medical care based on “a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” He also has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens…. An obvious example is not guaranteeing health services to patients with dementia.”
Such ideas are shocking, but they could ultimately be used by government bureaucrats to help determine the treatment of our loved ones. We must ensure that human dignity remains at the center of any proposed health care reform. Real health care reform would also follow free market principles, including the encouragement of health savings accounts; would remove the barriers to purchasing health insurance across state lines; and would include tort reform so as to potentially save billions each year in wasteful spending connected to the filing of frivolous lawsuits. H.R. 3200 is not the reform we are looking for.
Thank you for calling attention to this important matter. I look forward to working with you again to ensure that we keep the dignity of our senior citizens foremost in any health care discussion.
Governor Sarah Palin
1 See this
2 See HR 3200 sec. 1233 (hhh)(1); sec. 1233 (hhh)(3)(B)(1), above.
3 See HR 3200 sec. 1233 (hhh)(1)(E), above.
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