Most Americans do not create opinions by reading or consulting primary sources. Their information comes from commentaries and summaries provided by politicians, pundits, newscasters, talk show hosts, and these days, bloggers. Since this information is pre-digested, one of the most successful techniques for tilting sentiment is to frame the topic with biased language. In that way, long before an argument is engaged, the frame has already prejudiced the discussion.
In the abortion debate, by adopting the “Pro Choice” and “Pro Life” frames, each side chose a positive phrase, and neither won the framing battle. In tax policy, however, renaming the estate tax as the “death tax,” gave a huge boost to the anti-tax forces. Who wants to support death?
Framing has greatly influenced the debate on healthcare. Waiting to pull the plug on grandma, a “death panels” bogeyman lurks within Section 1233 of HR 3200, the House bill that is the focus of much of the health care controversy.
Sometimes framing has a valid basis, even if one supports the other side. In this case, it is nonsense.
Here’s what Sarah Palin wrote last week:
“The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil,”
And here’s here are a few citizens speaking out in a similar vein:
“a slippery slope to euthanasia”
“Government will instruct and consult regarding living wills, durable powers of attorney. Mandatory!…Government provides approved list of end of life resources, guiding you in death!…Government will decide what level of treatment you will have at end of life.”
What is really behind such twisted interpretations is the fear of more governmental involvement in our lives. It is reasonable to question whether an expansion of Medicare is good for society. But it is dishonest to create bogeymen where none exist.
What does Section 1233 really say? The relevant text is below (full text here), with my comments in bold font:
(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation’ 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.
This paragraph does not say that grandma must consult with the “death panel” every 5 years. It only says that if she chooses to have the consultation, Medicare will pay for it, but only once every 5 years.
Such consultation shall include the following:
(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
(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).
(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.
(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include-
(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
(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).
These paragraphs delineate what the consultation must include in order to qualify for reimbursement. They do not take any authority away from grandma, nor confer any authority on the doctor.
It is possible, as some claim, that access to information about end-of-life issues may encourage more terminally ill patients to limit medical efforts on their behalf. But those decisions would be made by the patient, based on knowledge, not ignorance.
If we shine a light, grandma can see where she’s going. Let her choose the path.
Many seniors have no end of life planning documents. Doctors presenting info about health care decisions reduces medical costs for those who don’t want extraordinary measures taken. It also empowers seniors by putting them in charge, rather than letting other people determine what is best.
Socialism, pure and simpleminded.
[...] See strange here: Death Panel Frame-Up [...]
interesting blog, it’s good to know that there’s something going on in the usa that isn’t just “how to peel a banana like a monkey” and whether a “pot belly on a guy is a fashion statement” these “news” stories courtesy of yahoo news
Alas, the art of reading is lost. We are a poorer culture for having so blithely relinquished the opportunity to scrutinize on our own — an opportunity unique to culture with freedom of speech.
We have succumbed to the folly of being shocked. Instead of being a society that embraces the right to read actual facts, we embrace the circus megaphone that broadcasts the train wreck. Like brainless twits, we simply want to be shocked. Reality tv is apparently so much more exciting than reality and the rights for which our forefathers shed blood.
Folly, to paraphrase Barbara Tuchman (The March of Folly, brilliant in 1985, resonating still today) is the practice of acting against one’s own best interests despite the clear evidence to support opposite actions. To believe what he said/ she said because it is sensational is unadulterated shortsighted folly.
Thank you for pointing out the regular (not even fine) print. I, for one, will start paying better attention.
And how many laws remain in their original form? If Medicare pays for the consultation, Medicare will have the power to determine who is consulted and what is said. Having a will is a good idea. Having one’s beneficiaries write the will is not so good. End of life counseling may be another good idea, but not if the government is in any way involved in the outcome.
Many laws remain in their original forms. Jim makes the assumption that Medicare, which under the bill as proposed will ONLY be empowered to approve or disapprove payment, will eventually acquire additional powers. As a current Medicare recipient, I have seen no evidence that Medicare has anything to do with either my choice of provider or my choice of treatment. Will my choices be restricted or influenced under the new system? Certainly not more than they were when I was privately insured (most of my life). Private insurance carriers can change premiums at will. And the horror stories of private insurers balking at paying for treatments are legion.
For my take on why government needs to hold the “invisible hand” of free markets, see my post about the subprime mortgage crisis:
http://stevecotler.com/tales/2008/03/24/subprime-thinking/
Here is Keith Olbermann’s response:
http://www.youtube.com/watch?v=m5HgfwPtxLw
I just FB’d yer article, but after reading several others, I admire your attempt to do what I spend a lot of time doing – getting people to actually *read* the information, and not just take opinion as fact. I am beyond sick to death of hearing people malign based on opinions offered as fact. Fear based reporting and worse – fear based “factual finding” is detrimental to all causes in the long run. The debates would be healthier and accomplish more if the the truth were spoken from word one. It’s wrong to continue to treat the American public like stupid sheep, but it’s worse that the American public continues to allow it!
[...] raised the spectre of Health Plan Death Panels (even though they did not exist…see my previous post), actual Death Panels have lurked in the catacombs of the Texas Health and Safety Code (Section [...]