"This is a common-sense proposal, and will comfort Americans who face death with the fear of the unknown. A few answers, and a little planning, goes a long way."

It's the patient's responsbility to ask those questions, and who's to say most docs don't do that already? There's a reason Hospice and other organizations like it exist.

I wholeheatedly disagree with the government mandating what doctors do and don't do, especially in conversations with their patients.

And what if a doctors refuses to talk about the issue? Who enforces it? Do we now open up lawsuits if a doctor doen't have a conversation about end-of-life care?

to Jason:

The bill DOES NOT MANDATE that doctors do anything. It DOES NOT MANDATE that patients do anything.

It merely says that if a doctor and a medicare patient choose to talk about end-of-life care, that the time spent doing so is an allowable expense for medicare.

Right now, if doctor wants to bring the issue up, they can not bill for that visit. Likewise, if a medicare patient wants to ask about it, their doc will have to tell them that doing so isn't covered and they'll have to bill separately.

If a given patient and doctor don't want to talk end of life plans, then they just dont. No one is making them do it or checking up on whether or not they have.

Blumenauer's amendment would compensate doctors for having a conversation with their Medicare patients about end-of-life care. Without mandating anything, it encourages doctors to raise the issue - and talk to their patients about what level of care they want.

Evidently, Chris Matthews didn't read the bill either because he was mindlessly parroting all the republican talking points on "Hardball" last night. I just wish for once he would do the research before just blurting out the first thought that comes into his head.

All republicans can do is wail, "Obama's the foreigner is gonna kill all the old white people." Really it's pathetic. This is what a party looks like when it's having a total mental breakdown.

I've often wondered how it was that the U.K. and Canada, two countries that have national governments in the parliamentary mode, but do elect their MPs with the same "first-past-the-post", winner-take-all lunacy that we use, have managed to obtain strong third-party representation in their houses of respective Parliaments?

We so badly need this in the U.S., because if all the Dems have to answer to are the moronic GOP then it's way too easy for the Dems.

but the willingness of Republicans to destroy the country in their attempts to claw back into power are deeply troubling

Why should that surprise you. We saw clearly that they had no problems destroying the country to MAINTAIN the power they had

My rant above about the idiocy of this issue aside, I'm afraid Paul is right about the optics and the Dems should have caught it. Idiotic as it is.

I think a larger issue here is that without a large scale vision being pushed by Obama, nor even by congressional champions, the leadership has left a vacuum. I'm not naive enough to think we'd have a sophisticated discussion of a bill's merits, but since the Dems are pushing this they ought to be driving the news agenda. Instead they are leaving a vacuum that of course is easy for the GOP to fill by pulling nuggets of doom out of context from one bill or another.

Kari, It's wonderful for you to be able to point at an obvious mean Republican move. What's the word describing their response on this? "Unhinged"?

  But I'm a little concerned about your role as a "political activist" and how that will play out as the people who pay you for your services, dance their way through this and then probably sell out the American People.

   I'm hearing that the public option is in deep trouble and the rest of it will be a diluted, pretend version of healthcare reform.

  At that point Blue Oregon will be caught between condemning the Democrats in Congress or continuing to cuddle up to the people you work for.

   That's when we'll see how much of a political activist you really are.

      But for now, let's look at those mean Republicans and how they're preventing the Democrats from representing the American Public on this. How is that again by the way?

    Never mind - just look over at those mean Republicans. Never mind those price tags hanging out from the suits of the Democrats in Congress. Please, ignore those.

   I wonder if genuine universal healthcare reform is getting ready for an end-of-life speech of its own.

"It's the patient's responsbility to ask those questions, and who's to say most docs don't do that already? There's a reason Hospice and other organizations like it exist. "

Jason, are you saying that in the current fee for service model that doctors really believe they have that kind of time?

Go to http://www.charlierose.com/schedule/
and look for the video of Dr. Frist debating Dr. Dean. For 2 former office holders of different parties who happen to be doctors, it is amazing how much they agree on. Neither is a big fan of fee for service medicine or the health insurance paperwork for private patients being so much more complex and bureaucratic than Medicare.

"We so badly need this (third-party representation) in the U.S., because if all the Dems have to answer to are the moronic GOP then it's way too easy for the Dems."

We could start the process by having enough registered Democrats and Republicans who are understandably disillusioned with their parties re-register as independents or non-aligned voters (NAVs). Then when it comes to voting, reject the lesser-of-two-evils option and vote for someone whose position you believe in, even if he or she won't win. The people of Vermont proved that you don't have to be a member of the Democratic-Republican duopoly to win.

"I think a larger issue here is that without a large scale vision being pushed by Obama, nor even by congressional champions, the leadership has left a vacuum."

Obama and the "leadership" in Congress are doing what their major campaign donors want them to do. Which is often the opposite of what the people want.

I commend the Representative for this amendment. It is sorely needed. Many patients facing the end of their lives cannot afford to have that conversation with their physician. I have a relative in another state who is terminally ill with cancer and on Medicare. She brought up end-of-life care and the doctor simply said "sorry, Medicare doesn't cover that and you're a Medicare patient so we can't discuss it". The relative offered to pay for the conversation and the doctor refused...too "difficult to figure out the billing issue". Billing shouldn't be an issue when discussing such an important subject.

The question is how many people will believe the Republican talking points and how many will actually learn the truth? I fear it will be too many of the former, but I appreciate the Representative's attempt.

Another handy distraction to shift the conversation from the latest DP sellout of its base:

Top Ten Ways To Tell Your President & His Party Aren't Fighting For Health Care For Everybody

1. Their plan doesn't cover the uninsured till at least 2013.

2013 isn't “day one.” It's not even after the midterm election. It's clear after the president's second term, if he gets one. Congress passed Medicare in 1965 and president Lyndon Johnson rolled out coverage for millions of seniors in eleven months, back in the days before they even had computers.

22,000 Americans now perish each year because they can't get or can't afford medical care, and this year three quarter million personal bankruptcies will be triggered by unpayable medical bills. Why this president and these Democrats are in such a hurry to pass health care now that doesn't take effect till two elections down the road doesn't make sense in any kind of good way.

1. Their “public option” isn't Medicare, won't bring costs down and will only cover about 10 million people.

The “public option” was sold to the American people as Medicare-scale plan open to anybody who wants in that would compete with the private insurers and drive their costs downward. But in their haste not to bite the hands that feed them millions in campaign contributions each hear, the president and his party have scaled the public option back from a Medicare-sized 130 million to a maximum of 10 million, too small to put cost pressure in private insurers. Worse still, the president and his party are playing bait-and-witch, not telling the public they have reduced the public option, to nearly nothing.

This remnant of a public option is not Medicare, as Howard Dean insists, and it will not lead to the sort of everybody-in-nobody-out health care system that most Americans, whenever they are surveyed say they want.

Some Senate and House Democrats want to ditch even the pretense of a “public option” in favor of something they're calling a private insurance “co-op”, which as near as anybody can tell has the same relationship to an actual cooperative that clean coal has to actual coal.

1. The president and his party have already caved in to the drug companies on reimporting Canadian drugs, on negotiating drug prices downward and on generics.

This explains why Big Pharma, the same people who ran the devastatin g series of anti-reform “Harry and Louise” ads to spike the Clinton-era drive to fix health care are spending $100 million to run Obama ads using the president's language about “bipartisan” solutions to health care reform.

1. The president and his party have received more money from private insurers and the for-profit health care industry than even Republicans, with the president alone taking $19 million in the 2008 election cycle alone, more than all his Repubican, Democratic and independent rivals combined.

Democratic senator Max Bacaus got $1.1 million in 2008. Democratic senators Harkin, Landreau and Rockerfeller each got over half a million, and Senator Durbin got just under half a million. Other Democratic senators got a little less. Four Democrats in the House, Rangel, Dinglell, Udall and Hoyer got over half a million apiece in 2008, with other Democrats not far behind.

Is there any wonder that the insurance companies, like the drug companies are also running “bipartisan health care reform” commercials using the president's exact language?

1. The president's plan, and those of Republicans and Democratic blue dogs too, will require families to purchase health insurance policies from private insurers.

This is something the policy wonks call an 'individual mandate”, under which Individuals will be “mandated” to purchase affordable insurance, though companies would not be required to offer it. In Massachusetts, the prototype state for the Obama plan, a family with an income of $33,000 can be required to spend $9,000 in deductibles and out-of-pocket expenses before the insurance company is obligated to pay a dime. As in Massachusetts, public money is used to purchase private insurance for the very poorest citizens. With the revenues of insurance companies on the decline, individual mandate programs are a welcome bailout for the private insurance industry.

1. The president's plan, and those of Republicans and Democratic blue dogs too, could force you to buy junk insurance.

Think about an insurance policy that costs a lot, but is full of loopholes, exceptions and steep deductibles and co-payments. That's junk insurance, and for many it's the only insurance companies offer. Even more pernicious is the widespread practice among insurance companies of “recission” in which claimants are routinely investigated and disqualified in the event that they finally make a claim. Insurance companies admit they do this to half of one percent of policies per year. That means if you hold a health insurance policy twenty years, you don;t have insurance – you have a ninety percent chance of having insurance.

1. The president's plan, as well as those of Democratic “blue dogs” and Republicans, are to be funded in part with cuts in Medicare and Medicaid.

Private insurance companies have always hated Medicare because it is far more efficient than they are. Medicare's administrative expenses are under five percent, as compared with the one third of every health care dollar taken by the for-profit insurance companies for their advertising, bad investments, billing and denial machinery, executive salaries and bonuses. Private insurers have, over the years, purchased enough influence in Congress and previous White Houses to restrict Medicare's payment rates and partially privatize it. But president Obama's plan, perhaps the most friendly to Medicare and Medicaid, calls for over $300 billion in cuts to the programs that now provide medical care to those with the fewest options, while failing to guarantee that care will come from elsewhere. In Massachusetts right now, hospitals are turning away poor people they used to be able to provide care for because funding that used to go to those institutions is now plowed into the state's “individual mandate” system.

1. The president, with the cooperation of corporate media and the Republicans is trying to make the argument about himself instead of a discussion on the merits of his policy.

The president and his critics are happy to talk about whether this will be “his Waterloo”, or his Dien Bien Phu, as if that matters more than the 22,000 Americans who die each year from lack of medical care, or the three quarter million who will go bankrupt because of unpayable medical bills. The concentration on whether the president looks good or bad takes up air, ink, and coverage time that might otherwise be spent explaining what is and isn't in the various proposals, and why.

If the president were not afraid of his own supporters publicly examining the merits and demerits of his proposals, he would mobilize those 13 million emails and phone numbers collected during the campaign. The reason he has not sone so already is that most of his own supporters favor a Medicare-For-All single payer health care system, HR 676.

1. The president and his party, and the corporate media have spent more time and energy silencing and excluded the advocates of single payer health care, mostly the president's own supporters, than they have fighting blue dogs and Republicans.

But no matter how diligently the spokespeople for single payer are excluded from media coverage and invitations to Obama's policy forums and round tables, no matter how many times the White House cuts their questions from transcripts and video of public events, the calls, emails and letters keep pouring into Congress and the White House demanding the creation of a publicly funded, everybody-in-nobody-out system, a Medicare-for-All kind of single payer health care plan.

1. . Despite the president's own admission that only a single payer health care system will deliver what Americans want, he and the leaders of his party insist that Medicare For All, HR 676, us utterly off the table.

Before he became a presidential candidate, Barack Obama identified himself as a proponent of a single payer health care system. All we had to do, he told us, was elect a Democratic congress and senate, and a different president. Now that this has been done, he insists that “change” is just not possible, and we have to settle for less. The president continues to admit that only a single payer health care system will cover everybody, but insists that America just can't handle that much change.

The truth is that Barack Obama campaigned as the candidate of change, and a health care system that covers everybody from day one with no exceptions is what people imagined they voted for when they swept him and an overwhelming number of Democrats into office.

A single payer Medicare-For-All system will eliminate 500,000 insurance company jobs and replace them with 3.2 million new jobs in health care for a net gain of 2.6 million new jobs according to a study by the National Nurses Organization. That's as many jobs as the US economy lost in all of 2007. Single payer will create hundreds of billions in annual wages and local and state tax revenues for cash strapped cities and towns. It will lift the shadow of bankruptcy for medical reasons from two thirds of a million American families yearly. It's what we deserve.

It's what we voted for, and we won't stop demanding it.

Bruce Dixon is based in Atlanta GA and is managing editor at Black Agenda Report. He can be reached at [email protected].

http://www.blackagendareport.com/?q=content/top-ten-ways-tell-your-president-his-party-arent-fighting-health-care-everybody

The R reaction is part of the larger "shoot the messenger" complex on the right. Like the abortion "gag rule" and limitations on public funding of reproductive services, the right to life crowd wants to make it a mandate to choose their position by denying patients the information necessary to make an informed choice. To them, our country is already too free, and this is just one way they can make it less so. They just don't care that it is at the cost of a large number of people spending time in agony when palliative care is available.

I stand corrected.

While the headlines scream that Obama's numbers are tanking, the reality is the Rs are losing the message war:

From the NY Times/CBS poll from yesterday:

1. Americans trust Obama over congressional GOPers on health care by a 55%-26% margin.

2. 72% think Congress is moving either too slowly or at the right pace.

3. 59% think Obama is moving either too slowly or at the right pace.

4. 76% think health care costs pose a serious threat to the nation's economy.

5. 66% support a Medicare-style public option for all Americans.

My wife has worked in the healthcare industry for about 9-years now, six of it as a medical transcriptionist. I wanted to know what she thought, so here it is:

I think it is absolutely necessary to pay doctors for their time. Counseling a patient on what type of care and what that looks like, talking with the family, making someone understand their illness and the scope of it takes a lot of time. It is one of the most vulnerable times in a person's life and many do not understand what they are facing or how to cope.

An appointment like that can take 30-40 minutes of a doctor's time, whereas a normal office visit may only take 10 minutes. If you start expecting doctors to perform services for free, the cost of health care will continue to rise. I would guess that it would be an either or type of deal; get end of life care through your PCP or opt for something like hospice.

Many people don't want to do something like hospice because they are afraid of somebody taking care of them that they don't know. If they have an established realtionship with their physician, that may be the only one they will get help from.

Right now if a doctor visit under Medicare doesn't have the "right" code, Medicare denies it. I am sure it wouldn't be that big of a deal because many doctors probably wrap the end of life care into another code and end up getting paid for it in the long run.

"I stand corrected."

Jason: You are not the only person on this site to get it wrong, but you are one of very few with the character to admit to doing so. My compliments.

"Currently joining third parties or no party at all is essentially to give up, and has the same consequence of marginalizing your views and opinions. I'm not saying that's good, I'm just saying that's how it is."

This approach is not giving up. It is declaration of independence and a way of saying "a pox on both your houses" with the possibility of modifying one party or the other or both to get a majority. The alternative is to stay with the party and let its oligarchy know they can do whatever they want, and you will go along with it.

How about if enough people in, say, twenty states rejected both parties and elected twenty senators to Congress. If the other 80 seats were split between the Democrats and Republicans, those 20 seats could be swing votes and decide the issue and, perhaps, modify the political culture. Admittedly, this is no guarantee. The corporations that own most of Congress could tell enough senators from one party to join with the other party to get the majority they want, but over time those independents could have a positive influence. Of course, what is really needed is campaign finance reform to take the money out of politics. That remains a formidable and daunting challenge.

"I'm not really sure what you're suggesting here: that I should get a new day job, or that I should shut down blueoregon? I'm not sure either alternative makes sense."

Kari: You may or may not be compromised by your clients, but you have done and are doing a great job maintaining Blue Oregon. Keep up the good work.

Kari, I'm suggesting that the Dems have the power to do what the American People want, but are not following through despite the fact that it can only ultimately help them. A similar thing happened in 2006 when the Dems rode a wave of anti-Iraq War sentiment into power in Congress and then proceeded to sell out, rolling over for President Bush at every turn.

   You have obviously made peace with your role as keeper of the spin, but your image of yourself as a political activist is a little annoying each time you come down squarely on the side of whomever's website you built.

   I keep hoping that the Democratic powers-that-be will monitor the Blue Oregon-style sites around the country and say, "Uh oh, we're losing the Kari's of the party. We've got to act on healthcare now!"

   Instead I bet they're saying, "All is well. We think we can blame it on the Republicans (as you do here) or the insurance companies (as Nancy Pelosi tried today.)"

  Anyone but the party that holds Congress and the White House.

Perhaps this could be a great example of overt politics muddying the water - on both sides. I don't know.

Doctor, doctor, Give me the News!

Case in point. Mu mom had a massive heart attack June 5, 2008. She was without O2 for over 20 minutes and even though the EMT's got her going again, she was on heart, breathing machines and full life support as soon as she arrived at the hospital. She was 72 so is a Medicare patient. The tests run included an EEG about 24 hours later. Once the results were available the treating physician had a talk with my dad, sister and me.

I don't know how the 'talk' was billed, but believe me of all the expenses racked up from about 9:00 pm the night before to about 6: pm the next evening, the 5-10 minute talk with us had to be minimal. We appreciated the calm way the matter was handled, and we were already prepared for the outcome of the tests.

Is this medicare language a good thing? Yes, perhaps. I'm somehow certain the talk has been going on for decades anyway and billed as 'patient care update; patient report update' or some other equally obtuse, yet covering format. I fear that this is a symptom in search of a cause, pun intended. Sometimes politicians can't help but delve into minutia as a ploy to avoid dealing with the seriousness of the issue(s) at hand.

I referenced Blumenauer's Website in my post on this issue. I cannot believe how dishonest republicans are attempting to manipulate our vulnerable elderly to take a stand against the health plan with their lies and fearmongering.

"I cannot believe how dishonest republicans are attempting to manipulate our vulnerable elderly to take a stand against the health plan with their lies and fearmongering."

<hr/>

Oh, I can. It's entirely believable. These are the same GOP politicians who tell Americans that Medicare isn't govt. run health care, or that their own health care isn't govt. run health care. http://www.dailykos.com/storyonly/2009/7/29/759321/-GOP:-We-hate-public-insurance,-but-love-Medicare

In fact, according to Gallup 29% of all Americans have govt. health care. http://www.gallup.com/poll/121970/Nearly-Insured-Government-Coverage-2008.aspx

Medicare and Generational Justice-

It is something of a wonder to me that in the health care debate that the issue of generational fairness hasn't emerged.

The day is coming when the working people 18-65 of America are going to rise up when they realize they are funding Medicare for seniors 65 and older, and all other govt. provided health care, and many of them have nothing or inadequate coverage for themselves and their families. They are going to demand they have some of that govt. run health care for themselves. Even William Kristol when pressed on the Daly Show, admitted the govt. run health coverage for the military is superior to what the public gets, but the tax paying citizenry doesn't really deserve it.

Ron Wyden talks about how the average American citizen should have health coverage equal to his own. But it has to be "sustainable." I wonder why it's sustainable for him but not for everyone else.

Why do serial liars like Lars Larson get a national platform, why does KXL continue to employ him, and why do advertisers continue to support him?

Yes, I realize that he afflicts the afflicted and comforts the comfortable, so they gain from his platform, but seriously, the guy has no qualms about just making things up.

After Hurricane Katrina he sent out a "timeline" purportedly from the New Orleans Times Picayune. The only problem is, there appeared to be no similar timeline available on NOLA website, and Lars was unable to produce the source for the timeline. KXL decided this was not a problem.

They have been contacted on numerous other occasions about Lars' fantasies that he presents as reality, and they've done nothing.

And here he is, once again, presenting his fantasy that Blumenauer's bill will lead to the government urging the killing of the elderly, and Hardball gives him a national platform to do it.

I would gladly debate Lars and his 'concerns' about this subject.

Kurt,

Good luck with that. If you know what you're talking about, Lars will likely interrupt you mid-sentence. Then, when you interrupt his interruption, he'll hit the kill button and berate you for interrupting him. Then he'll say he's "just trying to have a conversation."

Does Jason not understand the amendment?

Earl had a lot of good things to say but he needs to be a little bit 'cooler' for TV and express his frustration more subtly... IMHO

Thanks to Wrench Monkey for getting to the heart of the matter rather than commenting on the distraction.

The Mandate, Massachusetts-style. I've heard there is to be a 2.5% federal penalty for non-compliance on taxable income. There must be some uninsured middle-income folk out there who'll find the penalty to be a lot cheaper than having to buy private insurance.

And possibly there could be a legal challenge against the idea that a government can require the purchase of a for-profit item just as a matter of the citizen's existence. Of course it's proper to require auto insurance (although pay-at-the-pump, no-fault would be a lot cheaper) as driving is not a right, it's a privilege. I think we're in uncharted water when a government in the U.S. can require an uninsured person to go out and buy for-profit private insurance. It would be the same as a government requiring us to buy 401Ks.

But maybe the Mandate would foster some civil unrest, and maybe that might turn out to be a good thing as this debate degenerates into disappointment?

Government-provided insurance is a whole other matter, of course. It's merely a public utility.

Americans just get SO wacky about the "death" thing, don't we?

Regardless of what happens or doesn't happen to Earl's amendment - as sensible as it it - everyone NEEDS to have advanced medical directives spelled out for loved ones.

Having watched my father and sister die and having buried two other siblings, I can tell you it is CRUEL to expect people to wait until a loved one is on death's door and ask them AT THAT MOMENT to make rational decisions about a level of care if these issues have not already been addressed.

I watched as an emergency room physician asked my father what level of care he wanted for his dying daughter. She did not have an advanced directive and we had never discussed it with her. It was INSANE to expect that the person who helped give her life could make a decision AT THAT MOMENT. Immediately after my sister died, I wrote my advanced medical directive on a paper towel (the only thing I could find in her hospital room that I could write on) and have since made sure my family knows my wishes AND that my directives are legally binding.

A few years later, I had to ask my mother what her wishes were when my father was on life support. He never bothered to discuss it either. Thank GOD she said: "Let's wait for your brothers and sisters to get here and say goodbye..." Maybe the Japanese have a better attitude about these things.

I know that the brouhaha right now is about who pays for what and when but if we could just get over the ghoulish, boogeyman, grim-reaper histrionics and accept the fact that we are ALL dying, maybe we could have a more calm reasoned discussion about this.

The Republicans will have us sending seniors to their deaths no matter what we do or say and while there ARE a few Republicans I'd like to send out on an ice floe, I don't see that happening anytime soon without dire legal consequences for me. And with the global warming thing, that may not be a possibility anyway.

<h2>But in the mean time, we should ALL think about our own mortality and git yer damn medical directives written. Think about the people you love and think about whether or not you'd want them agonizing about what you would or would not have wanted at the end of your life. It's really not that big a deal.</h2>