The end of life bureaucracy-medicare and advance directives

The end of life bureaucracy-medicare and advance directives–23lh., b13.14

There are never enough bureaucratic controls or government programs to “incentivize us—in the jargon—to behave in ways the technocrats think best.

That is why we should look with a jaundiced eye at new legislation that would pay Medicare beneficiaries for preparing an advance medical directive. The Medicare Choices Empowerment and Protection Act is founded on the belief of its authors senators — Chris Coons (D-Del.) and Bill Cassidy (R-La.) along with representatives Diane Black (R-Tenn.) and Mike Thompson (D-Calif.)—that we are not doing a good job accomplishing what the government wants us to do. The legislators’ press release claims that 70% of us have thought about end-of-life care but “only” 30 percent have actually prepared written advance directives that would give instructions if we become incapacitated—and so an inducement is needed.

The 22-page bill would not just encourage the creation of advance directives. It would also make it easier to federalize the entire sector in coming years. First, the bill would grant Medicare beneficiaries a onetime benefit of $75 (indexed to inflation) to prepare an advance directive. The wisdom of having the government pay us to take care of our own business is questionable. But this being federal legislation, not just any advance directive will do. In order to qualify for the payment, the directive will have to be “certified” by the federal government and “executed in accordance” with the law of the State in which the beneficiary lives, not a federal standard.

To be accredited, vendors would have to meet extensive computer and online technical capabilities, including:

The facility to “create, adopt, modify, and terminate an advance directive through an online process.” ■ “comply with an annual quality review to be conducted by the Secretary.” ■ the capacity to provide the state statutory or alternative advance directive forms that comply with the particular laws of each state in which the vendor offers advance directives. the ability to allow “any family member, legal representative, or health care proxy … near real-time online access to the beneficiary’s advance directive,” as well as access to “providers of services and suppliers” under Medicare. ■ “comply with the Federal regulations (concerning the privacy of individually identifiable health information),” which is a very complex field of federal civil and criminal law. the capacity to successfully pass ‘rigorous independent testing regarding standards of timeliness, accuracy, simulating a realistic volume of beneficiaries a realistic and providers accessing advance directives simultaneously ■ the willingness and capacity to administer detailed “annual beneficiary surveys” for submission to the government.

That kind of technical know-how and capability will require the business or organization seeking accreditation to maintain a significant computer infrastructure supported by extensive IT capacities and security protocols to guard against hacking. This is how government favors large institutions over “a small, while continuing to expand its own regulatory intrusions.

Once a group received accreditation, it would be expected to maintain executed ADs for online retrieval by patient, surrogate, family, and/or health care providers, as, and wherever, needed.

The government will also maintain a clearinghouse to each state’s certified AD suppliers, with links, but will not authorized to store the documents in be authorized to store the documents in federal database.

The intent behind the Medicare Choices Empowerment and Protection Act is obviously not to empower “death panels.” No one would be forced to fill out an advance directive, and noncertified directives could still be crafted, as they are now. The bill would also require that the Medicare and You handbook and the HHS website contain a statement advising consumers, “You should not feel pressured to violate your own values and preferences, and you are entitled to implement them without discrimination based on age or degree of disability.” Of course, such a statement should be in the booklet anyway.

Right to life groups with the capacity to develop the required systems could just as readily become accredited as right to die organizations or businesses pushing the forms. Indeed, the National Right to Life Committee’s Burke Balch an unequivocal opponent of medical Unitarianism—supports the bill as a potential prophylactic against the vulnerable being pressured during end-of-life doctor/patient conferences into refusing expensive treatments, by ensuring that Medicare beneficiaries have wider exposure to—and information about— advance directives that make it easy to request care.

It is not in the nature of government to remain a neutral arbiter. Given bureaucracy’s natural intrusiveness, the bill would. over time, almost certainly result in increased federal influence over the content of our end-of-life choices.

source–weekly standard (12/7/2015), wesley smith, national right to life committee, burke balch



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