Obama's Advance Care Planning for Dummies

The U.S. House of Representatives finally released the text of the health care bill called ··America·s Affordable Health Choices Act of 2009·· HR 3200 and it can now be read in its 1,018 page entirety. The bill’s subtitle is ” A Bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. All the bill’s language was written to further this cause, i.e, to provide healthcare to everyone and to reduce the growth in spending. You can link to a pdf of the health care bill here.

Since the bill’s public release, a lot of people have gotten fired up in support and in opposition to it. Each side has called the other liars, and worse. One part of the bill in particular has touched a nerve. That is Section 1233, ADVANCE CARE PLANNING CONSULTATION.

Although the section is only ten pages long, it is still hard to digest. Below is a condensed version of this Section with cites to page number and line number. In Section 1233, the person being consulted is an individual over 65 in the medicare program. The Consultant is called a “practitioner”.

p. 428, l. 14-19 – A ‘practitioner” is a physician, nurse practitioner or physician’s assistant. The practitioner is the one who consults on Advanced Care Planning with the individual. There is nothing in the health care bill that states the consultation is voluntary.

p. 425, l. 17-21 – The practitioner first gives an explanation of and counsels on advance directives, living wills, durable powers of attorney and health care proxies.

p. 426, l. 4-8 – The practitioner then explains and counsels end-of-life services, palliative care where they ease pain without curing the underlying disease, hospice programs for meeting the physical needs of the terminally ill and the benefits for such services. The practitioner does not have to explain any drawbacks of these end-of-life services such as death itself.

P. 426, l. 9-16 – The practitioner finally explains the Order Regarding Life Sustaining Treatment and why it is beneficial to the individual and the individual’s family. The practitioner does not have to explain any drawbacks of this Order such as death itself.

After the consultation is over, the individual is not involved with any further parts of the Advance Care Planning Consultation. In no part of the process is the individual required to sign anything or execute any planning documents.

p. 427, l. 10-25 – Having a consultation in and of itself, allows the practitioner to formulate an Order Regarding Life Sustaining Treatment without any further input from the individual. The Order just needs to be signed by a physician, nurse practitioner or physician’s assistant to be in full force and effect. The Order is an actionable medical order designed to stay with the individual and to be followed by health care professionals for the remainder of the individual’s care.

p. 430, l. 1-4 The only input from the individual for the formulation of the Order is that it communicate the individual’s preferences regarding treatment. Since the individual doesn’t have to sign anything or affirmatively state anything during the consultation, it is up to the practitioner to presume and interpret the individual’s preferences.

p. 430, l. 13-24 The Order has the power to limit medical interventions, limit the use of antibiotics, limit nutrition and limit hydration. The Order can address whether an individual goes to the hospital or remains at a hospice or other nursing home.

So where does the language in the Order come from?

p. 428, l. 5-13 The Order is guided by a coalition of stakeholders including state hospice associations, home health association, etc. This is the section that has been decried as a “Death Panel” by Gov. Palin and others.

Since this house bill is written to reduce the growth of health care spending and people over 65 consume health care dollars at the end-of-life, it is pretty easy to see why Section 1233 was inserted into the health care bill.

Older Americans are not stupid. They can read and they can comprehend this health bill. No wonder so many older Americans are turning out in droves at town hall meetings. You would be angry too if the federal government was trying to kill you off.

If you want to vent, below are the phone numbers for our congress members and senators. Give them a buzz.

Dianna Degette – CD1 – 202-225-4431

Jared Polis – CD2 – 202-225-2161

John Salazar – CD3 – 202-225-4761

Betsy Markey – CD4 – 202-225-4676

Doug Lamborn – CD5- 202-225-4422

Mike Coffman – CD6 – 202-226-4623

Ed Perlmutter – CD7 – 202-225-2645

Mark Udall – Senate – 202-224-5941

Mike Bennett – Senate – 202-224-5852

Mike Robinson is Senior Partner at Robinson & Henry P.C., a Castle Rock, CO law firm.