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Why Does The Gang Of Six Want To Repeal The CLASS Act?

by Howard Gleckman
Jul. 20 2011 - 8:23 PM

The bipartisan deficit reduction plan proposed by the so-called “gang of six” Democratic and Republican senators would repeal the Community Living Assistance Services and Supports (CLASS) Act. CLASS, a national, voluntary long-term care insurance program, was included as part of the 2010 health law. The new budget plan, which President Obama called a “very significant step,” also proposed large but unspecified cuts in Medicaid as well as other unidentified reductions in non-Medicaid social service programs.


The combination of cuts in Medicaid and repeal of CLASS threatens to put millions of families in financial and physical jeopardy. Today, more than 40 percent of all long-term care is funded by Medicaid, the joint federal/state health program that is itself under tremendous financial stress. Only about 7 million Americans own long-term care insurance, which is both costly and often unavailable to those with pre-existing medical conditions. While CLASS is deeply flawed and needs to be reformed, it is an opportunity to transform long-term care from the means-tested Medicaid program to a public insurance-based system, much like Medigap insurance or Medicare Part D drug coverage.


CLASS has been a target of both Republican and Democratic deficit hawks since it was enacted, largely because they feared it would fail as an insurance program and eventually have to be bailed out by taxpayers. They also objected to budget accounting rules that made it seem as if CLASS was generating about $78 billion in new revenues that would be available to pay for health reform require long-term care services, either at home or in a nursing facility. By mid-century, twice as many will require this assistance.

After having read this article I was forced to begin to address what we all will certainly face, the end of life and living.

 As I contemplated the importance of drafting a Living Will and naming one of my family members to make the last decision I’ll ever make as a living being for me, I bristled. I decided I’d much prefer to make that decision for myself.

Neither could I bear the thought of my only living daughter having to pull the plug on her mother, nor my only sister. No. This is not something I haven’t thought about before. I have. As a cancer survivor, I’ve already decided, should it recur, I don’t want to submit to chemotherapy or more radiation.

What’s becoming clear from the article above is what with the paradigm shift in social consciousness, ie: the cuts to Medicare and to Medicaid, which I would depend upon for any extended care in a nursing facility the door seems to be closing on that. (Please do read the entire article.)

So then, for many of us of a certain age and with limited resources
some planning would seem to be in order.


How far would you go to sustain the life of someone you love, or your own? When the moment comes, and you're confronted with the prospect of "pulling the plug," do you know how you'll respond?

In Facing Death, FRONTLINE gains extraordinary access to The Mount Sinai Medical Center, one of New York's biggest hospitals, to take a closer measure of today's complicated end-of-life decisions. In this intimate, groundbreaking film, doctors, patients and families speak with remarkable candor about the increasingly difficult choices people are making at the end of life: when to remove a breathing tube in the ICU; when to continue treatment for patients with aggressive blood cancers; when to perform a surgery; and when to call for hospice.

This is an important film. It helped me in that it only strengthened what I’d already known about how I didn’t want to die. My hope is it may help you sort thorough similar concerns.

What used to be The Hemlock Society is now known as Compassion & Choices, Choice & Care at the End of Life

Here is a link to the latest information on a state by state basis as to how the laws are changing to allow physicians to assist in end of life issues.

For some, the idea of a physician assisted death would be unthinkable, for me it would beat the alternatives.

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Comment Preferences

    •  Back in the 70's (3+ / 0-)
      Recommended by:
      Annalize5, dewley notid, Catte Nappe

      my father passed away in hospital after an excruciating 5 weeks. Pure luck that I had dropped by the hospital and held his hand as he left us. The nurses urged me to request an autopsy. Without going into details, all I can say is it was the
      worst experience of my life and took me years to come to terms with. So later when my mother was diagnosed with terminal lung cancer, I vowed to be the most pro-active caregiver I could be and after reading everything I could find about the subject, on bringing her home, I told her physician that I wanted Brompton Cocktail treatment for her. He balked at first, but at my insistence finally agreed. So for months, each Friday I would go by his office and pick up a prescription for morphine which I took to a private (not chain) pharmacy. There the wonderfully compassionate pharmacist mixed the morphine into sherry wine. My mother was lucid, mobile and present in her life up until the last day or so, when she finally told me she was going "to the dance" - and so, as I held her hand and told her it
      was alright to go, she quietly passed away.

      I hope I am as fortunate. I wish everyone could be.

      Mitt Romney strapped the family dog to the roof of his car. Where's he gonna put grandma?

      by brook on Thu Jul 21, 2011 at 08:12:49 AM PDT

      [ Parent ]

      •  Oh, brook..."going to the dance"... (0+ / 0-)

        Thank you for sharing that most tender and intimate detail of your mother's leaving.

        I do beleive that some doctors have for some long while been compassionate enough to help without a lot of brouh-ha-ha.

        She was very lucky to have had a daughter like you in her corner.

        I hope I am as fortunate. I wish everyone could be.


  •  Thank you (10+ / 0-)

    I'm a big supporter of Compassion & Choices, as well as the hospice movement. I've written about supporting them here.

    My mom died a year ago this month of lung cancer. The dying process took her all of July. She made the decision to refuse additional treatment once her kidneys began to fail, but they naturally stabilized at around 7% function--just enough to keep her alive, in her sickbed, in a hospital room, for over a week.

    She lived and died in the Keys, where the only nursing facility was shuttered for violating state codes. So she had to finish her run in the hospital. Don't get me wrong, the hospital did an amazing job caring for her (and all of us--there were around ten of us on a rotating vigil), but hospitals are not generally going to dispense the same level of pain medication that a hospice will. My mother ended up enduring a longer and more painful death than she wanted or should have, and all of us had to endure the trauma of watching someone we loved slowly deteriorate into a fragment of her former self.

    This shouldn't even happen to a dog.

    ‎"Our greatest asset as advocates is a deep cognizance of our own ignorance, plus a willingness to do something about it." -Joseph Mitchell Kaye, 1966.

    by JR on Thu Jul 21, 2011 at 02:25:43 AM PDT

    •  So sorry about what your mother... (4+ / 0-)

      endured. So very sorry.

    •  But why didn't you arrange for at home (0+ / 0-)

      hospice care for that last week. As long as you had that many people around you all could have provided much of the care. Was there no hospice service to call?

      You don't need a facility. They do hospice care in the home. They will set up a pump to a vein in the arm so that the patient can self administer morphine as s/he wants it. Or a family member can give a dose when it really seems needed.

      My sister died of lung cancer in January and had been on home hospice care for months. At first a nurse came twice a week to help with things like bathing but to check and evaluate her condition. They can order what is needed such as oxygen if appropriate. They also help family members know what to expect as time goes on and talk about their feelings and other such help.

      IT was increased to three visits a week then it went to 5 days a week. My brother in law had help from their children too most of the time.

      Knowing what to expect all the time made things easier on them and being at home rather than a noisy, clangy, hooked up to machines and monitors with too much light and noise and stranger visits type of environment.

      A recent large study has confirmed that those people who forgo last ditch therapies — which if the doctor is honorable he will tell then that there would be no chance for full recovery — and accept hospice care not only have a better quality of life in end times but live 4 months longer on average.

      Your health care power of attorney can spell out just what sort of things you would want in various situations — and you should discuss it at length with the designee as well as at least somewhat with other family so you don't become the focus of arguments. You don't have to anticipate every detail and it helps to get medical information.  

      YOU CAN REVOKE IT AT ANY TIME. You can say I'm still making decisions; it is not in effect. It doesn't come into effect UNTIL you are unable to make decisions for your self so you NEED to make one out NOW. When you are discovered to have a terminal illness you can up date it with more specifics or at anytime as perhaps there are law changes that you want to take in account. But you don't know when you could be involved in a car crash or have a very damaging cardiac event. Then it is too late to make your wishes known. The easiest decision about tubing for respirator breathing is to not put one in. Discontinuing the machines is very hard; pulling the plug can be agony even if you know that is what they want. If your choice is not to be hooked up, make sure that someone with authority knows before it gets started.

      I have said no tubes, no attempts unless there is a good chance of intelligent mental state. If it is all downhill let it be faster rather than slower.

      You need protection because some doctors and hospitals have a greater interest in their income than their patients comfort and well being. And some doctors, while not being venal, just don't want to give up.

      We all will die. It is ridiculous not give some thought and MAKING SURE someone else will know about your wishes before you get in a situation where you have no control.

      Peace, Sam

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Thu Jul 21, 2011 at 04:48:26 AM PDT

      [ Parent ]

      •  As a society we have become very squeamish (3+ / 0-)

        about death. Somehow we have gotten  away from the idea that death should occur in our homes and we worry we won't know what to do next if it does.   It seems so much more modern for a person to die in a facility staffed with professionals as if every death requires a high-tech assist.

        We waste a lot of money and subject our dying to pain and indignities so the icky scary thing can happen somewhere else.

        Newt Gingrich: Believes marriage is between one man and a series of ever younger women. Wife #1 born ~ 1936, divorced when in her mid-40s...Wife #2 born ~1947, divorced when in her mid-40s...Wife #3 born ~1966.

        by trillian on Thu Jul 21, 2011 at 05:07:12 AM PDT

        [ Parent ]

        •  The Fronline documentary... (0+ / 0-)

          addresses the subject very well, both in terms of what physicians are up against as well as the patient and their families.

          It seems so much more modern for a person to die in a facility staffed with professionals as if every death requires a high-tech assist.

          We waste a lot of money and subject our dying to pain and indignities so the icky scary thing can happen somewhere else.

          It's the "high tech assist" that has turned ICU units into the place to die. The percentages are way up there. Further, the question families face in deciding how much is enough that adds to the grief of letting go of one they love.

      •  Air conditioning and distance. (1+ / 0-)
        Recommended by:

        It was July in the Keys, and my parents' house was off the grid about fifty minutes from the nearest medical care. Home hospice was the original plan, but after she began the final stages the thought of being in a house that couldn't go below around 78 degrees didn't appeal to her or anyone, and once her kidneys began failing the prognosis was for only a few days--their stabilizing at low levels was unexpected. I had suggested we get a suite at the Marriott and do hospice there, but the idea didn't fly with the rest of the family at the time I suggested it, and she wasn't in any condition to be moved after renal failure began.

        ‎"Our greatest asset as advocates is a deep cognizance of our own ignorance, plus a willingness to do something about it." -Joseph Mitchell Kaye, 1966.

        by JR on Thu Jul 21, 2011 at 10:09:54 AM PDT

        [ Parent ]

  •  I think hospice care (6+ / 0-)

    is what I would choose for myself. One of my parents had hospice care, the other did not. I have nothing but admiration for the hospice workers I dealt with. I will say that areas that are well served well by hospices seem to have resources such as a healthy economy that supports volunteers, or by excellent charity fundraising as is true locally here. They are my chosen charity, partly because I suspect I'll be there one day and partly because they have done so well by friends that found themselves in need.
    May your decision come a long way down the road though.

  •  I've always favored suicide bombing (5+ / 0-)

    as a way to go. You know, tell people what I think one last time. Make my paintings jump in price, or worthless, depending on who goes with me.  And then there's all those virgins.
    As a Bokononist though, I'll probably just climb some mountain and touch my finger to my lips for a taste of ice nine even though they say it has no taste.

    whatever, getting old is not my goal and I'm gaining on 63.
    I had more fun painting yesterday than I've had in years, or at least since last tuesday.
    WTF is that all about.

    "Peculiar travel invitations are like dancing lessons from god" Bokonon

    by tRueffert on Thu Jul 21, 2011 at 02:51:44 AM PDT

  •  I am a strong supporter of the right (4+ / 0-)

    to assisted suicide for the hopelessly ill and the severly handicapped. (And it`s something I would very much consider for myself).

    But I don`t want anybody to feel they "have to" make that choice for economic reasons/lack of other options.

  •  My Question is Where to Stack Mom While She Dies (0+ / 0-)

    over the coming 5-10 years, and her teachers' pension and pension health care and her Medicaid are all cut, now that she's about to spend out the last of her life's savings shitting her pants every 3 hours.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Thu Jul 21, 2011 at 06:01:47 AM PDT

  •  Monty Python's "Meaning of Life" movie (1+ / 0-)
    Recommended by:
    dewley notid

    Executed by being chased off a cliff by a bunch of boobs.

    Who'd ever think how prescient that would turn out to be?

    I see a very beautiful planet that seems very inviting and peaceful. Unfortunately, it is not.…We're better than this. We must do better. Cmdr Scott Kelley

    by wretchedhive on Thu Jul 21, 2011 at 06:51:15 AM PDT

  •  Worthwhile reading on the issue (1+ / 0-)
    Recommended by:
    Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left.

    Letting Go, Atul Gawande in the New Yorker. His articles on the health care and reform issue are all "must read" as far as I'm concerned.

  •  Strong supporter here of assisted suicide and (3+ / 0-)

    the right to have control over your own body regardless of the circumstances.  I've had two very elderly relatives (aunt and uncle in their early 90's) choose to commit suicide together, even though only one of them had a terminal illness.  But they wanted to go out of this life together; it was a very rational choice that they researched carefully and explained in full to their children in their suicide note, and I respected them for making a difficult and brave decision.  A year later my 96 year old mother, who hated hospitals and doctors and all things medical, decided the time had come and intentionally stopped eating and drinking (supported by a living will that declared her wish not to be force fed or hydrated, among other artificial means of prolonging life). Again, I totally respected her wishes on this and stayed by her side until the (surprisingly peaceful) end.  I just don't see that anyone has the right to tell other people how or when they should or shouldn't die.  This seems a pretty basic human right.  I should add that in both of these cases money, family support, and access to health care wasn't an issue.  It was simply about continuing to make choices for themselves about death as they had during their long, independent, happy lives.

    Nothing amuses me more than the easy manner with which everybody settles the abundance of those who have a great deal less than themselves. --Jane Austen

    by feeny on Thu Jul 21, 2011 at 08:08:31 AM PDT

    •  This: (2+ / 0-)
      Recommended by:
      feeny, Alexandra Lynch
      I just don't see that anyone has the right to tell other people how or when they should or shouldn't die.  This seems a pretty basic human right.  


      Thank you for allowing us to "see" inside your experiences with dying with dignity.

      It's humbling.

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