She must think the use of footnotes suddenly makes the ridiculous things she says look more correct, because the godzilla from wasilla responded (on facebook) to defend her death panel insanity.
Before the jump, Let me say I am just about 100% convinced after reading it that someone did this work for her since it's not covered in exclamation marks and written in absolute jibberish. Don't get me wrong- it's bad. But it's not Sarah Palin bad.
That being said, the entire thing is a completely incorrect farce.
Before we go on, here is the text of the section of the bill she is dumb enough to not know how to read (i'm going to bold/italic things that automatically refute anything she could say):
SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
•
1
(a) Medicare-
◦ (1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
▪ (A) in subsection (s)(2)--
▪ (i) by striking ‘and’ at the end of subparagraph (DD);
(ii) by adding ‘and’ at the end of subparagraph (EE); and
(iii) by adding at the end the following new subparagraph:
◦ ‘(FF) advance care planning consultation (as defined in subsection (hhh)(1));’; and
▪ (B) by adding at the end the following new subsection:
‘Advance Care Planning Consultation
•
10
‘(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. 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).
9
‘(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).
◦ ‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--
▪ ‘(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
◦ ‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--
▪ ‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;
‘(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;
‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
‘(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
• ‘(2) A practitioner described in this paragraph is--
◦ ‘(A) a physician (as defined in subsection (r)(1)); and
‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.
• ‘(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).
‘(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--
◦
1
‘(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
2
‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
• ‘(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items--
◦ ‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
‘(iii) the use of antibiotics; and
‘(iv) the use of artificially administered nutrition and hydration.’.
(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ‘(2)(FF),’ after ‘(2)(EE),’.
(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--
▪ (A) in paragraph (1)--
▪ (i) in subparagraph (N), by striking ‘and’ at the end;
(ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘, and’; and
(iii) by adding at the end the following new subparagraph:
▪ ‘(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;’; and
(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.
◦ (4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.
• (b) Expansion of Physician Quality Reporting Initiative for End of Life Care-
◦ (1) Physician’S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:
‘(3) Physician’S QUALITY REPORTING INITIATIVE-
▪ ‘(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.
‘(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’.
• (c) Inclusion of Information in Medicare & You Handbook-
◦ (1) MEDICARE & YOU HANDBOOK-
▪ (A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:
▪ (i) An explanation of advance care planning and advance directives, including--
▪ (I) living wills;
(II) durable power of attorney;
(III) orders of life-sustaining treatment; and
(IV) health care proxies.
▪ (ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--
▪ (I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);
(II) website links or addresses for State-specific advance directive forms; and
(III) any additional information, as determined by the Secretary.
▪ (B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act
Wow, This Sounds Soooooo Horrible.
Now, let's take a few minutes to completely crush The Quitter's latest facebook idiocy.
Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly, and the disabled would suffer the most under such rationing; and that under such a system these "unproductive" members of society could face the prospect of government bureaucrats determining whether they deserve health care.
1- You mean the claim that Obama was going to appoint a group of people to systematically murder the Down Syndrome infant you use as a stage prop? I'm relatively sure he was not responding to this. I'm also pretty sure that he wasn't responding to you personally, although I'm sure your ego (which, much like Alaska, is the largest in the US) won't let you believe that.
2- You have given no proof, and no substantiation of any claims you have made that there actually would be rationing for the sick, the elderly, or the disabled. You see, the way argumentation and debate work is the person who makes the claim has to prove it. It most certainly doesn't work where you get to say something, and people then have to prove it's not true. To put it more simply, imagine what it would be like if I took you court claiming that, one day in private, you transformed into a giant cockroach alien and told me of your plans to destroy the human race. And the judge then turned to you and said "Mrs. Palin, prove you are not a giant cockroach alien hellbent on destroying the human race."
3- I would also like you to answer why these "government bureaucrats" in your fantasy world are worse than the "insurance company fatcats" that already sentence thousands and thousands of people to death a year?
4- If the government bureaucrats are so bad, how come veteran health care, and medicare for the elderly, are so beloved?
5- There is a provision to make it so doctors and other professionals who deal with people regarding end-of-life issues are now quality controlled. This means less murder and euthanasia will occur and hospices and nursing homes will be better for everyone.
The President made light of these concerns. He said:
"Let me just be specific about some things that I’ve been hearing lately that we just need to dispose of here. The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma because we’ve decided that we don’t, it’s too expensive to let her live anymore....It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, etc. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready on their own terms. It wasn’t forcing anybody to do anything." [1]
The provision that President Obama refers to is Section 1233 of HR 3200, entitled "Advance Care Planning Consultation." [2] With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.
1- First off, let me say that there is a LOOOOOOOOONG distance between what you said last week, about government-run death panels literally murdering people who they deem "unproductive," and what you are saying now.
2- With all due respect, you don't get to call anyone out for being misleading when there are websites that have about fifty ridiculous lies you have told in the last 9 months. Also, when everything you say in this super-classy facebook post is misleading at best, and a blatant lie at worst.
3- Also, with absolutely no respect due, I think you may be borderline illiterate if you read that section and didn't think it was wholly voluntary.
4- Also, am I right to understand that now you are telling us that doctors are going to convince everyone to kill themselves when they get old or if they are disabled?? You are seriously saying that, once there is a Public Option, doctors can no longer be trusted?? Why do you hate doctors so much, Sarah?
Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often "if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program." (3] During those consultations, practitioners must explain "the continuum of end-of-life services and supports available, including palliative care and hospice," and the government benefits available to pay for such services. (4]
Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is "to reduce the growth in health care spending." (5] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As Charles Lane notes in the Washington Post, Section 1233 "addresses compassionate goals in disconcerting proximity to fiscal ones.... If it’s all about alleviating suffering, emotional or physical, what’s it doing in a measure to "bend the curve" on health-care costs?" (6]
1- it authorizes VOLUNTARY advanced care planning consultations. And if you health changes before five years, it doesn't leave you stranded if your condition or situation demands you edit your plan. Sounds simple enough to me.
2- With all due respect, trying to get context from you is farcical. If i want to know whether or not excrement is delicious, I'm not going to ask a dung beetle.
3- I don't think you understand that these consultations are not with the mayor of your city or a state senator. They are with doctors and health care professionals (which are not employees of the government). This, and this alone, completely invalidates everything you are saying.
4- Another way to invalidate what you are saying is that:
a- the bill also says it needs to stick within local and state laws. Euthanasia is illegal in almost every state.
b- a doctor cannot suggest that someone kill themself. That is called murder. A doctor would need to carry out the wishes of someone. And that someone needs to fit a LOT of conditions when it comes to terminal disease. Someone cannot simply go to a doctor off the street and ask the doctor to kill them.
5- Your argument, again, is that doctors, in an effort to lose themselves money, will convince the sick and elderly to kill themselves. Why do you hate doctors so much, Mrs. Palin?
6- Just in case you can't count either, the phrase "life sustaining" appears 10 times in just that section. All treatments must be life sustaining. Not life ENDING. Life SUSTAINING. I'm pretty sure that advising people on life sustaining treatments, and how to get your affairs in order, is not a death panel.
7- And, after all of that, your proof is that someone in the Washington Post is as ridiculous as you? Congratulations, some idiot agrees with you. None of this is proof, or suitable backup, for any of your claims.
As Lane also points out:
Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that’s an incentive to insist.
Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit "formulation" of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would "place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign," I don’t think he’s being realistic. (7]
1- again, quoting people (even if they have a D in front of their name) doesn't mean you are right.
2- why don't you want people prepared for when they die? do you really want their families to suffer? Do you really think doctors are going in there without the goal of helping people (and their families) get through a horribly tough time?
3- You see, purely voluntary means that they cannot be forced into a discussion. They don't have to start it, and they can end one if a doctor tries to talk to them about the issue. It says it right there "patients may refuse without penalty"
4- "Many will bow to white-coated authority"??? Are you serious?? Really, Sarah, why do you hate doctors so much???
5- And why do you think people are so stupid? I can tell you right now that, even if a doctor tried to convince me to kill myself, I wouldn't.
6- I guess you've never watched House or ER either, but you can already give the order to not let yourself stay on life support. DNRs (do not resuscitates) happen daily. People go to lawyers every day and tell them they don't want to be kept alive on machines. How is any of what your saying a change from the status quo??
7- Why did you put "formulation" in quotation marks?? Do you know how to use those?
8- Your response to Rep. Blumenauer is "nuh-uh. doctors are going to mind control everyone with their white coats and kill them!" Please explain why you don't think he's being realistic. You haven't even come close to it yet.
Even columnist Eugene Robinson, a self-described "true believer" who "will almost certainly support" "whatever reform package finally emerges", agrees that "If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending." (8]
1- Reducing end-of-life spending FOR THE PERSON WHO'S LIFE IS ENDING. Also this saves the government money and time. Think of how many families get taken to court to pay bills their loved ones accrued.
2- I know everyone is completely surprised, but you took Mr. Robinson completely out of context. The full quote from Mr. Robinson:
The unvarnished truth is that services are ultimately going to have to be curtailed regardless of what happens with reform. We perform more expensive tests, questionable surgeries and high-tech diagnostic scans than we can afford. We spend unsustainable amounts of money on patients during the final year of life.
Yes, it's true that doctors order some questionable procedures defensively, to keep from getting sued. But it's a cop-out to blame the doctors or the tort lawyers. We're the ones who demand these tests, scans and surgeries. And why not? If a technology exists that can prolong life or improve its quality, even for a few weeks or months, why shouldn't we want it?
That's the reason people are so frightened and enraged about the proposed measure that would allow Medicare to pay for end-of-life counseling. If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending. It's irresponsible for politicians, such as Sarah Palin, to claim -- outlandishly and falsely -- that there's going to be some kind of "death panel" to decide when to pull the plug on Aunt Sylvia. But it's understandable why people might associate the phrase "health-care reform" with limiting their choices during Aunt Sylvia's final days.
His entire argument is that the language of health care reform makes people justifiably uncomfortable, and that discomfort is being exploited by mountebanks such as yourself.
Additionally, I love how you left out the next sentence in his quote. The one about how you are irresponsible and flat out wrong.
So are these usually friendly pundits wrong? Is this all just a "rumor" to be "disposed of", as President Obama says? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:
Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives.... It is egregious to consider that any senior citizen ... should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. (9]
1- No, they aren't wrong. You are. They are all being misquoted and mangled by opportunistic politicians who don't care about honesty.
2- Again, quoting someone, even someone with a D before their name, doesn't make you right. You can quote all the democrats, or republicans, or morons you want. None of it makes the crux of your claims true.
3- It IS egregious that any senior citizen should be placed in a situation like that. The fortunate thing for us is that it's not going to happen.
4- Why don't you find it egregious that people who get cancer are kicked off of insurance rolls in order to save insurance companies money? That is something that is ACTUALLY HAPPENING. Not a fictional policy in Crazyworld.
5- I have to say that only a completely distorted mind would be able to even suggest "killing people will save us money, so we should kill people."
Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those "who are irreversibly prevented from being or becoming participating citizens....An obvious example is not guaranteeing health services to patients with dementia." (10] Dr. Emanuel has also advocated basing medical decisions on a system which "produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated." (11]
1- So your argument is now that everyone DOES deserve medical care??
2- Dr. Emanuel's article in footnote 10 is about medical ethics and philosophy, not policy. It has nothing to do with the health care bill. It's a question of liberalism and communitarianism.
3- Dr. Emanuel's article in footnote 11 similarly has nothing at all to do with health care policy as a whole. It is also taken horribly out of context. The article is titled "Principles for allocation of scarce medical interventions." It was written by three doctors, the last mentioned is Dr. Emanuel. The top paragraph says:
Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems.
It is very, very clear that not only did you take it out of context, but it is part of an inseparable collection of eight ethical considerations. Again, this is about medical ethics and philosophy. Not Policy. And it's a system we already use for organ donation.
President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.
1- Read- So it's obvious if i give no proof, quote people out of context, and ramble on with footnotes that what I have been saying is completely correct.
2- How are those two quotes by Dr. Emanuel proof of rationing of care? In debate, we would say there is no link there.
3- Additionally, health care is already rationed by a- scarcity b- insurance companies. Ask the fifty million people without health insurance whether or not they feel that care is rationed.
(1] See http://blogs.abcnews.com/...
(2] See http://edlabor.house.gov/...
(3] See HR 3200 sec. 1233 (hhh)(1); Sec. 1233 (hhh)(3)(B)(1), above.
(4] See HR 3200 sec. 1233 (hhh)(1)(E), above.
(5] See http://edlabor.house.gov/...
(6] See http://www.washingtonpost.com/...
(7] Id.
(8] See http://www.washingtonpost.com/...
(9] See http://www.nysenate.gov/...
(10] See http://www.ncpa.org/...
(11] See http://www.scribd.com/...
hahaha! footnotes.