Saturday, August 15, 2009

End of life advance directives

Why did CMS not just issue a regulation permitting advance directive counseling as a billable service?

If I were drafting, I’d require every insurance policy to include advance directive instructions from the policy holder. I’d insist on a requirement that each of us think about how we’d like to live and how we’d like to not live. Whatever instructions the policy holder wants. But instructions.

Why did the issue become not ‘who receives’ or what one receives but ‘who pays’ ?

Who introduced the reimbursement option into the health care legislation?


Was the motivation provider greed? Or uproar creation?

Is this a Trojan Horse? That backfired?

The result was to be a payment for a service to providers, and the chance for counseling twice a decade, for seniors and people with disabilities, if one wished. But the first reaction was a scream about killing seniors, forcing people to choose to die, euthanasia, Nazis, ... And then a counter, it’s counseling, it’s optional, ...

And now the country is having a discussion of end of life, planning, advance directives, extraordinary interventions, ...

What was the hoped for consequence, and what the unexpected?

How did that clause get into the suggested legislation?

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