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Friday, August 14, 2009

Who benefits from the world class ambiguity of section 1233 of House Health Care bill ?

Does section 1233 ( of the current version of the House bill dealing with Health Care "reform") make end of life counseling mandatory or voluntary or does the section's multi-layered and seemingly un-dissectable ambiguity enable the Secretary of HHS to determine what it "really means"?

Dr.RW discusses aspects of this general issue here quoting two sources with significant insight content from Kathleen Parker and Wesley Smith. Smith's quote is particularly noteworthy;

The bill might not create punishments [ in regard to quality measurement that the Secretary may enact concerning physicians who fail to counsel] , but the regulations that would be created in the shadows outside the direct democratic process could.

So the question arises is the bill written is such a way as no one really knows what it means which in turn raises the question "Are the bill's authors (whoever they are) merely bad at statute composition and are unable to clearly delineate what is to become law or is the ambiguity really quite artfully, purposely inserted so that HHS technocrats can do pretty much what they want"?

In another posting Dr. RW offers this comment:

Although a good palliative care service can save an institution money its focus is on what's best for the individual patient. Sometimes those goals are in conflict, sometimes not, but an excellent palliative care team will manage the conflict appropriately by putting the individual patient first, no matter the impact on the medical commons. When an end of life counseling provision is part of a bill with a clear agenda to control costs some degree of skepticism is appropriate.

How many other sections of the House bill suffer (or benefit) from this same type of opaque wording?


Roy M. Poses MD said...

I have to admit that up to now I had thought most of the discussion of "death panels" etc was hysteria.

But then I read Dr RW's posts on the subject, and looked at the actual text of the bill. The items on "quality measures" for advanced care planning gave me pause.

Advanced planning "orders for life-sustaining treatment" are generally only orders to restrict life-sustaining treatment. Patients who want maximally aggressive resuscitative and other life-sustaining treatments were a catastrophe to occur do not need advance planning orders to that effect. In the absence of advance planning orders, the expectation is to use all appropriate treatment, no matter how aggressive.

A "quality measure" that tabulates the creation of such orders seems to imply that the government would regard less aggressive end of life care as better, in general.

Maybe this was just badly, hastily written legislation, but it sure is worrisome.

Good work picking this up!

Hal Dall, MD said...

Sandy Szwarc has an excellent discussion of this section with full text.