Originally Posted by Villages Kahuna

Good idea, except I'm not sure any one of the 435 has earned the right to another term.

Working from the general to the specific in your opening post...

I agree with you that the proposed healthcare reform bill seems to be the most mis-managed exercise in legislation that I've ever observed. I've tried to figure out why, with legislation that is no where near being complete or final, some people are speaking of it's content with great certainty and others are complaining about not enough detail. Somewhere in there must lie the truth. I hope they don't enact anything that both the members of Congress and the public understands before it becomes the law of the land.

While I believe that the reform legislation should be crafted with adequate time and care and study, I think I'm also observing the special interest groups using the time it's taking to try to get Congress the feather their nests with the new bill. The resistance of the majority of members of Congress to consider, let alone discuss, the need for medical tort reform is one example. It sure would appear that the trial lawyers have the members firmly under their control. The resistance of many to a "government option" is another red flag to me. Now many are talking about a "co-op" owned insurance company (one neither owned or funded by the government) to offer alternative policies and premiums. If the co-op is owned by the insurance companies already competing privately, how is that different? In fact, I saw a former senior executive of a healthcare insurance company explained that the idea came from the insurance lobbyists and that such an option will never work because the co-op would always be undercapitalized and it's operations always underfunded. He opined that the insurance companies that will be "co-op owners" will see to that. He explained that's why Congress is now talking about this option and the insurance companies are going along with the idea--which was theirs in the first place--because they know it can't and won't work and certainly would be no competitive threat to their existing business. Notice that the insurance companies are all foursquare behind offering insurance to all citizens, legal, illegal or otherwise. Do you think the fact that as they lose the baby-boomers as customers as the move to Medicare, that their profits will be threatened? Of course, and that's why a law requiring another 40-50 million be insured is a good deal for them.

This is maddening to the nth degree, knowing that the people elected to represent us are in fact representing themselves and the special interests that pay them off on a subject as important as healthcare reform. It seems as though they act first to posture themselves politically for re-election, second to satisfy the wishes of the special interests, and then if they can accomplish all that, enact laws that will benefit the citizens who they're supposed to represent.

On the specific subject of how the proposed HR 3200 "requires" end-of-life counseling, speaking for myself I don't think that's a bad idea. I'm taking care of an elderly lady and had to do my own research on the differences between "palliative care" and "hospice care" offered by her nursing home. Her doctor never told me (I'm her medical and durable power of attorney) a thing. He just kept ordering tests, admitting her to the hospital, prescribing more drugs, and increasing the frequency of his billable visits to her in the nursing home. Based on the Medicare bills I receive, he's visiting her at about 2-3 time the frequency that he did in prior years and isn't doing a thing other than increasing his income to deal with her advancing dementia and increasing frailty. It's easy to see how some sort of required education on end-of-life issues might be beneficial to most Americans. If that's what the section of HR 3200 referred to accomplishes, I think it's a good idea that over time probably would reduce the costs of care being provided to patients near the ends of their lives for whom such care would accomplish little.

Another end-of-life example that probably should be addressed in the law is who should make the decision to cease care for patients either very close to death or even clinically dead? Should it be the family, with either insurance companies or the government paying for further care, the way it is now? Or should it be medical professionals who are trained to know life expectancies and the probabilities of success of additional treatment? Should all individuals be required to execute a Living Will so that whatever care is administered is their decision, not that of the family or even the medical professionals? Any of these choices would reduce the huge end-of-life costs being incurred with the existing system.