Medicare and advance directives.Dec 7, 2015, Vol. 21, No. 13 • By WESLEY J. SMITH
The federal technocracy, like the old B-horror-movie monster The Blob, grows by sucking all surrounding life into its amoeba-like digestive system. There are never enough bureaucratic controls or government programs to “incentivize” us—in the jargon—to behave in ways the technocrats think best.
That is why we should look with a jaundiced eye at new legislation that would pay Medicare beneficiaries for preparing an advance medical directive. The Medicare Choices Empowerment and Protection Act is founded on the belief of its authors—senators Chris Coons (D-Del.) and Bill Cassidy (R-La.) along with representatives Diane Black (R-Tenn.) and Mike Thompson (D-Calif.)—that we are not doing a good job accomplishing what the government wants us to do. The legislators’ press release claims that 70 percent of us have “thought about” end-of-life care but “only” 30 percent have actually prepared written advance directives that would give instructions if we become incapacitated—and so an inducement is needed.
There is nothing wrong with filling out an advance directive, of course. To the contrary, it is an important task given the evolving economics of medicine, and especially so if one wants expensive life-extending care. But once the government sticks its ever-growing nose into private, individual decisions, they rarely stay private or remain individualized. Hence, the 22-page bill would not just encourage the creation of advance directives. It would also make it easier to federalize the entire sector in coming years.
First, the bill would grant Medicare beneficiaries a onetime benefit of $75 (indexed to inflation) to prepare an advance directive. The wisdom of having the government pay us to take care of our own business is questionable. But this being federal legislation, not just any advance directive will do. In order to qualify for the payment, the directive will have to be “certified” by the federal government and “executed in accordance” with the law of the state in which the beneficiary lives, not a federal standard. Okay. But here’s the kicker: To be federally certified the advance directive must be “offered by an entity that has received accreditation from the Secretary” of health and human services.
As with everything governmental, official accreditation favors large, institutional suppliers. To be accredited, vendors would have to meet extensive computer and online technical capabilities, including:
- the facility to “create, adopt, modify, and terminate an advance directive through an online process.”
- “comply with an annual quality review to be conducted by
- the capacity to provide the state statutory or alternative advance directive forms that comply with the particular laws of each state in which the vendor offers advance directives.
- the ability to allow “any family member, legal representative, or health care proxy . . . near real-time online access to the beneficiary’s advance directive,” as well as access to “providers of services and suppliers”
- “comply with the Federal regulations (concerning the privacy of individually identifiable health information),” which is a very complex field of federal civil and criminal law.
- the capacity to successfully pass “rigorous independent testing regarding standards of timeliness, accuracy, and efficiency” and “real-time tests simulating a realistic volume of beneficiaries and providers accessing advance directives simultaneously.”
- the willingness and capacity to administer detailed “annual beneficiary surveys” for submission to
That kind of technical know-how and capability will require the business or organization seeking accreditation to maintain a significant computer infrastructure supported by extensive IT capacities and security protocols to guard against hacking. (Good luck with that!) In a nutshell, this is how government favors large institutions over small, while continuing to expand its own regulatory intrusions.
Once a group received accreditation, it would be expected to maintain executed ADs for online retrieval by patient, surrogate, family, and/or health care providers, as, and wherever, needed. (Apparently, the authors are unaware of an invention known as “scanners,” that can copy and email documents anywhere in the world.) The government will also maintain a clearinghouse to each state’s certified AD suppliers, with links, but will not be authorized to store the documents in a federal database.
Who decides to discontinue treatment?Nov 16, 2015, Vol. 21, No. 10 • By WESLEY J. SMITH
The media are cooing over the news that Medicare will reimburse doctors $86 for half-hour consultations about the kind of treatment patients would—or would not—want should they become incapacitated. Such coverage was slated to be part of Obamacare, but was dropped after it became controversial when Sarah Palin warned against “death panels.”
And Kasich wrong to expand Medicaid.1:50 PM, Aug 12, 2015 • By MICHAEL WARREN
Carly Fiorina says she disagrees with her Republican rival for president Donald Trump on the issue of Planned Parenthood. Trump told Fox News host Sean Hannity on Tuesday that "we have to look at the positive also for Planned Parenthood" and said abortions were just a "small part" of what the organization provides.
Share of Each Taxpayer Dollar Spent on Health Care Up 22 Percent Since 2012.
7:43 AM, Apr 16, 2015 • By JERYL BIER
Every year since 2011, the White House has used tax time to post a "Federal Taxpayer Receipt" showing taxpayers how their federal tax dollars are being spent.
Unreformable Medicare.Apr 20, 2015, Vol. 20, No. 30 • By JAY COST
On March 23, the House of Representatives overwhelmingly passed a permanent “doc fix.” Now it heads to the Senate, where it is expected to pass easily. This bipartisan effort will end the yearly ritual of bypassing Medicare reforms imposed by the Balanced Budget Act of 1997. Much of professional Washington greeted it with a cheer—a sign that comity in the capital is still possible.
6:00 AM, Feb 20, 2015 • By JAY COST
It is said that history is written by the victors. Maybe so, but in the United States over the last century, history has largely been written by the liberals. This inevitably leads to bias, which inevitably operates on even the most impartial of minds. While most historians try to be fair and judicious, the fact that the overwhelming majority of them are on the left generates an inexorable tilt to the American historical narrative.
7:45 AM, Sep 4, 2014 • By AVIK ROY
Given that I’ve probably published more articles critical of Obamacare than anyone alive, I’m often asked to speak to conservative audiences about our new health law.
1:47 PM, Jul 30, 2014 • By MARK HEMINGWAY
As I've made pretty clear, I am not a fan of the "explanatory journalism" trend that purports to take an empirical approach to explaining complex issues. Its chief practitioners are a bunch of young, terribly biased journalists who tend to treat politics and policy as some sort of game, even as they broadcast their ignorance. Anyway, if you want a concise example of why explanatory journalism is bad—so pure and crystalline it could have been produced by Walter White—let me direct you to this Vox.com piece on Medicare.
But the Louisiana Democrat supported similar changes to federal programs.3:14 PM, Jul 15, 2014 • By MICHAEL WARREN
The Mary Landrieu campaign is out with a new hit against the Louisiana Democrat's Republican opponent, Congressman Bill Cassidy. The 30-second ad focuses on Cassidy's support for policies that supposedly hurt senior citizens. Watch the video below:
"It was Congressman Bill Cassidy who voted to raise the Social Security retirement age to 70, cut Social Security benefits for retirees, and raise Medicare costs by $6,000," says the voiceover.
4:03 PM, Jun 4, 2014 • By MICHAEL WARREN
Senator Mark Pryor is making entitlements an issue in the Arkansas Senate race. Both Pryor and his Democratic allies are hitting Republican nominee and House member Tom Cotton over his support for a budget proposal that would have, starting in 2022, gradually raised the retirement age for receiving Social Security and Medicare benefits.
11:02 AM, May 13, 2014 • By JERYL BIER
On Sunday, the White House blog declared that Obamacare made this Mother's Day "particularly special." On Monday, the Obamacare website Healthcare.gov got into the act, suggesting that "Health insurance with Medicaid is the perfect Mother’s Day gift":
What LBJ wroughtMay 19, 2014, Vol. 19, No. 34 • By NICHOLAS EBERSTADT
May 22, 2014, marks the 50th anniversary of President Lyndon Baines Johnson’s “Great Society” address, delivered at the spring commencement for the University of Michigan. That speech remains the most ambitious call to date by any president (our current commander in chief included) to use the awesome powers of the American state to effect a far-reaching transformation of the society that state was established to serve. It also stands as the high-water mark for Washington’s confidence in the broad meliorative properties of government social policy, scientifically applied.
'No One Likes to Watch the Daily Show Make Fun of HHS'
9:01 AM, May 1, 2014 • By JERYL BIER
In October 2013, as the Centers for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services (HHS), was launching Healthcare.gov, CMS also launched a quieter initiative. As part of Ignite, an internal HHS program designed to spur innovation, a team within CMS's press office designed a system to help CMS communicate more quickly and efficiently with the press.
7:06 AM, Apr 15, 2014 • By JERYL BIER
Four years after Obamacare became law, the Department of Health and Human Services (HHS) is notifying Medicare providers and suppliers of new fingerprint-based background checks. Eventually, all individuals who hold a five percent or greater stake in a Medicare supplier or provider that is categorized as "high risk" will be subject to the requirement.
7:39 AM, Jan 2, 2014 • By JERYL BIER
The contractor building the financial management system for Healthcare.gov is being blamed by a Houston hospital for delayed Medicare reimbursements that have caused the hospital to miss payrolls for weeks. Novitas Solutions is the federal government's new Medicare payment processor for the south-central region of the country hired by the Centers for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services (HHS.) ABC-KTRK in Houston reports: