Dick Cheney: Too Old for a New Heart?


#1

Former Vice President Dick Cheney has been showing his newly slender physique around Washington, D.C. a lot more since Christmas, and it now appears he’s back in the spotlight from his self-appointed leave of absence from politics. But a long history of attacks has left many wondering just how long he will be back before needing another major procedure.

Dick Cheney: Too Old for a New Heart? - FoxNews.com

So under Obama’s death panels would this be allowed? When is it that a person reaches the age he or she should be stopped from receiving lifesaving treatment?

I read recently that the government has decided doctors do not need to give end of life talks.


#2

This was never what the “death panels” were about. How can something be called a panel when it’s just you and your doctor talking about your options?

The only REAL death panels are the insurance boards that decide to discontinue coverage if you cost them too much money.


#3

[quote=“Centered1, post:2, topic:28788”]
This was never what the “death panels” were about. How can something be called a panel when it’s just you and your doctor talking about your options?

The only REAL death panels are the insurance boards that decide to discontinue coverage if you cost them too much money.
[/quote]With your usual flair you have ignored reality. Obama wants those decisions decided by his people. The choice not to have end of life discussions with patients has nothing to do with having Obama’s people enacting rules that will end up restricting the care of older Americans or those they deem unfit to live because of other ailments or disabilities.


#4

Insurance companies do not fund killing off patients that cost them. We do however know how government works by incrementalism…give them the control over doctors discussing your death and before long the medical profession will be aiding you in that path. As if they aren’t already doing it.


#5

Then please point out to me where your “reality” lives. I’ve bolded a few key points that should making skimming a little faster for you.
There is NOTHING in this bill that insurance companies don’t already do.

LIMITATIONS ON CERTAIN USES OF COMPARATIVE CLINICAL EFFECTIVENESS RESEARCH

Sec. 1182. (a) The Secretary may only use evidence and findings from research conducted under section 1181 to make a determination regarding coverage under title XVIII if such use is through an iterative and transparent process which includes public comment and considers the effect on subpopulations.
[LIST]
[*]*TRANSLATION: Must be open and transparent and must consider effect on particular groups, but can use research to make determinations regarding coverage
[/LIST]‘(b) Nothing in section 1181 shall be construed as–
‘(1) superceding or modifying the coverage of items or services under title XVIII that the Secretary determines are reasonable and necessary under section 1862(l)(1); or
‘(2) authorizing the Secretary to deny coverage of items or services under such title solely on the basis of comparative clinical effectiveness research.
[LIST]
[
]*TRANSLATION: Coverage cannot be based solely on CER
[/LIST]‘©(1) The Secretary shall not use evidence or findings from comparative clinical effectiveness research conducted under section 1181 in determining coverage, reimbursement, or incentive programs under title XVIII in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill.
[LIST]
[
]*TRANSLATION: CER **cannot **be used to assign a lesser value to extending the life of the elderly, disabled or terminally ill (as compared to the younger and healthier) in regard to treatment.Health care dollars cannot be allocated first (or exclusively) to young and relatively healthy individuals under the rationale that extending the lives of the younger and healthier is, by definition, more valuable. The issue is further explored in 1182(e), discussed below. 1182(e) further limits the use of such valuations with regard to the Quality Adjusted Life Year.
[/LIST]‘©(2) Paragraph (1) shall not be construed as preventing the Secretary from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive programs under title XVIII based upon a comparison of the difference in the effectiveness of alternative treatments in extending an individual’s life due to the individual’s age, disability, or terminal illness.
[LIST]
[
]*TRANSLATION: When evaluating treatments to extend an individual’s life, CER can be used to determine whether Medicare will cover one treatment rather than an alternative. Specifically, an individual’s age, disability, or terminal illness can be a factor in deciding which treatment will be covered, reimbursed and/or incentivized. For example an elderly person with severe coronary artery disease may have two treatment options: surgery (e.g. revascularization) or drug therapy. Both of these treatments would theoretically extend the life of the patient by reducing the odds of a heart attack or stroke. However (hypothetically) CER data may demonstrate that an individual of advanced age lives longer on average if they opt for drug therapy. In such a circumstance, this section provides that CER data may take into account the individual’s age, disability and terminal illness when comparing two alternative treatments. It may also be the case that CER data shows that individuals with certain disabilities are less likely to respond to surgery or to different treatment, possibly due to immobility, or even impending death. Again, these facts can be taken into account in the CER calculus.
[/LIST]‘(d)(1) The Secretary shall not use evidence or findings from comparative clinical effectiveness research conducted under section 1181 in determining coverage, reimbursement, or incentive programs under title XVIII in a manner that precludes, or with the intent to discourage, an individual from choosing a health care treatment based on how the individual values the tradeoff between extending the length of their life and the risk of disability.
[LIST]
[
]TRANSLATION: The Secretary cannot use CER to deny or try to persuade a patient from choosing a treatment that may prolong their life but leave them severely disabled. Alternatively, the Secretary cannot prevent a patient from choosing a treatment which may improve the quality of their life, as opposed to an alternative treatment which may extend the length of life.
[/LIST]‘(2)(A) Paragraph (1) shall not be construed to–
‘(i) limit the application of differential copayments under title XVIII based on factors such as cost or type of service; or
[LIST]
[
]TRANSLATION: The extant differential copayment guidelines are unaffected.
[/LIST]‘(ii) prevent the Secretary from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive programs under such title based upon a comparison of the difference in the effectiveness of alternative health care treatments in extending an individual’s life due to that individual’s age, disability, or terminal illness.
[LIST]
[
]TRANSLATION
: See 1182©(2) discussed above.
[/LIST]‘(3) Nothing in the provisions of, or amendments made by the Patient Protection and Affordable Care Act, shall be construed to limit comparative clinical effectiveness research or any other research, evaluation, or dissemination of information concerning the likelihood that a health care treatment will result in disability.
[LIST]
[
]TRANSLATION: This section is straightforward. The Institute can compare various treatments and determine which is more likely to result in a disability, and disseminate those findings.
[/LIST]‘(e) The Patient-Centered Outcomes Research Institute established under section 1181(b)(1) shall not develop or employ a dollars-per-quality adjusted life year (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost effective or recommended. The Secretary shall not utilize such an adjusted life year (or such a similar measure) as a threshold to determine coverage, reimbursement, or incentive programs under title XVIII.’
[LIST]
[
]WHAT IS A QALY?: The Quality-Adjusted Life Year (QALY) is defined by the NIH as:
[LIST]
* A unit of measure of utility which combine life years gained as a result of health interventions/health care programs with a judgment about the quality of these life years.
(2) A common measure of health improvement used in cost-utility analysis, it measures life expectancy adjusted for quality of life. (See NIH’s Health Economics Information Resources, Glossary, at [COLOR=#2255aa]http://www.nlm.nih.gov/nichsr/edu/healthecon/glossary.html#QALY) [/COLOR]
[/LIST]
[
]The goal of the QALY is to ensure that healthcare resources are allocated in a manner which is most beneficial. Because healthcare resources are scarce, however, the $/QALY looks to allocate those resources economically. The QALY ipso facto discounts the value of life due to a disability. This is because the QALY works by assigning different states of health along a continuum, with perfect health being 1 and death being 0. The QALY is interested in whether different treatments provide more QALYs, In other words, QALYs are interested in whether one treatment provides more years at a better state of health (i.e., closer to 1) than another treatment. See M. Weinstein, [COLOR=#2255aa]Spending Health Care Dollars Wisely: Can Cost-Effectiveness Analysis Help? (2005)[/COLOR]
[/LIST]
[LIST]
[
]*TRANSLATION: The Institute cannot utilize a $/QALY ( or a similar measure) as a threshold to establish what treatment is cost-effective, recommended or incentivized. (It is, however, noteworthy that in describing “similar measure,” both “age” and “terminal illness” are not expressly excluded as prohibited criteria in the development of a metric, as they are throughout the text of other portions of the provision).
[/LIST]
[LIST]
[
]*Note:*1182©(2) does allow for a disability to be taken into account when comparing various treatments for an individual. That section must be distinguished from the current section (1182(e)), where the upshot is that the dollar valued QALY cannot be a benchmark by which to allocate resources. If we are only determining which of two resources to a given individual shall be reimbursed, then the individual’s disability may be taken into account, i.e., treatment effectiveness under the individual’s circumstances is a metric for which CER may be utilized; however, dollar value of life quality is not a permitted metric or criteria for treatment.
[/LIST]


#6

a 2800 page bill that addresses every scenario in health care multiple times as well as hundreds of things that are in no way affiliated with health care and this lefty thinks selecting a few paragraphs is an exhaustive look at how the law will be applied in real life circumstances.

If the government is paying then the government will decide who is worthy of expensive procedures and who is not.

Just like today where the private insurance companies are making those decisions because they are paying.

The difference is that private citizens can sue private insurance companies if they fail to perform. This check and balance will not exist when the government is culling the herd.

The government does everything poorly, giving them more to do and expecting them to handle it well is naive beyond comprehension.


#7

Excellent way to deflect actually READING the bill. I notice that you couldn’t point out the “death panel” provision.

Facts don’t mean anything if they don’t conform to your opinions.


#8

The health bill was a catch all for every little thing the democrats wanted to impose from restricting healthcare to infringing on more rights of Americans but as I have seen democratcentered can not see this because in his mind the Fuhrer is all important


#9

It was eliminated from the bill due to protest from the American people. From what I heard, after it passed, Obama reinstated it worse than before through some procedure or loophole that bypasses Congress.


#10

It won’t matter to most till they hit their sixties.


#11

[quote=“Caroline, post:10, topic:28788”]
It won’t matter to most till they hit their sixties.
[/quote]Been there done that… This is why I get a little hot under the collar when I see those who fail to realize that one day they to will reach old age baring no mishaps or other circumstances. The view it seems is it does not matter what you do to old people. Talk is cheap until it affects one personally