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.
8:12 AM, Nov 16, 2015 • By ELI LEHRER
Sometime in the next two years, if Obama administration bureaucrats get their way, public housing tenants who smoke in their own apartments will face sanctions, fines and perhaps even eviction. The proposed policy is deeply flawed. However, those who oppose it—as many conservatives will reflexively—ought to use their opposition to reconsider misguided if well intentioned efforts to micromanage the lives of the poor even when such efforts come from the political right.
9:45 AM, Nov 3, 2015 • By FRED BARNES
A tradition in the Senate required a newly elected member to wait a year or more before addressing his colleagues on the Senate floor. But that practice has been absent from the Senate for decades—until today.
When government bureaucrats attack.Oct 19, 2015, Vol. 21, No. 06 • By GEOFFREY NORMAN
It has long been good sport to make fun of the government. Ronald Reagan did it with a fine, almost deft touch. “The nine most terrifying words in the English language,” he would tell an audience, “are I’m from the government, and I’m here to help.”
Just about everyone, at one time or another, has used the phrase “Good enough for government work,” and we all know what it means: that something conforms to the high customer service standards one enjoys when shopping for stamps in the post office.
2:40 PM, Oct 5, 2015 • By GEOFFREY NORMAN
How happy in their jobs are government workers? Well, the sovereign answer to that question would be: “Who cares?” They have steady work and, for most of them, it is all indoors with no heavy lifting. And they practically have to commit a felony to get fired.
The fraying of the national political consensus.Oct 12, 2015, Vol. 21, No. 05 • By JAY COST
The latest political happenings—the rise of Donald Trump, John Boehner’s surprise resignation as speaker of the House of Representatives, Hillary Clinton’s slide against the septuagenarian socialist Bernie Sanders—remind me of a verse from the old Rolling Stones song “Jigsaw Puzzle”:
Oh, there’s twenty-thousand grandmas.
Wave their hankies in the air.
All burning up their pensions
Gleanings and observations.12:41 PM, Sep 30, 2015 • By IRWIN M. STELZER
Worry not about the tens of thousands of Syrians that Barack Obama plans to invite to take up residence here. Secretary of State Kerry assures us that the vetting process to screen out the bad guys will be thorough. Alas, Michael Steinbach, assistant director of counterterrorism of the F.B.I. told a House committee that Syria lacked the systems that would provide us with the information we need to evaluate refugees. Kerry is unworried, for two reasons.
3:59 PM, Sep 24, 2015 • By MICHAEL WARREN
Something has gotten into Ted Cruz. The Republican senator is known as a conservative firebrand willing to take on his own party, but in a Thursday meeting with reporters in his Capitol Hill office, Cruz was sounding almost ecumenical. Maybe it was the presence of Pope Francis.
8:45 AM, Sep 17, 2015 • By EDWIN MEESE III
In 1878, William Gladstone described the U.S. Constitution as “the most wonderful work ever struck off at a given time by the brain and purpose of man.” Gladstone was right.
The hidden cost of means-tested government benefits. Sep 21, 2015, Vol. 21, No. 02 • By DOUGLAS BESHAROV and NEIL GILBERT
Traditional marriage is in big trouble in the United States. Between 1960 and 2011, the share of white adults 18 and older who were married declined by 25 percent, while the declines for Hispanic and black adults were 35 percent and 50 percent respectively.
And an increase of 1,500 years of paperwork per year. 7:04 AM, Aug 25, 2015 • By SHOSHANA WEISSMANN
The American Action Forum (AAF) is out with a new report about the Obama administration's unsuccessful efforts to reduce regulations. The findings are jaw-dropping.
10:52 AM, Aug 10, 2015 • By GEOFFREY NORMAN
“We have already cut defense … about 30 percent over the last 10 years, and we’re still at war. We’re actively involved on multiple continents in real combat operations. We should not be drastically reducing our troop levels.”
10:29 AM, Jul 15, 2015 • By JERYL BIER
In the midst of revelations about a massive data breach at the Office of Personnel Management (OPM), the agency awarded a $4.3 million two-month contract extension to Northrop Grumman for the OPM's Data Warehouse Program (DWP).