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.
Nov 16, 2015, Vol. 21, No. 10 • By JEFFREY H. ANDERSON
We are just a year from November 8, 2016, and the election that will largely determine the fate of Obamacare, and the news isn’t good for President Obama’s centerpiece legislation. Premiums continue to rise, doctor and hospital networks continue to shrink, Americans continue to balk at buying government-mandated insurance, the legislation continues to be historically unpopular, and Republicans are getting close to uniting behind a conservative alternative that can lead to full repeal.
1:03 PM, Oct 29, 2015 • By JEFFREY H. ANDERSON
Today, in his remarks to the House of Representatives following his election as speaker, Paul Ryan reiterated his belief that “we can renew the America idea.” This recalls Ryan’s excellent speech on the fateful night of the Obamacare vote, on March 21, 2010, when he proclaimed,
2:16 PM, Oct 23, 2015 • By MICHAEL WARREN
The Boston Globe reports that Tom Stemberg, the founder of office-supply retailer Staples, has died. Stemberg started Staples with the help of Mitt Romney's Bain Capital investment firm, and the two men became friends.
The Globe quotes Romney speaking fondly of Stemberg and his influence on the future Republican nominee for president:
The next president’s daunting to-do list.Nov 2, 2015, Vol. 21, No. 08 • By BRIAN HOOK and NEIL BRADLEY
As we approach the third Republican presidential debate, conservatives should consider what they expect the next president to accomplish.
We certainly want the next president to repeal and replace Obamacare, undo the disastrous Iran nuclear agreement, and finally address the problem of illegal immigration. But after eight years of a president who promised to “transform” America, the “to-do” list is actually much larger.
7:14 AM, Oct 13, 2015 • By JEFFREY H. ANDERSON
It has been clear for some time that Republicans need just two things in order to repeal Obamacare—a winning alternative and political willpower. The jury is still out on how much of the latter the party possesses. But when it comes to uniting around a well-conceived alternative that can pave the way to full repeal, the news is increasingly good. Jeb Bush’s just-released Obam
8:26 AM, Oct 6, 2015 • By JEFFREY H. ANDERSON
One of the least-reported substantial policy victories in recent years was stopping Obamacare’s insurer bailout through last fall’s CRomnibus bill. Now we can attach a price-tag to that victory: $2.5 billion. That’s how much taxpayers would have been funneling to President Obama’s insurance-company allies if the bailout hadn’t been thwarted, according to Obama administration officials. Insurers were hoping for $2.87 billion but, thanks to the anti-bailout legislation, which required Obamacare’s risk-corridor program to operate in a revenue-neutral manner, rather than as a bailout, they will be getting only $362 million—the same amount that other insurers paid in.
1:54 PM, Oct 1, 2015 • By JEFFREY H. ANDERSON
The Republican congressional leadership has been nominally--but sometimes it seems only nominally--committed to repealing Obamacare and replacing it with a conservative alternative. Now one of the two leading candidates for House majority leader—the number-two position in leadership—is Dr.
Francis meets with the Little Sisters of the Poor.8:58 PM, Sep 23, 2015 • By MICHAEL WARREN
In the middle of his trip to Washington, D.C., Pope Francis made an "unschedued" stop to meet with members of an group of nuns suing the federal government over the Obama administration's contraception and abortifacient mandate in the health-care law. The Little Sisters of the Poor is an order of nuns within the Catholic Church that provides assistance for the elderly, and the group has sued on religious liberty grounds against the Obama administration mandate that employers provide contraception health-insurance coverage.
10:18 AM, Sep 21, 2015 • By JEFFREY H. ANDERSON
Jake Tapper and CNN pretended during the Republican presidential debate that Obamacare doesn’t exist. But Republican voters won’t follow suit. Instead, they are likely to cast their votes largely based on who looks most committed to repealing President Obama’s tenuously perched signature legislation.
9:32 AM, Sep 15, 2015 • By JEFFREY H. ANDERSON
One of the worst things about Obamacare is that it provides taxpayer funding of abortion. This is one of the nearly countless reasons why Obamacare must be repealed, and it’s one of the core reasons why it is crucial for Republican presidential candidates to show they have an alternative that would lead to repeal. So far, only Scott Walker has stepped up in this regard. For pro-life voters, this should matter greatly.
8:51 AM, Sep 11, 2015 • By JEFFREY H. ANDERSON
At a speech at President Reagan’s alma mater on Thursday, Wisconsin governor Scott Walker challenged his GOP rivals on Obamacare. Walker highlighted his own Obamacare alternative, promising he would send it to Congress on Day One. Observing that members of Congress “need a little incentive to get that repeal passed,” Walker said he would also take executive action that same day to end
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.
4:22 PM, Sep 3, 2015 • By JEFFREY H. ANDERSON
THE WEEKLY STANDARD has long observed that Obamacare, which President Obama pitched as a great deal for Americans of all stripes, is really only for the near-poor and near-elderly—at the expense of the middle class and the youn