Health Care
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Moderate Dems Reject Reconciliation To Pass Health Care
Two moderate Democratic Senators facing re-election battles this year said Tuesday they would oppose using a legislative tool that requires only 51 Senate votes to get health care legislation to President Barack Obama's desk.
Sen. Evan Bayh, D-Indiana, called the move, known as reconciliation, "ill-advised," while Sen. Blanche Lincoln, D-Arkansas, issued a news release rejecting the procedure.
"I will not accept any last-minute efforts to force changes to health insurance reform issues through budget reconciliation, and neither will Arkansans," Lincoln said in the statement.
Both the House and Senate have passed separate health care bills, entirely on support from Democrats.
Democratic leaders were working on merging the two bills, but the nation's political landscape changed last week when Massachusetts elected Republican Scott Brown to fill the Senate seat held by liberal Democrat Ted Kennedy for almost 47 years until he died in August.
Brown's victory cost Democrats their 60-seat super-majority in the 100-member Senate necessary to overcome a Republican filibuster. The shift means Republicans can block Democratic initiatives such as health care reform.
Now Democratic leaders are working on a plan for the House to pass the Senate bill, along with a separate package of changes in the Senate plan that reflect compromise between the two chambers.
The package of changes would have to pass both the House and the Senate.
Without the 60-seat super-majority, Senate Democrats now are considering using the reconciliation tool that would require only 51 votes to pass the measure.
However, some Democrats in tough re-election fights worry voters will see that as legislative gimmickry, reinforcing complaints that Democratic control of Washington has been business as usual.
Bayh told CNN that using reconciliation "would destroy the opportunity, if there is one, for any bipartisan cooperation on anything else for the rest of the year."
Senate Majority Whip Dick Durbin, D-Illinois, dismissed opposition to using reconciliation as a way to get health care legislation to the president.
"I think reconciliation has been used effectively by both parties," Durbin said. "I wouldn't walk away from it. It's an option we should keep on the table."
Senate Democrats still have 59 votes in their caucus, meaning they could lose eight Democratic votes and still have the 51 needed to pass a health care package through reconciliation.
Still, Democratic sources warn that using reconciliation is complicated and fraught with legislative hurdles, raising questions about whether it could happen even if enough congressional Democrats supported the move.
House Speaker Nancy Pelosi, D-California, emerged from a meeting with Senate Majority Leader Harry Reid, D-Nevada, late Tuesday and said they are making progress on "some kind of package," but reiterated that at this time "there are not the votes in the House, not anywhere near, to pass the Senate bill."
Earlier, Reid told reporters there is now "no rush" on health care.
Obama, who made health care his top domestic priority last year, will address the issue in his State of the Union Address on Wednesday, said White House Press Secretary Robert Gibbs.
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Advance Health Care Directives And Living Wills: A Step-By-Step Guide
Few decisions are more personal -- involving both health and death -- than those embodied in an advance health care directive or a living will, or a similar document. Some individuals want their lives prolonged by any means necessary, while others want medical treatments withheld, allowing for a natural death.
An advance health care directive lets caregivers and family and medical providers know a person's healthcare wishes if he's unable to speak for himself. The document can also appoint someone else to speak with legal authority for the person if he's unable to do so for himself.
If someone plans to set up an advance health care directive, living will, or similar document, here's what he needs to think about:
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1. The person should consider how he wants to live during a terminal illness, and what his end-of-life preferences are when creating a health care directive or living will.
It's not easy to bring up the subject of dying (especially if it's your parent you're caring for). But you, the individual, and the rest of his family will gain some peace of mind if you can get him to start thinking and talking about this subject, and eventually to execute documents that set down his wishes.
·One way many people get this discussion started is by showing the person the advance health care documents they've prepared for themselves. This both breaks the ice and gives the person a model on which to base his own documents.
·The job is to get him thinking about what will be important to him when he is incapacitated, and particularly when he's dying, such as where he wants to be -- at home if possible, or in a hospital -- and what treatments (particularly life-prolonging ones) he wants and doesn't want.
·He also needs to think about who he wants to make decisions for him if and when he's unable to do so himself.
·The person should discuss these things with family, healthcare providers, and trusted advisors who will help him consider his wishes, options, and fears.
·But remember that a conversation doesn't have the same legal force as an advance health care directive or similar written document, even if a doctor records it. In most states, only a written, signed, and witnessed advance health care directive legally must be followed by healthcare personnel and institutions.
2. The person should carefully consider whom he wants to serve as the agent to make decisions for him and support his choices when creating a health care directive or living will.
The agent the person in your care names in his advance health care directive should have several qualifications:
·The job can be emotionally difficult, so it should go to someone who cares deeply about his welfare.
·It should also be someone who is likely to be able to remain physically near him during a prolonged healthcare crisis.
·And it should be someone who has a strong enough personality to stand up to family members, doctors, and hospital personnel if necessary.
·Sometimes a trusted friend will make more objective decisions, or will follow the person's wishes more carefully, than a family member.
Whomever he winds up choosing, he has to discuss the responsibility with that person and make sure she's willing to accept it before naming her in the document.
3. Use sample forms for the advance health care directive or living will as planning tools.
Situations to address
Each individual's advance health care directive should be personalized to reflect his particular wishes. An advance health care directive should address situations such as:
·When (if ever) the person in your care would want artificial life-sustaining treatment, such as during permanent unconsciousness or severe dementia
·Types of life-sustaining treatment he would and would not want, such as artificial nutrition and hydration, surgical procedures, and cardiopulmonary resuscitation (CPR) -- and under what conditions
·Instructions about other medical procedures that may arise given the person's medical history
·Organ donation instructions
·Pain control preferences
·Where he wants his care (at home or at a designated nursing facility, for example)
Documents available online
Generic advance health care document forms are available from many sources, but the forms are designed to be planning tools only. They don't offer a final product -- the forms are meant to trigger but not replace communication between the person in your care (the principal) and the designated decision maker (the agent).
Still, they are useful for getting started. Most state legislatures provide official forms for advance health care directives and living wills. These examples, among others, are available online:
· New York
· California
· Delaware
· Illinois
· Oregon
· Massachusetts
Similar forms are provided by such groups as state medical and bar associations. For example, sample forms can be found online through the California Medical Association, AARP, and the American Medical Association.
The importance of state forms
·Though there's no single form that must be used for an advance health care directive, an individual should use his state's standard form if it has one. He should also follow his state's signature and witness requirements. For example, most states require two witnesses to the person's signature; some states also require notarizing the document.
·In most states, witnesses cannot include relatives, heirs, medical providers or their employees, or anyone responsible for the patient's healthcare costs. If the person in your care is in a nursing home, some states require a state nursing home ombudsman or patient advocate to witness the signing.
·Once the document is executed, the individual should give copies to his doctors and hospital, the person he designates as his healthcare agent, family members, and other advisors. He should keep a list of individuals and institutions that have a copy of the advance health care directive, in case he ever wants to revoke or change it.
4. Update the advance health care directive or living will based on changing end-of-life wishes.
·Encourage the person you're caring for to revisit his advance health care directive periodically, as long as he's able to do so. His feelings and choices may evolve as his situation changes -- for example, after he's diagnosed with a serious illness, or as he witnesses others going through the end of life.
·People commonly make changes right before a major surgery. He may also change his feelings about who should act as his healthcare agent, or his original choice might no longer be able to take on the job.
·He can terminate or change the advance health care directive as long as he has the mental capacity to do so. If he wants to make a change, he should prepare and sign a new document and have it properly witnessed again; just making handwritten changes on a previous document is not a good idea.
·If he does execute a new document, he should send a copy to every person and institution that has a copy of the previous one, explaining that the new one replaces the old. In most cases, completing a new advance health care directive automatically revokes all previous directives, but it's always a good idea to let everyone know personally.
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Caring.com Editorial Team Caring.com features original content focused exclusively on eldercare matters.Our 20+ editors and writers research and fact-check every article meticulously,and our advisory board reviews the site regularly to assure the accuracy and relevance of the material we publish. We have hundreds of articles and checklists on health, housing, finance, legal and family issues, and other caregiving concerns,and we're adding new articles and other resources every day.
Health directives and living wills
