UofL Bulletin on Swine Flu

During the summer, the 2009 H1N1 virus continued to spread globally and some local schools are already reporting cases of flu-like illnesses. It is only a matter of time before we see a growth in cases of 2009 H1N1 and the seasonal flu at UofL.

The 2009 H1N1 virus is of particular concern for us because people in their teens and early 20s are among the target groups for this virus. To stay informed as we move into the flu season, be sure to make frequent visits to our flu website at http://louisville.edu/update/flu/

Vaccines for the seasonal flu are expected to be available at UofL by the end of September. UofL provides free seasonal flu vaccines to full time faculty and staff and all students (a nominal fee is charged for part-time faculty, staff, and retirees). The seasonal flu vaccine does not protect against H1N1.

The 2009 H1N1 vaccine is still under development and federal officials say it should be available later this fall. More information about vaccines will be sent out in September.

Our university is working to minimize the spread of seasonal flu, 2009 H1N1 and other infectious diseases. Hand sanitizing gels are in place in all high traffic areas and campus dining locations. Additionally, sanitizing hand gels are being sent to computer labs. Also, Campus Health Services is distributing thousands of bottles of personal hand sanitizer, along with a seasonal flu and 2009 H1N1 prevention guide, to students. We continue to work closely with national, state and local health officials to provide the campus community with the most up-to-date information and guidelines.

But we need your help. Even our best efforts will fall short without the active participation of the campus community. Here are a few things we ask of everyone:

- Take time to be informed. Information on both the seasonal flu and 2009 H1N1 virus is dynamic and evolving. We will send out information periodically; it takes only a few minutes to read an email or a news item on our website. It is especially important for students to routinely check their UofL (Groupwise) email.

- Do your part to control the spread of viruses. Practice frequent hand washing, cough into your sleeve, keep your work area clean, and practice self-isolation if you become ill.

- Students living in campus housing with flu symptoms who are within reasonable driving distance should return to their homes or stay with a nearby relative or friend to recuperate. It is recommended that students returning to their homes have someone drive them.

Please take a few minutes to read the Frequently Asked Questions (FAQs) on our flu website for basic information on what you can do to fight back against the seasonal flu and 2009 H1N1. We also recommend a visit to the CDC website at http://www.cdc.gov/h1n1flu/

To assist in recognizing specific needs among students, faculty and staff relevant to the 2009 H1N1 virus, please look for a survey that will be distributed within the next few days. Do your best to complete the survey as requested as it will help us respond to this unique challenge.

Richard Clover, MD, Dean, School of Public Health & Information Sciences
Larry Owsley, Vice President of Business Affairs

Co-Chairs, Emerging Disease Planning Work Group

Health care reform means more power for the IRS

By: BYRON YORK
Chief Political Correspondent
September 2, 2009

A sign identifies the Internal Revenue Service building on Constitution Avenue NW in Washington, D.C., Jan (Bloomberg: Dennis Brack) (Bloomberg)

There's been a lot of discussion about the new and powerful federal agencies that would be created by the passage of a national health care bill. The Health Choices Administration, the Health Benefits Advisory Committee, the Health Insurance Exchange — there are dozens in all.

But if the plan envisioned by President Barack Obama and Congressional Democrats is enacted, the primary federal bureaucracy responsible for implementing and enforcing national health care will be an old and familiar one: the Internal Revenue Service. Under the Democrats' health care proposals, the already powerful — and already feared — IRS would wield even more power and extend its reach even farther into the lives of ordinary Americans, and the presidentially-appointed head of the new health care bureaucracy would have access to confidential IRS information about millions of individual taxpayers.

In short, health care reform, as currently envisioned by Democratic leaders, would be built on the foundation of an expanded and more intrusive IRS.

Under the various proposals now on the table, the IRS would become the main agency for determining who has an "acceptable" health insurance plan; for finding and punishing those who don't have such a plan; for subsidizing individual health insurance costs through the issuance of a tax credits; and for enforcing the rules on those who attempt to opt out, abuse, or game the system. A substantial portion of H.R. 3200, the House health care bill, is devoted to amending the Internal Revenue Code of 1986 in order to give the IRS the authority to perform these new duties.

The Democrats' plan would require all Americans to have "acceptable" insurance coverage (the legislation includes long and complex definitions of "acceptable") and would designate the IRS as the agency charged with enforcing that requirement. On your yearly 1040 tax return, you would be required to attest that you have "acceptable" coverage. Of course, you might be lying, or simply confused about whether or not you are covered, so the IRS would need a way to check your claim for accuracy. Under current plans, insurers would be required to submit to the IRS something like the 1099 form in which taxpayers report outside income. The IRS would then check the information it receives from the insurers against what you have submitted on your tax form.

If it all matches up, you're fine. If it doesn't, you will hear from the IRS. And if you don't have "acceptable" coverage, you will be subject to substantial fines — fines that will be administered by the IRS.

Under some versions of health reform now circulating on Capitol Hill, the IRS would also be intimately involved in how you pay for insurance. Everyone would be required to buy coverage. The millions of Americans who can't afford it would receive a subsidy to pay for it. Under the version of the plan currently under negotiation in the Senate Finance Committee, that subsidy would come through the IRS in the form of a refundable tax credit. Under the House plan, the subsidy would come directly from the Health Choices Administration.

In either scenario, the IRS would be the key to making the system work. Before you could receive any subsidy, whether through the IRS or not, the Health Choices Administration would have to determine whether you are eligible for it. To do so, the bills under consideration would give the Health Choices Commissioner the authority to demand sensitive, confidential information from the IRS about individual taxpayers. The IRS would have to provide it.

Under current law, it is a felony for a government official to release taxpayer information in all but the most limited of circumstances. One such exception is for law enforcement; the IRS is allowed to give taxpayer information to prosecutors in criminal cases. The information can also, in some instances, be released to the Social Security Administration and the Veterans' Administration for the determination of benefits. The health care bills would change the Internal Revenue Code to permit the IRS to give similar information to the vast, new health care bureaucracy.

That means the personal tax information of millions of Americans would enter the system whether they want it to or not. "There's a mandate to buy insurance," says one Republican House aide. "You have to buy it. You have millions of people who can't buy it without a subsidy, so they will have no choice but to accept the subsidy in order to buy insurance, and then the Health Choices Commissioner will have access to their tax records."

"How many hands would this information go through?" asks a GOP source in the Senate. "What are the quality controls? This increases the risk of misusing this information."

Some versions of the bill even permit the release of confidential taxpayer information for decidedly less pressing reasons. In H.R. 3200, the IRS would be required to provide taxpayer information to the Social Security Administration for the purpose of helping Social Security officials find qualifying seniors who can then be encouraged to enroll in the prescription drug program. "There is no precedent for using taxpayer information for the purpose of identifying people to go out and advertise to them," says the House expert.

So far, there has been little substantive public debate about the integral role of the IRS in nearly every aspect of the various national health care proposals. But people who are closely involved with the process are deeply concerned about what they view as a massive, and in some senses unprecedented, expansion of the Internal Revenue Service.

First, they wonder whether the IRS can handle the new demands. "There is a sense at the IRS that their purpose is to collect revenue and not to implement all sorts of other programs," says a second Senate GOP aide. "Also, the IRS isn't necessarily great at doing what it does already. How is it going to determine whether 300 million people have health insurance?"

Second, they are concerned about anticipated abuse of the system. "You're going to have lots of fraud," says the House source. "People claiming lots of affordability credits or refundable tax credits. The IRS is not going to have the resources and expertise to police this stuff."

Finally, there is a third concern, more fundamental than questions of whether the IRS can handle the job: Should the IRS be involved in health care enforcement in the first place? As seen in the town halls across the country in August, many Americans are concerned about the coercive nature of the proposed national health care system. Handing the IRS the power to monitor every American's place in the system worries them even more.

Backers of the Democratic bills are betting that the handouts involved — giving people money to buy health insurance — will outweigh concerns about privacy and coercive government. Perhaps. But before Congress makes any decision on national health care, voters should know just what it will involve.

Sources: Obama, GOP's Snowe work on health care compromise

WASHINGTON (CNN) -- President Obama and top aides have quietly stepped up talks with moderate Republican Sen. Olympia Snowe of Maine on a scaled-back health care bill, according to two sources familiar with the negotiations.

Sen. Olympia Snowe is part of the bipartisan so-called "Gang of Six" negotiating on health care.

The compromise plan would lack a government-run public health insurance option favored by Obama, but would leave the door open to adding that provision down the road under an idea proposed by Snowe, the sources said.

One of the sources said White House officials are "deep in conversations" with Snowe on a much smaller health care bill than Obama originally envisioned.

The modified proposal would include insurance reforms, such as preventing insurance companies from denying coverage to people with pre-existing conditions, according to the source.

The potential deal would give insurance companies a defined period to make such changes in order to help cover more people and drive down long-term costs. But if those changes failed to occur within the defined period, a so-called "trigger" would provide for creating a public option to force change on the insurance companies, the source said.

Snowe is pivotal to the debate because she may be Obama's last possibility for getting a Republican senator to support his push for a health care overhaul.

She is one of the so-called "Gang of Six" members of the Senate Finance Committee, three Democrats and three Republicans, involved in separate negotiations on the only bipartisan health care proposal in Congress so far.

Don't Miss

• Sources: Obama to address Congress on health care
• What's next for health care?
• Wading through the health care lingo
• In Depth: Health Care in America

However, the slow pace of those talks and recent partisan attacks by the other two Republicans in the negotiations have dimmed hopes for a breakthrough, leaving Snowe as the only Republican senator that White House aides believe they can work with on the issue.

Snowe first proposed the so-called "trigger" idea for a public option months ago, and has talked to Obama about it on several occasions, according to a source familiar with the discussions.

The source told CNN that the White House staffers increased their phone calls to Snowe aides and their interest in her trigger idea this week.

Obama and Democratic leaders seek a solution that could win support from a Republican or two, and more importantly, help bridge a divide among Democrats on the public option issue.

Allies of the president hope that if Snowe accepts a health care agreement, she might also bring along her Republican colleague from Maine, moderate Sen. Susan Collins.

Getting some Republicans to sign onto a proposal would improve Obama's chances of gaining the support of key moderate Democratic senators such as Ben Nelson of Nebraska, Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas. All three are skeptical of a government-run public option supported by their more liberal fellow Democrats.

Despite the flurry of direct talks this week between Snowe and White House staff, Snowe aides insist she remains engaged in the "Gang of Six" bipartisan talks that have been going on for months. Those talks have focused on creating nonprofit health insurance cooperatives instead of a public option to force competition and lower medical rates.

The source familiar with Snowe's discussions with the White House said Snowe's trigger idea isn't being considered in the bipartisan negotiations because of early resistance from fellow Republican negotiators, especially Sen. Mike Enzi of Wyoming.

Enzi and the other Republican negotiator, Sen. Charles Grassley of Iowa, insist they are still committed to the bipartisan negotiations. However, their recent sharp criticism of Democratic health care proposals favored by Obama has caused tense relations with the White House.

Fwd: KMA Legislative Bulletin

KMA President-Elect Urges Tort Reform KMA President-Elect John R. White, MD, had an op-ed published in the Lexington Herald Leader on Monday, August 24, 2009. It urges members of Congress and state legislative bodies to pass medical liability reform as a first step in reforming the United State's healthcare delivery system. Doctor White's op-ed is available online. White House to Hold Conference Call for Physicians On Tuesday, August 25, 2009, at 8:30 pm EDT, officials from the White House will conduct a conference call for physicians concerning the current debate over healthcare reform. Physicians may participate by using the following conference call number: (800) 230-1096. Physicians may also e-mail questions about healthcare reform to public@who.eop.gov in advance of the call. KMA Priorities for Healthcare Reform As a reminder, KMA urges members to contact their Congressman and urge them to include the following five principles in healthcare reform legislation that passes. Members of Congress will return to Washington after Labor Day to continue work on healthcare reform proposals. To contact Congress, call (800) 833-6354 or visit the KMA Legislative Action Center to e-mail them. Repeal of the SGR formula, avoiding the anticipated twenty percent cut in Medicare reimbursement based on the current formula, and the creation of a system that more accurately reflects the cost of operating a physician's office. Meaningful medical liability reform that will reduce the high cost of defensive medicine. Ending health insurance companies' subsidies under the Medicare Advantage program and using that money to fund other proposals, including a fix to the SGR. Health insurance reform that reduces the administrative burden on patients and physicians, and reduces the barriers to obtaining insurance and health care services for patients. Anti trust relief that allows physicians to negotiate on a level playing field and allows them to work with others in the health care delivery system to increase efficiencies in the delivery of health care that are so badly needed. Doctor in Special Election August 25 James F. Ditty, MD, a Dermatologist from Flatwoods, Kentucky, will be in a special election for the Kentucky Senate's 18th District tomorrow, Tuesday, August 25, 2009. Doctor Ditty received the support of Kentucky Physicians PAC (KPPAC) in his special election bid. Physicians and others interested in the future of medicine, who leave in Bracken, Carter, Greenup, Lewis, Mason, and Robertson Counties are urged to vote in tomorrow's special election. Join KPPAC to Register for Drawing Physician members are urged to join Kentucky Physicians PAC (KPPAC) prior to or at the KMA Annual Meeting in mid-September to be eligible for a drawing. Special prizes will be given away at the KMA/KPPAC Legislative Reception on Monday, September 14, and the KMA House of Delegates Meeting on Tuesday, September 15. Every physician who makes a KPPAC contribution prior to those events will be eligible for the drawing and you do not have to be present to win. To make your contribution, call KMA Headquarters at (502) 426-6200 or e-mail us. To learn more about the various contribution levels, visit the KPPAC website.

Fwd: AMA HSR Bulletin August 24, 2009

If you're having trouble viewing this email, you may see it online.

Aug. 24, 2009

Here's your regular update on efforts by the American Medical Association (AMA) to work with lawmakers in reforming the nation's health care system in a way that provides quality, affordable health care for all.

Senate negotiations continue
The U.S. Senate Finance Committee has been continuing bipartisan negotiations during the August congressional recess in an attempt to reach an agreement on health system reform legislation. Committee Chair Max Baucus (D-Mont.) has publicly stated his hope of reaching consensus on the legislation by Sept. 15, although there are signs that this goal may slip. It is unclear how Baucus and the Democratic leadership will proceed if an agreement is not reached by then.

Potentially complicating those negotiations, Sen. Jon Kyl (R-Ariz.), the minority whip, recently spoke out against the idea of nonprofit insurance cooperatives, which some committee members favor as an alternative to establishing a public plan to compete with private health insurers.

Availability of health IT funds announced
The Department of Health and Human Services (HHS) made a long-awaited announcement last week regarding the availability of $1.2 billion in Health Information Technology for Economic and Clinical Health, or HITECH, Act funding to help physicians and hospitals implement and use electronic health records. During a roundtable discussion on health system reform, Vice President Joe Biden, HHS Secretary Kathleen Sebelius and David Blumenthal, MD, director of the HHS Office of National Coordinator (ONC), provided details about two grant programs—the Health IT Regional Extension Program and the State Health Information Exchange Program.

Under the Health IT Regional Extension Program, HHS will award $598 million in fiscal year 2010 to support the creation of 70 Health IT Regional Extension Centers. These centers will help support physicians and hospitals in their adoption of systems which allow them to become meaningful users of health IT. Learn more about the program. Meantime, the State Health Information Exchange Program will award $564 million to states and qualified "state designated entities" to develop and advance mechanisms for information sharing. Learn more about this program.

Additional information about both programs is available on the ONC Web site.

New AMA resources available
The AMA's new health system reform Web site contains resources for not only physicians but for their patients, too. By selecting the "resources" tab, physicians can download documents about medical liability reform, graduate medical education and the physician work force, and status and procedures for federal health system reform. A frequently updated question-and-answer document about the House health reform legislation, H.R. 3200, is also available. Resources for patients include a flier describing what health system reform would mean for patients, a document containing a list of answers to frequently asked questions by patients, and a resource detailing every component of health system reform for patients, from health insurance market reforms to comparative effectiveness research. And to help debunk some of the myths that patients have about health system reform, the AMA developed a Virtual Town Hall video, in which AMA members answer commonly asked questions. Check out the AMA's Facebook page and Twitter site to get the latest AMA happenings in health system reform via ongoing live updates.

Physician outreach efforts ongoing
AMA leaders continue to conduct a series of regional tele-town hall Physicians' Forums to respond to members' questions about health system reform legislation and the AMA's advocacy efforts. Physicians' Forums are planned through the first week of September, and a schedule of upcoming forums are listed under the "Important dates" section of this newsletter. In addition, AMA Immediate Past President Nancy H. Nielsen, MD, PhD, will share the AMA's perspective on health system reform with physician leaders and the media in Detroit, Lansing and Grand Rapids, Mich., tomorrow, Aug. 25, and Wednesday, Aug. 26, as part of the AMA's National House Call campaign.

Cooperatives' Record Weighed in Health-Care Debate

Cooperatives' Record Weighed in Health-Care Debate

By Steven Mufson
Washington Post Staff Writer
Thursday, August 27, 2009

Sen. Kent Conrad (D-N.D.), a pivotal lawmaker in the health-care debate, wants to deliver coverage to the uninsured by starting up new cooperatives modeled on rural electric cooperatives that were founded during the Great Depression.

But rural electric cooperatives have a mixed track record, experts say. They brought electricity to millions of rural Americans who lacked it in the 1930s and today serve about 14 percent of Americans. But after 75 years, the rural electric cooperatives still rely heavily on federal credit subsidies, have weak balance sheets and, some studies suggest, operate less efficiently than privately-owned utilities.

Over the past three years, some rural electric cooperatives have also come under criticism for excessive payments to executives and for pushing forward with new coal-fired power plants at a time when many people concerned with climate change want to slow down or halt such plants. Yet they remain politically powerful through the National Rural Electric Cooperative Association.

Rep. Jim Cooper (D-Tenn.), a critic of rural electric cooperatives, agrees with Conrad that health-care cooperatives could help provide coverage for the roughly 47 million uninsured Americans. "I want everybody covered and I want it to be affordable," Cooper said. "Co-ops could do that. They are a time-honored mechanism for almost all of rural America. . . . They're kind of an interesting third way, halfway between the public and private sector."

But he warns that the new cooperatives would require close regulation to avoid many of the problems he says afflict rural electric co-ops. "You still have to watch co-ops like a hawk," he said. He said that rural electric cooperatives "became too big for their britches" and "indistinguishable from for-profit firms except that they love government subsidies." In an article in the Harvard Journal on Regulation last year, Cooper argued that rural electric co-ops "turned away from their historic role" and had taken on "deeply troubling anti-consumer behaviors."


Serving Rural Needs

Rural electric cooperatives -- nonprofit organizations owned by their customers -- date back to 1935, when President Franklin D. Roosevelt created the Rural Electrification Administration to bring power to poor and remote farm areas. Rural poverty at the time was captured in the 1939 book of photos by Walker Evans and text by James Agee titled "Let Us Now Praise Famous Men," which Agee opens by describing writing by the light of a coal-oil lamp.

Today, electric lines reach into virtually every household in America, and many of the once-rural areas served by cooperatives have become part of sprawling urban areas, such as Dallas-Fort Worth or Northern Virginia.

Yet they still rely on cheap, subsidized financing from the Rural Utilities Service, part of the Agriculture Department, which provides direct loans and loan guarantees. Co-ops also get financing from the National Rural Utilities Cooperative Finance Corp., a cooperative bank that in turn relies on billions of dollars of low-cost financing from the federal government and the Federal Agricultural Mortgage Corp., a government-sponsored enterprise commonly known as Farmer Mac.

On June 11, Farmer Mac chief executive Michael A. Gerber said in congressional testimony that Farmer Mac had lent the CFC $1.8 billion and that it planned to boost that figure by another $1 billion. He said Farmer Mac planned to pool the loans, turn them into securities, provide guarantees of timely payment and sell them to investors.

"A co-op by definition has several major advantages over private tax-paying corporations," said Ken Glozer, a former Office of Management and Budget official and president of a consulting firm called OMB Professionals. "They don't pay taxes, they borrow all their money from the U.S. government because they because can't raise capital, and they are political as hell because they depend on the government. Over time they will seek and get untold favors that a private company won't be able to get."

Glozer added that cooperatives are "quasi-federal agencies."


Debating the Model

Conrad argues that co-ops can be effective, citing the success of the model at Land O'Lakes, Ace Hardware and Group Health, a health-care co-op with 600,000 members in Washington state, as well as the rural electric co-ops. In a recent opinion piece published in USA Today, he said that co-ops would be "a public-interest alternative, but consumer-controlled and not government-run."

But others have reached different conclusions. In his article on rural co-ops last year, Cooper said: "Co-ops in some regions of the country have been doing a particularly poor job of protecting member interests."

Robert D. Reischauer, president of the Urban Institute and former director of the Congressional Budget Office, said rural electric cooperatives aren't a good model for health insurance regardless of their track record.

"Those were providing a service where no private enterprise wanted to operate because the population density was too low and the capital costs were too high," he said. "And what we're talking about is trying to create a viable insurer that would operate in metropolitan areas and rural areas and suburban areas."

Reischauer added that a firm capable of providing effective health insurance needs to be big, because that would bring economies of scale in administration and market power necessary to bargain with health-care providers. Rural electric cooperatives, by contrast, tend to be local. There are around 800 rural electric cooperatives nationwide, including 16 in Conrad's home state of North Dakota.

"What you want is something that is big and nimble at the same time," Reischauer said.

End-of-life care provision stirs angst in health reform debate

By Kevin B. O'Reilly, AMNews staff. Posted Aug. 24, 2009. The public outrage over reimbursement for patient counseling catches doctors by surprise but shows how delicate the discussion over advance-care planning can be. A relatively obscure provision in the House's massive health system reform legislation that would reimburse physicians for counseling Medicare patients about end-of-life care options came under intense fire from conservative opponents in August. The political fallout prompted a group of six senators working on health system reform to drop the idea from ongoing negotiations. The House may follow suit when Congress reconvenes in early September, sources said. But physicians said the controversy shows that despite decades of focus on helping patients choose what -- if any -- interventions they want as they die, end-of-life care remains a political and ethical tripwire. Republicans, conservative commentators and boisterous activists at congressional town hall meetings condemned the provision, Section 1233 of HR 3200, as part of a larger plan to ration medical care. In a post to her Facebook page, 2008 GOP vice presidential candidate Sarah Palin said the measure would place seniors before "death panels" who would decide what care they should receive. 30% of Medicare funds each year are spent on terminal care for 5% of the program's patients. The advance-care consultations eligible for Medicare reimbursement "are part of a bill whose stated purpose is 'to reduce the growth in health care spending,' " Palin wrote. "Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care?" The American Medical Association, which supports HR 3200, tried to set the record straight. "There has been a lot of misinformation about the advance-care planning provisions in the bill," AMA President J. James Rohack, MD, said in a statement. "Simply put, the bill would create a new Medicare benefit to pay physicians for time spent on advance-care planning consultations with seniors. It would be completely voluntary, and it will allow patients, if they wish, to discuss a broad range of issues, including hospice, living wills, advance directives and appropriate pain care. "These are important discussions everyone should have so they are fully informed and can make their wishes known. That's not controversial, it's plain, old-fashioned patient-centered care." Under the legislation, physicians could bill Medicare for advance-care planning consultations once every five years or when the patient's health conditions change dramatically. In states that have standardized life-sustaining treatment order forms, doctors could counsel patients about their choices and complete that documentation. The bill also calls for consensus standards on how to measure the quality of doctors' and hospitals' performances in carrying out patients' end-of-life care wishes. Doctors dismayed The political wildfire that flamed over a seemingly innocuous provision left many doctors and end-of-life care experts bewildered and dismayed. "I'm disgusted," said Anthony L. Back, MD, professor of oncology at the University of Washington School of Medicine and an oncologist at the Fred Hutchinson Cancer Center, part of the Seattle Cancer Care Alliance. Dr. Back's research has focused on how to remove barriers that prevent doctors and patients from communicating about end-of-life care decisions. Studies have shown that the 5% of Medicare patients who die each year account for 30% of Medicare's costs, with 78% of last-year-of-life expenses occurring in the month before death. A March 9 Archives of Internal Medicine study of 603 dying cancer patients at seven hospitals, oncology clinics and hospices found that care for patients who had end-of-life discussions with their physicians cost $1,295, compared with $2,780 for patients who did not have such talks. Dr. Back said encouraging physicians to have extended counseling sessions with their patients through the Medicare system could help patients get the care they want at the end of their lives while saving the health system money. 78% of medical expenses during the final year of life occur in the month before death. "But," he added, "I don't see any meaningful public discussion about this going on at all. The whole issue is just politically unsalvageable." Joseph W. Stubbs, MD, president of the American College of Physicians, agreed that the legislation's intent was mischaracterized by its opponents. "The provisions in the HR 3200 legislation providing for payment to physicians for advance-care planning became a hook used by political ideologues," Dr. Stubbs said. "It's basically become an ideological war about what role government should play in terms of the personal lives of individuals and has little to do with advance-care planning." Criticism of the measure has been "completely absurd," said Neil S. Wenger, MD, MPH, professor of medicine and director of the University of California, Los Angeles Health System Ethics Center. He was lead author of an August 2008 report to Congress on advance directives and advance-care planning that influenced the House provision. "Advanced-care planning has been a recommended care process for several decades, especially for the last 10 or 15 years. For there to be concern that it some way violates people's rights, especially the most sick at whom it's actually aimed, is bizarre," Dr. Wenger said. Some physicians, while reticent to echo the "death panel" rhetoric, did voice concern about the end-of-life care measure. "I'm dubious about Congress getting into the specifics of how physicians should interact with their patients and how to plan in the case of someone who's terminally ill," said Mark Schiller, MD, a psychiatrist in the San Francisco Bay area and a board member of the Assn. of American Physicians and Surgeons, which opposes the Democratic reform plans. "That's just not the place of Congress." Overall, though, the controversy signals a more universal problem. Americans are uncomfortable talking about end-of-life care and costs, Dr. Wenger said. "People are so afraid of this discussion that they can't even tolerate this occurring between one doctor and the patient, let alone at the societal level." This content was published online only. ADDITIONAL INFORMATION: Standardizing end-of-life decisions Under the House's health system reform plan, doctors in states with standardized forms for life-sustaining treatments would be reimbursed for discussing such interventions with patients as part of an advance-care planning consultation. Eight states currently use the Physician Orders for Life-Sustaining Treatment form, and nearly two dozen others are developing programs to use the standardized order set. POLST documents whether patients or their surrogates want the following interventions under certain end-of-life circumstances: Antibiotics Artificially administered nutrition Cardiac monitoring Cardiopulmonary resuscitation Cardioversion Intravenous fluids Intubation Mechanical ventilation Wound care Source: "Physician Orders for Life-Sustaining Treatment," Oregon Health & Science University Center for Ethics in Health Care (www.ohsu.edu/polst/programs/documents/POLST.JUNE.2009sample.pdf) Weblink "Health care costs in the last week of life: Associations with end-of-life conversations," abstract, Archives of Internal Medicine, March 9 (archinte.ama-assn.org/cgi/content/abstract/169/5/480) "Advance Directives and Advance Care Planning: Report to Congress," U.S. Dept. of Health and Human Services, August 2008 (aspe.hhs.gov/daltcp/reports/2008/adcongrpt.htm) Sample "Physician Orders for Life-Sustaining Treatment" form, Oregon Health & Science University Center for Ethics in Health Care (www.ohsu.edu/polst/programs/documents/POLST.JUNE.2009sample.pdf) Copyright 2009 American Medical Association. All rights reserved. RELATED CONTENT » White House redirects health reform spotlight to insurance abuses Aug. 24 » Doctors, lung cancer patients skirt hospice talk June 15 » Discussing death with patients can cut costs, ease abandonment fears March 30 » Defective directives? Struggling with end-of-life care Jan. 5 » California law mandates discussing end-of-life options Nov. 10, 2008 » Care for dying patients may sometimes be too aggressive Aug. 7, 2006