Tel-A-Vision for the 21st Century  

HR 3200 ~ The Affordable Health Choices Act of 2009
and its the provision for End-of-life planning (Section 1233) 

Faith Gibson, LM, CPM
Palo Alto, Ca

I am a conservative Mennonite, parent of 3, grandmother, former ER nurse, currently a professional midwife and appointed member of the Midwifery Advisory Council for the Medical Board of California.

After four decades as a health care professional and patient advocate, its obvious to me that America can’t afford not to reform the way we provide and pay for healthcare. Rarely has a robust public discourse been so important to the welfare of Americans as the debate on health care reform.

An intelligent debate requires access to the facts, so I downloaded House bill HR 3200, printed it out, put it in a 3-ring notebook and read all 1,100 pages with my handy yellow highlighter in hand.

I now have an informed opinion about the House of Representative's bill, including the the Advance Care Planning Consultation provision (Section 1233). I must state the obvious: Government-sanctioned euthanasia would be a crime according to state, federal and international law and reprehensible to every American.

The only way to prove that Section 1233 isn't a criminal conspiracy is to read it for yourself. To make that a bit easier, I posted a plain language version of Section1233 and also included the original uncut version of the same provision for direct comparison.

Easy to read, a plan language version of Section 1233       Full & unedited Version of Section 1233


The Affordable Health Choices Act is an excellent piece of legislation – politically moderate, but masterfully designed produce a health care system that our nation can be proud of – one that is fair and affordable, that preserves individual choice and reliably delivers healthcare that is as safe and cost-effective as any other industrialized country. Clearly it was written by people who were very familiar with the dysfunctional aspects of the current system and bold enough to propose legislative solutions that would fix these difficult problems.


Affordability: The goal of providing health ASSURANCE to all Americans can be achieved without taxing the middle class, rationing medical services for the elderly, limiting the advance of medical science or turning healthcare over to faceless government bureaucrats.


Two trillion a year is more than enough money to treat everyone and meet every genuine medical need. Money being spent unproductively (or unwisely) can be redirected. Forward-thinking reform can introduce science-based change in how health care and medical services are provided and financed, while appreciating the many benefits of scientific innovation and new technology.


Yankee ingenuity took us all the way to the moon, we can do HealthCare_2.0. Money being spent unproductively (or unwisely) can be redirected. Forward-thinking reform can introduce science-based change in how health care and medical services are provided and financed, while incorporating the benefits of scientific innovation and new technology.


All it takes is the right expenditure of our plentiful resources.


Practical way to make our resources work for us

(1) Health Care is not the same as Medical Care:

(2) Best Practices and Comparative Effectiveness:
The Other Pillar of a Cost-effective System – Primary Care:



2. ‘Advance Care Planning Consultation’-- Section 1233 of the Affordable Health Choices Act


Section 1233 is a provision to amend the Social Security Act written by a Republican Congressman from Georgia. For the last 20 year, the law has required hospitals to ask all patients being admitted to a hospital if they have an Advanced Directive. However, it did not reimburse medical providers for time spent in explaining or helping people to develop personal instructions for the medical staff on life-sustaining treatment for themselves.

My husband and I are both retirement age and both covered by Medicare and my mother-in-law in 87. We would all be highly offended by the slightest hint of duplicity in HR 3200. But there is absolutely nothing sinister in sec 1233 -- no ‘death panel’ for mentally or physically handicapped children, no scheme to save Medicare money by paying healthcare professionals to hand out hemlock to octogenarians. Not a single word in sec. 1233 (or anywhere else in the House bill 3200) even remotely hints at a government-sponsored plan to kill off the elderly or disabled, manipulate medical care providers or force doctors to rat on the end-of-life decisions made by Medicare patients to the government.

Section 1233 would simply permit medical practitioners (physicians, physician assistants and nurse practitioners) to be reimbursed for helping Medicare patients develop a plan for end-of-life care that suits their needs and that of their families. The provision identifies the very broadest range of option, stating that: “treatment … may range from an indication for full treatment to an indication to limit some or all or specified interventions.” It is always the patient that decides what kind of care they want, not the practitioner. Sec 1233 includes training for health care professionals “about the goals and use of orders for life sustaining treatment”. The only role of physicians or practitioners is to provide factual information on the full spectrum of possible choices and how to best achieve those goals, including necessary legal information.  Physicians, physician-associates and nurse practitioners would simply be responsible for reporting on how well the health care profession provides this information.

The only thing being tracked and reported by sec 1233 is the level of compliance by the health care professional with their obligation to inform the patient about advance directives and life-sustaining treatments. Exactly how this information is to be measured for its effectiveness and tracked is not mandated by HR3200 or dreamed up by government bureaucrats - that criteria is to come form a “consensus-based organization”. A further safe guard in the bill is a requirement that criteria proposed by the a consensus-based organization be published in the Federal Register and a period of public comment provided before it can be adopted.

The facts about the House bill are simple, and straightforward. The Advance Care Planning Consultation provision is thoughtful and well-written; it carries forward the intent of Social Security Medicare legislation of 20 years ago in a professional and effective way. Sec 1233 reimburses health care professionals for helping Medicare patients deal effectively with end-of-life issues thru a process of advanced planning. The information imparted by medical practitioners is to be developed or endorsed by a consensus-based organization and includes a feedback process before being implemented. Since it only amends the Social Security Act, so there is nothing hidden, either in the Sec 1233's own text or elsewhere in HR 3200.

Freed from distracting details and legalese, this plain language text makes it possible to understand what Sec 1233 does and doesn’t say.

Easy to read, a plan language version of Section 1233       Full & unedited Version of Section 1233

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