Understanding Advance Directives For Health Care: Fill & Download for Free

I don’t ask a doctor their religious or political affiliation when I go to see them. The only things I ask are the following:1) Do you agree that a doctor/patient relationship is a partnership? The doctor knowing the medicine, and the patient knowing their body and how it reacts.2) Will you respect my religious beliefs and wishes, even if they conflict with your own?3) Will you be, at all times, open and honest with me? Never leaving out treatment options or glossing over the seriousness of a health issue due to your beliefs?If that’s all good, then we’re probably going to get along well. I don’t go to my doctor to get preached to. I also don’t go to my doctor to get half-truths, or to have them omit treatment options because it goes against their religious or political beliefs.Finally, I made a Living Will via Compassionate Choices - A Federal Attack on D.C.’s Medical Aid-in-Dying Law Threatens All Such Laws]Included in that Living Will are such things as a “Letter to my Doctor” that states the following:“It is important to me to have excellent and compassionate care - to stay as healthy and active as possible over the course of my life. At the end of life, my personal values and beliefs lead me to want treatment to alleviate suffering. Most importantly, I want to ensure that if death becomes inevitable and imminent, the experience can be peaceful for me and my family.If there are measures available that may extend my life, I would like to know their chance of success, and their impact on the quality of my life. If I choose not to take those measures, I ask for your continued support.If my medical condition becomes incurable, and death the only predictable outcome, I would prefer not to suffer, but rather to die in a humane and dignified manner. I would like your reassurance that: If I am able to speak for myself, my wishes will be honored. If not, the requests from my health care representative and advance directives will be honored.You will make a referral to hospice as soon as I am eligible, should I request it.You will support me with all options for a gentle death, including providing medications that I can self-administer to help my death be as peaceful as possible.I am not requesting that you do anything unethical while I am in your care, but I hope for your reassurance that you would support my personal end-of-life care choices as listed above.I hope you will accept this statement as a fully considered decision, and an expression of my deeply-held views. If you feel you would not be able to honor such requests, please let me know now, while I am able to make choices about my care based on that knowledge. “It also has a section regarding religious and other such institutions/hospitals:“ I understand that circumstances beyond my control may cause me to be admitted to a healthcare institution whose policy is to decline to follow Advance Directive instructions that conflict with certain religious or moral teaching.If I am an inpatient in such a religious-affiliated healthcare institution when this Advance Directive comes into effect, I direct that my consent to admission shall not constitute implied consent to procedures or courses of treatment mandated by ethical, religious or other policies of the institution, if those procedures or courses of treatment conflict with this Advance Directive.Furthermore, I direct that if the healthcare institution in which I am a patient declines to follow my wishes as set out in this Advance Directive, I am to be transferred in a timely manner to a hospital, nursing home, or other institution which will agree to honor the instructions set forth in this Advance Directive.I hereby incorporate this provision into my durable power of attorney for health care, living will, and any other previously executed advance directive for health care decisions.”As you can see, I take my healthcare options very seriously. They are mine to make, and I should be free to make them. I do not want my doctor to violate their own ethics (or the law), but if their ethical stance prevents them from following my wishes, then they need to transfer my care to someone who will be able to better follow my wishes, if possible and legal.A doctor-patient relationship is a partnership. I must do my part, as a patient, to listen to my doctor and follow their instructions to the best of my ability. By that same token, the doctor must listen to me and to how I report my symptoms and side-effects, and my limitations with regard to what I can and cannot do. I will not have a doctor that tells me that it is “My way or the highway”. If that is my choice, I will find a different doctor (unless there is a VERY good reason for that position - such as I will die without following their specific instructions).

There is a reason the United States doesn’t have Universal Health care. It’s because we’re politically easily divided, and that means the folks who don’t want us to have it have significant advantages, politically. They are able to divide voters sufficiently to keep them from uniting in sufficient numbers to enact it.The pretext about cost: Many of us have been convinced that if we gave health care to everyone, it would cost even more than it does today. This is a strange argument, given that every country that does it that way spends less than we do per person. Still, the ‘more coverage will mean more expensive’ argument makes its own sort of intuitive sense, given that we spend lots of money already, and not all of us see a direct benefit from that spending. Our health care tax dollar is allocated from virtually everyone, to programs that not everyone is eligible to receive the benefits of. For example, I pay tax dollars into medicare (which benefits seniors and the disabled), for which I am not eligible. I pay into medicaid (which benefits the very poor) and to fund the VA’s health care program (which is for veterans) for which I am not eligible. Meanwhile, I am insured through my employer (which means a lot of money for my insurance was provided in the form of tax breaks to my employer), and the taxpayers indirectly underwriting my insurance aren’t eligible to participate in my policy.The benefits that come to me (in the form of taxpayer-subsidy to my employer-provisioned health care) aren’t visibly from the government, and the taxes I pay into the same government are very visible to me. This makes it very easy for folks like you and me to think the stuff the government does is for other people, none of it is for us- but nothing could be further from the truth:Americans with good jobs live in a socialist welfare state more generous, cushioned and expensive to the public than any in Europe. Like a European system, we pool our resources to share the burden of catastrophic expenses, but unlike European models, our approach doesn’t cover everyone.Like most of my neighbors I have a good job in the private sector. Ask my neighbors about the cost of the welfare programs they enjoy and you will be greeted by baffled stares. All that we have is “earned” and we perceive no need for government support. Nevertheless, taxpayers fund our retirement saving, health insurance, primary, secondary, and advanced education, daycare, commuter costs, and even our mortgages at a staggering public cost. Socialism for white people is all-enveloping, benevolent, invisible, and insulated by the nasty, deceptive notion that we have earned our benefits by our own hand. ~[Unspeakable Realities Block Universal Health Coverage In America]Another factor is that the solutions we’ve come up with so far have been sufficient to buy off just enough people to keep it out of reach, politically.There is history here.[1] Since the time America began to be an industrial nation it has wrestled with the impacts of capital’s adversarial relationship to labor, and health care would become a significant thread in the politics of it. For context, from the late 1800s onwards American labor and its new industrial barons faced each other in a world that saw the simultaneous decline of monarchy, the rise of socialism (and the advent of fascism) which would become the context for labor/capital relations going forward. Indeed, American right-wing capital fostered ‘red scares’ and became adept at race-baiting for domestic political purposes (those being to suppress and divide American socialists).Blessed with newfound industrial wealth, faced with contentious labor/capital relations and the advent of modern medicine (which started to become both more effective and expensive than it had been), Americans have recurrently fought over the idea of how best to organize health care.In the early 1900s, when doctors began charging more than most people could afford, the initial responses were individual pre-payment instruments, and the ‘blues’, (what would become blue cross and blue shield) emerged as private-sector solutions by which to finance health care. During this timeframe, the AMA emerged as a powerful entity in American politics, and it was very effective in squashing attempts to enact national-level social insurance programs that might give their patients more buying power than they thought would be good for them. Indeed, they were able to pressure FDR into dropping the planned health-insurance portion of what would become the Social Security Act of 1935.In the years after World War II, the western democracies that had not already done so adopted universal social safety net programs. These included health care, retirement and other benefits. President Truman introduced his plan for universal health coverage in 1945. It would have worked much like Social Security, imposing a tax to fund a universal insurance pool. His plan went nowhere. Instead, nine years later Congress laid the foundations of the social welfare system we enjoy today. They rejected Truman’s idea of universal private coverage in favor of a program controlled by employers while publicly funded through tax breaks. This plan gave corporations new leverage in negotiating with unions, handing the companies a publicly-financed benefit they could distribute at their discretion. ~[Unspeakable Realities Block Universal Health Coverage In America]It happens that employer-sponsored health care arose as an employer response to the Stabilization Act of 1942, which sought to control inflation during wartime by preventing employers from raising wages[2]. By way of an exemption to the law, employers were allowed to offer health insurance as a form of remuneration to keep the employees they couldn’t otherwise pay more. This, in turn, would give big employers a benefit they could use to lever workers against their unions.The Revenue Act of 1942 triggered another rush to enroll employees in health plans. By slapping corporations with tax rates of 80 or even up to 90 percent on any profits in excess of prewar revenue, Congress all but guaranteed a frenzied search for loopholes. Employee benefits, according to the new law, could be deducted from profits. As an anonymous employer observed in a study published on trends in health insurance, “it was a case of paying the money for insurance for their employees or to Uncle Sam in taxes.” ~[Employer-based health care was a wartime accident]Thus, we would establish (quite by accident) a tax-deduction-funded health care system for workers with good jobs- and this would in turn prove to be a good for many people- but not for everyone. In the much-vaunted 1950s onwards, the economic gains and middle-class growth would accrue almost exclusively to working-class white men, to whom jobs with health care benefits (with their invisible tax subsidies) were overwhelmingly reserved. This would prove to be a wedge that would be exploitable from then onwards- some portion of working class whites could be persuaded that if we afforded health insurance to everyone, it would come at their expense, and benefit undeserving “lazy” minorities.One other critical factor in the reason we don’t have universal health care today is that ever since the 1930s, Big-business conservatives have waged an ongoing (and well-funded) effort to promote the idea that less government regulation of their own interests (and much less in the way of taxing ability or popular support to do that) are vital. Their efforts would yield breakthrough results when they co-opted organized religion to their cause in the 1940s, and that in turn would foster a strain of Prosperity theology in American organized religion that would promote libertarian, anti-statist views from the pulpit, on behalf of their corporate patronage:Franklin Roosevelt had sold his New Deal to voters in part by explaining economic justice in terms of the Social Gospel, a progressive interpretation of Christian doctrine that casts sin not just as personal depravity, but as a cultural and institutional evil that demands a united effort to reform social structures and bring about the Kingdom of God.Leading industrialists struggled to counter this message until they found an ally in James W. Fifield Jr., a Los Angeles preacher who combined passionate hatred for the New Deal’s “encroachment upon our American freedoms” with public-relations savvy. In 1935 Fifield founded an organization called Spiritual Mobilization, which channeled donations from titans like tire magnate Harvey Firestone and Sun Oil’s J. Howard Pew into a publishing and propaganda campaign that urged ministers around the country to recognize “the anti-Christian and anti-American trends toward pagan stateism in America” and to promote the “free pulpit, free speech, free enterprise, free press, and free assembly.” ~[How Long Have We Really Been ‘One Nation Under God’?]Having recruited organized religion (and created televangelism as a thing) into the anti-statism chorus, and with middle-class labor threatened by the notion of universal health care costing them their excellent health care benefits, the Conservative-industrialist crowd were well-positioned to render the notion of universal health care (along with much of the rest of the New Deal and Great Society reforms) politically toxic. Indeed, every effort since (including those of JFK, Johnson, Nixon, and Clinton) have run afoul of well-funded political efforts by the following constituencies:The AMA, which is keen to avoid the sort of market changes that would occur if buyers had more powerThe now-incredibly-powerful private insurance industry, which is keen to preserve the status quo (which makes them a trillion-dollar segment of the economy)Class-insecure working conservatives with employer-provisioned health insurance, who worry that they’d lose their good insurance and pay a lot more for worse ‘public’ insurance that would be all used-up by poor people(because everybody know public insurance like medicaid is for poors, right?) Working folks are keen to shame those ‘sucking the public teat’, and doubly keen to avoid being shamed for doing the sameA strong component of this public-shaming of the poor and indolent is about race, given that class and race correlate so stronglyExclusion of the poor (and minorities especially) is a feature, not a bug, for many of these folks“because socialism” (many of these folks are assured that universal health care would destroy the economy because that’s what socialism does (never mind that the rest of the developed world has better health care and pay less for it than we do))Big business, which is keen to preserve its influence over its employees (control of health care is a big deal, and can be used to wedge labor out of unions), and still working on its long-game to reduce government to the role it had in their ‘golden age’ (which would be the time before the New Deal, and before World War II)Wall street- [Wall Street Was America’s First Foe in World War II]- to mobilize US industry into the war effort, wall street’s monopoly control of American industry had to be broken- a thing the erstwhile barons of wall street (and therefore, of America itself) want to restore.Organized religion, keen to maintain its political and cultural preeminence and standing within the conservative right.Not all of these groups know what the others are doing, or how they are being co-opted. At the individual voter level, many think they’re voting for the best of bad options, and few really understand that they are acting in the interests of a political coalition bent upon dismantling the United States government until it looks more like the one we had in 1907.So, all of that was a long way of saying “we don’t have universal health care because big money people don’t want that, and they’re very good at splitting up coalitions that would, if they united in common cause for mutual benefit, enact it yesterday.”Big money, organized religion, and racism. These are the wedges that divide us, and they’re why we bleed twice as much money into our hodgepodge of health care systems as the rest of the world’s wealthy nations do.Footnotes[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447696/[2] Employer-based health care was a wartime accident

Well, first of all, people who ‘prefer the current system’ should stop listening to the propaganda put out by health insurance companies who make billions (trillions?) of dollars off people like you while delivering what is arguably the worst health care outcomes in the industrialized world.What these people say about the Canadian health care system could be best characterized as libel and slander. Unfortunately those lies don’t directly cost Canadians anything, so we have no legal cause to sue them to stop.I live in Canada .. one of the countries these call Socialist, but the truth is, if you moved here, you would find precious few significant differences (healthier population being one of them). We do, however have a single payer health care system.. I’ll explain to you how it works for me and my family.Like the US, the health care systems are controlled by the individual provinces (equivalent to US states), but the bulk of the money for the health care system is paid by the federal government. The rule for federal payout is that a province must cover “any medically necessary procedure needed by it’s residents”.Canada spends less than 1/2 per person for health expenses that the US does, with better health outcomes, overall, and a longer lifespan (about 4 years longer, on average). Some provinces have per person (or per family, if your family is big enough) health insurance payments. Some do not. For those that do, lower income people/families usually get subsidized on a sliding scale (i.e. in British Columbia, where I live, a single person making less than $26K (net adjusted after deductions) pays $0.) If you make over $42K/year you pay the full $56/month … but the current government will be dropping that to about $30 this year, and completely end medicare payment in the coming years.How it works: I have a medicare card which essentially proves that I am a resident of the province, who thus qualifies for medicare. If I need medical care (sick, injured, etc.), I go to a medical care provider and hand them my card, and answer any questions they have. When I’m done getting care, I gather my stuff and leave. I do not receive a bill. What the doctor gets paid is pre-set by the government. (S)He reports what services were performed, and gets paid accordingly. No time is wasted determining which insurance provider I use, whether my care is covered (yes!), how much I have to pay ($0), or how I’m going to cover my portion($0).Net result: If I’m sick, I have no financial fear of going to the doctor or emergency. If it’s a minor problem I’m out in a flash. If it’s a major problem I get taken care of — no matter how long it takes, or how much it costs. This means that progressive problems tend to be taken care of earlier on, when they’re much cheaper to take care of.My mother:about 15 years ago, my mother was diagnosed with kidney failure. She didn’t want to go onto dialysis (because it would impact her lifestyle), so she initially attempted to control it by diet, in conjunction with the local clinic. Eventually the kidney failure progressed to the point where she ‘gave up’ and decided to go for dialysis. At the time, she was in Trinidad, so she flew back to Edmonton for treatment. When she walked (more like creeped) into the clinic, she was so obviously in distress that they put her on a dialysis machine and then did the blood work.. Total cost: $0.For a few years after that she received dialysis (cost $0), and waited for a kidney transplant. As luck turned out, my sister’s best friend (Kathy) was a match for a live non-related transplant (probability 1/50,000).However, there was a hitch. When Kathy got an extended checkup prior to transplant, she tested positive for pancreatic cancer. She had to be successfully treated before she was aloowed to donate. This caused about a 1 year delay. Normally pancreatic cancer is fatal because it prevents no obvious symptoms until it’s too advanced for successful treatment. Because Kathy was diagnosed early on she was successfully treated. Total patient cost for diagnosis and treatment? $0.My mother then received her transplant, and is still alive and well today. She will need immuno-suppressant medication for the rest of her life. (total patient cost: $0). Kathy died a few years ago for reasons un-associated with the transplant.It is said that some Canadians get health care in the US.. About 98% of those cases are people who get sick while travelling in the US and need treatment before returning to Canada. The majority of Canadians would prefer to get treatment in Canada vs being treated in the US. Well under 1% of Canadians get treatment in the US .. Usually for rare treatments available in the US, but not in Canada due to the smaller population. In many cases, those treatments are covered by the Canadian health care system. There are similar numbers of Americans who come to Canada for health care.We do have wait-lists for some procedures. The problem is not a lack of money — it’s a lack of specialists to do those procedures.Some Canadian doctors have gone to the US to work because they can make more money there. Many of them have returned to Canada. The reason why is that they prefer to spend their time treating patients rather than fighting with insurance companies. More than that, they find it absolutely heartbreaking having to tell a patient that they can’t afford a life-saving or lifestyle-improving treatment for themselves — or far worse, for their children. That almost never happens to Canadian doctors.Death Panels don’t exist in Canada. If you need health care it is covered… Period.People don’t put off visiting a doctor because of the cost. This means that:people are healthier because illnesses are taken care of earlier when they’re easier to treat.health care costs are lower because patients are taken care of earlier in the disease cycle which usually means that it’s far cheaper and faster to treat.Doctors also spend far less time in Canada on billing/insurance issues. This makes doctor time much more efficient, and is part of the reason why health care in Canada is so much cheaper than in the US.Cover for out-of-hospital medication in Canada is spotty — some provinces cover it, some do not. There is a bit of a loophole in that medication (including things like chemotherapy and dialysis) received at a Doctor’s office or hospital is always covered.. There is currently a move to have medication costs covered by a national system. This would reduce the overall cost of health care in Canada.A single-payer health system increases taxes, but reduces medical costs to roughly zero. The net effect is very positive for the vast majority of Canadians. The vast majority of Canadians like our health care system. From time to time, there is a push (usually by US health insurance companies or their proxies) to move Canada back to a US-style health insurance system. The idea horrifies most Canadians.. We watch a lot of US TV (via cable) and we can see directly how the US system works (or, rather really, doesn’t work). We do not want that system.Doctors do have the option of leaving the universal health care system and going with a US style pay-as-you-go system. Almost nobody prefers to go that way.Canadians do have the option of going to private doctors outside the universal health care system and getting their health care done that way, with US style payment systems. Almost nobody sees the value of going that path.Now that you have a better understanding of how a real, live, universal health care system works, you can better explain why you might prefer the current US system.