Friday, April 16, 2010

President Obama's 'order' on hospital visitation

A lot of discussion has gone on about Friday's headline: Obama extends health care rights to gay partners

On its face, this headline is misleading... health care rights were not extended by the president's order. The word rights is being tossed around so often that it's meaning is being diluted. Specifically, according AP:

[Obama's instructions said] Medicare-Medicaid1 hospitals, which include most of the nation's facilities, may not deny visitation and consultation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity or disability.

So there was no designation of health care rights for anyone... what the order does do is streamline the process to permit a patent's visitors getting access to the patients bedside. And that, in and of itself, is not a bad thing.  Specifically, during an illness or recovery from an accident, having a loved one nearby is often as good or even better medicine than any of the wonders of modern medicine.   Naturally, hospitals have a vested interest in limiting who and how many visitors may be bedside, according to staffing, patient count, and the severity of the patients illness.   But the overall question of a significant-other or other officially designated person being able to go bedside is not in question, nor should it ever be so.

However last night I questioned how President Obama could force a hospital extend/deny anything to anyone... he is Commander in Chief, but there are limits to his executive powers. And on this point I am still unsure where his authority to issue such an order comes from.

Last night I posted that question on Twitter , even pointing out that with a Health Care Power of Attorney, a hospital couldn't deny any such named person from accessing a patients bedside.  A short time after my tweet, I was questioned by a follower, K_Golden, whether my much-better-half would need a POA to visit me in the hospital?

My initial response was that question raised a fair point, but that I know gay couples who have POAs and who have not encountered visitation problems. But that issue was completely besides the point I was raising regarding a very-probable abuse of power by President Obama (at least in my opinion). 

Upon reconsidering the issue (one of the mixed-blessing of my long commute), it occurred to me that the longer I thought about it, the more her point seemed less fair than I originally believed.  Not only do I know gay couples who have POAs, I also know a hetero-couple who live together and have POAs for each other. They are not married, but have the document that allows them to assist the other in the event of illness.  

And it was then it occurred to me that my much-better-half and I do, in fact, have health care POAs for each other... we had them drawn up when we did our wills.

And then it hit me: she and I also have a POA by proxy, in that we signed a marriage license (how I managed to convince her to do so is still a mystery to all).

Now, we can discuss the issue of gay marriage, but that would be a separate thread entirely, and one that I will not entertain tonight. The focus of last night's tweet and tonight's post centers on President Obama's order, which I believe is nothing but window dressing; there's nothing here that addresses any need that wasn't already provided for under current law.  Further, despite what the so-called unbiased media may lead you to think, it confers no health care rights to anyone. 

Since the AP story reports that a couple in Miami were kept apart because a hospital refused to follow the advanced health care directive -- a particularly heinous act under the reported circumstances -- a more appropriate action for the president would have been to remind hospitals that they're obligated to follow the law vis-a-vis POA, and perhaps recommend the DoJ investigate whether this sort of abuse is widespread.   That is clearly what a chief executive ought to do, instead of issuing what best can be called a questionable order

1On a completely separate thought, watch for more hospitals and medical facilities to join the ranks of doctors who no longer accept Medicare/Medicaid;  my kid's doctor have already opted out, so if I lose my job, hypothetically, this could be a big problem for me.  And this is another reason why the president's order would have better been an advise regarding the applicability of POAs.

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