I don’t watch the news on tv regularly, nor do I read the daily newspaper, except for trying to con friends into copying the Sudoku for me. I listen to NPR most mornings in the car and get a brief news snippet, which is sometimes enough to avoid the fear and depression that most of the news incites. I have not followed all of the news on healthcare reform thoroughly, but I was intrigued by the flap over supposed “death panels”. Here is my understanding, which is based on what is written by reliable sources and my experience as a health care professional for over 20 years, 6 years of which were spent working in oncology.
First, the basics: Medicare is the government/taxpayer-funded health care payment plan for people over age 65. You still have to have “gap” insurance that you pay for yourself, that covers things Medicare doesn’t cover. That’s a whole other matter and I’m not going to cover it here. The original healthcare reform bill proposed by the Obama administration included a provision for Medicare to pay for annual wellness exams—a yearly physical. As part of this, Medicare would pay for doctors to discuss end-of-life care with their patients—and this discussion is voluntary, you have no obligation to have the conversation with your doctor if you don’t want to. What you may not realize is that doctors indicate how much time they spend with a patient during a visit, and they charge more to Medicare or whomever the insurer is for longer visits—so if they spend the time having the conversation with you, they can get paid, just like they get paid for any other service. Anyway, this means doctors could advise patients to prepare living wills, advance directives for healthcare, and those sorts of legal documents that specify what a person wants if they are no longer able to speak for themselves, as far as health care and heroic lifesaving measures, life-prolonging measures, etc, are concerned. If you have been hospitalized in the last 15 years or so, you know that even for simple things like childbirth, you are asked to provide a copy of your living will if you have one. So the idea of thinking about what you want done and writing it down, if something catastrophic or life-threatening happens to you, is nothing new. And hospitals cannot honor a living will or advance directive if they don’t have a copy (and life squads often don’t honor them—why call 911 if you don’t want to be saved?). So, the flap in the media was that some groups (the guilty shall remain nameless) were very opposed to Medicare paying doctors for their time to discuss your end of life wishes with you, if you chose to have the conversation in the first place (it was voluntary!). Let’s remember that these conversations are taking place during an annual physical—we are not talking about conversations at the bedside of a critically ill person. So again, some groups of people wanted to scare you by saying that allowing Medicare to pay a little extra to your doctor for time spent discussing what your wishes are for medical care at the end of your life, meant that there would be “death panels”, who could prevent you from getting lifesaving care if you wanted it. Doesn’t that sound ridiculous? I know it is ridiculous. There is no way, in our country where the answer to every unhappiness is to sue someone, that hospitals are going to stop providing lifesaving care without a legal document from a patient saying they don’t want lifesaving care, and the agreement of the family if there is one to speak for the patient. We are a long way away from anyone withholding lifesaving care that patient wants—it exposes the health care system to much risk for being sued.
So what’s my point, or rather, my opinion?
I don’t get how on earth the opponents to this part of the healthcare bill got from paying your doctor a few extra dollars to spend time talking with individual patients at a yearly check-up to “death panels” that mysteriously decide whether you live or die. That makes no sense to me and I think its a bunch of alarmist nonsense designed to scare all of us. That’s just not how it works. And I would argue that not paying doctors to spend the time on these conversations takes away your ability to get the facts and make a decision before a crisis occurs. I do not want anyone taking away my opportunity to think about and discuss such an important topic when I’m not sick and can think clearly about it. No one is trying to take away your freedom to decide what kind of care you want at the end of your life. There is research that shows that planning ahead for what kind of care you want or don’t want decreases stress and depression for your survivors—if you tell people what you want ahead of time, it eases their burden in a very difficult time. I think it is a great idea for people to be able to get the facts from their doctor about what kind of care they can have at the end of their life, and for the doctor to get paid for their time. If doctors can’t get paid for their time, they aren’t going to spend that time—they’re going to go on to the next patient for whom they can get paid. These conversations are important and you can’t get them from non-medical professionals. Your lawyer can’t really explain to you that if you want all the heroic measures, you will have broken ribs from CPR, you will be on the ventilator—the breathing machine—and at risk for pneumonia, etc. Nor will a lawyer be able to explain all the services that hospice offers if you and your family choose to use their services for the last 6-12 months of your life. These are conversations best had with your doctor first, and then with your family, so that they too know what you want. They want to know, when the time comes, that they are doing what you would have wanted. So let’s have the talks with the important people, write it down, and get the care we want.
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