Thinking About Health: Medicare helps with end-of-life counseling
December 4, 2015
What a difference six years makes!
In 2009 at the height of the debate on the Affordable Care Act, New York's former lieutenant government Betsy McCaughey appeared on television and made this startling remark: "Congress would make it mandatory-absolutely require-that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner."
McCaughey said the proposed law would help the elderly learn how to "decline nutrition, how to decline being hydrated, how to go in to hospice care… all to do what's in society's best interest or in your family's best interest and cut your life short."
Her remarks, though false, played well in the media. Former GOP vice presidential candidate Sarah Palin showed up on TV to talk about "death panels" that she and others claimed would ration care at the end of life.
"No death panels" became a rallying cry for opposition to the health law. A man I interviewed at a Pennsylvania Wal-Mart that summer brought up the so-called death panels. "If people are going to die, he [Obama] is going to put them to sleep," he told me. "It's like Soylent Green (a 1973 science fiction movie). That's his health plan."
Another man I met outside a church in Scranton told me, "I am against a panel of doctors telling you when you can live and die." When I explained that wasn't what the law would do, he said he didn't believe me.
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If the death panel hysteria taught us anything, it's that false beliefs die hard. Polls from the Kaiser Family Foundation conducted from 2010 through 2014 repeatedly found that 30 to 40 percent of respondents mistakenly believed that the health law established a government panel to make end-of-life decisions for Medicare beneficiaries.
In the wake of the political storm that followed the death panel hysteria, Congress dropped provisions in the ACA that would have paid doctors to counsel their patients about end-of-life treatment. Later Medicare tried to add such consultations to a package of proposed regulations but again scrapped the idea because as Oregon Rep. Earl Blumenauer, who championed the provision, told the New York Times, "The administration got cold feet and yanked it."
But "the times they are a changin'." With hardly a peep of opposition Medicare announced in October that beginning next year it will pay healthcare professionals, including nurse practitioners, for discussing end-of-life decisions with their patients. In fact, Medicare said a large majority of the public comments on the proposal agreed the time has come for such consultations.
A new Kaiser poll found that about 89 percent of adults say doctors should discuss end-of-life care issues with their patients and 81 percent reported said they believed Medicare should cover those discussions. "Almost universally, people say doctors should be talking to their patients about this," Lisa Hamel, who directs Kaiser's public opinion research, told the Times. But when Kaiser asked people if they had had these discussions only 17 percent said yes. Half of those who had not had such conversations said they wanted one.
Americans are just not comfortable discussing death and care at the end of life. Medicare payments might just be the spark needed to make such conversations more likely. Doctors and other healthcare professionals will be able to bill Medicare $86 for the first half hour conversation in a doctor's office and $75 for an additional 30 minutes. And if a doctor needs to talk later on about the subject, Medicare will pay again.
No one, however, should think those relatively small payments will instantly make it easier for seniors to have their wishes carried out. Even if they do what the doctor advises and set up powers of attorney, make advance directives, and fill out other documents that specify what kind of care they want or don't want if they become incapacitated, the decision could be taken from them.
Families often complain that treatment decisions are still made by hospitals and doctors and that even when patients and their families say they don't want extraordinary measures, it's hard to buck the ingrained culture of medical professionals trained to do everything possible.
Still, we've moved way beyond where we were in that summer of 2009, and people preparing for the consultations with their physicians might want to consider the following:
• Keep your wishes up to date in legal documents.
• Have end-of-life discussions with your family before an illness strikes.
• Make sure the person with your power of attorney knows what he or she is supposed to do.
We'd like to hear about your end-of-life experiences with family members. Write to Trudy at firstname.lastname@example.org.We’d like to hear about your end-of-life experiences with family members. Write to Trudy at email@example.com.We'd like to hear about your end-of-life experiences with family members. Write to Trudy at firstname.lastname@example.org.