A reader suggested I forward Sunday’s post to the Naples Daily News for publication, and after reading these two pieces, I decided to do just that. I did some more research, tweaked and edited. Below is what I submitted earlier today. Hopefully it will be printed.
An unhelpful distraction from an important national discussion
On Sunday, the New York Times reported that starting January 1, “the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.”
Since then, much has been written about this, and today the Naples Daily News printed an opinion piece by Cal Thomas, a conservative columnist and FOX News regular, titled “Death panels? Palin’s warnings coming true.”
Needless to say, there’s another interpretation. But first, the facts.
One of the new Medicare benefits under the Affordable Care Act is coverage for an annual wellness visit beginning in 2011.
According to the regulation, “the annual wellness visit will include the establishment of, or update to, the individual’s medical/family history, measurement of his/her height, weight, body-mass index or waist circumference, and blood pressure, with the goal of health promotion and disease detection and encouraging patients to obtain the screening and preventive services that may already be covered and paid for under Medicare Part B.”
The annual wellness visit can – “upon agreement with the individual” – also include “voluntary advance care planning,” which is defined in the regulation as “verbal or written information regarding an individual’s ability to prepare an advance directive in the case where an injury or illness causes the individual to be unable to make health care decisions, and whether or not the physician is willing to follow the individual’s wishes as expressed in an advance directive.”
An advance directive is a general term that describes two kinds of legal documents, living wills and medical powers of attorney. These documents allow a person to give instructions about future medical care should he or she be unable to participate in medical decisions due to serious illness or incapacity. Each state regulates the use of advance directives differently; in Florida they are regulated by the Florida Agency for Health Care Administration.
This is the context within which the “death panel” fear-mongering is being revisited.
Unless we as a nation begin to tackle health care spending in the final weeks and months of life, we won’t really be able to control health care costs. Statistics abound, but here are just a few from a recent PBS Frontline special “Facing Death:”
- Nearly 70 percent of Americans die in a hospital, nursing home or long-term-care facility, yet 7 out of 10 Americans say they would prefer to die at home.
- More than 80 percent of patients with chronic diseases say they want to avoid hospitalization and intensive care when they are dying.
- Almost a third of Americans see 10 or more physicians in the last six months of their life.
- Patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending.
- Medicare pays for one-third of the cost of treating cancer in the final year, and 78 percent of that spending occurs in the last month.
- One large-scale study of cancer patients found that costs were about a third less for patients who had end-of-life discussions than for those who didn’t.
Personally, if I’m miserable and in pain, with no realistic chance of a cure, I can think of nothing worse than having my life prolonged by a lot of costly and ultimately useless procedures in a hospital or nursing home. It’s good to know that I can make plans before that happens so I’m cared for according to my wishes. That’s why I’m going to have a discussion about end-of-life care with my internist and prepare an advance directive, even though I’m not yet covered by Medicare.
And given the many competing needs for government funding, I think we as a nation need to begin the discussion of just how much end-of-life care should be paid for with our limited tax dollars. Allowing Medicare to pay doctors to advise patients – with their consent – about their options for end-of-life care is a reasonable, necessary, and important first step toward addressing this difficult issue.
Bandying about the phrase “death panels” is an unhelpful distraction from an important national discussion.
We have to get out ahead of this issue. Please consider sending a letter to the editor of your own local newspaper. Help offset the cries about death panels!