Today is the 50th anniversary of Medicare, an essential program in our healthcare system. On this auspicious occasion, I’d like to revisit one of the most controversial proposed changes to Medicare: death panels.
“End-of-life counseling”, also known as “advance care planning”, was included in the original draft of Obamacare. Unfortunately, due to politicians framing it as “death panels”, it got taken out of the final bill. Not surprisingly, “death panels” were voted “Lie of the Year” by Politifact in 2009.
The Centers for Medicare and Medicaid Services (CMS) is currently reintroducing end-of-life counseling for Medicare. Far from being death panels, end-of-life counseling is when the government pays your doctor to have a conversation with you (assuming you’re over 65). During this conversation, you and your doctor will discuss your end-of-life health care options and help you decide on what kind of medical care you want when you get sick. It might look something like this:
Doctor: Look, you’re going to die eventually. Let’s talk about when it’s ok for us to stop trying to keep you alive.
You: Why wouldn’t I want to be kept alive as long as possible?
Doctor: You might want to be kept alive, and that’s your choice, but often there comes a point where the doctors at the hospital know you’re about to die, but they legally have to keep trying to keep you alive.
You: Well that seems like a waste. I guess it’d be fine to pull the plug then. But if I had cancer, I’d want as much treatment as possible.
Doctor: Actually, chemo and radiation therapy can be quite painful. If there’s a very low chance of survival, would you really want to go through with it?
This conversation would obviously go differently for each person, but the goal of the conversation is to form an “advance care directive.” Do you want to be kept alive as long as possible at all costs? Do you want the plug pulled when the doctors are certain you’ll never wake up again? This directive expresses your medical wishes for end-of-life care.
Although your doctor is there to educate you, they are not there to make decisions for you.
Think of it as a death panel of 1: you. You get to decide your own fate.
You can base that decision on your religious beliefs, on detailed cost/benefit analysis of the medical care, or even with a Ouija board if you want.
Everyone dies. Talk to your doctor to learn what you’re dealing with.
And if you want to help your elderly loved ones make their own health care decisions, you can support the rule change that the CMS is currently proposing. There’s a lot of bureaucratic legalese there, but under “ADVANCE CARE PLANNING” is a provision for paying doctors for end-of-life counseling.
To let the government know how you feel about this issue, you can publicly comment here on the rule change from now until September 8, 2015. Section II.I.4.c (Roman numeral 2, letter I) is the specific section that deals with advance care planning codes.
To let us know how you feel, comment here or on twitter or Facebook, and we’ll let the NSA know to pass your comment along to CMS.
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