End-of-Life Planning To Be Covered By Medicare in 2011
A new health regulation issued early in December revives voluntary end-of-life planning for elderly Medicare health care recipients, as reported in today’s New York Times. Democrats had dropped such planning from last year’s massive overhaul to health care legislation after heavy criticism by former Alaska Gov. Sarah Palin and some Republicans about ‘death panels.’
Actually, Palin went even further and personalized the issue by posting on her Facebook page that the President’s ‘death panel’ could ‘kill’ her ‘Down Syndrome baby.’ You can still read excerpts via Talking Points Memo such as:
The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.
I’m speaking here as the mother of a severely autistic 13 1/2 year old who, with my husband, Jim Fisher, spent a good part of 2010 putting together a Special Needs Trust for our son, not to mention our wills and living wills. A Special Needs Trust is ‘way to provide for the needs of [a] disabled child without making him or her ineligible for SSI (Supplemental Security Income) and other programs that require their users to have a limited income’—it’s just one of the legal and financial planning Jim and I, and parents of disabled children, have to undertake. If we don’t plan ahead now for our son’s care as an adult, and also when we are gone and when he himself is elderly, no one will.
Regarding the new Medicare regulation: The health care legislation that President Obama signed into law back in March authorizes Medicare coverage for ‘wellness visits’ or yearly physical examinations, during which doctors are to discuss end-of-life treatment as part of voluntary advance care planning. Individuals and their families can devise advance directives about having, or not having, aggressive life-sustaining treatments administered, should a person become too ill to express their wishes.
The Obama administration cited research by Dr. Stacy M. Fischer, an assistant professor at the University of Colorado School of Medicine, according to which “end-of-life discussions between doctor and patient help ensure that one gets the care one wants” and thus “protect patient autonomy” (go here for a PDF file of an article by Dr. Fischer).
Aside from revising the ‘death panel’ rhetoric, critics may argue that the new regulation is a thinly-veiled rewording of Section 1233 of the bill passed by the House in November 2009. Under Section 1233, Medicare was to pay for ‘consultations’ about advance care planning every five years. The new rule makes ‘annual discussions’ part of the wellness visit. The New York Times quotes Elizabeth D. Wickham, executive director of LifeTree, a ‘pro-life Christian educational ministry. She expresses concerns that ‘end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death. Patients, she states, will ‘lose the ability to control treatments at the end of life.”
But without any end-of-life planning, patients are left to the mercy of others their care when they are no longer to speak up for themselves. They have no control at all about what happens to them, with health care decisions left to whoever has power of attorney.
Representative Earl Blumenauer of Oregon was one of the Democratic members of Congress who had urged the Obama administration to cover end-of-life planning. While ‘very happy’ about the new regulation, he also noted via a November e-mail that ‘”this regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”’
Somehow, I have a feeling we will be hearing more about the ‘death panel’ myth by the likes of Sarah Palin.
Back in 2009, Palin completely missed the point by simplifying end-of-life and advance care planning into a catchy sound byte (‘death panel’—hell yes, that works!) crafted to stir people’s passions. She thereby did a real disservice to children likes her son and mine, not to mention scores of elderly Americans and their families. She and others will probably be upping ‘death panel’ talk and how ironic, as the whole point of end-of-life planning is to ensure the dignity and quality of individuals who are ill, who are disabled.
Photo by meddygarnet.