If you’re getting older, or you’ve got an aging parent, you’ve no doubt heard the latest misinformation campaign about health reform – it will kill old people. Or depending on the source of the rumor, it will use tax dollars to euthanize the elderly, counsel them on suicide, or flat-out deny them care until they die.
President Obama was even asked about this at a recent AARP town hall. “I have been told there is a clause in there that everyone that’s Medicare age will be visited and told to decide how they wish to die,” the woman told the President. “This bothers me greatly, and I’d like for you to promise me that this is not in this bill.”
Obama’s response – it’s not in the bill, promise. What is in the bill is language to help people understand advance care planning and living wills. He said, “The intent here is to simply make sure that you’ve got more information, and that Medicare will pay for it.”
But that hasn’t stopped the health-reform-killing-old-people rumor train from gaining more steam. The blogosphere is seething, and is fed by folks against reform such as Betsy McCaughey in the Wall Street Journal, who wrote, “The counseling would be focused on telling seniors how to end their lives, and it will be against the law to pay for any care that has been denied…The message is clear: Government can save money by encouraging old people to die.”
It’s a brilliant tactic to scare seniors from supporting health reform. The opposition knows seniors are more vocal, and more likely to vote, and what better way to get them to oppose reform than to tell them it would kill them.
So let’s have some facts. AARP has laid out the specific language here, but here is what the provision would do:
Every five years, Medicare will pay for counseling between you and your healthcare professional that includes:
• An explanation of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
• An explanation of advance directives, including living wills and durable powers of attorney, and their uses.
• An explanation of the role and responsibilities of a healthcare proxy.
• A list of national and state resources to assist consumers and their families with advance care planning.
• An explanation of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports available under Medicare.
• An explanation of orders regarding life sustaining treatment or similar orders. The consultation may – or may not – include the actual formulation of an order regarding life sustaining treatment or any advanced directive, and it must be signed by the medical provider (doctor) and the individual. It will state the individual’s preference for treatment and will stay with them, and must be followed by healthcare professionals.
“The only new thing about the bill is that Medicare will pay for end-of-life counseling every five years,” AARP’s Jim Dau told Businessweek. “If you decide to take one of these consultations, you don’t have to sign any document before you leave — no advance directives, no living will. These are, as they should be, completely optional.”
It’s completely understandable that talking about end-of-life care, living wills and advanced directives is frightening. No one really likes to think about it, let alone plan for it. But the thing about fear is, the more facts and information you have, the less frightening it can be. Having a discussion with your doctor, who knows the facts and medical realities, could help dispel much of the fear, and the myths, about this part of life.
I know first-hand the emotional devastation a family endures when a member doesn’t have an end-of-life plan. My grandmother was one of the most fiercely independent, loving, funny and beautiful people I have known. She so enjoyed her freedom that she lived by herself in an apartment until her mid-90s, turning down an offer to live with her daughter in a retirement community because she wanted to be around a mix of young people, not “a bunch of old folks.”
My grandma didn’t have much, but made sure she wrote down who would get her favorite photos, dinner plates and sewing box. But she never wrote down an end-of-life plan, though she told most of us how she wanted to go – on her own. When she was hit by a major stroke, unable to speak or walk, her only surviving daughter was left with the decision to keep her alive through a feeding tube and oxygen, or let her go without help. It was an agonizing time for the family, but worse for my aunt, who struggled for days before making the decision for her.
That experience taught me the value of making my own decisions about how I want to be treated near the end of my life. I tend to believe that those who included this provision in the health reform bill want to give others good information that will help them do the same.