Here’s another short video (about five minutes) from pediatrician and author Dr Aaron Carroll, this time talking about the importance of getting written down in advance your personal preferences about end-of-life care, well in advance of a medical crisis, and ideally after discussing it with your doctor. He also talks about why Medicare still won’t pay for this.
A few additional points:
Thanks to a change in the law initiated many years ago by a Republican member of Congress, Medicare has long reimbursed doctors for discussing with patients their options for end-of-life care, but only after a patient has been diagnosed with a terminal illness or is near death. Otherwise, if you wanted to see your doctor for advice in preparing a living will while you were still healthy, you had to pay out of pocket.
There’s one partial exception: Since 2005 Medicare has encouraged doctors to offer patients an initial 30-minute “Welcome to Medicare” visit within six months of signing up for Medicare Part B, and while the visit is supposed to focus on a physical exam, medical history, risk factors, preventive care, and planning, advanced directives can in theory come up, time permitting. (Note, however, that neither this description of the “Welcome to Medicare” visit for patients nor this one for doctors mentions the subject.) Medicare still won’t pay for a visit specifically to get advice on preparing an advanced directive until a patient is approaching death.
The 2009 proposal Carroll refers to would have expanded this slightly to let Medicare pay for such doctor visits even while patients were healthy, up to once every five years. But because it was part of the House version of the Affordable Care Act, opponents looking for ways to attack the bill picked up on the proposed modest change as a way to scare the public into thinking care would be rationed. They incorrectly claimed the that it would actually require doctors to discuss end-of-life decisions with their patients at least once every five years. One source of this misrepresentation was Betsy McCaughey, a former lieutenant governor of New York turned right-wing political pundit, who made a number of questionable attacks on healthcare reform, including a claim that the House bill promoted “euthanasia for the elderly” and “would make it mandatory” that doctors tell their Medicare patients “how to end their lives sooner.” This was a blatant misrepresentation, but at least it had some weak connection to reality.
Much worse were the bizarre rumors of “death panels,” supposedly empowered to decide whether people were “worth” having their lives saved. The Mad Cow Zero for that claim was Sarah Palin, and for all I know Palin may even have believed it, at least initially. But it’s pretty clear that a lot of politicians and political hacks kept repeating what PolitiFact called the “Lie of the Year” even after it had been thoroughly debunked. Indeed, some have kept at it, and almost a fourth of Republicans believe them.
In the video above Carroll suggests that Medicare may soon finally adopt the change, as it should have done years ago. For a supporting view see this July 10 editorial from the Minneapolis Star-Tribune.