Washington Post columnist Charles Lane has written a piece that is dressed up as the antidote to Sarah Palin’s hysterical “Death Panel” fantasy, but in searching to empathize with the right’s point of view, he raises some specious objections to section 1233 of the House reform bill. This type of story can be worse than Palin’s crazy-talk, because it spreads misinformation in reasoned drag.
He starts out by telling the Deathers to take their meds, but then comes the “But still…”
Still, I was not reassured to read in an Aug. 1 Post article that “Democratic strategists” are “hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors.”
If Section 1233 is innocuous, why would “strategists” want to tip-toe around the subject?
Um, to keep from having to engage wackaloon former governors about paying for controversial, yet medically accepted, treatments?
I suggest reading the whole article, as I am going to boil it down to just a couple of key objections.
#1. If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?
This is pretty simple. The purpose of the public option is not just to lower costs through competition, but to put in place a set of minimum standards for benefits. One of the ways private insurance companies pick up cheap customers is to sell junk policies that don’t cover anything when you read the fine print.
Most of his other quibbles seem better aimed at medical ethicists than this piece of legislation. The cultural pressure to “die with dignity” is such that anyone who isn’t ready to pull the plug is viewed as an infantile moron. Still, most Americans who want to be kept on life support are more than capable of telling their doctors to go fuck themselves.
On the other hand, Lane has a pretty backward view of who should initiate “the big talk.”
Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.
There are two problems with this. First of all, who wakes up one morning and says, “Gee, I’m feeling pretty mortal today. Let me go get my death-planning done.” Maybe a handful of emo teenagers, who aren’t really the audience for this section.
Knowing this, if I, as a guy who wants to sit in my coma until the right Michael Bolton song revives me, don’t have a living will, what is to prevent my greedy kids from punching my card the minute I have a fainting spell?
Then, there’s this:
What’s more, Section 1233 dictates, at some length, the content of the consultation. The doctor “shall” discuss “advanced care planning, including key questions and considerations, important steps, and suggested people to talk to”; “an explanation of . . . living wills and durable powers of attorney, and their uses” (even though these are legal, not medical, instruments); and “a list of national and State-specific resources to assist consumers and their families.” The doctor “shall” explain that Medicare pays for hospice care (hint, hint).
The section he’s quoting is a definition of advanced care planning, not a directive. This sort of language is standard in health insurance contracts, and serve to enumerate exactly what a patient is entitled to. That way, a doctor can’t half-ass it and still expect to get paid. There are similar details given for preventative visits, so the doctor can’t say, “Eat good and exercise. That’ll be 100 bucks.”
He’s also quoting selectively from a very long passage that also sets forth rights regarding “orders for life sustaining treatment” several times.
Finally, there’s his misdirected summation:
Indeed, the measure would have an interested party — the government — recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don’t have to be a right-wing wacko to question that approach.
This is completely backwards. It is the medical community which has been conditioning people to “die with dignity” for years, not the government. In the end, people deserve to know what their choices are, and their doctors deserve to be paid to deliver that care. If you don’t like the advice doctors are giving about this, I suggest taking it up with them.
Plus, the idea that authorizing payment for care is an “incentive” for treatment doesn’t make any sense. Are we incentivizing doctors to put random casts on people by paying for them?
I think Lane heard a horror story from Sarah Palin, and whistled bravely through section 1233.