This blog printed on 100% recycled electrons.
Watching Jon Stewart's interview with death-panel myth originator Betsy McCaughey1, it occurred to me that we are the death panel. You, me, anyone who signs a living will. Ah, but not every living will: only those living wills that ask for the doctors to at some point stop trying.
To the details: McCaughey continually cited "Page 432" of H.R. 3200, the House bill on health care reform.2 Here on the Net, it's not page 432; it's Section 1233(b)(3)(A)3, archived at this URL: http://www.opencongress.org/bill/111-h3200/text?version=ih&nid=t0:ih:2880. The text (which Stewart read verbatim after McCaughey's flustery page-flipping):
For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.
In other words, H.R. 3200 adds living will consultations and adherence to the 153 quality measures that are already part of the Physician Quality Reporting Initiative (PQRI). Doctors get an incentive for reporting this data (2.0% this year).
McCaughey says this provision will give doctors incentive to deny care and let patients die against their wishes. In her nightmare scenario, you sign a living will saying you don't want to be kept alive on a ventilator, then come to the hospital four years later with some serious trauma. Facing death, you change your mind and decide you'll take the ventilator, but the doctor says, "Uncle Sam will slap me if I don't adhere to your living will, so I'm not hooking you up."
But Section 1233(b)(3)(A) causes no such thing. This provision only calls for the doctors to report their assistance in creation of and adherence to living wills. They get their incentive for reporting. Even if a doctor goes ape and doesn't consult on or adhere to a single living will, as long as she faithfully reports that non-adherence, she gets her PQRI incentive.
Under Section 1233(b)(3)(A), the only person deciding that a patient will die—or live, or fight to live, or get treatments A, B, and C but not D—is the patient. The patient chooses to have an advanced care planning consultation (which, under HR 3200, Medicare pays for). The patient writes down her wishes in a living will, a document the patient can modify at any time4. And if the patient comes to the hospital and can't express her wishes, the doctor has her wishes on paper to follow, whatever those wishes may be... or at least may have been when that document was signed.
Not one line of H.R. 3200—not McCaughey's vaunted "Page 432" or "Page 425" anything else—empowers any government official to decide when to "pull the plug on Grandma," a claim that even the progenitor of that snappy phrase, Senator Charles Grassley, has completely repudiated. Senator Grassley agrees: the only person making end-of-life decisions under H.R. 3200 is you.
So who is the death panel? Right now, if you don't have a living will, it could be your kids, your doctors, your obstinate daughter-in-law, who knows who. If you get a living will, it's you... and H.R. 3200 will pay for your effort to get informed and put your choices in writing.
Oh yeah, and H.R. 3200 will help millions of Americans get insurance, save money, and save lives.
1Update 12:05 CDT: The day after her embarrassing performance on The Daily Show, McCaughey resigned from the board of Cantel Medical Corp. What?! a deceptive opponent of health coverage reform was working for the medical industry?!
2She cited it, but after making a show of lugging what she said were the first 500 pages of the bill on stage, she couldn't find it, didn't have it sticky-noted or highlighted or even, apparently, in sequential order. She looked like a novice debater, rolling into a debate round with five tubs of evidence but not able to find her central Disadvantage argument.
3Did you notice that McCaughey tried to make it sound as if Sec. 1233 and "Page 432" were different parts and that if Stewart had only read Sec 1233 he wasn't talking about the part of the bill with which she was defending her position?
4HR 3200 pays for end-of-life consultations once every five years. The bill makes an exception for folks whose medical/care situation changes significantly. And even if you don't qualify for that exception, nothing stops you from going to your doctor or lawyer and changing your living will as often as you want; you just pay for those visits yourself.
