Wednesday, September 9, 2009

Parsing H.R.3200: End of Life Care Provisions

Typically, I've tried to tackle political issues on this site without the use of ideological talking points; besides the fact that I abhor the concise, pre-packaged way of thinking about the world that is advanced on cable TV networks, I find it much more constructive to 1) assess who is likely to win upcoming elections, and 2) point out blatant dishonesty when I see it. Now, because of the dishonest nature of politics, I was forced to insert the word "blatant" into the previous sentence. That is to say, I only feel like the most egregious acts of political dishonesty are worthy of discussion. That being said, on the eve of President Obama's Congressional address concerning health care reform - an effort that in my opinion will ultimately be viewed as a failure - I'd like to go head first into the topic of HR 3200 and End of Life Care Provisions. Depending upon your political disposition, you may prefer to use the term "death-panels"; I however, will refrain from using this sort of dishonest innuendo-laden terminology.

My assessment of HR 3200 and it's end of life care provisions is based upon a research report prepared by the Congressional Research Service. The CRS is sort of like the policy analysis equivalent of the Congressional Budget Office; it produces objective legislative and policy analysis that is relevant. For those who don't have time to consume the full report, I'll summarize the portions of HR 3200 that deal with end of life care below.

Advance Care Planning
HR 3200 would expand Medicare to cover an advanced care planning consultation with your physician. This consultation would be completely optional, and would allow adults to have a discussion with their doctor about the various stages involved in end of life care. It would also provide patients with the education they need concerning "health care proxy's", or the appointment of a spouse or other family member who can effectuate medical decisions in the event the beneficiary has become incapacitated. This provision would also standardize end-of-life-care preference statements across jurisdictions so as to avoid confusion.

Quality Measures
This provision would incentivize physicians to report on end of life treatments from a quality perspective; that is, whether the treatment rendered helped improve the quality of the patient's life. Since improving quality of life should be the underlying purpose behind any end of life treatment, it seems that a centralized Medicare data collection initiative would have the best chance of maximizing that goal. This provision does not in any way institute panels which would make end of life decisions; it simply gives physicians a 2% bonus for reporting the effectiveness of a procedure.

Educational Aspect
Finally, the bill would update the well-known Medicare handbook titled "Medicare and You" to include language about advanced care planning. A separate House Energy and Commerce Committee amendment would direct the HHS secretary to establish a toll-free national hot-line that would provide answers to questions about advanced care planning.

There you have it. The above provisions are the only ones included in HR 3200 that deal with end of life issues. There will no be no government bureaucrats deciding whether you live or die. The ironic thing about that argument is people pretend there isn't already somebody else making these decisions for them. Given that very few people can actually pay cash for medical procedures, they are always relying on either an insurance company or the government to pay for them. In the case of the elderly, they are on Medicare, so the government is already making judgments concerning their benefits. This is the sort of thing that gets fleshed out in an intelligent debate; however, I haven't seen very many of those occurring. Sphere: Related Content

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