Is What I Hear True?

I heard that...

...healthcare reform will make older people and the disabled face a panel of government bureaucrats who will decide when and how they would die. Is that true?

This is not true. The Patient Protection and Affordable Care Act (PPACA) includes sections about advance care planning, which is not about making people die. It is about helping them get the care they want and avoid care they don't when they are unable to make their wishes known due to illness or injury.

The PPACA includes language about planning healthcare at the end of life. In general, the law encourages patients and doctors to talk ahead of time about the care the patients want if they cannot make their wishes known due to injury or other circumstances. This “advance care planning” helps people get the care they want and avoid the care they may not want.  It is not about making any people die.  Advance care planning is not required, nor does the House bill or other proposals allow the government to interfere.

Some people want every possible measure taken to try to save their lives, even if they may not recover or have a good quality of life.  Others do not want surgery or invasive procedures if these will cause pain and won't make a difference in the quality of their life or how long they live.  When there is no one who knows what the patient wants and there are no documents stating these wishes, doctors and families sometimes do every procedure they can think of to keep a person technically alive.

Advance care planning gives a person a voice in decisions about healthcare even when that person is unable to say what kind of care he or she wants. Someone may be very ill or unable to indicate what kind of care they want. An advance care plan lets people make their wishes known before they get in this situation, and can help the patient's family deal with difficult situations.  Advance care plans, under current state laws already in place, may include one or more of the following:

• setting up a written advance directive (permitted by law in some states)
• naming a proxy to make decisions (a medical or health care power of attorney)
• naming a durable power of attorney
• creating a living will (permitted by law in some states)

For example, think about the case of Terry Schiavo, who was severely brain-injured as a young person and who did not have any advance care directives.  In 2005, after her family disagreed about what was the right care for her, her case ended up in the courts. It also became a topic for news commentators and politicians who spoke about what they thought should be done. 

"Advance Care Planning" is covered in the House of Representatives bill (H.R. 3200). A description of the provisions, and a link to the exact language from the bill, is included below. The main Senate healthcare reform bill, which does not yet have a reference number, is the Affordable Health Choices Act, also known as the "Kennedy Bill" and the "HELP bill." This bill was reviewed and approved by the Health, Education, Labor and Pensions (HELP) Committee. The first version contains no reference to advance care planning or end of life care. However, the bill has several amendments, not yet made public, and may be reviewed and amended by other Senate committees. The entire bill, as introduced on June 9th can be found here: http://help.senate.gov/BAI09A84_xml.pdf  

The House Bill.In the proposed House of Representatives bill, H.R. 3200, also called the America’s Affordable Health Choices Act of 2009, there is language that provides for voluntary  "advance care planning consultation” between a patient and his or her personal doctor (including nurse practitioners and physicians' assistants in some states). Currently, Medicare does not pay doctors  to help patients with advanced care planning, although many doctors do help.  The bill makes the advance care planning a Medicare "covered service." This means that the doctor can be paid for helping patients figure out what kind of care they want, and how to get it done in their state (The legal requirements vary from state to state).  H.R. 3200 also defines what activities shall be done, if state law permits it, in order for the doctor to be paid for advance care planning. 

Advance Care Planning Consultations can be found in Title II: Medicare Beneficiary Improvements, Subtitle C: Miscellaneous Improvements, Section 1233. You can find this section (as originally introduced, without amendments) at http://thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/~c111N3D2UG:e513253::.  Because several committees are reviewing the bill at once and are making suggestions for amendments, a final version of the bill has not yet been produced.  For updates and changes to the bill, please visit http://thomas.loc.gov/cgi-bin/bdquery/z?d111:H.R.3200:.

CONTACT US