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How Will Health Care Reform Affect End-of-Life Care?


Updated April 05, 2010

Question: How Will Health Care Reform Affect End-of-Life Care?
One of the most hotly debated aspects of health care reform is in regard to how it will affect end-of-life care. Politicians have fueled the debate with their talk of "mandatory death panels" and "killing off our old people" by pushing them in to hospice care.

It's more important now than ever to understand the end-of-life lingo and separate truth from lies about health care reform.

So, how will health care reform really affect end-of-life care?

Answer: It's important to understand what end-of-life care is before we can discuss how health care reform will affect it. End-of-life care refers to the medical, social, emotional, and spiritual care that someone receives in the last several months of their life. The most common form of end-of-life care is hospice care.

Hospice is a philosophy of care that focuses on comfort and quality of life. Hospice is only appropriate for someone who has a life expectancy of six months or less and wants to focus on managing symptoms, such as pain and shortness of breath rather than pursuing aggressive, curative treatments. Hospice patients have access to palliative care physicians, 24 hour on-call nursing care, social and emotional support, and spiritual counseling.

Hospice is paid for by the Medicare Hospice Benefit. Medicare recipients on hospice care receive all the benefits of hospice and never see a deductible or co-pay. State Medicaid and private insurances also cover hospice care but coverage may differ from the Medicare Hospice Benefit.

Hospice as Euthanasia?

Inflaming the health care reform debate is the misguided claims that physicians will be encouraged to push their patients in to hospice care instead of pursuing aggressive, more costly treatment. Some of these claims have gone so far as to call hospice "euthanasia."

These claims are not only misguided, they are downright false. Hospice is NOT a form of euthanasia. Hospice professionals are not in the practice of intentionally ending a patient's life or intentionally hastening death. They are there to support a patient's wishes for how they choose to spend the final stages of life.

Health Care Reform and the "Death Panels"

The idea made popular by Sarah Palin and New York's former Attorney General Betsy McCaughey is that the government would make it mandatory for all Medicare recipients to undergo end-of-life counseling sessions "that will tell them how to end their life sooner". These so-called "death panels" would essentially be a way for our government to decide who was worthy of receiving expensive medical care and the elderly and frail would be at the bottom of that list. These poor elderly and sick people would be "killed off" if our government had their way.

This is a flat-out lie.

One version of the bill included a provision to pay for end-of-life consultations every five years. These proposed consultations would NOT be mandatory and would be patient-led, meaning that patients get to choose their path of care, not the physician. The doctor's part in the consultations would be to present all available treatment options to the patient, including hospice and palliative care. These consultations were also meant to discuss the important task of planning ahead with advance directives or living wills - something patients of all ages should be considering. The intent was for the patient to have the opportunity to learn about end-of-life options and choose the treatment plan that suits their personal goals and beliefs.

Many physicians today are reluctant to discuss end-of-life care. They may fear that bringing up options to discontinue aggressive care or go with hospice care will be viewed as a failure on their part to "fix" the patient. Unfortunately, this sometimes means that patients continue to get care that is uncomfortable, sometimes dangerous, and possibly futile without ever knowing they have another choice.

This provision in the health care reform bill would have helped facilitate important discussions between patients and their doctors so patients can make their wishes known. This would NOT have been our government's way of rationing health care or limiting what care the frail and elderly are entitled to receive.

Because this part of the health care reform bill became so controversial, the entire provision was left out of the final bill that President Obama signed on March 23, 2010.

Here are details on how health care reform will affect hospice care.

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