Health care provocateur Betsy McCaughey is pushing back against critics who claim that the end-of-life counseling provision in the House bill is “voluntary.” “Partisans for the legislation claim that it simply aims to provide Medicare coverage for once-every-five-year conversations with doctors over end of life care. Wrong,” she writes.

In fact, after initially claiming that “the Congress would make it mandatory, absolutely require, that every five years, people in Medicare have a required counseling session that will tell them how to end their life,” McCaughey is now arguing that the bill does not directly mandate the sessions. Instead, the language would encourage doctors to perform consultations by basing a “doctor’s quality” and reimbursement levels on “the percentage of your doctor’s patients who create living wills and adhere to them.” “Doctors will incur penalties when families don’t adhere to end of life plans,” she argues:

Partisans for the legislation claim that it simply aims to provide Medicare coverage for once-every-five-year conversations with doctors over end of life care. Wrong. The new “benefit” is inserted in legislation with the express purpose of controlling health care costs (page 1). The bill lists what must be covered in the consultation (pages 425-30). Worse still, the legislation states that the Medicare system will rate your doctor’s “quality” and (and adjust reimbursement) based on the percentage of your doctor’s patients who create living wills and adhere to them.

McCaughey’s claim that the benefit’s express purpose is to “control costs” is an outright invention. Page 1 of the bill doesn’t even mention the provision. Moreover, if the bill pegged a physician’s reimbursement to the actions of the patient, then it could potentially be construed as coercive. But pg 432 of the House health bill allows the provider to offer a patient a comprehensive perspective of end-of-life counseling and adhere to certain quality standards. Nowhere does the language connect a physician’s “quality” or “reimbursement” with “the percentage of your doctor’s patients who create living wills and adhere to them.”

Ironically, the “quality standards” language that “patient advocate” McCaughey is perverting are intended to encourage doctors to provide patients with comprehensive information about end-of-life decisions and protect patients from incomplete or improper sessions.

This morning, as the President Obama prepares to address the Veterans of Foreign Wars in Phoenix, Arizona, “conservative groups including Americans for Prosperity are planning to protest” greater government involvement in the health care system. But like Medicare recipients who oppose government interference in the health care system, opponents of a public option should be weary of denouncing ‘government care’ in front of veterans who rely on the Veterans Health Administration.

The VA “outpaces other systems in delivering patient care,” consistently delivering higher quality health care more efficiently.

A recent study by the RAND corporation found that “VA patients were more likely to receive recommended care” and “received consistently better care across the board, including screening, diagnosis, treatment and follow up”:

The study also concludes that “if other health care providers followed the VA’s lead, it would be a major step toward improving the quality of care across the U.S. health care system.” The public option — a frequent target of critics who argue that government health care would ration care or provide subprime coverage — would push health providers to adopt some of the VA’s delivery system reforms.

A public health insurance option is not a threat to Americans with private health insurance coverage; it’s an important component of the nation’s public-private health infrastructure. In 2008, federal, state and local governments contributed 47 percent of health care spending and if the VA system is any indication, then rather than intruding between the patient and the doctor or rationing care, federal dollars have only improved access and enhanced the delivery of care.