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.