Beyond the shouting — understanding reform

Andrew Cannon
Andrew Cannon

Vigorous debate between proponents and opponents on the merits of congressional health reform proposals has, in recent weeks, descended into shouting matches. Unfortunately, understanding of the proposed reform has not always been as deep as the passion on the topic.

Recent discussions have brought attention to a provision deep within the proposal regarding end-of-life counseling for Medicare recipients. Opponents have suggested that the provision opens the door to euthanasia.

A closer look at the actual provision, however, shows that these concerns are overblown. The critical language in the proposal produced by the House Energy and Labor, Education and Labor, and Ways and Means committees reads:

“[T]he term ‘advance care planning consultation’ means a consultation between the individual and a practitioner … regarding advance care planning … Such consultation shall include the following:

“(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

“(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney and their uses.

“(C) An explanation by the practitioner of the role and responsibility of a health care proxy.

“(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning …

“(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title. …”

The provision would allow Medicare to reimburse medical professionals for voluntary end-of-life consultations with Medicare patients. Such consultations would allow Medicare enrollees to make medical decisions before being incapacitated by an illness, or allow the patient to transfer the medical decision-making power to a loved one (a “health care proxy”).

As Senator Johnny Isakson, R-Georgia, pointed out, this provision actually protects Medicare enrollees and their families:

“[T]he most money spent on anyone is spent usually in the last 60 days of life and that’s because an individual is not in a capacity to make decisions for themselves. So rather than getting into a situation where the government makes those decisions, if everyone had an end-of-life directive or what we call in Georgia ‘durable power of attorney,’ you could instruct at a time of sound mind and body what you want to happen in an event where you were in difficult circumstances where you’re unable to make those decisions.”

The “practitioner” described in the legislation is carefully defined and limited as being only a physician, a nurse practitioner, or a physician’s assistant. The relationship between a patient and his or her care provider is in no way disrupted by government officials or an anonymous “panel.”

The provision would block reimbursement for counseling promoting euthanasia as an option. Euthanasia and physician-assisted suicide remain illegal in the majority of states, including Iowa, and this provision does nothing to alter that.

Though the recent discussion of the end-of-life counseling provision in the health reform proposal has brought a considerable amount of disinformation and heated rhetoric, it has brought attention to a service that has been long overlooked.

Jon Radulovic of the National Hospice and Palliative Care Organization told Kaiser Health News that that the discussion is “providing the end-of-life care community with an opportunity to talk about what good care is and the services that are available.”

While the subject of vociferous and inaccurate protests, the end-of-life consultation provision has been endorsed by a number of advocacy and medical groups, including the AARP, the American College of Physicians, and Consumer’s Union, among others.

Posted by Andrew Cannon, Research Associate

Iowa Uninsured: New — Startling — Numbers

Families USA today released a new report that crunches more numbers about uninsurance in Iowa. The numbers are startling.

Mike Owen
Mike Owen

According to the nonpartisan organization, about 686,000 Iowans — about 1 in 4 under age 65 — were without health insurance at some point during 2007-2008. We typically see figures for uninsurance in Iowa just under 300,000, but those figures are from Census data designed to reflect people uninsured for an entire year.

This new study looks at that Census data and other sources to determine how many people were without insurance for a portion of two years — and Families USA director Ron Pollack emphasized, the study took care not to duplicate anyone in the count.

The study found:

  • •  More than 1 in 4 (about 27 percent) of non-elderly Iowans were without insurance for some part of 2007-08.
  • •  Of the 686,000 uninsured Iowans in that period, about 70 percent went without insurance for six months or longer.
  • •  Most of the uninsured — about 85 percent — are members of working families.

This is as much about the insecurity caused in the current economy as anything.

It was of concern enough before to know of almost 300,000 Iowans being without insurance, whether it’s over a full year or for one or two months.

A lot can happen in a time of uninsurance that jeopardizes a family’s financial security — not to mention the overarching concern of assuring that people have access to quality health care when they need it.

As the Families USA report shows, people can be working and still not have access to health care.

Our own research has shown:

  • •  Job trends keep showing that growing sectors (which are few right now) are sectors that are less likely to pay well and are less likely to offer health-insurance benefits.
  • •  Those trends also show that declining sectors are the ones where pay and benefits have been better.
  • •  The combination of these trends means that it’s more difficult to get insurance through employment.

We had seen these trends backed by Census information in the past, as well as the clear evidence of the value of public health insurance in keeping the situation from getting worse.

The Families USA report is an important addition to the factual discussion on which sound public policy decisions may be made regarding health care. In the research community, we welcome these findings.

Posted by Mike Owen, Assistant Director