Betsy McCaughey was on The Daily Show last night. Don’t know who she is? Lucky you. She seems as mental and single-minded as Orly Taitz (Queen of the Birthers), but her personal gripe is the “mandatory” end-of-life counseling in the health care reform bills … which isn’t mandatory at all and has nothing to do with the euthanizing old people.
Her particular complaint at the moment seems to be that living wills and so on are mandatory, even though the bill says no such thing, and that this will lead to killing old people against their will and doctors working within the Medicare system being chastised (in the form of lower pay) for not killing old people. Her proof? A single sentence from one of the House versions of the health reform bill, in a section that will amend the Social Security Act, which involves the quality reporting system employed to collect data on the quality of care received by beneficiaries of Medicare.
Such measures shall measure both the creation of and adherence to orders for life sustaining treatment.
If that seems rather innocuous to you, it should. When reading the section of the proposed health reform bill in the context of where this section will be placed in the Social Security Act, it boils down to this:
Doctors who treat Medicare patients can voluntarily take part in what is known as the Physician Voluntary Reporting Program, which I mentioned earlier is designed to gather data to improve outcomes for Medicare recipients. Please note the word “voluntary” in the name of the program. Doctors do not have to take part in the reporting. There is nothing mandating they report anything to this program.
This data is then used by Quality Improvement Organizations, which, as the name might imply, work to improve the quality of care for Medicare recipients. Once again, this is voluntary on the part of hospitals. They do not have to be involved with these organizations, though I do think it should be noted that hospitals taking part do seem to give better quality care. Also the QIO handle patient complaints and appeals about their care and rectify these situations.
All this still seems very innocuous and, in fact, helpful. It’s all entirely voluntary, and no hospital or doctor is in any way required to take part in any of the data collection or quality improvement measures. There’s two-thirds of her argument in the trash can right there.
But wait! She insists it is mandatory, even though she admits it never says any such thing! Her proof in this case is Medicare’s Pay-for-Performance Initiatives. These initiatives are essentially bonus payments to hospitals and doctors who provide outstanding care and have the best outcomes. She says doctors providing care for Medicare recipients will have their pay from Medicare cut if they don’t force patients to have the end-of-life counseling and file end-of-life care orders. She is, of course, not speaking the truth.
To begin with, the quality of care for the Pay-for-Performance Initiatives are tied, once again, to the voluntarily provided data collection previously mentioned, as well as on patient complaints about the care they have been provided, and data collected on whether or not the health care providers are following the standard Medicare protocols. In short, health care providers not following Medicare protocols and/or having numerous patient complaints and/or not working to improve the quality of care they provide will not receive bonus payments from the Pay-for-Performance Initiatives for improving care or providing outstanding care with excellent outcomes.
Yes, I said “bonus” payments. Not receiving a bonus is not the same as having one’s pay cut. What won’t happen is the doctor or hospital getting paid less than the standard Medicare payments, so long as they are following protocols and aren’t providing horribly substandard care (which would lead to larger problems than not getting a bonus). They just won’t get a bonus. A bonus is –or should be– something one receives for going above and beyond and doing a great job.
Now that I have addressed her irrational and ill-conceived argument against the end-of-life counseling provision in the health care reform bill(s), let me share my thoughts on the matter.
I have no problem with health care providers taking part in voluntary reporting and programs designed to improve the quality of care they give. I have no problem with said health care providers receiving bonus payments for providing exceptional care. In fact, I would have no problem with any of the entirely voluntary programs being mandatory and the information gathered being readily and freely available to all health care consumers. I would like to know which doctors aren’t discussing all available options for end-of-life care and treatments and all potential outcomes from said care and treatments, and I most definitely would like to know which doctors are not adhering to end-of-life orders created by their patients.
Let me re-quote the statement Ms. McCaughey has based her entire argument upon:
Such measures shall measure both the creation of and adherence to orders for life sustaining treatment.
Wouldn’t you like to know that if you’d created an end-of-life order stating you wanted everything –including the kitchen sink– thrown at you at the end of your life to sustain your life that your doctor was going to follow that order to the letter and not decide for himself you are a goner so why bother? For that matter, if you created an end-of-life order stating you did not want anything thrown at you to sustain your life when you are dying, wouldn’t you be upset if your doctor did not abide by that and you woke up hooked up to machines you didn’t want to be hooked up to … in pain, suffering, and still dying? I would, and I would want to avoid being under the care of any doctor who did not abide by a patients wishes … at the end of life or any other time.
Furthermore, if you are partaking in an end-of-life counseling session with a doctor, wouldn’t you want him to provide information on all available treatments and options and not leave something out of the discussion because he personally doesn’t agree with it? It isn’t possible to make sound end-of-life plans without knowing all available options and potential outcomes, and for your average human being, the creation of such end-of-life orders isn’t generally something one sits down one afternoon and just crafts in five minutes. It requires some measure of knowledge not only of the potential illnesses and injuries which might call such an order to be acted on but also the legal methods by which they are created to make them actionable and enforceable.
As we have seen during this month’s town hall meetings, a great many people do not at all even understand what an end-of-life order is or what it does. It isn’t “pulling the plug on grandma” … unless that’s what grandma wants. End-of-life orders empower patients to make their own decisions at a time when emotional factors are less likely to be the motivating force for medical decisions. They are not orders from the government for enforced euthanasia, and, in fact, they remove both the government and health care providers from being able to make decisions against the patient’s wishes. A patient can just as easily have an end-of-life order that states “Keep me alive, no matter what!” as they can have one that states “Don’t do anything to sustain my life, no matter what!” and both of these orders should be equally followed by health care providers … no matter what their feelings on the matter are.
The foremost problem with Ms. McCaughey’s reading of the proposed health care reform bill(s) is she either refuses to read it with an unbiased eye. Anyone reading or researching something that has an outcome of what they expect to find will be able to twist anything they read to fit their possibly skewed expectations. Additionally, the ability to read and comprehend English is important. The words “mandatory” and “voluntary” are on opposite ends of a verbal spectrum. Something cannot be both mandatory and voluntary at the same time. These are not subjective words. They have solid, objective meanings. I suggest Ms. McCaughy spend some time with a dictionary.
Additionally, when reading legal documents –legislation in particular– one must read it in the context it will eventually reside. That one sentence statement I have quoted twice earlier in this post for example, will eventually reside in the Social Security Act. It is an amendment to said act. If it isn’t read within the context of where it will reside once being passed, there is no way to understand what its implications will be. Occasionally, this requires reading and compiling statements, amendments, and information from even more than one source. Certainly, it can be confusing for someone unaccustomed to reading laws and legislation or for anyone too lazy to take the time to compile the necessary to put things in the order they belong, but it’s not impossible for someone with reading comprehension in the English language and the willingness to take time to piece things together and look at the whole without any preconceived notions of what they expect to find to understand legislation … even without a college education.
I am growing weary of the entire health care reform debate, mostly because it isn’t much of a debate. On one side there are people capable of reading and understanding the meanings of words and sentences, and on the other side there are people who are seemingly incapable of doing so and either ignorantly or maliciously propagating lies … or just sticking their fingers in their ears and screaming “NO!” without bothering doing any reading at all. In order to have a debate on a subject, both sides must be arguing from points of fact which prove their position. Truth vs. lies isn’t a debate, or at least it isn’t a debate worth having.
An Aside: When making arguments, most notably in public and on televisions programs, it does help to not only have notes but to have the information one wants to use to argue one’s point in an easily accessible format. I realize Ms. McCaughey enjoys carrying around large notebooks containing the entirety of H.R. 3200’s text for the shock value provided by the apparent size of the thing, but shuffling through pages trying to find the page one wants to argue about and from –and not being able to find it quickly– is, in a word, unprofessional and neither helps her argument nor makes her appear to be informed.
Additionally, though the full text of said bill when printed out in the standard legal document form does, in fact, look like entirely too much text for any human to read and comprehend in a single sitting, when condensed down from the wide-margin, double-spaced, and single-sided printing format used in our legal and legislative documents, it’s no longer than a Harry Potter novel, and the language contained in it is no more complex. I know both children and adults who read Harry Potter novels in less than a day. Of course, those are fun to read, aren’t they?
Behind the cut are videos, quoted information, and links for the programs, bills, and people discussed in this post.
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