Thursday, November 12, 2009

End of Life Issues in HC Reform Bill - Good Analysis

Joanne Kenen of the New America Foundation posted an excellent analysis of the importance of advance care planning language that was supported and kept in the house bill despite the emotional ruckus about straw man arguments this summer.

I love her introduction and wish I could come up with something like this when I am writing posts:

After all the sound and fury of last August, we're pleasantly surprised that the right hasn't risen again with all sorts of horror stories about the resurrection, so to speak, of the "death panels." Maybe because all that fear-mongering was finally discredited. Maybe we are finally getting just a little bit smarter.
She makes a lot of good points:
Right now, there are all sorts of built-in disincentives -- cultural, emotional, legal and yes financial -- against having that conversation. The incentives lie in the other direction: Doctors, and ERS and ICUs are all reimbursed for giving you the aggressive care, and aggressive care is often the default form of care. Maybe our system should make sure you want it.
Although I can't agree with her on all points but the only disagreement I have is more of a technical quibble about DNR vs. AND, which I blogged about earlier this year.
(And we do so wish that the move to change the terminology eventually catches on, so that instead of Do Not Resuscitate, or DNR, we talk about Allow a Natural Death, or AND).
She does add some info I was not aware of:
The Finance bill sets up a 26-site hospice concurrent care demonstration project in Medicare, so adults too in these test programs can have both curative and hospice care.
And the New America Foundation also marks the blogging debut of Dr. Ira Byock in his own accompanying editorial post (actually his second since his first was in August, but still the blog is his debut!)

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