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 theShe makes a lot of good points:sound and fury of last August, we're pleasantly surprised that the right hasn't risen again with all sorts ofhorror 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.
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.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.
She does add some info I was not aware of:(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 Allowa Natural Death , or AND).
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!)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.
