End-of-life counseling stays in health care bill

Here’s a piece of very good news just in from Associated Press reporter Ricardo Alonzo-Zaldivar:

It’s alive. The Medicare end-of-life planning provision that 2008 Republican vice presidential nominee Sarah Palin said was tantamount to “death panels” for seniors is staying in the latest Democratic health care bill unveiled Thursday. The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

The business of thinking ahead toward end-of-life decisions and making  one’s own wishes known through legal documents such as advance directives has long been encouraged by federal policies. But when coverage for talking things over with one’s doctor was incorporated into health reform it was quickly distorted by Republicans.  Sen.Charles Grassley led the successful campaign to strike it from the Senate bills. But saner heads have prevailed in the House.

“There is nothing more basic than giving someone the option of speaking with their doctor about how they want to be treated in the case of an emergency,” said Rep. Earl Blumenauer, D-OR. “I think the outrageous and vindictive attacks may have backfired to help raise awareness about this problem, which is why it’s been kept in the bill.” The legislation would allow Medicare to pay for a counseling session with a doctor or clinical professional once every five years. The bill calls for such sessions to be “completely” voluntary, and prohibits the encouragement or promotion of suicide or assisted suicide.

The counseling provision is supported by doctors’ groups and AARP, the seniors’ lobby. It was not included in health care bills passed by two Senate committees.

It’s alive! End-of-life counseling in health bill.

Helping Mom die

Flight #12 had not even left the gate in San Francisco yesterday before the conversation was underway. The man in seat #16F was talking to his new friend in #16E about his trip: another of many undertaken by himself and his siblings to their mother’s home in the long process of packing up, sorting through, tossing out, agonizing over. The scene is a familiar one to millions of Americans: aging, often isolated mom; far-flung, often cash-strapped, over-stressed children; a bewildering assortment of issues to be dealt with, ranging from health to housing to family dynamics.

I, of course, am the mom. Well, not #16F’s mom, and currently in good health and of relatively sane mind. But 76, with children across the continent and a dizzying amount of Stuff to be dealt with if my husband should have the crass inconsideration to die first and leave me to deal with it. (Actually, he’s been very good about making arrangements for disposition of his Stuff, but still, there are those piles and boxes and shelves of miscellany and cupboards of chipped dishes. And closets full of clothes from the 1950s and still perfectly wearable… but I digress.)

My sisters and I were fortunate that our dad looked after our mom as she slowly died, swearing they had a fine conversation the night before although dementia had long stolen her ability to converse; my father created his own realities. Twenty years later, the town of Ashland, VA, with the assistance of Randolph-Macon College, looked after our dad, because indeed it takes a village. But fewer and fewer of us have the traditional village, and more and more of us have the complications: dementia, physical issues, personal problems, too little financial and emotional resources, too much Stuff.

There is help. There are community centers and assisted living arrangements, there is the new Villages concept (more about that one in the next week or so) and an array of other anti-isolationist possibilities; there are nonprofits of every sort, from the Family Caregiver Alliance to multiple physical/emotional-needs groups to my alltime favorite, in name at least, the National Study Group on Chronic Disorganization. God willing, we may even get health care, but thanks to those earlier, similar battles we at least now have Medicare and Medicaid.

But too many of us still put it all off, and it falls to the children. We cling to the past in the form of too many boxes of old photos and letters and opera programs; we drive too long and invite fender-benders or worse; we think that old chair is worth too much for a garage sale; we forget to take the pills.

The issue, of course, is not about dying; it’s about living. Living as well as possible for as long as possible, as closely as possible to what we would choose for ourselves. But here’s what happens eventually: mom dies. It’s tough, but it’s probably okay.

I gave my card with the True/Slant website on it to the nice people in #16E and #16F; maybe they’ll check in. When I get back home, though, I think I’ll clean out some files.

Will Anti-Abortionists Sink Health Reform?

Already the right wing, Catholic officialdom and Sarah Palin have won their battle to make sure that I, and countless other millions, will likely die only after expensive, prolonged, futile, aggressive, undesirable treatment rather than peacefully at home as I choose. Now they want the generations younger to be sure that any accidental, criminal or otherwise unplanned pregnancy results in another unwanted child coming into this overpopulated world. An assault on health reform is their latest battleground. I am careful to say Catholic officialdom, because all of the lay Catholics I know, many of them Good Catholics, support both reproductive and end-of-life choice. I am careful to mention Sarah Palin just to prove I have absolutely no resentment over the fact that whereas I can’t interest publishers in my several excellent book projects, she has a planned first run of 1.5 million on her dashed-off memoir.

But back to the problem at hand. Writing in Tuesday’s New York Times, David Kirkpatrick presents the new scary problem:

As if it were not complicated enough, the debate over health care in Congress is becoming a battlefield in the fight over abortion.

Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions.

Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation.

Never mind that Obama has promised that no federal funds will go for elective abortions, and the current policies would remain unchanged, here is a handy opportunity to make points with conservatives and throw a monkey wrench into the works of reform.

Lawmakers pushing the abortion restrictions say they feel the momentum is on their side, especially because the restlessness of other Democratic moderates is making every vote count.At least 31 House Democrats have signed various recent letters to the House speaker, Nancy Pelosi, urging her to allow a vote on a measure to restrict use of the subsidies to pay for abortion, including 25 who joined more than 100 Republicans on a letter delivered Monday.

Representative Bart Stupak of Michigan, a leading Democratic abortion opponent, said he had commitments from 40 Democrats to block the health care bill unless they have a chance to include the restrictions.

So it’s all about halting abortion — maybe — or all about halting reform — maybe — but some of us who simply, desperately, wish better care and a few decent options for our less-advantaged citizens are left to wonder what it’s really all about.

Abortion Fight Complicates Debate on Health Care – Readers’ Comments – NYTimes.com.

Some Women's Views of Health Reform

First Lady Michelle Obama is making the news in support of her husband’s health plan, hoping to tap into the energies of one group who voted for Obama in large numbers: women. Reform is everyone’s concern, but in many ways it occupies a specific gender niche. As reported by Voice of America’s Kent Klein,

Mrs. Obama says health care reform is a women’s issue. “Women play a unique and increasingly significant role in our families.  We know the pain, because we are usually the ones dealing with it,” she said. The first lady spoke Friday to a gathering of women near the White House, and said the state of the U.S. health care system is unacceptable. “For two years on the campaign trail, this was what I heard from women:  That they were being crushed, crushed by the current structure of our health care.  Crushed,” she said.

A host of women’s groups, blogs, newsletters and web writers have also recently joined in. Posting in the National Women’s Law Center blog, Outreach Manager Thao Nguyen told the poignant story of hearing from a friend that she’d just married her long-time hesitant boyfriend. The marriage news was good news, but its terms took the joy out: having lost her job, it was the only way she could get health insurance.

Her point seemed so logical, but the entire idea was couched in such an insane reality I was simply speechless. Lucy is in her early 30s but she has a pre-existing condition so buying individual health insurance and the unfair, overpriced premiums that come with it was out of the question. Lucy has been living with Dan for 10 years, but unfortunately, he works for a company that doesn’t offer domestic partner benefits.

I couldn’t help but think: is this what our broken, unstable health care system means for millions of Americans around the country? As the economy continues to struggle, employers continue to shed jobs, and every day 14,000 more Americans wake up realizing that they are now uninsured and just one illness away from financial ruin. Are reluctant bachelors around the country going to put away their Megan Fox posters, cancel the “poker nights” (aka X-Box marathons we’re on to you), and start settling down?

My own run-in with healthcare weirdness is minor in comparison to most, but I still remember the shock. Making a routine call to renew the prescription for a bone-building drug I had taken for years to stave off osteoporosis, the message center person said she probably should warn me that rather than the $24 co-pay I’d been having per quarter my cost would now be $230. I do need these bones, but couldn’t see them worth $920 a year. I hung up and started drinking more milk. Had to get breast cancer, for which I now take a covered post- cancer drug which my oncologist prescribes… mainly to keep my bones healthy. Something is bizarre here.

Or maybe we women might bend the old macho adage a little: It’s broke, fix it.

VOA News – Michelle Obama Joins Health Reform Campaign.

Health Reform Geezer Gap

At least one more old geezer — we are legion — is fed up with the Medicare generation getting all the blame for opposing health reform. James Ridgeway writes in his Unsilent Generation blog today that

This health reform debate is about substituting a phony intergenerational war for what ought to be class war – pitting the old against the young, instead of pitting the rich against the poor, or the corporations against the little guy. There WILL be cuts to Medicare, and everyone says this has to happen to keep Medicare from going bankrupt before younger people get to use it. But in fact, if pols were willing to cut the profits of insurance and drug companies, there would be enough for everyone–we could have Medicare for all.

Which does certainly cut to the chase. Ridgeway cites his own earlier writing that applied Dean Baker’s chutzpah definition to today’s economy.

The classic definition of “chutzpah” is the kid who kills both of his parents and then begs for mercy because he is an orphan. The Wall Street crew are out to top this. After wrecking the economy with their convoluted finances, and tapping the US Treasury for trillions in bail-out bucks, they now want to cut Social Security and Medicare because we don’t have the money.

I am still with President Obama on paying for reform through elimination of waste and fraud, though that’s obviously not going to happen overnight and not going to pay for it all by a long shot. But Medicare’s going to survive, as will most Medicare recipients although we are all terminal. The moments of truth will come when the bargaining is over and we learn what the trade-offs really cost. That is, whether Big Pharma and insurance industry negotiations trump the public option, and other details still near and dear to many hearts.

So many trillions, so many sectors looking to save their own skins — or their own trillions, as the case may be — can boggle the mind quickly enough to send Jane Q. Public desperately in search of simplification, and blaming a generation is easy. The Medicares don’t want to lose their benefits, the Boomers worry that there won’t be enough for them (a legitimate worry, in fact) and the people who need health care get lost in the shuffle. Ridgeway fills in a lot of blanks. Check it out.

Hospital Safety 101: Didn't Mom Teach You to Wash Your Hands?

San Francisco Chronicle Washington Bureau writer Carolyn Lochhead reported today on a new idea somebody had about making hospitals safer: get folks to wash their hands. Hello?

The president of a leading medical standards organization announced a new program Thursday that is designed to improve health care safety practices, starting with a rigorous approach toward hand-washing by hospital staffers.

And this is serious business.

Hand-washing failures contribute to infections linked to health care that kill almost 100,000 Americans a year and cost U.S. hospitals $4 billion to $29 billion a year to combat, said Dr. Mark Chassin, who leads the Joint Commission, which sets standards and accredits hospitals and health care organizations.

Chassin’s announcement came after Hearst Newspapers published the results of an investigation, “Dead by Mistake,” which reported that 247 people die every day in the United States from infections contracted in hospitals.

Anyone who has ever come home from surgery with an infection, or more specifically anyone whose spouse has come home from surgery with an infection (nasty-wound-tending not having been fully explained in those for-better-or-for-worse lines) will applaud the new program, but it’s hard not to wonder what has taken the medical profession so long. Hospitals have found, Lochhead reports, that “caregivers washed their hands less than 50 percent of the time when they should.”

If there’s ever been a good example of potential savings to pay for universal health care, this is one to top the list. Consumers, we who would do well to wash our own hands when visiting or inhabiting hospitals, owe a debt of gratitude to the Joint Commission (and to Hearst Newspapers for the excellent ‘Dead by Mistake’ series.)

Maybe more sinks will be adorned with the sign that gave my husband and me a healthy chuckle during a recent visit to the Kaiser emergency room:

“Hand-wash unto others” it read, “as you would have them hand-wash unto you.”


Hospitals urged to strictly enforce hand-washing.

Saving for Retirement: Take Two

About those initiatives to encourage Americans to save for retirement (see below)? There are those around the country who would say, Phooey. Or possibly something stronger.

Born in the 1930s, ’40s and ’50s, these are people who did everything right: they saved a respectable percentage of all earnings, invested cautiously in companies that seemed to be socially and fiscally responsible, some of which were supposed to be subject to regulation, and switched funds to other choices when those companies acted badly. They paid off their mortgages and credit cards on time (credit card companies never liked them) and lived within budgets. Most of these folks raised their own children on the time-honored formula that said when you have a dollar you give ten cents to your church or synagogue, ten cents to charity, put ten cents into U.S. Savings Bonds, etc, etc, and only with the last five cents would you buy an ice cream cone.

These citizens have now watched their IRAs fade to nothing and their investments income disappear. Want an example? That $10,000 carefully saved for a cash cushion in case of an emergency and invested in a money market fund or savings account once could be counted on to grow, or to pay for a weekend trip. Now, thanks to the Fed’s target rate for fed funds it might earn $25 in a year. The citizens do not notice any hardship, meanwhile, being visited upon the CEOs of those investment fund companies, or anybody at Goldman Sachs.

Beyond saying Phooey a lot, these citizens are worried. The same people who got them in the mess Mr. Obama inherited now seem to be running the economic show in Washington. The citizens want universal healthcare, but can’t help wondering if they’re going to be sunk, themselves, by a catastrophe for which they no longer have funds. The citizens can’t exactly re-enter the workplace.

In short, the prospect of golden years ahead for others is not ameliorating the tarnish of their own.

New Way to Count Old Poor

As if there weren’t enough bad news to go around, a new(ish) formula for calculating the national poverty rate could boost the number of over-65 poor from 9.7 percent — or 3.6 million of us — to 8.6 percent, or a hefty 6.8 million. Just like that, the poor get poorer; or in any event they get to be more of us.

It’s not really a new formula, it’s a revision of the half-century-old National Academy of Science’s formula…

which is gaining credibility with public officials, including some in the Obama administration. The original formula, created in 1955, doesn’t take account of rising costs of medical care and other factors.

If the academy’s formula is adopted, a more refined picture of American poverty could emerge that would capture everyday costs of necessities besides food. The result could upend long-standing notions of those in greatest need and lead eventually to shifts in how billions of federal dollars for the poor are distributed for health, housing, nutrition and child-care benefits.

Using this formula, overall poverty in the U.S. would rise to an estimated 15.3 percent, or 45.7 million.

The current calculation sets the poverty level at three times the annual cost of groceries. For a family of four that is $21,203. That calculation does not factor in rising medical, transportation, child care and housing expenses or geographical variations in living costs.

I’m not at all sure my current family of two could eat (OK, and drink too, with an occasional dinner out) on $21,203. It may certainly be time for a re-calculation. And a little more help.

via New measure doubles number of elderly poor.