Now that the critics of the Affordable Care Act have moved on to questions about keeping your doctor, limited competition and premium rates, it is time to revisit the challenges of end-of-life conversations and planning.
Those conversations were impossible when the specifics of Obamacare were being formed, as the label “death panels,” one technique designed to blunt support for Obamacare, prevented any reasonable discussion. Health-insurance plan critics claimed the plan mandated the conversations, and that in front of a government-appointed panel, the patient would be certain to be the loser. Problem was, nothing was mandatory. But the damage was done, and the subject of Medicare covering the cost of voluntary conversations with knowledgeable end-of-life experts was deleted.
A fresh study by the highly regarded Institute of Medicine, a research branch of the National Academy of Sciences, has put the value of such planning back into focus. In a story in The Wall Street Journal last week, the study is praised for pointing out how fractured current conversations are, with doctors unschooled in how to have what can be a difficult conversation and how late in life those conversations usually occur.
Much better, the authors write, is to have end-of-life conversations earlier with a doctor familiar with the individual and the family. Too, the role of palliative care is not fully understood by most Americans, and hospice – which has palliative care at its heart – is available only within six months of the end of life. Palliative care is often needed much earlier.
The Wall Street Journal story says the American Medical Association has provided federal Medicare and Medicaid centers with proposed service codes for end-of-life planning sessions, in expectation that the cost of those services would be reimbursed. Just a few years ago, the AMA had no use for the looming ACA.
In conversations with family members and friends of the recently deceased, it is often quickly clear whether the wishes of the deceased had been known, and how that played out. Too often the deceased had not been clear as to what “life” meant to him, and there had been differences among family members as to what life-saving steps to take or not to take. Often, family members have stood back while excessive life-extending steps were applied by hospitals, too awed or unknowledgeable to speak up and ask “is the accompanying pain and discomfort really worth it at this point?”
Yes, while the report centers on how to develop a good end-of-life plan between the individual and medical resources, the benefit of cost savings is included. A proper plan likely will be less costly than the tardy and fragmented engagement with health-care resources that occurs all too often today.
We expect to hear more about effective end-of-life conversations and decision-making, and that will be welcome.