First lets begin by saying end-of-life counseling, living wills and advanced directives are great to understand, plan for and do for every American and everybody in the world...it is all good. I have in fact had plans made up as a 45 year old relatively healthy person and have had discussions about my parents advanced directives. We all have living wills in our family and written advanced directives as well as who is delegated to make decisions for each other...again it is all good.
Lets get something else cleared up, this is not caving to the fearmongering. I was opposed to this way before the fear mongering by the opponents of HCR. Their suggestion that this is death panels is disgusting and should be vigorously debunked...
So what is wrong with having a federal mandate to reimburse for such counseling and planning?
Well just because something is a good idea...does not mean it is a good idea to have it be a service that is reimbursed on a mandatory basis. Anything that is mandated to be reimbursed is likely to be utilized and reimbursed by those who do not need it. So for me as an example, I met with attorneys not doctors for my advanced directives as well as family members. Talking to my doctor about my end-of-life care would be the last place I would go. But here are my objection
- Why does everything that is a good idea need to be paid for by an insurance company or the federal government. We are talking about a small benefit here 1 consultation every 5 years so like a $50 benefit every 5 years...and it ads $2 Billion unnecessarily to the cost of the bill.
- Why should we limit the benefit to Doctors. When I discussed advanced directives with my family, I did not involve doctors at all, I discussed it with attorneys? What about your priest, rabbi, clergy?
- Why is your family phsician especially trained or qualified to give this advice and is it the best advice? I would not say that just because you have a great and trusted PCP that he/she can provide the best, comprehensive and informed advice on this topic...so why should they be the only ones to be reimbursed?
- Why is setting up a PSA program, coupled with free information on the HHS website and access to NFP organizations for counseling for those who cannot afford to pay and want it any worse than allowing doctors to bill for a consultation? Isn't such a reimbursement fraught with fraud potential? I could see doctors setting up clinics where a secretary hands out some pre-printed information and meets with someone for 2 minutes and bills the government $50? Really, is the value of this well meaning worth the risk and cost?
- So lets say you are right and there is some benefit to reimbursing doctors for this service, how big of a problem do we really have here and is it needed to include it in an already massive bill for a relatively few disputed cases every year...
In the end, I am not against counseling and discussing end of life care...I think it is great...but mandating some reimbursement for that is not the best way to encourage such consultations IMHO.../peace