"Well, Senator Baucus does not speak for the entire Finance Committee."
That was the most encouraging of many encouraging moments in a nearly hour-long conversation at the Tampa office of Senator Bill Nelson (D-FL) yesterday. As suggested by President Obama's Organizing for America campaign for the August recess, Herself and I made an appointment with Sen. Nelson's local constituent services director to discuss health care reform. It was a memorable and worthwhile experience.
More below the fold....
Nelson (FL) aide - Baucus does not speak for the Committee
The surprises began in the elevator, where Herself and I shared a car with three other constituents visiting the Tampa office of Senator Bill Nelson (D-FL). All three held the same Organizing for America petition stating why we support President Obama's efforts for reforming our broken health care system. When we reached the senator's office, we found the office full, and a harried-but-smiling receptionist collecting petitions and encouraging us to fill out constituent feedback forms.
This was, she said, the busiest week she'd seen since she worked there, with a near-constant stream of constituents coming in to share their views ... busy enough that she spent a lot of time coyping extra feedback forms and information packets. She explained that the feedback forms would be collated into a report for Sen. Nelson's staff in D.C., and so far the overwhelming majority of constituents were supporting health care reform.
So far as I could see, she could have put that speech on a continuous loop, because she had to repeat it several times while we were waiting to meet with Sen. Nelson's local constituent director. Herself and I had made an appointment so she could discuss a recent Blue Cross/Blue Shield "guaranteed health insurance" mailing, and so I could discuss end of life care counseling.
We had a brief wait, only because the aide with whom we were meeting shared an office with another woman who was on the phone planning a series of town hall meetings for later in the month. She was focused on small meetings - rotating 20 or so people at a time into a venue like a library - rather than the massive, easily disrupted events we've seen on the news. This would, she hoped, encourage more constructive dialogue between Sen. Nelson and his constituents. It's an interesting idea, and I'm curious to see how it works out.
After a few minutes, we were ushered into the office and Herself began by explaining her concerns with the "guaranteed health insurance" offer from BC/BS. For those who aren't aware of this pending statistical charade, she gave a detailed critique in Tuesday's Morning Feature. In brief, this "guaranteed health insurance" isn't insurance at all; it's a minimal discount plan for certain routine medical care, offering no major medical protection whatever aside from allowing the "insured" to pay out-of-pocket the same rates BC/BS would pay if you really had their insurance. Rather than going bankrupt because you can't pay what the providers would charge an uninsured patient for treating a severe illness or injury, the plan lets you go bankrupt because you can't pay whatever amount BC/BS would have paid were you really insured. It allows companies like BC/BS to claim that everyone can afford private health care insurance, when in fact the plan offers no real coverage ... a band-aid on the suppurating wound that is health care in the United States.
The aide made copies of the BC/BS mailing, both for Sen. Nelson's staff in D.C. and so that we could share copies with the rest of the Florida delegation. She seemed stunned that such a charade could be foisted off as "insurance." Herself also explained that without a public option, so she and others like her could get preventative care for conditions like diabetes, there was no way to control Medicare costs. Diabetes (type 2) is not a quick killer, and left untreated it often destroys the kidneys. For most diabetes patients, dialysis becomes the only option, and all dialysis is paid for by Medicare at an average cost of over $70,000 per year (link is to winterbanyan's comment below with updated information correcting my earlier amount, which was based on older data). As is so common with chronic conditions, ensuring access to preventative care offers major savings over later treatment in addition to better quality of life and higher longevity.
I then summarized my research on end of life care consulting, which I discussed in Morning Feature on Thursday and Friday. I emphasized that this is not merely about living wills and other advanced directives. While it's important to have a living will, living wills don't apply in most end of life care cases because the patient is still able to speak for him/herself. This is not about "pulling the plug on grandma." It's about grandma going to see the doctor for a persistent cough, an annoying bump under her arm, or that odd mole ... and learning she has terminal cancer. Or any of hundreds of conditions where a routine doctor visit brings that tragic, traumatic news. In such cases, it's the will of the living and not a living will that governs care.
I mentioned the 2006 Mayo Clinic study showing that almost 40% of lifetime medical costs occur in the last six months of life, and the 2008 Dartmouth Institute study showing that in most cases that spending does not extend or improve the quality of the patient's life. Often the costs are for tests and procedures to convince a terrified patient and his/her family that the diagnosis is correct. It's "defensive medicine," where doctors often run scores of tests to rule out every alternative diagnosis, even when the doctor is very confident of his/her original diagnosis ... because the patient and his/her family insist that no stone be left unturned, that no faint hope of a triumphal, treatable, House, M.D. diagnosis be left unexplored.
The Dartmouth study found that taking time to talk with patients and their families is critical in end of life care. The more the patient and his/her family are comfortable with their doctor and the diagnosis - and studies show that's a direct function of the time spent explaining the situation and answering their questions - the more likely they will make rational, reasonable decisions about how to proceed, and the less likely the family will sue the doctor later. Malpractice insurance studies have long shown that quality time spent with the patient is the best safeguard against a malpractice suit, but too often the doctor can't be reimbursed for that time. Guaranteed reimbursement for doctors' time spent in end of life counseling is not about euthanasia. It's about making sure doctors can practice the most humane and effective kind of medicine: answering the patient's tearful, fearful questions and concerns.
"That's why I was so upset to read today that Senator Baucus has removed end of life care counseling from the Senate Finance Committee version of the health care reform bill," I said. "Senator Grassley's glib claims aside, this isn't something people can do twenty years in advance."
"Well," Sen. Nelson's aide replied calmly, "Senator Baucus does not speak for the entire Finance Committee. Senator Nelson sits on that committee, and he is very concerned about end of life care. No matter what the news media say, there are no deals being made right now, because the Senate is not in session. This is very much a work-in-progress, and Senator Nelson intends to be part of that process."
She'd taken a lot of notes while Herself and I talked, and said much of what we shared was new information for her. She promised to pass along that information to Sen. Nelson and his staff in D.C., and reaffirmed his belief that "the health care system in America is broken and must be overhauled." She also gave us an 18-page report, published in July by the Congressional Research Office, outlining the health care bills currently under consideration and the issues each addresses. I'll discuss that report in a Morning Feature next week.
Did she promise that Sen. Nelson would oppose any health care reform that did not include a public option and reimbursement for end of life care consultations? Of course not. That wasn't her promise to make. But I felt that Herself and I got a full and attentive hearing.
Most senators and representatives are holding similar office hours in their local offices this month. If you haven't yet, please go to Organizing for America and find out how you can best share your concerns with your elected officials. "The dog that didn't bark" is a clever clue in a Sherlock Holmes mystery, but it's not a good recipe for citizen involvement.
+++++
Happy Saturday!