The politics of death: follow the money

I am angry this morning. Reading the New York Times online is my morning newspaper, and this morning brought an article reporting that the Obama administration had caved on a Medicare provision for advance care planning as a covered service.

This is the service Republicans criticized last fall using — in my opinion — unethical and inaccurate language. As the article states:

Sarah Palin, the 2008 Republican vice-presidential candidate, said in the summer of 2009 that “Obama’s death panel” would decide who was worthy of health care. Representative John A. Boehner of Ohio, the House Republican leader who is to become speaker on Wednesday, said the provision could be a step “down a treacherous path toward government-encouraged euthanasia.”

Advance care planning does no such thing, as I well know, having advocated for it as a pastor and helped my own parents to do it. All that happens in advance care planning is that a person has the opportunity — at the point in their lives when they are well and able to make sound decisions based on personal preference — to choose what life-sustaining measures they want taken at points when they may be nearing death.

Don’t you want to be able to make those choices? Why would you want your grieving, perhaps traumatized family members to have to make hard choices about your care when you are so sick or close to death that you can’t speak for yourself?

It seems so self-evident that advance care planning is both wise and humane, and that it involves no one’s choices but your own. It certainly does NOT involve a panel of doctors sitting around discussing whether to pull the plug on you.

Why would Sarah Palin and John Boehner want their voting base to think that?

I wonder, too, if that’s even what they are concerned about. Maybe there is election financing they are keen to protect.

Because there is money to be made in the last year or so of life; perhaps someone wants to protect the revenue stream.

I remember my father’s death. My mother — who couldn’t bear to let him go — went for every intervention possible. We had doctors streaming through Dad’s room who didn’t do anything but chat with him for a minute, and then go out and code a chart that would generate an invoice to Medicare. They were punching Dad’s clock. Instead of being allowed to rest and die easily, he was pushed into “rehab” that did nothing but tire and confuse him, until his heart and lungs said that was enough.

My mother’s death was different, and still hard. I was thankful her doctor recommended hospice when she did. Because my mother was in a skilled nursing facility oriented toward rehabilitation, it was still a fight to get the staff to let Mom be. It was up for rehab, and up for meals, and up for anything and everything else that punched the Medicare clock.

Going into hospice care — which Medicare also pays for, but on a different set of services, those that dying people need, like pain care and companionship and personal comfort — should have stopped all that. But it took personal intervention on my part, on one of my visits from out of state.

I’d like to say Mom’s care remained good until the end. It didn’t. Hospice and the SNF fought all the way, a turf battle waged on my mother’s flesh. At the end, I’d like to say the caregivers gave uniformly compassionate, quality care. They didn’t. Some were tender and solicitous and skilled. Some weren’t. Supplies weren’t adequate; pain relief wasn’t adequate; and her care wasn’t adequate.

That’s not the fault of Mom being in hospice; that’s not treatment caused by some death panel. That’s the treatment a dying person gets in too many settings because the funds are not there for adequately trained staff and adequate numbers of them. The job of caring for dying people is even more undervalued in our society than that of caring for children — it’s low-pay, hard work. And why are the funds not there? Because they have gone to the creation of ever more advanced technologies and treatments for forestalling death. You know … where there is money to be made, and profits generated.

It doesn’t have to be this way.

But as long as the Palins and the Boehners are running the show, we’ll all keep denying death right up till the end, with money being made all the way by someone — studies show 75-95% of your health care dollars are spent in the last year of life.

Advance care planning is no panacea for changing our culture around death from avoidance to compassionate care. But it was a small step in the right direction. And Obama’s administration just took a step back in the wrong direction.

I wonder whose cash register is ringing now ….

This is of course a theological issue, for Christians, anyway. We profess to believe not only in a life after life — in which we will come face to face with our Creator, in a setting of unimaginable joy, which you would think we would eagerly anticipate — but in a life of abundance here. Surely that abundance extends to the quality of our deaths.

It doesn’t have to be this way.

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One Response to The politics of death: follow the money

  1. Marsha says:

    As a former hospice chaplain, I have never read such a clear and poignant accounting of the struggle for Medicare funds between SNF and hospice care providers.

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