During a Hardball discussion about a provision in the House health care reform bill that provides coverage for end-of-life counseling as a service through Medicare, host Chris Matthews purported to correct Washington Post reporter Lois Romano's explanation of the provision, claiming: "We already have that in Medicare." In fact, Romano was correct; the bill would require Medicare to cover the cost of such counseling for the first time.
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Matthews on provision: "It's not about Medicare, Lois. We already have that in Medicare."
From the July 29 edition of MSNBC's Hardball with Chris Matthews:
MATTHEWS: Well, that's how hot it's getting. Lois Romano, Jonathan Martin -- Lois, your thoughts about this debate. It's a provision in the energy bill -- energy and commerce version of the health care bill in the Energy and Commerce Committee. It was put in, this provision, by Earl Blunauer from Oregon -- Blumenauer.
MARTIN: Blumenauer, yeah.
MATTHEWS: Blumenauer. It's -- there it stands. It's a provision which allows you to get counseling every five years or so. I wonder what the hell this provision's doing in a bill that's aimed at people who are younger. It's not about Medicare recipients, people over 65. Why we'd want to be visited every five years by somebody to talk about how you want to die? I think it's crazy this is in there, but your thoughts.
ROMANO: But, it's not in there. I mean, basically --
MATTHEWS: It is in there.
ROMANO: No, but it's --
MATTHEWS: It's in the bill; it's in the Dingell bill.
ROMANO: It's a benefit. First of all -- first of all -- Chris, first of all, it's an extension of a 1999 bill that was enacted during the Bush administration, and it's a self-determination -- a patients' rights bill. And all it really says is that Medicare will pay if somebody wants to go in and have a consultation. It doesn't say you have to have a consultation. It doesn't --
MATTHEWS: It's not about Medicare, Lois. We already have that in Medicare. This is about people under 65 -- younger people. This is not about Medicare. We've got it in [unintelligible] you're saying that. This is about a health care bill to help people in their middle years and their younger years. Why would you have this conversation with them?
ROMANO: I think it's just basically to give patients some rights. They want to go in and have a conversation. It's about a living will, as [President] Obama said. It's about making choices about being prepared, you know, whether -- and I think most people would opt to use it if they were ill. I don't think you and I, healthy, would go in and say, "Oh, listen. Can we talk about how I'm going to die in 20 years if something happens." I think it's -- you're talking about a person -- say they're under 65, say they're 45, and they're dying, and they just want to go and have a consultation.
The provision would require Medicare to cover the cost of counseling for the first time. According to PolitiFact.com:
Sec. 1233 of the bill, labeled "Advance Care Planning Consultation" details how the bill would, for the first time, require Medicare to cover the cost of end-of-life counseling sessions.
According to the bill, "such consultation shall include the following: An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to; an explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses; an explanation by the practitioner of the role and responsibilities of a health care proxy." [PolitiFact.com, 7/16/09]
AARP moderator stated that the provision would allow Medicare to "cover consultation." During a July 28 AARP health care forum, moderator Michael Cuthbert said: "As I read the bill, it's saying that Medicare will, for the first time, cover consultation about end-of-life care." Cuthbert's statement was a response to a questioner who said: "I have been told there is a clause in there that everyone that's Medicare age will be visited and told to decide how they wish to die."
Obama made clear the intent is to "simply make sure that you've got more information, and that Medicare will pay for it." In his follow-up to Cuthbert, Obama stated, "But understand what the intent is. The intent here is to simply make sure that you've got more information, and that Medicare will pay for it." Obama later added: "So if Medicare is saying you have the option of consulting with somebody about hospice care, and we will reimburse it, that's putting more power, more choice in the hands of the American people, and it strikes me that that's a sensible thing to do."
Rep. Blumenauer: "The provision merely provides coverage under Medicare." Blumenauer, who Matthews noted co-authored the provision, released a fact sheet on advance planning consultations in the House health care bill that states: "Myth: Patients will be forced to have this consultation once every five years. Fact: Advance planning consultations are not mandatory; this benefit is completely voluntary. The provision merely provides coverage under Medicare to have a conversation once every five years if -- and only if -- a patient wants to make his or her wishes known to a doctor. If desired, patients may have consultations more frequently if they are chronically ill or if their health status changes."
Matthews says provision is "social policy dynamite," but eldercare groups support the counseling provision
From the July 29 edition of Hardball:
ROMANO: I think it's just basically to give patients some rights. They want to go in and have a conversation. It's about a living will, as Obama said. It's about making choices about being prepared, you know, whether -- and I think most people would opt to use it if they were ill. I don't think you and I, healthy, would go in and say, "Oh, listen. Can we talk about how I'm going to die in 20 years if something happens." I think it's -- you're talking about a person -- say they're under 65, say they're 45, and they're dying, and they just want to go and have a consultation.
MATTHEWS: That's -- no. This is on a regular recurring basis. It seem like something --
ROMANO: But it's not mandated, Chris. It's not mandated.
MATTHEWS: It's not mandated, but what's it doing in there? I just have a sense this was put in by a lobbyist who wanted this in for hospice care -- somebody pushed this in there. It's the kind of social policy dynamite that sounds like Denmark or Scandinavia, and it's that kind of mind-set that drives a lot of moderates and conservatives crazy. Your thoughts, Jonathan.
MATTHEWS: We'll come back on this. I think it's like the abortion issue that's been jammed into this thing. There shouldn't -- we have a Hyde Amendment, Lois, that says the government will not pay for abortion. People are talking about putting that into the bill here. Pro-choice people that want the government to pay for abortions. There's a lot of social policy being jammed at us, on what is essentially a financing issue.
Numerous eldercare groups support the provision. According to the fact sheet distributed by Blumenauer's office, the provision is "Endorsed By: AARP, American Academy of Hospice and Palliative Medicine, American Hospice Foundation, Consumers Union, Gundersen Lutheran Health System, Medicare Rights Center, National Hospice and Palliative Care Organization, Providence Health System."