Wash. Post latest to promote end-of-life counseling myth


A Washington Post article about President Obama's AARP forum on health care promoted the falsehood that a provision in the House Democrats' health care reform bill makes end-of-life counseling for seniors mandatory -- it does not. Ceci Connolly wrote that "[o]ne woman asked Obama about 'rumors' that under the proposed legislation, every American over age 65 would be visited by a government worker and 'told to decide how they wish to die,' " but Connolly did not report that the "rumors" -- which have been promoted by conservatives -- are not true.

From the July 29 Post article:

Polls show that senior citizens are more skeptical about health-care reform than any other age group.

One woman asked Obama about "rumors" that under the proposed legislation, every American over age 65 would be visited by a government worker and "told to decide how they wish to die."

First, Obama joked that there aren't enough government workers to undertake such a task. Then he got serious and personal, mentioning that his grandmother, who died shortly before Election Day last year, had a medical directive.

"It gave her some control ahead of time so that she could say, for example, if she had a terminal illness, did she want extraordinary measures even if, for example, her brainwaves were no longer functioning? Or did she want just to be left alone?" he said. "You know, that gives her some decision-making power over the process."

House bill does not make end-of-life-counseling mandatory

Advance care planning is not mandatory in the House health care bill. The House health care reform bill provides coverage for counseling as a service through Medicare and is not mandatory. Section 1233 of America's Affordable Health Choices Act of 2009 amends the Social Security Act to ensure that advance care planning will be covered if a patient requests it from a qualified care provider [America's Affordable Health Choices Act, Sec. 1233]. According to an analysis of the bill produced by the three relevant House committees, the provision "[p]rovides coverage for consultation between enrollees and practitioners to discuss orders for life-sustaining treatment. Instructs CMS to modify 'Medicare & You' handbook to incorporate information on end-of-life planning resources and to incorporate measures on advance care planning into the physician's quality reporting initiative." [waysandmeans.house.gov, accessed 7/29/09]

Rep. Blumenauer: "Myth: Patients will be forced to have this consultation once every five years." Rep. Earl Blumenauer (D-OR), who 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."

AARP, Obama explained counseling provision at health forum

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 the 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."

Outside groups support the counseling provision

AARP: Supports provision, criticized "gross," "cruel" distortions. A July 28 Politico article on the counseling provision reported: "'This measure would not only help people make the best decisions for themselves but also better ensure that their wishes are followed,' AARP Executive Vice President John Rother said in a statement. 'To suggest otherwise is a gross, and even cruel, distortion -- especially for any family that has been forced to make the difficult decisions on care for loved ones approaching the end of their lives.' "

National Hospice and Palliative Care Organization: Supports provision, no "responsible legislative analyst" would indicate it is mandatory. The July 28 Politico article also reported: "Jon Keyserling, vice president for public policy and counsel at the National Hospice and Palliative Care Organization, said: 'I was surprised that any responsible legislative analyst would indicate this is a mandatory provision. That is just a misreading of the language and, certainly, of the intent.' " According to a fact sheet distributed by Blumenauer's office, the National Hospice and Palliative Care Organization supports the provision.

Conservatives have used "pants on fire" falsehood to fearmonger about the provision

Betsy McCaughey was forced to backtrack after calling the provision "mandatory" -- a "pants on fire" falsehood. As Media Matters for America noted, after repeatedly falsely asserting that the bill makes end-of-life counseling for seniors "mandatory," former New York Lt. Gov. Betsy McCaughey was forced to backtrack from her claim -- a claim PolitiFact.com called "a ridiculous falsehood. That's a Pants on Fire." Confronted with accusations that she lied about the bill, she claimed, as she had done with a prior falsehood about another bill, that she was right about the effect (if not the literal wording) of the legislation.

Other conservatives in the media have advanced McCaughey falsehood. Fox News host Sean Hannity cited McCaughey to falsely claim that under the House provision, senior citizens would be "forced to undergo" end-of-life counseling. Similarly, syndicated radio host Rush Limbaugh has falsely claimed that seniors would be subject to "[m]andatory counseling" at "a minimum of every five years, more often if the seasoned citizen is sick or in a nursing home." He added, "That's an invasion of the right to privacy." Washington Examiner chief political correspondent Byron York falsely claimed on Fox News' Fox & Friends that the bill "says that there will be consultation between a caregiver and a patient to discuss things like hospice care and other issues -- other end-of-life issues," which he claimed raised the question of "whether there's any coercive element to this."

Posted In
Health Care, Health Care Reform
The Washington Post
Ceci Connolly
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