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How can you plan the end of your life? Death Panels! Got your attention, right? Well, although we're going to discuss death panels a little, they're not real. What are real are advance directives, and those are the topic of this week's Healthcare Triage. We're all going to die, but the best time to have a say in your end of life care is in advance.


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Death Panels! Got your attention right? Well though we're going to discuss Death Panels a little they aren't real. What are real are advance directives. Those are the topic of today's Healthcare Triage.

Although no one wants to hear it, eventually everyone is going to die. We will all face end of life decisions. Hopefully far into the future, but they're coming. Accept it. Take a few minutes if you need to.
Doing so will make the rest of the video much easier.

The problem is that end of life decisions are sometimes difficult. These decisions often take place when people are older, when people are sicker, and when people need to make big decisions about their medical care.

How would you like to be treated at the end of your life? Would to like everything to be done, no matter what? What if it meant living the rest of your life on a ventilator, stuck in a bed. Would you like that care continued, even if you weren't aware and you had no chance of recovery? Not everybody does.

Maybe you'd like someone else to be making those decisions for you. Perhaps a spouse or a parent. Maybe a child. If so, if might be good to make that clear while you still can make those decisions coherently. You can't make them once you're incapacitated.

And that's the point. It's impossible to predict the future. You can't tell what's coming, or when. So it's better to make those decisions - wait for it - in advance. That's why it's called an advance directive.

Sometimes advance directives are very basic. My wife and I have one. The gist of them is that we say clearly that if one of us is unable to make medical decisions in some capacity, we direct doctors and hospitals to listen to the other. We trust each other to make those hard decisions.

If both of us are somehow incapacitated, medical decision making passes into other specific individuals that we trust. If by some catastrophe none of them are available, then we discuss specific measures: What's acceptable to us?, When?, In what case? and, what specifically we don't want to be done?

Let's be clear. Advance directives aren't always about stopping care. Sometimes they're about making sure you get the care that you want. Your advance directive might be telling hospitals to do anything to extend your life, regardless of what it means, regardless of the cost.

This can be a difficult conversation. It also may involve some complex questions or considerations about really detailed medical care. It might be helpful to have such a conversation with an actual physician. But come on, you don't wanna rush this discussion. That means it might take some time, and doctors don't have lots of free time in the office to sit around and answer questions about advance directives, no matter how much we might like to. We might need to find some way to make it easier for doctors to have such a conversation.

So one of the initial versions of the Affordable Care Act, otherwise known as ObamaCare, included provisions to authorize Medicare to reimburse physicians for a visit dedicated to helping people prepare an advance directive. We all agree that advance directives are a good idea, and we all agree that doctors might help in the decision. To be honest, I don't think many people preparing the legislation thought that this was gonna be a controversial provision.

If you wanna be specific, the language appeared in section 1233 on page 425 of the House's final draft of the Affordable Care Act, but in a now infamous Facebook post, Sarah Palin labeled this provision "death panels". "The America that I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society" whether they are worthy of health care." And when she was asked where those "death panels" were in the bill, her spokesperson said, "Section 1233", advance directives were the death panels.

I know people who tried to defend this characterization. They told me that they distrust government so much that they felt that any law that got government involved with the making of end of life decisions would eventually mutate into government deciding when people should die, regardless of individual's wishes. But this wasn't that. This was about getting doctors to help patients make decisions for themselves. It was about getting them reimbursed for taking the time to do so. Unfortunately, since government pays for so much healthcare in the United States, it meant the government has to pay the bills. There's no way around that. And this was definitely a politicized thing.

Many, many, many politicians who attacked the ACA for having "death panels" had previously supported advance directives and finding ways to get them filled out. I'll note without further comment that PolitiFact called "death panels" in the Affordable Care Act the lie of the year in 2009.

The problem that necessitated Section 1233 years ago didn't go away, and so it wasn't surprising that the Obama administration tried to add payments back in for advance directives with regulations in 2010, but still, the political climate wasn't ready and they were forced to back off.

Things may be changing. Medicare just rolled out some new rules that would start paying doctors for the advance directive talks in 2016, and the sky didn't fall. In fact, I haven't seen much obstruction or political hay being made of it at all. It'd be nice to take politics out of this. It's in all of your best interests to consider your future and medical care. Talk to your loved ones. Make decisions ahead of time. Get them written down in advance directives, no matter what you want, we want you to get just that.

Healthcare Triage is supported in part by viewers like you through Patreon.com, a service that allows you to support the show through a monthly donation. We'd especially like to thank our honorary research associates, Cameron Alexander and Qadeem Salehmohamed. Thanks, Cameron and Qadeem. If you'd like to support the show, more information can be found at patreon.com/healthcaretriage

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