I just finished watching The Daily Show, and I think my head is going to explode. Their guest was Betsy McCaughy, PhD. She was arguing against the most recently-proposed health bill. I was so astounded at her misreading of the bill that I wanted to reach through the TV and smack her. Additionally, it's amazing that people are so outraged at this proposed bill because the bill is not law.
My responsibilities at my previous employer included researching and making technical rebuttals over proposed legislation back to the federal government on provisions we disagreed on; assisting clients in making such technical rebuttals; understanding Congressional intent in my own little corner of the regulatory world; and implementing and assisting clients to implement such technical and overarching operational guidance. I also worked with our lobby to change legislation and even managed to do so on some occasions. After that experience, my biggest beefs with Dr. McCaughy's points were:
1. First and foremost, the bill is not law. The way bills generally work in Congress (at least my understanding) is that one person proposes something (or sponsors it, anyway). The bill makes its way through the chain. People hate it. They send back their comments. The people who created it make changes to it and send it back again. Then rinse and repeat until they get a final bill everyone can live with. So if everyone would shut the hell up for five seconds and realize that, perhaps we can get something through Congress to help people.
2. The overarching Congressional intent on Medicare is to protect its beneficiaries, which is one of the many reasons complicated fraud, waste and abuse and quality reporting requirements are implemented. Other checks are put in place as well to prevent private companies (including health plans insuring beneficiaries, their physicians, pharmacies and anyone associated with the program) from defrauding or otherwise doing anything not in the best interest of the beneficiary. Sub-regulatory guidance like this includes marketing provisions, enrollment/disenrollment provisions, reporting requirements over and above quality (such as prescription drug event, medical event, etc.) and more. In other words, don't screw with the beneficiary.
3. Dr. McCaughey was referring not to the actual provision of the issue at hand (the end-of-life discussion, whether it's required and what's to be discussed), but the reporting requirements, which indicate that the doctor must provide life sustaining care if requested by the patient and/or his/her health proxy. Nothing, absolutely nothing, is said that the physician must choose to terminate or otherwise withold treatment - it all focuses on sustaining the life of the patient. Nowhere in the provisions (see page 424 through 431 of the bill). Indeed, the physician isn't even required to have such a discussion with the beneficiary if he or she declines. Further, the discussion between the medical professional and patient must focus on factual information only. As in, these are the ways you can tell people what you want, here's who can help you do that and here are some other resources. That's it.
At this point, it appears that no one really gives a rat's ass what the bill says, but what they've decided it says. Also, Dr. McCaughey kept repeating herself like a freaking parrot, but said absolutely nothing of value. I find it completely disgusting that people like her are preying on others' confusion simply to advance some sort of agenda, and I'm sad that she was given a national forum on which she could continue to spread such misinformation.
Do I think the bill is great? Good God, no. Is it even good? Not really, but it's a place to start. So shut up and get started already. Times a' wasting and people are underserved, dying and going broke trying to ensure their families have access to insurance and healthcare. To both sides: shut your traps and get to work. Isn't that what we pay you for anyway?
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