I want to give it to them. I want this desperately. Not right away, to be sure, but someday, in exchange for the right to talk to my doctor about end-of-life care. In fact, $60,000 seems low -- we could be talking more -- almost free for the asking.
And what do I get in return? A vile, forwarded e-mail from my right-wing uncle spewing hate, fear and paranoia.
What kind of thanks is that?
It was a terrible message, fronted by a picture of an angry-looking black dude with his finger pointed right at me. Just below, a line of bright blue text warns in large and agressive type: "This is very scary especially for we older people. I appears that Nancy Pelosi, Henry Waxman and Barack Obama want to reduce health care costs as well as the population by killing off older people."
Of course the message continues along those lines, and of course, that scary-looking guy is my beloved President, the one I worked so hard to help elect. I knew it was childish crap, but I've learned from having actual children that directly denouncing their tantrums as childish crap is not usually very helpful. So when my Mom wrote to ask for help understanding her brother's note, I tried to think calmly and explain to her in more rational terms what the argument is all about.
This is what I came up with, please let me know what you think and whether I got it right.
Dear Mom,
I'm sorry Uncle xxxxx is so upset but I don't think you have to worry. I'm not a real policy wonk, but let me try to explain what I think the problem is.
I believe it was a Republican Senator ( Johnny Isakson, from Georgia) who originally suggested that everyone, regardless of income, was entitled to respectful and focused attention from our doctors when it came to end-of-life decisions, whether we are days or many decades away from death. Unfortunately, the code for medical billing doesn't include that kind of counseling as a billing option, so even if we really want to talk, the doctor cannot easily be reimbursed for his or her time. Our doctors might be willing to take that time, but other people's doctors might not feel that unpaid time is time well spent.
Do you remember when Daddy was sick, and we had to go into that poky little room to get the news that his doctor had suggested we get a DNR (Do Not Resuscitate) order? Everything was happening so very fast that it took us by surprise, and we cried and then we had to spend a long, long time thinking about what options we really had and what the different scenarios might include if we didn't sign it. That took more than an hour, I think. Then we had to go, with the doctor, to tell Daddy. And that took another hour, at least. It was a nightmare, and we had a lot of questions and a lot of tears. It was awful, and I will never forget it, but I'm glad we decided to bring him home and that we were able to be there and that he didn't spend an extra week in the hospital undergoing desperate procedures that cut him away by inches, with each inch promising another hour of a life that had already been lost.
Back then, I don't know how they managed to get paid for all that time or why they spent so much time with us at all. But now, if the doctor can't bill for it, you might just be out of luck. If the doctors don't know you and don't decide to do it out of the goodness of their hearts, you don't get it. You are on your own. People don't get to make informed and loving choices for themselves and for the people that they so desperately love.
The health care bills going through Congress right now would not mandate that everyone get end-of-life counseling. Some people don't want it because they don't want to think about it. Others believe that as long as their is life, there is hope, and they truly want extraordinary measures. Under these bills, this is fine, you don't have to talk about it. What these bills will do -- unless the idea is abandoned -- is to put a line into insurance law that guaranteed payment for doctors for the time they spent counseling families and individuals about end-of-life issues IF THE FAMILIES AND INDIVIDUALS WANTED TO TALK ABOUT THEM!!!
Does that sound so bad?
But here's the part that caught the public imagination, I think. People are afraid, abjectly afraid, and I have all sorts of theories about why, but maybe why isn't important tonight.
There is an incredibly good public policy and budgetary reason why people should have more control over the last month or two of their lives. Those last desperate measures in the last few days are incredibly expensive. Up to half of Medicare expenses are spent in the last year of life. That's an enormous amount of money.
Scared people hear that and imagine that the rest of us get angry if they would like to stay alive. They fear that we would like to deny them that last year so that we can save money. They are, in fact, terrified that they might feel shamed or coerced into giving up too soon.
I understand that. These laws wouldn't restrict their choices, but they are worried about the generosity of their fellow Americans. Most of us would let them or their Grandmas choose to stay alive, on a respirator, for another six days, or for as long as they wanted, I think. And under these proposed laws, they would have that right. But they don't believe it -- they truly don't believe it. Sometimes I suspect that this is because for some of them, if it was MY Grandma who wanted to stay alive, they would not be willing to help to pay. They realize this, and it frightens them.
We don't need to save money on the backs of those who don't want to take advantage of a hospice option, for whatever reason. Different people want different stuff. And that's OK. I know, for instance, that you believe in miracles and would like to be kept alive until the time for miracles has passed. But there are plenty of savings to be had from the likes of me, and I believe that I am in the majority. I hope to fight off all sorts of health threats for as long as I still have hope. But I truly, desperately don't want to spend my last six days on a respirator, getting more tests and procedures, if my hospital is just trying to eke out a few more billable hours as I lie in a hopeless coma. I don't want to have to lie there, fuming through my last moments in a voiceless rage while my doctor, who has never spent time talking to me, indulges in his time-share in the local MRI. Unfortunately, since doctors don't get paid, they might not ask what I want. And even if they do ask, studies show that hardly anyone gets to die without extreme intervention because doctors and hospitals are paid to DO stuff, and they just can't seem to stop doing it, even when they are asked to stop.
I don't want these opponents of health care reform to save me $60,000 or more on end-of-life care for the people THEY love.
I'm asking them to let ME save THEM $60,000, or more, on MY end of life care. But they either can't hear me, or don't believe me. Sounds crazy, doesn't it?
Love Always,
Zenara
Mom wrote back to tell me that after she read my note, she told a fundraiser for the DSCC that she wouldn't be sending them any money this quarter, since the money might go to help Blue Dog senators that don't support the public option and don't speak out against the "Deathers." She's sending money directly to support action in favor of the public option instead.
She also forwarded my note to everybody else on my uncle's fear-mongering forwarding chain. I haven't heard back about that one yet . . .