HCR -- Two Links

By John Ballard

?A nutrition label for health insurance By Sarah Kliff

No, really. 
Ezra Klein's column tells about a standard consumer information "label" for insurance policies that will clarify what's covered, what's not and what the costs will be.

You can see the full, four page version here. The information included [in the image at the link]  reflects an example plan, not any set of benefits that the administration is endorsing.

Think of it as a nutrition label for health insurance, with a rundown of what procedures cost. It includes everything from having a baby to picking up a generic drug at the pharmacy. It�ll certainly be more complicated than anything you�d find on the back of a cereal box, but likely a lot simpler than what we have now. The big focus in drafting this document - a process that has taken the better part of last year - was making insurance accessible to consumers. The font, for example, must be at least 12-point size. The document is limited in page length.

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One possible hiccup in implementing this provision of the law now: It could create some confusion in the individual market. Most insurance plans there are underwritten, meaning that insurers charge more to patients who they think will be more expensive, likely those who are older or have a pre-existing condition. The insurance form notes this with the explanation, �After the insurer reviews your application, your actual premium may be higher or your application may be denied.� So a disconnect could emerge between what consumers see on this form - an estimate based on preliminary information - and what the carrier ultimately charges.

How much use these forms get is also likely to be somewhat subject to how highly they�re publicized. As an Health and Human Services fact sheet, released Wednesday morning, says, the summary will be provided �to shoppers and enrollees upon request and before they buy coverage.� Consumers will need to know to request this form, while comparing plans, to make use of it. Part of that will hinge on a good PR campaign, to ensure that consumers know about the new summary of benefits before selecting a plan.

?Hospice And The �End Game� By Eleanor Clift

I know readers are tired of all my links and preaching about hospice, palliative care and the importance of advance directives for medical care. But these topics are just too important and too often skipped over to be ignored. Time permitting, then, once again go to another link and read Elanor Clift's account of her husband's final weeks and months as he died of cancer at the age of sixty-four.

The day finally arrived when Tom�s oncologist gently suggested that he might want to take a break from the regimen of drugs that didn�t seem to be doing much good anyway. It was just after Thanksgiving in 2004, some four years after Tom had been diagnosed with metastatic cancer�a pretty good run, given the relentless nature of the disease. The doctor made it sound as though Tom had earned this reprieve, which he certainly had, but tucked in among the well-wishing was the word hospice.

I didn�t know much about hospice care then, but I did know it was meant for people who had six months or less to live. I don�t think Tom even heard the word, because he looked puzzled when he saw me crying.

They say hospice is the best medical care that no one wants because it signals the end of life, and American culture is all about fighting until your last breath. But hospice is far more than a waiting room for death; it�s a different philosophy of care for both the patient and the family. Entering hospice generally involves an end to harsh treatments and a focus instead on palliative care to provide the best quality of life in the time remaining. I remember when the nurse doing the hospice intake visited us at home to enroll Tom, and the odd sense of relief I felt now that the day I had been dreading for so long had arrived. Tom had a phrase for it, �the end game,� and he seemed okay with that.

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In 2009, when a provision was inserted in proposed national health reform legislation that would have allowed Medicare to pay physicians and certain other health care providers to discuss end-of-life choices with beneficiaries, former Republican vice-presidential contender Sarah Palin characterized the proposal as leading to �death panels.� The phrase took hold, putting Democrats and President Barack Obama on the defensive, even though it was a Republican, Sen. Johnny Isakson of Georgia, who�d introduced the provision. �How someone could take an end-of-life directive or a living will as that is nuts,� he told the Washington Post. �You�re putting the authority in the individual rather than the government. I don�t know how that got so mixed up.�

My first reaction, too, was disbelief. I thought surely the facts would catch up with the distorted interpretation that Palin and others were touting. Boy, was I wrong.

Critics of health care reform were able to twist a benign provision into something diabolical, igniting primal fears that, in a time of scarcity, old people and people seen as defective would be denied care. I realized the damage that had been done when, at a town meeting in July 2009, a woman named Mary stood up to confront President Obama. She said she�d been told that a clause in the health care plan says that everyone of Medicare age will be visited and told to decide how they wish to die.

Obama at first tried to make light of her concern, saying there aren�t enough government workers to carry out such a task. Then he explained that the intent of the clause was to encourage people to fill out a living will, so their wishes would be respected. He noted that he and his wife, Michelle, have such documents, and that if the provision became law, Medicare would cover the cost of a consultation about end-of-life care every five years.

The provision didn�t become law, and although the Centers for Medicare and Medicaid Services later proposed a similar arrangement through regulation, the agency ultimately withdrew that proposal as well. So in a political environment of heightened suspicion of government, the perception still lingers that end-of-life planning is code language for the government�s wanting to force people to prematurely end their lives.

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Hospice care not only offers people a better quality of life in their final days, but it�s also less expensive than traditional hospital care. A 2007 Duke University study found that Medicare saves about $2,800 per beneficiary when hospice is brought in at the end of life.