EOL Switch Again

Word that Medicare is reversing its course and will not allow expanded discussion of patient choices such as advanced directives and options such as palliative care as part of Medicare annual exams. This is bad in policy terms and serves to limit access to important care for America's elderly. I guess the politics were understood to be too negative, especially the notion by some that this effort was sneaky and done in secret, put out in the federal register with little fanfare. OK.

Sing this from the rooftop, no more secrets.

We will all die. It is a matter of when, and from what. I want my grandmother, my mother, my father, myself, my wife and everyone I know to be able to hear the truth about prognosis, choices and quality of life. I want to make sure that informed consent means both 'informed' and consent which means 'made a choice.' Palliative care focuses on improving quality of life regardless of prognosis. I want access to it, again for those I love and for me. Everyone doesn't have to make the same choices my family makes or that I make.

Lets talk about this more, over and over. When you have an inevitable outcome of death, eventually there will be diminishing returns on what we do to forestall death. If you don't believe this, you believe it is possible you could live forever. You cannot. Lets talk about these facts as a country and figure out what we want to do. But, we need to start from the only thing I know to 100% true of the health care system: we will all die, it is only a matter of when, and from what. What do we want to be true about the care available in the Medicare program (8 in 10 deaths in the U.S. occur among Medicare beneficiaries) as this reality unfolds?

Quick update: I don't know if there was a faulty procedure in how Medicare put out this change; if yes, that is quite amateurish; if no, then politics are overriding policy/best care for patients.