What is the Truth About Health Care Reform?

(from Carolyn McClanahan's Forbes' column, 7/3/2012 - click here for the original post. Carolyn is a physician, financial planner, educator and storyteller. For more on Carolyn, visit her Forbes' profile.)

When the Affordable Care Act was originally passed, misinformation and inflammatory lies regarding the law made their rounds on the internet. Great examples from the right – seniors on Medicare would face rationed care, death panels were going to be enacted, or you would have to pay extra taxes on the sale of your home to name a few.  Great examples from the left – the life of “Julia” and the exaggeration of the numbers who would be denied coverage because of preexisting conditions.

The lies and misinformation slowed down a bit over the past few months as everyone waited on the Supreme Court decision with rabid anticipation.   Those against the law thought the case was all locked up to repeal.   Immediately after the Supreme Court decision was released the misinformation started again.  What a surprise (not really.)   On Facebook, what showed up?  The oldie but false picture of a van with the following painted on the side – “President OBAMA – If the Health Care Reform Plan is so Great, Why does it EXEMPT YOU, Michelle Obama, Congress, Senators, and their families?  Page 114 Line 22”

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I’ll debunk this in a minute, but first I want to share my hope for the people of this great country as the election approaches.  My hope?  We take the time to understand the problems in this country from more than our individual perspective and then obtain non-partisan education on solutions from reputable sources.   We should choose our leaders based on truth, understanding, and a desire to improve our greatness instead of basing our decisions on rhetoric and ideology.  When we hold ourselves to a higher standard in our own education on important matters, we can hold our leaders to a higher standard, and maybe they will begin to deliver.  I am an optimist.

To help you focus on issues with health care, I point you to two non-partisan and highly reputable resources. These will help you pick through the bunk and exaggerations from both sides.

Kaiser Family Foundation:
This is the granddaddy of all sites on health care reform. There is a section with the basics, and delves as deep as you want to go into the details of health care and the Affordable Care Act. In addition, the good people at Kaiser Family Foundation provide regular updates and a roundup of the news in health care on The Scan. I also enjoy the regular polls they conduct and share from others on public opinion in numerous facets of health care.

FactCheck.Org:
This site looks at the facts behind statements in the press, chain emails, and other questionable propaganda. Sponsored by the Annenberg Public Policy Center, FactCheck.org goes beyond health care and is a great tool for all matters of fact in our public debates. In their archive, 408 articles are devoted to health care or the health care law. There is an abundance of misinformation out there, and this site helps you sort through the bull. It has an easy search engine if you are looking for a particular topic, like our lovely quote on the van.

So don’t rely on some photo of a van with billboard lies to learn what this law is about. Check out the facts for yourself. Even better, stop the misinformation and lies. As for the van? A waste of paint. Congress, the President, and the First Lady are subject to the law. The van doesn’t even reference the law – it references a draft of a bill not part of the Affordable Care Act. Page 114 of the real law discusses the four different levels of health insurance that would be sold on the exchange – and line 22 focuses on the “gold plan.” FactCheck.org backs me up on this one. In case you are curious, Title I, Section 1312 “Consumer Choice” contains the verbiage that Congress is required to use plans created under the law. You can actually go read it. Go to page 157, starting at Line 16.

Make no mistake about it. The Affordable Care Act has warts, but the majority of the law contains good provisions that will eventually make our country stronger and healthier. Learn what is good in the law, learn about the warts, and demand that our leaders move forward with further solutions.

Who is Going to Pull Your Plug?

(from Carolyn McClanahan's Forbes' column, 5/22/2012 - click here for the original post. Carolyn is a physician, financial planner, educator and storyteller.  For more on Carolyn, visit her Forbes' profile.)

We have all heard the stories – accidents, sudden illness, or slow decline taking away a person’s capacity to make their health care decisions. Unfortunately, few people have taken the time to appoint someone as health care surrogate to act on their behalf in these situations and only a handful of people have discussed their wishes with their surrogate. Today I discuss how to pick your health care surrogate – it definitely requires some thought.

What does a “health care surrogate” do? Basically, they make your health care decisions if you are incapacitated and can’t make decisions for yourself. Note – you have to be both incapacitated and unable to make decisions. For those who have a hard time making decisions, you can’t punt your healthcare decisions to someone else just because multiple choices paralyze you.

Move up http://i.forbesimg.com tMany people think a health care surrogate acts only at the end of life, but there are many situations that are not necessarily life threatening where your wishes may need to be shared by someone else. If an accident takes away your ability to communicate, your health care surrogate will need to step up to speak for you and they must be willing and able to do this at a moment’s notice.

What are the qualities of a good health care surrogate?

The health care surrogate must be a level-headed individual:

If you sustain a severe head and neck injury, and the doctor tells your spouse that despite best efforts, you will never be able to feed yourself or engage in a conversation ever again, what will your spouse do? Will he freak out and want to keep you alive forever in the hope of a miracle when you’ve explicitly stated that you do not believe in miracles? A spouse does not always make the best health care surrogate. Be certain to choose someone who can follow your wishes and make good decisions in light of heart wrenching emotions. For this reason, the role of health care surrogate may be best delegated to a health care professional within the family.

The health care surrogate cannot be shy about asking questions and must be intelligent enough to understand the implications of the answers:

To fulfill this responsibility, your surrogate must understand your goals. Every treatment the health care providers want to perform must reach the eventual outcome of the goals you’ve shared with your surrogate. For me, it is so important to always have the use of my brain and my hands. If I am in a situation where we know I have a good chance of those two functions being restored, do everything toward achieving that outcome. If it is obvious that my brain will no longer allow me to write this blog or have my fabulously self deprecating sense of humor, the only things I want done are comfort measures to let me die quickly. Your surrogate must constantly ask, “Will this help my loved one reach the goals of _________.”

The health care surrogate must be willing to stand up to the health care system:

The health care system is wired to “DO EVERYTHING!” Our malpractice and payer systems greatly affect how medicine is practiced. High pressure situations lead to high pressure heroics, especially if doctors do not have a previous relationship with you. It is in the provider’s best interest to do everything possible until your health care surrogate has screamed, “ENOUGH!” If you have been clear in your wishes to limit care in certain situations, your health care surrogate will have to be vocal and not easily intimidated by overbearing health care professionals. For example, if the doctor says you will die if they do not place a feeding tube into your abdomen, and it has already been determined that your desired ability to recognize your loved ones is not in the cards ever again, will your health care surrogate have the fortitude to say no to their request?

The health care surrogate should live in close proximity if possible and have the time to address your urgent situation:

Ideally, the likelihood of needing your health care surrogate is small. However, someone who lives across the country may not be in the position to uproot their life to address your health care needs.

Other considerations:

In addition to your primary health care surrogate, it is good to have one or two backups. Ask their permission in advance, and share a written copy of your health care goals with them. Share your decision on who is serving as surrogate with other family members, and let the entire family know you have written clear wishes that are not to be messed with. The biggest impediment to a successful outcome is to have other family members not on board with your desires. When multiple family members question decisions of your health care surrogate, angst results. Your surrogate has a difficult enough job without the added burden.

I wish us all a quick, painless, and planned for death at about age 100, but unless you plan on riding your Vespa off a cliff, planned death is unlikely. Therefore, choose your health surrogate wisely just in case you need to visit that topic sooner than you desire.