Sunday, December 26, 2010

"Do You Have A Living Will?"

Considering that the elder of the Two Sisters will be having her 65th birthday in about a month and a half, and the younger Sister is only fourteen months behind, all rulings concerning Medicare take on a different and more personal interest.  It would be lovely if after reaching age 65 one could retain the insurance they have, but the law does not allow it.  The moment one's 65th birthday approaches the mailbox is filled with all sorts of directions for registration for Medicare, a Medicare card is sent out to the future recipient, and of course a fee is charged out of the Social Security earnings once it becomes effective. 

In spite of the Medicare coverage it is imperative for those who can afford it, to maintain the premiums on a secondary insurance policy, either private or through a retirement program.  Theoretically one can decline Medicare benefits, but only those who are in either extremely good health, or wealthy enough to pay primary care premiums without any sort of financial assistance, do.  We've done our math, and the fact that Sister One and husband will both be Medicare recipients, and the cost of the supplementary insurance premiums have increased significantly, the  total cost of being insured has increased by nearly $200.00 per month. 

Contrary to what many believe, Medicare is not a free government program.  Not only did recipients, especially Baby Boomers who are now turning 65, pay into the system during their working careers, but there is that $100.00 monthly fee that is automatically withdrawn from the Social Security earnings.  Getting old isn't cheap folks, and if you haven't planned for your so called "Golden Years," now is the time to start.

Included in that plan is the question of the "Living Will" or making plans to face one's inevitable death.  As one late friend used to say, "The only thing in life that is certain is death and taxes." 

We began to think about this subject late this evening when we read that new Medicare regulations have revived the discussion of end-of life planning.

The news first broke in the New York Times, and the following article is very much a repetition of the original:

Medicare regulation revives end-of-life planning

WASHINGTON – A new health regulation issued this month offers Medicare recipients voluntary end-of-life planning, which Democrats dropped from the monumental health care overhaul last year.

The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

But the practice was heavily criticized by former Alaska Gov. Sarah Palin and some other Republicans who have likened the counseling to "death panels."

The "voluntary advance care planning" is included in a Medicare regulation issued Dec. 3 that covers annual checkups, known as wellness visits. It goes into effect Jan. 1.

The new regulation was first reported by The New York Times.

For years, federal laws and policies have encouraged Americans to think ahead about end-of-life decisions and make their wishes known in advance through living wills and similar legal documents. But when House Democrats proposed last year to pay doctors for end-of-life counseling, it touched off a wave of suspicion and anger.

Opponents said end-of-life planning should be left to families, while proponents said doctors' advice was a basic element of health care.
Prominent Republicans singled it out as a glaring example of government overreach. Palin's use of the phrase "death panels" solidified GOP opposition to the health care bill.

Although advance planning never made it into the law, few Republicans joined in supporting the health care overhaul, President Barack Obama's signature domestic legislative achievement.

We write about this subject with mixed emotions and a heavy heart.  The loss of our parents in 2007 and 2009 is still too fresh in our minds.  On days like today,  Christmas, and especially after the birth of a new great-grandson for them just two days ago, brought back  loving memories and our longing to be able to share these joys with them.

Our parents lived long and productive lives.  At the time of their deaths both were of very sound mind.  They were intelligent, articulate, capable of reasoning and determining their future, in spite of having several illnesses not uncommon at ages 89 and 88.  They kept abreast of all the changes in Medicare laws and rules.  Our mother went over every statement with a fine tooth comb.  She knew how much Medicare paid each doctor or the hospital, how much they charged the system, what amount their supplementary insurance paid, and what they owed after all others had paid all the charges that they would cover. 

Our father survived cancer and very difficult surgeries in his late 70's and mid eighties.  Our mother suffered from hypertension and diabetes, was impaired by arthritis, but never underwent any type of surgery.  Most of their bills were accrued by Dad's illnesses and hospitalizations. They remained fairly independent until Dad's last illness in 2005.  He was 87 years old.

Many Americans experience the same travails we did with aging parents.  The one thing neither one of our parents ever agreed to do was to write a Living Will.  Instead they gave us health power of attorney to decide their fate.

What is a Living Will?  The dictionary defines it as "a will in which the signer requests not to be kept alive by medical life-support systems in the event of a terminal illness."

If you or a dear one has ever been hospitalized you will know that one of the very first questions that you are asked upon admission is, "Do you have a Living Will?"  In many cases if you don't, the hospital will offer their services to help you write one. Our parents always declined. and it got to the point that we had extra copies of our Power Of Attorney (POA), in the car because with each new admission, a new copy was required.

This proposed regulation would pay the doctors for end-of-life counseling.  The whole issue of "Death Panels" began in August of 2009 when Former Alaska Governor Sarah Palin wrote on her Facebook page:

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care."

No one is more opposed to Obama's health care reform than we are.  Our opposition has nothing to do with end-of-life counseling.  Rather it is a matter of economics.  The Obama Health Care Reform bill was pushed through the Congress without adequate time to discuss it by both parties in Congress.  Democrats met behind closed doors and decided what to put in that monstrously expensive bill without consulting the GOP, or even allowing them to make suggestions or changes. Congress stayed in session during the Christmas break last year until they had bribed and cajoled enough members in order to get the required number of votes to pass the legislation.  In plain English, they rammed an obscure, obscenely expensive bill down the American public's throat, even after Americans had protested time and time again that they DID NOT WANT IT!

We don't oppose end of life counseling, we feel all should have it.  In all honesty we are opposed to the doctor being PAID to counsel their patients on writing a living will because it is our experience that they do it anyway.  Doctors talk to patients about what they can expect from their illnesses and most doctors that we've gone to advice patients to write a living will.  We see no reason to pay a doctor for what we feel should be part of his/her service to the patient.  What we fear is that there might be an ulterior motive behind the proposal.

"Do you have a living will?"  We do.  After our experiences with our parents we knew that no one would have to convince us to make those arrangements while we could still reason.  In our case the fear was that the POA gave us permission to decide whether our parents should be put on life support, or whether to terminate it.  Although we still grieve our parents' loss, it was a blessing that both died suddenly, unexpectedly, and the decision was taken out of our hands.  Although a sudden death is difficult to accept, we simply cannot imagine having to make the decision to disconnect life support and terminate a life.

There are many valid and important reasons why writing a living will should be considered.  Again, economics is part of it, and at the end of this article we will list some links for further reading.  Our uncle, a physician, passed away fifteen days after our mother, his sister, had died.  He had an iron clad living will in which he stated that he wanted to be cremated, where he wanted his ashes scattered, and above all he wanted no services at the time of his death.  His explicit instructions were followed.  Like our mother he too died suddenly, but the town he'd served for over fifty years wanted closure, and moths later, a meaningful memorial was held in his honor.

Are there "Death Panels"?  Is there a hidden agenda besides Obama's driving desire to socialize the American Health Care System?   We are learning about all the developments along with our fellow citizens.  Our advice to our readers is to carefully read Section 1233 of H.R. 3200.  If we are to decide for ourselves, then we must be well informed in order to make the choices that best fit us and those who will be left behind.


At December 26, 2010 at 8:20 AM , Blogger said...

Great article. Great advice! I've been dealing with guilt pangs over not contributing to the blog, but you're doing so damn well without me, I wonder if you even need another writer. BTW...Thanks for broadcasting our advanced ages to the world at large! GGRRRRR!!!

At April 14, 2015 at 1:09 PM , Blogger Sergio Freddson said...

Thanks for sharing your experience with us! I never realized that Medicaid and living wills were so interconnected. It's important to know what you're going to do with your assets before you're in real danger of losing your life. This will ensure that everything is divided up quickly and painlessly without any major incident.

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