Straight Talk, Part I

The end-of-life myth and the real long-term care stories to be told

With charges, countercharges, information, disinformation, flat-out lies, and half truths being disseminated on all sides of the health reform debates, how is a poor citizen to learn the real story? Today begins the first in a series of occasional posts called Straight Talk that will sort out information and misinformation for readers who may feel themselves caught in the middle and not knowing who to believe. We invite you to send us examples of questionable claims on which you would like us to comment. Direct your questions to trudyal530 [at] The entire series is archived here.

In mid-July, Betsy McCaughey, identifying herself as a former lieutenant governor of New York state and chair/founder of the Committee to Reduce Infection Deaths, penned op-eds in two editorially conservative newspapers: The Wall Street Journal and the New York Post. The first, published in the Post on July 17, rambled on about people being forced into “qualified” health plans with limited access to specialists and treatments. It sounded scary, but McCaughey didn’t tell readers that the term “qualified plans” may mean plans that will offer minimum benefits as protection against being underinsured and potentially bankrupt when illness strikes. That’s a good thing.

McCaughey then went on to mention “one troubling provision in the House bill” that, she said, “compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care.” She posited that the sessions cover “highly sensitive matters” and that the mandate “invites abuse.” Seniors, she said, “could easily be pushed to refuse care.”

The day before the Post published another of her op-eds, entitled “Deadly Doctors”, McCaughey appeared on former Sen. Fred Thompson’s radio show, saying that “Congress would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner”—an inaccurate assertion that apparently scared the bejesus out of Thompson’s listeners.

In the Journal op-ed, which was mostly about seniors being denied care, she offered more scary stuff. McCaughey claimed that the House bill:

Ensures that seniors are counseled on end-of-life options, including refusing nutrition where state law allows it (pp 425-446). In Oregon, some cancer patients are being denied care by the state that could extend their lives and instead are afforded the benefit of physician-assisted suicide instead.

To set the record straight, we checked in with Washington and Lee law professor Timothy Jost, an expert on consumer-driven health care. Jost told us that the bill allows Medicare to pay for voluntary consultations between doctors, nurse practitioners, and physician assistants about advance planning for the end of life. Medicare will pay for the service every five years, or more often if warranted by changes in a patient’s health. Consultations can cover such issues as hospice and palliative care, setting up a durable power of attorney, and advance directives which instruct medical providers about your wishes for end-of-life care. In my other writings, I have urged consumers to set these up, but according to Howard Brody, who directs the Institute for the Medical Humanities at the University of Texas, Galveston, only about one-quarter of Americans have done so.

“There is nothing new here,” Jost explained. The proposed legislation builds on the Patient Self-Determination Act of 1990, signed into law by George H.W. Bush. That law requires hospitals, nursing homes, hospices, and home health agencies to provide the same kind of information contemplated in the House bill. “Anyone who has been though the death of a parent knows the value of this service,” Jost said. “It is impossible to believe that this innocently got twisted into this ‘death panel’ legislation.”

In the op-eds, McCaughey did not mention her affiliation with a group called Defend Your Health Care—which, according to a receptionist at the Committee to Reduce Infection Deaths, is her policy organization. The group’s bare-bones Web site spotlights some of McCaughey’s appearances in print and on television, and offers links to the House and Senate bills and various other articles about health care reform—like one by Charles Lane, an editorial page staffer at The Washington Post, who is worried that the consultations may not be so voluntary; and a Wall Street Journal opinion piece by a woman with cancer, who fears that comparative effectiveness research studies will lead to rationing and will prevent cancer patients from getting all the tests and treatments they need. These articles reinforce points McCaughey has been making.

McCaughey is an academic by training, with a somewhat notorious past. She helped scotch the Clinton plan with two New Republic articles later repudiated by the magazine, which apologized for running them. The articles made such claims as “the law will prevent you from going outside the system to buy basic health coverage you think is better.” Her claims were later challenged, and Andrew Sullivan—then-editor of The New Republic—said he knew her stories were flawed but ran them anyway in order to provoke debate. Her M.O. this year seems similar.

At that time, she was a fellow at the conservative Manhattan Institute, and her writings made the rounds in right-wing and mainstream media outlets, just as they are doing now. This year, she has written about the evils of comparative effectiveness studies, an idea that first appeared in the stimulus bills. Drug and device makers aren’t too keen on them, either.

All this makes us wonder if McCaughey is speaking for herself, or for other interests. As we’ve pointed out before, special interests that oppose legislative provisions often use front groups to help build support for their positions. Is Defend Your Health Care one of them?

Of course, it’s impossible to link cause and effect here, but shortly after McCaughey’s Post op-eds appeared, the notion that the House bill would limit end-of-life-care and encourage euthanasia struck a nerve among the pols, the public, and the press. Intended or not, McCaughey’s message gained political currency. “This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law,” House minority leader John Boehner and Michigan Rep. Thaddeus McCotter said in a statement which flowed all over the Internet. Sean Hannity explained the provision this way: “In other words, they would mandate that those who get government care literally could be pushed to refuse care.”

While some media organizations, like ABC News’s Fact Check and the St. Petersburg Times’s Truth-O-Meter, tried to counteract McCaughey’s statements, once the proverbial cat is out of the bag in the disinformation business, truth goes on the defensive.

There’s a major problem with all this media myth-making. It deflects attention from telling the stories that do matter. There’s no national outrage against old people dying from bad care in nursing homes, and the poor regulation that contributes to their deaths. There has been no discussion of the ticking time bomb—how to pay for long-term care as Baby Boomers age. And there have been virtually no stories about the suffering that has resulted from state budget cuts for long-term care services that keep elders in their homes, instead of more costly nursing homes. Those people have truly been hurt by government actions. New America Media just aired such a piece. More are needed. Maybe Sean Hannity and Rush Limbaugh should take a look.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.