AARP Spokesman On End-Of-Life Provision

At his meeting Tuesday on health care with the AARP, President Obama faced a question on a provision in the health care proposals that would pay for end-of-life consultations. AARP spokesman Jim Dau says the measure would empower individuals to make the best possible choices.

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MADELEINE BRAND, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Madeleine Brand in California.

ROBERT SIEGEL, host:

And I'm Robert Siegel in Washington.

We speak casually of the health care debate. In fact, there are multiple debates underway. Health care covers so much legislative and economic turf, there are countless issues to get upset or excited about, some of them of greater interest to particular demographic groups.

For example, this moment, during President Obama's town meeting yesterday, the meeting was hosted by AARP, and at one point a caller named Mary put this question to the president about something that she had heard is in the House bill.

MARY: I have been told there is a clause in there that everyone that's Medicare age will be visited and told to decide how they wish to die. This bothers me greatly, and I'd like for you to promise me that this is not in this bill.

SIEGEL: Well, the president assured the caller that nobody's going to be knocking on her door telling her to fill out a living will. But he did talk about end-of-life decisions, and he joked that there are not enough federal workers to go asking everyone over 65 how they want to die.

Well, for the AARP it was evidently a very familiar, if misplaced, concern about the House bill and it apparently enjoys some undue credence among seniors.

James Dau is the AARP spokesman, and he joins us in the studio. Hi.

Mr. JAMES DAU (Spokesman, AARP): Hi. Thanks very much for having me.

SIEGEL: What exactly does the House bill say about end-of-life counseling?

Mr. DAU: The House bill includes a provision that would allow Medicare to pay doctors for taking the time to talk with their patients about the very difficult choices that people face at the end of their life about health care: What kind of interventions you might want in the case of a bad accident or debilitating illness. It would empower individuals to make the best possible health care choices for them and their families and allow doctors to provide their patients with this so that no one's guessing at the end of a person's life.

SIEGEL: Because you're saying that that consultation that the doctor would offer or another health care professional might offer would, under the bill, now become covered by Medicare.

Mr. DAU: That is correct.

SIEGEL: They'd be paying for that. And that's not the case as it is today.

Mr. DAU: It's not formalized like that. Right now doctors can talk about end-of-life care as part of your Welcome to Medicare physical. But now, this would allow every five years that you're in the program.

SIEGEL: But the caller Mary is not unique. There are other people. You hear members of AARP who hear tales of the federal civil servant body snatchers who are going to come and make you - say how indeed do you intend to die.

Mr. DAU: Absolutely. We've been hearing, especially for the last, you know, week-and-a-half, two weeks, from people that are legitimately frightened about the prospect that in this bill is a requirement that will have Medicare pull the plug, or make you sign a piece of paper that forces you to determine now how you want to die. It's just flat untrue. It's mean and it's a cruel distortion. But we have been hearing about it from many members because it sounds awful.

SIEGEL: Is there a kernel, a small kernel of truth in the fear, which is that we incur a huge share of our lifelong medical expenses at the end of life and that a more rational system would get us to spend less? And inevitably there'd be fewer procedures and fewer treatments in the last six months or last year of our lives than what people are accustomed to now.

Mr. DAU: The numbers that you see flying around about Medicare spending in the last year of your life, they're big. There's no doubt about it. And to some degree, you should be spending more on health care at the end of life. Presumably, you're healthier before then, which is hopefully what we should get out of health care reform. But all that said, it has zero to do with this.

Two people presented with the same option, if you tell them that your choice is a very intensive intervention, which could add a year to your life, probably deteriorate the quality of your life to the point that you're not entirely responsive and it's going to cost half your retirement savings, one individual will say yes. Absolutely. Give me every possible treatment you can. Another person will say, I can't put myself through that. And I don't want to put my family through that. And that is completely their choice, as it should be.

SIEGEL: Mr. Dau, thank you very much for talking with us.

Mr. DAU: Thank you very much.

SIEGEL: James Dau is the spokesman for AARP. And his organization has not endorsed any of Congress' health care plans, but it is backing individual proposals, including the one regarding end-of-life consulting.

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