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You are here: Home / Anderson On Health Insurance / Information for tough decisions

Information for tough decisions

by David Anderson|  May 24, 201610:31 am| 33 Comments

This post is in: Anderson On Health Insurance

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The New York Times reports that seniors are seeking information for tough decisions that they’ll make.  Doctors are getting paid to offer end of life planning support.

Three non-profits — the California Health Care Foundation, Cambia Health Foundation and John A. Hartford Foundation — fielded a poll of 736 doctors who see patients 65 and older. Only 14 percent said they had already billed Medicare for the new counseling, though the survey was conducted February 18 through March 7, meaning the earliest participants only had about six weeks from the start of the benefit. Altogether, 95 percent of doctors in the poll expressed support for the Medicare benefit and a big majority considered such conversations important….

All told, it was only about 20 minutes before Diamond’s white sneakers shuffled out of the room and the appointment was over. He was to review the paperwork with his two daughters before signing it, but he said he had looked forward to the session simply because it was a new experience. Diamond said he saw it as both necessary and comforting.

Medicare reimbursements for the appointments vary by region and the type of facility, but on average, an initial 30-minute session in a doctor’s office costs $86. As those experiences proliferate, the topic of discussing end-of-life care may return to the relatively uncontentious mantle it once enjoyed.

Death is scary, but lots of things are scary.  Having a plan to address uncertainty helps a lot of people become less scared as well as maintain control over themselves and their environment.  In a medical finance context, having a plan allows people to get the care that they want with some modicum of dignity.  It is not a death panel.  People can choose to have the hospital go all out with a strong possibility of a long stay in an ICU while others may choose to have hospice as their preferred option.  It is a matter of choice instead of a mandated non-choice that all people will get every type of care even when the individual would prefer not to have that care.

It is not a death panel.  It is information and advice from a trusted expert to make good choices.

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Reader Interactions

33Comments

  1. 1.

    gene108

    May 24, 2016 at 10:42 am

    It is not a death panel.

    It is a death panel. This is exactly what a death panel* looks like. This is exactly how death panels were originally part of the PPACA. Obama’s sneaked in death panels, while no one was looking.

    Where is Sarah Palin, when you need her?

    * Medicare Death Panels are rather dull affairs, but they are still Death Panels.

  2. 2.

    Gin & Tonic

    May 24, 2016 at 10:56 am

    I’d be OK with an actual death panel for Betsy McCaughey.

  3. 3.

    Cermet

    May 24, 2016 at 11:07 am

    Now, if one of these could just meet to handle the problem of cheney …

  4. 4.

    Scout211

    May 24, 2016 at 11:09 am

    Attention Californians:

    If you already have advanced directives and DNR forms for yourself and your family members, starting in June, we have yet another document that we need to fill out. We also need a physician to sign the form. This is all to comply with the new end-of-life law that goes into effect this year.

    ETA: Link not working: capolst.org is the site to download the forms.

  5. 5.

    Botsplainer, Cryptofascist Tool of the Oppressor Class

    May 24, 2016 at 11:12 am

    I’m genuinely saddened that we never got the televised death panels we were promised, with saintly white Christian grannies and grandpas (along with their family and friends) tearfully begging for lifesaving medications and procedures on reality shows.

  6. 6.

    Chyron HR

    May 24, 2016 at 11:22 am

    Did somebody say DEATH PANELS?!?!?!

  7. 7.

    amygdala

    May 24, 2016 at 11:24 am

    In a medical finance context, having a plan allows people to get the care that they want with some modicum of dignity.

    This. A thousand times, this. Even if no money is saved, making it easier for folks to make their end-of-life wishes known is the right thing to do.

    Thanks, Obamacare.

  8. 8.

    the Conster, la Citoyenne

    May 24, 2016 at 11:33 am

    That whole death panel freak out the summer before Obamacare passed and the press’s shameful reporting of it like it was actually a thing to take seriously because the Idiot Palin babbled about it, was maybe the dumbest thing in politics I’ve ever witnessed. I remember there were actually morons who thought Obama was deciding on who lives and dies, because you know, he has nothing better to do all day except put his feet up on his desk with the daily folder of tens of thousands of dying Americans he gets to pick and choose from to die on that particular day. I actually wish there were death panels, but for idiots, and I could be on one.

  9. 9.

    Helen

    May 24, 2016 at 11:34 am

    I just received a letter from Health First telling me that my premium increase for 2017 will be 6.5% (provided NYS approves the increase.) But here’s the interesting part. They broke down the percentages as such: Inpatient care 0%, Outpatient care .7%, Physician services .9%, Prescription drug unit costs 3.9%, Specialty drug utilization 1%. So of the 6.5% increase 4.9% or SEVENTY-FIVE percent is for drugs. We are a stoned country.

  10. 10.

    CONGRATULATIONS!

    May 24, 2016 at 11:41 am

    That whole death panel freak out the summer before Obamacare passed and the press’s shameful reporting of it

    @the Conster, la Citoyenne: The press, every last one of them, should have been put up against a wall for that horseshit. There is nothing more important in medicine than this. NOTHING. And the press chose to run with an utterly false interpretation, made for no other reason than scoring political points against a president by an opposition party, and did a grave disservice to literally millions of people and the entire medical profession.

    I’m not the kind of guy to call for the elimination of whole groups of professionals, unlike some here, but the press…the press needs some controls. A LOT of controls. And that needs to happen sooner rather than later, because they’re not informing anyone. They’re spreading one-sided politically motivated disinformation and that cannot be allowed to continue. We don’t need a “fairness doctrine”. That wouldn’t fix the current problem. We need something much stronger and all-encompassing, and can’t afford much in the way of delays.

  11. 11.

    gratuitous

    May 24, 2016 at 11:44 am

    What?! Acknowledge the possibility that I’m going to die someday? You heartless bastards, how dare you?

    Okay, now that the stupid, ersatz outrage is out of the way, yes, this needs to be a part of every person’s thinking, and making a plan ahead of time takes some of the uncertainty and worry out of it. Talking about it with your children or younger relatives is a way to make it less scary, and more a natural part of the life cycle. You don’t have to dwell on it morbidly, but mapping out how you want to end your sojourn here is a loving and responsible way to live, and does a big favor to those around you. “Gee, we don’t know what Dad wanted, we never discussed it! What should we do, what should we do???” Nice little turd of a gift to leave your kids. It’s tough enough watching you go, but at least they can be sure of what you wanted to happen.

  12. 12.

    a hip hop artist from Idaho (fka Bella Q)

    May 24, 2016 at 11:45 am

    @amygdala:

    In a medical finance context, having a plan allows people to get the care that they want with some modicum of dignity.

    This. A thousand times, this. Even if no money is saved, making it easier for folks to make their end-of-life wishes known is the right thing to do.

    Thanks, Obamacare.

    This, by an exponential number of 1000 times, please. People need the ability to make informed choices instead of finding themselves in an ICU for weeks receiving care that’s often futile in terms of improving the quality of their lives. Without enough information from medically knowledgeable professionals (often known as doctors and nurse practitioners, as examples), people may find families reflexively choosing care the patient may not have preferred if s/he’d gotten more information.

  13. 13.

    Eric U.

    May 24, 2016 at 11:54 am

    the thing I’m really afraid of is that I will be dragging on past where in any rational world I would be allowed to die. If past is prologue, there will be at least a year or more where everyone will be better off if I was dead. That happened to my father, and it was really hard as a relative to know what to do. He was in a nursing home, but it was indistinguishable from a hospital in my mind. “yes, changing his bedpan is consistent with his dnr, kthx” — it never got that bad, but it felt that way

  14. 14.

    Snarki, child of Loki

    May 24, 2016 at 12:00 pm

    The only true “death panels” are stocked with hospital CEOs and accountants, deciding which of the poors get their life-support turned off.

    See Texas, ‘Futile Care Law’, signed by Dubya.

    Palin has been brain dead for YEARS, when is someone going to pull the plug?

  15. 15.

    gindy51

    May 24, 2016 at 12:00 pm

    @Helen: That’s because the US cannot negotiate with drug companies like other countries can.

  16. 16.

    Scout211

    May 24, 2016 at 12:00 pm

    @Scout211:

    To further explain this new form for Californians making end of life decisions . . .

    The mister attended a training session for senior peer counselors in my county. He has been a senior peer counselor for the past year. The EMTs that gave the training were strongly urging everyone to fill out these new end-of-life forms and have a physician sign them as well.

    They have been told they must continue all life-saving measures for any patient unless there is one of these forms with the patient, signed by a physician. DNRs and advanced directives will not be honored. I have no information if this applies to hospitals. But they insisted that it applies to all emergency services personnel.

    This new form will comply with the new end-of-life law that goes into effect next month. It makes sense to have this form in cases of assisted suicide, but apparrently EMTs and paramedics have been told that it applies in ALL medical emergencies.

    capolst.org

  17. 17.

    shortstop

    May 24, 2016 at 12:06 pm

    @Eric U.: That’s what we all worry about, but as I watch my mom rapidly losing cognitive ability while her body stays relatively strong, I wonder if that will really be the new frontier.

    The third baseman and I are at the extreme tail end of the Boom. Those of you ahead of us, please try and figure out a better way for those with advancing dementia to make decisions about how they’ll leave this world. Without children to get my back as we’ve got my mom’s, I am absolutely terrified at the prospect of being cognitively out of it and at the mercy of strangers.

    I can’t be the only one thinking that I’d like to call my own exit if it comes to that. I imagine public resistance to legal assisted suicide is going to diminish rapidly as the bulk of Boomers age and deal with this one.

  18. 18.

    EconWatcher

    May 24, 2016 at 12:11 pm

    Unless you have been through it, you cannot imagine how ugly some family members can get when a relative is on death’s door. Living wills can help not only the dying but their family members who are trying to deal with the process.

    I had to intervene to stop a relative who saw my father’s advanced brain cancer as an opportunity to get money from him. Then she attempted to retaliate by saying she would refuse consent to pull the metaphorical plug (end prolonging interventions) when he was literally shouting out for God to help him. Luckily, he had made clear paperwork putting me in charge on both the medical and financial front. I knew the relative had issues, but that behavior just blew my mind. I have not spoken to her since, and probably never will.

    Since then, I’ve run into a number of people with similar stories. This kind of thing is much more common than I could have ever guessed.

  19. 19.

    Waspuppet

    May 24, 2016 at 1:01 pm

    @the Conster, la Citoyenne: I know we’re not supposed to say this, but the fact that anyone ever thought that could actually possibly be a thing is one of the most underrated examples of racism among Obama critics: “Yeah! Someone going through the political routines necessary to win three political offices, all so that he could sit at the head of a death panel an judge people as unworthy of living? That’s TOTALLY plausible, because there’s just – I dunno, SOMETHING about that Obama guy that seems sinister. I can’t put my finger on it, but – you know what I mean?”

  20. 20.

    Soprano2

    May 24, 2016 at 1:15 pm

    End-of-life directives are not only smart for all the reasons cited above; they also save money in the best way possible, by reining in unnecessary care. I heard this podcast last year http://www.npr.org/sections/money/2014/03/05/286126451/living-wills-are-the-talk-of-the-town-in-la-crosse-wis A quote from it is below:

    In fact, La Crosse, Wisconsin spends less on health care for patients at the end of life than any other place in the country, according to the Dartmouth Health Atlas.

    Well worth listening to. The whole country should follow their lead; we’d all be a lot better off.

  21. 21.

    Ruckus

    May 24, 2016 at 1:26 pm

    @EconWatcher:
    I’ve delt with this before and while the person had the interest of the dying at heart they were putting their own religious ideals ahead of everything else. It got so contentious that I no longer can deal with this person.

  22. 22.

    Cermet

    May 24, 2016 at 1:36 pm

    I see people here are just dying to post on this thread …Not.

  23. 23.

    Prescott Cactus

    May 24, 2016 at 1:45 pm

    @shortstop:

    They have been told they must continue all life-saving measures for any patient unless there is one of these forms with the patient, signed by a physician.

    Not sure if the reasoning is the same but in AZ the thought process was that they wanted patient / physician dialogue before both signed the form. It’s been that way for years.

    Also has to be printed on “Halloween” orange paper here. YMMV

  24. 24.

    satby

    May 24, 2016 at 1:49 pm

    Working on a trauma floor in a hospital gave me a fairly regular view of dysfunctional family dynamics keeping terminally ill patients alive artificially while the family members fought over when to end life support. Ugly stuff, and the hospitals will err on the side of not pulling the plug primarily to protect themselves from lawsuits. Especially if you have hyper religious or deeply estranged family members, be sure you have everything spelled out and a medical power of attorney named.

  25. 25.

    Botsplainer, Cryptofascist Tool of the Oppressor Class

    May 24, 2016 at 2:01 pm

    @satby:

    I’ve seen some atrocious stuff over the years involving competing factions of family.

    Also, interesting enough, the more modest the estate, the more vicious the infighting.

  26. 26.

    Scout211

    May 24, 2016 at 2:05 pm

    @Prescott Cactus:

    In California, this is new. Previously, we could file a DNR and advanced directive with our attorney, along with a power of attorney for healthcare matters.

    On the other hand, even if you had the legal documents, emergency service personnel would still perform life saving measures and transport to the hospital. And hospitals would often wait for all family members to agree to the DNR. My mother was transported twice to the ER from her Alzheimer’s care facility against the family’s wishes (and her legal documents). She finally was allowed to die when the facility got their approval for two hospice rooms. Thank FSM for hospice.

    This new form seems to be more powerful than the previous ones. If the EMTs are legally allowed to reduce life-saving measures, then this form is much, much better for the patient who has expressed his/her end of life choices.

    Since it was designed to fit the new law, it would have to be fairly powerful.

  27. 27.

    Roger Moore

    May 24, 2016 at 2:13 pm

    @Botsplainer, Cryptofascist Tool of the Oppressor Class:

    Also, interesting enough, the more modest the estate, the more vicious the infighting.

    That makes some kind of sense. The importance of the estate depends on how badly the heirs are doing, and poor people are more likely to have poor heirs than rich people.

  28. 28.

    WereBear

    May 24, 2016 at 2:59 pm

    @the Conster, la Citoyenne: All this stupidity, when there had been insurance-based Death Panels for decades.

    I am completely baffled by their choice of corporations over government. If there is a profit in it, there is someone who will render you down.

  29. 29.

    WereBear

    May 24, 2016 at 3:01 pm

    @Helen: We are a stoned country.

    Oh, girl, don’t I wish. We are overdue for some mellowness.

  30. 30.

    J R in WV

    May 24, 2016 at 4:52 pm

    Richard,

    Another long-term commenter asked the other day if insurance for people dealing with trans-sexual health issues may change given the new federal policies that have been published. I haven’t seen any discussion of this yet.

    Obviously, making Trans people eligible for insurance coverage would be a blessing to many people living in a shadow world with few financial resources to deal with complex and expensive endocrinology issues, and even surgery at some point.

    Any clue on changes in insurance policies in the wake of these federal changes? Or too early to tell?

    Thanks,
    JR

  31. 31.

    Richard Mayhew

    May 24, 2016 at 6:34 pm

    @J R in WV: don’t know, I will ask our legal folks next time one of them owes me a beer

  32. 32.

    StringOnASick

    May 24, 2016 at 8:46 pm

    My father in law died this morning, as peacefully as someone with his emotional history could have, all thanks to excellent hospice care and all relatives being in agreement on his care. No theatrics, no family drama. People, fill out those forms, make sure your doctor has a copy, and be as clear as you can with your family. Read Atul Gawande’s “Being Mortal, medicine and what matters in the end”, this is the most helpful book I read in years and NOT depressing at all!

    Tail end Boomers without kids like my husband need to plan even more aggressively. The last completely cognizant thing my FIL said was in reference to his very nice, very low population assisted living facility was ” I HATE this place!”. The lack of autonomy, his inability to walk or eat anything other than puréed food, all the aides constantly in his room, all of it was exactly what he didn’t want life to be, but a series of non-fatal strokes took away all his choices.

  33. 33.

    Richard Mayhew

    May 25, 2016 at 4:09 am

    @StringOnASick: hugs

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