Published July 28, 2009
At a town hall meeting at the AARP headquarters in Washington, President Obama answered a woman in North Carolina, who asked if it was true "that everyone that's Medicare age will be visited and told they have to decide how they wish to die."
The president at first joked the government doesn't have enough workers to ask everyone how they want to die, then more seriously suggested the idea is to expand the use of living wills. His aides suggested the misunderstanding was part of a calculated attempt by health reform opponents to undercut support for the effort by misrepresenting parts of the bills.
Critics have concerns the Medicare reimbursement could involve the government in end of life issues. A quarter of all Medicare spending is made in a patients final year of life, and that's when the biggest potential savings could be made.
Iowa Republican Senator Charles Grassley says end of life decisions should be strictly between patients, families and doctor -- and that many fear some ideas in these bills can lead to the government influencing that decision making.
"That's unethical as far as I'm concerned," said Grassley.
But Obama affirms that nobody will be forced to make a set of decisions on end-of-life care based on "some bureaucratic law in Washington."
Press Secretary Robert Gibbs says decisions will be made by doctors and patients and that the provision in the House bill would allow Medicare to pay for counseling sessions on end of life issues, but it doesn't require them. Gibbs believes the misunderstanding is a result of intentionally spread misinformation.
"I think there are people that have knowingly spread inaccurate information to hold up progress on health reform," said Gibbs.
Still, end of life counseling is sometimes conducted by people with an interest in steering patients away from hospital care and toward less expensive hospice care. And while studies show people actually prefer hospice care, it's important they receive the most informed decision on when to end curative care, and that should come from their doctor.
The White House says the president encourages the creation of living wills, but aides won't say if he specifically supports Medicare reimbursement for end of life counseling sessions.
Officials do say the president doesn't share concerns by Sen. Grassley and others, that such reimbursement might lead to the government making life or death decisions about health care.