In a July 23 Wall Street Journal op-ed titled "GovernmentCare's Assault on Seniors," former New York Lt. Gov. Betsy McCaughey falsely claimed the House Democrats' tri-committee health care reform bill will “pressure the elderly to end their lives prematurely,” referring to a provision in the bill that she characterized as “ensur[ing] that seniors are counseled on end-of-life options, including refusing nutrition where state law allows it.” In fact, the "Advance Care Planning Consultation" section of the bill McCaughey refers to simply amends the Medicare Act to allow coverage for patients to receive counseling about end-of-life care options every five years if they so choose. Moreover, prominent medical societies have supported such counseling.

From the bill:

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

(a) MEDICARE.--

(1) IN GENERAL. -- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended --

(A) in subsection (s)(2) --

(i) by striking ''and'' at the end of subparagraph (DD);

(ii) by adding ''and'' at the end of subparagraph (EE); and

(iii) by adding at the end the following new subparagraph:

"(FF) advance care planning consultation (as defined in subsection (hhh)(1));''; and

(B) by adding at the end the following new subsection:

“Advance Care Planning Consultation

(hhh)(1) Subject to paragraphs (3) and (4), the term 'advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years.”

Subsection (s) of the Medicare Act currently provides:

(s) The term “medical and other health services” means any of the following items or services:

(1) physicians' services;

(2)(A) services and supplies (including drugs and biologicals which are not usually self-administered by the patient) furnished as an incident to a physician's professional service, of kinds which are commonly furnished in physicians' offices and are commonly either rendered without charge or included in the physicians' bills (or would have been so included but for the application of section 1847B);

[...]

(DD)^[450] items and services furnished under an intensive cardiac rehabilitation program (as defined in subsection (eee)(4));^[451]

(EE)^[452] kidney disease education services (as defined in subsection (ggg));

According to an analysis of the bill produced by the three relevant House committees, section 1233:

Provides coverage for consultation between enrollees and practitioners to discuss orders for life-sustaining treatment. Instructs CMS to modify 'Medicare & You' handbook to incorporate information on end-of-life planning resources and to incorporate measures on advance care planning into the physician's quality reporting initiative.

Rep. Bill Pascrell (D-NJ) stated in a July 21 release that the claim that upon the bill's passage, “The government will pull the plug on dying seniors (i.e. end-of-life planning)” is a “myth.” From his release [emphasis added]:

TRUTH: There is nothing in health reform that will deny seniors or any individual needed medical care. Health reform provides for voluntary advanced care planning consultations under Medicare so that seniors can sit down with their health care providers to discuss end-of-life care, rather than leaving these decisions to families during difficult times. The advanced care planning provided for in the legislation allows for thoughtful discussion between a senior, their family, and their health care provider. The government will have no authority over the contents of such plans.

In a "Statement on End-Of-Life-Care" posted on its website, the American Medical Association expresses support for "[t]he opportunity to discuss and plan for end-of-life care. This should include: the opportunity to discuss scenarios and treatment preferences with the physician and health care proxy, the chance for discussion with others, the chance to make a formal 'living will' and proxy designation, and help with filing these documents in such a way that they are likely to be available and useful when needed."

Additionally, in an article on "End-of-Life Care: A Guide for Seniors and Caregivers," posted on the website of the American Geriatrics Society, Dr. Steven Lipson wrote that "[a]dvance planning-discussing such issues while you are still healthy-is always a good idea. Be sure your family and other caregivers know your plan." Lipson also recommends to patients, “Always discuss your wishes with your doctor.”

McCaughey previously falsely interpreted the House provision on advance planning in a July 17 New York Post op-ed, in which she wrote that "[o]ne troubling provision" of the bill “compels seniors to submit to a counseling session every five years ... about alternatives for end-of-life care,” adding that the “mandate invites abuse, and seniors could easily be pushed to refuse care.” On his July 17 radio show, Sean Hannity cited her Post op-ed in stating that according to McCaughey, “under the House provision and the House version, perfectly healthy senior citizens are going to be forced to undergo, quote, 'end of life counseling,' apparently to encourage them to check out before their time is up.”

Other claims in WSJ op-ed

McCaughey also wrote in the WSJ that a measure supported by the Obama administration for inclusion in a health reform bill that would establish an Independent Medicare Advisory Council (IMAC) with the authority to make recommendations on Medicare payment rates and other reforms “is designed to circumvent the democratic process and avoid accountability to the public for cuts in benefits.” In fact, in a July 17 letter to House Speaker Nancy Pelosi referenced by McCaughey, White House budget director Peter Orszag made clear that there are democratic mechanisms involved; all IMAC recommendations would need to be approved by the president before their implementation, and Congress would have the power to stop changes via a joint resolution.

From the July 17 letter:

This proposed legislation would require the President to approve or disapprove each set of the IMAC's recommendations as a package. If the President accepts the IMAC's recommendations, Congress would then have 30 days to intervene with a joint resolution before the Secretary of Health and Human Services is authorized to implement them. If either the President disapproves the recommendations of the IMAC or Congress passes such a joint resolution, the recommendations would be null and void, and current law would remain in effect. The review process would permit intervention if the IMAC's reforms are not in keeping with the goals of Congress or the President, while retaining autonomy for implementing annual payment updates and other Medicare reforms for the IMAC.

McCaughey also wrote: “The assault against seniors began with the stimulus package in February. Slipped into the bill was substantial funding for comparative effectiveness research, which is generally code for limiting care based on the patient's age.” She later added, “In Britain, the formula leads to denying treatments for older patients who have fewer years to benefit from care than younger patients.” McCaughey's claims echoed misrepresentations of a provision in the recovery act that establishes a Federal Coordinating Council for Comparative Effectiveness Research and calls for funding to “be used to accelerate the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies” and for the Health and Human Services secretary to “consider any recommendations” by the council. But the law in no way empowers the council to dictate which treatments may or may not be prescribed and, in fact, specifically states that "[n]othing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer."

As Media Matters for America has documented, McCaughey frequently appears in the media to advance falsehoods about progressive health care reform proposals. On February 11, CNN health care reporter Elizabeth Cohen debunked an earlier health care reform assertion repeatedly advanced by McCaughey. Cohen reported of McCaughey's claims that provisions in the economic recovery act would permit the government to control health care: “I had a PDF of the bill up on my computer. I said, 'Show me where in the bill it says that this bill is going to have the government telling your doctor what to do.' And [McCaughey] directed me to language -- it didn't actually say that.” Cohen added, “Now when we asked the folks who wrote this bill, 'Hey, is this bill going to allow the government to tell doctors what to do?' they used words like, 'preposterous' and 'completely and wildly untrue.' ”

From McCaughey's July 23 WSJ op-ed:

Since Medicare was established in 1965, access to care has enabled older Americans to avoid becoming disabled and to travel and live independently instead of languishing in nursing homes. But legislation now being rushed through Congress--H.R. 3200 and the Senate Health Committee Bill--will reduce access to care, pressure the elderly to end their lives prematurely, and doom baby boomers to painful later years.

The Congressional majority wants to pay for its $1 trillion to $1.6 trillion health bills with new taxes and a $500 billion cut to Medicare. This cut will come just as baby boomers turn 65 and increase Medicare enrollment by 30%. Less money and more patients will necessitate rationing. The Congressional Budget Office estimates that only 1% of Medicare cuts will come from eliminating fraud, waste and abuse.

The assault against seniors began with the stimulus package in February. Slipped into the bill was substantial funding for comparative effectiveness research, which is generally code for limiting care based on the patient's age. Economists are familiar with the formula, where the cost of a treatment is divided by the number of years (called QALYs, or quality-adjusted life years) that the patient is likely to benefit. In Britain, the formula leads to denying treatments for older patients who have fewer years to benefit from care than younger patients.

When comparative effectiveness research appeared in the stimulus bill, Rep. Charles Boustany Jr., (R., La.) a heart surgeon, warned that it would lead to “denying seniors and the disabled lifesaving care.” He and Sen. Jon Kyl (R., Ariz.) proposed amendments to no avail that would have barred the federal government from using the research to eliminate treatments for the elderly or deny care based on age.

In a letter this week to House Speaker Nancy Pelosi, White House budget chief Peter Orszag urged Congress to delegate its authority over Medicare to a newly created body within the executive branch. This measure is designed to circumvent the democratic process and avoid accountability to the public for cuts in benefits.

[...]

While the House bill being pushed by the president reduces access to such cures and specialists, it 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.