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Happy 50th Anniversary Medicare & Medicaid

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Fifty years ago this week, President Lyndon B. Johnson signed legislation that established Medicare and Medicaid to protect the health and well-being of millions of Americans and improve the economic security of our nation.

Recently, Medicare proposed a new rule that would reimburse doctors for discussing advance care options with people. While such a policy is an important step in the right direction, much more must be done if it is to be applied efficiently and effectively.

Even if they are paid for their time, doctors rarely have enough time in an office visit to introduce a new concept to patients who may be there just to address a medical issue or have a check-up – not contemplate long-term values in how they would like to be treated in the event of a healthcare emergency. Advance care planning must be a critical part of everyone’s lives, from an early age. We must educate and empower people to start thinking about advance care planning long before they become a critical care patient.

Create a draft plan at home, with the input of family and loved ones, when there is time and space to think these priorities through. The purpose of discussing the plan with a doctor, then, becomes reviewing any questions or talking about one’s healthcare values. This is far superior to starting the conversation from scratch.

And for their part, doctors need training. Conversations in advance care planning require resources and patience. As part of its new rule, Medicare should direct healthcare providers to tools they can share with people on starting the conversation at home.

Once they create an advance care plan, people deserve confidence said plans can be found 24/7, anywhere in the world – in the event they want to update it as circumstances change, or because something happens where implementation of that plan is needed. This is also the best way to prevent Medicare fraud for reimbursing discussions that didn’t happen.

We wish ongoing success for the next 50 years for Medicare and Medicaid and hope they will continue to prioritize educating and empowering people to take an active role in their healthcare journey, especially when it comes to advance care planning.


How to make farewell conversations more meaningful

Spending time with family over the holiday season can be a joyful reminder of just how much we cherish our conversations with loved ones. Whether it is sharing a meal with a sibling who lives in another city or enjoying quality time with a parent, we all seek these often fleeting opportunities to express ourselves to a loved one in a meaningful way.

What we can take for granted though, is that there will come a time when the ability to connect with family members is taken away from us without warning. That is why many experts tell us to have these important conversations while we are still able.

Bruce Feiler confronted this issue in a recent article in the New York Times entitled, “Exit Lines.”

Feiler writes,

Shelly Kagan, a philosopher at Yale and the author of ‘Death,’ said the odds are so ‘vanishingly small’ that you’ll know when you’re in a final conversation, you should avoid any possibility of regret by initiating interactions earlier. This includes what kind of medical interventions the person might want as well as what that person meant to you…

‘One of the things you can accomplish in these conversations is telling people broadly what it is they’ve done for you. What they taught you. Having an appreciation of that can deepen one’s sense of a life well-lived…’

When his own mother died, Dr. Kagan said, she was not in a position to have a conversation at the end. Later, her children found a letter she had written to them, along with one to her grandchildren, expressing her hopes for their lives. It was her way of having a meaningful conversation while her mind was still strong, Dr. Kagan said…

Dr. Kagan said there is considerable evidence that forcing ourselves to say things out loud helps us clarify thoughts that might otherwise be unformed. ‘It’s a richer experience when the receiving party is able to react,’ he said. ‘But even if they’re not, the vocalization can help in that you now have thoughts you wouldn’t have had anyway.’

People who have lost loved ones suddenly can attest to the power of that ‘final conversation,’ especially when faced with the despair of missing the chance to have that conversation.

Being proactive about recording a message either in writing or on video is significant because it allows you the security of knowing your voice will be heard. And maybe even more importantly, it ensures that your loved ones will never be in the helpless position of not knowing how you really felt.

MyDirectives continues to encourage individuals to record video messages because that is the most effective way of knowing that your voice will be heard if you are no longer able to communicate.

Have you taken steps to leave a message for your loved ones or have you received a message from a friend or family member? Share your story using the comments below, on Facebook or on Twitter.