Fact check: A look at claims about health-care overhaul

WASHINGTON — Former Republican vice-presidential candidate Sarah Palin says the health-care overhaul bill would set up a "death panel." Federal bureaucrats would play God, ruling on whether ailing seniors are worth enough to society to deserve life-sustaining medical care. Palin and other critics are wrong.

Nothing in the legislation would carry out such a bleak vision. The provision that has caused the uproar instead would authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes.

Questions and answers on this and other controversies:

Q: Do the health-care bills promote "mercy killing," or euthanasia?

A: No.

Q: Then what's all the fuss about?

A: A provision in the House bill written by Rep. Earl Blumenauer, D-Ore., would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health-care proxy, learning about hospice as an option for the terminally ill, and information about pain medications for people suffering chronic discomfort.

The sessions would be covered every five years, more frequently if someone is gravely ill.

Q: Is anything required?

A: Monsignor Charles Fahey, 76, a Catholic priest who is chairman of the board of the National Council on Aging, a nonprofit service and advocacy group, says no.

"We have to make decisions that are deliberative about our health care at every moment," Fahey said. "What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini — then let me go."

Q: Do the bills advocate assisted suicide?

A: No. Funds for counseling that presents suicide or assisted suicide as an option would be blocked. The House bill would give seniors on Medicare the option to sit down with a doctor for an "advance care-planning consultation" every five years to discuss options should they become seriously ill or unable to make medical decisions. Topics could include the development of a living will and directives for care.

Q: Who supports the provision?

A: The American Medical Association (AMA), the National Hospice and Palliative Care Organization and Consumers Union are among groups supporting the provision. AARP, the seniors' lobby, this week is taking out print advertisements that label as false the claim that the legislation will empower the government to take over life-and-death decisions from individuals.

Q: Should the government be involved with living wills and end-of-life questions — decisions that are highly personal and really difficult?

A: It already is.

The government requires hospitals to ask adult patients if they have a living will, or "advance directive." If the patient doesn't have one, and wants one, the hospital has to provide assistance. The mandate on hospitals was instituted during a Republican administration, in 1992, under then-President George H.W. Bush.

Q: How does a living will work, and how is it different from a health-care proxy?

A: A living will — also called an advance directive — spells out a patient's wishes if he or she becomes incapacitated. People often say they don't want to be kept alive on breathing machines if their condition is terminal and irreversible.

A health-care proxy empowers another person to make medical decisions should the patient become incapacitated.

Q: Would an overhaul of health care change the way people now deal with making end-of-life decisions?

A: Supporters of the provision say the main consequence would be to formally bring doctors into a discussion that now takes place mainly among family members and lawyers. The AMA says involving doctors is simple common sense.

"There has been a lot of misinformation about the advance care-planning provisions in the bill," AMA President Dr. James Rohack said in a statement. "It's plain, old-fashioned medical care."

Q: Will the government ration care?

A: Under the current system, private insurers and the federal government limit what kinds of medical procedures, imaging and drugs they will pay for. Millions of people with pre-existing conditions face even more limits, as private insurers refuse to sell them policies.

Both House and Senate bills would prohibit insurers from denying coverage to anyone, thus eliminating one form of rationing in the current system. The legislation also would give the federal government the authority to set minimum benefits levels that insurers would have to offer in order to sell policies in the new exchanges. That could mean more coverage for millions of individuals and many small businesses now shut out of the health-care system.

Most controversially, the bills would fund more research into the comparative effectiveness of various drugs and medical procedures. The legislation does not dictate that the research be used to limit coverage of any procedures. .

Q: Will I be able to keep my current health insurance?

A: The bills do not require insurers or employers to continue offering the health benefits they now provide. The House bill sets detailed standards for "acceptable health-care coverage," which would define "essential benefits" and permissible co-payments.

The Senate health committee bill goes somewhat further by offering an "option to retain current insurance coverage."

Q: Will Medicare be cut?

A: To help finance coverage for the uninsured, Congress would squeeze huge savings out of Medicare, the program for older Americans and the disabled. These savings would pay nearly 40 percent of the bills' cost.

The legislation would trim Medicare payments for most services, as an incentive for hospitals and other health-care providers to become more efficient. Providers make a plausible case that the cutbacks could inadvertently reduce beneficiaries' access to some types of care.

The bills would cut more than $150 billion over 10 years from federal payments to private health plans that care for more than 10 million Medicare beneficiaries.

Q: Will the government start paying for abortions?

A: Neither House nor Senate versions of the health-care legislation contains any requirement that federal funding be made available for abortions. Claims that tax dollars will be used for abortions, as a television ad from the Family Research Council contends, are premature and somewhat misleading.

It appears unlikely that the government would require the plans in this marketplace to cover abortions. In fact, one version of the legislation explicitly prohibits such a requirement. But some private insurers in the exchange may cover abortion services. If a woman who receives public subsidies for her coverage selects one of those plans, it could be argued that the government is helping to fund abortions.

Compiled from The Associated Press, Los Angeles Times and The New York Times.