Dear President Obama:

[Joanne98]

Dear President Obama:

My name is ; I am a registered nurse. Today I spoke with a woman who, during the Depression, managed securing a factory job manufacturing jackets. With it she provided for her three daughters, who now all have good jobs, children of their own, and who still come to visit her in the nursing home once a week. I spoke to the daughter of a veteran of WWII, once a caretaker of his own wife and active member of his local community of veterans, who has recently been laid low by multiple strokes. I cared for a nun, who mused on the loss of her order of life, of prayerfulness and community. My job allows me to meet a true cross-section of humanity, for my patients have in common something that will at some point be true for all of us: each of them is very likely to die within the next six months.

I am a hospice nurse. I work with a team of social workers, chaplains, home health aides, and doctors who provide a range of services and care to support both patients and their families: to bring rest to bodies, clarity to minds, and much-needed peace to souls. Much of medicine pays lip service to the ideal of holistic care: in hospice care, I have found that ideal to be a reality. I am writing to humbly petition you, as 45 senators and 171 congressmen have done, to reconsider the upcoming cuts to medicare hospice reimbursement rates in CMS 1420.

You are at long last attempting to overhaul the daily human catastrophe that is our healthcare system. I want to thank you, deeply, for doing so. To provide a public option will certainly aid in eliminating the greed surcharge of private insurance. However, without fundamentally reallocating our healthcare spending, our efforts will fall short. The growing cost of intensive care for the chronically ill is raising the cost of care to such a point that few can afford it. The average cost of an ICU stay to the American people (and I am glad that we agree that private insurance costs are a public burden) is per my research roughly $2,400 per day. 40% of Medicare spending, or roughly $182 billion per year, takes place in the last month of life. America today is addicted to the illusion of immortality, and for that lie we are selling our future.

Still, health care providers cannot legally or ethically decide when a patient is ready to die, and for good reason. It is abominable to demand that a citizen die for the common good, and flies in the face of our fundamental American right to life, liberty, and the pursuit of happiness. At the same time, death is not actually optional. Indeed, according to our shared faith, death is the very vehicle of our transformation into beings worthy of our Creator: a gift crafted subtly before the dawn of time, before our blindness and selfishness caused us to imagine it to be a curse. Our political opponents have often spoken of creating a “culture of life,” but as a nurse, as a Christian with a degree in Religious Studies, and as a citizen of a struggling nation, I believe urgently that a sane culture of death must be fostered as well.

Hospice care is the vanguard of that culture. It is a fairly new modality of care, first imagined as recently as 1960 and first made part of Medicare policy in 1980. It is poorly understood by many, but which if understood and utilized can aid enormously in stabilizing our healthcare system. Where ICU stays cost us $2,400 a day, the total cost of hospice care even in the last days of life is roughly $600 per day if in a hospital or nursing facility, or $750 if they require 24-hour skilled care at home. Outside of the most intense periods of illness, hospice care costs only roughly $135 per day: $135 for nursing, aides, social work, chaplains, doctors, and support staff, as well as all medications and medical supplies for the patient’s comfort and for their terminal condition. It’s not only efficient: hospice patients on average have better outcomes in the terminal phase, experience more comfort, and actually live longer than patients seeking life-sustaining care. Allowing hospice agencies to grow is good for our people’s souls and bodies, and good for our national financial survival.

For these reasons I implore you to reconsider the upcoming cuts to Medicare reimbursement for hospice care (CMS 1420). At present, hospices are slated to receive a double cut on October 1st: the first was engineered as a delayed measure under the last administration; the second was drafted recently as part of the plan to pay for the upcoming healthcare overhaul. Together these cuts will amount to a 6.4% loss to hospices, which run an average profit margin of only 3.4% under current reimbursement rates. It is understood that quality healthcare needs to be funded, and cannot be borrowed from the international community indefinitely. It must also be noted that the help given through the American Recovery and Reinvestment Act, which delayed these cuts for another year, are appreciated. Still, when implemented, these cuts will take the wind out of the sails of a growing healthcare movement, one with the promise to end our national addiction to the illusion of immortality, and the power to take the sting from death.

I hear from the families of my patients, every month, that I have opened their minds to the unity of life and death. Through the care our team provides, they have come to understand what they are and where they will someday go. They have become part of a true culture of life, and perhaps, God willing, they will in their time allow themselves the gift of hospice care, saving themselves pain and our people a crushing debt. We in hospice are on your side, on the side of justice, on the side of health, and on the side of truth. Let hospice care continue to grow by overturning these intended cuts.

Thank you, and may God bless America, now and in the hour of our death,
, RN Case Manager, of Rhode Island

http://redcrosse.livejournal.com/20264.html

[lbrtbell]

1. K and freakin' R!!

This is an abomination. Hospice care SAVES money and makes the final stages of terminal illness easier for both the patients and their caregivers. It was a godsend for us, when one of our loved ones was terminally ill. It was fully covered by Medicare, and that's as it should be.

This isn't health care reform. This is heartless.