Care Tactics

by Jeremy Smerd
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Not that she’s been ducking the cameras. Though McCaughey (pronounced McCoy) says she did not anticipate being a vocal critic of health-care reform this time around — only that she would read the draft legislation and translate obtuse legislative language into plain English — she views her media appearances as a kind of public service. In her effort to make “the legislative proposals accessible to people,” she includes the page numbers of the bills she refers to in her articles, a device that lends an added authority to her claims.

McCaughey came from modest means to earn a fellowship to Vassar College and a PhD in constitutional history from Columbia, where she deepened a predilection for primary sources. After her time in politics, which included a run as Democratic nominee for New York governor in 1998, she became a health-care advocate and founded the Committee to Reduce Infection Deaths. Having worked on reducing hospital-acquired infections, she says she has come to understand that hospital patients, most of whom are elderly, are unlikely to resist a doctor’s recommendations. And in her mind, such medical advice would be tainted if it were to be prescribed by a government more interested in saving money than in saving lives.

“When someone in a white coat who is an authority figure walks into a hospital room to discuss end-of-life options with you, the patient does not say, ‘I’m not interested, I don’t have time,’” she says. “Patients don’t even speak up to say, ‘Would you please wash your hands?’ They are meek, compliant, and receptive. That’s what patients are. They don’t say no.”

When a visitor suggests that providing Medicare coverage for counseling that is already pro forma at many hospitals is not the same thing as promoting cost-cutting euthanasia, McCaughey quickly turns to her primary source on her dining room table.

“I think before we continue this conversation we should go ahead and read those pages,” she says.

She strides past her picture with Ronald Reagan, opens the three-ring binder containing the initial draft of the House Democrats’ health-care bill, and flips to the section on how the government will reimburse health-care providers for counseling patients on end-of-life care (page 424).

McCaughey believes that this system of payment would create a fiasco in which anonymous health-care providers (not a doctor with whom the family has a relationship), reading from a state-sanctioned script, will make vulnerable seniors feel that they are a burden to their families and to society, and should just go quietly (and cheaply) into that dark night.

The pages don’t say that. McCaughey’s reading of the bill’s language, it turns out, is highly interpretative.

But for McCaughey, the problems are spelled out clear as day: If you doubt it, she’ll give you the page number and you can look it up yourself.

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