Last month I had the opportunity to watch Alexandra Drane announce the Engage With Grace: The One Slide Project at the Health 2.0 Conference in San Francisco. The idea behind the project is to get people to share just ONE slide that helps them and their loved ones talk about having a purposeful end-of-life experience.

Alexandra’s talk personally touched me because my family went through a similar experience 30 years ago when I was 12 years old. My mother died at home with cancer in 1978. She had the opportunity to die at home surrounded by her 5 children because both my dad and uncle were her doctors. In the past and today, not all families are given this important choice. The memories I have of my mother’s final days 30 years ago are still important to me today. As a health care lawyer who has been involved in the legal aspects of end of life decisions expressing your wishes, knowing the wishes of those who you love and legally documenting them are important.

Last week, Matthew Holt who blogs at The Health Care Blog and Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston who blogs at Running A Hospital, spread the word to bloggers about a viral campaign (call it a blog rally) to raise awareness by encouraging families to discuss end of life care issues while gathering for the Thanksgiving holiday weekend.

For West Virginia readers who want to learn more about end of life care I recommend checking out the resources provided by the West Virginia Center for End of Life Care. There is also valuable information for health care professionals. Here individuals can find forms for the standard West Virginia Living Will and Medical Power of Attorney. The site also includes information, FAQs, list of West Virginia palliative/hospice providers and other resources.

Engage with Grace from Health 2.0 on Vimeo.

Below is a message being posted at blogs around the country and world today and through the Thanksgiving holiday weekend:

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don’t express our intent or tell our loved ones about it.This has real consequences.

73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences. But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started. Let’s start a viral movement driven by the change we as individuals can effect…and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team)

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What goes into life insurance rates, anyway?

• Smoking status: Do you smoke? Good, because if did, you’d pay a whole lot more for life insurance. A whole lot more.
• Marital status – Singles pay less than married couples.
• Family size – Fewer dependents equal lower rates.
• Age – Life insurers are ageist—they prefer younger policy holders.
• Health – The healthy will pay less than the unhealthy, and many life insurance companies require a physical before issuing a policy. Our advice (which we’re working on heeding ourselves): More veggies and trips to the gym.
• Occupation – The school teacher will pay less than the lion tamer. The guy who juggles chain saws will pay more than the lion tamer. In other words, those with hazardous jobs pay more than office park Dilberts.

Another good way to save on life insurance is to shop around and compare rates.

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By Donna Smith

CHICAGO — While other devoted election workers and issue activists were taking a much deserved breather following the November 4th general election and planning their trips to celebrate their success in Washington in January, single payer healthcare reform activists stepped up their energy levels and gathered twice in national formations within just 10 days after the historic election of Barack Obama as the 44th President of the United States. 

The Leadership Conference for Guaranteed Healthcare met in Washington, DC, on November 10th and 11th, with leaders from the California Nurses Association/National Nurses Organizing Committee along with other labor organizations, faith-based groups, Healthcare-Now, Progressive Democrats of America, medical students, Physicians for a National Health Program and representatives from more than 20 diverse organizations.

Just three days later, in Chicago (see above), the committed activists from Healthcare-Now convened their 2008 National Strategy Conference with representatives from 23 states and the District of Columbia to pull together the various states organizations and member coalitions of Healthcare-Now and map out the immediate efforts to support HR676, Rep. John Conyers' national single payer bill.  Single payer is the publicly funded, privately delivered healthcare reform plan that addresses and repairs the lack of access and affordability issues facing millions of Americans.

Rep. Conyers attended both national meetings.  He assured both the group assembled in Washington and the folks gathered in Chicago that he will reintroduce HR676 in the 111th Congress and that his support is stronger than ever for the bill. 

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While we’re on the subject of life insurance, have you ever taken a close look at your life insurance policy? Do you know what information it contains—or would you rather get hit by a Mack truck than read through your boring old insurance policy?

While life insurance certainly isn’t the most exciting subject to read or talk about, knowing what your loved ones will be up against when the time comes leaves little room for worry.

So dust off your policy’s jacket, lean back in your comfy chair, and take a look at what’s really inside. What you see there should look something like this:

• Declaration page. The first part of your policy, this section identifies who’s insured, the risks or perils covered, the policy’s face value (e.g. $25,000, $50,000, etc.)and the period of time the plan is in effect.
• Insuring agreement. States the types of losses paid by the insurer, the items the insurance company agrees to pay on your behalf and additional services provided by the insurer (e.g. lawsuit defense).
• Exclusions. Explains the risks, losses and situations your policy doesn’t cover.
• Conditions. Lists special qualifications, requirements or limitations (placed there by the insurance company) which, if not met, may cause your life insurance claim to be denied. Includes requirements like proof of loss (e.g. a death certificate) or failure to cooperate during the company’s investigation of death.
• Definitions. Defines specific insurance terms used in the policy. (If you hate “insuranceeze,” this part of your policy will make your life easier!)
• Endorsements and Riders. Written statements that add to, delete or modify the provisions in the insurance contract.

Now that you know what’s contained in your life insurance policy, check to see if it needs updating. If you’ve gotten married, divorced, had children or experienced another major life change since the policy was written, it may be time to add or amend your coverage.

P.S.—If you don’t have a copy of your life insurance contract, contact your insurance company to request one.

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First of all, I have to say I am grateful to the people at
the National Public Radio's The Story with Dick Gordon for telling my
story.

This has been a long journey and I have not posted on my blog for
some months. I am now eight months post-op. I had Artifical Disc
Replacement (ADR) in my lumbar spine at lumbar disc 4/5 and my health
insurance company Blue Cross of California refused to pay for my
surgery.

After many delays and postponements, I had surgery on March 11,
2008. I found out after my surgery from the hospital finance dept
that my surgery was authorized but afterwards when the hospital
contacted Blue Cross, the insurance company refused to pay for it as
it was deemed "experimental" and "investigational".

ADR surgery is not "experimental" or "investigational",
two terms that insurance companies like to throw out, because it is
FDA-approved. Other insurance companies routinely cover single level
disc replacement and Blue Cross has also approved the surgery for
other patients, but not me.

Currently, there are two FDA-approved lumbar artificial discs and
they are Charite (2004) and ProDisc (August, 2006). I had ProDisc.
There are other discs that are not yet FDA-approved, but people have
received them in clinical trials. There are also other discs that
have been implanted in patients in Europe and in other countries.

Secondly, my fight against Blue Cross has not been a lone
pursuit. The California Nurses Association (CNA) has given me
invaluable help. I remember feeling like I had no where to turn and
people at CNA offered me help. Also people on the internet have been
my support system and the "Insurance Warrior", Laurie Todd,
has given me advice that I used in my appeals to Blue Cross. I want
to make a point of this because without these people I would have
stopped fighting BC and had fusion or decided to live my life on
disability and not been able to get off the narcotics because of the
pain.

My church family, who paid for a baby-sitter for my three-year-old
son for the first six weeks after I came home, has been great and
supportive of my family and I. Also my friends and my siblings kept
me going when I was going to stop from frustration.

I also have to point out that surgery is not a slam dunk ever and
should only be undertaken when it is emergent or like with my case,
the pain is so bad that you are prevented from living your life.

Thirdly, I am so happy I had the surgery, even though I
have had to battle my insurance company. I am in a lot less pain and
have been able to get off the heavy narcotic medications I was taking
for months. My thoughts are much more clear now. My surgeon and me
wanted ADR because with ADR there is about a third the chance of
developing disease in adjacent discs than with fusion.

I am eternally grateful to my surgeon for his skill and care. As I
continue to heal from this major surgery, I look forward to being
able to do more things. Last weekend, I went to the movies and was
able to sit for the whole movie. That is not something I could do
before my surgery.

Still, it amazes me that Blue Cross has denied ADR surgery for so
many people. BC has not "approved" my surgery but I believe
I have made some inroads to getting them to approve it. Who knows,
maybe they will wake up and see how less expensive ADR surgery is
over the long run.

Like I said in the radio program, my health is more important than
anything and I will not let some insurance company dictate what is
best for me over what my doctor says is best.

We need to put health care decisions back in the hands of doctors.

For those out there fighting insurance companies, I have one thing
to say, "Keep Fighting".

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1.High marks from independent rating agencies like Moody’s and A.M. Best. Because insurance is a long-term investment that is *not* backed by the federal government, it’s important to do business with an insurer in sound financial condition. Click here to learn more about gauging the financial strength of a company.

2. No complaints. Each state regulates life insurance companies doing business within its borders and keeps records of consumer complaints. Click here to get a listing of state departments of insurance.

3. Good service. Life insurance can get complicated, so it pays to have an agent who has the time, inclination and integrity to explain things in a clear and unbiased way.

4. A product that suits your needs and fits your budget. A company may have all of the qualities listed above, but if it doesn’t have a product whose features match your needs, best to keep shopping.

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Res Ipsa Blog brings you this week’s edition of Blawg Review — Blawg Review #186. This edition begins with a summary of the raging Twitter Wars and includes a link to a post I did last week discussing some of the legal implications of live tweeting in health care.

Check out this week’s edition for the latest law news from around the blogosphere.

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HealthcareIT News reports on the announcement of a Medicare personal health record (PHR) pilot project that will be made available to Medicare beneficiaries in Arizona and Utah.

The four PHR companies selected out of almost 40 who applied to participate in the pilot are: Google Health, HealthTrio, NoMoreClipboard.com and PassportMD.

The Arizona Republic has more on the pilot project. More background information on CMS’s PHR projects.

Tip to iHeathBeat on the article.

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Yesterday Robert Hendrick, health care disruptor (I mean that in a positive way) and co-founder of change:healthcare, live tweeted his laser ablation surgery at the Surgical Clinic in Nashville. He also tweeted the first installment of his surgery to remove his varicose veins — Live from the Operating Room.

Robert and his counterpart, Christopher Parks, are all about transparency in health care, especially as it relates to payment issues. This serves as just one more example of their efforts to engage health consumers and create transparency in health care.

Robert’s live tweeting during surgery struck me as an interesting application of Twitter and other mobile social networking application. Here are just a few thoughts:

• A way to keep friends and family updated on your condition, surgery, etc.
• Useful for others who might be contemplating a particular procedure or surgery to get a real time look at what might be involved. I know someone who is contemplating undergoing the same procedure and plan to share Robert’s posts with them.
• As more and more patients and providers start to document information via social networking avenues - what might this mean during future litigation and discovery? Certainly seeking tweets, historical Facebook updates, etc. might be valuable in either pursuing or defending litigation. What are the rules for lawyers in pursuing such evidence? What might this mean for the companies providing such services as they see more and more subpoenas for information?

For a real time look at surgery tweets check out Twitter Search for the term — surgery. Interesting stuff. I welcome others thoughts on the topic.

Thanks Robert for making my day for awarding me “best tweet of the procedure.” Follow Robert on Twitter at @Robert_Hendrick.

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