“Death Panel”: A few weeks ago, former Governor Sarah Palin caused a stir when she referred to provision for “death panels” in the proposed health care legislation, which would put the lives of the elderly and disabled at the mercy of some government committee (or some such thing). Hyperbole aside, it is certainly worth investigating. From what I can gather, Section 1233 of H.R. 3200 simply allows doctors to now be reimbursed via Medicare for “end-of-life counseling”, which is often given already and encouraged in federal law. Such counseling is voluntary for the insured. There are no mandates, just a limitation that only one such counseling session is reimbursable every five years or “yearly if the medical condition of the patient makes significant changes or they develop a chronic illness… or upon admission to a skilled nursing facility, a long-term care facility… or a hospice program.”
Doesn’t sound too sinister, right? But, the real concern is about something a bit more subtle. I mean, we are not just talking about suggesting that someone have a living will. Consider that the President has said “Our government will undertake very difficult decisions about how to reduce the costs of those chronically ill and those near the end of their lives since they potentially are 80% of the total health care (costs).” So, rather than recommending the latest-n-greatest – but expensive – drug or treatment or procedure to give Grandma a few more months or years of life, her doctor will be paid to advise her about hospices, palliative care, and ways to end her life so that she is no longer a burden on her family and on society.
But, you say, these counseling sessions are voluntary, remember. Well, as Charles Lane points out in the Washington Post, “To me, ‘purely voluntary’ means ‘not unless the patient requests one.’ Section 1233, however, lets doctors initiate the chat and gives them an incentive – money – to do so. Indeed, that’s an incentive to insist. Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit ‘formulation’ of a plug-pulling order right then and there…. Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party – the government – recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don’t have to be a right-wing wacko to question that approach.”
It is this type of subtle persuasion towards giving up on life and foregoing life-sustaining treatment, especially when the individual is already depressed or in pain or otherwise vulnerable, that causes worry and fear and incites people young and old to oppose such legislation.
< to be continued… >