You may recall that when Obamacare was first introduced, one of the features that critics seized on was the fact that doctors would be reimbursed for counseling Medicare patients on end-of-life care. This was taken as proof that the government was seeking to cut costs by condemning grandma to death by cutting off life-saving treatment for those who were no longer able to live productive lives. As a result of the furor over what were called ‘death panels’, that feature was removed.
But we now learn that it has been quietly reinstated.
Six years after end-of-life planning nearly derailed development of the Affordable Care Act amid charges of “death panels,” the Obama administration has revived a proposal to reimburse physicians for talking with their Medicare patients about how patients want to be cared for as they near death,
The new proposal from the Department of Health and Human Services would not require Medicare patients to sign any order or even to talk with their physicians about end-of-life care.
Rather, the proposed regulation would allow medical providers to bill Medicare for “advance-care planning” should a patient want to have the discussion.
So why is there no fuss about death panels this time? Part of the reason may be that Obamacare has survived its botched rollout and major court challenges and seems to be here to stay. It has outlived its usefulness as a rallying cry for the Republican party in two election cycles and they have moved on to other things.
But not entirely. Some dead-enders are still out there. Betsy McCaughey, who led the charge back in 2009 with all manner of horror stories about death panels, is back with a new attempt at resuscitating those old fears. But the fact that even Jeb Bush just two months ago suggested that Medicare patients should be encouraged to spell out the care they want if they become incapacitated suggests that this issue is pretty much over.
Few will deny that caution has to be used in implementing the proposal so that old and sick people are not pressured to sign things that are not in their best interest but are doing so because of being pressured to agree to things that benefit others or to simply cut costs. But it should not be hard to put in those safeguards and other countries have plenty of experience with it that we can learn from.