The New York Times reported on December 26, 2010 that the Obama Administration had by regulation quietly re-injected life into the “death panel” provisions stricken by popular acclaim and popular ignorance from the Health Care Reform legislation enacted into law last March. The dreaded Section 1233, excised from the so-called Affordable Care Act, would have authorized payment to physicians for consulting with their patients on end of life planning and options. As a practical matter, in the world of Medicare that which is not compensated for is rarely achieved. The government quietly issued new regulations in November that henceforth physicians would be compensated for their time in discussion end of life options and advance directives with their patients. Horrors!!
It is indeed disturbing that the government is sneaking around and pushing this provision into the Medicare system after it was so roundly discredited during the original health care debate. The action seems to be at once, both an affront to the popular will and the public’s right to be ignorant as well as a sneaky act of bureaucratic cowardice. Now that the health care bill has been enacted and the election is over it will be interesting to see where the demagogues come out on all of this. Will Ms. Palin lead the charge again? Will Senator Grassley and Rep. Boehner, who knew better, pass on further comment?
Demagoguery has its consequences and they can be lasting. The Times article cited a recent Kaiser Family Foundation poll that concluded that 30 percent of the population 65 years of age or older believed that the health care legislation that passed actually allowed a government panel to make end of life decisions for Medicare recipients.
There is an irony and a cost of ignorance at the end of life. It is a time when patients have the least control over the course of their treatment. When important decisions are left to traumatized family or health care institutions the result is what Dr. Berwick of CMS called a “form of assault.” People should have the right to decide whether, when and if to continue with useless care and that should be achieved before a crisis. The cost of the last year of life for Medicare recipients is 25 to 33 percent of the entire Medicare budget and 30 to 40 percent of that is in the last month of life. It costs the country $50 billion dollars a year for the last month of life. Many or perhaps even most of us would choose to die with dignity without the intrusion of unwanted health care procedures and expense if the end were near and inevitable.