A New Rule Could Reopen the ‘Death Panels’ Debate

Six years after Sarah Palin said that President Obama’s health care law would establish “death panels,” the administration is tackling the controversy once again.

In a coda to the Supreme Court’s decision in favor of Obama on health care reform last month, his administration disclosed Wednesday that it would plan to begin reimbursing doctors for taking the time to talk with their patients about dying. The goal is to make sure that physicians and families know what a patient wants ahead of time, explains Lena Sun in The Washington Post:

If a doctor is treating, for example, a 68-year-old man with heart failure and diabetes who is taking multiple medications, the talks could include long-term treatment options, such as a heart transplant if his congestive heart failure worsened. They also could deal with advance care planning, including a patient’s desire for treatment if a health problem ‘adversely affects his decision-making capacity.’ …

Many doctors already have these often-difficult conversations with their patients without being paid to do so. Medicare reimbursement is significant because the government program is the second largest insurer of health care, and many private insurers follow its lead.

Palin, the former Alaska governor, objected to a similar proposal in 2009, warning that government bureaucrats would decide how to treat patients at the end of their lives. That wasn’t accurate, writes Sarah Kliff at Vox:

Neither the Affordable Care Act nor these new regulations will let any government panel decide what end-of-life care is or isn’t appropriate for patient.

Patients, meanwhile, face a different and very significant loss of autonomy when they don’t have these conversations. They don’t get to decide what type of death they want, what goals will be important to them, and what type of life-sustaining treatment they’d prefer. …

Unarticulated end-of-life decisions get outsourced to family members and doctors, who make their best guess at what a loved one would have wanted. Without advance care planning, patients end up living a version of the scenario that the death panel rhetoric made so fearsome: giving over decisions about their last moments of life to another party.

The news from the Centers for Medicare & Medicaid Services is another reminder that the debate over Obama’s reforms isn’t over. Leading GOP senators want to pass a bill that would repeal the law commonly known as Obamacare and force the president to issue a veto, as Caitlin Owens and Dylan Scott report in National Journal. If that legislation advances, it’s a safe bet some conservatives will be talking about the new rules on end-of-life planning.


By Max Ehrenfreund

Original article:  http://www.washingtonpost.com/blogs/wonkblog/wp/2015/07/09/wonkbook-a-new-rule-could-reopen-the-death-panels-debate/

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