Outside the Beltway

Death Panels Are Back. Good.

With the last legal hurdle to Obamacare cleared, “death panels” have made a quiet comeback.

James Joyner
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With the last legal hurdle to Obamacare cleared, “death panels” have made a quiet comeback.

LAT (“Obama administration revives plan once criticized as ‘death panels’“):

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 proposal, contained in a large set of Medicare regulations unveiled Wednesday, comes amid growing public discussion about the need for medical care that better reflects patients’ wishes as they get older.

Two months ago, former Florida Gov. Jeb Bush, one of the front-runners for the Republican presidential nomination in 2016, suggested that Medicare patients should sign so-called advance directives that spell out the care they want if they become incapacitated.

The American Medical Assn. has recommended the Medicare billing change.

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.

Aside from the cleverness of “death panels” as a mobilizing tool, capitalizing on longstanding American fears about government control of healthcare, I’ve never understood the argument against the practice. Of course physicians ought to discuss with their patients what their end-of-life options are once they become terminally ill or sufficiently advanced in age. And, so long as we maintain a fee-for-service model, of course they ought get paid for it.

To the extent that government is a prime payer of healthcare expenses—and for those over 65, there’s little controversy over the fact that it is—there is something of a conflict of interest at work, in that care for terminal patients eats up an inordinate percentage of lifetime costs. But it strikes me as absurd that doctors are going to talk their patients into ending their lives prematurely mostly on the basis of cost savings.

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31 responses to “Death Panels Are Back. Good.”

  1. mantis Avatar
    mantis

    The wingnuts are already up in arms about this in the agenda-driving swamp on the right (Washington Examiner, WND, Newsmax, various blogs), which will quickly bubble up to more “respectable” outlets with columns in the Washington Post and of course extensive discussion on Fox News. Their primary attack, it seems, is to claim that this is just a clever way to force doctors to push their elderly patients into assisted suicide.

    Oh, and there’s a healthy dose of “Sarah Palin was right!!!!1!!1”

  2. Moosebreath Avatar
    Moosebreath

    James,

    “Of course physicians ought to discuss with their patients what their end-of-life options are once they become terminally ill or sufficiently advanced in age. And, so long as we maintain a fee-for-service model, of course they ought get paid for it.”

    You have automatically disqualified yourself for being elected to office as a Republican. How dare you look at facts and draw straightforward conclusions?!?

  3. Pete S Avatar
    Pete S

    Aside from the cleverness of “death panels” as a mobilizing tool, capitalizing on longstanding American fears about government control of healthcare, I’ve never understood the argument against the practice.

    But that was the whole basis of Republican opposition, was twisting the meaning of sensible ideas to scare the base electorate. How clever was it in the long run to convince so many people that a law which could really help them was intrinsically evil? Maybe in the framework of winning elections but not so much in terms of the actual public service part of the job of being a politician.

  4. Hal_10000 Avatar
    Hal_10000

    I would go further. When you sign up for Medicare, you have to fill out a living will. There’s no restrictions on what is in it, but you have to do it. Most people don’t realize that, in the absence of a will, they will get the most extreme measures by default. Families don’t want to pull the plug. Doctors can’t. And so people get hundreds of thousands of dollars of care they don’t want.

    The public is paying for this. I don’t think they need pay for the luxury of allowing people to pretend they won’t die. If they want the last full measure, fine. But you have to specify it.

  5. Hal_10000 Avatar
    Hal_10000

    One note: I though “death panels” was mostly used in reference to the IPAB, not end of life planning. (Addendum: just checked; looks like it was applied to both).

  6. de stijl Avatar
    de stijl

    @mantis:

    Sarah Palin was right

    Of course she was right. Death Panels already exist. They’ve existed for about a hundred years. They’re called insurance companies.

  7. stonetools Avatar
    stonetools

    This is where President Obama’s rational approach to government ran smack into Republicans’ calculated opportunism and appeal to the worst instincts of the Republican base:

    ” The crazy black man in the White House wants to shove us into the next world, Ethel, so he can spend more money on HIS people! That’s what Obamacare is all about!”

    Looking back on it, it was a political blunder to bring it up , but then it was the right thing to do.I applaud him for doing so-and for bringing it back up again.
    I expect to see more nonsense about it from the Republican clown car again. Hopefully, the Prsident will do a better job of squelching the nonsense this time, instead of ignoring it as just being too stupid to take seriously.

  8. Hal_10000 Avatar
    Hal_10000

    @de stijl:

    Actually, most end of life care is almost entirely handled by Medicare (since most terminally ill people are over 65). That’s part of the problem. They’ll just vomit out money for intensive maintenance care (they do occasionally fight on surgeries; but the biggest expense is day-to-day hospital care).

  9. mantis Avatar
    mantis

    @de stijl:

    Of course she was right. Death Panels already exist. They’ve existed for about a hundred years. They’re called insurance companies.

    That’s true, but that wasn’t what she was talking about.

  10. de stijl Avatar
    de stijl

    @Hal_10000:

    Yeah, I know. I was being hyperbolic.

    Something like 85% of lifetime healthcare outlays pay for the last 6 months of a person’s life on average. And Medicare ponies up.

    I say bring back the ice floes.

  11. mantis Avatar
    mantis

    Sure enough, here’s LifeNews and the National Right to Life Committee coming out against the change.

    The Obama administration is reviving the controversial “death panels” that former vice-presidential candidate Sarah Palin famously lambasted and that have been condemned by pro-life groups as targeting disabled and elderly patients.

    After years of debate about whether the government should be paying doctors to encourage so-callled end of life planning, which could involve pushing patients to seeking assisted suicide…

    Sarah Palin right! – Check
    Pushing elderly into assisted suicide! – Check

  12. JohnMcC Avatar
    JohnMcC

    Interestingly enough, “death panels” did exist. When dialysis first became possible on a research basis the question arose, who would have access to what was a rare and extremely expensive therapy. So the medical researchers wrote standards and formed committees and these combed through medical records to find patients who fit the standards. These were colloquially called ‘death panels’ because so few patients passed through and got dialysis. Since no one could afford the treatment all of it was financed by what amounts to research funds. So there was no financial incentive to make more dialysis available.

    In 1973 Medicare agreed to pay for everyone’s dialysis who needed it. With payment guaranteed, it became a growth industry.

    Let’s see, wasn’t that an R after the president’s name back in ’73? Another example of the ways that Nixon would have been a great president except that he was Nixon.

  13. de stijl Avatar
    de stijl

    Betsy McCaughey was the originator of the term. Palin was the viral vector.

    Voluntary counseling to Medicare patients about living wills, advance directives, and end-of-life care options got dubbed death panels, but any health care provider or funder makes these types of decisions for us every day.

    What gets paid for and what gets covered and what doesn’t has consequences to individuals. If you suffer from a super-rare affliction (or a super-expensive affliction) you’re less likely to get effective intervention than if you have a bog-standard and cheap-to-treat affliction.

    Palin and Grassley made political hay out of the end-of-life counseling provision in the PPACA by calling those Death Panels.

    But when you allocate limited resources on health-care, any decision about how to allocate those resources is essentially a Death Panel.

  14. Jeremy R Avatar
    Jeremy R

    @Hal_10000:

    I though “death panels” was mostly used in reference to the IPAB …

    My recollection was the rhetoric was initially focused on end of life directives, but after that provision was killed there was a great deal of effort to retcon it into “respectability” as having been an attack on IPAB all along (leading to IPAB being made toothless as well).

  15. de stijl Avatar
    de stijl

    Just as general advice, please advise all of your loved ones to complete a living will and talk frankly with their designee about how they wish to be treated if they are unable to make the decision themselves.

  16. Franklin Avatar
    Franklin

    But it strikes me as absurd that doctors are going to talk their patients into ending their lives prematurely mostly on the basis of cost savings.

    In fact, I would think it would bias the opposite way: doctors get *more* money if the patient stays alive.

  17. ernieyeball Avatar
    ernieyeball

    @Pete S:..twisting the meaning of sensible ideas to scare the base electorate.

    See Phyllis Schlafly and her mendacious propaganda that successfully defeated the Equal Rights Amendment.
    She claimed that the ERA would lead to “public unisex bathrooms.”

  18. CS Avatar
    CS

    @Franklin: If your doctor is actively trying to convince you to kill yourself, consider changing your doctor…

  19. LaMont Avatar
    LaMont

    Jeb Bush having already come out in support of such policy, the fact that this issue potentially drives a wedge between Bush and the conservative base is a bonus for Hillary.

  20. de stijl Avatar
    de stijl

    @ernieyeball:

    She claimed that the ERA would lead to “public unisex bathrooms.”

    I never understood why this argument was successful. Every domicile with more than one person living there essentially has a public unisex bathroom. It’s the norm, not the exception.

    TMI – Every now and again I have a shy bladder. I just want a door that locks and goes all the way down to the floor.

  21. C. Clavin Avatar
    C. Clavin

    This is great news.
    I am hopeful that I can get appointed to one of these Death Panels.
    Those Obama donations are finally going to pay off!!!

  22. grumpy realist Avatar
    grumpy realist

    @de stijl: Which is ironic because doctors are supposedly the least willing to inflict “life-extending” options on themselves.

    Rather than “life-extending care”, I’d much rather have good hospice care, lots of opiates, as much Laphroaig and smoked salmon that I can stuff down, and several dachshund puppies to frolic all around me. Even with 30-year Laphroag it’s gotta be cheaper than your standard hospital….

  23. michael reynolds Avatar
    michael reynolds

    @grumpy realist:

    I’ve been giving this some thought. There’s nothing like hitting 60 to focus one’s attention.

    I’ve decided the question comes down to whether life still holds at least some genuine pleasure. If I still enjoy my wife, my kids, my Scotch, my coffee and my bowl of Ben and Jerry’s Half-Baked, I’ll hang around.

    Life without pleasure is unlivable – as I keep telling Vegans and Mormons. Death isn’t something to fear, pain and weakness and the loss of interest is, so at the point where I lose the capacity for joy, I’ll be ready to float away on a pillow of opiates.

  24. Pete S Avatar
    Pete S

    We lost my mother to cancer last summer. Every step of the way the doctors were pushing more treatment, more treatment. It was next to impossible to get a straight answer about the likelihood of a recommended treatment working, the upside if it did, the downside if it didn’t, and the likely impact of side effects. Her attitude all along was that she wouldn’t give up, but she also didn’t want to make herself feel even worse getting a treatment which would be a longshot to help or where the upside would be an extra month or two.

    I know it is too much to ask, but a lot of families could probably be helped if patients were encouraged to have end of life directives and if the right wing media outlets could avoid equating a grownup discussion about palliative care with pushing assisted suicide.

  25. ernieyeball Avatar
    ernieyeball

    I never understood why this argument was successful.

    It worked because many citizens are gullible and stupid.

  26. gVOR08 Avatar
    gVOR08

    @JohnMcC: I saw that story about dialysis some years ago, don’t recall where. As I recall the Doctor who invented the first machine did it in occupied Holland during WWII. In addition to inventing dialysis, using sheep gut I believe, he also managed the hospital he worked in and was a leader in the Dutch resistance. Really impressive. I believe it was the Rockefeller Foundation who brought him to NY after the war to develop the machine.

  27. Andy Avatar
    Andy

    Of course physicians ought to discuss with their patients what their end-of-life options are once they become terminally ill or sufficiently advanced in age. And, so long as we maintain a fee-for-service model, of course they ought get paid for it.

    Well, I disagree with the notion that medical “services” must continually be deconstructed into an ever-growing number of “billable” events. It’s a great way to grow physician compensation (thanks AMA!) and those in the medical billing profession, but this is a fee-for-service model run amok.

  28. al-Ameda Avatar
    al-Ameda

    We’ve ALWAYS had Death Panels, they’ve never gone away.

    They’re otherwise known as private health insurance companies.

    They way they – the Death Panels – operate is extremely simple: (1) if you are seriously ill and you have a low grade insurance policy and not easily liquidated assets at your disposal, your policy probably will not cover the very expensive procedures necessary to extend your life, and (2) if you have a high-end expensive policy and other requisite cash resources you will get the necessary expensive treatment and care that will enable you to avoid death.

  29. Tyrell Avatar
    Tyrell

    So the government is going to pay doctors more for talking to a patient ? I thought that was what they are supposed to be doing ? What is next, paying them extra to answer a guestion ?

  30. Grewgills Avatar
    Grewgills

    Tyrell you do understand that there are multiple reasons to go to a doctor, don’t you? End of life planning is a reason to consult with a doctor and for some odd reason doctors expect to be paid for consults.

  31. mantis Avatar
    mantis

    @Tyrell:

    Yeah, a doctor should spend an hour going over all of the choices and implications of an individual’s end-of-life planning, and that doctor should just do it for free. Because reasons.

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