Wednesday, January 5, 2011

Death by Rationing: The Return of 'End of Life' Counseling

8:46:20 PM
‘Death panel’ debate revived
by Sheila Liaugminas | 4 Jan 2011 |

Over the Christmas holiday, the Obama administration inserted ‘end of life’ counseling into the health care plans for Medicare patients when few were paying attention. They are now.

On Christmas Day, the New York Times reported that although Democrats had dropped the proposal when it caused public controversy, the Obama administration sort of did an end run around the process.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end of life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet.

Until this one put out a memo on it. Urging stealth.

Rep. Earl Blumenauer (D-Ore.) is distancing himself from a memo sent by his office that urged health reform advocates not to advertise new end-of-life counseling regulations to avoid reviving talk of “death panels.”

The weeks-old memo recommended that end-of-life advocates celebrate a “quiet” victory out of concern that Republican leaders would “use this small provision to perpetuate the ‘death panel’ myth.”

In the memo, his office

expressed concern that new attention to end-of-life care planning could doom an end-of-life provision included in a Medicare regulation issued last month.

“Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response,” the memo read. “The longer this goes unnoticed, the better our chances of keeping it.”

Then came the Times story.

“It doesn’t help that advocates wanted to keep it quiet,” (a Democratic health policy) source said, “because it’s impossible to keep anything quiet in this town.”

Democratic strategist Bill Galston agreed Blumenauer’s office hurt Democrats’ defense of the provision by trying to keep it a secret.

“It was stupid,” Galston told The Hill.

However, Blumenauer’s new political strategy is to essentially dare congressional Republicans to make this end-of-life counseling regulation a target when their larger goal is ‘repealing the entire reform law.’

So ‘death panels’ are back as a matter of debate. Are they really that sinister, and just what will this mean? Wesley Smith answers “rationing.”

Indeed, under the economics of much of health care today, medical professionals and institutions often make less money–or sustains a greater loss–the sicker and more care a patient needs.

Moreover, as we have discussed here, some very powerful medical groups support rationing, as does Dr. Donald Berwick, the (temporary) head of Medicare.

Bioethics committees will calculate a quality of life formula, he says, and even decide when patients’ advance directives ‘should’ be overruled on the basis of this “cost/benefit analysis.” So…’s not exactly a ‘death panel’, he says.

But those who worry about seniors and other Medicare recipients, such as people with disabilities, being abused by explicit and futile care-style rationing in the medical system, are not paranoid alarmists. To the contrary: The danger is clear and present.

The new 112th Congress is open for business Wednesday. This debate to be continued…
Retrieved January 4, 2011 from

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