Friday, December 31, 2010

Health Reform and Resuscitation of Death Panels

During the health reform debate, on August 7, 2009, to be precise, Sarah Palin wrote on Facebook.

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil.”

This Palin Facebook posting, as we all now know, promptly became partisan political fodder.

Democrats and the mainstream media assailed mention of “death panels” as a right-wing scare tactic, as a distasteful and unseemly manifestation of a malicious Republican campaign to make seniors fearful of widespread govenment rationing, and later even as a “lie” concocted by Tea Party extremists.

Republicans, said what Palin said was perhaps overstated, but nevertheless signaled a drift toward government rationing of Medicare services.

The actual facts are these. An early version of the health reform law, contained a Medicare provision authorizing payment for doctors for end-of-life consultation to plan for “advance directives “ to avoid extraordinary and unnecessary measures to prolong life.

Which made sense. End of life care consumes somewhere between 10% to 20% of all Medicare spending. But because of the political controversy and posturing engendered by the Palin comment the Medicare provision was removed from the final bill. Democrats feared death panels would sink the bill.

The “death panel” debate has resurfaced because of actions by HHS Secretary Kathleen Sebelius and CMS Administrator Donald Berwick approving a regulation permitting consideration of annual Medicare payment for such consultations – which the last Congress explicitly rejected. So too will the new Congress.

Republicans and conservatives regarded this this re-insertion of pre-death consultations in Medicare as an end-run around the will of Congress, a "recess" dodge, if you will. Under the new Medicare policy, outlined in a Medicare regulation, and endorsed by the Obama administration, Medicare will pay doctors who advise patients on options for end-of-life care, which includes advance directives to forgo aggressive life-sustaining treatment.

This decision may re-ignite the end-of-life debate, with inflammatory talk about killing Grandma. This is a tempest in a teapot. Most sensible people would agree advanced planning for end-of-life care is a good thing. Laying out the options after consultation with patients and families consistent with the elder patients’ moral value is a good idea.It is a variation off the living will concept.

The problem, as I see it, resides in the wording. “Death” is a word , and anticipation of death, is a concept, that makes Americans uncomfortable, particularly when coupled with the thought of government “rationing.”

A larger problem is that we as a people, do not want to make every medical problem a political matter. This is exemplified by the recent decision by Medicare not to pay for Avastin, an anti-cancer drug, for advanced cancers. This is already a raging controversy in Britain which rations cancer drugs for patients.

Another problem is the danger of spouting off on Facebook, now read by 500 million members across the globe. As they used to say in World War II, “Loose lips sinks ships.” Political slips on Facebook, may also sink political battleships ships.


1. Robert Pear, “Obama Returns to End-of-Life Plan That Caused Stir,” New York Times, December 25, 2010.

2. Review and Outlook, “Death Panels Revisited: The Left Won’t Admit that Sarah Palin Had a Point about Rationed Care,” Wall Street Journal , December 29, 2010.

3. David Rivkin and Elizabeth Foley, “ ‘Death Panels’ Come Back to Life; The FDA’s Restrictions on the Drug Avastin is the Beginning of A Long Slide Toward Health-Care Rationing,” Wall Street Journal, December 30, 2010.


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