Health care: The return of ‘death panels’

The American people mustn’t “fall for the same trick twice,” said Mary Sanchez in Newsday. Back in 2009, former Alaskan Gov. Sarah Palin memorably denounced what she called the “death panels’’ that would be created by President Obama’s health-care-reform plan; government bureaucrats, she insisted, would now decide whether to deny medical care to old people. Palin’s claim “was patently false,” said the Baltimore Sun in an editorial, “but it had an effect.” The Democrats had to delete the offending clause, which turned out to be an innocuous provision giving Medicare reimbursement to doctors for talking with patients about end-of-life decisions: Would they want to be kept alive through the use of feeding tubes, ventilators, and other extraordinary measures? Medicare, thankfully, will pay for that humane conversation after all. Obama last week authorized new Medicare rules that include paying for end-of-life consultations between doctors and patients—if the patient wants to have that talk. By encouraging people to think ahead, and put their wishes in a living will or other document, this rule gives patients more control over what happens to them in the hospital should they become incapacitated by illness.

Obviously, the Left still can’t “admit that Sarah Palin had a point,” said The Wall Street Journal in an editorial. We’ll concede that her “death panel” rhetoric was “sensationalistic,’’ but her underlying critique of Obamacare was valid. Any centrally administered health-care system will, inevitably, make “cost-minded judgments about what types of care” should be provided to which categories of patient. Government technocrats may decide, for example, that it’s a waste of money to give expensive treatments to people deemed terminal or too old. That’s where the “end-of-life counseling” comes in, said Peter Roff in USNews.com. By incentivizing doctors to provide such counseling to the elderly in a system that necessarily rations care, the overwhelming likelihood is that patients will be pressured into “choosing” the least expensive end-of-life options—that is, those that bring about their death sooner rather than later.

But death panels are already here, said Norman Ornstein in The Washington Post. In cash-strapped states like Indiana and Arizona—both governed by Republicans, for the record—teams of government bureaucrats are making “painful choices” about which patients deserve a share of dwindling state Medicaid funds. Indiana officials last year refused to pay for a $500,000 operation that might save the life of a 6-year-old boy, while in Arizona, the state cut off reimbursements for organ-transplant procedures for the poor. The new end-of-life planning provision is nothing like that, said the Portland Oregonian in an editorial. If patients don’t want to discuss end-of-life care with their doctors, they don’t have to. “There is nothing to fear here.’’

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As a practicing physician, I’m not so sure, said Dr. Marc Siegel in the New York Daily News. Today, I rarely can say with any certainty that patients are “terminal,’’ because we have such sophisticated tools to combat life-threatening illness. I’m fully aware, however, that Medicare spent $55 billion last year on just the last two months of elderly patients’ lives—and with the baby boom generation growing old, that figure is sure to soar. For Obama to “bend the cost curve,’’ as he promised reform would do, the cost of “end-of-life care” has to be cut. That’s why doctors like me will now be paid to persuade the elderly not to linger on.