By Peter Roff
Posted: December 28, 2010
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Share ThisHaving failed to get the idea of “death panels” in through the front door of the new healthcare law the Obama administration is trying to sneak them in through the back way.
On the day after Christmas The New York Times reported that the Obama administration, which had walked away from a proposal to let Medicare reimburse physicians for their work on “end-of-life planning” from legislation overhauling the nation’s healthcare system, would instead revive the proposal through regulation, starting on January 1.
“Under the new policy,” the Times explained, “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.” [Read more about healthcare reform.]
The new rule is part of a massive regulation setting Medicare payments for thousands of services and was issued by Dr. Donald M. Berwick, the controversial administrator of the Centers for Medicare and Medicaid Services who was an Obama recess appointee and who is a longtime advocate for a healthcare system based on the widely problematic British model.
Now there is nothing per se wrong with “end-of-life” counseling alone--as long as it is voluntary and if the patient requests it. However, given that Medicare will provide reimbursements to physicians for this so-called service, the idea that it will remain “voluntary” is debatable if not doubtful because the government has created a financial incentive to offer it. [Check out our editorial cartoons on healthcare.]
The other major problem with the idea of end-of-life counseling is that it cannot be viewed in an isolated way but has to be taken together with other elements of the healthcare plan--particularly the rationing that will inevitably take place as a cost cutting measure and the use of what is known as “Comparative Effectiveness Research”--a way to determine what medical technologies work on specific populations and to determine if the projected outcomes justify the costs involved.
Taken together, end-of-life counseling, rationing, and comparative effectiveness research easily combine to create, in function if not in organizational structure, what former Alaska Gov. Sarah Palin and others have criticized as “death panels”--which are really no more than government regulations and processes and standards that will make decisions about who among the sick and elderly may live and who must die. It’s a scary thought, which is probably why the Obama administration kept these new regulations under wraps until the holidays, hoping they could get them out there without too many people noticing. [See photos of Sarah Palin and her family.]
Their plan, obviously, failed. The challenge now is to convince congressional Republicans, once they have held their up or down vote on repeal of the entire Obamacare package, to hold hearings on this one issue and to offer a single piece of legislation that eliminates the reimbursement for end-of-life counseling--if the circumstances warrant. Right now though, it looks too much like the very top of the slippery slope leading down to a permanent culture of death
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