End-Of-Life Counseling and Health Care Rationing: Enough With The "Death Panels" Lie

The Obama Administration announced just before Christmas that it would use its Executive Order authority to enact regulations allowing physicians to be reimbursed for providing end-of-life counseling to patients and their families.

Predictably, conservative talking heads once again took up the cry of government interference in life-or-death decisions via the formation of "death panels", and of the slippery slope toward rationing of health care services.

Puh-leez...

It was a mark of the President's relative inexperience with hard-ball politics which led him to lose control of the debate over end-of-life counseling in the spring of 2010. And his unwillingness to engage with his opponents over the issue led to one of the key mistakes committed by novice politicians: letting your opponent define the terms of the debate.

It would seem the President and his minions are a little better prepared to pick up that fight again. And it would be good for the country if he succeeds. Here's why.

First, the new rule simply enables physicians to be paid for what most of them and their clinical and nursing staffs already do: assist patients and their families in weighing the pros and cons of treatment or palliative care options toward the end of life...whether it be the life of an aged and infirm relative, a traumatically injured younger person, or even a severely ill premature infant.

If you've ever been in a position to make such a decision, you know how difficult it is. Rarely are even the best-educated individuals capable of thinking straight when someone they love is teetering on the brink of death. And for many, clinical efficacy (whether or not a treatment will cure the patient) is rarely the first consideration.

And that leads to the most important reason that end-of-life counseling makes sense: it can lead to dramatic reductions in hospital and physician costs.

Over half...by some accounts, as much of 70%...of hospital costs are directed toward individuals in their last three months of life. Much of those costs come from providing high-technology supportive services to patients who have no hope of surviving. Many physicians will say privately that, when facing a hopeless clinical situation, they will often accede to family members' demands to spare no expense, or to try anything, to extend their suffering loved one's life, even if such efforts are obviously futile, to avoid possible legal action.

The ability to educate patients and families about the possible benefits of hospice, for example, could have a dramatic effect on health care expenditures for private insurance, and especially for Medicare. So to the extent that health care spending reductions, and deficit reduction, are supposedly objectives of meaningful health care reform, such a policy makes sense.

Where are the "death panels?" Nowhere. Nowhere is it even suggested that anyone's going to insist that "the plug be pulled on Grandma." That's just a rather spurious lie, as anyone who's read the rule, or even the original legislative language, can tell you for certain. I know many of the Republican members of Congress who've taken up this banner. They're smart. They KNOW they're perpetuating a Big Lie. It's apparently in their political self-interest to do so. They should be ashamed of themselves...if they're capable of feeling shame.

Does such a rule lead inevitably to "rationing" health care services? Depends on your definition of rationing. At its foundation, "rationing" is all about the rational allocation of unlimited resources, whether food or, in this case, money (in the form of services). So literally, one can NOT engage in rationing only if resources are unlimited.

Up till now, for most patients, end-of-life care is "rationed" based on the lifetime maximum of their health insurance policies. Providers have often thrown a bunch of technology at patients until they reach their lifetime max; then they're sent home, or into hospice care.

With the elimination of lifetime maximums on most fully-insured health plans, that form of rationing goes out the window. Absent more patient involvement in critical decision-making, hospitals will no longer have even THAT incentive to shut down their treatments for critically- or terminally-ill patients.

One would think that those advocates for "patient empowerment" out there would celebrate this rule as a potential benefit to patients, their families, and the overall system of care. One can only assume that the REAL opposition to the imposition of such a rule would be hospitals, whose revenues could suffer if more patients and families actually begin making educated choices.

And that may be what's REALLY at the root of this furor. As is usually the case with insurers, it's also true for hospitals that an uninformed patient is often their best (and most profitable) customer.