In a stealthy move, the Obama administration has slipped end-of-life planning, famously criticized as “death panels,” back into the law by means of a new Medicare regulation. The action was exposed, equally stealthily, by The New York Times on Christmas Day when few would be reading the paper. The rule was issued by Dr. Donald M. Berwick, administrator of Medicare and Medicaid Services (CMS) and an advocate of cost-cutting and rationing of health care. The rule takes effect Jan. 1.
When the health care overhaul was stumbling its way through Congress early this year, Sarah Palin was excoriated by Democrats for suggesting that the nascent law included “death panels” for the elderly in order to save costs of treating the oldest and most expensive patients. In a Wall Street Journal op-ed, Palin wrote that Obama had asked Congress to create an independent Medicare Advisory Council-–an unaccountable group of experts charged with containing Medicare costs. She pointed out that in an interview with The New York Times, the president suggested that such a group “should guide decisions regarding that huge driver of cost…the chronically ill and those toward the end of their lives[.]”
Palin went on to write, “Is it any wonder that many of the sick and elderly are concerned that the Democrats’ proposals will ultimately lead to rationing of their health care by—dare I say it—death panels?” That phrase rang true for many Americans.
Palin’s charge and building criticism touched off a torrent of confusion among Democrats. The end-of-life planning was cut from the legislation. But never-to-be-denied cost saving over quality, the Medicare potentate, Dr. Donald Berwick, has secretly restored the end-of life provision through a Medicare regulation. It says Medicare will cover “voluntary advance care planning” to discuss end-of-life treatment as part of the annual doctor’s visit. Doctors will be given federal money to have such talks with patients. And discussions are to include such topics as palliative measures and hospice (the last step on the way to death). The original provision (Section 1233) would have allowed a health care provider other than a doctor to sign end-of-life papers. Having doctors bring up the subject at every annual physical may well suggest to some patients that they must decide on when they want to have “the plug pulled.”
The attitude of backers of the end-of-life provision is most revealing. After learning that the administration had reached up its sleeve to retrieve the controversial provision, Rep. Earl Blumenauer (D-OR), an enthusiastic supporter of Oregon’s physician assisted suicide law, is quoted in the Times story as calling it “a quiet victory” but urged supporters not to be overly vocal about it. “We won’t be shouting from the rooftops because we aren’t out of the woods yet….this regulation could be modified …if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.” Hush, hush, Blumenauer cautioned in an e-mail, the Times reported. ”We would ask that you not broadcast this accomplishment out to any of your lists, even if they are supporters—e-mails can too easily be forwarded.”
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