Of all the words the Obama administration is most tired of hearing, it’s not hard to imagine that “death panels” are pretty high up on its list. The provocative phrase was first coined by Sarah Palin in 2009, when she accused President Obama of planning to cut off medical care to certain populations, such as disabled children and the elderly, in his proposed health care legislation. Palin’s words sparked an intense national debate—and though her claims about the “death panels” were thoroughly debunked, Obama’s 2010 Affordable Care Act was still forced to leave out a provision to pay physicians for providing end-of-life counseling. When the administration tried to set up a payment system for such counseling through regulations a few months later, it once again caved into political pressure and rescinded the plan.
But now, the administration is trying to bring that idea back. Medicare, the federal program that offers insurance to 55 million elderly and disabled Americans, released a new set of rules Wednesday in which it proposes to reimburse doctors for holding conversations with patients about whether and how they would like to be kept alive if they were to become too sick to speak for themselves. Under these new rules, doctors would be paid for helping patients complete an advance care directive for their health care. As Vox points out, the new rules provide an example of a situation in which such a conversation would take place:
This could occur in conjunction with the management or treatment of a patient’s current condition, such as a 68 year old male with heart failure and diabetes on multiple medications seen by his physician for the evaluation and management of these two diseases, including adjusting medications as appropriate. In addition to discussing the patient’s short-term treatment options, the patient expresses interest in discussing long-term treatment options and planning, such as the possibility of a heart transplant if his congestive heart failure worsens and advance care planning including the patient's desire for care and treatment if he suffers a health event that adversely affects his decision-making capacity.
Most Americans right now don’t have advance care directives to tell doctors what to do if they fall too ill. When patients don’t leave explicit directions, it’s their families who are left to make decisions on their behalf—which leads to some situations in which patients are artificially kept alive for years because their families refuse to let go. Health care providers, patients, and doctors across the country agree that it is important for more anticipatory end-of-life conversations to take place in hospitals.
For years, the White House has tried to distance itself from the issue of end-of-life care, having deemed it toxic after Palin’s incendiary comments in 2009. But the Obama administration is putting its foot down this time. It’s telling America that end-of-life conversations are important, and that the creation of incentives for these conversations is worth a possible fight.