"End of life counseling" has been framed. No longer is it a neutral phrase that refers to a government-fostered enhancement of the doctor-patient dialog. It is now apparently so polarizing and so toxic now that the Senate Finance Committee is willing to strike a provision from its bill that would add a counseling benefit to Medicare. The Wall Street Journal reports that the measure will be excluded from the committee's mark because it has become controversial. As the Journal notes, "dumping the provision would thwart a broad effort in recent years by doctors and hospitals to encourage patients to plan for end-of-life care." That's as close as a newspaper can come to saying: what a dumb thing they're doing! The issue _is_ touchy -- but in the context of the health care debate, it has become, in just a few days, synonymous with an attack against the entire concept of health reform: that Democrats want to ration care. A question, though, for those Democrats and liberals who'll be angry about this: the response to Palin's remarks about "death panels" as well as to Sen. Chuck Grassley's repetition of the idea was swift and fairly unequivocal: it's not as if the pro-reform side didn't quickly rebut the issue with better facts. My sense is that fear-based emotional appeals set in more quickly than reason-based emotional appeals -- always have.This is idiotic. Granted, there are several different bills right now, between the various committees in the House and Senate (something you wouldn't know to listen to, well, most people), but providing funding for counseling on end-of-life issues is terribly important. I've felt pretty strongly about this ever since the Terry Schiavo lunacy a few years back. Here's conservative Republican Senator from Georgia Johnny Isakson, speaking on the floor of the Senate in 2008:
Isakson recently called the deathers "nuts" for claiming that the language in the bills would be "death panels" or forced euthanasia or anything of the sort. After being name-checked by Obama in his NH town hall, Isakson got some grief from Limbaugh and subsequently distanced himself from the President and the House bill. Now, his more recent statement brings up a more specific question. The language of the House bill (see section 1233, starting on p. 424) is fairly specific, and says that consultation on end-of-life issues shall be covered every five years, and talks about the various options that doctors shall include. Chuck Lane and others, including Isakson in that statement, have suggested that this incentivizes doctors coercing you into hospice care. I don't buy it. But if the problem is that the House bill gets too specific, fine, let's not adopt that portion of the language when this all gets worked out in committee.
I will talk about what we need to do in terms of Medicare eligibility. When somebody signs up for Medicare when they are 65 years old--you are supposed to go in 90 days before your 65th birthday; I am getting close, so I am looking at these things--I think you ought to be required to execute a durable power of attorney when you become eligible.
Eighty percent of the cost of health care to me, to you, and to anybody else happens in the last 60 days of life. More often than not, people are not in a condition to make a decision for themselves. Because of laws, and because we are a compassionate nation, the physician will keep you alive as long as he can. If you had a chance, you might rather say if I am being hydrated and given nutrition but will never become conscious again, I give the doctors the authority to make the appropriate medical decision. The money that would save is in the ``gazillions'' of dollars--if there is such a number. It would help us to manage that cost.
BUT! as Isakson said on the floor in '08, lets make execution of a durable power of attorney mandatory for people signing up for Medicare. Make it clear that patients can say "I don't care how much sugar you have to grow to put in the IV drip that will keep me alive in a storage locker until they figure out how to thaw out Walt Disney and cure whatever I'm mostly dead from - do it!" if that's their desire. Don't remove all consideration of end-of-life stuff. Don't kill reform as a whole. Don't let this issue, especially this specific issue within the issue, be demagogued. Don't screw this up. Please. It's too important.
For more on this, read Jim Fallows' post on the media environment and how despite her history and the fact that the internet exists now, the claims of the (as far as I'm concerned) villainous Betsy McCaughey have once again come to define the debate on health care reform.