Remember all the hue and cry about “Death Panels” last year? Recall how powerful the fear was that it invoked, and how the outcry wound up blocking legislation aimed at reimbursing doctors for the time required to provide patients with information regarding end-of-life care?
Well, where legislation failed, it looks like regulation will prevail. The New York Times carried a front page article a couple days ago leaking news that under new Medicare regulation, starting on January 1, 2011, doctors will now be reimbursed for the time required to provide patients with adequate counseling for end-of-life care planning.
“The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.
Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.”
As some of you may remember, I wrote about this subject a while ago in Christmas Trees and Death Panels: How Fear Sets A Snare. Back then, I was disappointed but not terribly surprised that this legislation failed because it’s nigh-on impossible to legislate something that no one will even discuss. As someone who worked for six years with hospice and who strongly advocates for end-of-life care conversations, I’m certainly glad it finally passed.
But my reaction is hardly all leaping joy and ribbon waving.
On the one hand, I’m profoundly relieved that one of the major roadblocks to physician/patient discussions about end-of-life care is now removed. Even though this policy doesn’t address the real elephant in the room…the fact that most doctors are clueless about how to have that particular discussion with a patient…it at least now provides a financial incentive for them to face into all their deepest fears about death and dying and try to learn how to talk about it.
And I believe that’s a good policy. To explain why, I’ll refer once again to the decades long experiment in La Crosse, Wisconsin where doctors have been having regular end-of-life care conversations with their patients since the mid-1980’s. I’m not exaggerating when I say that this one, simple practice has made the quality of dying in La Crosse among the most benign, respectful, compassionate, comfortable, and enlightened in the nation.
Having said all that however, I’m still bummed at the stealth used to get this policy instated.
“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”…
The e-mail continued: “Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.
So why does this kind of behind-the-scenes maneuvering dismay me? Because it’s going to make having an open, constructive, educational, illuminating, respectful, national conversation about dying even harder than it already was. (I didn’t know that was even possible.) Far from building any kind of consensus or trust, or making an attempt to listen to or address some of the real fears feeding into the Death Panels uproar, it instead seems to confirm one of the deep fears a lot of people already have about linking how we die with big government: namely, that those in power don’t really care about the concerns or desires of everyone they govern, but are only intent on imposing laws that they believe are best for everyone.
Overall, I rate this new regulation as basically two steps forward for health care policy, and one step back for public discussion and trust.
Sigh.
I foresee, with my magic crystal ball, that setting public policy around dying is going to continue to be a tough dance for everyone to learn.
copyright 2011 Dia Osborn
Update: Snoring Dog Studio expressed some confusion in the comment section as to what part of this regulation I was objecting to. Great question. It made me realize I didn’t reference something important that was said later in the article. I have now included the pertinent quote. Thanks Snoring Dog!
The Odd and Unmentionable 
