Health care reform is complicated. Constraining the cost of medical care in the face of an aging population, new technologies, and increased health care expectations is hard. Providing health care coverage to the millions of Americans who cannot afford it or feel they don’t need it is challenging. And the list goes on.
Given this reality, one might hope the focus of the nation would be on the many legitimate public policy differences worthy of debate. Are current proposals for a public plan creating fair competition with private carriers or unfair competition? What is the appropriate role (if any) for an exchange? How can comparative effectiveness research restrain medical costs without shackling doctors to menu medicine?
Unfortunately attention is being diverted from these substantive issues to those which generate fear and conflict, but do nothing to illuminate or resolve tough issues.
Take euthanasia, or what former Governor Sarah Palin refers to as the “death panels.” Section 1233 of "America’s Affordable Health Choices Act" (HR 3200) is the source of this controversy. Section 1233 makes consultations between patients and doctors concerning end-of-life discussions a covered expense under Medicare. It does not require these discussions. Nor does it require patients to consult with a government panel nor is the patient obliged to take any action as a result of the discussion. All this section does is reimburse doctors for taking the time to talk about what services (such as palliative care and hospice) Medicare will cover and how powers of attorney, living wills, and the like work. That’s it. And it only covers these consultations once every five years, when there is “a significant change in the health condition of the individual,” or when the patient enters a skilled-nursing facility, nursing home or hospice. In other words: twice a decade or when the individual needs to talk about these matters.
Section 1233 is written in legislative language which is, admittedly, difficult to follow (but then, it is legislation). Take the time to read it, however (it starts on page 424), and it clearly does not encourage euthanasia. It takes a substantial twisting of common sense and logic to make it even seem so. Apparently it’s all about “context.” Here’s Governor Palin convoluted reasoning as presented on her Facebook page:
- President Barack Obama has said that one purpose of health care reform is to “bend the curve” on medical costs. Authorizing payments for end of life consultations is, consequently, a cost cutting move. Costs will be reduced not by informing patients of lower cost options (hospice versus nursing home versus hospital care versus home care), but by encouraging the patient to commit suicide.
- Because HR 3200 calls for paying doctors to have these consultations physicians will have an incentive to initiate these talks. Due to the fact that doctors are authority figures in white coats, unwilling seniors will be pressured to have them. In order to reduce overall medical care spending in the country, doctors will use their influence to coerce patients into “’formulation’ of a plug-pulling order right then and there. Apparently doctors are so greedy a fee for spending time with a patient is enough to turn Dr. Welby into Dr. Kevorkian. Yet they are so patriotic they will kill off their patients in order to reduce health care costs. They also must be dumb. Because if they initiate these discussions only to make a few bucks, you’d think they’d be smart and greedy enough to figure out that dead patients pay no bills. If Governor Palin was being consistent, wouldn’t she assume the doctors would be encouraging people to hang in there and consume as much health care services as possible?
- Dr. Ezekiel Emanuel, an advisor to President Obama on health care and the brother of White House Chief of Staff Rahm Emanuel has written that medical spending needs to take into account the patients age, condition and chances of recovery. While I haven’t seen Dr Emanuel’s statements in context, what do they have to do with the legislation? The language of a bill is the language of a bill. What someone wants it to say does not trump what it does say. You’d think a governor might know that.
- So, as mentioned, it all comes down to context. Health care reform is about cutting medical costs, doctors are greedy, patriotic and stupid, and what a presidential advisor says trumps the clear meaning of the legislative language. Given this context, Section 1233 can only be read as a cost cutting measure that will encourage doctors to talk their patients into committing suicide. (I still don’t see where the death panels come into this. They must be in the fine print only real Americans can see).
Maybe it’s me, but this doesn’t strike me as logic. But it does look like fear mongering. Or ignorance. Or maybe it’s just evidence of a world view that sees Democrats as elder-killers, doctors as untrustworthy, and older Americans as incapable of comprehending that that suicide is not only illegal, it’s optional.
Nah. It’s fear mongering.
There are plenty of reasons to oppose the health care reform put forward in Congress thus far and to fight for a better reform package. Let’s stick to the rational ones.