Update: Bumped by Aaron Worthing, because I think this does not deserve to be lost over the Christmas weekend.
[Posted by Karl]
When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.
Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.
The terms of controversial section 1233 of the House version of ObamaCare are to return by regulatory fiat? And its supporters want to keep it a secret? Yeah, it is tough to see how that plays well.
Of course, Sarah Palin was not the only person who had the heebie-jeebies over this proposal. Liberals like Charles Lane and Eugene Robinson, and civil libertarians like Nat Hentoff ranged from uneasy to scared after considering the issue. As Lane wrote at the time:
Section 1233 *** addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they’re just trying to facilitate choice — even if patients opt for expensive life-prolonging care. I think they protest too much: If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?
Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.
Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.
What’s more, Section 1233 dictates, at some length, the content of the consultation. The doctor “shall” discuss “advanced care planning, including key questions and considerations, important steps, and suggested people to talk to”; “an explanation of . . . living wills and durable powers of attorney, and their uses” (even though these are legal, not medical, instruments); and “a list of national and State-specific resources to assist consumers and their families.” The doctor “shall” explain that Medicare pays for hospice care (hint, hint)…
Incidentally, as I did not write much about the “death panels” kerfuffle, I should state for the record that I always thought it a term that would have been better applied to proposals like those for the Independent Payment Advisory Board, which would become a key part of “bending the cost curve down,” just as is happening with global budgeting in Massachusetts. Obama and his minions always said those recommendations for rationing would be non-binding, but as we see today, the statists will always come back for more, even if they have to do it undemocratically and as secretly as they can.
Update: You will be shocked to learn that the unconfirmable Donald Berwick was behind this.