Shedding light on those "death panels"

OK, let's stipulate that anyone who passionately opposes America's
Affordable

hb3200-jpeg.jpg

HB 3200. The first of 1017 pages

Health Choices Act is an easily manipulated blockhead.

Now
that we've got the name-calling out of the way, maybe we can look at
what the legislation -- House Bill 3200 -- actually says about those
"death panels" that supposedly will be sending Grandma packing before
her time. Nothing, as far as I can find.

But that doesn't mean that there's no room for discussion about what the Democrats'
big health-care reform bill calls "Advance Care Planning Consultation."
There are 10 pages detailing new rules governing doctor-patient
relationships on the matter, including requirements for "end-of-life"
care. Several things can be said about these highly specific
requirements:
1
They were not a part of the list of public demands for health-care
reform. People want an end to health-insurance exclusions for
pre-existing conditions, greater access to coverage for the uninsured
and the like. Few, if any, Americans are banging the drums to be told
how to die.

2
The end-of-life advice that the physicians are required to give their
patients include "advance care planning and advance directives ...
living wills, durable power of attorney, orders of life-sustaining
treatment and health-care proxies." With all due respect to physicians,
they're not the ones to be giving this advice. This job belongs to
lawyers. Would the bill require that physicians be trained as lawyers?
Would physicians be held legally accountable for bad advice given?
Would physicians be reimbursed for necessary extra training? How much
more would this increase the cost of this horrendously expensive bill?

3
Private sector managed-care groups already press physicians hard enough
to hold down costs, including the amount of time they spend with each
patient. So, how much more time will end-of-life consultations take
away from what physicians now have? The time my wife and I spent with
our lawyer having all this explained to us was measured in hours. Of
course, since a physician can't legally execute these end-of-life
documents, patients -- after spending time with physicians -- would
still have to consult with lawyers and pay for the service. Which
raises the question: If end-of-life consultations are so important --
and they are -- can't the argument be made that the bill should require
that lawyers give this advice, so that it's done right?

4
This end-of-life consultation requirement "interferes with the very
private patient-physician relationship." I put this in quotes, because
this is exactly the objection that pro-choicers raise when they oppose
any legislation that would require a doctor to counsel his patient
about the details and dangers of abortion. I'm in favor of that kind of
counseling -- the government is in the business, we're told, of
protecting consumers -- because of a woman's right to be fully informed
by competent authority of the risks of any medical procedure. It is not
in the financial interests of abortion providers to give women any
discouraging information. Of course, we hear no such objections to
interfering with the patient-physician relationship in the
health-reform bill.

Mind you, these are just a few of
the questions that can be legitimately asked

pig-in-poke.jpg

Pig in a poke (bag)

about only 10 pages of a
1,017-page bill. Similar questions can be asked of the other 1,007
pages, about each of its titles: "Protections and Standards for
Qualified Health Benefits Plans"; "Health Insurance Exchange and
Related Provisions"; amendments to "Internal Revenue Code Of 1986";
"Medicaid and Chip; Community Health Centers"; "Prevention and
Wellness; Quality and Surveillance" -- to name a few. In total, this is
a cosmic-size bill, a classic case of America leaping into the unknown
before looking.

I highly recommend end-of-life consultations,
done properly. But as part of a cosmic bill that reconstructs the
entire health-care system, it and other issues are not getting the
debate they deserve. The reasonable path to reform is incremental. Why
do we have to try to swallow whole this cosmos of health-care
commissioners, health-insurance exchanges, health benefit advisory
committees and the rest of it? Agreement can be reached now, for
example, on prohibiting exclusions for pre-existing conditions. Let's
try that, see how it goes and tackle what comes next. Better than this
pig in a poke.

This column also appeared in the Chicago Tribune

Comments

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  • First, thanks for agreeing that the bill doesn't create death panels. However, let's make sure a couple of things are understood:

    First, no doctor is required to do any end-of-life consulting. The bill just makes it reimbursable if they do. Therefore, it doesn't interfere with the relationship, like required anti-abortion counseling would. A doctor is already required by professional standards to discuss the risks of the procedure. This requirement would force the doctor to discuss "options". However, there is no medical option to abortion. This requirement puts the doctor in the position of being a moral counselor to the patient, which many are, but not because they are forced by the government. Doctors are free to attempt to dissuade women from having an abortion, or to refuse to do it. But if a woman comes in for one, no doctor should be forced to try to talk her out of it. That's government interfering in the relationship.

    Second, just because people aren't demanding this service doesn't mean it's not a good provision. Many people believe that better end-of-life planning by more people will enhance their quality of life at the end, and will save money on unnecessary care to extend the lives of people who don't want to extend their lives by a few days, weeks or months. Too many people have this forced upon them because they haven't adequately planned. How can anyone be opposed to encouraging people to take control of their lives in this way. Nobody would be forced to do anything... the best definition of "freedom" I can think of. And it will probably save money.

    Debate all you want about whether we want health reform in it's current form, or at all (yes we do to the latter). Debate whether the government should stick its nose in private enterprise (e.g., legislate away an insurance company's ability to consider pre-existing conditions) (no, it shouldn't... a free market is a free market). Debate whether tort reform should be part of the package (absolutely!). But we need to stop throwing out these red herrings. They muddle the debate and detract from the important issues. End-of-life planning is such a small thing to spend any time on.

  • Does it matter what the bill says?

    We are involved in long arguments about what is in, or will be in, any health care

  • Mr. Byrne,

    Your proosal to fix only one part of health care is misguided. A moderate is someone who takes one step forwared when two are required. Our health care system is broken; only major surgery will do.

    I agree that lawyers should be consulted. Everyone should have a living will.

    There is a difference between abortion and end-of-life consultations. Pro-lifers would mandate the former, while health care reformers would make the latter voluntary.

    While only a minor part of the bill, the end-of-life provision has raised quite a ruckus. That is because death is a sensitive topic. People tend to avoid it. That is why the majority of people do not have a will. Bringing up the subject of death strikes a raw nerve.

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