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June 09, 2014 3:46 PM Return of the “Death Panels”

By Ed Kilgore

Sometimes a reasonable and even compelling idea that is slain by slander and demagoguery cannot be perpetually suppressed. That’s the case with the idea of encouraging health care providers to discuss “end-of-life options” with patients to the extent that they are reimbursed by Medicare as would be the case with any other legitimate medical consultations.

As you probably recall, such a provision, endorsed strongly by the medical profession, and originally associated with Republicans, when placed in the Affordable Care Act led to one of the most infamous smears in recent political history, the “death panel” meme, which suddenly became part of the conservative attack on the ACA via a know-nothing Facebook post from that great public policy wonk, Sarah Palin.

The end-of-life consultations provision was duly removed from the ACA before passage, under the theory that it wasn’t worth the trouble of rebutting the immense propaganda devoted to distorting it. But as Stateline’s Michael Ollove reports, the American Medical Association may soon recommend that the Obama administration implement an end-of-life consultation reimbursement provision for Medicare by regulation. (There’s separate legislation introduced by the very brave Rep. Earl Blumenauer of OR to accomplish the same purpose).

It’s as reasonable an idea as ever:

Geriatricians, oncologists and other medical specialists who see gravely ill patients say it’s crucial to elicit a patient’s wishes for treatment and other pastoral or psychological supports in a dire medical situation. Would a particular patient, for instance, want to pursue additional procedures that, while grueling, offer some slim possibility of success? Or would the patient want doctors to intervene only to alleviate pain?
If Medicare reimburses doctors for such discussions, as it pays them for examining patients and performing procedures, they are much more likely to happen.

These end-of-life decisions, of course, are made by families all the time when it’s too late to secure advance directives from patients—though often not without expensive and painful procedures taking place without their consent. It is, in my opinion (having gone through two of these situations in the last two years) immoral to deny anyone the information they need to make their own decisions and spare their loved ones the agony of watching and waiting until they are in a legal position to decide for them.

Want to guess, however, how this AMA request turns out once Palin and company get hold of it?

It’s instructive that the most vocal opponents of end-of-life consultations are members of the antichoice lobby, as illustrated by this quote from Ollove’s piece:

Burke Balch, director of the Powell Center for Medical Ethics at the National Right to Life Committee, said he wasn’t aware of the AMA’s proposal. But Balch expressed concern that the measure would result in the “denial of life-saving medical treatment.”
“It is one thing genuinely to determine what people’s treatment wishes are but the danger is very grave that efforts to pay for advance care planning sessions (under) Medicare will turn into subtle efforts to pressure some of the most vulnerable patients to surrender their right to live,” Balch said.

More to the point, it’s been an ancient strategy for antichoicers to accuse prochoice advocates of favoring euthanasia along with legalized abortion. That is undoubtedly why Palin, who was a heroine of the antichoice movement before John McCain made her nationally famous, seized on the “death panel” smear so quickly and forcefully—and reflexively. Even if you take Balch’s argument seriously that reimbursing health care professionals for informing people of their medical options exerts some sort of “subtle” pressure on them, it took someone as irresponsible as Palin (along with the notorious health policy misinformation specialist Betsy McCaughey, and Rep. Michele Bachmann, who were fellow “death panel” pioneers) to turn this provision into some sort of faceless set of bureaucrats making life and death decisions without any input from the people most affected.

Is it worth the effort this time around to move ahead with the likely AMA recommendation and weather the storm of “death panel” lunacy? I don’t know. But sooner or later prochoicers need to push back hard and definitively against the underlying smear that we’re all eager to kill off old people, out of some supposed neo-nazi eugenics impulse. In my worst moods towards conservatives—i.e., when I think about the “death panel” smear—I would never attribute to them the kind of active and diabolical evil they routinely attribute to people like me. If only for the refutation of “false equivalency,” they need to be held accountable for this sort of behavior, at the expense of dying patients and grieving families.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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