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Does new Medicare rule make death panels a reality?

Maryalene LaPonsie | December 28, 2010

At the height of the debate on health reform, opponents warned of 'death panels' that would decide who would live and who would die. If, for example, you were 82 and facing cancer, a panel of government-appointed 'experts' might decide you were too old to be worth the expense of Medicare health insurance-funded chemotherapy.

The Obama Administration and supporters of health reform denied that Section 1233--which would have approved Medicare funding for end-of-life discussions with doctors--would create death panels. However, the uproar resulted in Section 1233 being eliminated from the final version of the bill.

Medicare rulemaking and end-of-life medical coverage

While end-of-life planning may not have made it into the Patient Protection and Affordable Care Act, supporters have found a way to sidestep the legislative process. A new Medicare rule, which takes effect Jan. 1, creates a mechanism for Medicare to pay for advance directive discussions between seniors and their doctors.

Supporters of the Medicare rule say that it does nothing more than allow Medicare reimbursement for annual wellness visits that include discussions of patients' final wishes. In their opinion, these discussions empower patients and give them more control over their ultimate destiny.

Opponents, meanwhile, see the discussions as an opportunity to bully or guilt vulnerable seniors into foregoing life-extending treatments. Financial considerations will drive these conversations, and the elderly will be manipulated into agreeing to concessions to their medical coverage, they say.

Health insurance treading on common sense

This may be a case where both parties are right. An individual's final wishes are highly personal and something best discussed with one's family and loved ones. Why should physicians be part of deciding what life-saving and life-extending treatments are best?

On the other hand, shouldn't physicians be bringing up the subject of end-of-life planning with all patients? After all, we are all just a car crash away from needing life support. These discussions can be as simple as passing out a power of attorney form and asking patients to consider their wishes and write them down.

The even bigger question is why do we need a Medicare rule--or health insurance coverage of any kind--to pay for these types of discussions? Creating awareness of end-of-life planning should be a regular part of comprehensive health care in the United States and included in wellness visits already covered by medical insurance.

However, it is not the place of doctors to try to convince patients of the merits of a particular course of treatment or non-treatment, as the case may be. And it certainly doesn't seem necessary to have special permission or reimbursement for physicians to spend 5 minutes during an annual physical to share power of attorney paperwork and discuss the need to write down one's final wishes.

Tags : medicare, health insurance, senior health insurance

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