Death Panels – American Style

By Greg Scandlen

The new Medicare benefit for end-of-life counseling that was snuck in by the Obama Administration over the objections of Congress and the American people, is the fourth and final step of a process that will indeed lead to “death panels.”

Now, don’t misunderstand. You will not go before a panel of bureaucrats to plead for your life. That was Franz Kafka’s early twentieth century Bohemia. We are much more sophisticated today. In twenty-first century America, your sentence will be delivered by your friendly family doctor.

STEP ONE — We started two years ago with the appropriation of $20 billion to set up a mandatory Health Information Technology (HIT) system. This was part of the wonderful “stimulus” bill that was enacted well before ObamaCare. This law requires every physician’s office and every hospital to be wired up to a centralized database, so the government may know exactly what each doctor is doing with every single patient.

All of the research available says that HIT does not improve care or lower costs. Quite the opposite — it worsens care and raises costs. What it does do is enable the government to know with precision what a doctor is doing.

STEP TWO — The next step was also funded in the stimulus bill – the “Comparative Effectiveness Research” (CER) initiative. This will allow a panel of experts to determine what works and what doesn’t work in medical treatment. By “work,” they mean what is the best use of the available dollars. If something is quite expensive and doesn’t prolong life by many months, it will be deemed to “not work.”

That might be useful knowledge to have for a physician who is looking at treatment options. It could be one more piece of information in his understanding of what to do for a patient. But it becomes a problem only once the next step is implemented.

STEP THREE – Now we get to ObamaCare, and the presumption that the best (only?) way to finance health care is through “Accountable Care Organizations” (ACOs), that pay physicians on a “Pay-For-Performance” (P4P) basis. P4P says that doctors will get paid more when they do the “right thing,” and less when they do the “wrong thing.”

Now we’ve got something. Now we have HIT telling the government what every doctor is doing, and we’ve got CER determining what is the right and what is the wrong thing to do, AND now we have a payment system that will “incentivize” doctors to do what the government says. There is only one thing missing – how to tell the patient.

STEP FOUR – “End-of-Life Counseling.” There is no acronym for this as yet. End-of-Life  Counseling will pay physicians to deliver the bad news to the patient — “I’m afraid your breast cancer is quite advanced and there isn’t anything further we can do. How can I help you get your affairs in order?” Now, notice the physician is not explaining there IS something that can be done, but the government decided to not pay for Avastin because it costs too much. Or any of the other life-enhancing treatments that would be available if not for federal intervention. No, Medicare would not pay the doctor to deliver this information because it might upset the patient.

So, there you have it. In twenty-first century America, our Death Panel is good old kindly Dr. Marcus Welby. Don’t you feel better already?

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8 Responses

  1. Like a great deal of the coverage on government run healthcare, the media stories are being framed in a manner that constitutes an error of ommission.

    The government, through the Centers for Medicare and Medicaid Services (CMS) has been “running” healthcare since the early 90’s. If you doctor prescribes oxygen, CMS will not pay for it unless a test proves that your oxygen saturation level falls below 89%. Who decided that was the right level? A CMS panel.

    Have sleep apnea? Again its not enough that your doctor prescribes the treatment. CMS requires an overnight sleep study that yields specific data. Even then, you will have prove to the doctor within 90 days of receiving your CPAP or BIPAP machine that you are using it or CMS will not pay for it.

    “Yes” you say, “but what about private insurers?” Every private insurance contract not only bases its rate as a percentage of medicare, it will also require the provider to comply with all of CMS’ guidelines.

    The government has been running healthcare for a long time, and that is one of the main reasons that the cost has gone up!

  2. Can one ask their doctor to recommend uncovered treatments if he thinks they are desirable with the understanding that you will pay out of pocket; and that you will also pay him for his personal services in this case if the insurance does not?

    If the answer is no, allowing this would be a useful law for the new congress to pass. And would be very popular also, I expect.

    Can HSA accounts be used for this purpose?

  3. […] socialized medicine in general: the choice to keep your own doctor, and the problem of bureaucratic death panels: No, there are no death panels.  And, technically, the government has not mandated that patients […]

  4. Indeed a good reason to have an HSA is that you have the power to pay for what you want, including things that CMS won’t. We recently had precisely this experience with a CT scan for a terminal cancer patient.

    Many physicians will recommend the right thing irrespective of coverage. If you are lucky you’ll get one of those. I prefer to make my own luck by fully funding my HSA.

  5. Greg, I would love to send this particualr piece to others. How can I do it easily from this page?

    Like the blog

    Thanks,

    Bob

  6. Greg: Excellent analysis. But don’t forget the Medicare Independent Advisory Board. They will also promulage “death panel” edicts for seniors. And then there’s Dr. Ezekiel Emmanuel, Rahm’s brother, with his life analysis work claiming that benefits are less useful to those over 50. More “evidence” to fuel the real life death panels.
    I agree with you: the final edicts will be delivered by family doctors, or more probably by nurse practitioners or the new RNs with doctorates. Bottom line: you can no longer trust your primary care provider – doctor or nurse – to do what’s best for you. The new mandate is to do what is best for the budget and the State.

  7. […] Scandlen writes: The new Medicare benefit for end-of-life counseling that was snuck in by the Obama Administration […]

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