For the second time, President Obama has bowed to conservative critics and backtracked on a plan to allow Medicare to pay physicians for end of life consultations with their patients. He should be ashamed.
In late November, the government adopted new rules that included discussion of advance directives as one of many services physicians could provide during routine annual physicals for their Medicare patients. But The New York Times reported this morning that the White House has now overruled the Department of Health and Human Services and withdrawn the provision.
The decision echoes the decision by the White House and congressional Democrats who dropped a similar provision from the 2010 health reform law in the face of pressure from the political right. During that congressional debate, Sarah Palin and others made the absurd claim that Medicare payments to doctors for discussing advance directives was akin to creating “death panels” where government officials would withhold care from some patients. Democrats were so slow to respond to these charges that even recent polls reported many seniors still believe the death panel canard.
Obama’s decision is a tragedy for patients. The rule would have done nothing more than pay doctors for the time they took to discuss advance directives during annual Medicare “wellness visits.” Patients could have refused this service if they chose. And nothing in the rule would have in any way constrained end-of-life choices by patients. They could have written living wills however they wanted, or not prepared such a document at all.
The Times quoted new House speaker John Boehner (R-OH) as saying the provision “could be a step down a treacherous path toward government-encouraged euthanasia.” Nothing could be further from the truth. In fact, frank talk about end-of-life choices achieves exactly the opposite result. Advance directives give patients more control over medical decisions, not less. It allows them to make their own choices based on their own moral, ethical, and religious views.
As a society, we struggle to confront death. Patients struggle, and so do many physicians. This modest Medicare rule would have provided a small incentive for doctors to take a more active role in helping their patients think about end of life care. And perhaps it might have encouraged better training for those physicians who are not prepared to discuss these issues.
Now, thanks to a toxic mix of conservative ideology, Obama’s lack of political courage, and more than a little political cynacism, patients and doctors are left with only confusion and uncertainty. They and their families deserve so much more.