The Obama administration surrendered to Sarah Palin politics this week and eliminated a reference to end-of-life planning in a new set of Medicare regulations.
The regulation eliminated would allow a doctor to talk to a patient about the care the patient wanted and get paid for the time. Taking the provision out of the regs won’t really change anything. Patients still may have those conversations, as they certainly should.
But with the new Congress flexing its muscles, the administration was probably smart to play it safe and avoid the bombast.
The only negative consequence will be the de-emphasis of an important idea.
A huge percentage of the total amount spent on health care of Americans who die old is incurred in the last weeks of their lives. It is incredibly expensive to keep a person in intensive care, hooked up to machines, fed through tubes, having their breathing done for them, depending on electrical impulses to have their hearts beat, while they lie there insentient waiting for the inevitable.
A great many of us, me included, have made living wills directing the health care world to allow us to go gently into the good night without prolonging life — which is really not life. Such documents — yes, you should have one, no matter how old you are, dear reader — also designate an individual, a wife, a son, a daughter or good friend to make decisions in those directions if the designator is no longer able to do so, which is often the case.
One of the downsides to the advancement of medical knowledge is that ways have been found to keep a person alive when they no longer can think. Most of us don’t want to go past that stop on life’s bus ride.
And that’s why people should talk to their doctors about such things. Because that’s the way they earn their livings, doctors should be paid for the time they spend with patients talking about the subject.
POLITICS SOMETIMES gets in the way of good sense. Sarah Palin can smell out a headline opportunity far better than the average pol. She looked at a similar recitation of facts and saw death panels springing up to decide when to pull the plug on grandma. That put her on front pages in all 50 states. Not to be outdone, Rep. John Boehner of Ohio, then the Republican leader, soon to be speaker, tearfully declared that providing for end-of-life discussions would be “a step down a treacherous path to-ward government-encouraged euthanasia.”
There are no death panels. Nothing like euthanasia is implied by having Medicare pay doctors to talk to their patients about end-of-life care or any other aspect of their health care.
But the facts don’t matter. Sarah is still out there, eager to spring. Speaker Boehner clouds up at the very mention of old folks dying. New rhetoric will be needed to deal with the obvious.
— Emerson Lynn, jr.
