Medicare to Cover End-of-Life Counseling
In 1920, H.L. Menken wrote, “The whole aim of practical politics is to keep the populace alarmed by menacing it with an endless series of hobgoblins, all of them imaginary.” University of Michigan professors Arthur Lupia and Jesse Menning echoed those sentiments at a 2006 symposium in Lincoln Nebraska. Said Menning, “Politicians can use fear to achieve self serving outcomes (or suboptimal policies) that are bad for voters. In it, a politician provides information about a threat. His statement need not be true.”
In the spring of 2009, President Obama was in the throes of lobbying for his proposed healthcare reform legislation. The Affordable Care Act would, among other things, provide for Medicare-covered end-of-life counseling. Under the plan, doctors would be reimbursed for sitting down with their elderly patients, and educating them about such things as a living will and hospice care. It was a good plan too, because according to the Kaiser Family Foundation, about 75 percent of the people who die each year in America are age 65 or older, and many of them don’t understand the benefits of hospice care until it is too late.
In an effort to derail “Obamacare”, Sarah Palin, Representative Virginia Foxx and other Republican alarmists spewed inflammatory myths about end-of-life counseling, saying that it would allow the government to create “death panels”, and decide when seniors would die. “Republicans have a better solution that is pro life because it will not put seniors in a position of being put to death by their government,” said Foxx. It was the kind of political hate speech and fear mongering that Menken and Menning had warned about, and it was effective. Obama had to jettison Medicare covered end-of-life counseling from ACA, or else watch his healthcare reform package go down the tubes.
In the years since then, a modicum of reason has replaced some of the rhetoric, thanks in part to a 2014 report from the Institute of Medicine (IOM) titled “Dying in America.” According to the Associated Press, the report concluded that “too many deaths are filled with breathing machines, feeding tubes and other treatments that fail to extend life, and make its final chapter more painful and unpleasant.” That report inspired Medicare officials to announce last Wednesday their intentions to fully cover end-of-life counseling starting in 2016.
Dr. Joe Rotella, Chief Medical Officer of the Academy of Hospice and Palliative Care told the AP that Medicare’s move is a, “little miracle, given the death panels furor.” Rotella also said that he thinks the controversy has finally passed. The AMA even jumped on the bandwagon with Presidentelect Andrew Gurman saying, “This issue has been mischaracterized in the past, and it is time to facilitate patient choices about advance care planning.” And here in North Carolina, last week’s announcement was long overdue for hospice providers. “Hospice care allows patients to live out their final days and weeks in dignity and comfort. Medicare’s new regulation will help facilitate education about the care we provide so that patients can avail themselves of hospice services while there’s still time,” said Denise Watson, CEO of Mountain Valley Hospice & Palliative Care.
And so, barring any unexpected uproar over the next 60 days, the new regulation will be cleared for implementation next year, and it will allow some 55 million Medicare beneficiaries and their families to make more informed choices about end-of-life care.
Back in 2009, “death panels” was a Republican talking point by political alarmists, designed to derail healthcare reform. In 2015 those same alarmists are six years older, and that much closer to needing end-of-life care themselves. I guess now their muted opposition to Medicare covered counseling is what Menning meant by self-serving outcomes. !
JIM LONGWORTH is the host of “Triad Today,” airing on Saturdays at 7:30 a.m. on ABC45 (cable channel 7) and Sundays at 11 a.m. on WMYV (cable channel 15).