Tuesday, January 4th, 2011
One of the most persistent, and outrageous, rumors about last year’s health care reform law was that the law would establish “death panels” to decide which patients were worthy of receiving medical care. Nothing even remotely like that was ever in the law, but millions of Americans were convinced otherwise.
As a result of the hysteria, a perfectly benign, and sensible, provision was taken out of the Affordable Care Act before it was passed last spring. An earlier version of the bill would have allowed Medicare to reimburse physicians for providing what’s called “end of life” counseling, which only means providing information to people with terminal illnesses so that they can make their own decisions about medical care. This includes informing patients about choosing a hospice or designating someone close to the patient to be a proxy in case the patient goes into a coma.
It is a sad fact that medical science can’t fix everything. There are some diseases that are nearly always terminal, such as mesothelioma. Sometimes patients and their families struggle to make hard medical decisions, especially when aggressive and painful procedures no longer appear to be helping. If physicians take the time to talk to patients and families about what medicine can and cannot do, and what to expect as the illness progresses, it can relieve a great deal of stress.
The important point here is that decisions about medical care ultimately would rest with the patient and the patient’s family. The point of the provision was only to encourage physicians to take the time to give patients information they need to make informed decisions.
However, you will remember, a number of politicians got hold of this provision and began screeching about death panels, implying that the bill would establish committees to make end-of-life decisions for patients. This was never, ever, in any way, in the health reform bill.
So the end-of-life provision was taken out of the bill to placate the screechers and help get the law passed. But recently right-wing news outlets learned that a similar provision had been added to Medicare regulations, and the screeching began anew.
The fact is, for years private insurance companies have had their own “death panels.” They meet in secret and decided which procedures they wanted to pay for, and which would take too much out of corporate profits. The annals of American medicine are stuffed to the hilt with stories of people who were denied life-saving care because their insurance carriers refused to pay for it.
There are other “death panels” you might not know about. The states of Virginia and Texas have passed what are called “futile care” laws. These allow a medical facility to refuse to give life-sustaining treatments to a patient if a panel of doctors decide the care is futile. Under these laws, facilities can halt kidney dialysis treatments or refuse to give patients respiratory assistance even when the patient is conscious and wants to keep fighting his disease.
As a practical matter few facilities would refuse to extend treatment — as long as it is being paid for. Patients with no insurance, or whose insurance refuses to pay, are left vulnerable to the decisions of the real “death panels.”