www.baltimoresun.com/topic/la-ed-end-of-life-20130731,0,7481195.story

baltimoresun.com

Editorial

'Death panels' done right

A provision to help patients make their own choices about end-of-life treatment is back.

By The Times editorial board

August 1, 2013

Advertisement

Among the most egregious distortions to cloud the healthcare debate in 2009 was the false notion that the Patient Protection and Affordable Care Act called for "death panels," through which the government would determine whether seniors and the disabled should receive care. So dishonest was this characterization, popularized by Alaska's then-Gov. Sarah Palin, that PolitiFact named it the "Lie of the Year."

In truth, one of the provisions of the act that gave rise to Palin's critique would have done just the opposite: help patients make their own decisions about their treatment at the end of life. But it was removed from the bill in the heat of the death panel rhetoric. Now it is back as part of HR 1173, introduced by Rep. Earl Blumenauer (D-Ore.) with 17 bipartisan cosponsors.

The bill requires that Medicare and Medicaid cover the cost of voluntary end-of-life consultations every five years and more often if there is a significant change in health status. Conversations about treatment decisions in the final stages of life take time, so it's important that insurers cover one-on-one consultations with physicians. By offering coverage more than once, the proposal recognizes that advanced care preferences change depending on age and health. At its core, the bill affords individuals greater choice in what are often the most sensitive decisions a person will make in his or her lifetime.

Currently, many patients speak informally to their doctors about advanced care planning and some are encouraged to fill out an advance directive. But Medicare, Medicaid and most private insurers typically don't cover consultations specifically for these discussions. Some experts believe that if Medicare and Medicaid were required to cover advance-care consultations, insurance companies would follow suit.

The Blumenauer proposal also calls for greater portability and accessibility of advance-care directives by including them in electronic records and helping ensure that they are honored across state lines.

With memories of the 2009 debate still lingering over any healthcare discussion in Washington, it's easy to write this off as politically unfeasible. But in reality, it's a policy most Americans support. According to a 2011 survey from the Regence Foundation and the National Journal, 81% of Americans agreed that advance-care discussions should be covered by Medicare. What's more, legislators don't have to support Obamacare to rally behind this sensible legislation. In fact, one of its primary advocates, Rep. Phil Roe (R-Tenn.), is an ardent opponent of the president's law.

Blumenauer's proposal is smart policy now, as it was in 2009. Americans are ready to talk about death. Our politicians should be ready also.