Sarah Palin's "death panels" must shoulder much of the blame for the elimination of a provision in the Patient Protection and Affordable Care Act that would have allowed Medicare to reimburse doctors for providing requested end-of-life counseling.
Yes, that's Sarah Palin's death panels, not President Barack Obama's. The former Alaska governor was the one who coined the ridiculous phrase to frighten Americans and bolster criticism of the health care reform proposal. It worked. The reimbursement was taken out of the bill that became law in 2010.
That's a shame because older Americans are too often undergoing invasive, unpleasant and expensive surgeries and procedures in their last year of life that don't improve the quality of their remaining months. And worse, many of these people don't even get a chance to discuss the pros and cons of such questionable medical care with their doctors.
Such discussions were the point of the reform law's provision to make counseling more readily available. Without reimbursement, many physicians who contract with Medicare to treat elderly Americans simply aren't inclined to spend the time it would take to fully inform patients about treatment options. The health-care reform law would have provided Medicare funds to reimburse doctors for such talks, which would have been entirely voluntary. The provision mandated nothing.
The value of counseling in preventing unwanted end-of-life surgeries is apparent in the results of a report done at the Harvard School of Public Health. The research shows that almost a third of the 1.8 million Medicare recipients over age 65 who died in 2008 had surgery in their final year of life. Researchers explained that many of these elderly patients were dying, and the surgeries did little to make them more comfortable, while adding millions to overall Medicare spending.
Certainly there are many older patients with terminal illnesses who would choose further medical treatment. Sometimes surgery to treat cancer, for example, can add years of good health to a patient's life. Those are the possibilities that should be part of a discussion between a patient and doctor. When surgery or another procedure has little chance of improving or prolonging life, a patient should be told and allowed to make an informed decision.
But, as the study shows, too few of those conversations occur. And too often, doctors and hospitals, with a built-in financial incentive to do something, seem hell-bent on operating, regardless of the probable outcome or the informed consent of the patient. That's a kind of disrespect we can't afford.