Editorial: A gutless decision on end-of-life care

Star Tribune

"Death panels" are a malicious lie promoted by those who want to see federal health care reform fail at any cost.

And yet this shameful falsehood triumphed this week with the spineless reversal of a key end-of-life-care decision by the U.S. Department of Health and Human Services.

HHS, tasked with implementing the 2010 Affordable Care Act (ACA), had made the courageous though incremental decision to tweak a Bush administration policy on planning end-of-life care.

In late 2008, the Bush administration, taking a cue from recently passed legislation, issued the federal rules outlining Medicare reimbursement for doctors who talk to their patients about what medical care is desired in the event the patient becomes deathly ill.

The change meant that this voluntary planning conversation -- one ensuring that a patient's individual wishes would be respected in his or her final days -- would be reimbursed by the federal Medicare program if the discussion took place during a patient's initial "Welcome to Medicare" physical exam.

The change by the Obama administration simply upped the frequency of reimbursement for this counseling -- something that opponents of health care reform had ludicrously said would lead to "death panels" of bureaucrats deciding who would live and die.

Those who actually bothered to look at the facts would have gleaned the truth about this minor policy change from a previous, Republican administration.

Instead of reimbursing end-of-life-care planning once when a patient entered Medicare, this consultation would have been reimbursed during Medicare's "Annual Wellness Visit."

From a practical standpoint, more frequent reimbursement would give physicians greater incentive to bring up this difficult-to-talk-about topic. And it would give patients more of an opportunity to customize and change their preferences.

This was a sensible and compassionate policy.

So why did the Obama administration cede the moral high ground?

On Wednesday, four days after the change took effect, HHS officially announced it was removing the regulatory language that specifically references coverage for end-of-life-care consultations during annual wellness visits.

Doctors, however, are free to talk with patients about this. The consultations are still covered during the patient's initial "Welcome to Medicare" exam.

The explanation for the policy about-face was pure bureaucratic mumbo-jumbo. HHS officials officially said they hadn't followed bureaucratic steps to give the public enough time to comment on the change.

The reality is that this was done out of cowardice.

It's clear there were fears that Congressional Republicans would exercise their option to do a regulatory review of the new policy and make political hay by conjuring up the old, deceitful death panel argument first promulgated on former Alaska Gov. Sarah Palin's Facebook page.

HHS Secretary Kathleen Sebelius and her agency ignominiously ran instead of fighting with the truth.

The real blame, however, lies with those who irresponsibly spread the death panel garbage and those who willingly swallow it.

Voluntary end-of-life-care planning is widely supported by medical professionals. It is meant to ease the last days of a Medicare patient and their families.

The inability to have a factual, rational discussion about this issue is a national embarrassment.