Time for the inevitable freakout from Snowball Snookie and the appalling Betsy McCaughey (thanks for that, Sully) to start yapping on Fox about death panels:

Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.

Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans. People are living longer with illnesses, and many want more input into how they will spend their final days, including whether they want to die at home or in the hospital, and whether they want full-fledged life-sustaining treatment, just pain relief or something in between. Some states, including Colorado and Oregon, recently began covering the sessions for Medicaid patients.

But far more significant, Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association, the country’s largest association of physicians and medical students. One of the A.M.A.’s roles is to create billing codes for medical services, codes used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare.

The Centers for Medicare and Medicaid Services, which runs Medicare, would not discuss whether it will agree to cover end-of-life discussions; its decision is expected this fall. But the agency often adopts A.M.A. recommendations, which are developed in meetings attended by its representatives. And the political environment is less toxic than it was when the “death panel” label was coined; although there are still opponents, there are more proponents, including Republican politicians.

If Medicare adopts the change, its decision will also set the standard for private insurers, encouraging many more doctors to engage in these conversations.

“We think it’s really important to incentivize this kind of care,” said Dr. Barbara Levy, chairwoman of the A.M.A. committee that submits reimbursement recommendations to Medicare. “The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them.”

What a difference a few years make:

Reversing a potentially controversial decision, the Obama administration will drop references to end-of-life counseling from the ground rules for Medicare’s new annual checkup, the White House said Wednesday.

The latest shift on the sensitive subject comes ahead of a vote next week in the new GOP-led House to repeal President Barack Obama’s landmark health care overhaul.

The decision is not likely to have much impact on patients and doctors already discussing options for care in the last stages of life. For example, voluntary end-of-life planning is already covered as part of the “Welcome to Medicare” doctor visit, available to seniors within the first year of joining the program.

The original House version of the overhaul legislation sought to expand coverage, allowing for discussions every few years. But the plan was dropped after Sarah Palin and other Republicans raised the specter of “death panels” deciding the fate of vulnerable seniors. Those charges were later debunked by several non-partisan fact-checking groups.

It’s like this with everything. Democrats propose something common sense, Republicans scream bloody murder and many in the media pretend they have legitimate concerns (although even this was too much for Politifact to issue a both sides do it opinion), the Democrats and the common sense plan is kneecapped, and then five to ten years later the change happens with little or no outcry, because it just makes sense.

32 replies
  1. 1
    the Conster says:

    I think death panels are a great idea, and I’m disappointed that there isn’t one I can join. And I’m not talking about old people.

  2. 2
    NotMax says:

    Call it “pre-rapture counseling” and they idjits will trample one another to get in line.

  3. 3
    NotMax says:


    For whatever it’s worth, General Motors already has killed the Olds.

  4. 4
    Violet says:

    private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans.

    Totally different when a private business does it. Capitalism uber alles.

  5. 5
    Baud says:

    There is a sizable portion of this country for whom opposing Democrats is their number one public policy priority. Trying to discuss actual public policy issues with them is a fool’s errand.

  6. 6
    muddy says:

    I look forward to my doctor bringing this up to me. I hadn’t filled out an Advanced Directive because the standard form just has Do Not Revive. I was thinking they could try a little to revive me! They said get with a lawyer about the details and I wasn’t into that ($), so I just said I didn’t want the DNR then. I would like one spelling out what stuff was okay to do what was too much, and you’d think they’d want me to have one.

  7. 7
    dmsilev says:

    @NotMax: And Obama bailed out GM!

    See! It’s all Obama’s fault.

  8. 8
    StringOnAStick says:

    @muddy: Muddy, what you want is called a Living Will. You get to list exactly what you want done from “everything” to “DNR” and all permutations in between. All the hospitals in my area give out booklets that are exactly this, and let you fill them out as you wish; then you give a copy to your primary care doctor. Doctors that treat a lot of older patients tend to have a pile of these forms to give away too. Your only choice should NOT be DNR or not, the push for Living Wills has been on for years; I filled mine out before I turned 50 and every year my doc asks if I am still OK with my current version.

  9. 9
    muddy says:

    @StringOnAStick: Ah, thanks. I have a visit soon, I will ask for this.

  10. 10
    raven says:

    @StringOnAStick: And, in my understanding, none of that may mean diddly depending on what hospital you are in?

  11. 11
    StringOnAStick says:

    Since this is a medical thread, I want to tell this story. I’ve noted elsewhere here that my BIL was just diagnosed with lymphoma; we won’t know what stage until next week. As I have been informing friends and family members, the first thing everyone says is “thank God he got that state job last year and has good insurance”, including some anti-ACA tealibangecals. FFS, 1.5 years ago he was unemployed and let his COBRA lapse unbeknownst to us because he is super strict about money; if this had happened then would they have said “oh, too bad he has to die for lack of care, but that’s the breaks”? Hell no they wouldn’t have, they’d expect some sort of treatment and would be showing their total ignorance of the US medical system simply because they hadn’t run head-on into it yet or are busy cruising on Medicare.

    It’s never “real” to people until it happens to them or someone they are close to, and then they all devolve into reasoning away why this could never happen to them because they are such careful, good people. Shit happens to everyone, and we shouldn’t have a medical system that only cares about it if you have the proper paperwork in order.

  12. 12
    FlyingToaster says:

    @muddy: Odd. Whenever one of us has to go into the hospital, it demands to have a Healthcare Proxy on file. My husband and I have two each; if something happens to the other spouse at the same time (car wreck), our lawyer/WarriorGirl’s godmother has the power of attorney to enforce our directives (which is the Living Will, though Massachusetts doesn’t recognize it as such — the Commonwealth demands a person be in charge).

    Each state has its own terminology and specs; for this, a lawyer isn’t always necessary, but it might be a good idea to make sure the form you use conforms to state law.

    The nice thing about having a person in charge is that they can read the riot act to the hospital, and enforce it with a magistrate’s order. Even the most Catholic of hospitals can’t screw around with the Healthare Proxy, despite the same-sex-spouse they don’t want to recognize. Which is why (I think) they sold all of their hospitals to Steward.

  13. 13
    StringOnAStick says:

    @raven: I’d make it a point to avoid catholic hospitals if you can for that reason alone. Of course, easier said than done. The western half of Colorado has one major medical center between Salt Lake City and Denver, and it is catholic; if something awful happens to you in that part of the region, you are going to end up at Saint Mary’s.

    I figure all you can do is fill out a Living Will, make sure your doctor and closest relatives know it exists and have a copy of it, and hope for the best. As more and more Boomers hit that most medically expensive point in life, there will be more pressure to get Living Wills out there and make sure they are followed, just based on economics alone.

  14. 14
    JCT says:

    @raven: It can, but the major issue is the “reversibility” clause built into almost all Living Wills that usually states that the MDs have some discretion in applying the Living Will if the presenting illness (what brought the patient in) is potentially reversible – pneumonia is the classic example . These are tough calls sometimes.

  15. 15
    FlyingToaster says:

    @raven: It depends on your state and enforcement mechanisms, as much as the hospital. Think of Schaivo.

  16. 16
    dubo says:

    Every time DEATH PANELS!!!! gets brought up, the media needs to point out that Palin’s “death panels” claim was that Obamacare would instruct doctors to kill disabled infants

    The “we were talking about end-of-life counseling” thing was a whitewash that came later

  17. 17
    raven says:

    Lot’s of good information, I got my medicare card yesterday but still have a couple of months till it kicks in.

  18. 18
    Another Holocene Human (now with new computer) says:


    Which is why (I think) they sold all of their hospitals to Steward.

    They sold all their hospitals? A hahahahaha.

    Even St Elizabeth’s in Brighton? A ha ha hahahahaha.

    Hahahahahaha a ha a ha hahahaha

  19. 19
    Emma says:

    @muddy: Also, each state may already have a form online that can help you draft it. I know the Florida Bar has a sample one online that has been co-drafted by the Attorney General’s office.

  20. 20
    FlyingToaster says:

    @Another Holocene Human (now with new computer): Yep. St. E’s and Carney, both.

    Whatever happened to Caritas Christi, eh?

    I once did a CAI project at St. E’s, so I naturally followed the whole Cerberus/Caritas Christi/Steward saga. Yes, it is to laugh.

  21. 21
    Ruckus says:

    Still a pup then?

    Sorry, couldn’t resist. When I was younger, about 2 or 3 centuries ago, anyone at least a day younger was a kid and anyone a day or more older was a geezer. Now that I’m officially a geezer my own self I’ve revised this. Anyone younger is still a pup, and anyone the same age or older is in the geezer brigade.

  22. 22
    raven says:

    @Ruckus: I’m still standin even after a brutally hot Dawg game!

  23. 23
    MattF says:

    Via Charley Pierce, a new argument against Obamacare: when people get access to healthcare, they go to hospitals, and hospitals are dangerous places:

    I kid you not.

  24. 24
    WereBear says:

    @MattF: WIngnuts are just not problem solvers, are they? Not in any way, shape, or form.

  25. 25
    Ruckus says:

    So I was right!

  26. 26
    Ruckus says:

    No, wingnuts are not problem solvers. They are carriers. Similar to typhoid Mary, only they bring stupid problems that cause almost irreparable harm and have to be cleaned up after.

  27. 27
    Lurking Canadian says:

    @StringOnAStick: Catholic hospitals shouldn’t object to a DNR. The official position is “conception to natural death”. There are definite problems with the former, but the latter means that if you are dying, nobody (including you) has an obligation to slow or stop the process. You wouldn’t get a deliberately fatal dose of morphine at the Catholic hospital, but there should be no problem with palliative care and a DNR.

  28. 28
    WereBear says:

    @Lurking Canadian: Don’t be so quick to think so.

    Slightly less well known are the Catholic strictures on end-of-life care. Church dogma requires medical staff to provide certain life-support measures, like feeding tubes and intravenous hydration, indefinitely, even when the patient has given end-of-life directives in advance. In those cases, Catholic institutions will ignore the individual’s wishes if they conflict with Church teaching… even if the individual in question is not a Catholic.

    Why Catholic Hospitals Should Scare You

  29. 29
    RaflW says:

    @StringOnAStick: I spend a lot of time in Summit County, CO, so I looked and the hospital there is part of Centura Health, who’s mission starts with Christ stuff.


    On the other hand, their web site has info on Advance Directives and says “Living Will: Provides your physician instructions regarding procedures that are meant to prolong your life. Your physician and your health care surrogate are required to follow all the directives in a Living Will.”

    So I guess they are OK with pulling the plug? I hope so, I have specific instructions about saying buhbye to me if I’m in a persistent vegetative state.

  30. 30
    debbie says:


    My dad died from cancer in 1974. His doctor (a childhood friend) was Catholic and was registered at a Catholic hospital, so that’s where my dad ended up. As he came to his end, the hospital did everything to keep my father comfortable and as pain-free as possible, and they did nothing to extend his suffering. Sure it wasn’t in keeping with their beliefs, but my father’s dying wasn’t about their religion, it was about my father.

    A whole flock of nuns showed up at temple for his memorial service. Flustered a few yentas, maybe, but you’d never see this kind of honest compassion today.

  31. 31
    mclaren says:

    I’d like a doctor have a chat about this with Dick Cheney and the Koch Brothers. And Mitch McConnell, while he’s at it.

  32. 32

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