The Obama administration may come to regret its decision to sneak a rule into a Medicare’s annual update for reimbursement rates that would reimburse physicians for helping the elderly write end-of-life directives. As The New York Times revealed, the rule was published in “early November,” yet was deliberately kept quiet by supporters to avoid invoking the wrath of the “death panels” crowd. By violating their own promise to run an open government, they’ve needlessly endangered a much-needed policy.
First, let’s be plain about the importance of this measure. As I and millions of other Americans know from first hand experience (in my case, from my mother, who passed away two years ago at age 86 after a long, debilitating physical decline that involved crippling arthritis, diabetes and heart disease), it is crucial to begin these discussions before an elderly person loses the capacity to make decisions on his or her own. Doctors need to be encouraged, i.e., reimbursed, to engage individuals and their families in these discussions. As I sat with mom in her final days, which were spent more or less in a coma, I was glad I could spend those final hours holding the hand of a person who did not have a single tube attached to her body, and who had made that decision to die that way on her own when she had the capacity to do so.
Similar scenes take place every day and in every state and community in the nation. If people like Elizabeth D. Wickham, executive director of LifeTree, which is described in the Times story as a pro-life Christian educational ministry, wants to die with tubes sticking out every orifice, unconscious for days or weeks, and cut off from family and friends while surrounded by machines that go “ping,” that’s their business. But they should not be allowed to impose their religious values on anyone else.
If certain politicians want to win votes by stoking ignorance about the realities of end-of-life decision-making, such as happened earlier this year during the debate over health care reform and was preceded by the Terry Schiavo circus, they need to be confronted. Their political opportunism is not only cruel, it is fiscally irresponsible, since creating an environment where individuals can make voluntary decisions to reduce or eliminate useless interventions near the end of life can save Medicare billions of dollars annually.
It would have been better if the new leadership at the Centers for Medicare and Medicaid Services used adoption of this new rule to educate the public about the importance of developing end-of-life directives, while simultaneously stressing that such actions are totally voluntary. Instead, CMS chief Donald Berwick snuck it into a rule that no one reads. If this winds up becoming the next political football for opponents of health care reform, reformers like Berwick will have no one but themselves to blame.
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