End-of-life planning benefits are not death panels. They offer a voluntary opportunity for patients to discuss how they’d like to live out their last months of life. The Care Planning Act also explicitly prohibits the use of funds in violation of the Assisted Suicide Funding Restriction Act of 1997, so the panels won’t be encouraging physician-assisted suicide — another myth some have associated with end-of-life planning benefits.
Despite what they may be labeled by the media, many healthcare professionals welcome end-of-life benefits. In 2012, Medicare paid out $536 billion for benefit payments, accounting for 16 percent of the federal budget. CMS estimates that roughly one of every four of those dollars was spent on patients in their last months of life. Presenting patients with accurate information about the likelihood of treatments to extend life, how long they might extend life and their side effects could reduce this spending considerably, while allowing patients to make more informed choices about their end-of-life care.
The argument for this benefit certainly isn’t all about cost either. An excellent article by Ken Murray, MD, a retired family practice physician, last year in the Wall Street Journal does a great job of explaining “Why Doctors Die Differently,” which was also the headline of his article. He argues that doctors have knowledge about the limits of end-of-life care that isn’t shared as widely with patients, resulting in some patients undergoing expensive treatments that negatively impact their quality of life and only extend life for a short amount of time.
Yet, physicians aren’t currently paid to have these discussions with patients, which may take a considerable amount of time. (Our financial reporter Helen Adamapolous goes into more detail on this issue in an excellent article she wrote for Medicare News Group earlier this year).
But wait…I just saw a story about a “death panel” last week. What’s that about?
Here is where it gets confusing. It seems the media has also labeled the Individual Payment Advisory Board as a death panel. This too, can be traced back to Sarah Palin. In Dec. 2009, just months after referring to end-of-life care planning as a “death panel,” she used the phrase to describe the IPAB. Here, the term may make more sense than to describe care planning, but it still is a bit far reaching.
The IPAB was created by the PPACA of 2010 to slow the growth of Medicare spending. The IPAB will include 15 presidential appointees who will have the power to cut Medicare spending to slow its growth, which opponents argue could restrict care — potentially to the point where treatments needed to sustain life would be denied coverage, argue opponents. So, while treatment would not be barred, the cost of it could potentially not be covered. Additionally, the IPAB will have no administrative oversight and will only be able to be overridden by Congress — another concern of its critics — as detailed in a great WSJ opinion piece by David Rivkin and Elizabeth Foley.
Most recently, several democrats have begun to back away from supporting the IPAB, and that’s why we’re seeing the term “death panel” in the news again. Howard Dean has made the biggest splash in his criticism, writing “The Affordable Care Act’s Rate-Setting Won’t Work,” in the WSJ. He writes:
“One major problem is the so-called Independent Payment Advisory Board. The IPAB is essentially a healthcare rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.
There does have to be control of costs in our healthcare system. However, rate setting — the essential mechanism of the IPAB — has a 40-year track record of failure. What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients. Most important, once again, these kinds of schemes do not control costs. The medical system simply becomes more bureaucratic.”
Dean, it appears, is worried that the IPAB won’t cut costs, not that it will lead to deaths. “Death Panel” is a scary term, especially to typical Americans who aren’t healthcare literate. News media has succumbed to throwing a quoted scary phrase — “death panels” — in headlines to draw readers, but how far do they go to support or dispute the accuracy of the use of “death panels” by those in power who have used it? Not far enough in my opinion.
