By Dave Andrusko

Even though the Obama Administration has pulled back its Medicare regulation that funded end-of-life planning (at least for now), the commentary that it provoked is very much worth keeping in the front of our brains. That’s so for lots of reasons, including the oft-overlooked fact there are other provision ObamaCare likely to be used to persuade patients that they will be just as well off, or better, if they forego life-preserving treatment. (For more about that, be sure to read Burke Balch’s front-page story in the January National Right to Life News.)

Very briefly I would like to take about an article written by Dr. Marc Siegel that appeared in the New York Daily News.

Let me be clear: I do not agree with some of Dr. Siegel’s observations, but what he gets right, he really gets right!

As you remember the final statutory version of ObamaCare authorizes Medicare coverage of a yearly “wellness visit.” But under the new regulation (now revoked) as of January 1, the annual visit would cover “voluntary advance care planning” to discuss end-of-life treatment.

Siegel cuts right to the chase. “Like many physicians, I talk to my patients about how aggressive they want me to be if and when they are dying,” he writes. “But I don't see a role for the government incentivizing this kind of planning session on a regular basis except as a way of advancing their own agenda, which clearly is decreasing end-of-life care.” While sympathetic to attempts to cut costs, the practice of medicine, Siegel writes, “is about saving people, not pinching pennies.”

Siegel also keenly understands how so-called “advanced directives” work out in “the real world of medical care. " Dying “is almost never as envisioned; people who are sure they would want to give up often wind up being the biggest fighters against death,” he observes. That is why advanced directives "have a limited value when a life-threatening illness actually comes.”

Siegel, unlike yours truly, has “no problem with Medicare providing an incentive for end-of-life discussions.” But he understands perfectly how incentives work. If these conversations happen yearly…. well, “Having too frequent end-of-life discussions sends an unfortunate message to the patient that death could be imminent. How much angst and excess worry will result from death planning sessions?”

His conclusion can almost be seen as the last word on the subject. “The Medicare-sponsored yearly end-of-life discussion is a clever way of manipulating patients into a mindset of scaling back on this technology's use, even when it may be quite appropriate - just as this technology's medical potential is rapidly accelerating,” which is not, Siegel concludes, “good medicine.”

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