Are Obamacare "Death
Panels" Truly a Myth?
Part Two of Two
By Burke J. Balch, J.D., director of NRLC's Powell Center for
Burke J. Balch, J.D.
Enormous scorn continues
to be heaped on the accusation that the Obama health law
includes "death panels." The original use of the term referred
to a provision in the House bill, not included in the
legislation ultimately enacted, that would have provided
reimbursement under Medicare for health providers to discuss
advance directives (such as the "living will") with their
patients. Critics feared that doctors would be paid to push
patients into rejecting life-saving medical treatment so as to
save the government money.
THE INDEPENDENT PAYMENT
In the Obama health law as
actually enacted, a good candidate for the title of "death
panel" is the obscurely named "Independent Payment Advisory
Board." This board will reach into every corner of the private
(not just government) health care system to limit what Americans
can spend to save their own lives.
Starting in 2015 and then
every two years thereafter, its 18 members are given the duty,
with regard to private health care, to make "recommendations to
slow the growth in national health expenditures ... that the
Secretary [of Health and Human Services] or other Federal
agencies can implement administratively." The board's initial
mission is to force what we are allowed to spend below the rate
of medical inflation.
IMPOSITION OF "QUALITY"
AND "EFFICIENCY" MEASURES
In turn, the Secretary of
Health and Human Services is empowered to impose "quality" and
"efficiency" measures on health care providers (including
hospices, ambulatory surgical centers, rehabilitation
facilities, home health agencies, physicians, and hospitals)
which must report on their compliance. Indeed, doctors who do
not abide by the "quality" standards will not be permitted to
contract with qualified health insurance plans.
What this amounts to is
that doctors, hospitals, and other health care providers will be
told by Washington bureaucrats just what diagnostic tests and
medical care is considered to meet "quality" and "efficiency"
standards not only for federally funded health care programs
like Medicare, but also for health care paid for by private
citizens and their nongovernmental health insurance. And these
will be standards specifically designed to limit what ordinary
Americans may spend on health care so that it cannot keep up
with medical inflation. Treatment that a doctor and patient in
consultation deem needed or advisable to save that patient's
life or preserve or improve the patient's health but which the
government decides is too costly will run afoul of the imposed
standards – even if the patient or the patient's insurance is
willing and able to pay for it.
In effect, there will be
one uniform national standard of care, established by Washington
bureaucrats and set with a view to limiting what private
citizens are allowed to spend on saving their own lives. In some
cases this will mean that patients whose lives modern medicine
could have preserved will die.
A little-noticed portion
of the Obama Health Law bears a close relation to the original
provision that inspired the term "death panels." Under the title
of "Shared Decisionmaking," the new law provides funding to
nongovernmental organizations to develop "patient decision aids"
that are supposed to help "patients, caregivers or authorized
representatives . . . to decide with their health care provider
what treatments are best for them." These organizations will
also receive funding to establish "Shared Decisionmaking
Resource Centers . . . to provide technical assistance to
providers and to develop and disseminate best practices. . . ."
In the creation of these
materials and the "assistance" given health care providers, what
point of view will the nongovernmental organizations awarded
grants and contracts espouse?
An Oklahoma bill that was
clearly modeled on this part of the federal law gives a clue.
That bill, which failed to pass the state legislature, actually
named specific national groups who were to be consulted in the
creation of the protocols and patient decision aids: the
Foundation for Informed Medical Decision Making, the Center for
Information Therapy, and Healthwise.
If you go to the website
of the Foundation for Informed Medical Decision Making, you
immediately come across a little box titled "Did You Know?" And
in that box flash statements like these: "About 25% of Medicare
dollars are spent on people in their last 60 days of life."
"Whether or not they receive active treatment, most men
diagnosed with early stage prostate cancer will die of something
else." "Back patients in Idaho Falls, Idaho are 20 times more
likely to have lumbar fusion surgery than those in Bangor,
Maine, with no clear difference in . . . quality of life." "For
at least 70% of people who have heart bypass surgery, the
survival rate is no better than if they had chosen to take
medication alone." "More care does not equal better outcomes."
"In many people with stable heart disease, medications are just
as good as stents or bypass surgery."
Notice a pattern? Clearly,
this is a group that wants to discourage patients from choosing
treatment that may be extensive or costly.
What do you find on the
website of the Center for Information Therapy? This statement:
"Toward the end of life, too many people receive ineffective,
expensive medical treatments." What about "Healthwise"? The home
page of its website proclaims "avoid unnecessary care with
Healthwise consumer health information," and its "Mission
Statement" says, "We help people ... do as much for themselves
as they can [and] Say 'no' to the care that is not right for
There can be little doubt
that under the guise of giving accurate and unbiased information
to guide patients' informed consent, these groups will develop
materials designed to push and persuade us to agree to forego
intensive medical treatment.
In short, not only will
the Obama health law limit our ability to use our own money to
save the lives of our family members, it will also fund
propaganda to convince us this is all for the best.
What have Americans got to
lose under the Obama health law? Years before his appointment,
as the Obama Administration's director of the Centers for
Medicare and Medicaid Services, Donald Berwick made clear the
care he would like to limit: "Most metropolitan areas in the
United States should reduce the number of centers engaging in
cardiac surgery, high-risk obstetrics, neonatal intensive care,
organ transplantation, tertiary cancer care, high-level trauma
care, and high-technology imaging." In order to "reduce the use
of inappropriate surgery, hospital admissions, and diagnostic
tests," he wrote, "Important initial targets include management
of stage I and stage II breast cancer, prostatectomy, carotid
endartrectomy, coronary artery bypass surgery, treatment of
low-back pain, hysterectomy, endoscopy, blood transfusion, chest
roentgenograms [x-rays], and prenatal ultrasound."
Death panels? Maybe not so
far-fetched after all . . . .
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