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Are Obamacare "Death
Panels" Truly a Myth?
Part Two of Two By Burke J. Balch, J.D., director of NRLC's Powell Center for Medical Ethics
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 ADVISORY BOARD 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. "SHARED DECISIONMAKING" 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 them." 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 . . . . Please send your comments on Today's News & Views and National Right to Life News Today to daveandrusko@gmail.com. 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