The Death Panel Controversy

Much has been made of the "Death Panel" provision in the current health reform proposals. The actual provision, at least as has been revealed to date, was to give reimbursement to physicians for counselling patients about end of life decisions. Why this needs a separate payment schedule from any of the other things we counsel patients about is another discussion altogether. This has obviously been exagerrated and there is no question that it has been used to score some political points. Big surprise there. The real focus, however, should be on why this issue arose in the first place.

Human nature being what it is, if you make any proposal on an important subject, keep the details hidden in 4 separate House and Senate bills each over 1000 pages long, have many congressmen who admit they don't even read most of the bills they vote on, and then insist that it come to a decisive vote within 2 weeks, you are going to raise a little suspicion. Rumors and inuendo are the least response one could expect. Trying to evade facing the issue and labelling protestors as a mob of undemocratic stooges will only make it worse.

Let's be honest. The thrust of the current proposals is mainly to limit health care costs. No matter how you parse that, it means that some things are going to be cut. When you spend a lot of time talking about how much money is being spent in the last year of life for Medicare patients, it's natural to assume this a place where cuts will occur. In fact, that is exactly what has been done in England, where the euphamistic acronym of NICE has been applied to a panel of "experts" who decide what treatments are worth the money spent per "quality life year."

How anyone thinks they know what you might consider to be a quality life year seems to be the height of arrogance. Consider the dilemma this presents to a physician. If I decide that I think this is the last year of your life and then withhold treatment, then it likely will be the last year of your life. The common expression for that is "self-fulfilling prophecy." Any honest physician will admit there are patients who survive and live long lives despite expectations. Does that mean that there are no limits? No. Only that you and your family decide rather than a bureaucratic panel.

And things change over time. Recall that Jacqueline Kennedy had a premature baby die while her husband was President. Here you had one of the richest and most powerful people in the world, yet the best medical science could not save that baby. If there were a NICE panel at the time, surely Neonatal Intensive Care would have been on the cutting floor. But today many of these babies are saved and their intellect and accomplishments match their age groups. The only reason this happened is that there were no artificial limits placed on neonatal care.

So, there is nothing surprising about this controversy. If people can express their concerns, regardless of how diplomatically they do it, then the situation can be clarified. Denying that only makes it worse. The lesson should be to have more transparency about what else is hidden in each of those 1000 pages.