Starting this year (as of 1/1/11), Medicare has to reimburse physicians for end-of-life care option counseling. This is scary stuff because of the issue around starting “death panels” as part of our PPACA reform. The fact is that we do have a tax in place for research on cost-effectiveness in health care. If you don’t know what that means, read Dr. Orient’s blog about it. In a nut-shell:
“This is only the research phase of Comparative Effectiveness so that they can gather data and prove that it is better for the payer (the insurance company or the government) to replace the transmission of a 2009 BMW than the transmission of a 1973 Vega if both are broken. So if they have two patients in need of a new heart, one is 25 and the other is 55, the surgery will be more “effective” on the 25-year-old, therefore the better place to put money for a better outcome. After all, he has a longer life-span ahead of him. This would have nothing to do with the fact that the 55-year-old man has as many people, if not more, at home who love him and want to see him well. The 55-year-old has also probably paid more in taxes during his life.” (read more)
When end-of-life counseling was introduced into the health care reform bill in 2009, Republicans and pro-life advocates were in an uproar, fearful that allowing doctors to counsel critically ill patients would lead to “death panels.” That option was left out of the legislative overhaul, but the Obama administration has achieved the same result by regulating that Medicare will pay for annual wellness exams and counseling. This counseling may include advising patients on advance directives to opt out of aggressive life-prolonging procedures should they wish it. While the medical community is largely in favor of advance care planning, detractors are up in arms over what they see as an end run around the final health care bill. Is the new law a death sentence for the critically ill and elderly? Or will counseling on advance care offer greater comfort for those who want to control their medical care?