Saturday, January 05, 2013

But this I know and know full well . . .

Dr. Ezekiel Emanuel wrote this article in the NY Times on January 3.

Among other things, Dr. Emanuel states  "A related intervention - an idea that never actually was in the Affordable Care Act but inspired the death panel accusation - is that physicians should be paid a one-time fee to talk with patients about their preferences for end-of-life care."

This is technically true.   However - this end-of-life “intervention” WAS INCLUDED in HR3200 – the Bill that eventually was passed as the Affordable Care Act.  The end-of-life provision was removed from the final version of the Bill only because of widespread public outcry.

Dr. Emanuel knows this history full well and thus his statement above must be considered deliberately misleading.   Besides, Dr Emanuel is a long-time advocate of withholding care from some people in favor of other people.

More specifically, Section 1233 of HR3200 went on for 11 pages and 249 lines of text - remarkably long for a provision that its defenders claimed was innocuous.

Section 1233 of HR3200 would have compensated physicians for mandatory end-of-life counseling. It stated in detail exactly what physicians shall discuss, with whom, and at what times. Keep in mind Section 1233 was proposed legislation. Regulations are written after enactment and are always much more prescriptive than legislation.

So, was the objection to Section 1233 about compensating physicians?  Of course not.  People who objected to Section 1233 did not fear “physician compensation”  - they feared a “death panel”.  And why was that? The Affordable Care Act depends on a large reduction to Medicare spending.   Medicare patients fear that such a large reduction will end up harming them by making care less available.  Given that fear, mandatory end-of-life counseling was not seen as a means to bring out patients' "preferences" but rather as a tactic for the administration to reduce Medicare spending. 

That is, Medicare participants perceived a threat of withholding end of life care. This issue still has traction because neither the administration nor the Congress has ever, persuasively, answered the concerns raised about this threat.  By appearing evasive, the administration actually intensified the fears.

Those fears have not disappeared.  Dr. Emanuel also knows that full well.
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