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Sneaky Consultation

A Bad First Step



When it comes to health care, the administration has heard the voice of the people. And it couldn’t care less.

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Chuck  Colson

During the debate over health care reform, one of the most controversial proposals was for the government to pay for consultations regarding end-of-life treatment.

The tag “death panels” stuck to the proposal like white on rice, and the administration had to drop the idea from the final bill.

But on December 3rd, apparently under cover of darkness, the Obama administration issued a new Medicare regulation that implemented what Congress and the American people explicitly rejected. It authorizes Medicare to pay doctors for “end-of-life-care counseling” during patients’ annual check-ups.

The Administration and its supporters did their level best to keep the regulation quiet. But the New York Times broke the story three weeks later—on Christmas Day!

Predictably, the administration sees the change as “minor,” even salutary. It says that “advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives.”

When you spin it that way, it sounds benign, but there’s a lot more going on here than the spin. It’s all part of what a recent Wall Street Journal article called “government's broader agenda to ration healthcare based on cost and politics.”

Folks, this is a big deal.

The object here isn’t to “reduce stress” or promote “patient and family satisfaction”— it’s to convince people to forego treatment when it’s expensive. This is especially true as governments become the health insurer of last and, increasingly, first resort.

The government would rather have people pass up expensive treatments voluntarily. But don’t doubt the bureaucracy’s willingness to do it with or without your cooperation.

The Journal piece cited the example of the breast-cancer drug Avastin. The FDA disapproved it for the treatment of advanced-stage breast cancer, despite the fact that it extended the lives of women.  Why? Not because of the side effects, but because of the cost. Avastin didn’t provide “sufficient benefits” to justify the costs, at least in the minds of FDA technocrats. I’m sure it did in the minds of the patients, however.

This is a preview of what we can expect. The federal government is already spending more than a billion dollars to fund research into “comparative effectiveness.” That, folks, is the grease on the slippery slope. It’s exactly how Britain rations health care, measuring treatments in terms of “quality-adjusted life years.”

The prospect of government playing an active role in these kinds of matters is why people reacted so strongly to the proposal in 2009. They saw it for the dangerous first step it is.

Yet it’s back. Well, it should come as no surprise. Congress rejected the administration’s global warming proposals, yet the EPA is getting ready to achieve through regulation what it couldn’t get through Congress. Bad ideas often have very committed advocates.

End-of-life planning should be a government-free zone. It should involve you and your family—and parties who have no economic stake in your decisions, like your pastor and perhaps your lawyer.

Remember: It is good to make plans about your future health care. Patty and I have living wills. But the government shouldn’t be part of our planning. That’s the path to real anxiety—like premature death.

Further Reading and Information
Obama Returns to End-Of-Life Plan that Caused Stir
Robert Pear | The New York Times | December 25, 2010

They're Back! The Return of the Death Panels
Paul Greenberg | Townhall.com | January 03, 2011