Maybe those "Death Panels" weren't such a bad idea

This is the fourth piece in a five part series on Medicare.  Join "Health on the Horizon" on Facebook!

My first job out of college was in a rehabilitation hospital for people with traumatic brain injury, an experience that changed my life.  My primary placement was on the floor for people on ventilators, feeding tubes and in level I and II comas.  In the time I spent there I observed the pain and heartbreak confronted by thousands of families every day in this country, the inability to care for their loved ones because there were no advance directives, including a living will (a document indicating the type of medical treatment one desires if in a vegetative state).  I watched families unable to make healthcare decisions for their loved ones that were in vegetative states because there was no health care proxy (a legal document designating another person to make healthcare decisions if you are ever rendered incapable of making them known).  For some of these families this nightmare went on for decades.  

Soon after my experience working with these patients and their families, I made the decision to do everything in my power to never put my own loved ones through the same trauma.  I called a lawyer and completed a “health care proxy” and “a living will”.  I was in my late 20’s and the lawyer chuckled that I was not only the youngest client, but among the few he had ever issued this legal documentation to.  A sad statement, but true.  In fact, according to the University of Minnesota Center for Bioethics, less than 5% of people over age 65 have advanced directives.

When the Patient Protection and Affordable Care Act was first signed into law in March 2010, there included a provision for voluntary end of life counseling for Medicare patients.  This would have allowed Medicare patients access to completing a health care proxy and living will.  However, in January of 2011, Obama reversed course on the provision and it was removed (New York Times, January 5, 2011).  This voluntary access to end of life counseling would not only save thousands of families from the years of heartache I observed, but would also save our Medicaid and Medicare system millions of dollars by no longer performing costly medical interventions that are being done against a patient’s  will.  Estimates show that 27% of Medicare’s annual budget goes to recipients in their last year of life.   

To understand why Obama did this we need to reflect back upon those chaotic days of when we were debating health care reform.  The misinformation, political grandstanding and lobbyists in Washington were abundant.  The volume was high and the noise was loud.  The ignorant fears that labeled these advanced directives as “Death Panels” flooded the news.  The opposition was willing to say anything for political gain.  Guess what?  It worked.

While the provision made it into the original legislation, Obama removed it soon after when the noise started going up again.  He caved to the political pressure at the expense of public health.  It’s been about 15 years since my days working with coma patients and their families and I think about them often.  These family members came loyally each day for decades to support their loved ones.  In the end, they were powerless.  This heartache would have been prevented if only these patients had access to “death panels”.