Ignoring nonsense, Medicare to cover 'advance care planning'

A family practice provider uses a stethoscope to examine a patient in an exam room. (Photo by Andrew Harrer/Bloomberg/Getty)
A family practice provider uses a stethoscope to examine a patient in an exam room.
As recently as two weeks ago, an actual member of Congress, Rep. Mo Brooks (R-Ala.), argued publicly that the Affordable Care Act has provisions that will decide "whether a group of people live or die."
The Alabama Republican added that for Americans with life-threatening ailments, "they're gonna tell you to get your affairs in order because they're not gonna provide coverage and you're gonna die."
All of this, in reality, was complete nonsense, but it served as a disheartening reminder that, even now, the "death panels" garbage persists in some far-right circles. Fortunately, Obama administration officials are ignoring ridiculous right-wing myths and moving forward with a sensible and responsible policy on end-of-life care.

Medicare said Wednesday it plans to pay doctors to counsel patients about end-of-life care, the same idea that sparked accusations of "death panels" and fanned a political furor around President Barack Obama's health care law six years ago. The policy change, to take effect Jan. 1, was tucked into a regulation on payments for doctors. It suggests that what many doctors regard as a common-sense option is no longer seen by the Obama administration as politically toxic. Counseling would be entirely voluntary for patients.

Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer, said yesterday, "Today's proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team, as part of coordinated, patient- and family-centered care."
And what's wrong with that? In reality, nothing. For some unhinged partisans, everything.
As we discussed in April, the irony is that end-of-life counseling was one of the more bipartisan elements of the entire reform initiative. The idea couldn't be simpler: doctors would be reimbursed through the Affordable Care Act for helping guide seniors through their end-of-life care options.
One of the idea's more notable champions was Sen. Johnny Isakson (R-Ga.) who explained back in 2010 that having advance directives or a living will "empowers you to be able to make decisions at a difficult time rather than having the government making them for you."
The right didn't care. A certain former half-term Alaska governor started throwing around the phrase "death panels"; some policymakers who knew better embraced the lie; and the worthwhile idea was quietly scrapped, chalking up a victory for mindless propaganda over sensible policymaking.
Now, however, officials are moving forward with the exact same idea. The NBC News report added, "Medicare is using a relatively new term for end-of-life counseling: advance care planning. That's meant to reflect expert advice that people should make their wishes known about end-of-life care at different stages of their lives.... The counseling aims to discern the type of treatment patients want in their last days, with options ranging from care that's more focused on comfort than extending life to all-out medical efforts to resuscitate a dying patient."
So far, I haven't seen much in the way of Republican apoplexy, which is a promising sign -- perhaps the madness fever has passed. Indeed, Republican presidential hopeful Jeb Bush has not only endorsed the idea, he's actually gone further than the Obama administration, suggesting advance care planning should be mandatory.
We'll know more about the possible political pushback soon enough, since yesterday's news marked the start of a 60-day public comment period. The goal is for CMS to finalize the Medicare rule by Nov. 1, and implement it on Jan. 1.