Why “bend the cost curve” with end-of-life planning?

In any system that promises top-down control of medical care costs, the end effect will be rationing of services by artificial methods that get at least partly disconnected from the patient. The specific methods may be murky, but Charles Lane at the Washington Post has some questions about one section of the House version of ObamaCare. Section 1233 imposes a requirement for end-of-life planning sessions every five years for Medicare patients — and immediately after patient gets a terminal diagnosis. Lane wonders why that section gets dropped into a bill that purports to “bend the cost curve”:

Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they’re just trying to facilitate choice — even if patients opt for expensive life-prolonging care. I think they protest too much: If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.

What’s more, Section 1233 dictates, at some length, the content of the consultation. The doctor “shall” discuss “advanced care planning, including key questions and considerations, important steps, and suggested people to talk to”; “an explanation of . . . living wills and durable powers of attorney, and their uses” (even though these are legal, not medical, instruments); and “a list of national and State-specific resources to assist consumers and their families.” The doctor “shall” explain that Medicare pays for hospice care (hint, hint). …

Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party — the government — recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don’t have to be a right-wing wacko to question that approach.

Indeed.  While people should be able to access “end-of-life planning” when they desire, and having a living will is a good idea, it isn’t the role of government to push those ideas in a hard-sell approach.  It shouldn’t be the government’s business in any case, but this shows how getting the government involved in your health care reduces your privacy and your rights to individual choice.

These aren’t “death panels,” but they’re creepy nonetheless.   They’re sales presentations for surrender.   If HMOs required patients over 65 and with potentially life-threatening diagnoses to sit through presentations about how great hospice care and plug-pulling orders are, people would rightly scream about it from the rooftops.  And patients can change HMOs and insurers now, or opt to pay out of their own pocket; when government takes over health care, there will be nowhere to run.

And what happens when these sales presentations fail to get people to agree to die quickly for the greater good, and the projected cost savings do not appear?  How long will Section 1233 remain “voluntary,” even in name?

This is nothing other than an attempt to save money by convincing the sick and the elderly not to seek life-saving medical treatments.  In Barack Obama’s words, Section 1233 is where government says, “Maybe you’re better off not having the surgery, but taking painkillers.“  Monty Python had it just about right more than thirty years ago:

Update: Legal Insurrection in the Green Room has more on rationing care to the elderly and infirm.

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