*Catastrophic Care*: Chapter 5 (death panels)

I was disappointed to read the following in Chapter 5 of David Goldhill’s Catastrophic Care (emphasis added).

The furor over supposed “death panels” during the ACA debate demonstrated how emotionally charged this issue already is. On the one hand, as health care enables us to keep more—maybe even most—patients alive long beyond when real recovery is possible, doesn’t Medicare have to impose some restrictions on end-of-life care? But on the other, do we really want Medicare to determine when to pull the plug?

Having raised the death panel debate, shouldn’t Goldhill accurately describe what it was? His use of “supposed” above indicates that he knows it wasn’t what he makes it seem to have been. It was not a debate of, on the one hand, the attempt by “Medicare to impose some restrictions on end-of-life care” and, on the other, the rejection of the idea that Medicare should “determine when to pull the plug.” Nobody on either side of the debate thought that Medicare should do such a thing. The debate, if anything, was between people spouting absolute nonsense and others correcting the record.

Having mislead the reader as to the nature of the debate from the start, I had hoped Goldhill would patch things up later. So let’s read a bit further.

I don’t believe we’ll find a politically acceptable solution to the end-of-life conundrum when it’s expressed this way. None of us want the government deciding when to end the life of a loved one, and none of us want to pay unlimited amounts for some other person’s “hopeless” treatment.

Right. But “the government” never expressed a desire for such a thing. A reader unfamiliar with the entirety of the death panel debate, particularly, say, a student reading the book a few years from now, might not know that. Here are the basic facts, with links to more: The death panel charge was purported to relate to Section 1233 of the House Bill HR 3200, entitled “Advance Care Planning Consultation.” In fact, neither that section nor anything in any health reform bill at the time included anything that was or would lead to euthanasia of Medicare beneficiaries. A timeline of the death panel falsehood documents its spread from a July 2009 claim by Betsy McCaughey on Fred Thompson’s radio show to a Sarah Palin Facebook post and beyond. The idea that death panels or anything like them were ever in a health reform bill is undeniably false, and that fact has been explained manymanymany times. But not by Goldhill.

Further on:

Medicare is incapable of functioning according to patient preference. The idea of health care being a want—even a serious want—rather than a need is completely foreign. But with end-of-life care, there can be no disguise—fundamentally, it’s all about wants. Since Medicare structurally can’t accept that there is no one correct medical answer to the question of how much end-of-life care any single person gets, it has accidentally committed assault on our seniors by pretending there is one. The result is that our seniors are getting a lot of end-of-life care today, much of which is in excess of their wishes and ignores their best interest or comfort. Several studies have shown that many physicians rarely discuss preferences with their seriously ill patients and that many patients who express a strong desire to die at home wind up dying in a hospital. […]

Do we really prefer for our government through Medicare to make these decisions for us? Do we as a society really believe that a central decision maker can honor the range of individual beliefs and preferences inherent in how we die?

I agree there are problems with Medicare. Some of the basic issues Goldhill raises are legitimate, though I’d say Medicare’s problems are inherent in American health care. They’re shared by Medicare and private insurers alike. Singling out Medicare as the sole source of evil is a stretch. Moreover, we don’t have to pretend there was a debate about whether Medicare should euthanize seniors or that the program forces over-treatment on them.

Nevertheless, I understand that Goldhill wants options to be clearer to seniors. Hey, here’s an idea: Maybe we ought to help seniors pay for assistance in establishing end-of-life plans so that they end their days as they wish. Though the offending “death panel” provision — to pay doctors whose Medicare patients voluntarily wished to be advised on end-of-life planning more consistent with their values and wishes — was dropped from the House health reform bill, it was effectively reinstated through a regulatory process. This too was not mentioned in the chapter.

UPDATE: As addressed in the comments, I have removed any claim that Goldhill intended to mislead the reader about the death panel debate. I maintain that, nevertheless, there is a high risk that he has done so.


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