• Media watch: The New York Times blows it on “death panels”

    In the The New York Times today, under Reed Abelson’s byline, you’ll find what I characterized on Twitter as a worthwhile but unfocused piece. It’s mainly about how the new health care marketplaces can provide coverage that will help early retirees bridge the gap between employer-sponsored insurance and Medicare. That’s a worthwhile subject and Abelson covers it skillfully.

    But then comes the unfocused bit:

    At contentious town hall meetings held by lawmakers before the law’s passage, critics also claimed that “death panels” would sharply limit care at the end of life. But the focus of the ire of many, the Independent Payment Advisory Board, a government body created to try to control costs, has yet to get off the ground. Many lawmakers still seek to eliminate the board altogether.

    “Death panels”? Seriously? Give me a break!

    Why are “death panels” even in this article? Perhaps those approaching the age of Medicare eligibility might be worried that the law includes them. Maybe they heard as much from some politician or pundit. Maybe they’re wondering if the law will help them get insurance or whether it will, instead, authorize government bureaucrats to decide whether they are deserving of care.

    So, perhaps they’re confused. And, now they’ve turned to the The New York Times for the truth!

    If that’s why death panels are in the article, shouldn’t the article help the reader come to a conclusion about that truth? Yes it should but, BREAKING, It doesn’t.

    Critics claim that “death panels” will deny care. So what? The reform’s critics claim a lot of false and stupid things, as do its advocates. How about sorting out what’s fact and what’s fiction? How about pointing out that the law authorizes no such thing as a “death panel”? How about pointing out that this whopper was the lie of the year? The piece does include a summary of changes to Medicare, and the addition of “death panels” is not among them. But I think if you’re going to raise a claim of “death panels” you have an obligation to call it what it is: bulls*#t.

    Another reason “death panels” may be in the piece is to illustrate “balance.” Go ahead and insert your favorite false equivalency rant. I don’t have one in me. We all know this game.

    But “death panels” are not necessary, even for false equivalence. The piece already lays out the benefits and limitations of various aspects of the law. I read it as quite reasonably “balanced” — as defensible “true equivalence” — until I hit the “death panel” paragraph, that is.

    Apparently the “death panels” meme won’t die. We can thank the The New York Times for helping to keep this zombie alive … or undead … or whatever.


    • It is not going to go away. It is firmly inserted into the national psyche. What you need to remember is that many people want to believe it is true. I remember having a back and forth with Avik Roy on this topic at his old site. In an effort to prove that death panels were a real issue be brought up literature from the VA, IIRC, from some years ago on end of life issues. Nothing to do with the IPAB, just an effort to reach and find something that could be twisted to support the belief.


    • Calling the characterization of IPAB as a “death panel” as the “lie of the year” said more about the folks at the Tampa Bay Times than about the legitimacy of concerns about IPAB.

    • Hmm. I read the inclusion of death panels as intentionally raised as another example of hyperbole. Death panels blew a good idea (end of life counseling) so far out of context as to completely distort its purpose. The opposition to the IPAB is along the same lines. At least, that is why I thought they brought it up.

      The IPAB may not do anything to help control costs, and might create confusion and distortions, but I find it hard to see it as a major threat. It is yet another centralized solution based on an assumption that we really know enough about the value of essentially everything physicians do to create a comprehensive pricing without benefit of the market.

    • Calling it a “death panel” may be a bit of overwrought hyperbole, but does anyone doubt that cutting payments to doctors and hospitals (which is the only tool in the IPAB toolbox) won’t lead to reduced access to care, and that this will lead to poorer health outcomes for some people?

      And while there are some self-pay options for Medicare beneficiaries so they can get the care they might otherwise be denied or have to wait an unnacceptably long time for, they are fewer than those available to non-Medicare recipients due to prohibitions on doctors getting paid directly by one Medicare patient while being paid by Medicare for other patients.

      • Yes, I can see plenty of places where cuts to Medicare won’t end up harming patients. I have a bunch of relatives in their 80s who underwent operations to enhance mobility. They were slow to recover because recovery is slow in the 80s, in the process losing some mobility from the enforced post-surgical immobilization. I’m not sure how many of them will end up with significantly better mobility than before their operations.

        I’d bet there are whole classes of procedures on certain groups (like the older cohort) that aren’t worth doing. And yes, people are going to scream that the Gov’t is preventing them from dancing again, when it is really preventing them from being oversold a serious medical procedure with uncertain outcomes.

      • Is the answer then to just keep paying more to doctors and hospitals?


      • Sean Parnell says:

        “And while there are some self-pay options for Medicare beneficiaries so they can get the care they might otherwise be denied or have to wait an unnacceptably long time for… , they are fewer than those available to non-Medicare recipients due to prohibitions on doctors getting paid directly by one Medicare patient while being paid by Medicare for other patients.”

        This comment is interesting in multiple dimensions.

        I wonder in what way are there “SOME self pay options for Medicare beneficiaries?” I am guessing some is the wrong word. A Medicare beneficiary can come to any agreement with a doctor on costs and payment terms for ALL services Medicare does not cover (for example, an annual physical or a nose job). Is that what you mean by denied? On the other hand, I would think that a doctor withholding a Medicare-covered service for an “unacceptablly long time” — for any reason but particularly to get a bribe to change the schedule — would get some attention from the licensing authorities.

        The whole phrase about prohibitions seems equally confusing but perhaps you do mean “denied” in the sense that a Part C Medicare health plan needs to pre-approve some procedures (e.g., a cataract surgery, more days in a SNF than otherwise allowed by the policy).

        I have a lot of experience with Medicare — personal and as a SHIP volunteer — and what is described here would be very rare if it is even OK for a doctor accepting assignment in Medicare.

        • My reference to some options for Medicare recipients as self-pay patients was about going to see a doctor that doesn’t accept Medicare at all, and simply charges a real price for treatment to be paid by the patient. Unfortunately cash-only doctors tend to be more in the primary-care end of things rather than specialists, and of course as we age our care needs become somewhat more serious and we’re more likely to need to see specialists. So finding a cash-only doctor isn’t all that difficult for a younger person needing primary care, but is more challenging for an older person seeking specialty care. This is the sort of thing I write about at my blog, FYI – http://theselfpaypatient.com/ if you’re interested.

          As for being denied care or long waits, there may be a difference of opinion here, but it’s my belief that IPAB will wind up effectively limiting access to care – imposing price controls leads to a shortage of supply, as any economist can tell you (also, any Venezuelan). Among the wild-eyed radical libertarians who subscribe to this notion is Dr. Howard Dean http://online.wsj.com/article/SB10001424127887324110404578628542498014414.htmll.

          • @ Sean Parnell

            I agree that the miniscule number of doctors (as a percent of total) that do not provide services to anyone on Medicare can do anything they want and a patient on Medicare can make any arrangement he or she wants with that doctor. (The doctor will make the Medicare patient sign a private contract that he or she the Medicare patient understands that he or she the doctor doesn’t accept Medicare.) I find just the opposite trend however; that it is the specialists that make up this miniscule group, not the GPs.

            But I still don’t get the second half of your second paragraph, the one about prohibitions about one Medicare patient being covered through the local B or C insurance company and another Medicare patient self paying. In that situation, whether the doctor accepts assignment or is non-participating, he or she is in the Medicare system and must follow Medicare rules.

            • I’m speaking of the cash-only doctors specifically, which are definitely clustered within the primary care community, not specialties. And many of them do “provide services” to people on Medicare, it’s just that they don’t accept Medicare for payment, only cash (or check/credit card/etc) from the patient.

              As for the second part of the second paragraph, I’m specifically referring to the rule that generally says, if a doctor accepts Medicare for payment from a single patient, they cannot allow any patient to pay out-of-pocket for a covered service. Here’s a pretty good summary of the issue, tied in with balance billing: http://www.medscape.com/viewarticle/742271

    • This is more inane than the NYT piece.

    • I sit on the ethics committee for a non-profit hospital. At the request of the hospital CEO, corporate board and finance office, we have recently been discussing limits on cancer care for uninsured individuals. Would we provide a liver transplant to an uninsured person with newly diagnosed, non-metastasized liver cancer? Will we allow charity care for certain courses of chemo therapy? I am fairly sure this hospital is not alone in having these conversations, more frequently perhaps at the finance committee.

      There are death panels. I sit on one. It’s a death panel for poor people.

      • It’s also a “death panel” operated by private industry, in the interests of financial gain.

      • If there is a death sentence it was made by those that set a system that required the patients more money than they have. And its motivation is very clear: “no money no treatment”, not a “we can’t do anything good for that patient”