Death Panels: What Are They?

With some of the hoopla over the "death panels," for lack of a better word, dying, and concentrations slowly moving away to other aspects of the health care reform bill, I'm trying to figure out what exactly have we been arguing about? What are the "death panels", formally known as End-Of-Life counseling, and why all the commotion around it?

Betsy McCaughey, former lieutenant governor of New York state and current chairman of the Committee to Reduce Infection Deaths, told Fred Thompson on his radio program, on July 16th , 2009 that, "Congress would make it mandatory - absolutely require - that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner."

She explained that the end-of-life counseling sessions were a way for the government to convince the elderly to, "decline nutrition...decline being hydrated...go into hospice care ... all to do what's in society's best interest or in your family's best interest and cut your life short."

Radio talk show host Rush Limbaugh reiterated McCaughey's remarks on his show, on July 21st, 2009, "Mandatory counseling for all seniors at a minimum of every five years, more often if the seasoned citizen is sick or in a nursing home. ... That's an invasion of the right to privacy. We can't have counseling for mothers who are thinking of terminating their pregnancy, but we can go in there and counsel people about to die."

So by these two descriptions the end-of-life counseling is a way for the government to convince the elderly into giving up care.

McCaughey stated that on page 425 of the reform plan handed down by the Democrats clearly confirms what she was saying.

Page 425, Section 1233 of the bill is labeled "Advance Care Planning Consultation". It explains that Medicare will cover the costs of end-of-life counseling. Here is the direct quote from the bill:

"such consultation shall include the following: An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to; an explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses; an explanation by the practitioner of the role and responsibilities of a health care proxy."

Medicare will cover one session every five years. If a patient becomes very ill in the interim, Medicare will cover additional sessions.

In a very public statement made on Facebook by former Governor of Alaska Sarah Palin, the program once being called end-of-life counseling was now popularly renamed "Death Panels". And the Dems' reform plan was criticized for using the guise of counseling as a cover-up for the government's true intent of trying to deny the elderly care.

The notion of death panels has terrible imagery attached to it. One can almost envision a committee of shadowy characters coldly sending down decisions of who may live and who will be denied healthcare for the sakes of a balanced budget.

In town hall meetings across the nation Congressmen were screamed at and debated by fearful citizens. These citizens were outraged at such a possibility. Was this how Obama was intending on keeping costs low?

This fear or anger at the system was then fuelled by some in the media and politics that repeated the accusations and suggestions made by Limbaugh and McCaughey, and adding to the allegations new fear of euthanasia and Eugenics.

Coupling the Death Panel fears with the birther movement, economic woes, the fear of the disappearance of the rural lifestyle and low confidence in the government has made a very mundane topic health care into a topic more divisive and important than perhaps the Iraq War and President Bush's presidency.

And while the nation has been concentrating on Section 1233 of the bill, many are missing out on learning about the rest of the 1100 pages.

So to set the record straight, what is end-of-life counseling?

According to the bill itself, it is advise on who to talk to for decision making, options on the type of care, options on advance directives and their uses (things like living wills and power of attorneys: meaning people that can voice your opinions for you if you end up being in a situation where you can not communicate your wishes).

End-of-life counseling is something that was endorsed by Palin while announcing "Healthcare Decision Day" when she was still Governor of Alaska on April 16th, 2008.

Here are excerpts from her proclamation:

"WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. [...]

WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaska's citizens with advance directives.

WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives."

On July 2, 2009, just the beginning of last month, Newt Gingrich wrote in a column in the Health Care Reform section of The Washington Post:

"More than 20 percent of all Medicare spending occurs in the last two months of life. Gundersen Lutheran Health System in La Crosse, Wisconsin has developed a successful end-of-life, best practice that combines: 1) community-wide advance care planning, where 90 percent of patients have advance directives; 2) hospice and palliative care; and 3) coordination of services through an electronic medical record. The Gundersen approach empowers patients and families to control and direct their care. The Dartmouth Health Atlas has documented that Gundersen delivers care at a 30 percent lower rate than the national average ($18,359 versus $25,860). If Gundersen's approach was used to care for the approximately 4.5 million Medicare beneficiaries who die every year, Medicare could save more than $33 billion a year."

A few months before this the former Speaker of the House had this to say about the same hospital to PBS:

"They have an advanced directive program, and over 90 percent of their patients have an advanced directive. They have electronic health records, so everybody on the staff knows what the advanced directive is. They have a very strong palliative care program for using drugs to manage pain. They have a hospice program.

The result is today, the last two years of your life in costs are about $13,600. The last two years of your life at UCLA are $58,000. Now, why should Medicare pay $58,000 for the same outcome if it could pay $13,600? You can say, well, Los Angeles is more expensive; they do a couple of more complicated things. So fine. So let's say it ought to be $20,000 at UCLA. That's still [$38,000] less than it currently is. ...

We don't think the politicians can ever fix this because the hospital lobby is so powerful, and the doctor lobby is so powerful, and the pharmaceutical lobby is so powerful, and the medical technology lobby is so powerful...

And we also know - this is the great irony - the best places in America are always less expensive than the worst places. Health is not like jewelry and automobiles. In jewelry and automobiles you pay a lot more to get a lot better. In health, because the best places do it right the first time, they do it very efficiently, they pay real attention to quality, they're actually less expensive than the places that are bad."

In 2003, The Congress passed a Medicare prescription drug bill. This bill was passed with the vote of 203 GOP House of Representative members and 42 GOP Senators. This is an excerpt from that bill:

"The covered services are: evaluating the beneficiary's need for pain and symptom management, including the individual's need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning. Payment for such services equals the amount established for similar services under the physician fee schedule, excluding the practice expense component. The provision would apply to consultation services provided by a hospice program on or after January 1, 2005."

Up until recently, the Republicans did not have any complaints against advance directives, also known as end-of-life-counseling and Death Panels. Nor did they have a problem with the government paying for the counseling through Medicare.

Jim Dau, a spokesman for the AARP, a group that represent people over fifty years of age, called the accusations made by McCaughey, Limbaugh, Palin and Gingrich (after they had decided to use the death panels as a way of attacking the reform plan), as cruel and untrue.

"We want to make sure people are making the right decision," Dau said to St. Petersburg Times, "If some one wants to take every life-saving measure, that's their call. Others will decide it's not worth going through this trauma."

Dau wants to make clear that these sessions would not be mandatory, "The only thing mandatory is that Medicare will have to pay for the counseling."

So what are some of the medical procedures an elderly person might want to opt out of going through?

Richard Dooling, a former respiratory therapist who has written an Op-Ed piece in the New York Times, was asked by Rebecca Roberts of that on NPR's Talk of the Nation. This is from the transcript of that show:

"Well, before we have ventilators, an elderly person, let's say in they're 90s, they have pneumonia. If you read Sherwin Newland's "How We Die," it was a great description of this, used to take about three days because your lungs were filled up with fluid, you would slowly go to sleep. In the last two days, you would be unconscious, and then you would die.

Nowadays, you get pneumonia, you're 90 years old, and the question becomes, should we put you on a ventilator?

Now, I'm not saying nobody should go on a ventilator, but I'm saying when you do go on the ventilator and you don't get off, then it takes you three, four, five months to die. The whole time you're being stuck with needles, you're being turned, you're acquiring bedsores. You can't talk because you're intubated. The intubation tube goes in between your vocal chords into your trachea. And, of course, you feel like you're chocking the whole time, so you want to pull that tube out. So what do they do? They tie your hands down to make sure that you can't pull that tube out.

So, if you're going to that situation without having some end-of-life counseling, which everyone is hysterically referring to now as a death panel, you go in there with no information, it's basically too late. You're in no condition to express your wishes, which may be, please, just get these machines out of here and let me go to sleep."

He then describes what it is like to be in situations some would want to avoid:

"If people could see a videotape of what it is like to spend the last two, three months of your life receiving mechanical ventilation, kidney dialysis, being turned, what do bedsores look like and so on, you would have a lot more discretion. You would have a lot more people saying to themselves, gee, I didn't know that life ended like this. It's a mess. It's never pretty."

So what are the Death Panels? They are a figment of your imagination. What is end-of-life counseling? It is the kind of information one receives to deal with situations described by Dooling above. So why the heated debate over end-of-life counseling? The right-wing decided it was something it could use to attack the Dems' healthcare reform plan, which broke the camel's back on the right side of the political spectrum.