But to Gawande, it’s not enough that other hospitals adopt such procedures on their own. A provision in Obamacare was to provide government funding for doctors to have end-of-life discussions with their patients; to Gawande’s dismay, “it was deemed funding for ‘death panels’ and stripped out of the legislation.” The obvious question doesn’t seem to occur to him: Why do we need a government program to pay doctors to have thoughtful conversations about their patients’ eschatological desires — something they should be doing already, and that doesn’t cost a dime?
Amazingly enough, there are ways to improve the quality of end-of-life care in America that don’t involve a government program. Gawande knows this, for he writes compellingly and often about the successes of people like the doctors in La Crosse.
But it is a constant struggle for Gawande to see what is in front of his nose: that such improvements come not from Olympian government officials, throwing lengthy pronouncements down from D.C. office buildings, but from the accumulation of thousands of small innovations by individual doctors, nurses, and administrators.
One of the great slanders of the last year was that conservative opposition to Obamacare’s end-of-life provisions was demagogic and dishonest. It is true that we often try too hard to extend life at times when it is futile to do so. It is true that, thanks to unwise government policy, we often expect care we don’t need, because we are insulated from its price.
There are legislative reforms that can help address these problems. But they involve reducing, not expanding, government control of the health-care system. They involve letting patients decide for themselves, with the aid of their doctors and their families, how best to negotiate their last days on earth. If a free country can’t be about that, it can’t be about much.
– Avik Roy is an equity research analyst at Monness, Crespi, Hardt & Co., and blogs on health-care policy at The Apothecary.