Critical Condition

Even If It’s Not a ‘Death Panel,’ It Doesn’t Belong in Medicare

Lots of hullabaloo over Sarah Palin accusing the president of establishing a “death panel” to knock off handicapped kids and elderly folks. So, I thought I’d take a gander at the bill myself. What she’s talking about is the proposal for Medicare to cover Advance Planning Directives every five years. As Jonathan Cohn pointed out to Stephen Colbert, his own show’s group policy has the same benefit.

But even if we don’t go off the deep end with the “death panel” rhetoric, there’s still a fundamental problem with this, which gets to the core of why health insurance is so expensive: There is no reason for a health insurer to pay for such counselling. It’s a service you choose to use, not a risk.

The bill shows why: It directs the secretary to establish guidelines for “quality” in the counselling sessions and figure out how much to pay a physician for each counselling session. The day after this bill passes, the physicians will be interviewing lobbyists who can demonstrate an expertise in increasing the Medicare payments for these counselling sessions. There will be public-awareness campaigns to “educate” Americans about the tragic lack of counselling that seniors (don’t) receive, and urgent prompts to “call your legislator” to stop any rollback of payments for end-of-life counselling.

Covering end-of-life counselling sessions is only marginally less silly for private insurance: Insurers still have to process the claims (while identifying and eliminating fraudulent ones), credential providers whose “quality” of counselling they cannot possibly observe, and perhaps pay for a second opinion if patients don’t like their first counselling session! These costs go straight onto premiums.

Furthermore, this is a very intimate issue, into which no third-party payer should be sticking its nose. If you want an end-of-life counselling session you should either get it for free (from your church, for example), or directly pay a professional planner to advise you. Having health insurance cover end-of-life counseling is like having car insurance covering someone to advise you on whether you should buy a Toyota or a Chevy after you’ve totalled your old wheels.

— John R. Graham is director of Health Care Studies at the Pacific Research Institute.

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