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Death Panels: The Bad, the Ugly - and the Good

By Dr. Evan Saulino
. 2 Comment(s)

A year ago, Death Panels dominated the national conversation about health care reform. The idea turned many older voters against the Affordable Care Act, and even now 36% of seniors still believe they exist.

Designed to shoot fear in the hearts of Americans like a recurring bad dream, the Death Panel lie was started by a pundit, and perpetuated by politicians like John Boehner (R-OH).  Late last July he issued a statement saying, “an end-of-life counseling provision in the House bill may start us down a treacherous path toward government-encouraged euthanasia if enacted into law."

But things really got ugly after Sarah Palin’s Facebook Post, claiming the law would allow the government to deny health care for her baby with Down’s syndrome. 

The claim was then defended by Newt Gingrich, former Speaker of the House and possible Presidential candidate in 2012.

Senator Charles Grassley (R-IA) followed with, “We should not have a government program that determines if you’re going to pull the plug on Grandma.”

As a primary care doctor who has end-of-life conversations with patients all the time, I was astonished and disgusted that politicians would poison the sanctity of the doctor-patient relationship with partisanship.

Of course what was actually in the legislation was nothing like “pulling the plug on Grandma”.  The provision everyone was shouting about, co-sponsored by Rep. Earl Blumenauer (D-OR) and Rep. Charles Boustany (R-LA), simply would have allowed Medicare to pay for a conversation between you and your doctor about available choices at the end of life. 

As he described in a New York Times Op-Ed, Rep. Blumenauer introduced the legislation because he, “found it perverse that Medicare would pay for almost any medical procedure, yet not reimburse doctors for having a thoughtful conversation to prepare patients and families for the delicate, complex and emotionally demanding decisions surrounding the end of life.”

Everyone will die - that we know.

But how we will die, we don’t know. 

What is done to us, or for us at the end should be our choice.

But in order to make informed choices, we need to know what choices there are, and have time to discuss them with someone we trust.

An end-of-life conversation with our doctor is one way each of us can have some control over how we die.

I wish things were different, but the reality of the medical industrial complex today is that only things that make money are given time.  So if my important 30-minute conversation with an 85 year old woman and her family about what she wants from end-of-life care makes $0 for my clinic, it will receive ZERO minutes in my daily schedule. 

Of course, striving to be a good doctor, I try and do it anyway. But I, and the rest of my patients that day pay the price. And, sometimes I put off the conversation until the next visit, or the one after that…

The proposed legislation would simply have allowed the bean counters who have so much control in health care today to place some value on that critical conversation - which would in turn give doctors like me time to have it. 

It would have strengthened the doctor-patient relationship.

It seemed like a no-brainer. 

Naively, at the time, I was sure opponents of health care reform had overreached with their Death Panel paranoia. I was positive this was their Terri Schaivo moment and Americans would see through the insanity. I was wrong.

Bowing to political pressures, the proposal was left out of the final Affordable Care Act eventually signed into law in March, 2010. 

So where’s the good part?

Thankfully, Rep. Blumenauer has not backed down from the fight. 

He is reintroducing his proposal as The Personalize Your Care Act, again with bipartisan support.  He has garnered support from physicians, representatives from health care and senior groups, and from religious groups.

But it’s clear he’ll need a lot of help to pass the bill.  

Ultimately, what happens to this common-sense legislation may depend upon the November election, and whether Americans choose a Congress that promises to repeal the Affordable Care Act, or one that promises to build on and improve it.

Share Your Comments


  1. Chris Gates


    I wholeheartedly support Blumenhauer's latest proposal, and thank you Evan for posting this important piece of news.

    I, too, share your value about this kind of critical conversation, and the need for it to be submitted to Medicare for reimbursement.

  2. RedMango


    Very nice post!

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