Once more into the end-of-life breach

ONCE MORE INTO THE END-OF-LIFE BREACH…. The idea was once so obvious and uncontroversial that it enjoyed broad bipartisan support. As the proposal goes, doctors would be reimbursed for voluntarily speaking to Medicare patients about end-of-life care*.

The whole point of the idea was to ensure that these decisions are made by individuals in consultation with their doctors. As Sen. Johnny Isakson, a conservative Republican from Georgia, explained last year, having end-of-life directives or a living will “empowers you to be able to make decisions at a difficult time rather than having the government making them for you.”

But professional liars didn’t quite see it that way. This basic concept was inexplicably twisted into “death panels” — one of the single most idiotic policy arguments ever presented — and the reimbursement plans were scrapped from the health care reform proposal.

The problem, of course, is that the idea continues to have merit, and seniors and their families would still benefit. Americans shouldn’t suffer because unhinged conservatives successfully smeared a modest, sensible proposal.

So, the Obama administration is reviving the idea, achieving the same ends though regulatory means.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment. […]

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress.

The discouraging angle to this is that those who understand the policy are delighted to see the Obama administration do the right thing, but they’re reluctant to say so.

Rep. Earl Blumenauer (D-Ore.) said the regulatory policy will “give people more control over the care they receive,” but urged policy advocates to celebrate “a quiet victory.” Why? Because congressional Republicans might “try to use this small provision to perpetuate the ‘death panel’ myth.”

Indeed, in an email last month to people working on end-of-life care, Blumenauer specifically said, “We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ — e-mails can too easily be forwarded.”

I don’t blame Blumenauer at all, but his concerns are a reminder about how truly ridiculous our discourse has become. When positive developments occur, we’re not supposed to talk about it, because radical ideologues might seize the opportunity to lie to the country again.

* edited for clarity