The Right Prescription

Death Panel Siding

Suddenly, end of life care is back in vogue among Obamacare givers.

By 8.25.10

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Need to shut down comparative effectiveness now.

Suddenly end of life care is back in vogue.

Here's the New York Times explaining why:

In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared -- but they also lived nearly three months longer.

The findings, published online Wednesday by The New England Journal of Medicine, confirmed what palliative care specialists had long suspected. The study also, experts said, cast doubt on the decision to strike end-of-life provisions from the health care overhaul passed last year.

"It shows that palliative care is the opposite of all that rhetoric about 'death panels,' " said Dr. Diane E. Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine and co-author of an editorial in the journal accompanying the study. "It's not about killing Granny; it's about keeping Granny alive as long as possible -- with the best quality of life."

Here's what the study found and what the New York Times conveniently ignores: People with end stage lung cancer who were given palliative care at diagnosis -- and simultaneously with standard cancer care --

had a significantly better quality of life and significantly lower rates of depression than those who received only standard care.

They also lived longer -- median survival for patients in the simultaneous-care group was 11.6 months and in the standard-care group was 8.9 months (P = .02). This survival benefit of 2.7 months is similar to that achieved with standard chemotherapy regimens.

The New York Times skews the study to make it seem that palliative care was used instead of actual treatment of the disease and that it was therefore wrong to eliminate end of life counseling from Obamacare by calling it a death panel.

In fact, end of life counseling in the original version of Obamacare was not about "keeping Granny alive longer."

Section 1233 of the health-care bill drafted would have paid doctors to give Medicare patients end-of-life counseling "every five years -- or sooner if the patient gets a terminal diagnosis."

And the counseling was to include advanced care planning, including key questions and considerations, important steps, and suggested people to talk to about "living wills and durable powers of attorney, and their uses …a list of national and State-specific resources to assist consumers and their families." Not a word about living longer. To suggest now that's what Democrats meant is absurd: If spending more money to let Granny live longer after a terminal diagnosis was the goal, why keep reminding people every five years about "living wills"?

Because it's a way of telling seniors as they get older that living longer is not very valuable. Here's Victor Fuchs, an Obamacare advocate, economist, and long-time consultant to Donald Berwick and Obama's health policy adviser Ezekiel Emanuel, on technologies that extend life:

..further gains in life expectancy will mostly mean keeping more Americans alive while they are retired and dependent on indirect transfers of funds from younger workers for much of their living expenses, health care, and social services.

Because keeping people alive longer is so…wasteful, Fuchs suggests government discourage "innovations that increase life expectancy" in favor of "innovations, such as joint replacement, that improve the quality of life for both the elderly and the near-elderly."

This is ideology masquerading as science. In fact, advances that improve quality of life also tend to improve survival, especially when it comes to diseases associated with aging. And it winds up reducing or slowing the cost of treatment. Since 1996, the average per patient costs for cancer, heart disease, and mental illness have declined in inflation adjusted dollars. And life expectancy continues to increase as well.

But that's not good enough for Fuchs, Berwick, and others. And just because end of life counseling is gone, Obamacare has other tools to shorten life. Hospice care is being cut under Medicare. Another way to shorten life is to have the government not pay for any new technology that doesn't meet this goal. Still another is not to count spending on such innovations when determining if a health plan spent the federally required 80-85 percent of its premiums on medical care.

Steering people to use fewer life-extending innovations based on what the government thinks is valuable is the defining function of Obamacare. As Fuchs states: the government should only pay for "innovations whose main effect is to substantially decrease cost while holding quality constant or reducing it only slightly." The combination of palliative and standard care for end stage lung cancer patients would not meet that government set criterion.

Reduce quality and discourage people from living longer? Maybe the term "Death Panels" isn't so inaccurate after all.

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About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.