Remember the controversial provision of Obamacare that would have paid physicians extra money to provide “end-of-life counseling” to seniors whose conditions required expensive medical care? That feature of “reform” caused such a public outcry that the Democrats had to drop it from the final legislation. But the government apparatchiks didn’t give up. On Christmas Day, 2010, it came to light that the Centers for Medicare and Medicaid Services (CMS) planned to implement the program anyway. Within a week, however, vehement objections by clinicians and citizens alike forced the CMS bureaucrats to back off once more. Well, they’re at it again.
The New York Times reports, “Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association.” If CMS accedes to this “request,” many doctors will find it difficult to resist the resultant financial pressure to counsel gravely ill seniors concerning their “options.” Why? At present, Medicare doesn’t pay enough to cover the cost of an office visit to a family physician. But an additional payment for end-of-life counseling will render such visits marginally profitable, which will encourage doctors to inform Granny about the “pros and cons” of some treatment plan that might land her in Forest Lawn.
There are, of course, few “pros” associated with relocation to the local necropolis. So, what makes the Obama administration believe end-of-life counseling will be more acceptable now than it was four years ago? This time, it will use the vestigial prestige of the American Medical Association (AMA) for cover. The public believes the AMA is, as the Times puts it, “the country’s largest association of physicians and medical students.” In reality, it represents less than 20 percent of practicing physicians. The vast majority of the AMA’s income emanates from its government-granted monopoly on the Current Procedural Terminology (CPT) coding system.
CPT is the byzantine system used by Medicare and Medicaid to determine the values of, and payments for, the myriad medical procedures performed by doctors. And, as Dr. Hal Scherz pointed out when this alleged association of physicians and medical students was colluding with the White House during the Obamacare debate, the AMA’s copyright on this coding system creates a clear conflict of interest: “This monopoly generates income of $70 million to $100 million annually for the AMA. That makes the AMA less an association looking out for doctors and more a special-interest group beholden to Congress and the White House.”
Now, the AMA has created a CPT code for end-of-life counseling and recommended it for approval by CMS. When the latter inevitably includes it among the codes for which physicians may bill Medicare, end-of-life counseling will become a permanent feature of the clinical landscape—despite the objections of the public and the absence of any language authorizing it in the Patient Protection and Affordable Care Act (PPACA). And, when objections are once again raised, the Obama administration’s health care bureaucrats will claim that they are merely following the sagacious recommendations of the venerable American Medical Association.
What we have, then, is an alleged physician association with a transparent conflict of interest providing a convenient pretext for an administration that has long wanted to ration health care to the elderly. And that, if it’s not obvious, is where all this is going. President Obama and his minions at CMS believe the only way they can control Medicare spending is by denying health care to the most vulnerable of our citizens. Knowing that about 25 percent of Medicare’s annual budget is consumed by elderly patients during the last year of their lives, they believe the only way to save that money is find some way to get these seniors into their graves a year sooner.
How can they possibly know when a patient has crossed that threshold into the last year of her life? The obvious answer is that they can’t, except in a few cases involving extreme trauma, advanced cancer, etc. But such tragedies simply don’t occur frequently enough to enable the rationing ghouls to reduce Medicare spending by anything like 25 percent. The projected expenditure for the program in 2014 is about $512 billion, which means they have to deny care to the tune of $128 billion to hit the goal. The only way to get there is to impose some arbitrary method of determining how many “quality” years a patient will gain from a given treatment regimen.
Who would be authorized make that call in the age of Obamacare? Can you say “death panel”? No? Well, many advocates of Obamacare certainly have no problem saying it. As Newsbusters reported last year, Paul Krugman, one of the PPCA’s most prominent pimps, brought it up in a list of actions that will be required to control the national debt: “[W]e’re also going to have to make decisions about health care, doc pay for health care that has no demonstrated medical benefits … which I shouldn’t even say because it will get me in trouble is death panels….” Similar sentiments are expressed by those enthusiastic about Obamacare here, here, here, here, and elsewhere ad taedium.
The important thing to note here is that costs can be controlled without forcing doctors to “counsel” Granny concerning the high cost of keeping her alive for another year or two. There’s no need to make her feel guilty for breathing. It is, in reality, quite possible to utilize market forces to control Medicare costs. One very sensible plan for doing so has been put forward by Paul Ryan. A similar market-based approach was used with considerable success in the Medicare Part-D program. Unfortunately, market-based solutions are not popular with the president or the Democrats who control the Senate at present.
For them, “cost control” means government-imposed rationing of care to the elderly, and they want to force physicians to become co-conspirators in this process. There is only one way to stop them from imposing “end-of-life counseling” on the elderly—give them the bum’s rush in November.