End-of-Life Counseling Returns, But Death Panels Still Nonsense

A proposed program to cover counseling sessions for seniors on end-of-life care has risen from the ashes of health care reform and found a new life in Medicare regulations, Jason Hancock of the American Independent reports.

In August, former Alaska governor Sarah Palin started a rumor via her Facebook page that the the Obama administration was backing “death panels” that would vote on whether the elderly and infirm had a right to live. In reality, the goal was to have Medicare reimburse doctors for teaching patients how to set up their own advance directives that reflect their wishes on end-of-life care.

Patients can use their advance directives to stipulate their wishes for treatment in the event that they are too sick to make decisions for themselves. They can also use those directives to demand the most aggressive lifesaving interventions.

Waste not, want not

Though end-of-life counseling was ultimately gutted from the Affordable Care Act (ACA), the legislation will eventually ensure health coverage for 32 million more Americans. However, Joanne Kenen in The American Prospect argues it will do comparatively less to curb the high costs of health care. The architects of the ACA had an opportunity to include serious cost-containment measures like a robust public health insurance option to compete with private insurers, but they declined to do so.

Kenen argues that the government should more aggressively target waste within the health care delivery system, especially Medicare and Medicaid. Unchecked and rising health care costs through Medicare and Medicaid are a significantly greater driver of the deficit than Social Security or discretionary spending:

“The waste is enormous,” says Harvard health care economist David Cutler. “You can easily convince yourself that there is 40 to 50 percent to be saved.” Squeezing out every single bit of that inefficient or unnecessary care may not be realistic. But it also isn’t necessary; eliminating even a small fraction of the current waste each year over the next decade would make a huge difference, he added. Health care would finally start acting like “a normal industry.” Productivity would grow, in the one area of the economy where it has not, and with productivity gains, prices could be expected to fall.

The new end-of-life counseling program will help reduce waste in the system, not by pressuring people to forgo treatments they want, but by giving them the tools to refuse treatments they don’t want.

Teen births down, but why?

The teen birth rate has dropped again, according to the latest CDC statistics. Births to women under the age of 20 declined by 6% in 2009 compared to 2008. One hypothesis is that the reduction is an unexpected consequence of the recession, an argument we pointed to in last week’s edition of the Pulse. John Tomasic of the Colorado Independent is skeptical of the recession hypothesis. He writes:

Emily Bridges, director of public information services at Advocates for Youth, agrees with other observers in pointing out that teens aren’t likely to include national economics as a significant factor in pondering whether or not to have unprotected sex. Peer pressure, badly mixed booze, general awkwardness, for example, are much more likely than the jobless recovery to play on the minds of horny high schoolers.

Some states with weak economies actually saw a rise in teen birth rates, Tomasic notes. However, this year’s sharp downturn in teen births parallels a drop in fertility for U.S. women of all ages, which seems best explained by economic uncertainty.

It’s true that prospective teen moms are less likely to have jobs in the first place, and so a bad job market might be less likely to sway their decisions. However, young women who aren’t working are unlikely to have significant resources of their own to draw on, which means that they are heavily dependent upon others for support. If their families and partners are already struggling to make ends meet, then the prospect of another mouth to feed may seem even less appealing than usual.

Abortion is the elephant in the room in this discussion. The CDC numbers only count live births. Logically, fewer live births must be the result of fewer conceptions and/or more terminations. Some skeptics doubt that economic factors have much to do with teens’ decisions about contraception. However, it seems plausible that decisions about abortion would be heavily influenced by the economic health of the whole extended family.

Last year’s decrease was notably sharp, but teen birth rates have been declining steadily for the last 20 years. The Guttmacher Institute, a New York-based non-profit that specializes in research on reproductive choice and health, suggests that successive generations of teens are simply getting savvier about contraception. Births to mothers between the ages of 15 and 17 are down 48% from 1991 levels, and births to mothers ages 18 to 19 are down 30%.

Stupid drug dealer tricks

Martha Rosenberg of AlterNet describes 15 classic dirty tricks deployed by Big Pharma to push drugs. These include phony grassroots patient groups organized by the drug companies to lobby for approval of dubious remedies. Another favorite money-making strategy is to overcharge Medicare and Medicaid. Pharmaceutical companies have paid nearly $15 billion in wrongdoing settlements related to Medicare and Medicaid chicanery over the last five years.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint.

Photo credit: wikimedia commons
by Lindsay Beyerstein, Media Consortium blogger


Martha Eberle
Martha Eberle6 years ago

I'm an R.N. The first thing that is asked of a patient, entering a hospital, during the history-taking, is "do you have Advanced Directives"? This is to ensure that procedures are not done to patients who do not want them done. There is nothing worse than to force a patient to undergo procedures that are against their wishes. Many do not understand that they have the right to determine their treatment. EVERYONE HAS THE RIGHT TO LIVE AND DIE ACCORDING TO THEIR OWN WISHES. We need education of people, not scare tactics about death panels for political, not humanitarian, reasons, which is exactly what Palin did to the American discourse. Shameful.

I know that when it is time for my body to die, I do not want to be "kept alive" on a ventilator. That is not life, but only keeping the heart and lungs going. People need to know this.

Petra Luna
Petra Luna7 years ago

It's a confusing process. But it's to put the end of life decision into the hands of the individual, not the family or doctor.

Ernie Miller
william Miller7 years ago

End of life planning is nothing more that a person taking responsibility for their life when they are either to sick to do it or after they have already died. it is the process of making lifing wills and wills to dispose of their belongings and debts. it is taking the hurtfull process of arranding their final preperations into their own hands instead of forcing it on the hurting souls they loved and cherished.

As far as ins and organ donations there are very few viable organs available and they need to be matched to the bodies that will respond in the most positive ways. And i am sure you dont want to hear my personal beliefs of health care. Just because science knows how to do something dont mean they should.

Marcie Hutch
Marcie Hutch7 years ago

With the trend our country is taking,seriosly,do you actually believe that isn't coming? Wake up and smell the coffee people the human race and politics in general are not that decent. We have become a race of death dealers;a serious step back into the old days when the old were left behind when they couldn't keep up. God forbid they effect our precious economy,or worse yet, curtail our next vacation.

Marcie Hutch
Marcie Hutch7 years ago

With the trend our country is taking,seriosly,do you actually believe that isn't coming? Wake up and smell the coffee people the human race and politics in general are not that decent. We have become a race of death dealers;a serious step back into the old days when the old were left behind when they couldn't keep up. God forbid they effect our precious economy,or worse yet, curtail our next vacation.

Kathleen D.
Kathleen D7 years ago

It would indeed be a horrible atrocity if healtcare professionals were able to just "pull the plug" but that is not the case. While I am sure, because we, on occasion do hear of cases of this happening, professionals adhere to the wishes of the individual or family members. I've personally known of cases where the spouse has carried out the wishes of their loved one through the hospital, not to resuscitate, only to be shunned by other relatives and friends. This is horrible and disrespectful of the deceased.

I believe respect along with honoring those who are to pass before us, and holding to the trust the person has placed in us who has given directives, is the greatest gift we can give our loved one.

As Alan Grayson so aptly expressed it, the attitude of the Republican politicians ; "don't get sick and if you do get sick, die quickly". We desperately need single payer healthcare in this country to insure all humans receive the care they need. Apathy needs to be replaced with respect.

Barbara Erdman
Barbara Erdman7 years ago


Walter Firth
Walter Firth7 years ago

Each person has a right to chose when he lives and when he dies. But no one has the right to make that decision for that person.Only souless creatures like Hitler impose compulsory euthanasia on the sick and infirm as he did in Germany.

Christine S.
Christine S7 years ago

Think about all the insurance companies who have denied people life saving organ transplants or medicines because it would "cost too much"? Don't blame the democrats for death squads, the insurance companies are already there!

Pamela H.
Pamela H7 years ago

The tea party people believe that everyone should be forced to live and suffer for as long as possible; that is unless one of their loaded juries put you on death row, then it's ok to execute you, preferably in a painful and humiliating manner.