Antichoice at the End of Life.
Last week a regulation to provide Medicare coverage for advance care planning counseling—that is, offer reimbursement to doctors for time spent talking to patients about end-of-life care— was abandoned… for the second time.
Section 1233 of the Patient Protection and Affordable Care Act (PPACA) died a first death in the summer of 2009 in the debate over healthcare reform, during which healthcare opponents characterized the provision as a call for government-run "death panels." Former Lieutenant Governor of New York State Betsy McCaughey, who consulted with Philip Morris while working on the hit piece against the Clinton healthcare plan " No Exit," coined the "death panel" moniker; Sarah Palin popularized it. Then John Boehner, at the time the House minority leader, claimed that the provision would lead the country down "a treacherous path toward government-encouraged euthanasia." Fox & Friends repeated the "death panel" meme dozens of times, and soon, the provision was stripped from the healthcare bill. But last November, the Obama administration quietly inserted it into Medicare's annual regulations—after the customary public review period. The New York Times's Robert Pear broke the news on Christmas Day that end-of-life counseling was to be covered by Medicare. Immediately, right-wing think tanks, some with legal cases against the healthcare bill, leveraged the "death panel" rhetoric to bolster their arguments. While "prolife" blogs spread the news alongside accusations that the regulation would further endanger the "sanctity of life," much of mainstream media pushed back at reemergence of what Politifact called "the biggest lie of 2009." On Fox, guest host Tucker Carlson said that the regulation would convince Americans to "forego aggressive life-sustaining treatment," but was challenged by another correspondent. Nonetheless, the Obama administration, blaming procedural irregularities, dropped the regulation only three days after it went into effect, but it's clear political considerations played a role.
Opponents of the healthcare bill got the White House running scared by spreading the "death panel" meme from conservative legal groups to Fox to right-wing blogs and back again, both after the Affordable Care Act passed and after Christmas. But they weren't building a messaging chain from scratch. Instead, they worked the same network that has been mobilized since the 1970s to fight legal abortion. For the past decade, those same religious organizations have begun working to limit treatment choices for those facing the end of their lives, a development that increasingly impedes meaningful healthcare, and resigns countless elders—including millions of aging Baby Boomers—to "healthcare" that does little for, or even damage to, their quality of life.
A host of anti-abortion groups denounced the end of life counseling regulation, including Operation Rescue's Troy Newman and Janice Crouse of the Beverly LaHaye Institute at Concerned Women for America. Family Research Council's director of Congressional affairs, David Christensen, told The Christian Science Monitor, "We're concerned this [the regulation] could be misused, especially in a state like Oregon that sees mercy killing as a legitimate medical service." Three days after Pear's story, Mathew Staver, chairman of Liberty University's Liberty Counsel, a conservative legal organization (think "Choose Life" license plates case), said, "When you remove the sanctity of life from the equation and place health care under the control of government bureaucrats, you end up with increased costs, decreased care, and death panels." Judie Brown, the president of American Life League, gave a succinct summary of the "prolife" conflation of end of life care with abortion: "Nothing good can come of this. This will affect everybody's parents and grandparents and preborn babies, and it will not affect anybody for the good."
About 80 percent of Americans wish to die at home, yet 80 percent die in institutions, because the default mode of medical care in the United States is to "do everything," as Thaddeus Pope, law professor at Widener University, describes it. For the past fifty years, medicine has focused on curing illnesses and ailments but not on guiding patients through the dying process. So terminal patients are now frequently given rounds of treatment long after they've been found ineffective simply because doctors fear "giving up." Aggressive intervention enables doctors and patients to deny the inevitability of death and prevents them from planning for the process of dying.