Freedom New Mexico
In the New York Times News story, Robert Pear wrote drily: “While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor.”
The rule in question was an administrative decision to do what Congress chose not to do when it passed Obamacare last year — to provide Medicare reimbursement for “‘advance care planning’ as one of the services that could be offered in the ‘annual wellness visit’ for Medicare beneficiaries,” as Pear wrote. The proposal, included in early versions of Obamacare but not in the final bill, was inaccurately attacked as a first step toward “death panels” in which panels of bureaucrats rather than doctors and patients would decide what kind of potentially expensive care would be permitted as elderly people approach death.
Such advance planning, which can include statements about whether an older person would want medical professionals to use strenuous efforts to extend life, is generally a good idea. And with or without Medicare reimbursement, many patients and doctors already collaborate on such planning, which can spare relatives the necessity of making difficult decisions if a patient is in such a condition that he or she is unable to communicate preferences coherently.
As we have noted previously, it is not this provision that could — not inevitably perhaps but possibly — lead to something resembling “death panels.” A different provision that could lead that way, the formation of an Independent Payment Advisory Board, is in the bill as finally passed.
As for the advance care planning provision, the administration noted that it was not in the first version of the proposed rule promulgated last July but was slipped into the rule in November. Given that there might not have been sufficient time for comments on that specific provision, it is being dropped — for now.
However, something of a political firestorm erupted after it became public that the rule had been finalized. The burden of complaints was that the administration was imposing by administrative fiat a provision it didn’t have the courage to include when Congress was considering health care reform.
We have already seen another example of such sleight-of-hand in the Environmental Protection Agency’s determination to impose carbon emission limits although a Democratic Congress last year declined to pass cap-and-trade. Given the current composition of Congress, we are likely to see other examples.