Earl Blumenauer, D – Oregon, explains in an op-ed today where all the “Death Panel” uproar was born. He says that in his years in congress he has made many attempts to change the way Medicare pays doctors from the current fee-for-service system but has not been successful. When he realized that doctors could be reimbursed for thousands of medical procedures (whether necessary or not and whether effective or not) but could not be reimbursed for the time spent “having a thoughtful conversation to prepare patients and families for the delicate, complex and emotionally demanding decisions surrounding the end of life,” he introduced language to the bill being put together to authorize payment for such discussions every five years. Big mistake!
In the first place, he gave up his principles driving him toward changes in the misguided system in place and just caved and started adding to the complexity. Second, to single out this one controversial doctor-patient discussion subject from hundreds of possible valuable and meaningful doctor-patient discussion subjects as meriting reimbursement by the government was sure to bring it to the attention of all who have any serious interest at all in the contents of the bill and especially of those who are out to defeat it.
And justifiably so. “Death Panel” is an emotional and inflammatory term, but if we believe that the planned Medicare cuts and rationing required to achieve them will not result in reductions in end-of-life care that will, in some cases, hasten the end of life, we are not paying attention. It is a fine line between heroic and unnecessary fee generating end-of-life treatments that do little more than extend suffering and reasonable treatments that improve comfort and quality of remaining life and allow persons to die with dignity at a natural pace. Work on exactly where that line is should be done by patients and families in confidential consultation with their physicians and not by or subject to review by Medicare contract employees in an office building somewhere.
So, Congressman Blumenauer had it right first time. Let’s get rid of this onerous, privacy invading, time and money consuming, paperwork generating, fee-for-service system and pay doctors the same way we pay lawyers, for their time. Then we can let the subjects of doctor-patient discussions remain confidential as they should.
But that is not likely. Even after all the uproar, the end-of-life provisions are in the bill as finally passed by the House of Representatives last week. I don’t know if there are provisions for reimbursing doctors for time spent discussing beginning-of-life issues such as starting families, pregnancy, childbirth, child care, family planning, etc.
For more on this insulting, demoralizing, and disrespectful fee-for-service system of physician payment, see Free the Doctors.