Medicare’s push for end-of-life counseling will cut costs and help patients

For former Alaska Gov. Sarah Palin, talking about “death panels” that would ration health care for older people was pure political rhetoric and convenience. But unfortunately the vice presidential nominee of Arizona Sen. John McCain in 2008 diverted attention from something that needed to be discussed: how insurance companies, particularly Medicare, would handle coverage for end-of-life counseling.

Now, thankfully, Palin, who didn’t even finish her term as governor, has faded from the national scene except for being a heroine to the extreme tea party. And Medicare has announced it will pay doctors who counsel patients about that end-of-life care. It’s an important decision, because three-quarters of the people who die in the United States each year are 65 and older, and Medicare is their insurer.

Many people who are terminally ill, or rendered helpless and virtually lifeless by injury, would if they could limit their end-of-life care and spare themselves the prolonging but ultimately hopeless treatments available with modern medical science. Doctors should be able to counsel them as to their alternatives while they are able to make decisions.

That does not constitute a “death panel,” but rather a fully informed choice. Some people might choose to use every medical alternative available, and that ought to be their right. But others, realizing the treatment likely would not change outcomes, might decide to pass on some treatments.

As Dr. Philip Pizzo, a co-chair of a report on end-of-life issues from the Institute of Medicine, said: “End-of-life discussions should be part of the life cycle.”

That Medicare will cover counseling from doctors is important because it brings the government insurer for the elderly into line with what a number of private insurers do. This is good medicine, and enlightened care, and there is nothing political about it.

This story was originally published July 12, 2015 at 4:00 PM with the headline "Medicare’s push for end-of-life counseling will cut costs and help patients."