Accusations that the health care reform bill now pending in the House of Representatives would use "death panels" to deny care to sick seniors and children with birth defects have taken center stage in the health care debate, giving the Obama administration even more of an uphill climb in getting the measures enacted into law.
But health care experts – even those who do not support the version of the health care reform bill now being discussed – note that these accusations are shocking, inflammatory and incorrect.
At issue is a 10-page section of a 1,000-page House health care reform bill on "advanced care planning consultations." These consultations would reimburse a doctor for talking with a patient once every five years about what kind of care they want near the end of life.
The provisions spurred conservatives, including former New York Lt. Governor Betsy McCaughey, a Republican and now a conservative commentator, to charge that these consultations would ration health care for elderly and "tell them [seniors] how to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go into hospice care."
That led to shouts of "This is euthanasia!" from angry citizens at health care town halls all across the nation hosted by members of the House or Representatives. One person said, "Adolf Hitler called his program the 'Final Solution.' What will we call ours?"
In fact, doctors and supporters say, the intent of the measure is not for doctors to tell patients what to do, but to give doctors more incentives to talk to patients about all of their options.
The provision cited by McCaughey requires only that Medicare cover end-of-life consultations for patients who want it. It does not force clinicians to provide them or patients to undergo them, doctors say.
"Advance care planning has nothing to do with 'rationing care,' and calling it 'death panels' is derogatory and preposterous," said Dr. Marcin Chwistek, an attending physician in oncology with the pain and palliative care program at Fox Chase Cancer Center in Philadelphia. "I sincerely hope that such consultations will initiate what has been long due in the American health care system -- a thoughtful care that results from careful discussions and planning between patients and their doctors, as opposed to a care that is chaotic, based on assumptions, and frequently in conflict with patients' deep held values."
Currently, Medicare doesn't pay for consultations focusing on end-of-life care. Under the bill, Medicare beneficiaries would have them covered every five years, or more frequently if the individual's clinical condition deteriorates.
In addition to the coverage expansion, the bill also calls on the Medicare system to adopt quality standards for end-of-life care.
The AARP defended the legislation too. In a statement, the powerful seniors' lobbying group said McCaughey's charges were "rife with gross -- and even cruel – distortions... McCaughey's criticism misinterprets legislation that would actually help empower individuals and doctors to make their own choices on end-of-life care."
"Right now it seems there is an intentional effort to distort what's in the legislation and that's confusing the public debate," AARP executive vice president of policy John Rother said.
In La Crosse, Wis., such "end-of-life consultations" are already common because of a program put in place by a local hospital.