ABC News Chief Medical Editor Dr. Timothy Johnson, who says he believes the provisions for end of life care discussions are a good idea, said that– there are other aspects of the potential legislation that deserve further scrutiny, depending on the details involved. One of these aspects, he noted, is the Physician's Quality Reporting Initiative for end of life care, which will "measure both the creation of and adherence to orders for life sustaining treatment" – a facet of the plan that he said could turn out to be logistically difficult and "maybe has too much the flavor of reporting back to big government or big brother."
Another issue, Dr. Johnson noted, is the fact that payments to doctors for such counseling are tied to whether or not the patient and family actually follows through with the end-of-life care plan set forth during a consultation. If a patient were to change his or her mind, in other words, the doctor would not be reimbursed for the counseling provided.
"I doubt most physicians would pressure a patient or family to adhere to an end-of-life care plan just so they could qualify for a bonus, but why link payment to something like this?" he asked.
Still, Johnson noted, "these kinds of questions should not scotch the effort to increase such services. We spend far too much money and emotional resources prolonging death versus supporting life during terminal care in this country."
But there is also the issue of cost, and whether in fact end of life care adds significantly to those costs. Varying estimates place the cost to Medicare for the last six months of life at 25 percent to 50 percent. So, many supporters of the provision argue that reducing these consultations included in the bill could save money. However, Joseph White, director of the Center for Policy Studies at Case Western Reserve University in Cleveland said the bill's defenders were wrong in suggesting that such consultations would produce cost savings.
"The share of Medicare spending that goes to patients in their last year of life has not grown over the past four decades or so," White said. "That means costs at the end of life are not the driver of cost increases... The whole idea that costs go up particularly because we keep proliferating services to old people at the end of their lives, compared to services to anyone else, is simply wrong. False."
Even a longtime supporter of Republican approaches to health care backed the provision in the bill. Gail Wilensky, who headed the Health Care Financing Administration and chaired the Medicare Payment Advisory Commission during President George Bush's administration in the early 90s, said:
"There are plenty of things not to like about 'Obama-care,'" she said. "This is not one of them."