Look Out, Grandma: Uncle Sam Is Selling ‘Death With Dignity’

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Look out, Grandma. Medicare said last week it wants to start paying for end-of-life counseling. It’s being sold as “death with dignity,” but it’s more like dying for dollars. Seniors are pressured to forego life-sustaining procedures to go into hospice. That enriches the booming hospice industry and also frees up dollars for the left’s favored social causes.

Why is the government meddling with how we cope with death? The Institute of Medicine doesn’t mince words. Scrimping on seniors will free up money “to fund highly targeted and carefully tailored social services for both children and adults.” Just like Obamacare. Robbing Grandma to spread the wealth.

In 2009, President Obama said seniors are getting too many procedures and maybe they’re “better off not having the surgery, but taking the painkiller.” Obama’s health guru Ezekiel Emanuel argues the elderly should be a lower priority because “they have already had more life-years.”

It’s the perfect storm of ideology and industry greed, with hospice providers lobbying lawmakers to make end-of-life counseling the standard. And not just once. Hospice advocates want to drill their morbid message into patients’ heads. “It has to be a series of recurring conversations over years,” an industry representative insists.

Imported from Europe, the hospice industry has boomed — and taken a sharp turn from nonprofit to aggressively for-profit. Revenues are up 500 percent since 2000, and the industry is flexing its muscle in state capitols and Washington, DC.

In 2010, industry lobbyists convinced New York lawmakers to compel all doctors to offer end-of-life counseling to patients with terminal illnesses. New York’s law imposes heavy fines, even jail time, on doctors who don’t.

The state’s physicians protested that some patients will break down at the mention of hospice and give up on life. Other patients are religiously or culturally opposed. But the law prohibits exemptions.

Forcing New York doctors to say things violates their First Amendment rights. Just last week, the United States Supreme Court allowed a ruling to stand that struck down a North Carolina law dictating what doctors said to certain patients.

How about pressure on patients? Advocates say end-of-life counseling is always voluntary for the patient. Technically that may be true, but if your doctor faces penalties for not doing it, you’re going to feel forced to go along.

That was the problem with the end-of-life counseling provision in an early draft of Obamacare in 2009. It said Medicare would pay doctors for end-of-life counseling. Fine. But the bill went on to prescribe what doctors would have to discuss. That’s not fine. Uncle Sam can’t possibly know better than your family, the doctor at your bedside, and maybe your minister or rabbi.

Even worse, the provision would have punished doctors who didn’t comply, something the Institute of Medicine is calling for again.

A doctor’s quality rating (and pay from Medicare) would have depended partly on the proportion of patients who had advanced directives and how many adhered to them. How voluntary is it if your doctor’s pay is affected by whether you stick to your Do Not Resuscitate order. That’s what’s ahead with this latest proposal.

Already, some seniors who could survive their illness and go home are pushed into refusing medical care. Advocates parrot the statistic that 25 percent of Medicare hospital expenditures are for the last year of life. That’s like harping on how often Babe Ruth struck out.

Three-quarters of the time, this care is helping seniors. A major study of 208 California hospitals in the Annals of Internal Medicine proves that spending more on Medicare patients leads to substantially higher survival rates. The money isn’t wasted. In the hospitals that spend more, seniors have a better chance of recovering, going home, and resuming life.

Despite the hazards of end of life counseling, Jeb Bush is on the bandwagon, saying seniors should be forced to fill out an advanced directive to get Medicare. His Republican rivals should make it clear they don’t support government interfering in this highly personal decision.

Ms. McCaughey is a senior fellow at the London Center for Policy Research.


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