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Inside a meeting of Obama's "death panel."

By Ezra Klein  |  August 28, 2009; 1:16 PM ET
 
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I was a member of my father's "death panel" - if that's what we're calling end of life discussions these days. My father was on that panel, as were his doctors. The dialogue shifted and changed as my father's illness progressed.

This was years ago, when doctors did not need a billable box on the insurance form in order to discuss end of life issues with patients.

My experience does NOT lead me to believe that these are conversations that need to be scripted and scheduled by government regulation.

I'm no Sarah Palin. I'm very much in favor of real health care reform. And I'm a liberal who believes government intervention can provide real benefits.

However, I passionately believe that leaving Congress to legislate the terms of end of life conversations is a grotesque mistake.

Ezra, you are mistaken if you think that Section 1233 of HR 3200 is reform of any kind. It's an admission that there is no health care provided to patients unless there is a billable box on an insurance form that covers it - and a government regulation that defines the terms of such care.

In injecting highly inflammatory language into the debate, Sarah Palin did the reform effort a huge disservice. Though Section 1233 does not establish death panels at all, it sets up government intrusion of the very worst kind. And creating silly videos about killing old people does nothing to focus the debate in a meaningful way.

Posted by: anne3 | August 28, 2009 2:04 PM | Report abuse

How kind of you to expect doctors to work for free for your convenience, anne3.

Posted by: constans | August 28, 2009 2:11 PM | Report abuse

First of all, doctors don't work for free, now do they? Nor should they. And the doctors who worked with my father were paid very well. As they should have been. They are experts who worked very hard to develop the expertise they need to treat patients. They also did not need a government regulation and a fee to bring up the end of life discussion with the patient and his family.

I don't think that the government needs to get involved in end of life discussions. It is something doctors should do as they provide treatment and consultation to patients.

What we have right now is a system that pays doctors based on the boxes they can check off on an insurance form. If there is not a box for a condition, it's not treated. Thus, we do not provide health care. We treat disease. Obesity is an example of this - people are not treated for weight issues until obesity creates a disease that requires surgery or meds.

If you truly believe that mandating end of life discussions and creating a payment structure for them will aid in the reform of health care, we must respectfully disagree.

Posted by: anne3 | August 28, 2009 2:32 PM | Report abuse

Constans, I think what anne3 is saying is that doctors already have end-of-life conversations with patients and their families, when the time is right. Such conversations take place at a normal office visit, and the normal office visit is paid for by Medicare in the normal course of events. I've been involved in similar discussions with my parents' physicians, so I can vouch for anne3's experience.

Sec. 1233 of HR 3200 would require a physician take on duties of a social-service agency and would require the physician to give out information that is non-medical -- i.e., names of legal service agencies in the patient's area. It would also require the physician to explain non-medical documents, such as a durable power of attorney.

It seems to me that any physician's time would be better spent focusing on patient care, rather than taking on social-service obligations.

Posted by: Policywonk14 | August 28, 2009 2:38 PM | Report abuse

*I don't think that the government needs to get involved in end of life discussions. It is something doctors should do as they provide treatment and consultation to patients.*

Yes, I'd hate to think the government might get involved with medicare.

*If you truly believe that mandating end of life discussions*

Mandating? You seem to be overloading on straw.

*creating a payment structure for them will aid in the reform of health care, we must respectfully disagree.*

Yes, I'm pretty sure that creating a payment structure for services provided by a physician is, pretty much, part of any government health care program. But nice of you to think that doctors shouldn't be compensated for their expertise/time.

Your indignation seems a bit misplaced. That you back it up with a bunch of straw man arguments makes me extra-suspicious.

Your arguments are no different than saying that we shouldn't have medicaid pay doctors because they're perfectly willing to accept charity cases.

Posted by: constans | August 28, 2009 2:51 PM | Report abuse

How kind of you to expect doctors to work for free for your convenience, anne3.

Posted by: constans | August 28, 2009 2:11 PM | Report abuse


oh so THAT'S your angle. You're a doctor. Oh i get why you hate insurers now.

Why is it that doctors have to charge a seperate fee for end of life procedures. Why just not have it be inclusive of the fee they charge for their standard 5 minute office visit? Isn't $200 enough for that?

Alright I say $200 in jest because in the end while doctors bill a set amount, insurers and medicare pay a lot less and across the country it varies as it should for cost of living but I don't know a lot of doctors that are struggling. I know a lot of Americans that are struggling though.


If you're a doctor I'd ask you how many medical bankruptcies you've been responsible for? How many people have you sent to collections because they're out of network, their insurance didn't cover this or that or whatever? Is it in the hundreds or thousands?

Posted by: visionbrkr | August 30, 2009 4:28 PM | Report abuse

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