Sneaking end-of-life consultations into Obamacare

During the debate over Obamacare last year, controversy erupted over a Medicare provision related to end-of-life consultations with doctors. Following well-publicized criticism from former Alaska Gov. Sarah Palin concerning government “death panels,” the provision was promptly dropped. But now the New York Times reports that it has been resurrected in new Medicare regulations. There is both a right and a wrong reason to be outraged about this. Some have responded with the charged term coined by Palin, but this criticism is misplaced in the present instance. “Death panel” is entirely justified when used in reference to another provision of Obamacare — the Independent Payment Advisory Board — whose members will attempt to save money by making one-size-fits-all recommendations for skimping on care protocols and treatment regimes, particularly for older patients.

This new regulation merely provides that Medicare will pay for annual consultations in which, among other things, a patient can discuss with a doctor what should be done in the event he finds himself in extremis and cannot communicate. In itself, this should not be morally objectionable. No church of which we are aware (certainly no mainline Protestant denomination or the Catholic Church) places a moral obligation on doctors or patients to prolong life through heroic or extraordinary means, irrespective of the patient's wishes. All recognize a distinction between intentionally causing the death of someone (for example, by poisonous injection or dehydration) and merely allowing a dying person to pass away.

What is objectionable about the end-of-life regulation is that President Obama and his minions refused to defend it when it first became public and dropped it like a hot potato last year, only to sneak it back in under the cover of regulatory darkness this year. This is part of a broad pattern of opacity and deception, coming from the same White House that opened its visitor logs only after being forced to do so by Judicial Watch's threat of continuing litigation, then began holding meetings with lobbyists and special interest groups in a nearby coffee bar to avoid disclosure. It comes from the same president who issues reports praising his administration for the amount of information it makes public under the Freedom of Information Act, but in fact pads the numbers by releasing as much irrelevant and unnecessarily redacted material as possible, as Bloomberg News discovered when it requested information on corporate welfare given to Citigroup.

The regulatory resurrection of a rejected legislative proposal is dangerous and undemocratic. It reminds us of Rep. Don Young, R-Alaska, who once added earmarks to a bill that had already passed both houses of Congress. But where Young was ultimately forced to back down, Obama presses on. His Obamacare is a slapdash 3,000-page monstrosity most of whose contents remain a mystery, even to most of the members of Congress who voted for it last March. We're still learning about what this bill does, months after House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid and Obama bullied, bribed and badgered congressional Democrats into passing it in a raw display of rotten insider politics.

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