Medicare Payment for End of Life Care

Representative Earl Blumenauer (D-OR) has reintroduced his bill that would allow Medicare to pay doctors for having talks with their patients about their preferred end of life care. It has bipartisan support in the House and a similar bill is being drafted in the Senate by Mark Warner (D-VA) and Johnny Isakson (R-GA).

From Politico:

The heart of the Blumenauer bill is simple: Doctors and patients should talk about aging and about how a disease is likely to progress so that the patient can make clear and informed choices, and the doctor can understand and respect them. Those conversations can and should take time.

Doctors are paid well for doing procedures, Blumenauer said. They should also be paid for the time they talk to a patient about something this important. The bill calls for Medicare to reimburse the physician for one such conversation with the patient every five years, more frequently if the patient’s health deteriorates.

Every time Blumenauer brings up the bill, conservatives immediately start screaming “death panels” and rally opposition against it. But this is just silly.

There’s no good reason Medicare shouldn’t pay doctors to have these talks with patients. As people near the end of their lives, they should understand what they’re going through, different options they have and ensure that their wishes are respected. That’s the role of a medical professional and Medicare should be reimbursing them for it.

This reminds me of another agency that Republicans have been screaming “death panels” about – the Independent Payment Advisory Board (IPAB). IPAB is a 15-member board that analyzes Medicare reimbursement rates and finds ways to cut spending while not reducing quality of care or eligibility. The American Medical Association notes the many restrictions the agency has in its cost-cutting mission:

The IPAB is prohibited from submitting proposals that would ration care, increase revenues, change benefits, modify eligibility, increase Medicare beneficiary cost sharing (including Parts A and B premiums), or change the beneficiary premium percentage or low-income subsidies under Part D.

Nevertheless, Republicans have been screaming that it will ration care and throw grandma off a cliff. That’s not what the board does. It’s not about rationing care and explicitly cannot do so. The same is true with Blumenauer’s bill. It’s not about Medicare telling doctor’s to convince patient’s to forego expensive surgeries or prevent them from receiving desired treatments. It’s about abiding by their wishes and making them as comfortable as possible at the end of their lives. There shouldn’t be any opposition to that.


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