On Medicare Paying Doctors for End-of-Life Counseling

The Wall Street Journal published my letter this morning on the Administration's (since rescinded) decision to pay doctors an extra fee for providing end-of-life counselling to Medicare beneficiaries.  I wrote it in response to a letter by a physician who advocated such reimbursements.  My letter disagreed:

"Annette M. Bernard (Letters, January 11) notes that our ability to keep patients on feeding tubes "has far outgrown our moral and ethical skills at understanding how to help our patients in the last stages of their lifes."  She concludes that the federal government paying her to provide end-of-life counseling to Medicare patients would somehow cause these moral and ethical skills to grow.  The opposite is true.

Before reframing Obamcare as a struggle against health insurers' greed, the president was more forthcoming about his goals.  In April 2009, he declared that he would have spent as much money as necessary to keep his own grandmother alive, but once "society" - that is, the federal government, took over the responsibility, citizens would have to accept a "very difficult democratic conversation."

The Obama administration's attempts to influence end-of-life decisions have nothing to do with improving physicians' "moral and ethical skills," but are intended to drag them into compliance with the government's desired political and fiscal outcomes.  This conflict of interest isn't reassuring."