An early version of the health care reform law of 2010 included a provision that would have done something almost everyone who has studied the issue closely believes is a good and necessary step to improving the health care system:
It would have allowed Medicare to pay for voluntary end-of-life consultations, providing an additional health care service.
It would have given patients more options and information.
It would have strengthened the doctor-patient relationship. The consultations would be between a doctor and a patient - at the patient's request - and if the patient preferred, family members and other trusted associates could be included.
It would have helped stem the tide of runaway health care costs, given that a ton of money is wasted on unnecessary, inefficient and ineffective services that are performed when it is hardest to make rational decisions about care. The bulk of Medicare expenses are used at this stage of life.
It would improve the final months of life for severely ill patients and reduce the stress on their family and friends. Numerous studies have shown that end-of-life consultations give a patient a stronger say in the kind of care he receives when things are most dire because once those situations occur, the patient's ability to express his wishes declines rapidly.
They could choose the at-all-costs option - the utilization of every measure available - no matter how effective they are likely to be, or for an all-out lifesaving effort only up to the point doctors have reason to believe the treatment might work, and thereafter shift the focus to preserving the quality of the patient's remaining time on Earth.
The studies also show that those left behind after the patient's inevitable death would not be as depressed. They have fewer reasons to second-guess their handling of their loved ones final months. And they get to spend quality time that otherwise would have been robbed from them because those patients end up living longer and in more comfort than those who do not have the consultations.
Those facts are not in dispute. But the provision that would have allowed Medicare to pay for the consultations was removed from the law after talk of "death panels" began.Recently, the New York Times reported that the provision has returned, through the health care law's regulatory process.
And even given the clear facts above, proponents of the measure don't want to celebrate what is clearly a victory for common sense. They are afraid that the demonization will return and the much-needed measure would be stricken down again.
Those who spoke of "death panels" initially claimed that the provision meant Medicare would make health care decisions based on a person's worth to society. Those with defects supposedly would be denied care in favor of maybe someone who might one day cure cancer.
Though that claim has never been true - ever - it continues to resonate because it builds upon a fear of the obvious, that there is a finite amount of health care services.
Those who talk of "death panels" then take the leap to conclude that rationing will occur, then extrapolate that the end-of-life consultations will be used to convince ill patients to forgo potentially effective medical care.
That has never been the case - in any form. The consultations would be between a patient and his chosen doctor. The claim can not be true unless private doctors are untrustworthy and unethical men and women who will ignore their oath to first do no harm. If doctors really are that evil, nothing we do to reform the system will work. I happen to believe that most doctors are much more ethical and professional than that.
Will health care be rationed? Health care has always been rationed. That's the reality. No matter what system we adopt - strictly private or single-payer - that won't change. It was true in the early 20th century before Medicare, and it has been true since.
That's what private health insurers do. It's the only way they can make services available to a wide swath of Americans and remain in business while making a profit. That's also why a health care system built entirely upon the free enterprise market is not desirable. As we age, we naturally become more susceptible to disease and other health maladies. It's an unbendable reality of life. But if private insurers take on too many of us in that state, they cannot make a profit and could not survive as a business.
And more of us are living longer - which means more of us will be affected by diseases such as cancer in our later years.
That's why our current system is a hodgepodge of private and public health care options and funding. It's just that we have not done a good job of making the system more efficient, which is the purpose of health care reform. If we make it more efficient, we can get a handle on costs and improve quality of care for millions more Americans, many of whom are currently shut out because they can't afford the care.
But we won't be able to do that if even rational measures - such as the end-of-life consultations provision - that have been studied and proven to be effective can be so easily demonized.
Such distortions will eventually hurt us all, including those peddling them.