Thursday, January 06, 2011

Mission Accomplished

It's the lie that won't die no matter how we try (sigh). Sarah Palin was right, Rush Limbaugh said yesterday, when she

accused Obamacare of having death panels. They denied it. "No, there aren't any death panels." But yet the White House has now said, (paraphrasing) "Okay, we're gonna get rid of the death panel rule." How can you get rid of something that wasn't there? Proving once again how stupid Sarah Palin is.

The White House now, he said, has been

caught trying to sneak in the death panels, essentially. A federal rule that Medicaid doctors, in order get paid by Medicaid, Medicare, had to have end-of-life discussions with their seasoned citizen patients once a year.

Uh, no. The federal rule never mandated advanced care planning but permitted Medicare to reimburse doctors who believe patients should consider their options for care at the end of life. When Sarah Palin fantasized about death panels in August of 2009, explained

The fact remains that the bill wouldn’t require patients to receive counseling sessions, nor would it require a doctor to offer one. Rather, it modifies Section 1861(s)2 of the Social Security Act, defining what services Medicare will pay for. So if a patient receives a counseling session from a doctor or health care practitioner, he or she doesn’t have to pay for it – Medicare will. As we pointed out in our earlier story, Medicare will also pay for prosthetic limbs, but that doesn’t mean that every recipient gets those, too.

In the article to which Rush referred in the segment yesterday, The New York Times' Robert Pear explained how "you get rid of something that's not there." It's because it was intended to be there.

Although a provision for advance planning was included in the health care bill passed by the House, final version of The Affordable Care Act did not mention the topic. However, it "was included in a huge Medicare regulation setting payment rates for thousands of physician services (when) he final regulation was published in the Federal Register in late November." But when the proposed rule was published for public comment in July, the provision was omitted.

It was included in November, however, by an advocate of end-of-life planning, the administrator of the Centers for Medicare and Medicaid Services. Although "an administration official" declared "we realize that this should have been included in the proposed rule, so more people could have commented on it specifically," the White House clearly was concerned the new rule would have upset Republicans. (The Times' reporter did not suggest who may have left out the explicit authorization in July.)

Okay, this all is boring and could end with "Rush is still wrong. And Sarah Palin is still stupid," which at least would have been pithy. But Sarah Palin isn't stupid, merely conveniently ill-informed. Limbaugh, meanwhile, is not ill-informed. Pear noted that the consultation was included in July as among the services that could be included in the "annual wellness visit" of Medicare patients. There was no suggestion that doctor "must have end-of-life discussions," merely that reimbursement would be provided if it were done.

Doctors generally are supportive of making advance planning available to their patients, many of whom cannot afford to pay for it themselves. When they make it far less available, Limbaugh, Palin, and other conservatives have- as insurance companies routinely do- successfully come between the doctor and his or her patient. Mission Accomplished.

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