Obamacare: A Death Panel For Legislation

Obamacare: A Death Panel For Legislation

The Obama administration has now reversed its reversal on “end-of-life-counseling,” aka “death panels.”

Reversing a potentially controversial decision, the Obama administration will drop references to end-of-life counseling from the ground rules for Medicare’s new annual checkup, the White House said yesterday.

As the New York Times described this latest reversal today,

The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.

The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1.


Although the health care bill signed into law in March did not mention end-of-life planning, the topic was included in a huge Medicare regulation setting payment rates for thousands of physician services. The final regulation was published in the Federal Register in late November. The proposed rule, published for public comment in July, did not include advance care planning.

In case you’re have trouble following these reversal reversals, here’s what I think is a fair summary:

1. The White House strongly supported end-of-life counseling and wanted it in the Obamacare legislation.

2. But because of intense political opposition, it was not included in the final bill that passed.

3. Because of continuing opposition end-of-life counseling was not published in the proposed rule in July.

4. But it was nevertheless included in the final rule that was adopted in November, a regulation, explains The Times, that “was issued by Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services and a longtime advocate for better end-of-life care.” Dr. Berwick, you will recall, was appointed without the advice or consent of the Senate in a controversial recess appointment, which drew “ire” from Republicans and some others.

5. This is the regulation the White House has just announced it “will amend … to take out voluntary advance care planning.”

Far more significant, in my opinion, than whether end-of-life-counseling is or is not covered under Obamacare is the utter incoherence these serial reversals reveal of this legislation and the irrelevance of the legislative process that led to it. The president never really knew exactly what he proposed; the Congress certainly did not know what it passed; the whole thing was a Hail Mary bomb thrown long distance into sticky fingers of federal bureaucrats to define it as they stumbled along.

Given the track record so far, it’s beginning to be clear that repealing Obamacare and replacing it with nothing would be a big improvement, and repealing Obamacare and replacing it with anything would be a big improvement.

Say What?