These words begin the Constitution of the United States: “We the people.” But neither the Constitution nor “we the people” will mean anything if politicians and judges can continue to do end runs around both. Bills passed too fast for anyone to read them are blatant examples of these end runs. But last week, another of these end runs appeared in a different institution when the medical “end of life consultations” rejected by Congress were quietly enacted through bureaucratic fiat by administrators of Medicare.

Although Congressman Earl Blumenauer and Senator Jay Rockefeller had led an effort by a group of fellow Democrats in Congress to pass Section 1233 of pending Medicare legislation, which would have paid doctors to include “end of life” counselling in their patients’ physical checkups, the Congress as a whole voted to delete that provision.