“Death panels” killed something after all: Republicans’ desire to evaluate whether a medicine or treatment is really worth its cost.
It’s been six years since Sarah Palin stoked political controversy over end-of-life counseling she termed “death panels.” But many GOP lawmakers still regard any cost-benefit discussions as paramount to rationing care, even as the U.S. spends more healthcare dollars per person than any other developed country.
That’s an ongoing frustration for conservative healthcare economists, who say it remains difficult to broach the topic with Republicans.
“I would love to say the word ‘cost-effectiveness’ again in policy circles,” said Stephen Parente, who at the time of the “death panel” controversy was advising Republican Sen. John McCain on his 2008 presidential campaign, which included Palin as vice presidential nominee.
“I can’t,” he added. “It frustrates me to no end. Even … the fiscally conservative [Republicans] are like no, no we can’t. We’re not ready for that.”
More Americans now have health coverage due to the Affordable Care Act, but economists remain concerned about healthcare spending. Healthcare becomes especially expensive as patients near death, with about one-quarter of all Medicare dollars spent during their final month of life.
Some government-run healthcare systems, including the United Kingdom’s, give independent panels the authority to decide what treatments will be paid for based on how essential and effective they are. But while that’s been shown to lower costs, conservatives worry such panels would give the government too much power over personal healthcare decisions.
Palin played off that fear when bipartisan members of Congress proposed paying Medicare doctors for end-of-life counseling as part of the healthcare law, charging that they would create “death panels” who get to decide who lives and who dies.
Palin’s statements were widely debunked. But Gail Wilensky, who led the Centers for Medicare and Medicaid Services under President George H.W. Bush, says because of her misstatements, it’s tough to get Republicans to talk about cost-effectiveness to this day.
She says that at one point, former House Majority Leader Eric Cantor — who lost his Virginia seat last year — told her it’s an issue his members “don’t want to hear.”
“I’ve encountered some members of Congress who just don’t want to talk about it,” Wilensky said. “I think in the heat of trying to discredit the Affordable Care Act, what is a perfectly reasonable concept got wrapped up in the heat of the moment in what was a very unfortunate way.”
Parente, who is now director of the Medical Industry Leadership Institute at the University of Minnesota, agrees that there’s still a lingering stigma around discussing whether particular healthcare treatments deliver patients with enough benefits to justify the price tag.
“Unfortunately, the way it’s been translated is any thought of talking about cost at all is ‘we’re going to shut people out,'” he said.
Implementing cost-effectiveness in the U.S., where private insurers still cover many Americans, would look different than in European countries. But policymakers say there are many ways to incentivize doctors to help patients consider costs when treating them.
One of those ways is to reimburse physicians for counseling elderly or terminally ill Americans on which medical interventions to choose or skip in their final days. And some conservatives support such a policy — including Doug Holtz-Eakin, former director of the Congressional Budget Office who also worked for McCain and now heads the American Action Forum think tank.
Holtz-Eakin says he’s OK with Medicare paying for end-of-life counseling — as long as it’s “initiated by the family.” Talking about it in those terms rather than Palin’s “death panels” is more palatable to Republicans, he said.
“There’s a big difference between the policy question and the politics of it,” he said. “Politics are driven by fear and anger and that’s what it was,” he said.
