In 2011, 28 percent or about $170 billion of Medicare spending went to patients in the last six months of life. That simple fact of Medicare spending has led most healthcare analysts—and certainly the writers of the Afforable Care Act—to find ways to address end-of-life care that wouldn't just cost less money, but would give dying people and their doctors the opportunity to discuss how they wanted those last months to unfold. The law was to add Medicare reimbursements to doctors to have voluntary discussions with their patients about their end-of-life wishes. Those discussions aren't not explicitly covered by the program now.
What is at its essence a supremely humane idea—that people get to consult with their doctors to determine what happens to them medically in the process of dying—became Sarah Palin's infamous "death panels." The idea foundered. It hasn't really resurfaced in a significant way until now, when the panel of the American Medical Association that helps determine Medicare policies requested that end-of-life talks be covered by the program. If Medicare adopts it, many private insurance companies will likely follow.
But there is still political toxicity over "death panels," with more than a third of Americans still believing that they exist in Obamacare and they mean that the government is trying to kill granny.
Will this time be different?
Support for covering voluntary end-of-life planning is actually remarkably strong across the political spectrum. In addition to the American Medical Association panel’s recommendation, both private insurers and states such as Colorado and Oregon are now offering coverage for these consultations. Even critics of President Obama’s health care plan such as National Review’s Wesley J. Smith and Senator Johnny Isakson, Republican of Georgia, are in favor of advance planning.
That bipartisan support for the concept of advance planning didn't do much to dispel the death panel myth five years ago, since fighting Obamacare was more important than anything else. Now that the Republican repeal fight is fizzling, this recommendation to Medicare might just be adopted quietly. But with Sarah Palin and Ted Cruz and the entire Republican House still around, don't count on it.