Can't we all just talk (about death)? Yes, we can

James M. Berklan
James M. Berklan

The lessons keep flowing from the political debacle that has been Sarah Palin's political career since she left her job as mayor of a small Alaska town. You'll recall it was Palin who launched the irresponsible phrase "death panels" into the stratosphere back in 2009, a time when conservatives and liberals were battling over the very life of the Affordable Care Act.

It was Palin, parroting another conservative talking head, who used her huge platform to expand “death panel” fear mongering. Once the former GOP vice presidential candidate took the partisan dogma and ran with it, a frothy media horde was all too willing to help her launch it further.

To be fair, Palin has proved herself as no mere puppet of the Republican party. She resumed ominous “death panels” warnings less than two weeks ago on her own, beating that dead horse even while the overwhelming majority of her party had abandoned such reckless rhetoric. (Maybe a little end-of-life counseling is in order for her and that horse?)

The reason the topic has come up again, of course, is the Centers for Medicare & Medicaid Services' announcement that it wants to pay Medicare doctors, physician assistants and nurse practitioners for time spent with patients in end-of-life planning.

That announcement was July 8, and it would be only slightly exaggerating to say you could hear a pin drop in the aftermath. Compared to the barnyard baying when such coverage was proposed in 2009 as part of the Affordable Care Act, this month's announcement provided a whispering librarian's delight.

Amazing what a lack of a political puffery can produce. This time around, administration officials took things out of the hands of malleable lawmakers and offered a payment change on their own. Comments are being collected on the recommendation until Sept. 8.

It's not a slam-dunk that the payment proposal will go through, but the chances are very, very good. Just as they should be.

As many in the healthcare community have attested (sometimes through silent non-protest) more-informed decisions made at a personal level are good. Long-term care providers already strive to make them possible day in, day out while they tend to some of the nation's oldest and most frail citizens.

The rise in the popularity of hospice services is no accident. This is a reflection of a gradually evolving American mindset. Hospice services aim to prevent further suffering down the line, and, it should be noted, are also reimbursed by government funding.

So why should physicians exploring options with their patients be any different? They shouldn't. And that's what everyone, now that they are removed from the political hot stove, seems to be recognizing. Oh, it's not 1,000% unanimous, but it's close enough to scream repudiation about the shameful theatrics Palin's brought in 2009 and again just this month.

Long-term caregivers, loved ones and especially the failing elderly all have something to gain here. The last can guide the first two as to what they want for medical care, especially if they lose the ability to communicate later on. This often might mean that less is more.

Medicare officials say they hope to file a final proposal by Nov. 1, with a new regulation going live by Jan. 1. Perhaps by then the list of professionals who would be in line to be trained and reimbursed for such sensitive, vital discussions will grow to include certain mental health and social work professionals.

Political gadflies need not apply.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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