The American Medical Association wants to jumpstart a health care discussion that died a political death almost five years ago: to “death panel,” or not to “death panel?”

Of course, we’re not talking about actual panels making life-or-death decisions on behalf of patients, but mandated coverage for “end of life discussions” between patients and doctors. Back in 2009, Sarah Palin coined the divisive term, and woke America up to the possibility that yes, handing over our health care decisions to the government a little bit at a time could backfire in spectacular and inhumane ways.

The New York Times reports that the AMA is putting pressure on the Center for Medicare and Medicaid Services to begin covering these end of life discussions. If the Center adopts the AMA’s recommendations, Medicare patients could start receiving coverage for these conversations as early as next year.

From the Times:

“We think it’s really important to incentivize this kind of care,” said Dr. Barbara Levy, chairwoman of the A.M.A. committee that submits reimbursement recommendations to Medicare. “The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them.” Now, some doctors conduct such conversations for free or shoehorn them into other medical visits. Dr. Joseph Hinterberger, a family physician here in Dundee, wants to avoid situations in which he has had to decide for incapacitated patients who had no family or stated preferences.

Although the Affordable Care Act contains no coverage requirements for end of life conversations, many private insurance companies have made the choice on their own to cover these appointments.

If asked to describe the conservative position on health care in one word, I would go with “choice.” I believe that patients should be able to choose whether or not to have these conversations with their doctor, and I believe that they are just as important as office visits spent diagnosing strep throat, or cancer, or those spent arranging post-surgical pain management. For some, end of life considerations only come when their life, or the life of a spouse or child, is in danger. To automatically dismiss these private conversations between doctor and patient as an unacceptable norm in American health care is disingenuous; however, ignoring the slow(ish) creep of government control over our bodies is equally so.

In an article from National Review, Wesley Smith makes an important point:

Doctor and patient discuss what should or should not be done. Patient’s condition improves or worsens. Often, that will spark another conversation–and then another. Now, if insurers want to pay for this, fine with me. If Medicare pays for it, fine too–depending on the details.

Details are so important when it comes to actual policy implementation. I don’t think that it will be productive if conservatives who are invested in this battle to keep the government out of our health care decisions immediately drag us all back into last decade’s debate. This year’s debate should focus on the level of government intervention that can (and most likely will, if the ACA goes the way of the NHS) come between a patient and his doctor when the government gets to decide how long the horrible conversations about feeding tubes, ventilators, and “extraordinary measures” should last.

Progressives tend to obsess over the sanctity of the body against invasive government action. Feminist overtones (set very far) aside, conservatives should adopt this same obsession—it’s my body, my choice, and my conversation with my doctor about how I want to spend my last moments on Earth. This reborn conversation about end of life coverage is inevitable, and how we address the issue is crucial to regaining and maintaining autonomy in our health choices. Avik Roy’s 2010 article on the issue remains prescient:

It comes down to this: if the government is funding health care, and simultaneously funding end-of-life counseling, the government has a conflict of interest. The government has a financial incentive to encourage people to “pull the plug on granny,” regardless of whether or not that is consistent with granny’s, or her family’s, wishes. It is, at bottom, the same reason we insist on a free, independent press (and free speech in general): when the government controls the media, it has a conflict of interest; i.e., an incentive to promote journalism that is favorable to the government.

The message is clear: leave my body alone. My doctor and I have it covered.



