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Ivy Chang '10: Much ado about nothing

Just as the "birther" craze has begun to die down, President Obama must face yet another sensationalist rumor ­— one that his detractors have taken up as a rallying cry.

Sarah Palin and other conservatives caution that Obama is seeking to create "death panels" for government rationing of health care. Palin warns that our beloved grandparents and disabled children could be forced to face the panels and be evaluated "subjectively" on whether or not they deserve treatment.

This rumor is understandably a source of protest for those who actually believe it. However, it is nothing but a misunderstanding of proposed funding for Medicare-covered end-of-life counseling.

Patients who opt for counseling would be informed of their options concerning end-of-life services, such as hospice care. These services simply allow patients to authorize living wills, which will sometimes ask doctors and families to cease treatment in certain conditions.

Since Obama's opponents have been trying to stir fears of government-enforced euthanasia since the election, the truth about end-of-life counseling is more than often pushed aside in favor of exaggeration.

Conservatives criticize any health care bill that would include physician-assisted suicide, euthanasia or funding for family planning. This summer's counseling proposal seemed to be proof that Big Government was willing to do anything to cut health care costs.

It is worth noting that the closest thing we have to an actual "death panel" was signed into law by former President George W. Bush as governor of Texas. The controversial Advance Directives Act, also known as the Texas Futile Care Law, gives hospitals authority over patients or their families in deciding when treatment has become "futile." Ironically, Palin promoted advance directives as governor in a proclamation that is on the State of Alaska's Web site. It's quite obvious now, if it wasn't before, that Palin either has a terrible memory, doesn't write her own material or both.

Medicare cost-cutting is an undeniably prickly subject, but it can't be avoided for much longer. Medicare makes up over 20 percent of national health spending, and a third of that is spent on patients in end-of-life treatments. Medicare pays by service, and doctors naturally will order more procedures for their patients as they get sicker. But by 2018, spending on health care is expected to nearly double, costing an unsustainable one-fifth of the GDP.   

We have more expensive health care than any other industrialized nation, and yet still place last in preventable death rankings.  The problem — according to Dr. Elliott Fisher, a professor at Dartmouth Medical School, in a Sept. 12 Newsweek article — is not rationing of care but rather "unnecessary and unwanted care." He added that people in the U.S. are overtreated by about 30 percent.

Massachusetts, which has mandated health insurance since 2006 as an experimental trial of sorts for universal health care, currently suffers from ballooning insurance premiums. This is due in part to increased hospital visits by the elderly and physician demand for expensive treatments.

We should not let the government define "unnecessary" care, if the overwhelmingly negative response to Britain's National Institute for Health and Clinical Excellence is any indication.

But it is unfortunate that we are incapable of discussing end-of-life counseling without arousing irrational paranoia about "death panels." A study in the Archives of Internal Medicine reveals that physician counseling sessions with patients reduce health care costs by up to 35 percent. Cost-cutting benefits aside, providing patients with information about their choices in every aspect of health care is an extremely important and often overlooked aspect of the doctor-patient relationship.

Hospice care, as opposed to hospital stays, is sorely under-used. While 70 percent of people state a wish to die at home, about 50 percent spend their last days in hospitals undergoing life-sustaining treatment. Hospice care has been proven to increase quality of life and even prolong life.

How can patients ensure that they can spend their last days comfortable and pain-free according to their wishes, rather than continuing treatment? By writing out living wills, with the help of end-of-life counseling.

As they near their final years, many people do not view death as something to be feared and avoided. It is important to remember, especially in arguments about health care, that patients should always be allowed the dignity of making informed choices.

Ivy Chang '10 is a human biology concentrator from Los Angeles, California. She can be reached at ivy_chang(at)brown.edu.




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