Death panels are back – just ask Sarah Palin

Remember death panels? Obamacare opponents claimed that the law would create them to make life or death judgments about frail elderly patients.

Where did the opponents find these sinister bodies in the thousands of pages that comprised the Affordable Care Act? In a provision that would have permitted Medicare to reimburse physicians for counseling patients about end-of-life planning.

Sarah Palin gained media attention with a Facebook post announcing their existence during the debates over the law in 2009. The charge was thoroughly debunked, but the resulting furor was so intense that the law's sponsors deleted the provision before the final vote.

Well, death panels are back. The federal Centers for Medicare & Medicaid Services, which administers Medicare, announced last week that it would soon issue a regulation to accomplish the same goal as the deleted provision. The new rule would encourage end-of-life discussions between physicians and patients by paying physicians for the time involved.

Some private insurers already pay for end-of-life counseling, and some physicians already engage in it without payment. But the new rule would make it more common.

And Sarah Palin is back, too, as strident as ever. On Friday, she warned on her Facebook page that the new rule would resurrect the same death panels she uncovered in 2009.

In her words," Politicians just don't get it. Their 'Death Panels' still won't die. Last night Obamacare masterminds decided they'll pay healthcare providers for vulnerable patients' "end-of-life" plans."

Is this the start of a general outcry by Obamacare opponents? So far, aside from the former Alaska governor, they have been largely quiet.

Why has the cry of death panels not been as widespread this time? Perhaps because most politicians recognize that encouraging physicians to discuss end-of-life planning with patients is a good idea. It empowers patients to take control of important decisions.

Without prompting from their physician, patients may be reluctant to initiate discussion of such a sensitive subject or may even be unaware that there are decisions to discuss. But when patients do engage in advance planning, wrenching decisions can be avoided later on, sparing many families from emotional turmoil.

In fact, the idea of end-of-life physician counseling had been proposed in 2009 by a Republican Senator, Johnny Isakson of Georgia.

The original death panel outcry was about politics, not policy. It was part of an attempt to derail the ACA with scare tactics. Now that debates over the law's passage are over (at least until the next repeal vote), the idea of end-of-life counseling can be considered more rationally. (Sarah Palin take note.)

Maybe, this will be the start of a trend toward political discussion of other important health policy topics in a more constructive manner.

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