Star Tribune

Advocating end-of-life care planning does not equal end-of-life advocacy.

That critical distinction is deliberately buried by irresponsible health care reform opponents in the long, ludicrous debate over nonexistent "death panels.''

This ugly discourse is shamefully flaring anew with a recent New York Times story detailing a new Obama administration policy to reimburse health care providers who advise Medicare patients on advance care planning during an annual wellness exam.

Those recklessly claiming that "death panels are back" are at best ill-informed and at worst are engaging in prevarication.

The planning is voluntary, and the decisions are made by the patients themselves.

Senior citizens who want heroic measures to extend their lives if they become deathly ill are free to make that choice. Those who prefer less intrusive care can also make that call.

All can change their minds at any point.

"There's no binding contract that you have to live out. This is not a discussion that you can't revoke, change or alter,'' said Art Caplan, a renowned University of Pennsylvania medical ethicist.

Much of the discourse about advance care directives over the past several decades has rightly focused on the dignity this planning affords patients.

This is an intensely personal decision. It needs to be thought through with care, not delegated to frightened family members during a medical emergency.

It's hard to think of a better time to weigh this than during a routine exam with a patient's own knowledgeable health care provider.

Providing reimbursement simply is a way to get providers to bring up a topic that's hard to discuss. It's also an enticement for providers to fit this into their already crowded schedules.

Reimbursing providers for this planning is not a new concept -- a fact that the death panel crowd disingenuously ignores.

The Obama administration's new policy actually amounts to a minor update of end-of-life care planning reimbursement regulations drafted by the George W. Bush administration in 2008 and put in place in early 2009.

The Bush regulations implemented legislation passed by Congress in July 2008. That bill was called the Medicare Improvements for Patients and Providers Act.

Deep within it is language specifically stating that end-of-life care planning is part of the preventive service package covered during a senior's one-time "Welcome to Medicare" exam.

The Obama change now means this type of planning is part of the array of services covered during Medicare's annual wellness visit. The definition of advanced care planning used in the Obama administration rules is identical to that used by the Bush administration.

And again, if patients don't want to discuss this, they don't have to.

Unsuccessful proposals to make end-of-life planning a separate, free-standing benefit in the 2010 Affordable Care act were unproductive and unnecessary.

Proponents' intentions, however, were good. The goal was to respect individual choices and to avoid inflicting expensive medical care onto those who don't want it. Instead of defending end-of-life care planning as a rare opportunity to increase patient satisfaction while controlling costs, proponents folded when those spreading death panel lies hijacked the debate.

This time, proponents should stand their ground. This is a compassionate and sensible policy.