Will Medicare end-of-life talks suffer from treatment bias?

The last time the Obama administration proposed paying doctors to have end-of-life conversations with their patients, opposition focused on the possibility physicians would get to decide who lives and dies. This time around, opponents are more concerned about doctors encouraging patients to die early to save the nation's health system money.

Under a new rule announced last week, Medicare will allow doctors to bill for conversations with their patients about issues including living wills, palliative care, and assisted suicide.

“We’re not against the government paying for counseling,” said Diane Coleman, the president of anti-euthanasia group Not Dead Yet. “We are concerned that the conversation … is biased against treatment.”

The Obama administration first proposed federal funding for end-of-life counseling in 2009 as part of the Affordable Care Act. It pulled the regulation after pro-life groups and conservative politicians raised an uproar, calling the meetings “death panels.”

Now, the scene is different. Rep. Earl Blumenauer, D-Ore., believes America is ready for this regulation.

“It’s basically responding to where the rest of America is going,” he said.

Medicare created the new regulation in response to a 2015 report by the Institute of Medicine that claims American end-of-life care is seriously flawed. Jim Sedlak, vice-president of the American Life League, thinks it originated in something else: finances.

“We don’t have enough children,” he said. “Your whole system is upside down from what is supposed to be, and the only way you can survive is to get rid of old people.”

Care for older patients is expensive. An article on end-of-life counseling from the American Association of Family Physicians claims the system must pay $145,000 for every year an older patient’s life is extended. The group recommends doctors redirect, “the patient’s focus from a cure to a more reasonable goal … even a pain-free death.”

Doctors having end-of-life conversations can be motivated to “save money,” said Coleman, adding, “that bias is a great concern to us.”

Sedlak recounted a story about relatives who brought their 99-year-old mother-in-law into the emergency room with pneumonia. The doctor counseled the family to let her die, saying she had already lived such a long life.

His family was not the only one to receive such counsel, Sedlak said. After a recent article about the issue, his organization received comments from people across America telling similar stories.

His 99-year-old relative lived two more years after the emergency room doctor recommended she die. Sedlak called the new Medicare regulation to pay doctors for counseling “outlandish.”

“What do doctors know?” he asked.

The Associated Press contributed to this report.