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A provision in President Obama's health care reform bill encourages "end-of- life" counseling for seniors -- sparking euthanasia fears among some of the legislation's critics and leading others to believe that the White House is looking to save money by pressuring insurers to provide less coverage to seniors.
The provision, tucked deep within the House bill, would provide Medicare coverage for an end-of-life consultation every five years, and more frequent sessions if a person is suffering a life-threatening disease.
Health providers would be required to explain to seniors the end-of-life services available, including "palliative care and hospice."
"This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law," House Minority Leader John Boehner, R-Ohio, and Rep. Thaddeus McCotter, R-Mich. said in a statement last month.
But the sessions are not required, as President Obama reassured seniors last week at an AARP town hall meeting, when one woman said she'd been told that the policy requires everyone of Medicare age to be visited and told they have to decide how they wish to die.
"Nobody is going to be forcing you to make a set of decisions on end-of-life care based on, you know, some bureaucratic law in Washington," the president said.
Obama encourages people to create living wills, but it's not clear if he supports Medicare reimbursement for "end-of-life" counseling.
A Harvard study released earlier this year directly linked end-of-life counseling with lower health care costs and better quality of life for patients with advanced cancers.
Researchers, who interviewed 603 advanced-cancer patients about whether they had end-of-life conversations with their physicians, found that patients who did had an estimated average of $1,876 in health care expenses during their final week of life, compared with $2,917 for those who didn't. Patients also associated higher costs with a worse quality of death during their final week and typically did not live longer if they received intensive care.
"As the nation looks to ways to improve patient care and reduce costs of health care, end-of-life conversations should be considered, " said the study's senior author, Holly Prigerson, a professor of psychiatry at Harvard Medical School.
"Policies that promote increased communication, such as incentives for end-of-life conversations, may be cost-effective ways to both improve care and reduce some of the rising health care expenditures."
White House aides acknowledge it's a sensitive issue.
A quarter of all Medicare spending takes place in a patient's final year of life, and studies show most people facing a terminal illness or simply very old age prefer less medical intervention to more. That suggests the potential for savings.
Last fiscal year, the government spent $455 billion on Medicare -- 15 percent of the federal budget -- to cover 46 million Americans. Medicare spending is projected to skyrocket to 20 percent of the budget by 2019 as baby boomers increasingly become eligible for the program.
In 2010, 40.2 million seniors 65 years and older will be eligible for Medicare. That number is projected to rise to 54.8 million in 2020 and 88.5 million in 2050, according to the U.S. Census Bureau.
But Medicare's program for hospital stays is already spilling red ink. A report earlier this year showed that because of rapidly declining revenues, the Medicare trust fund for hospital expenses since last year has been collecting less in taxes and interest income than it pays out in benefits.
The fund's reserves will be exhausted by 2017, making it insolvent two years earlier than the trustees predicted last year. Medicare's total unfunded obligations, including its programs that use general revenues to pay for doctors' fees and prescription drugs, have reached $37.8 trillion.
When the Bush administration expanded Medicare reimbursement to cover hospice care, which is less expensive than hospital care, hospice use grew 240 percent. Studies show people prefer hospice care but officials are concerned about people outside a patient's family or doctor influencing the decision to give up on curative care.
"And that's where a lot of people fear that some of these ideas in these bills lead you to and that's unethical as far as I'm concerned," Sen. Charles Grassley, R-Iowa, said.
Charmaine Yoest, president and chief executive of Americans United for Life, said in a blog post that health reform "must respect life, and not contain provisions that mandate or encourage the withdrawal or curtailment of effective life-sustaining treatment to the terminally ill, the chronically ill, or the permanently disabled."
Lawmakers say making end-of-life decisions ahead of time is a good thing -- and it should be done early.
"Think about it when you're 50 years old instead of when you're 85, what sort of care you want," Grassley said.
The White House says even though Medicare would reimburse for the counseling sessions, it wouldn't conduct them.
"These decisions will be made by doctors and patients," White House spokesman Robert Gibbs said.
And Gibbs accused critics of misrepresenting that part of the health reform bill.
"I think there are people that have knowingly spread inaccurate information to hold up progress on health reform," he said.
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