Tonsillectomies, Part Two

On July 22, President Obama talked about health care and said:

Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there. So if they're looking and you come in and you've got a bad sore throat or your child has a bad sore throat or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, "You know what? I make a lot more money if I take this kid's tonsils out."

Now, that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies. Maybe they have something else that would make a difference.

This statement was greeted with derision on the Right, as it should have been. It portrayed doctors as greedy opportunists who cared nothing for their patients’ well-being and made treatment decisions based solely on how much money they could squeeze out of the system. Jim Geraghty at the Campaign Spot wrote a July 23 post called “Is the Most Justifiable Criticism of Obama That He ‘Still Seems Too Good to Be True’?” in which he expressed incredulity at a sycophantic reviewer of Obama’s performance by asking:

He saw the claim of America's doctors engaging in tonsil profiteering, right?

Now Geraghty has up a post recommending an article by Charles Lane at the Washington Post. Lane has written about the House’s overreach in their health care bill (HR3200), specifically (you guessed it) Section 1233 under which Medicare will now pay for an end of life counseling session. I’ve already explained (here, here, and here) why I don’t share Lane’s concerns and I’m not going to get into that again.

I was, however, struck by something in the paragraphs Geraghty quoted from Lane’s article (emphasis mine):

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that's an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they're in the meeting, the bill does permit "formulation" of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would "place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign," I don't think he's being realistic.

. . Ideally, the delicate decisions about how to manage life's end would be made in a setting that is neutral in both appearance and fact. Yes, it's good to have a doctor's perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party — the government — recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don't have to be a right-wing wacko to question that approach.

So physicians who would never participate in “tonsil profiteering” will be more than willing to “insist” their elderly patients undergo end of life counseling where the doctors will “sell” the patients on living wills and hospices and “pressure” them to sign on the dotted line - all for a little extra money (which, incidentally, the doctor gets whether the patient signs something or not). What shall we call this? “Death profiteering” seems awfully harsh and “euthanasia profiteering” is almost worse. “End of life profiteering” is a mouthful and “1233 profiteering” is a little obscure.

I know. How about “granny profiteering”? I think it has a nice ring to it.