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Posted by on Apr 20, 2015 in At TMV | 3 comments

Jeb Bush and “Death Panels”

Ezra Klein notes Jeb Bush’s support for end-of-life directives on

The dumbest controversy of Obamacare, by far, was when Sarah Palin took an anodyne provision directing Medicare to cover end-of-life care consultations and branded it a “death panel.” Senator Johnny Isakson, a Georgia Republican who had backed the idea, was unsparing. “How someone could take an end-of-life directive or a living will as that is nuts,” he said. PolitiFact gave Palin its coveted “Lie of the Year” award.


But Palin won. The provision was deleted from the bill. And politicians learned to fear any discussion of end-of-life care, even though roughly 30 percent of Medicare’s spending comes in the last six months of a patient’s life.


And that’s been the sorry state of Washington’s conversation over end-of-life care. Until now.


In New Hampshire on Friday, Jeb Bush made a startlingly sensible proposal. “I think if we’re going to mandate anything from government, it might be that if you’re going to take Medicare, you also sign up for an advance directive,” the New York Times reports Bush saying.

This goes much further than the provision in Obamacare. All that did was allow Medicare to pay for “voluntary advance care planning.” Bush appears to be suggesting something much more radical, and much more sensible: that Medicare mandates an advance directive as a condition of receiving insurance.


This shouldn’t scare anyone. An advance directive can say that the patient wants all measures used to prolong her life, or it can say that the patient wants nothing done. An advance directive doesn’t tell you what to choose; it simply forces you to make a choice.


And people should be forced to make a choice. Because if they don’t, then terrible things can happen to them at a point when they’re no longer mentally or physically capable of choosing.


“End-of-life care” is such a clean euphemism. But CPR cracks the ribs of 92-year-olds with dementia. Brutal surgeries are performed that will leave patients with a few more months of life, at best. There are fates that are worse than death.

Cross-posted from The Sensible Center

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