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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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  • Well Jeb and I agree on one thing. I have to only look at my experience. My fathers final few years were a hell on earth. One invasive surgery after another each keeping him alive only until the next surgery and each one reducing the quality of his life. Upon advice from a wise doctor when he was 87 we made the decision to cease “heroic” measures to keep him alive. In my mothers final few years I learned to say no to surgery for her. She peacefully died in her own home at 90 and was part of home hospice the final 4 months.
    My mother’s brother is another example. He was diagnosed with cancer at 77. He went through a surgery and then 2 years of toxic chemotherapy and radiation. His last 2 years were once again hell on earth. When he died at 79 he was a shadow of his former self.

  • JSpencer

    “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.”

    I don’t blame the Sarah Palins of the world for this, because there have always been – and always will be idiots in positions of influence. I blame the cowardly politicians who are tasked to address these issues and who instead tuck their tails between their legs and run.

    And btw, when I reach the point where my quality of life is so compromised that others will be required to take care of me? That will be my cue to exit.

  • Libby123

    I believe that it’s important for us all to make our wishes known to our families who will make decisions when we cannot. I think it’s a good idea to have a plan written down and on file with the doctor, the hospital, the lawyer and with MORE THAN JUST ONE member of the family so that an emotionally overwrought person doesn’t take matters into their own hands because they can’t handle it.

    But I absolutely disagree that people should be forced to make an advanced directive. Who would do the forcing? Who would enforce such a law? What would be the penalty for failure to obey? This enters into the realm of Big Brotherdom.

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