It's debatable whether, under Obamacare, "death panels," perhaps committees of bureaucrats charged with deciding what types of medical care the government will pay for and what it won't, especially as the costs rise toward the end of life, are a fevered fantasy or a prudent fear, with respectable arguments either way. What now cannot be debated is that the Obama administration has decided to incorporate, by administrative fiat, the provision in the health care proposal that not quite accurately sparked the death-panel debate.
During debate last year over the president's health care proposal, a Medicare provision authorizing payment for end-of-life consultations with doctors — advance directives on extraordinary measures to prolong life and the like — was part of the bill. It was a stretch to extrapolate this, as some did, into "death panels" deciding what treatments would be allowed based on considerations other than the best interests of the patient (another provision, the Independent Payment Advisory Board, is a better candidate). Instead of defending this provision, however, the administration simply removed it from the version that achieved final passage.
Apparently the possibility that this provision would not have been approved by Congress (let alone the new Congress coming in January) didn't discourage advocates. Health and Human Services Secretary Kathleen Sebelius recently approved a regulation permitting Medicare payment for such consultations, not every five years, as in the Obamacare proposal, but annually. At least one member of Congress who supports the provision advised other supporters not to broadcast the decision too widely lest it stir up controversy.
Besides highlighting an administration preference for administrative over democratic procedures — and the penchant for operating with considerably less than full disclosure in an administration that had promised unprecedented transparency — the new provision could contribute over time to the kind of bureaucratic rationing of health care many Americans fear. It creates a new Medicare entitlement without paying for it. As such entitlements proliferate to the point that outlays exceed inputs in a system already approaching a fiscal tipping point, the temptation to ration care to keep costs down is likely to become irresistible. Whether those who administer such rationing are called "death panels" or something else could well be academic.