RUTHFULLY YOURS

At a stroke, Medicare chief Donald Berwick has revived the “death panel” debate from two summers ago. Allow us to referee, because this topic has been badly distorted by the political process—and in a rational world, it wouldn’t be a political question at all.

On Sunday, Robert Pear reported in the New York Times that Medicare will now pay for voluntary end-of-life counseling as part of seniors’ annual physicals. A similar provision was originally included in ObamaCare, but Democrats stripped it out amid the death panel furor. Now Medicare will enact the same policy through regulation.

We hadn’t heard about this development until Mr. Pear’s story, but evidently Medicare tried to prevent the change from becoming public knowledge. The provision is buried in thousands of Federal Register pages setting Medicare’s hospital and physician price controls for 2011 and concludes that such consultations count as a form of preventative care.

The office of Oregon Democrat Earl Blumenauer, the author of the original rider who then lobbied Medicare to cover the service, sent an email to supporters cheering this “victory” but asked that they not tell anyone for fear of perpetuating “the ‘death panel’ myth.” The email added that “Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch.”

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Getty ImagesMedicare chief Donald Berwick

The regulatory process isn’t supposed to be a black-ops exercise, but expect many more such nontransparent improvisations under the vast powers ObamaCare handed the executive branch. In July, the White House bypassed the Senate to recess appoint Dr. Berwick, who has since testified before Congress for all of two hours, and now he promulgates by fiat a reimbursement policy that Congress explicitly rejected, all while scheming with his political patrons to duck any public scrutiny.

But if Dr. Berwick’s methods are troubling, the substance is more than defensible. Certain quarters on the political right are following the media’s imagination and blasting Dr. Berwick’s decision as the tangible institution of death panels. But the rule-making is not coercive and gives seniors more autonomy, not less.

The affront is that Medicare needs to sneak around in order to offer a type of care that is routine in private insurance. If the medical experts in Congress haven’t decided that some treatment or service is worthy of the fee schedule, then the program won’t pay for it even if it is in the best interests of patients.

In this case, fully a fifth of the U.S. population will be over age 65 inside of two decades, and whatever the other marvels of modern medicine, the mortality rate remains 100%. Advance care planning lays out the options and allows patients, in consultation with their providers and family members, to ensure that their future treatment is consistent with their wishes and moral values should they become too sick to decide for themselves.

The real death panel myth is that the term ever had anything to do with something so potentially beneficial. We wrote at the time that Sarah Palin’s coinage was sensationalistic, but it was meant to illustrate a larger truth about a world of finite resources and infinite entitlement wants.

Under highly centralized national health care, the government inevitably makes cost-minded judgments about what types of care are “best” for society at large, and the standardized treatments it prescribes inevitably steal life-saving options from individual patients. This is precisely why many liberals like former White House budget director Peter Orszag support government-run health care to control costs: Technocrats in government can then decide who gets Avastin for cancer, say, and who doesn’t.

Democrats and the press corps accused Mrs. Palin of misrepresentation to avoid reckoning with this inexorable rationing reality that President Obama has himself implicitly acknowledged. In a 2009 interview with ObamaCare advocate David Leonhardt of the New York Times, he called for “a very difficult democratic conversation” about the costs that are incurred in the last six months of life. The President even mused about whether his own grandmother’s hip replacement following a terminal cancer diagnosis represented “a sustainable model.”

The real problem is the political claim that Medicare and other entitlements are imposing on the culture of U.S. health care. Everyone, on the left and right, now behaves as if every medical issue is a political matter that the government or some technocratic panel can and should decide. No wonder “the ‘death panel’ myth” has such currency among Americans who won’t be doing the deciding.