Talk about the end

Six years after the idea was scuttled by Sarah Palin’s talk of “death panels,” Medicare announced that it plans to reimburse doctors for conversations with patients about care at the end of life. Perhaps this time around, Americans are ready to acknowledge the wisdom of having these conversations.

As it is, 80 percent of Americans say they want to discuss end-of-life treatment with their doctors, but only 7 percent of seriously ill patients ever do. Medicare’s proposal is a modest move toward encouraging a crucial discussion, serving people’s wishes, and improving the quality of care.

Though many people say they would prefer to avoid fruitless medical procedures and want to die at home rather than in a hospital attached to tubes and machines, intervention remains the health system’s default mode. Medicare is often more likely to pay for open-heart surgery on a dying patient than for hospice care. Medicare spends 28 percent of its budget on patients’ last six months of life, and it’s been estimated that up to 30 percent of these expenses have no meaningful impact—except, in many cases, to prolong and increase suffering.