We'll be hearing a lot from politicians this summer and fall about the urgency of dealing with Medicare spending, which will begin to rise sharply in the coming years as increasing numbers of the country's 75 million baby boomers turn 65.
If we're fortunate, some courageous candidates will call for renewed debate on a provision of the health care reform bill that had once enjoyed bipartisan support. The one that spineless Democrats decided had to be yanked when a certain former vice presidential nominee claimed, falsely, that it would create government-run "death panels."
Medicare expenditures now total more than half a trillion dollars annually, representing 15 percent of federal spending. The only programs to which the government devotes more dollars are Social Security and national defense, both of which consume 20 percent of yearly federal outlays.
The Congressional Budget Office projects that the average annual growth in Medicare spending will be 5.8 percent between 2012 and 2020. It would have been one percentage point higher than that, according to the CBO, if not for the cost-constraining provisions of the Affordable Care Act, most notably the one that will gradually eliminate the bonuses the government pays private insurers to participate in the Medicare Advantage program.
The Affordable Care Act might have been able to curtail spending further if it hadn't been for Sarah Palin's reckless rhetoric. It was Palin who charged that a provision of the law allowing Medicare to pay doctors for having end-of-life discussions with their patients would lead to government-run "death panels."
That provision was important because, according to the Congressional Research Service, about one-fourth of total Medicare spending is for the last year of life, and a lot of that spending could be avoided if more folks received counseling from their doctors on what they should do to ensure that their wishes are carried out when the grim reaper comes calling.
No one understands this better than Dan Morhaim, an adjunct professor in the Johns Hopkins Bloomberg School of Public Health and deputy majority leader of the Maryland House of Delegates. Morhaim, who also has been an emergency room physician and internist, has seen many cases in which people were hooked up to machines in vain attempts to restore their health -- so many, in fact, that he wrote a book that should be required reading on Capitol Hill.
After reading Morhaim's book, The Better End -- Surviving (and Dying) on Your Own Terms in Today's Modern Medical World, you'll want to be sure you have a living will or advance directive in place -- for your own good, for your family's good and for your country's as well.
Advance directives, which allow you to specify the kind of care you want as you approach the end of life, "offer something rare and important in our modern medical system," Morhaim wrote. "They provide an opportunity to exert influence."
And that's never been more important, Morhaim contends. "As the baby boom generation reaches its senior years, as new lifesaving medical treatments are announced almost weekly and as our health care system confronts a crisis of affordability, the need is urgent for ordinary people to demand participation in end-of-life decisions."
Another physician lawmaker who once shared Morhaim's passion on this issue is Rep. Charles Boustany of Louisiana. Boustany, a heart surgeon, was one of three Republicans who cosponsored a bill in 2009 that formed the basis of the provision Palin maligned and mischaracterized.
When other Republicans began adopting Palin's talking point, Boustany was forced to defend his support of the original bill. He was quoted as saying that he knew of many situations in which a critically ill patient hadn't made his wishes known, leaving family members with the burden of making end-of-life treatment decisions. "This happens every day, multiple times, in hospitals across the country," he said. "It's a very important issue."
The principal sponsor of the legislation, Rep. Earl Blumenauer, D-Ore., said he was stunned when the controversy erupted. "It's just beyond bizarre," he told reporters at the time, noting that his bill had broad bipartisan support before Palin posted the death-panel charge on her Facebook page.
What was a good idea then is a good idea now, but Palin so poisoned the well that not a single Republican, not even Boustany, will go near it, certainly not in an election year. Blumenauer has reintroduced the measure as a stand-alone bill, and it has several cosponsors. But as you might imagine, all of them are Democrats. And because Republicans now control the House, Blumenauer hasn't even been able to get a hearing on the measure.
There is still some hope that the bill might someday become law. Boustany indicated in a 2009 interview that he and other proponents might be willing to back it again "at some point when the temperature has cooled down."
Many families -- and the Medicare program -- will be better off if that moment comes sooner rather than later.