America's Heartland: Cradle Of 'Death Panels'

Nobody in La Crosse, Wisconsin, ever thought the local hospital's initiative to help people prepare for the inevitable end of life would become a talking point in the national debate on health overhaul.


But that's what happened to Gundersen Lutheran, the flagship hospital of a health system serving three Midwestern states, after a House health bill included a provision this spring to allow Medicare to pay for end-of-life counseling, the Washington Post reports. Gundersen Lutheran had pushed for Medicare to pay for the work.

It didn't take long for opponents of the administration's plans to remake health care to label these counseling sessions "death panels" and hold them up as Exhibit A for the government's intrusion into the most personal of health decisions. No matter that the characterization has been pretty much debunked. If there's one part of overhaul plans most likely to be dropped, it's government payment for end-of-life counseling, now a political "third rail."

"It's really distressing," medical ethicist Bud Hammes told the Post. "These things need to be addressed."

Gundersen Lutheran began blazing a trail to improve end-of-life planning and care in the 1980s. The community-wide approach enlists churches and even the rival hospital in town to get the message out. A case study of Gundersen Lutheran published last month by the Commonwealth Fund noted 96 percent of 400 residents who died in the hospital's home county in recent years had an advanced directive or similar orders for physicians.

In combination with improved palliative care, the end-of-life initiatives of the hospital have resulted in Medicare spending of about $18,000 in the last two years of life, 29 percent less than the national average of nearly $26,000.

A retired teacher in her 70s told the Post she and her husband signed directives a decade ago, explaining, "We all die, and we want to do so with the most dignity and most control."



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