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" &amp;quot;It let&amp;#039;s you make your own choice,&amp;quot; says Barbara Aplin, shouldering an oxygen tank on her way to the lunch line here at the senior Community Center in Green Bay, Wisconsin. She is speaking not of her meal options in 2011 but of so-called &amp;quot;death panels,&amp;quot; the more colloquial name for the new Medicare rule now paying doctors to counsel this seventy-six-year-old (&amp;quot;and three-quarters!&amp;quot;) and her fellow senior citizens about end-of-life care. If you listen to the new fear merchants from the right, the rule pushes seniors to opt out of medical treatment that might prolong their lives. But take an afternoon to listen to the actual grandmas, and you get a much different kind of scare. If her children don&amp;#039;t listen to an end-of-life plan, Aplin says, &amp;quot;I&amp;#039;ll come back to haunt them.&amp;quot; Barb can rest easy, because that&amp;#039;s the whole point of what the Sarah Palins and Tucker Carlsons of the world call &amp;quot;death panels&amp;quot; but what Medicare billing will now call &amp;quot;voluntary advance care planning&amp;quot;: Seniors makes up their minds in a conversation with a doctor \u2014 a conversation that the two-dozen seniors and several doctors we spoke with said was happening anyway. No medical compensation for creating an &amp;quot;advanced directive.&amp;quot; No added outcome required. No mention to Medicare (i.e. &amp;quot;the government&amp;quot;) of what the voluntary conversation&amp;#039;s result even was. Just a payment, once per year per patient, to a doctor who spends some time with a patient on the subject of death.  What&amp;#039;s getting Fox News&amp;#039;s granny panties in a twist comes down to a new billing code \u2014 &amp;quot;voluntary&amp;quot; instead of &amp;quot;v66.7&amp;quot; \u2014 that the Obama administration added back in to Medicare regulation on New Year&amp;#039;s Day after dropping it from the rather contentious Section 1233 of the health-care bill. But we couldn&amp;#039;t find a single elderly American on Medicare who was against the provision. &amp;quot;Death panels,&amp;quot; now that they&amp;#039;re going down in a slightly different way, don&amp;#039;t strike those a bit closer to actual death as particularly deadly \u2014 and certainly not as anything new.  &amp;quot;You telling me Medicare is going to change something?&amp;quot; asks a ninety-year-old man named Ken. When I explain to him that the &amp;quot;change&amp;quot; is an expansion of a 2003 (Republican-backed) rule compensating doctors for counseling terminally ill patients \u2014 just without the &amp;quot;terminally ill&amp;quot; part \u2014 he responds, &amp;quot;You mean they didn&amp;#039;t already do that?&amp;quot; When asked if she knew who paid for the counseling that helped set up her advanced directive, seventy-eight-year-old Ruth Thomas replies, &amp;quot;I don&amp;#039;t know. I just went to the hospital and did it.&amp;quot;  A seventy-seven-year-old named Nancy says she created her directive, though her family ended up suffering through heartbreak anyway when her husband, who never bothered to, suffered a stroke. Some feisty old comedian behind me asks her which husband. Apparently Nancy had five.  Eighty-two year-old Alice Engebretson says she set up an end-of-life plan at the hospital but didn&amp;#039;t speak with her doctor. Of the twenty-two seniors who spoke with The Politics Blog since Christmas Day, each one said the &amp;quot;death panel&amp;quot; discussion has become such a popular one that even finding a doctor to have it with can be much more challenging than whether to have it at all. What the Doctors Think Here&amp;#039;s something Fox News won&amp;#039;t tell you: While the controversial billing code for an end-of-life conversation did not exist on Medicare forms until January 1, many doctors had the chat anyway \u2014 uncompensated. One primary-care physician told us that others found a way to bill &amp;quot;for the disease, and then add a v66.7 &amp;#039;encounter for palliative care.&amp;#039; And then I bill by time and code them usually a 99215, as it is usually forty-plus minutes.&amp;quot;  With the new health-care regulation, she says she&amp;#039;ll simply bill for &amp;quot;voluntary advance care planning.&amp;quot; A different check box, as it were. Dan Morhaim, a veteran physician and professor at both the University of Maryland Medical School and Johns Hopkins Bloomberg School of Public Health, remains shocked that conservatives who normally champion individual rights haven&amp;#039;t yet come around to being as supportive of the new rule as the patients already were. &amp;quot;We are in a very unique place in human history when we can empower individuals to take this much control of their own lives.&amp;quot; That the rhetoric around &amp;quot;death panels&amp;quot; has focused on seniors is even more surprising, he says, given that the country&amp;#039;s three most famous end-of-life cases \u2014 Terri Schiavo, Nancy Cruzan, and Karen Ann Quilen \u2014 involve women around thirty years old. Among the multitudes of physicians and medical professionals he knows, Morhaim told The Politics Blog he had encountered not one who was against the new provision. We couldn&amp;#039;t find one either. Who Really Stands to Gain If they really want something to be paranoid about, &amp;quot;death panel&amp;quot; opponents might turn toward the private-insurance industry, which stands to save a pretty penny should advanced directives become more popular. Wendell Potter, former head of communications for insurance giant CIGNA and author of the soul-numbing insurance tell-all Deadly Spin, sees a number of potential gains for private insurers in wake of the new law (if it doesn&amp;#039;t get repealed first). Potter says insurance companies are now more &amp;quot;data companies&amp;quot; than anything else and the new Medicare billing format may be just one more specific data set for tracking patients, outcomes, and the reducing of expenses. What&amp;#039;s more, insurers may discover a financial (if not quite moral) stake in convincing their clients to create end-of-life plans that forgo expensive life-extending care. Potter says that insurers have always been skittish about the subject, but he envisions them offering bonus payments to doctors who get perfectly healthy patients to complete &amp;quot;death panel&amp;quot; directives. And then there&amp;#039;s always an incentive for employers who get employees to fill them out. &amp;quot;In a new job,&amp;quot; Potter says, &amp;quot;we sign a lot of things without always being aware of what&amp;#039;s there.&amp;quot; As for grandma, she&amp;#039;s aware enough to talk with her doctor, and happy not to pay for it herself. &amp;quot;What&amp;#039;s the big deal?&amp;quot; asks eighty-year-old Grace Guenther, raising her voice to get a word in edgewise amongst her fellow residents and their voluminous support of their still-voluntary planning. &amp;quot;It&amp;#039;s normal.&amp;quot; PLUS: Anatomy of the Right Wing&amp;#039;s Death-Panel Meme &amp;amp;gt;&amp;amp;gt; "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.esquire.com/news-politics/news/a9185/death-panels-are-real-4718193/>