It is a new year and a new Congress, but the changing of the calendar has served only to usher in new controversy on a settled subject; health care reform. The Affordable Care Act, passed by majorities in both houses, consolidated into one measure according to congressional rules, and signed by the President, is under attack by revisionist conservatives. Lacking any real, democratic basis for repealing the measure, the conservative mainstream media revived the original law’s biggest boogieman; the Death Panel.
You remember the Death Panel, don’t you? A relic from the battle over Clinton’s health care initiative, Betsy McCaughey, went on the Fred Thompson radio show and blew the debate over health reform wide open. She used an increasingly common (and embarrassingly bipartisan) technique for accomplishing her goal; she took a clause out of the bill and lied her ass off about it. Once she let the false cat out of the bag, Governor Palin and others fanned the flames into an inferno. What once was a debate about various market-based fixes to a broken health care delivery system, degenerated quickly into shouting matches and shrill accusations.
The real tragedy of this event goes far beyond the politics or economics of health care reform. Death panel or “end-of-life counseling”, whatever label one uses to describe the rule, don’t relate to a liberal versus conservative issue; this is a Terri Schiavo issue. You might remember the young women who fell into a vegetative state and became the subject of national attention? Her husband made the decision to remove her feeding tubes, believing that is what his wife would have wanted. Her parents filed suit to stop the action, and a court had to make the final decision. In our country, the Schiavo story is repeated on some level every day; terrible decisions and arguments over the desires of loved ones whose wishes can never be known, tear apart thousands of families.
Most American don’t understand the legal options available to them regarding this reality; the fact is we will all die, and many of us will be unable to make decisions regarding how we are cared for as our death approaches. What is more shocking than our own lack of knowledge, is that many practicing physicians share the ignorance. Living wills, medical power of attorney orders, do not resuscitate (DNR’s), and orders for palliative care are all concepts we should understand. If you want to be kept alive along as there is a glimmer of hope, you say so in your living will. If you don’t want to be subject to 90 minutes of chest compressions and other interventions if you have a major heart attack at 90, then you have a DNR. These objects cover the gamut of options for us at the end of our lives, from fighting at all cost to sliding quietly away.
Politically, providing seniors with information about these options, via their general practitioner, seemed like an excellent choice. The first steps to this counseling were taken in the Medicare legislation of 2004, which was a Republican-sponsored law. When Democratic staffers inserted the same essential clause into the structure of the proposed public option, they undoubtedly thought it would be the least controversial measure in the bill. And why not, this is how the infamous Death Panel clause read:
H.R. 3200, page 425: Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning … .
(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders …
Not exactly the stuff of rampant government gone crazy is it? As the public option did not survive the process, the rewritten version of this clause (which was substantially longer to crowd out the potential for controversy), did not appear in the final bill. President Obama sought to rectify this by writing the rule directly into Medicare and providing the funding necessary to compensate doctors for these services. The political nonsense referred to above made this move impossible, and more is the pity. Contrast the clause above and the intent of the rules, with new Speaker of the House John Boehner’s interpretation:
This provision may start us down a treacherous path toward government-encouraged euthanasia.
This is politics with integrity and the Speaker’s attempt to “restore civility” to the House? This is the political straw man all over again. This is the same old dysfunctional politics, built on the premise that one does not need to prove that a measure is wrong, one only needs to scare the public. The lack of public knowledge about the medico-legal realities at the end of our lives costs money for sure; more importantly, it is a destructive force on American families that is easily remedied. The Obama Administration was forced to pull back from this measure despite the fact that some conservative stalwarts, pro-life groups to name one, are starting to consider the rules on their merits rather than the politics.
Political branding and the label wars are a part of the process now, as distressingly normal for our democracy as voting. But we the people can take small steps towards the restoration of sanity in our government by calling the politicians and the pundits on the carpet when they use tactics like these. This is an issue worth a real, honest, all-encompassing discussion in our nation, and the John Boehner’s of the world have consigned it to target drone status. Some things, I believe, are too important to be political footballs.
The Rational Middle is listening…