Blogging for the 99% and the preservation of our Democracy against the Corporatists and the Citizens United ruling.
Sarah Palin, unwilling to ever back down about anything, or keep from responding to what she feels is an attack, went on the offensive saying that the health care reform bill *does* indeed contain language about “Death Panels”.
The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.
Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual … or upon admission to a skilled nursing facility, a long-term care facility… or a hospice program.” During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services.
Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones…. If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?”…
Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens….An obvious example is not guaranteeing health services to patients with dementia.” Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.”
Even columnist Eugene Robinson, a self-described “true believer” who “will almost certainly support” “whatever reform package finally emerges”, agrees that “If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.” [8]
So are these usually friendly pundits wrong? Is this all just a “rumor” to be “disposed of”, as President Obama says?
It’s an “Advanced Directive”. I fault the Republican Senator Isakson, for introducing the bill in terms of using the unfortunate phrase “end-of-life counseling” on his senate page at:
http://isakson.senate.gov/floor/2008/042408healthcare.htm
What end-of-life counseling (such a bad term) means is that whether you are 20 years old or 90 years old, you can tell the doctors to go all out and do everything it takes to keep you alive, or you may stipulate that if you have no hope of recovery, not to do anything extraordinary to keep your body alive (ventilator, feeding tubes, etc.).
Democrats just don’t know how to communicate like Republicans so the public gets it. Democrats need to go to “slogan school”. There needs to be a Democratic version of Frank Luntz, just less evil.
Dr. Ezekial Emanuel’s article in the Lancet talked about the hypothetical rationing of things like flu vaccine should the need ever exceed the supply. It’s well thought out, but morally and ethically extremely difficult to discuss without being offensive and scary.
He is basically describing the “lifeboat” example, where the lifeboat is already full, but there are more people to be rescued from the shipwreck still in the water. Do you say, “No More!, Or else we won’t survive”? Or do you say, “Get into the boat -we’ll just have to take our chances”. Do young people count more than old people? Should some who are injured be tossed out in favor of those who are uninjured, and have a greater chance of survival?
I think there would be a vigorous debate about those options among the people within the lifeboat, each with their own point of view. That is why Republicans are misleading people into thinking that the government is going to end their life if health care reform passes. It’s a topic that easily scares people.
As for Eugene Robinson’s remarks in Sarah Palin’s quote above? She took them out of context, not including the very next sentence in which Robinson slams Palin:
That’s the reason people are so frightened and enraged about the proposed measure that would allow Medicare to pay for end-of-life counseling. If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending. It’s irresponsible for politicians, such as Sarah Palin, to claim — outlandishly and falsely — that there’s going to be some kind of “death panel” to decide when to pull the plug on Aunt Sylvia. But it’s understandable why people might associate the phrase “health-care reform” with limiting their choices during Aunt Sylvia’s final days.
Eugene Robinson’s criticism was like mine. Don’t phrase things so ghoulishly without thought to how the weakest-minded Americans might interpret these statements. It should have been called something like “Affirmation of Life Decisions.” That would have been hard to distort by insurance company thugs.
The unfortunate thing to realize is that the private insurers are actually doing this to Americans now. It has been estimated that 18,000 unnecessary deaths occur each year because people lack health insurance coverage. In addition, private insurance company’s have their own “Death Panels” to deny care to young and old alike, despite them having paid their premiums with full expectation of having insurance when needed to save their lives.
Here is Lino Pino, M.D., describing to Congress how she wrongfully denied coverage to a patient and it cost him his life. She also admits to denying other needed health care for the sake of the insurance company’s profits:
