CQ TODAY ONLINE NEWS
Aug. 14, 2009 – 9:55 a.m.
End-of-Life Provision Discarded in Senate Overhaul Bill, Grassley Says
By Jane Norman, CQ HealthBeat Associate Editor
Republican Sen. Charles E. Grassley said Thursday that the Senate Finance Committee dropped consideration of end-of-life provisions similar to those that have prompted claims by opponents that the House health overhaul bill authorizes so-called “death panels.”
Grassley, one of the six bipartisan negotiators who have been engaged in talks for weeks on the content of the Finance bill, said in a statement the panel has been trying to avoid “unintended consequences” by working methodically through the consequences of policy options.
“We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly,” Grassley said in a statement. “Maybe others can defend a bill like the Pelosi bill that leaves major issues open to interpretation but I can’t.”
The comments from a top player in the health care talks came as a loud and occasionally unruly debate over the overhaul continued to grip the nation in a sort of trial by town hall meetings, as well as on radio and television talk shows and on the Internet.
Grassley on Wednesday particularly helped raise the noise level when he said at an Iowa town hall that “we should not have a government program that determines if you’re going to pull the plug on grandma.”
Said Grassley: “There is some fear because in the House bill, there is counseling for end-of-life. And from that standpoint, you have every right to fear. You shouldn’t have counseling at the end of life. You ought to have counseling 20 years before you’re going to die. You ought to plan these things out. And I don’t have any problem with things like living wills. But they ought to be done within the family.”
Former Alaska Gov. Sarah Palin popularized the term “death panels” for a provision in the House version of the overhaul bill would authorize Medicare payments for an “advanced care planning consultation” between individuals and doctors, if a patient chose to schedule such an appointment.
While Palin’s claim has been rated as “pants on fire” by the Web site Politifact and refuted by AARP, she’s continued to defend it, saying on her Facebook site that “the issue is the context in which that information is provided and the coercive effect these consultations will have in that context.”
The session is supposed to include an explanation of directives including living wills, durable powers of attorney, and end-of-life services available such as hospice care and palliative care. Orders on how the patient wants life-sustaining treatment to be administered may be written during the consultation.
New sessions also could be authorized when “there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program,” according to the bill.
The liberal talk show host Rachel Maddow on MSNBC labeled Grassley “Dr. Deather” for his Iowa remarks. “That’s not some random, misinformed senior being taken advantage of by the special interests,” Maddow said. “That was actually the senior senator from the state of Iowa.”
A fellow Iowa congressman who represents Grassley’s hometown, Democratic Rep. Bruce Braley , put out a statement saying he was “shocked” by what Grassley said. “This comment is demeaning to seniors who want the choice of consulting with their doctor about important end-of-life health care decisions,” said Braley.
Sen. Claire McCaskill , D-Mo., said Grassley was “just wrong” in his comments. “I’m sure he probably said it in a way that he didn’t mean to,” she said on “Hardball” on MSNBC. “I don’t want to say that he purposely is misleading folks. But it just is not true. We would never do that. It’s wrong morally. It’s not American. And by the way, it’s not even smart politically.”
White House Press Secretary Robert Gibbs was even quizzed about the Grassley comments at the Thursday briefing. “We again will hope to quell the misconceptions that are apparently held even by some in the Senate about what the bill is and what the bill isn’t,” said Gibbs. “But we’ll continue to hope that they can make progress. Now, whether or not it happens, you know, I don’t know.”
But Grassley said the bill is so “poorly cobbled together” that it’s open to misinterpretation. “On the end-of-life issue, there’s a big difference between a simple educational campaign, as some advocates want, and the way the House committee-passed bill pays physicians to advise patients about end of life care and rates physician quality of care based on the creation of and adherence to orders for end-of-life care, while at the same time creating a government-run program that is likely to lead to the rationing of care for everyone,” he said.
In a teleconference with Iowa reporters, Grassley wouldn’t predict what impact the town hall tribulations might have on negotiations, though he said it might be clear very soon if it’s a negative one in terms of moving legislation ahead.
“I think you’d have to ask me that question more the first week of September after we get back after Labor Day because I’m going to have to talk to my colleagues. And maybe — we are going to have to phone conversations this month that we’re in recess,” he said.
“But, you know, we won’t really know until we get back there the full impact. But it could have the impact of stalling it. It could have the impact of starting all over again. Or who knows. It could have the impact that nothing’s changed and you just move ahead.
“But if it’s the latter, it’s still going to take weeks before we get a bill to the president. If we start over again, you know, it’ll probably be more incremental, probably less controversial and maybe get done, but it still will take time to do that.
“Now, if somebody comes to the conclusion this is no time to deal with this issue, I’m sure that conclusion is going to be made and make an impact on the Senate’s agenda early after Labor Day.”
Meanwhile. Sen. Johnny Isakson is fighting back against a comment by President Obama at a town hall meeting in New Hampshire on Tuesday linking Isakson to the end-of-life provisions. Obama, in seeking to dispel fears about the provision, said “the irony is that actually one of the chief sponsors of this bill originally was a Republican — then House member, now senator, named Johnny Isakson from Georgia — who very sensibly thought this is something that would expand people’s options.”
Isakson, however, in a statement said he “vehemently” opposes both the House and Senate bills and played no role in drafting the controversial language.
“The House provision is merely another ill-advised attempt at more government mandates, more government intrusion and more government involvement in what should be an individual choice,” Isakson said.
In July, during hearings of the Senate Health, Education, Labor and Pensions Committee, Isakson said he offered an amendment to the committee’s overhaul bill saying anyone who enrolls in the long-term care benefit included in the bill could use it to obtain assistance in formulating a living will and durable power of attorney. He said the difference is there is no government incentive for doctors to initiate such counseling.
However, Isakson also during the 110th Congress did co-sponsor legislation that never became law and would “provide for coverage of an end-of-life planning consultation as part of an initial preventive physical examination under the Medicare program,” though he has said that the approach in that bill was different.
On the other side of the country, Rep. Brian Baird , a Washington Democrat who’s received death threats, issued a lengthy statement apologizing for saying health care opponents at town halls had a “lynch mob mentality” and “close to Brownshirt tactics.” The second reference is to Nazi followers.
Baird said that “at no point did I compare opponents of health care reform to ‘Nazis,’ certainly I do not believe that to be the case.” But he said his words were “unfortunate” and he regrets them, and he plans to hold his own town hall meetings.
Another congressman, Republican Rep. Jeff Flake of Arizona, wrote House Speaker Nancy Pelosi to quibble with her description of town hall protestors as “un-American,” saying his own town hall meeting drawing more than 2,000 attendees found people with concerns “anything but artificial or manufactured.” He said the group was “far from an angry mob” and the discussion was “civil and courteous.”
On that point, Republicans and the Obama administration may be able to find agreement. “I hate to break it to you: I don’t think all the town halls are as you’re seeing them on TV,” Gibbs told reporters at the Thursday briefing. “While I appreciate that you all have decided that every town hall meeting ends in pushing, shoving and yelling . . . they’re not completely indicative of what’s going on in America.”
• From CQ Top Docs: Grassley Statement | Flake Letter | Baird Statement (pdfs)
This story originally appeared in CQ Healthbeat.
Comments
Counseling 20 years before you die...hm, nice to have that degree of foresight.
Well heck yes there is fear,it is drilled and repeated over and over and over and over,on every single extremist radio and television program not a 15 minute segment will go by with out some fear mongering.Even my local news (not cable) Fox they have jumped on this fear mongering about the death panels.With out a divergent point of view most of the viewers think there is actually a provision and people will have to go before these panels and plead for their lives. I am considering going to these "town hall meetings" and protest myself about the immoral,unethical and dishonest use of this topic. I have prayed several times about this and I am certain god wants me to fight this dishonesty,after all,healing those who could not afford treatment was one of his favorite duties as our savior. I can say god does not want these greedy Insurance companies "protected" from poor people with existing medical conditions,I am positive when god made the earth and all that reside in it he had no intention in the profit margin of an insurance company rejecting treatment as is so common right now.
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