Friday, August 14, 2009

"Death Panels", Obama, and Palin

Sara Palin's description of the "Advanced Care Planning Consultation" provisions in the House Health Care Bill as "Death Panels" illicited a response by Obama in a recent townhall meeting.
“Let me just be specific about some things that I’ve been hearing lately that we just need to dispose of here. The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma because we’ve decided that we don’t, it’s too expensive to let her live anymore....It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, etc. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready on their own terms. It wasn’t forcing anybody to do anything.” [1]
Well, Palin shot back in a Facebook posting which reiterates the very valid concerns about what these consultations will actually result in.
The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” [2] 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." [3] 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. [4]

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.” [5] 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?” [6]

As Lane also points out:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.

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? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:

Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives.... It is egregious to consider that any senior citizen ... should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. [9]

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.” [10] 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.” [11]

President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.
Facing off vulnerable, ill, elderly seniors with a doctor about end of life care raises very legitimate concerns about overreach and pressure to sign documents which will end their lives sooner and even prematurely. Knowing the worldview of the bill's proponents regarding abortion, should shed some light on how they might interpret a provision addressing end of life decisions. The specter of euthanasia is not an alarmist concern.


Elaine said...

Fear tatics can only go so far.

Lead with Positive Motion, and Concern for the Nation and Health care.

This is what our president is doing.

You scare, and bully people into submission.

Claude said...

The fake-outrage over the non-existent "death panels" is probably the most despicable and transparent political ploy I've seen in my lifetime.

here are some facts some numbers.

Weekly Tracking Poll: Democrats Win First Round of Town Hall

PRESIDENT OBAMA 60 (60) 36 (37) +1

PELOSI: 36 (35) 56 (57) +2
REID: 34 (33) 55 (56) +2
McCONNELL: 16 (17) 66 (66) -1
BOEHNER: 11 (12) 66 (65) -2

CONGRESSIONAL DEMS: 43 (42) 51 (52) +2
CONGRESSIONAL GOPS: 10 (10) 76 (75) -1

DEMOCRATIC PARTY: 45 (44) 48 (49) +2
REPUBLICAN PARTY: 17 (18) 74 (73) -2

Watching this blend of opportunistic charlatans and self-deluded fools in action provides some first-hand understanding of how anyone could have looked at the work of Galileo and said, "But the Earth doesn't move."

Again happened, and is fact and truth.

Elaine said...

Because people need to see more than fox news illererate brainwashing fear tactics.
Op-Ed Columnist
Republican Death Trip
Published: August 13, 2009

“I am in this race because I don’t want to see us spend the next year re-fighting the Washington battles of the 1990s. I don’t want to pit Blue America against Red America; I want to lead a United States of America.” So declared Barack Obama in November 2007, making the case that Democrats should nominate him, rather than one of his rivals, because he could free the nation from the bitter partisanship of the past.

Skip to next paragraph

Fred R. Conrad/The New York Times
Paul Krugman

Go to Columnist Page » Blog: The Conscience of a Liberal
Times Topics: Health Care ReformReaders' Comments
Readers shared their thoughts on this article.
Read All Comments (380) »
Some of us were skeptical. A couple of months after Mr. Obama gave that speech, I warned that his vision of a “different kind of politics” was a vain hope, that any Democrat who made it to the White House would face “an unending procession of wild charges and fake scandals, dutifully given credence by major media organizations that somehow can’t bring themselves to declare the accusations unequivocally false.”

So, how’s it going?

Sure enough, President Obama is now facing the same kind of opposition that President Bill Clinton had to deal with: an enraged right that denies the legitimacy of his presidency, that eagerly seizes on every wild rumor manufactured by the right-wing media complex.

This opposition cannot be appeased. Some pundits claim that Mr. Obama has polarized the country by following too liberal an agenda. But the truth is that the attacks on the president have no relationship to anything he is actually doing or proposing.

Right now, the charge that’s gaining the most traction is the claim that health care reform will create “death panels” (in Sarah Palin’s words) that will shuffle the elderly and others off to an early grave. It’s a complete fabrication, of course. The provision requiring that Medicare pay for voluntary end-of-life counseling was introduced by Senator Johnny Isakson, Republican — yes, Republican — of Georgia, who says that it’s “nuts” to claim that it has anything to do with euthanasia.

And not long ago, some of the most enthusiastic peddlers of the euthanasia smear, including Newt Gingrich, the former speaker of the House, and Mrs. Palin herself, were all for “advance directives” for medical care in the event that you are incapacitated or comatose. That’s exactly what was being proposed — and has now, in the face of all the hysteria, been dropped from the bill.

Yet the smear continues to spread. And as the example of Mr. Gingrich shows, it’s not a fringe phenomenon: Senior G.O.P. figures, including so-called moderates, have endorsed the lie.

Senator Chuck Grassley, Republican of Iowa, is one of these supposed moderates. I’m not sure where his centrist reputation comes from — he did, after all, compare critics of the Bush tax cuts to Hitler. But in any case, his role in the health care debate has been flat-out despicable.

Elaine said...


Last week, Mr. Grassley claimed that his colleague Ted Kennedy’s brain tumor wouldn’t have been treated properly in other countries because they prefer to “spend money on people who can contribute more to the economy.” This week, he told an audience that “you have every right to fear,” that we “should not have a government-run plan to decide when to pull the plug on grandma.”

Again, that’s what a supposedly centrist Republican, a member of the Gang of Six trying to devise a bipartisan health plan, sounds like.

So much, then, for Mr. Obama’s dream of moving beyond divisive politics. The truth is that the factors that made politics so ugly in the Clinton years — the paranoia of a significant minority of Americans and the cynical willingness of leading Republicans to cater to that paranoia — are as strong as ever. In fact, the situation may be even worse than it was in the 1990s because the collapse of the Bush administration has left the G.O.P. with no real leaders other than Rush Limbaugh.

The question now is how Mr. Obama will deal with the death of his postpartisan dream.

So far, at least, the Obama administration’s response to the outpouring of hate on the right has had a deer-in-the-headlights quality. It’s as if officials still can’t wrap their minds around the fact that things like this can happen to people who aren’t named Clinton, as if they keep expecting the nonsense to just go away.

What, then, should Mr. Obama do? It would certainly help if he gave clearer and more concise explanations of his health care plan. To be fair, he’s gotten much better at that over the past couple of weeks.

What’s still missing, however, is a sense of passion and outrage — passion for the goal of ensuring that every American gets the health care he or she needs, outrage at the lies and fear-mongering that are being used to block that goal.

So can Mr. Obama, who can be so eloquent when delivering a message of uplift, rise to the challenge of unreasoning, unappeasable opposition? Only time will tell.

Claude said...

Palin hasn't always been against end-of-life counseling. As Alaska governor, she signed a proclamation making April 16, 2008, Healthcare Decision Day with the goal to have health care professionals and others participate in a statewide effort to provide clear and consistent information about advance directives.

The proclamation noted that only about 20 percent of Alaskans, and 50 percent of severely or terminally ill patients, have an advance directive. "It is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about advance directives," it said.

Claude said...

The accepted definition of end-of-life planning means thinking ahead about the care you would like to receive at the end of your life – which may include the choice to reject extraordinary measures of life support, or the choice to embrace them. For instance, the National Library of Medicine describes end-of-life services as “services [that] are available to help patients and their families deal with issues surrounding death.” This can include making decisions about treatment, designating a health care proxy, choosing a hospice program and putting together a living will, all of which the bill mentions explicitly as being part of an advance care planning consultation. In a 2003 study, the Agency for Healthcare Research and Quality found that “[p]atients who talked with their families or physicians about their preferences for end-of-life care had less fear and anxiety, felt they had more ability to influence and direct their medical care, believed that their physicians had a better understanding of their wishes, and indicated a greater understanding and comfort level than they had before the discussion.”

Furthermore, the bill would not make these sessions mandatory. It modifies section 1861(s)(2) of the Social Security Act, defining what services Medicare will pay for – if these definitions made treatments mandatory, seniors would all be required to get artificial legs and midwife services, too. In other words, this section of H.R. 3200 would require Medicare to pay doctors when they counsel their patients about such things as living wills, but no more frequently than once every five years, unless there’s a significant change in health status. “Both myself and our outside counsel have reviewed section 1233 of the House bill, and neither one of us can reach the conclusion that it is a mandatory consultation for Medicare and Medicaid beneficiaries,” Jon Keyserling, vice president of public policy at the National Hospice and Palliative Care Organization, told us. “The opportunity for the consultation is not only voluntary but patient-initiated.”

ABC correspondant Jake Tapper contacted Palin to find out what part of the bill contained the “death panel.” A spokesperson referred him to the same “advanced planning care consultation” section that McCaughey referred to in her remarks.

Apparently Sarah Palin doesn’t know too many of the facts about the health care bill. That’s not too surprising, since she could not name a single newspaper or magazine she reads. Instead, she sticks to rhetoric in her facebook postings. The good old argument from outrage is a favorite in politics, as well as the straw man and appealing to people’s fears. Palin’s claims have no basis in reality

Elaine said...

The news papers across the nation and the world has debunked all of this.

Do your fact checking, your research, and listen to more than just one outlet the extremist religious colonizing right that want to control with their power and greed.

Amy said...

Palin's claim sounds a little like another statement making the rounds, which says that health care reform would mandate counseling for seniors on how to end their lives sooner. We rated this claims Pants on Fire! The truth is that the health bill allows Medicare, for the first time, to pay for doctors' appointments for patients to discuss living wills and other end-of-life issues with their physicians. These types of appointments are completely optional, and AARP supports the measure.

Herb said...
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Herb said...

Please dear readers do your research.

These scare tactics are not just fear tactics they are down right lies.

Your so called leaders are lieing to you.

Just as they did with Iraq. They will go as far as illegal acts to pull the wool over your eyes.

Do NOT let them scare you from the one most important act that Obama can do for all Americans, which is to ensure Health care for all citizens. I would think as true Christains that this would be the first thing all of you would jump at. To ensure that all people are taken care of, and through the same acts of you putting your dimes into the baskets each week at church you will need to put your tax dimes into the baskets to cover yourselves, your neighbors, the ones you love, the ones you say you love but hate the sin of their lives. What ever the case, this is about reform of the best kind.

Jesus was a Liberal said...
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Jesus was a Liberal said...
This comment has been removed by the author.
Jesus was a Liberal said...

I found this one article to be very profound.

I tried to copy it here but I am not very text savey

As a pro christ site, I am hoping that you will change your attitude on health care reform.

I understand your wants to not cover cost for items you find offensive in your religion. Such as abortions.

But that is not what this health reform is about.

Its about a very sound justice.

Its about service to all men.

Its what Jesus would have wanted.

Continue your voices in the public on change on moral ground, you are covered by the first admendment to do so.

But to lie to your public and to use fear to make them follow is wrong.

ex-right-wing said...
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ex-right-wing said...

Remember the 2003 Medicare prescription drug bill, the one that passed with the votes of 204 GOP House members and 42 GOP Senators? Anyone want to guess what it provided funding for? Did you say counseling for end-of-life issues and care? Ding ding ding!!

So either Republicans were for death panels in 2003 before turning against them now--or they're lying about end-of-life counseling in order to frighten the bejeezus out of their fellow citizens and defeat health reform by any means necessary.

ex-right-wing said...

Let's go to the bill text, shall we? "The covered services are: evaluating the beneficiary's need for pain and symptom management, including the individual's need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning." The only difference between the 2003 provision and the infamous Section 1233 that threatens the very future and moral sanctity of the Republic is that the first applied only to terminally ill patients. Section 1233 would expand funding so that people could voluntarily receive counseling before they become terminally ill.

Anonymous said...

Isn't it God's Will to have end of live planning?

Former Alaska governor signed a proclamation urging medical professionals to participate in end-of-life planning, only she called it "advance directives." If the phrase "advance directives" will ease public apprehensions, by all means call it that.

In fact, end-of-life planning exists in law now. Medicare requires hospitals, nursing homes and hospices to tell patients of their right to accept or refuse treatment and to urge them to make a "living will" and designate a proxy to see that it is carried out if they are incapacitated.

Terrence said...

Sarah Quoted
"The rationing system proposed by one of President Obama’s key health care advisors is particularly disturbing. I’m speaking of the “Complete Lives System” advocated by Dr. Ezekiel Emanuel, the brother of the president’s chief of staff. President Obama has not yet stated any opposition to the “Complete Lives System,” a system which, if enacted, would refuse to allocate medical resources to the elderly, the infirm, and the disabled who have less economic potential."

ironically, it's Emanuel himself who's proven that cutting back on end-of-life care wouldn't make much of a dent in total healthcare spending.

I see nothing forward thinking in any of these statements and arguements on the health care bill.

I see only the want to take down the one thing all of us need, which is health care.

Canada is doing great on this type of bill. I have relatives In Toronto. The lies of long lines, people turned away is again a lie.

My family loves the coverage and is striving in the politics of our country to the north. So are all their friends and family.

Please readers do not believe all that is written here. Travel, go outside the country, talk to people around the world.

We are young as politics goes and we are seen as that through out the world.

The last eight years has taken down all our dignity. It is time to regain it. With health care for all people is a huge start.

The debates on if health care should cover abortions, end of life dealings will continue. The healthy debate will allow us to grow as a nation.

I believe that to be circumcised is wrong, but do I pose that onto all people? of course not.

I am a buddhist. I am a Man. I do not think that all people should follow my thinking, but I feel that there is room for all thinking.

I think we all need to take care of each other.

Health care is the first step to do this.

Anonymous said...

The only Death Panel there is, is the one we will have if we dont have health care reform.

For all the scare tactics out there, what is truly scary is if we do nothing...For all the chatter and the yelling and the shouting and the noise, what you need to know is this: if you do have health insurance, we will make sure that no insurance company or government bureaucrat gets between you and the care you need

Besides, as long as they have a good product and can sustain themselves, private insurers should have no problem competing with the dumpy government plan.

Ups and Fedex are doing just fine, its the post office thats always having problems!

This is about having choices.

For those who dont have a choice.

But perhaps you are in favor of not allowing the poor, the middle class to access to health care.

larry said...

I am a republican, I am a Christain, i can only see benefits from health care reform.

My faith, and my politics do not always mix. but I try to combine them.

I believe its time to change the path the focus on the family is going.

To be able to have more people follow, we need to follow Christs laws. Which is to accept all people, and to take care of all our Christs creatures.

I am sadden by Abortion, I am also sadden by death penalties and by war.

I am sadden that we do not take care of our own people and go to other countries and destroy theirs.

I am sadden that we have not rebuilt New Orleans.

I am sadden by the fear that is brought to the people to try and get them to leave the true flock of Jesus.

goosetheliberal said...

Once again the extremist groups and Lies make us a laughing stock in the world. The lies Palin stated, and the alarmist tactics have caused huge relationship ties over seas.

Brittan is demanding appologies from our Nation for the lies people like the MFC have stated that their health care system isn't working. Which is is. Canada does not have huge days wait for a broken finger, and worst of all there is no death panel syndrome in the stated health care reform bill.

The mfc should provide for a full on appology for the lies.

Elaine said...

Goose, The MFC will never appologize. It has been caught fully here. Gut response on me though is that they don't care. I just hope their followers see and understand the lies.

the news is covering all angles on this lie and the world is laughing at us.

Claude said...

The specter of euthanasia is not an alarmist concern.

How do you explain your article now that millions of people have been shown the truth on this matter? And even conservatives have been quoted on the fact that Palin spoke out of turn? which is a nice way to say she lied?

Will you appologize? Will you say that this article is a mistake?

Elaine said...

I see since the facts can not be distorted anymore that the mfc will not give answer to any of the comments put here.

Elaine said...

I am still waiting for a response on how your posting was irresponsible and dangerous to be so much of an alarmist.

It was not justified, and it was plain lies.