Republicans back away from ‘end of life’ issue

Until last week, Republican Sen. Johnny Isakson was among the most enthusiastic backers of end-of-life counseling in government health care programs like Medicare.

That was before conservatives called it a step toward euthanasia and former Alaska Gov. Sarah Palin likened the idea to a bureaucratic "death panel" that would decide whether sick people get to live. And even though those claims have been widely discredited, the issue remains a political weapon in the increasingly bitter health care debate.

Now, Isakson and other Republicans who eagerly backed the idea are distancing themselves from it or lying low in the face of a backlash from the right.

"Until last week this was basically a nonpartisan issue," said John Rother, executive vice president for policy at AARP, the seniors lobbying group. "People across the political spectrum recognize that far too often people’s wishes aren’t respected at the end of life and there is a lot of unnecessary suffering."

The idea for government-backed end-of-life counseling — while delicate given the subject matter — has garnered significant consensus on Capitol Hill, fueled in part by cases such as that of Terri Schiavo, whose divided family fought for years over whether she would want to be kept alive in a vegetative state.

Just a year ago, Congress overwhelmingly approved legislation requiring doctors to discuss issues like living wills and advance directives with new Medicare enrollees. And the government already requires hospitals and nursing homes to help patients with those legal documents if they want support, under a 1992 law passed under Republican President George H.W. Bush.

Supporters say the current House proposal just goes one step further by paying for the counseling, with the idea that doctors and patients would spend more time on it instead of just having a cursory discussion in an initial Medicare visit. The counseling is voluntary.

Isakson and other Republicans such as Sens. Richard Lugar of Indiana and Susan Collins of Maine have co-sponsored legislation in recent years promoting the counseling, including in initial Medicare visits and through a proposed government-run insurance program for long-term care.

In the House, Republican Reps. Charles Boustany of Louisiana, Geoff Davis of Kentucky and Patrick Tiberi of Ohio co-sponsored legislation from Rep. Earl Blumenauer, D-Ore., that would authorize Medicare to pay for the counseling. That measure served as a model for the current House language.

Earlier this summer, Isakson sponsored an arguably more far-reaching measure that would have required that new Medicare patients have a living will or other advance directive.

But the Georgia conservative found himself in a storm of criticism when President Barack Obama said at a town hall meeting this week that Isakson was a chief architect of the House approach. Isakson quickly issued a statement repudiating the proposal.

"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," he said.

Pressed later to explain his opposition, Isakson and his spokeswoman, Joan Kirchner, said he doesn’t like the fact that the House bill would expand Medicare costs by paying for the consultations and giving doctors an incentive to conduct them. He also said the House bill is too specific in detailing what must be discussed in the sessions.

"There are similarities … but there are substantial difference," Isakson said. "I’m not running away from anything but I’m not going to accept the president of the United States telling people I wrote something that I didn’t."

Isakson, who initially called Palin’s "death panel" characterization "nuts" in an interview Monday, declined later in the week to criticize Palin’s statement, in which she said the measure would force people like her baby Trig, who has Down syndrome, "to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide … whether they are worthy of health care."

"The best I can read she’s applying the House bill and using her child with Down syndrome as an example," Isakson said. "I would never question anyone’s defense of their child."

Spokesmen for Lugar and Collins — two other longtime proponents of end-of-life planning — declined to comment on the House bill.

Sen. Charles Grassley, an Iowa Republican and a lead negotiator on health care legislation, told constituents at a community meeting last week that they have good reason to fear the proposal.

"I don’t have any problem with things like living wills, but they ought to be done within the family," he said. "We should not have a government program that determines you’re going to pull the plug on grandma."

Grassley said Thursday that lawmakers negotiating on the Senate version of the health care bill had dropped the provision from consideration, citing how it could be misinterpreted.

Comments like Grassley’s puzzle Rother, who said "it’s been a little disappointing" that more Republicans haven’t stepped forward to defend the legislation.

He and Jon Keyserling, a vice president at the National Hospice and Palliative Care Organization, say there is little difference between the current proposal and past legislation that Republicans have supported. The current bill specifies that the counseling would be covered only every five years to prevent people from overusing it, and describes what the consultations must include.

Keyserling said many people wrongly assume that end-of-life counseling is about terminating treatment. But it really is about making sure a patient’s wishes are known, he said, including if that means continuing life-sustaining treatment in all circumstances.

He said he’s been surprised at the backlash, particularly given the close attention that Congress paid to Schiavo’s case, which he said clearly highlighted the need for better end-of-life planning.

Schiavo was removed from life support in 2005, though the Republican-led Congress and President George W. Bush had intervened in the family dispute in an effort to continue her care.

"I think the House bill is about as innocuous and helpful as possible," Keyserling said. "It’s about making sure people are prepared and informed to make decisions."


  1. storky

    Too late!

    The damage is done . . . to the bill and to the Republican Party.

    Deception may have worked when they were in the majority. Not now. How do they figure criticizing a plan, while offering no alternative makes them look? Petty and disingenuous come to mind.

    Then they take it a step further and distort provisions, some of which were their own contributions, into Death Panels, financial probes and the “slippery slope” toward communism.

    McCarthyist tactics are back. For that alone, they shouldn’t merely be beaten back, but for depriving 50 million fellow citizens of adequate health care, they should be embarrassingly and overwhelmingly routed.

  2. storky

    What Bolsheviks?

    Sorry, your authoritarian delusion doesn’t fly. Your paranoid fantasies don’t affect our reality.

    “Of the people, by the people, for the people”

    In your eyes, Abe Lincoln was a commie!

  3. almandine

    No, but Lincoln was a statist, as evidenced by the Civil War – which he prosecuted to prevent secession of the southern states.

    Authoritarian ?? “Bolshevik” describes members of the [Russian] Social-Democratic Workers’ Party, which started as a grass-roots political movement. They were, of course, co-opted by Lenin and his “visionaries and functionaries” who managed to split them and form the Russian Communist Party. Thus, they were just another well-meaning political party gone bad because of the “Vision at the Top”.

    Deja vu all over again.

    BTW – don’t tell me what I believe, since you clearly don’t know.

  4. storky

    Let me see if I follow:

    Democratic Party ~= Social-Democratic Workers’ Party
    Obama ~= Lenin

    So teabaggers, birthers and deathers are trying to save us from ourselves?

    No thanks! With 9-11, Katrina, two failed wars and an economic collapse to their credit, prognosticators from the right have the poorest of track records.

    “BTW – don’t tell me what I believe, since you clearly don’t know.”

    True. I am not qualified to probe those depths of delusion.

  5. storky

    Yeah, if you ignore 90% of what I’ve posted.

    So is my assessment of your post correct?
    – – – – – –
    Democratic Party ~= Social-Democratic Workers’ Party
    Obama ~= Lenin
    – – – – – – –
    Is that what you believe?

  6. almandine

    An historical look at you posts confirms that OVER 90% contain ad hominem attacks as the modus operandi. It seems that anybody with an alternative opinion is below your standards.

    The Social Dem Workers Party exceeded our own Dems in the commitment to action, the willingness to strive behaviorally for their cause, the fervor with which they fought for their ideals. Our Dems are complacent… eagerly willing to let the pols carry the load… as if it was being carried to their advantage.

    If current political action is any gauge, maybe the awakening conservatives could best be labeled activist. And not a moment too soon.

    Lenin in the early years was a reformer, a man of change, a visionary to rally round… with much the same goals as Obama. His main goal was to form a permanent contingent of revolutionaries to force his ideas to fruition. Only after many years in power did he become violently authoritarian. Do the two form a mirror? A rhetorical question at best.

    So go ahead… throw your bullshit as best you can… studied debate not being your forte.

    Guess we all have to dance with what got us here, huh?

  7. storky

    OVER 90% contain ad hominem attacks as the modus operandi

    More projection.

    ” It seems that anybody with an alternative opinion is below your standards.”

    I come down fast and hard on disinformation. Post your idle speculation and deluded fantasies all you want, but don’t be surprised by the reaction when what you claim as fact isn’t.

  8. almandine

    I’ll use this thread as mere evidence. The only post without attack was the one immediately after I asked about it, and then back to it again on the next one.

    It’s not about disinformation with you, it’s all about calling names, making ridicule, raising a fist, demonstrating rhetorical control.

    Go ahead. You’re known here for who you are.

  9. danders3

    It’s really a shame, when it comes down to it. Folks should be counciled on end of life options and how to set up the documentation do assure their wishes, and doctors who choose to do so under Medicare shouldn’t have to do it gratis. A good idea gets trampled down because of fear-mongering.

    Dale Anderson

  10. gazelle1929

    The bottom line is that this is making a very large mountain out of a very small molehill. Does anyone think that their doctor is not going to talk to him or her because there is no specific diagnosis code to put down for insurance reimbursement purposes?

    Come on. There are sure to be hundreds of existing codes under which to pigeonhole this discussion.

    This is just the typical BS on the part of the right wing to scare the crap out of uneducated Americans.