Senate Bill Will Not Address End-of-Life Care: Will President Obama now apologize to critics of H.R. 3200?

Senator Charles E. Grassley of Iowa said that the Senate Finance Committee "dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly." Could be? It gets better. The Iowa Senator then admits that the House legislation was "so poorly cobbled together that it will have all kinds of unintended consequences."

President Obama, who always seems to be calling for "reason, calm and dialogue," should follow his own advice. Speaking to a crowd of about 1,800 at Portsmouth High School in New Hampshire, Obama was quoted as having said that opponents of H.R. 3200 [and most especially those concerned over Section 1233] "will try to scare the heck out of folks and they'll create bogeymen out there that just aren't real." But this bogeyman was real. Which is why the Senate Finance Committee is dropping the end-of-life provisions.

This isn't the first time the president has attempted to demonize his opponents. Just recently he went on record as saying that Americans who disapprove of homosexuality are clinging to "worn arguments and old attitudes." Clearly no one has ever gifted Obama with a copy of Dale Carnegie's best-selling book.


Sophocles, in Antigone 1. 1023, says, "Stubborness and stupidity are twins." How so? Dr. Montague Brown explains as he makes the distinction between tenacity and stubborness: "Tenacity is the dedicated adherence to something we know to be worthwhile. As such, tenacity is positive. It involves a clear purpose - to persevere in what is good - and welcomes new evidence and perspectives that clarify or enrich that good...Tenacity is particularly evident when the adherence required is difficult. If my perseverance requires great effort of body or mind, or if it requires me to face a great deal of peer pressure and perhaps even ridicule, then my holding fast to my good purpose shows strength of mind and courage. In such cases, there may be little to gain in terms of social standing, but much in moral standing. Tenaciously holding to what is true and good not only benefits me in terms of virtue; it also works to ensure the stability of these goods in the community....Stubborness is the uncompromising insistence on having our own way. As such, stubborness is negative. It involves a kind of blindness, along with a willful rejection of evidence and the perspectives of others. Stubborness is particularly evident when the compromise required is easy. If the evidence I need to convince me to change my mind is readily available, or if accepting another's perspective would mean giving up little of importance, then my refusal to yield is not reasonable, but is motivated by stubborness. There is little to lose except my desire to be in control. Such rigid clinging to my own will hurts the community, because I refuse to cooperate with others, and it also prevents me from becoming successful and virtuous." (Dr. Montague Brown, Ph.D, The One-Minute Philosopher, pp. 162-163, Sophia Institute Press).

Is President Obama tenacious or stubborn? Is he interested in creating real and meaningful dialogue or demonizing his opponents? His track record, thus far, provides us with an answer.

Sarah Palin responds to President Obama on Facebook

Concerning the "Death Panels"
Yesterday at 8:55pm

Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly, and the disabled would suffer the most under such rationing; and that under such a system these “unproductive” members of society could face the prospect of government bureaucrats determining whether they deserve health care.

The President made light of these concerns. He said:

“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]

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. [7]

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.

[1] See http://blogs.abcnews.com/politicalpunch/2009/08/president-obama-addresses-sarah-palin-death-panels-wild-representations.html.
[2] See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[3] See HR 3200 sec. 1233 (hhh)(1); Sec. 1233 (hhh)(3)(B)(1), above.
[4] See HR 3200 sec. 1233 (hhh)(1)(E), above.
[5] See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[6] See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html].
[7] Id.
[8] See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.html].
[9] See http://www.nysenate.gov/press-release/letter-congressman-henry-waxman-re-section-1233-hr-3200.
[10] See http://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf
[11] See http://www.scribd.com/doc/18280675/Principles-for-Allocation-of-Scarce-Medical-Interventions.

Related reading here and here. It was President Obama who said: "The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health-care bill out here." See here.

Critics of the president's health-care bill don't have to create "bogeymen." Not when they have statements like the one above.

Catholic League: Bill implies federal government may become involved in euthanasia

Bill Donohue, president of the Catholic League, issued the following statement in response to Section 1233 of H.R 3200, the health care reform bill that was introduced in the House:


There is language in this section of the bill that implies that the federal government may become involved in euthanasia. So over the past two days, July 27-28, Catholic League staff contacted the following persons, committees or offices looking for clarification:

Rep. Nancy Pelosi; Rep. John Dingell; Rep. Rob Andrews; Rep. Frank Pallone, Jr.; Rep. Charles Rangel; Rep. Pete Stark; Rep. Henry Waxman; Rep. George Miller; Rep. Dale Kildee; Rep. Carolyn Maloney; Health and Human Services (HHS) Secretary Kathleen Sebelius; HHS Center for Faith-Based and Community Initiatives; HHS Office of the Assistant Secretary for Aging; HHS Office of the Deputy Assistant Secretary for Legislation for Discretionary Health Programs; HHS Office of the Deputy Assistant Secretary for Legislation for Mandatory Health Programs; HHS Office of the Assistant Secretary for Planning and Evaluation; HHS Congressional Liaison Office; HHS Office of Human Services Policy; HHS Office of Disability, Aging and Long-Term Care Policy; HHS Office of Planning and Policy Support; HHS Office of the Deputy Assistant Secretary for Legislation for Human Services; Ways and Means Committee; Education and Labor Committee; Energy and Commerce Committee; Oversight and Government Reform Committee; Budget Committee; White House Health Reform Office.

No one with whom we spoke said the government is entering the business of euthanasia. But this is not enough. We need to know exactly what is meant by the following: “An explanation by the practitioner of the continuum of end-of-life services and supports available….” We also need to know exactly what is meant by “The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning….” The public has a right to know exactly what is meant by terms like “end-of-life services” and “quality measures.” Now is the time to settle this issue.

Contact healthreform@hhs.gov


Related reading: New Hampshire: En Route to Mass Murder?

New Hampshire House Bill 304 (and especially Section XIII), is chilling. And brings to mind a decree issued by Adolph Hitler in October of 1939 and back dated to September 1, 1939, which widened, "the authority of certain physicians to be designated by name in such manner that persons who, according to human judgment, are incurable can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death."

Is that where health care in the United States is heading? Are we traveling a familar road to euthanasia?

Photo is of Hitler's euthanasia order.