10 Oct

Five years after ‘death panels,’ Earl Blumenauer still wants to talk about death

These days, we see politicians offering all kinds of explanations, from explaining that overheard statements were taken out of context to insisting that the shadowy figure seen on the videotape was a niece.

But hardly anyone has offered a clarification like the one Earl Blumenauer put forth on The New York Times op-ed page in 2009:

“I didn’t mean to kill Grandma.”

It sounded like the start of a press conference by the Big Bad Wolf.

The actual situation seemed to be equally out of a fairy tale. In the multi-month course of Congress’s working on health care reform in 2009, Blumenauer had proposed, and gotten included in the House bill, a provision allowing Medicare and Medicaid to pay for conversations with doctors about end-of-life treatment. It seemed a plausible way to support planning widely encouraged by the medical community.

Then the roof fell in.

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘productivity in society,’ whether they are worthy of health care,” throbbed Sarah Palin. “Such a system is downright evil.”

It was a passionate denunciation of a non-existent policy.

Politifact crowned it the 2009 “Lie of the Year” – an impressive distinction, considering the competition – saying, “We agree with Palin that such a system would be evil. But it’s definitely not what President Barack Obama or any other Democrat has proposed.”

But in the super-heated politics of 2009-10, the charge of “death panels” spread like a runny nose in preschool.

“It fit into the Tea Party medium of crazy talk,” remembered Blumenauer last week. “It was part of an onslaught, a time of outright lies that were treated as acceptable language.”

Did he see it coming? “Not remotely,” he recalled. The idea had gotten through the Ways and Means Committee without complaint from either side.

In fact, he points out the language stayed in the bill the House passed, and just expired in the Senate. But the proposal hasn’t resurfaced since, during four years when the House wasn’t interested in passing anything about health care reform except complete repeal, which it supported about 50 times – becoming itself a death panel, if an ineffectual one.

But Blumenauer persists. “This is my sixth year on the subject,” he diagnoses. “I’m not discouraged.”

At the end of September, he sent the Obama administration a letter, signed by 32 other House members, seeking support for a bill to allow such payments. “Patients who wish to make clear their goals, values and wishes through discussions with their trusted providers,” the letter insisted, “should have the opportunity to do so.”

And the drive has picked up other voices. The American Medical Association statement on elements of final treatment begins with, “The opportunity to discuss and plan for end-of-life care.” Last month, the Institute of Medicine, in a report on “Dying in America,” declared, “advance care planning is critically important to ensure that patients’ goals and needs are met,” and “the advance care planning process can begin at any age or state of health and should center on frequent conversations with family members and care providers.”

Last Sunday in The New York Times, the doctor and journalist Atul Gawande wrote, “First, in medicine and society, we have failed to recognize that people have priorities that they need us to serve besides just living longer. Second, the best way to learn those priorities is to ask about them. Hence the wide expert agreement that payment systems should enable health professionals to take sufficient time to have such discussions and tune care accordingly

None of this means, of course, that there will be actual activity on end-of-life policy, in 2015 or 2016, from a Congress that seems comatose beyond recovery. Whether or not Republicans narrowly gain or narrowly miss control of the Senate this year, they will have a stronger presence in both houses.

Bipartisan progress on controversial bills might have a dim prognosis.

Blumenauer offers a second opinion.

Republicans “are facing a tidal wave in 2016,” he forecasts. “They’re not going to want to have a zero level of accomplishment.”

And, after all, there’s always 2017.

Blumenauer has seen too many strange, unexpected developments on this issue to advise Medicare and Medicaid patients to make doctor’s appointments for end-of-life conversations any time soon.

But maybe when you’ve spent years working on planning for death, you believe some things are inevitable.

NOTE: This column appeared in The Oregonian, 10/8/14

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