Three Important Things That Are Missing From Healthcare Talks

The healthcare "debates" have been underwhelming. President Obama has behaved as if he: 1. is afraid to take a solid position; 2. lacks the passion on this issue suggested by his campaign; or 3. is so strongly committed to making everyone happy that he wants to keep an open and largely undefined position. Neither of these options, however, contributes to solid debate or to an effective marketing strategy.

Obama's amorphous stance on the issue has prevented him from delivering a coherent case for reforming the nation's healthcare system. As a liberal, I am inclined towards healthcare reform. Nevertheless, if had to rely solely upon Obama's marketing of this issue, I am not sure he would get my vote.

Over the weekend, the news wires reported that the White House was getting ready to ditch the public plan option, which was a part of Obama's campaign. Today, however, many of the same media are suggesting that Obama was simply testing the political climate or that the media misread signals from the Obama administration. Regardless of his intent, many liberals (in Congress, the blog world and elsewhere) have pushed back against a White House plan (real or imagined) to abandon the public plan option.

Changing the Debate
Because Congress will not vote on this issue in the immediate future, there is still sufficient time to conduct a useful debate regarding healthcare reform. Here are three ways that the President -- and the Republicans -- can do a much better job than they already have. It would be hard for them to do worse.

What Is Missing from Healthcare Reform Talks?

ONE: Medical Professionals
For the most part, politicians have led healthcare talks on behalf of the White House (and Republicans). Members of Congress and, more recently, Obama himself have held "townhall" discussions trying to market the idea. While some of these sessions were interrupted by protests, others were conducted smoothly.

The debate so far, however, lacks a strong contribution from the medical profession. Although doctors and nurses are represented in Obama's "consensus" group, they are not at the center of the townhalls, and politicians have not sufficiently utilized the medical profession's expert knowledge on the issue of healthcare. This is an absolutely inexplicable and damaging omission.

Doctors and nurses are at the frontline of the healthcare industry. They have keen insight on patient needs and their own professional requirements. Certainly, voters would benefit more it they heard the views of doctors and nurses than they would if they continued to hear primarily the voices of Sarah Palin, Charles Grassley, Kent Conrad, other members of Congress, and yelling protestors. Hearing medical professionals explain why they support or oppose various aspects of the proposed reform legislation could really improve the talks.

TWO: The Uninsured
During Hillary Clinton's unsuccessful presidential campaign, she often told the story of a young pregnant woman who died, along with her infant child, after a hospital denied her care. The woman was uninsured and owed the hospital $100. Several anti-Clinton journalists said that Clinton was "veer[ing] on the dark side." But it is easy for a journalist who has health insurance to dismiss stories about the plight of the uninsured as too gloomy. These stories, however, are not fictional (a falsehood the media floated); they represent real life in the United States. And even journalists who portrayed the stories as representing the "dark side" admitted that they were effective with voters.

The fact that the White House has not spent much time personalizing the issue of healthcare reform is perplexing. A compelling personal narrative could reach voters who are on the fence and embolden those individuals who already support the proposed reforms. As talks continue, the White House should definitely do more to portray the experiences of uninsured people.

THREE: Economists
The "bottom line" has driven many of the protests by opponents of the Democrats' healthcare proposals. Nevertheless, the talks have not prominently featured the views of economists who could talk about the macroeconomic impact of financing the various proposals and who could analyze the potential savings, if any, that the reforms could generate in the long run.

In part, the White House has not discussed the money issue too greatly because Obama is afraid of tackling the "T" word. But as Robert Reich recently argued, it is time to come clean. Healthcare reform will certainly cost money, and it will increase the deficit in the absence of new taxes in the shortrun. And unless GDP increases, tax revenues will continue to fall. These are serious issues, which complicate the Democrats' proposals. The public, however, can decide whether it wants to make the investment.

Also, the taxation issue is not as politically dangerous as Obama's behavior might suggest. Robert Reich advises Obama to confront this issue, but he says that:

[T]axes will be raised only on the very top. The President needs to decide whether he favors a surcharge on the top 2 percent, or a cap on tax-free employee benefits (which would affect only the very top), or some combination, and then announce which he prefers and why.

President Bush convinced the nation to spend nearly $700 billion dollars and to send thousands of Americans to their deaths or to serious injuries looking for nonexistent weapons of mass destruction and forcing "regime change" in a country that was not a threat to the United States. Given this recent history, I suspect that the nation could also decide, if given adequate information, to invest in healthcare reform. Paying attention to the bottom line will help the public assess the costs and benefits.

Former Labor Secretary Robert Reich has some great advice for Obama on this subject. See: How To Fight Heathcare Fearmongers and Demagogues.

Would President Hillary Clinton Have Run Away From Healthcare Reform Like President Obama Is Reportedly Going to Do?

Would President Hillary Clinton have run away from healthcare reform like President Obama is reportedly going to do? Yes, I went there, but someone needed to say it. Unfortunately, I only have time to pose the question and to offer a few comments at the moment. I will provide more analysis tomorrow.

What provokes this question? Well, for starters, the White House has been a lot less than passionate about healthcare reform. The blatantly wrong and deceitful Sarah Palin has a louder voice on the issue than President Obama.

Also, Obama campaigned on "unity," while Clinton campaigned as a "fighter." I always thought true reform required a fighter. That is certainly how it has occurred historically. But people without knowledge of history do not understand or appreciate this reality. Change does not come from chanting, and an election is not a social movement.

During the presidential campaign, many of Obama's most ardent supporters were young Web users, who enthusiastically spread his positions across the Internet and smacked down those who stood in their way. Where are they now? Hint: Summer break. Another question: Where are all of those "guy" Senators who endorsed Obama and called for Clinton to end her "divisive" campaign?

Today, the wires are reporting that Obama is prepared to drop a public plan option -- with hardly any public debate on the issue. Yet, Obama was supposed to bring us the "better-than-Clinton healthcare reform process. Say what you like about Clinton (and most people have strong opinions either way), but no one can honestly assert that she lacks passion on healthcare reform and a true drive regarding the subject.

Obama is apparently retreating because a "Gang of Six" members of the Senate Finance Committee decided to vote against it, and one of them, Sen. Kent Conrad -- a North Dakota Democrat -- has said that the Democrats lack the votes to get over a likely Republican filibuster. Conrad's "no" vote virtually guarantees this result.

It is unclear, however, why the public should give six members of one Senate committee -- not even the full committee -- so much power over this important issue. Healthcare is not in the committee's general area of expertise. Also, the Gang of Six includes the wretched Senator Charles Grassley, who along with Palin, has repeatedly described the medically sound "end-of-life counseling" provision as a death panel. The Gang of Six deleted the measure from the committee's proposed legislation. Medical professionals, however, back the provision. The six Senators did not act in good faith when they dropped this provision, which raises questions about their judgment and their honesty.

Obama has apparently ceded what he described as one of his primary policy goals to six conservatives (3 Democrats and 3 Republicans) without public debate and without much advocacy from the White House. Where I am sitting, unity looks like capitulation -- or a clever way of letting six men on one Senate committee take responsibility for killing a measure that Obama really did not want in the first place. Neither option looks that good.

PS: I had planned to offer only a "few" comments, but they turned into "several."

Medical Experts Respond to "Death Panel" Deception

For the last two weeks, Sarah Palin has been acting like a creepy version of Dr. Quinn Medicine Woman, with her creepier sidekick Senator Charles Grassley. The two have repeatedly stated that the proposed healthcare legislation would create "death panels" to decide whether patients could live or die.

Many commentators have debunked the horrible distortion (see, e.g., here) and have exposed the hypocrisy of Palin and Grassley on this issue. Nevertheless, the fearless and factless duo continue their assault on the truth.

Palin -- obviously believing that adding footnotes to a lie transforms it into the truth -- released yet another Facebook statement on the perils of liberal death squads. And Grassley invoked the image of the government pulling "the plug on grandma" in order to scare constituents into believing his deceit.

Two Medical Experts Rebut Palin and Grassley
CNN has published a very thoughtful essay written by two medical experts who, based on their area of expertise, probably have a lot of experience with patients who could benefit from end-of-life counseling. Douglas W. Blayney, MD and Brenda Nevidjon, RN have authored an op-ed for CNN that rebuts conservative distortion of the legislation and that explains why the provision would advance patient care.

Blayney "is president of the American Society of Clinical Oncology and professor of internal medicine at the University of Michigan. He specializes in the treatment of breast cancer and lymphoma and was in private practice for 17 years in California." Nevidjon "is president of the Oncology Nursing Society and clinical professor of nursing at Duke University School of Nursing. She was the first nurse and first woman to be chief operating officer of Duke University Hospital."

Responding to the Deception
Blayney and Nevidjon argue that the conservative depiction of the provision is "completely false":

This provision simply provides for Medicare to pay for voluntary conversations between patients and their health care practitioners on the difficult but important subject of planning for care at the end of life.

The provision is purely optional, and patients would be able to choose whether to discuss the issue with their practitioners. For those who decide to do so, there would be clear benefits.

Medical Benefits of End-of-Life Counseling
Blayney and Nevidjon also discuss the medical benefits of having advanced end-of-life counseling -- something critics of the healthcare proposal universally ignore. This type of counseling, as the American Medical Association has concluded (see AMA policy E225), can ensure that end-of-life treatment will reflect the patient's intent:

We discuss end-of-life care with patients to fulfill our commitment to them throughout the course of their care. When a disease cannot be cured, we can assure our patients that we can make them comfortable in their last days. When these conversations are done in advance and done well, everyone benefits -- patients, families and all members of our care teams.

As practitioners, we know from experience that discussions with patients in the end stages of their cancers and with their family members may be long and emotional, but ultimately lead to end-of-life care centered on the patient's wishes. We have seen many patients who were well-cared-for by their families, with professional help, and were comfortable in their surroundings.

Rebutting Palin and Grassley's lies has wasted precious time and energy. There are many aspects of the proposed legislation that warrant debate. Palin and Grassley have disserved the public with their intentional distortion of the proposed healthcare legislation.

Ditto. . . .

Here's the latest on death panels, courtesy of Time Magazine:

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!!

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.

Oh, and guess who voted "yea": Senator Grassley!

PS: "Ditto" simply means, more hypocrisy. . . .

For earlier articles on death-panel hypocrisy, see:

Sarah Palin Sponsored "Euthanasia Day" as Alaska Governor

Dumb and Dumber on Death and Dying

Today's Shameless Hypocrite Award Winner: Senator Charles Grassley

Sarah Palin Sponsored "Euthanasia Day" as Alaska Governor

Sarah Palin sponsored "Euthanasia Day" as Alaska governor. Well, actually, it was called "Healthcare Decisions Day." The day was specially recognized to encourage Alaska residents to get information about end-of-life issues. Yes, hypocrisy prevails -- with even greater force than I initially believed. Think Progress has the messy details, but I visited the Alaska government website to get the full breadth of Palin's rancid hypocrisy:

WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. [...]

WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaska’s citizens with advance directives.

WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives.

WHEREAS, as a result of April 16, 2008, being recognized as Healthcare Decisions Day in Alaska, more citizens will have conversations about their healthcare decisions; more citizens will execute advance directives to make their wishes known; and fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient.

So, it was fine for the State of Alaska to encourage its residents and medical professionals to talk about end-of-life issues and to prepare medical directives and living wills. But, as an annoying rabble-rouser seeking to prevent honest debate about healthcare reform, this same policy amounts to a "death panel." Good one, Sarah. Real cute.

On the utter hypocrisy of Palin and Grassley regarding this issue, see: Dumb and Dumber on Death and Dying.

Dumb and Dumber on Death and Dying

Sarah Palin and Senator Chuck Grassley are working together to spread lies regarding the substance of pending healthcare reform legislation. Last week, Sarah Palin posted a note on Facebook, which states that:

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 “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

Not to be outmatched by his conservative colleague, Senator Grassley stated yesterday that people “[s]hould not have a government run plan to decide when to pull the plug on grandma. . . .”

Palin and Grassley Are Liars
It is difficult to use polite prose when two individuals are intentionally making false statements. As many commentators have already observed, conservatives like Palin and Grassley are attempting to foment fears concerning a fairly innocuous and medically sound provision in the proposed healthcare reform legislation that would compensate medical providers for offering “end-of-life” counseling to individuals. During the counseling sessions, the caregivers would provide information to patients related to: advanced directives, health care proxies, state and national resources that assist patients and families regarding end-of-life issues, palliative care, and care in a hospice setting (see sect. 1233 of the proposed healthcare legislation).

Despite the plain language of the proposed statute, Palin and Grassley continue to float their death narratives. As the Politico reports, Palin remains defiant and has released another statement (in response to criticism by President Obama) which asserts that: [I]t’s misleading for the president to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. . . .” Of course, Palin’s new statement fails to point to any specific language in the bill that would make such counseling mandatory.

Furthermore, Grassley made his “pull the plug on grandma” statement after many commentators had already debunked Palin’s death panel claim. Facts mean nothing in a smear campaign.

Medical Professionals Endorse End-of-Life Counseling
One of the worst aspects of the conservative effort to stoke fear regarding the end-of-life provision is that medical professionals strongly advise that this type of counseling take place. The American Medical Association, for example, has issued an official policy statement (E.225) that addresses the inadequate nature of end-of-life counseling:

More rigorous efforts in advance care planning are required in order to tailor end-of-life care to the preferences of patients so that they can experience a satisfactory last chapter in their lives. There is need for better availability and tracking of advance directives, and more uniform adoption of form documents that can be honored in all states of the United States.

The AMA has issued several recommendations, based on its own assessment of the “discouraging evidence of inadequate end-of-life decision-making.” One formal recommendation states that: “Physicians should discuss the patient’s preferences with the patient and the patient’s proxy. These discussions should be held ahead of time wherever possible” (italics mine). The proposed legislation basically enacts this measure by compensating caregivers who hold such counseling sessions every five years for their senior patients.

Palin and Grassley Are Shameless Hypocrites
The worst aspect of Palin and Grassley’s deception regarding death is their utterly shameless hypocrisy. They, like a growing number of conservatives, portray the proposed healthcare reform legislation as symbolizing the horrors of a “big government” invading individual liberty and privacy. They also suggest that it is particularly egregious for a government to decide who can live or die. If Palin and Grassley applied these principles consistently, they would not have an audience among social conservatives.

Palin and Grassley are both staunchly anti-abortion. Grassley earned a perfect 100 score from the National Right to Life Coalition. Apparently, he has never voted against an abortion restriction. Palin does not support abortion at all – including in cases of rape or incest – unless the mother’s life is at risk. This position places among the most conservative pro-lifers.

Although Palin and Grassley express disgust over the idea of the government compensating doctors who counsel patients on end-of-life issues, they believe that it is appropriate for the government to deny doctors and patients any autonomy on the question of choice. Palin and Grassley would invite the government into the lives of women and doctors without their consent, but they would deny a role for the government to facilitate care that a doctor and patient view as medically necessary and beneficial.

Grassley’s hypocrisy on this issue is even greater than Palin’s. Today, Grassley condemns an imaginary scenario involving the government deciding when to pull the plug on grandma. In the recent past, however, when Grassley encountered a real-life version of this story, he made a decision that contradicts his current rhetoric.

In 2005, Grassley supported legislation that injected Congress into the Terri Schiavo saga. Schiavio’s husband – and medical proxy under Florida law -- waged an almost 10-year legal battle to refuse life-sustaining medical treatment on behalf of his wife, who was in a persistent vegetative state. After a federal judge ordered the removal of food and hydration, Congress intervened and passed a law that was blatantly crafted to nullify the Florida litigation and to keep Schiavo alive against the wishes of her husband, who acted on her behalf.

Although the Senate passed the statute by unanimous consent, Grassley revealed his position and expressed his support for the measure, stating that: “I support the effort to protect Terri Schiavo. It’s the first case of its kind, a chance to choose life over death. I gave the option to life. . . .” Grassley, however, did not vote for life over death. Instead, he voted to authorize direct federal involvement in an end-of-life medical decision – something he currently claims to abhor.

And to finish icing this cake, Palin and Grassley both support the death penalty. Capital punishment indisputably involves the government determining whether someone will live or die.

“Dumb” Works
Apparently, “dumb” works. According to the latest Gallup poll, the conservative backlash to healthcare reform has eroded support among voters – particularly independents. If members of the corporate media (as Glenn Greenwald affectionately describes the “news” outlets) did their job and uncovered the deception and hypocrisy associated with this backlash, then this movement’s rhetoric would actually face greater scrutiny and would perhaps lose some of its effectiveness.

The White House also fell asleep at the wheel, as this movement continued to mobilize and to work the media. Furthermore, I suspect that many of Obama’s Web-warriors are enjoying the final weeks of summer break and have not sufficiently organized on this issue.

Public opinion, however, is extremely malleable. If progressives redouble their efforts, a pretty solid reform package might actually get through Congress without damaging (and even possibly helping) the Democrats. Stay tuned.

Note: This blog entry is cross-posted in Glenn Greenwald's column on Salon.com.

Today's Shameless Hypocrite Award Winner: Senator Charles Grassley

Just added: Would President Hillary Clinton Have Run Away From Healthcare Reform Like President Obama Is Reportedly Going to Do?

* * * * * * * * *

It is amazing how base the public discourse on healthcare reform has become. Apparently, the riotous behavior has calmed down, but this has seemingly morphed into utter distortion and hypocrisy. Today's bandit: Senator Charles Grassley of Iowa.

Grassley has made sure that a completely false description of the proposed healthcare reform legislation remains alive. Fact: The proposed legislation would compensate medical providers who counsel older patients regarding "end-of-life" decisions. The information provided during the nonmandatory sessions would include informing patients of their right to establish a living will or a medical directive, to resist or to seek life-sustaining medical treatment, etc. This is good medicine -- which is often overlooked until it is too late.

Recently, Sarah Palin distorted the content of the proposed legislation when she said it would create governmental "death panels" that would pick and choose who gets to live. As horribly deceptive as this statement was, other conservatives have continued to offer it as the truth.

Today, Grassley signed on to the lie when he criticized the proposed reform by saying that the United States "should not have a government run plan to decide when to pull the plug on grandma." Question: Will Iowa voters pull the plug on Grassley's Senate career for this rotten tomato-deserving commentary?

Startling Hypocrisy
Grassley's misrepresentation of the proposed legislation is not his worst offense. Hypocrisy is. Although Grassley opposes the hypothetical notion of the government intervening in a decision to remove life support, when presented with an actual case involving this issue, Grassley's actions did not match the "anti-government" rhetoric he is spewing today. The case surrounded the life of Terry Schiavo.

Although Schiavo's husband had engaged in litigation for nearly a decade in Florida to reject life-sustaining medical treatment on her behalf, Congress nevertheless decided to pass a law to extend the case even longer. The hospice had already removed the feeding and hydration apparatus from Schiavo, but Congress still intervened.

Although the Senate voted by unanimous consent, Grassley expressed his views at the time: "I support the effort to protect Terri Schiavo. It’s the first case of its kind, a chance to choose life over death. I gave the option to life. . . ." But Grassley did not support "life." Instead, he supported governmental intrusion into one of the most delicate situations we face in our lives. Today, he supposedly abhors the very action that he proudly endorsed in the recent past. Grassley's utterly contradictory stances make him the shameless hypocrite of the day. Congratulations, Senator!

UPDATE: Grassley is a staunch pro-lifer, who earned a perfect 100 score by the National Right to Life Committee. Grassley definitely suffers from the same contradictory approach to "big government" that plagues many other opponents to healthcare reform. The pro-choice lobby believes that the government should not interfere with a woman's decision to terminate a pregnancy. Grassley votes to make the choice for her. Who's really afraid of big government?

UPDATE II: Grassley is also a staunch supporter of the death penalty. The government actually pulls the plug in this instance!

UPDATE III: The hypocrisy gets thicker by the day:

Dumb and Dumber on Death and Dying

Sarah Palin Sponsored "Euthanasia Day" as Alaska Governor

Ditto. . . .