THE TREATMENT AUGUST 4, 2009
Republicans have a stable of bona fide health policy experts. These are recognizable, sometimes quite partisan conservatives. Yet they are handicapped as political operatives by their residence in the reality-based community. Hence the role of provocateurs such as Dick Morris and Betsy McCaughey, who are less constrained in delivering low blows in alley fights over health reform.
(Click here to read Ed Kilgore on The Plank today taking down Pat Buchanan on health care.)
...be eligible for the entire range of medical services, all free of charge. That would trigger severe rationing... : bureaucrats deciding who gets to see an oncologist, who can have an MRI--and even who can have bypass surgery and who'd die for lack of it.
These decisions would be made not on the basis of legal status but on the brutal facts of triage: Treat the 37-year-old illegal with his whole life to live before you spend scarce resources on an overweight, diabetic, 80-year-old citizen with high blood pressure who smokes...
The piece omitted one pertinent fact, stated by Candidate Obama on national television: His health plan specifically excluded undocumented immigrants.
Republicans are still raising this theme. As Congressman Steve King's press office proudly phrased things,
Taxpaying families, already weighed down by bailouts and massive spending bills, cannot afford to pay for health insurance for millions of illegal aliens.
Like Morris, Representative King seems unfamiliar with the basic technology of Google search. A few keystrokes might have led him to Section 246 of the House bill, helpfully titled No federal payment for undocumented aliens.
Then in the New York Post, Betsy McCaughey writes:
One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration.
This mandate invites abuse, and seniors could easily be pushed to refuse care. Do we really want government involved in such deeply personal issues?
Republican leaders have picked this one up, too, releasing a public letter which claimed that this same section "may start us down a treacherous path toward government-encouraged euthanasia." They go on to say:
With three states having legalized physician-assisted suicide, this provision could create a slippery slope for a more permissive environment for euthanasia, mercy-killing and physician-assisted suicide because it does not clearly exclude counseling about the supposed benefits of killing oneself.
Actually, the House bill expands (and thus necessarily describes) Medicare coverage for counseling about advance directives and palliative care. You are permitted to have one such a counseling session with your doctor every five years, more frequently if you have a life-threatening illness. To state the obvious: No patient is forced to undergo this counseling, to sign an advance care directive or living will. As far as I know, no one is forced to do anything at all.
The Republican letter claims, absent supporting evidence, that such counseling encourages mercy-killing and physician-assisted suicide. For the record, I suspect the opposite is true. Surveys indicate that fear of unmanaged pain and the fear of losing control provide powerful motives for suicide among patients with serious illnesses. Proper counseling and advance directives could reassure millions of patients and their families. AARP's John Rother gets this exactly right, when he notes:
This measure would not only help people make the best decisions for themselves, but also better ensure that their wishes are followed. To suggest otherwise is a gross, and even cruel, distortion-especially for any family that has been forced to make the difficult decisions on care for loved ones approaching the end of their lives.
These attacks fit a pattern. As recently reported in the Washington Post, conservative politicians and talk radio hosts are trying with some success to frighten seniors.
This rhetoric is a bit strange. Aren't Democrats the ones regularly accused of pandering to seniors and ignoring the entitlement crisis? I guess that's yesterday's (and maybe tomorrow's) talking point. As the Republican base conspicuously grays, the party's rhetoric is changing. Today's talking point is that liberals want to divert resources from Medicare to address other social needs and constituencies.
The irony of yammering to seniors about the evils of government-financed care is always notable, as is the selfish appeal. In 1965, liberals enacted Medicare, perhaps the most radical social engineering project in American history. Some liberals believe that this was a strategic error, because it shrunk the constituency for truly universal coverage. I love my parents too much to go that far.
Unfortunately, Republican rhetoric hits a nerve with millions of vulnerable seniors who rely on large (and growing) public resources, and who understandably worry that young people will grow weary of paying the bill. They hear vague talk that health reform will cost $1 trillion-a number trumpeted without context or timeframe by most commentators. Seniors understandably fear that this will come from them. At a gut level, conversations about cost-effectiveness--even rhetoric trumpeting prevention-has frightening undertones to anyone beset with a costly chronic illness.
At a deeper level, these talking points go beyond the usual Medicare politics and pander. Seniors comprise right-wing talk-radio's core audience, but the anxiety extends beyond retired ditto-heads. A conspicuous number of scare stories pitched to seniors suggest that the main beneficiaries of health reform will be various frightening others. These listeners have endured dizzying social change, ranging from gay marriage to the rise of immigrants (legal and illegal) as a powerful political and demographic force. This predominantly white group watched an unprecedented youth vote fuel the unlikely ascendance of a black president with an Islamic middle name.
For millions of older people, America suddenly seems very different from the country they once knew. So when President Obama asks seniors to trust him as they trusted many Democrats before him, even his remarkable persuasive powers sometimes fall short.
Click here to read Ed Kilgore on The Plank today taking down Pat Buchanan on health care.