A National Journal-sponsored study released today reveals that 93 percent of Americans believe conversations about care at the end-of-life should be a top priority of the U.S. health care system. But when the opportunity arose in 2009, many politicians wavered in their stance on who should be instigating these conversations, whether they’re among family members, patient and doctor, or insurance providers. Here’s what’s been said -- and often taken back -- about end-of-life care during the health care debate.
Sarah Palin’s pushback against what she called “death panels” was widely publicized in 2009. On her Facebook page, Palin said she feared a scenario “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." But as the health care debate heated up, Palin seemed to back off. In a later post, she said: “We must stick to a discussion of the issues and not get sidetracked by tactics that can be accused of leading to intimidation or harassment…. Let's not give the proponents of nationalized health care any reason to criticize us.”
Rep. Earl Blumenauer, D-Ore., suggested at a National Journal policy summit on Tuesday that Americans should be allowed to choose health insurance plans that fit their individual expectations for the end of life. In 2009, Blumenauer took the lead in attempting to debunk the death panel claims, endorsing a provision that “simply allows Medicare to pay for a conversation between patients and their doctors if the patient wishes to speak about his or her preferences and values.”
Sen. Michael Enzi, R-Wyo., ranking member on the Senate Health, Education, Labor, and Pensions Committee, was initially viewed by liberals as someone who could help them negotiate with the GOP on a health care bill, but as the debate wore on, this hope began to fade. In August 2009, Enzi wrote a USA Today op-ed that renewed the death panel argument, warning that under Democratic proposals “Washington bureaucrats would literally decide whether patents would live or die by rationing newer, more expensive therapy.”
More than a year after death-panel rhetoric cooled and the health care reform bill passed, the Obama administration announced in December 2010 that it would implement a system to pay Medicare doctors to have voluntary conversations with patients about their options at the end of life. Obama had dropped the provision in the original bill, but defended its addition as “common-sense discussions that doctors are already having with patients,” according to the Christian Science Monitor.
Unlike the president, Senate HELP Committee Chairman Tom Harkin, D-Iowa, never wavered on his defense of end-of-life counseling and his critique of Republicans for making the issue controversial and political. “I think the Obama administration should not have dropped that reference,” Harkin said in January, according to the Iowa Independent. “I think that we need that type of counseling in Medicare when you go in for an annual check-up. It’s not death panels. It’s just basically letting people know what their rights are and giving them the option.”