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“No Longer Any Political Margin To Be Gained”: Why Republicans Won’t Object To The Return Of ‘Death Panels’

There was a lot about the period leading up to the passage of the Affordable Care Act that was ridiculous and maddening, but perhaps no episode was worse than the controversy over “death panels.” Here you had a small provision of the bill that doctors, patient advocates, and health care experts all agreed would lead to better care, not to mention cost savings. Then Republicans concocted a lie about it, spread that lie as far as they could, and finally saw the provision removed from the final legislation.

Well, now Medicare is finally doing what that provision of the ACA would have done.

Under a newly proposed rule, it will reimburse doctors for the time they spend with patients planning how they want to be cared for near the end of their lives. And just you watch: this provision that Republicans said six years ago was so horrifying? They’re not even going to bother opposing it anymore, now that doing so serves no political purpose. It’s barely going to be a controversy at all.

That’s not what everyone else seems to be predicting. All over the web there are articles about this issue, many illustrated with photos of Sarah Palin, predicting that this is going to blow up into another angry debate. But I say it won’t. Here’s why: Republicans’ opposition to end-of-life counseling was always utterly cynical, a performance enacted for no purpose other than undermining the legislation. At this point, with the law implemented long ago and the major legal challenges over, there’s no longer any political margin to be gained in shaking their fists at patients and doctors talking about the options for end-of-life care.

Let’s review a little history. This whole thing got started when conservative activist Betsy McCaughey appeared on the radio in 2009, when versions of the legislation were working their way through Congress, and said this about the one in the House:

“And one of the most shocking things I found in this bill, and there were many, is on Page 425, where the Congress would make it mandatory — absolutely require — that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go in to hospice care. And by the way, the bill expressly says that if you get sick somewhere in that five-year period — if you get a cancer diagnosis, for example — you have to go through that session again.”

To paraphrase what Mary McCarthy said about Lillian Hellman, every word of that statement is a lie, including “and” and “the.” The actual provision stated that if a patient wanted to have a consultation about their options, including how to create an advanced directive that would lay out what sorts of treatment they wanted and didn’t want if they got to a point where they couldn’t communicate it themselves, Medicare would pay the doctor for the time counseling the patient. Nothing was mandatory, nothing would require doctors to “tell them how to end their life sooner,” and nothing required anyone to have the session again. It was all lies.

But that didn’t prevent the claim from taking off like a rocket. Sarah Palin floated the “death panel” talking point. Chuck Grassley told a crowd back home, “We should not have a government program that determines if you’re going to pull the plug on grandma.” Although media outlets tried to explain that the allegation was false, millions of people believed it anyway. Chastened Democrats removed the provision from the bill.

So now that Medicare is finally moving ahead with this provision, are Republicans really going to fight it? No, they won’t. I’ve been looking around for condemnations from conservative media outlets or prominent Republican politicians, and so far I’ve come up empty. There was one small item on the National Review’s blog, with no substantive objection, just a little harumphing about bureaucracy. No outraged statements from Mitch McConnell and John Boehner, no thunderous denunciations from the presidential candidates, nothing.

Maybe they just haven’t gotten around to it yet, and the indignation is on its way. But I wouldn’t bet on it. In this somewhat cooler environment, it isn’t going to be easy for them to argue that patients shouldn’t sit down with their doctors and plan for their future care. And with congressional Republicans all but giving up on repealing the ACA, this isn’t a battle that offers much to be gained.

So five years after the ACA was passed, doctors will know that they can get paid for this absolutely vital service, explaining the options to their patients and making sure that when the time comes, those patients’ wishes are honored. The people like McCaughey, Palin, and Grassley who back then lied to the country in order to score a few points against Barack Obama ought to hang their heads in shame. But at least it’s finally happening. Better late than never.

 

By: Paul Waldman, Senior Writer, The American Prospect; The Plum Line Blog, The Washington Post, July 9, 2015

July 10, 2015 Posted by | Affordable Care Act, Death Panels, Medicare | , , , , , , | 3 Comments

“Are ‘Death Panels’ Coming To Scott Walker’s Wisconsin?”: A Scheme To Make Middle-Class Workers Pay Even More For Health Care

Scott Walker could be on the verge of giving Infowars some great conspiracy theory fodder. A move by Wisconsin’s Group Insurance Board to substantially increase how much state employees pay for their health insurance is drawing unqualified and sharp opposition from labor leaders but could once have drawn criticism from Sarah Palin, as well. That’s because the proposal includes “consultations about end-of-life care, which some called ‘death panels,’” as the Wisconsin State Journal put it.

Death panels?! In the great Badger State? Putting Badger Staters to death? How could this be? One may have asked, as some on the right did during the debate over the Affordable Care Act. But here we are, with the Wisconsin state government overseeing what’s set to be the controversy-free implementation of new policies designed to save the state money through its employees’ end-of-life decisions.

Quick background: The Wisconsin state government is having some tough fiscal times, and Walker’s budget proposal suggested substantial cuts in a number of areas, including to the University of Wisconsin system and to K-12 education. The governor’s budget proposal also called for savings of $81 million on the state employees’ group health insurance program. (Remember that in 2011 the governor oversaw the passage of Act 10, which virtually ended collective bargaining for most of the state’s public sector unions.) But the budget wasn’t too specific about how to save that $81 million. Instead, Walker’s proposal directed the state’s Group Insurance Board to work with Atlanta-based Segal Consulting to figure it out.

The most buzzed-about change, the Wisconsin State Journal reported, will require public sector employees to pay twice as much out of pocket for their health care than they do now. These changes are projected to save the state $85 million over the next two years (Wisconsin passes budgets biennially), and most of the savings “will come from increasing out-of-pocket limits and introducing deductibles for the vast majority of state workers who don’t have them,” according to the paper. Individual employees will have new $250 deductibles, and family deductibles will be $500.

The Group Insurance Board voted for the changes on May 19, and unless the legislature’s Joint Finance Committee moves to require legislative approval for the changes, they will go into effect Jan. 1, 2016, according to Mark Lamkins, communications director for the state’s Department of Employee Trust Funds. The board that approved the changes has 11 members, some of whom are Walker appointees. The majority of the Walker appointees on the board voted in favor.

And the change has labor leaders irate.

“What the group insurance board did today is unconscionable,” said Wisconsin AFSCME executive Marty Beil, according to THOnline. “I’d also call it evil that they’re treating state employees at that level. It’s incredible.”

But Walker’s critics on the left aren’t just going after him for increasing public sector employees’ expenditures for their health care. They’ve also targeted him for a tiny provision the board approved that seeks to save a bit of money through end-of-life care. The memo laying out the cost-cutting health-care proposal doesn’t detail how these changes would work, and the State Journal reported that “[e]nd-of-life care consultations, also called advanced care planning or palliative care, would save $292,500.” That’s hardly a hefty sum. Lamkins said the changes would involve “keeping people out of institutions near the end of life, giving them more opportunities to manage their care-treatment plan.”

He added that the change is designed “to ensure that members facing serious illness and survival of less than six months are informed of care options and are able to make treatment decisions based on their individual values and goals of care.”

Reached for comment, Laurel Patrick, a spokeswoman for the governor, pointed out that the phrase “death panels” is nowhere to be found in any of the health care change proposals. But that hasn’t defused liberal ire about the panel’s move.

That’s because Walker has been one of the most outspoken conservative opponents of the Affordable Care Act.

“When Sarah Palin was trying to derail Obamacare over ‘death panels,’ Scott Walker didn’t say a word defending the need for people to have end-of-life counseling and instead on his first day as governor wasted taxpayer dollars suing the federal government over Obamacare,” said Scot Ross, executive director of One Wisconsin Now. “But wrapped in a scheme that would make cash-strapped middle-class workers in Wisconsin pay even more for health care, Team Walker quietly slides this into the mix. The inclusion of the palliative counseling is critical, but Scott Walker would have saved families a lot of grief if he would have stood up to the Tea Party in 2010 instead of this backdoor deal now.”

Robert Kraig, executive director of Citizen Action of Wisconsin, voiced support for Walker’s so-called death panels but said he was frustrated the governor didn’t do more to defend the Affordable Care Act.

“The right, using Sarah Palin, shamelessly tried to call simple voluntary end-of-life consultation a ‘death panel’ early in the debate over Obamacare,” he said. “There’s obviously a great irony that the Walker administration would now come forward with an end-of-life consultation provision. I still have to say that it’s good policy, most likely, it’s just incredible hypocrisy for them to come out with that after Walker has been one of the most disingenuous critics of the ACA.”

It’s doubtful, of course, that any of this will be a problem for Walker’s 2016 ambitions. Nobody ever did poorly with Iowa Republican caucus-goers because critics on the left were too noisy. But the debate highlights one of the tricky aspects of running for president as a governor: that the tiniest provisions in uncontroversial policies can easily become flashpoints for controversy.

 

By: Betsy Woodruff, The Daily Beast, May 21, 2015

May 22, 2015 Posted by | Death Panels, Public Employees, Scott Walker | , , , , , , | 1 Comment

GOP Returns To ‘Death Panels’ Narrative In Desperate Effort To Change The Medicare Story

Republican Member of Congress, Phil Gingrey (GA), has decided that the moment has arrived to get back on offense in the debate for the future of Medicare.

At a press conference earlier this week, Gingrey returned to one of the GOP’s favorite ‘boogeymen’ in an effort to make us forget just how much we hate the Republican approach to reforming Medicare. He went after the fifteen-member panel of medical experts established by the Affordable Care Act who go by the name the Independent Payment Advisory Board (IPAB).

According to Gingrey-

“Democrats like to picture us as pushing grandmother over the cliff or throwing someone under the bus. In either one of those scenarios, at least the senior has a chance to survive.

But under this IPAB we described that the Democrats put in Obamacare, where a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy, I guarantee you when you withdraw that the patient is going to die. It’s rationing.” (Via Politico)

Wow…that does sound scary! In fact, it sounds an awful lot like a …..Death Panel.

Thank goodness that absolutely nothing Gingrey said at his press conference beyond “My name is Phil Gingrey” has even the slightest connection to the truth.

Like it or not, here are the facts –

In order to keep Medicare spending under control, the Affordable Care Act, aka “Obamacare”, established specific target growth rates for the government program that cares for our seniors.

To ensure that these targets are met, the reform law created the IPAB for the purpose of monitoring the growth of Medicare spending and to make recommendations to cut the same in those years where it looks like we are going to blow past the targets – and only in those years.

So, if the growth in Medicare costs is staying within the boundaries set by law, the IPAB has no authority to propose any changes whatsoever.

Why was it necessary to create this panel of experts?

Prior to creation of the IPAB, it was left to Congress to make decisions about who and what should be covered by Medicare.

While Congress has long had their own board of experts to rely on (“Medipac”), the profound influence of special interests combined with a general lack of understanding of the world of medicine – and the economics that rule that world – made it fairly obvious that Congress was not the best place to get the job done.

If you doubt this, simply look at how poorly Congress has managed the growth in Medicare costs to date. And before you blame this on whichever president you would like to put in the crosshairs, you should be very clear that it is, indeed, the job of Congress to make these decisions and manage this policy.

The IPAB was created to solve this problem.

As noted earlier, the board has no statutory impact whatsoever on Medicare payment rates and policy during the years when the spending targets are being met. Their powers only come into play in those years where Medicare actuarial reports suggest we are spending too much money per the restrictions established by Obamacare.

During those years when the board is required to come up with proposals to get spending under control, they will provide these proposals to the DHHS who must then implement them – unless Congress takes it upon itself to come up with their own proposals and pass them into law.

Thus, Congress retains the absolute ability and opportunity to effectuate its own program to bring Medicare costs back in line with the targets any time they wish. Maybe it was me, but I don’t recall Gingrey pointing out this little detail. And there is something else that Representative Gingrey forgot to mention during his tirade. There is an entire list of policy items contained in the ACA that are specifically prohibited to the IPAB.

And what would you imagine is at the top of that list?

The Board is legally barred from proposing anything that will ration health care, restrict benefits or modify the eligibility criteria for beneficiaries.

What’s more, until 2020, the IPAB may not come up with proposals that place the rates being charged by primary hospitals and hospice programs in their sights. This prohibition was the result of the ACA already putting the moves on these organizations when it comes to what the government pays them. Thus, it seemed fair to give them some breathing room for the next eight years or so.

As a result of these inconvenient truths, it is rather difficult to concoct the scenario where Gingrey and friends see this insidious opportunity for the board to ration our health care.

The only argument I can imagine is to suggest that the board could recommend reducing the sums paid to physicians who provide Medicare services to patients. Were this to occur, more physicians might decide to drop out of Medicare, creating a longer waiting period for patients needing to see a doctor.

Of course, even this is not rationing.

Further, the SGR issue is about to become a thing of the past as Congress moves toward reaching a permanent solution to the problem created by an outdated formula that puts physicians in a position of taking major pay cuts from Medicare each year.

Once the physician payment issue is resolved, it becomes hard to see where the IPAB is going to exercise this health rationing Gingrey so fervently fears.

What should disturb each and every American is not only that Gingrey is willing to flat out lie in order to feather his political nest, he is using that lie to pull our attention away from the true health care rationers in our system – the private insurance companies.

Think this is a liberal red herring designed to distract you from the evil government plan to kill grandma?

Ask your physician about the hoops he or she must jump through to gain insurance company approval to do the job you hire them to do. Ask them how much of their time and money is wasted arguing with health insurance company representatives whose sole job is to turn down a requested procedure so that they will not have to pay for the same. Take a look at some of your statements from your insurer and see where they’ve denied payment on any number of technicalities resulting from a contract you signed that you could not possibly understand.

This is the true rationing problem in the United States today.

Still, polls continue to show that many Americans are deeply displeased with Obamacare.

I continue to believe that this is the direct result of so many of us not understanding what the legislation does – and does not – do.

But there is one thing we should all be able to understand.

If the opponents of health care reform and the current approach to Medicare are continuously left to base their arguments solely on lies, should it not occur to us all that maybe the law is better than what we’ve been led believe?

If not, why the lies instead of criticism based on the truth?

By: Rick Ungar, The Policy Page, Forbes, June 24,  2011

June 25, 2011 Posted by | Affordable Care Act, Congress, Conservatives, Death Panels, Democrats, GOP, Government, Health Care, Health Care Costs, Health Reform, Ideologues, Lawmakers, Medicare, Politics, Republicans, Right Wing | , , , , , | Leave a comment

A “No New Taxes” Pledge Is A Death Trap For Seniors

This has to be one of the funniest political stories of recent weeks: On Tuesday, 42 freshmen Republican members of Congress sent a letter urging President Obama to stop Democrats from engaging in “Mediscare” tactics — that is, to stop saying that the Republican budget plan released early last month, which would end Medicare as we know it, is a plan to end Medicare as we know it.

Now, you may recall that the people who signed that letter got their current jobs largely by engaging in “Mediscare” tactics of their own. And bear in mind that what Democrats are saying now is entirely true, while what Republicans were saying last year was completely false. Death panels!

Well, it’s time, said the signatories, to “wipe the slate clean.” How very convenient — and how very pathetic.

Anyway, the truth is that older Americans really should fear Republican budget ideas — and not just because of that plan to dismantle Medicare. Given the realities of the federal budget, a party insisting that tax increases of any kind are off the table — as John Boehner, the speaker of the House, says they are — is, necessarily, a party demanding savage cuts in programs that serve older Americans.

To explain why, let me answer a rhetorical question posed by Professor John Taylor of Stanford University in a recent op-ed article in The Wall Street Journal. He asked, “If government agencies and programs functioned with 19% to 20% of G.D.P. in 2007” — that is, just before the Great Recession — “why is it so hard for them to function with that percentage in 2021?”

Mr. Taylor thought he was making the case for not increasing spending. But if you know anything about the federal budget, you know that there’s a very good answer to his question — an answer that clearly demonstrates just how extremist that no-tax-increase pledge really is. For here’s the quick-and-dirty summary of what the federal government does: It’s a giant insurance company, mainly serving older people, that also has an army.

The great bulk of federal spending that isn’t either defense-related or interest on the debt goes to Social Security, Medicare and Medicaid. The first two programs specifically serve seniors. And while Medicaid is often thought of as a poverty program, these days it’s largely about providing nursing care, with about two-thirds of its spending now going to the elderly and/or disabled. By my rough count, in 2007, seniors accounted, one way or another, for about half of federal spending.

And in case you hadn’t noticed, there will soon be a lot more seniors around because the baby boomers have started reaching retirement age.

Here are the numbers: In 2007, there were 20.9 Americans 65 and older for every 100 Americans between the ages of 20 and 64 — that is, the people of normal working age who essentially provide the tax base that supports federal spending. The Social Security Administration expects that number to rise to 27.5 by 2020, and 31.7 by 2025. That’s a lot more people relying on federal social insurance programs.

Nor is demography the whole story. Over the long term, health care spending has consistently grown faster than the economy, raising the costs of Medicare and Medicaid as a share of G.D.P. Cost-control measures — the very kind of measures Republicans demonized last year, with their cries of death panels — can help slow the rise, but few experts believe that we can avoid some “excess cost growth” over the next decade.

Between an aging population and rising health costs, then, preserving anything like the programs for seniors we now have will require a significant increase in spending on these programs as a percentage of G.D.P. And unless we offset that rise with drastic cuts in defense spending — which Republicans, needless to say, oppose — this means a substantial rise in overall spending, which we can afford only if taxes rise.

So when people like Mr. Boehner reject out of hand any increase in taxes, they are, in effect, declaring that they won’t preserve programs benefiting older Americans in anything like their current form. It’s just a matter of arithmetic.

Which brings me back to those Republican freshmen. Last year, older voters, who split their vote almost evenly between the parties in 2008, swung overwhelmingly to the G.O.P., as Republicans posed successfully as defenders of Medicare. Now Democrats are pointing out that the G.O.P., far from defending Medicare, is actually trying to dismantle the program. So you can see why those Republican freshmen are nervous.

But the Democrats aren’t engaging in scare tactics, they’re simply telling the truth. Policy details aside, the G.O.P.’s rigid anti-tax position also makes it, necessarily, the enemy of the senior-oriented programs that account for much of federal spending. And that’s something voters ought to know.

By: Paul Krugman, Op-Ed Columnist, The New York Times, May 12, 2011

May 13, 2011 Posted by | Budget, Congress, Conservatives, Death Panels, Democrats, Economy, Federal Budget, GOP, Government, Health Care Costs, Lawmakers, Medicaid, Medicare, Politics, Republicans, Seniors, Social Security, Tax Increases, Taxes, Voters | , , , , , , , , , , , | Leave a comment

Health Care Hypocrisy: How Paul Ryan And House Republicans Are Contradicting Themselves Over Medicare

In the debate over the House Republicans’ budget plan championed by Representative Paul Ryan, it’s been remarkable to watch the contortions and contradictions in the GOP on the issue of health care. The cornerstone of the Republican critique of the Affordable Care Act over the past year or so has been that it would lead to rationing. While Republicans initially manufactured lies about this issue—anyone remember death panels?—they eventually focused on one provision in the bill that was focused on cutting costs: the Independent Payment Advisory Board (IPAB). As specified in the legislation, the IPAB is a 15-member board of medical experts who are appointed by the president, confirmed by the Senate, and tasked with cutting costs in the Medicare system, unless Congress acts to alter the proposal or discontinue automatic implementation. The legislation also specifies that a goal of such cost-cutting should be to actually improve access for beneficiaries. At a time when rising health care costs are a concern for families’ pocketbooks and the federal budget, the IPAB was a means to maintain public oversight of Medicare but insulate it from the normal politics of congressional decision-making, thus helping ensure that best medicine was the driver of cost reductions.

Republicans, however, viciously attacked the IPAB as being a bunch of unelected bureaucrats making decisions to cut costs at the expense of the quality of care seniors would receive. The rhetoric became quite heated: Congressman Phil Roe went so far as to call the IPAB the “real death panel.” Other Republicans, like Representative John Fleming, likened the IPAB to communism, saying, “It will take you back to the old Soviet Union, that’s the way they did things—with a central planning committee that set prices, targeted costs.”

Now, more than a year after health care reform passed, Paul Ryan, facing stiff opposition to his plan to end Medicare as we know it, has taken to attacking the IPAB as a way to rebut his critics. He’s arguing that, while his plan would keep Medicare the same for current beneficiaries, the IPAB “puts a board in charge of cutting costs in Medicare” that will “automatically put price controls in Medicare” and “diminish the quality of care seniors receive.” It’s this sort of dishonest vitriol that has led to 73 House Republicans, as well as some Democrats, to cosponsor legislation to eliminate the IPAB.

What’s fascinating about the posture of these cosponsors is that it runs into direct conflict to the vote the House took mere days ago on the overall Ryan budget, which passed thanks to broad Republican support. Indeed, the budget, which the co-sponsors voted for, changes Medicare into a voucher program in which seniors can only choose from among private insurance options, eliminating the public insurance that is currently at the heart of Medicare. In other words, rather than public officials, elected or unelected, making decisions as to what is covered in Medicare, the Republicans just voted to more or less privatize the program. So, , after all of their complaining about how the IPAB moved too far away from public accountability, they’ve just proposed eliminating all such accountability, insisting instead that private insurance companies know best.

Would Americans really feel better with insurance companies deciding whether they or their parents get the care they need? Probably not. The truth is that Republicans are not actually worried about accountability or giving Americans more health care options. They are not even worried about cutting costs: Medicare has a much lower cost per beneficiary than private health care now, so it makes no sense to privatize it in order to lower costs. What they are worried about is public health care; they can’t stand it—and are even willing to contradict themselves and hand people’s health over to unelected, private insurers to defeat it.

By: Neera Tanden, Chief Operating Officer, Center for American Progress, April 30, 2011

May 1, 2011 Posted by | Affordable Care Act, Conservatives, Death Panels, Federal Budget, GOP, Health Care, Health Care Costs, Health Reform, Insurance Companies, Medicare, Middle Class, Politics, Public Health, Rep Paul Ryan, Republicans, Right Wing, Seniors, Uninsured | , , , , , , , , , , | Leave a comment

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