If you have any interest in the perennial race-to-the-bottom known as the Republican Party’s opposition strategy, from false-flag town hall operations to fearmongering, you’ll have heard, no doubt, of Palin’s charge that Obama’s health care program would subject her special-needs child to a “death panel,” who would decide if he lives or dies. It’s exactly as monstrous as it sounds, and it’s exactly as dishonest, too. As pointed out by Tommy Christopher, the charge, picked up by Fox & Friends and other Republicans before Palin, traces to § 1233 of the “Americans’ Affordable Health Choices Act of 2009” — aka, “the health care bill.”
First, before looking at the actual text, let’s ground the section in context. AAHCA is a gargantuan bill. The version that I have from Tommy clocks in at 1,018 pages (PDF), broken down into “Divisions,” which group statutory sections, and then Titles, Subtitles, and Sections.
§ 1233 comes from Division B, “Medicare and Medicaid Improvements,” Title II, “Medicare Beneficiary Improvements,” and Subtitle C, “Miscellaneous Improvements.” The section purports to, and actually does, nothing more than amend Medicare. The features in the operative section are not portions of the new public option plan; they’re “Miscellaneous Improvements” on the existing public health care plan, Medicare, which applies only to persons over 65. Thus, even if § 1233 promotes euthanasia, it wouldn’t apply to anyone not enrolled in Medicare. ‘Lil Trig is safe, if he was ever in danger at all.
Knowing now the limited application of the putatively offensive provision, let’s turn to the text. § 1233 amends Medicare (“Section 1861 of the Social
Security Act (42 U.S.C. 1395x) is amended…”) to add a new type of benefit, known as “advance care consultation,” § 1233(a)(1)(A), which § 1233(a)(1)(B) proceeds to describe, as follows:
[T]he term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes [. . . ]
This benefit, if passed, would be located at 42 U.S.C. § 1395x(hhh)(1). Look for it there in the fall.
Apparently, the worry-word is “palliative” — “palliative care” being that which abates the symptoms of a disease, without effecting a cure. In other words, “make him as comfortable as possible.” But “palliative care” is a far cry from euthanasia. Rather, it’s a concession to inevitability — that once a cancer, for example, has progressed to a certain degree, the patient can but emphatically need not opt to forego treatment, and instead ask his doctors to provide only whatever comfort is possible in his twilight hours. (E) only provides that Medicare will pay for a consultation on the meaning of palliative care, if the patient requests. It does not require it.
Critically, “palliative care” is not even the focus of the “advance care consultation” benefit. The consultation, by its own words (see new subsections (A)-(E), (F)(i)), focuses on ensuring that a patient has a durable power of attorney, or other legal document that directs his doctors on his wishes if he is incapacitated. The medical system, patients, and patients’ families all benefit from the certainty provided by living wills, durable powers of attorney, and health care proxies. We should applaud the drafters of the healthcare bill for acknowledging the value of certainty by providing a new Medicare benefit that encourages it.
As so often happens, the cure for Republican mendacity is to read the bill yourself. I encourage you to, whenever an issue comes up regarding the healthcare bill, consult the text yourself, rather than relying on Sarah Palin’s Facebook page. If the past is any judge, she’s sure to lie to you.