Health Care & End-of-Life Issues: Don't Get Distracted

Rep. Earl Blumenauer from Oregon suddenly finds himself in the media spotlight because of a provision he inserted into the health care legislation that allows Medicare to pay for consultations between doctors and patients about end of life care. It does not mandate such consultations nor in any way require advocacy on the doctor’s part of euthanasia. The proposal enjoys bipartisan support. It is also tone-deaf.

The focus of health care reform has to be two fold: It must contain insurance costs for those who already have it and it must extend insurance coverage to those who don’t already have it. Period. As a side benefit, and principal argument for the necessity of doing something now, the containment of costs will not only help average Americans, it will save the government money. If left unaddressed, the costs of Medicare and Medicaid will break the government’s budget irrevocably.


Blumenauer, heretofore known mostly as the founder of the Bike Caucus, argues that his idea is non-controversial, that the people objecting are just trying to sink health care reform more generally. He says that the opposition is making up lies, arguing that the provision will lead to pressure on patients to end their lives, making euthanasia more common. (Blumenauer is from Oregon where assisted-suicide is already legal.) That may be true, but he fails to see how his idea, and indeed any idea, that does not directly relate to cost-containment or the achievement of universal coverage must be set aside because it distracts people and it alarms them. In a large bill like this, people worry what will have been snuck in. Rep. John Conyers admitted that members do not actually read the entire legislation. So, even if Blumenauer’s idea is right, he still should not be giving the enemies of health care reform another cudgel.

Also, Blumenauer and liberals more generally should know that after Roe the rest of us learned that when one is considering a moral issue, you do not go to a doctor, you go to an ethicist. To say that abortion and end of life issues are medical issues, is to rig the game. Medicare should reimburse priests and rabbis and ministers for these discussions, not doctors. So, there are reasons to object to his proposal that are legitimate.

Of course, the administration spokesmen don’t always do better. On Sunday, on George Stephanopoulos’ show, Treasury Secretary Timothy Geithner, who clearly knows his stuff, got into a line of reasoning that, while true, is bad politics, arguing that our health care reform efforts would achieve what other nations have achieved, including the savings. Again, this may be true, but American exceptionalism remains so strong that it is a horrible argument to make. Pat Buchanan, every night of the week, sits across the table from Chris Matthews to say, in so many words, "Thank God we are not French." Sadly, Mr. Buchanan’s argument has more effective salience with the electorate than does Geithner’s.

Democrats are close to achieving a goal that has eluded them since Harry S. Truman sat in the Oval Office. They should not use health care reform to do anything except contain costs and extend coverage. Anything that smacks of social policy beyond those goals must be set aside, most especially abortion, but Rep. Blumenauer’s proposal too. Do not muddy the waters. The choice facing the Congress should be narrowed to this: Do we change the system to make it more affordable and accessible, or not? Change was the mantra that carried President Obama into the White House last year and so long as "change" remains a contentless noun, almost everyone is for it. Now, as the White House fills in what it means by change on health care, it should keep the focus narrow and avoid anything that suggests a change in mores. They have enough on their hands as it is.



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9 years 7 months ago

Well, you make a good point, but the fact is that your argument on "American exceptionalism" can be used against you. The high priest to many and maybe most Americans is the doctor, not the minister, rabbi, or priest. Who has the biggest house and who makes the most money? What do people really look up to and to who? So, to recommend someone other than the doctor for what is perceived as a medical-moral issue  is to seem to throw the game. The doctor is seen as caring and objective; the religious worker as biased and hard.

You say that, "To say that abortion and end of life issues are medical issues, is to rig the game." Exactly, but the game is in fact rigged by both what you call "American exceptionalism" as you pointed out, and by perceived "medical issues". Neither abortion nor euthanasia is a "medical issue". However, most of the people and most doctors would believe that  this is the case; hence the problem; you seem to want to deny medical care for ,"medical issues". Who wants to follow you down that road? Why do the democrats fight so hard for abortion ? Because they have bought into the rigged game rules.

The way out is to let them have their way for now; the right should not stop health care reform over these issues. Rather, hold the doctor's feet to their Hippocritic oath and educate the public and doctors about the facts about both abortion and euthanasia. Remember, all doctors are taught that abortion and euthanasia is a medical issue that they have the say over; Federal funds are used to support both the medical students and their schools. Federal funds  already support abortion and euthanasia by training doctors to do these very deeds contra their own oath to, " no harm...; in fact, any student who choses to opt out is opted out of medical school. Change needs to start at the root of the problem.  Education is the road to change, not power politics.

9 years 7 months ago

My response to Rep. Blumenauer's proposal is personal, but I think it reflects the fears of many parents and caretakers who are ultimately respnsible for the well-being of their disabled loved ones.  As an aging parent of mentally disabled children, my greatest concern is what will happen to them when I die?  I agree, Michael, with your statement that anything that smacks of social policy  (beyond the goals of universality and cost containment) must be set aside.  We already have euthanasia via abortion.  In economically devastating times like the present, the people with disabilities are even more vulnerable than usual.  Their care is consicered "too costly" and they are usually not productive members of society with little voice in political decision.  Just look at California's budget!

And, yes, any counseling should be done by a priest, minister or rabbi.  Not all doctors are competent.  And certainly, not all doctors follow the Hippocratic Oath.  I can imagine my children, docile and trusting as they are, agreeing to whatever some doctor smight tell them.  They are burdens to society, let them die.

Janice Johnson


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