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More on Isakson and End-of-Life Counseling

Sen. Johnny Isakson's office is not happy that Isakson is being used to rebut attacks on the "end-of-life counseling" provision in the House's health-care reform bill. "I categorically oppose the House bill and find it incredulous that the White House and others would use my amendment as a scapegoat for their misguided policies,” reads the press release.

In our conversation yesterday, it was Isakson himself who brought up the House bill. To go back to the tape, I asked Isakson how we'd ended up in a conversation about euthanasia. I didn't mention any of the specific bills or amendments. He replied:

I have no idea. I understand -- and you have to check this out -- I just had a phone call where someone said Sarah Palin's Web site had talked about the House bill having death panels on it where people would be euthanized. How someone could take an end of life directive or a living will as that is nuts. You're putting the authority in the individual rather than the government. I don't know how that got so mixed up.

That is not to suggest that he supports the House bill in general, or even the bill passed by the Senate Health Committee. But he was pretty specific in trying to ratchet down the misinterpretations of the House's end-of-life counseling section.

And, given Isakson's record, there's plenty of reason for that. The specific amendment Isakson offered in the Health Committee is substantially different than what's in the House health-care reform bill. But the 2007 Medicare End-of-Life Care Planning Act, which Isakson co-sponsored, is actually very similar to the section on end-of-life planning in the House bill. And Isakson wasn't the only Republican on the legislation.

All of these amendments and provisions attempt to do the same thing, albeit in slightly different ways: Expand Medicare's coverage of voluntary end-of-life counseling. Encouraging Medicare to cover end-of-life planning just isn't a partisan issue. Nor is it an effort to make anyone shuffle off the mortal coil before they're ready. It's an attempt, as Isakson explained yesterday, to ensure that individuals make their own decisions when they're of sound mind and body, rather than leaving those questions to grieving spouses, doctors who fear a malpractice lawsuit or accountants. It's a good policy, and all the legislators supporting it deserve praise for trying to encourage an adult conversation about death. It's a shame that it's suddenly become polarized.

By Ezra Klein  |  August 11, 2009; 6:07 PM ET
Categories:  Health Reform  
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I don't understand what the big deal is. In the healthcare field there has already been a big push for establishing resuscitation/intubation status, especially when a patient arrives at the hospital. This way doctors will get paid for what they should be doing anyway.

Posted by: studentdoctor | August 11, 2009 6:45 PM | Report abuse

I don't remember anyone using Isakson for any other purpose than to debunk the nonsense euthanasia claim.

Nobody claimed he was supporting the House bill in sum.

Posted by: SteveCA1 | August 11, 2009 6:57 PM | Report abuse

Perhaps you should check the horse's mouth:

WASHINGTON – U.S. Senator Johnny Isakson, R-Ga., today denounced comments made by President Obama and his spokesman regarding Isakson’s alleged connection to language contained in the House health care bill on “end-of-life counseling.”

Isakson vehemently opposes the House and Senate health care bills and he played no role in drafting language added to the House bill by House Democrats calling for the government to incentivize doctors by offering them money to conduct “end-of-life counseling” with Medicare patients every five years. Isakson also strongly opposed the House bill language calling for doctors to follow a government-mandated list of topics to discuss with patients during the counseling sessions.

By contrast, Isakson took a very different approach in July during the Senate HELP Committee hearings on the Senate version of the health care bill. Isakson’s amendment to the Senate bill says that anyone who participates in the long-term care benefit provided in the bill – if they so choose – may use that benefit to obtain assistance in formulating their own living will and durable power of attorney.

Isakson’s amendment, which was accepted unanimously by all Republicans and Democrats on the Senate HELP Committee, empowers the individual to make their own choices on these critical issues, rather than the government incentivizing doctors to conduct counseling on government-mandated topics. Isakson ultimately voted against the Senate health care bill.

“This is what happens when the President and members of Congress don’t read the bills. The White House and others are merely attempting to deflect attention from the intense negativity caused by their unpopular policies. I never consulted with the White House in this process and had no role whatsoever in the House Democrats’ bill. I categorically oppose the House bill and find it incredulous that the White House and others would use my amendment as a scapegoat for their misguided policies,” Isakson said. “My Senate amendment simply puts health care choices back in the hands of the individual and allows them to consider if they so choose a living will or durable power of attorney. The House provision is merely another ill-advised attempt at more government mandates, more government intrusion, and more government involvement in what should be an individual choice.”

Posted by: 4commonsense | August 11, 2009 7:22 PM | Report abuse


Posted by: DICKERSON3870 | August 11, 2009 7:22 PM | Report abuse

We are still circling wagons here...

When President claims that new reforms will not 'pull the plug' on Grandma; he does not sound convincing. The reason is unless that decision is made plain and simple, Tax Payer money - Medicare money - will be continued to be spend. The whole idea is whether there can be any curtailment of such treatment or not. Impression here is at present Medicare indeed never stops footing the bill, even say such hospitalization rakes bills in millions for a single person.

You want to stop run way cost of Medicare - you got to talk about 'pulling the plug' on Grandma. Everything else is useless talk.

What leadership we need is, it is incumbent on Fed / Congress / White House NOT to look at that this problem as their morality quandary; but they only way of accepting 'financially gravity'.

Unless such upfront bluntness is there, White House will continue to face difficulties in convincing more people and we will continue to talk about frivolous issues.

Posted by: umesh409 | August 11, 2009 7:51 PM | Report abuse

Isakson is up for re-election in 2010. He can't be seen speaking out against the crazies, even if it looks silly given his legislative record, for fear of a primary or their withholding of campaign cash.

Ah, democracy.

Posted by: pseudonymousinnc | August 12, 2009 12:25 AM | Report abuse

I'm incredible that Senate staffers would make such a blatant grammar error.

Posted by: rjw88 | August 12, 2009 6:02 AM | Report abuse

Ezra, if a bill required that women seeking an abortion receive "voluntary counseling" about abortion alternatives, you'd denounce it as an interference with the doctor-patient relationship and an effort at intimidation.

Posted by: tomtildrum | August 12, 2009 7:18 AM | Report abuse

Back in the 1960s people died when they got end-stage renal disease. It was a fatal condition. Then dislysis machines were developed and could save the life of someone with end-stage renal disease indefinitely through regular dislysis treatments. The machines were expensive. Insurers called them experimental. There were few machines so rationing began at hospitals that had them. Real death panels were created in hospitals to ration the machines, basing who would live on their worth, such as a family to provide for, children to raise, etc. It was an ugly time and people were upset watching patients die from a treatable disease. But insurers would not cover it. It was way too expensive they argued. An expensive treatment for life certainly is. The private sector had no answer.

But in 1972 what teabaggers today would call a socialist system was brought in. Legislation was passed by congress to allow Medicare coverage for those with end-stage renal disease at any age. The problem quickly ended. Insurers were off the hook. Everyone was covered which meant everyone could pay which allowed more machines to be bought by hospitals. In a short time no one was dying from end-stage renal disease because they could not get dialysis. The private sector failed, the public sector succeeded.

Todau we hear it is government that would set up death panels to save money, but the history of end-stage renal disease shows it is the private sector that sets up death panels and government which removes them.

The story of end-stage renal disease is repeated with many other conditions. Study the history of healthcare and you will see where fear should be placed. Its not in the government, which has risen to save lives where private health care or insurance failed.

Posted by: Fate1 | August 12, 2009 12:22 PM | Report abuse

"Ezra, if a bill required that women seeking an abortion receive "voluntary counseling" about abortion alternatives, you'd denounce it as an interference with the doctor-patient relationship and an effort at intimidation."
Posted by: tomtildrum

Really? I doubt that. If Medicare would cover voluntary abortion counciling I don't see why anyone would give a hoot.

Posted by: Fate1 | August 12, 2009 12:27 PM | Report abuse

Shorter tomtildrum: pregnant women lack agency.

At what stage does tomtildrum believe pregnant women become unable to make medical decisions for themselves? The second trimester?

Because that's surely what tomtildrum believes, if he's comparing it to the elderly receiving guidance in advance of a time when they may no longer be able to give informed consent.

Posted by: pseudonymousinnc | August 12, 2009 5:26 PM | Report abuse

I have no idea what you're talking about. The fact is that in the past, when pro-life legislators have tried to require abortion-alternative counseling before a woman could obtain an abortion, it's been generally denounced on the left for the reasons I mentioned above. Yet it's considered OK in the hospice context.

Am I right, then, that Fate1 and pseudinnc are pro-lifers?

Posted by: tomtildrum | August 13, 2009 10:13 AM | Report abuse

Tomtildrum, have you *still* not figured out that this whole "mandatory end-of-life counseling" thing is a lie? Once again: the health plan will *cover* the counseling. There is absolutely nothing in the bill requiring it. Of course.

Posted by: Nick27 | August 14, 2009 3:30 PM | Report abuse

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