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The End of End-of-Life Counseling?

As you'd probably expect, the Senate Finance Committee is moving toward dropping coverage of end-of-life counseling from its bill entirely. Luckily, the committee's ranking member, Chuck Grassley, has some advice for those who are confused about such things as "living wills" and "advance directives" and "full and aggressive treatment."

I think the best thing to do is if you want people to think about the end of life, number one, Jesus Christ is the place to start, and after that, in the physical life, as opposed to your eternal life, it ought to be done within the family and considered a religious and ethical issue and not something that politicians deal with.

Grassley makes it sound like the House bill directs Medicare to force you into a long conversation with Deepak Chopra about death. But it doesn't. This is not about how you feel toward death. A conversation with your pastor is not a substitute. End-of-life counseling is not a religious issue. It's a medical issue. It's about clearly articulating your preferences in the event that you become mentally incapacitated or comatose.

What Grassley is actually proposing here is not that people talk to their families. It's that if families want to talk with a doctor about these issues, Medicare won't cover the cost. He's not making sure they have a choice. He's making sure they don't.

By Ezra Klein  |  August 13, 2009; 2:05 PM ET
 
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Comments

How is it possible this stuff is happening? really.

Posted by: bdballard | August 13, 2009 2:17 PM | Report abuse

"I think the best thing to do is if you want people to think about the end of life, number one, Jesus Christ is the place to start, "

do you think, that Jesus Christ, in his infinite compassion and forgiveness, is starting to getting fed up with these folks?
all i can say, is, it's a good thing that chuck grassley isnt jewish, because he might be turning into a carton of morton's salt by now.

Posted by: jkaren | August 13, 2009 2:31 PM | Report abuse

In terms of planning my health care, f@&k Jesus.

Posted by: PorkBelly | August 13, 2009 2:33 PM | Report abuse

"...take the pill."

No, it's not what they say it is. It just looks like it is.

Posted by: whoisjohngaltcom | August 13, 2009 2:33 PM | Report abuse

Does this mean grandma gets that new hip now instead of a script for Percocet? I'm thinking not.

Counseling or not, grandma still gets told to take the pill.

Posted by: whoisjohngaltcom | August 13, 2009 2:37 PM | Report abuse

Following the same logic...

So if Medicare pays for hysterectomies, that means everyone has to get one? That means some 'government bureaucrat' is going to be empowered to tell you and your wife, your sons and your daughters, 'go out and get a hysterectomy -- or else'?

Posted by: leoklein | August 13, 2009 2:42 PM | Report abuse

Ezra, you're right. Our government is horribly broken. This is a sham, a farce, a disgrace. This is not governing.

Posted by: mrmoogie | August 13, 2009 2:55 PM | Report abuse

Having a clearly defined living will that outlines your wishes is a very big help to your family. I speak from experience.

I don't imagine the jeebus was really envisioning a time when people could be kept alive by machines and medicines in a completely dependent state almost indefinitely. I suppose if that's the way you and your family want you to take leave of this planet, go ahead. I guess I will even help you pay for it! But don't try to force your religious hocus pocus on me.

Posted by: luko | August 13, 2009 3:02 PM | Report abuse

How are these insane people driving the car? Once again Liberals protest war and Conservatives protest health care! The Right wing is afraid of education.

Posted by: sjmuffler | August 13, 2009 3:06 PM | Report abuse

It is a hard truth: at some point over 65 or so, some folks begin progressive decline in mental functioning. Grassley gives evidence (not just in this context) that he's not hitting on all the cylinders anymore - yet he's writing health insurance reform for everybody. He clearly is speaking nonsense on this end-life counseling issue. [I'll grant that maybe he's just a political hack following the GOP elephant into the La Brea tar pits].

Anyway, he needs to be gently pushed aside by the Dems. Make him an ambassador to Uruguay or something. Or just ignore him.

The GOP Senate group is filled with marginal awareness, over-the-hill-mentally guys who are FOS: Jim Bunning, John McCain, Chuck Grassley, Saxby Chambliss, Jim Inhofe....

Posted by: JimPortlandOR | August 13, 2009 3:09 PM | Report abuse

So many kinds of inappropriate. I think this calls for it: it might be impossible to overstate how irresponsibly Grassley is handling this.

Posted by: bean3 | August 13, 2009 3:17 PM | Report abuse

bean3, you're exactly right. Grassley is being completely and utterly irresponsible. I cannot comprehend why someone who is not participating in the legislative process in good faith is still given a seat at the table. He's doing his best to kill any legislation.

Posted by: davestickler | August 13, 2009 3:24 PM | Report abuse

As Managing Director of the Partnership for End-of-Life Choices, I am appalled at the lack of information -- even on the part of politicians and journalists -- about the constitutional right guaranteed to all Americans over 18 to document their wishes about end-of-life care and avoid the trauma of ending up like Terry Schiavo.

The sad truth is that less than 25% of Americans have taken advantage of the legally-binding Advance Directives available under every state law. When Congress passed the Act 20 years ago, they never funded the "education" portion, so few people have documented their choices and fewer still know how to make them effective.

All this bill says is that seniors can get Medicare reimbursement if they want to talk to a doctor about this. What about the rest of us, who need to learn about and take advantage of what is already allowed by law?

Posted by: arufus | August 13, 2009 3:30 PM | Report abuse

It would be an absolute disgrace if the committee dropped the provision. It would represent--no, it would in fact be--a surrender to lies instead of fighting them.

If politicians are going to surrender to lies, then we'll never have any good policy regardless of where on the political spectrum you're on.

Instead of pulling the provision, proponents should call opponents on their scaremongering and rip their credibility to shreds. Otherwise this pathetic stunt is going to get pulled over and over again.

There's plenty of material for legitimate criticism and debate on health care reform. But this one is just absurd, and should be held out to the nation as such.

Posted by: dasimon | August 13, 2009 4:31 PM | Report abuse

"I think the best thing to do is if you want people to think about the end of life, number one, Jesus Christ is the place to start..."

Sorry Jews, Muslims, Buddhists and nonbelievers - you're just not part of this conversation.

Posted by: Sophomore | August 13, 2009 5:56 PM | Report abuse

This has to be the stupidest outcome possible.

The only "Death Panel" the elderly face are their own families.

Why are Republicans trying to scare them away from being well-informed at critical moments?

Posted by: bluespapa | August 13, 2009 6:13 PM | Report abuse

Well, I guess with Jesus we don't need any health insurance after all, Grassley!!!

Grassley had never intended for health reform to work. He was simply prolonging the debate in an attempt to kill it.
And that is a "reasonable" ranking Republican senator that Obama has been praising. Well, you can kiss your bipartisan approach goodbye. Now it is up to the Democrats to excercise their reconciliation and vote for single payer healthcare reform (HR 676). But since Democrats are as much slavish to the health industrial complex as the Republicans we have no choice but to ensure a strong public option for now.

Posted by: Single_Payer | August 13, 2009 7:52 PM | Report abuse

I don't want end of life counseling; I want end of life choices! Ending life in some medical experiment on how much pain tolerance exists, or how long one can drag a crippled body to and fro or how demented the mind can become more it stops...all based on not running out of money and/or insurance or both.. is no choice at all. The single most valuable reason to own a hand gun is for its single purpose; namely to kill its owner!

Posted by: Chaotician | August 13, 2009 7:54 PM | Report abuse

Grassley is such a chicken-sh*t. Rather than clarify the issue and set the record straight on what end-of-life counceling really means for people, he'd rather stir the pot, then drop the provision and further dilute healthcare legislation until it's worse than meaningless.

Posted by: stopthemadness2 | August 13, 2009 9:20 PM | Report abuse

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