By Peter Roff, Thomas Jefferson Street blog
The Democrats are in trouble.
For the moment, the White House appears to be losing the debate over how to transform America's healthcare system, in no small part because many Americans have reached the conclusion that the critics are right when they talk about the inevitability of care being rationed, especially for seniors. This is helping to push public confidence in the Democrats down, with the party's approval rating down below 50 percent for the first time since Barack Obama was inaugurated, according to the latest Pew poll.
Try as they might, with the help of MSNBC and the New York Times and other serious purveyors of information and news, they have not been able to convince people that reform is not about coming up with an excuse to "pull the plug on Grandma," a phrase introduced into the debate, no doubt to his everlasting regret, by the president himself.
Actually, the White House and the Democrats in Congress set themselves up for this.
First, they announced that healthcare reform was necessary in order to control costs that, in the future, would be unsustainable when measured against U.S. GDP.
Second, they failed to take into account the message the need for cost control would send when measured against the fact that most of America's healthcare dollars are spent providing care to people in the last year to six months of their lives.
Third, House Democrats put into their legislation a section encouraging healthcare providers to engage in end-of-life counseling once every five years, and after significant health events occurred.
It is, admittedly, hard to believe that people would insert language into legislation encouraging the "pull the plug on Grandma" option. It is not hard to believe, however, that a rigid government bureaucracy would develop such a program as part of its implementation of new rules, especially if it were called something else. As healthcare expert and Obamacare critic Betsy McCaughey wrote Monday for the American Spectator:
Partisans for the legislation claim that it simply aims to provide Medicare coverage for once-every-five-year conversations with doctors over end-of-life care. Wrong. The new "benefit" is inserted in legislation with the express purpose of controlling healthcare costs (page 1). The bill lists what must be covered in the consultation (pages 425-30). Worse still, the legislation states that the Medicare system will rate your doctor's "quality" and (and adjust reimbursement) based on the percentage of your doctor's patients who create living wills and adhere to them.
The President and his supporters claim that the provision is "voluntary." The bill does not have to use the word mandatory to make the counseling mandatory. In fact, the word mandatory is seldom used in any legislation. But if there is a penalty for noncompliance, it is mandatory. In this case the penalty is on your doctor.
The American people did not need calculators to do the math. They understand the role incentives play—and providing compensation to healthcare professionals for providing end-of-life counseling directed at developing living wills that eschew extraordinary means to keep people alive is a big incentive. And, if history teaches us anything, that would only be the first step.