A blog about politics.

Death Panels

Michael Scherer's excellent interview with Ezekiel Emanuel below should be required reading, and so should Ezra Klein's interview on Monday with Senator Johnny Isakson, who has made end-of-life counseling a personal cause. It is difficult to bear the nihilist cynicism of mainstream Republicans like Sean Hannity and Rush Limbaugh on this issue. The cruelty inherent in scaring the elderly to score political points is beyond reprehensible. I've had recent personal experience with this issue. In fact...

I've spent quite a bit of time with my elderly parents--they're both 89 and have been together since the age of 5--trying to help them steer their way through some difficult decisions, and trying to guarantee that their decisions about the rest of their lives will be honored, even if they have lost the ability to announce those decisions themselves. This isn't easy. My mother and her two sisters are quite frail and entirely dependent on my father, who has made no specific plans about what should happen to them should he lose the ability to take care of them. He has a living will, he thinks. My mother has often said that if she becomes severely debilitated, "Just let me die." But I'm not sure she has made that clear in a legal document. My father is reluctant to talk about these sensitive subjects and has resisted signing a power of attorney, to be activated if he becomes incapacitated. 

My father grew up during the Depression and like many of his peers, he doesn't like spending money on services he suspects are unnecessary. End-of-life counseling on issues like living wills and powers of attorney is something he could clearly use--from a skilled professional who, unlike me, knows the best way to describe these things and the easiest way to enact them--and he would be more likely to take advantage of this service if it were offered free-of-charge, and regularly updated, by Medicare. Although, even then, I have to admit I'm not sure he'd want to take advantage of it. 

I could say a lot more about this situation, about the  details that make it particularly difficult, but those details are, of course, private. Suffice to say that I am personally appalled and outraged that Republicans like the nitwit Palin and the showbiz demagogues Limbaugh and Hannity have chosen this particular subject to exploit. It is an issue that needs sunlight and careful explanation. It involves the saddest and most lonely moments of life--and with a population living longer and longer, it is one that affects ever increasing numbers of parents and children. 

I can understand conservatives who oppose government activism as a matter of principle. They say they hold their beliefs as a matter of respect for the rights of the individual. But the sort of scurrilous campaign they are conducting--the seditious fear-mongering that is the main staple of their public diet--is a matter of profound disrespect and incivility toward the individuals whose rights they claim to cherish. The sort of people who would conduct such a campaign can only be described as ingrates.

Update: Senator Susan Collins who, being sane, exists outside the Republican mainstream on this issue, also supports end-of-life counseling, via Greg Sargent.

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  • 1

    Joe: I certainly empathize with the situation with your parents. I went through a similar situation with my parents years ago, and would have been grateful for any assistance provided by Medicare. It is difficult enough to confront from an emotional, much less financial standpoint.

    There are far more descriptive and profane terms with which I could describe these @#%$ who distort these things to suit their needs, and I am glad that both you and MS (there, I said it!) are publicly calling them out for their distortions and outright lies. More truth please!

  • 2

    From the Dead Horse Department:

    So why is no reporter confronting the seditious fear-mongers (at least the elected ones, or their official party representatives) with the demonstrable falsehood of their statements? When they refuse to repudiate the scare tactics these public figures become complicit in the offense – why do they continue to get passes from the media on the basic issue of their honesty?

  • 3

    Thanks Joe,
    .
    That post exactly filled the gap I noticed in Michael's article.
    .
    It never ceases to amaze me how much what can only be described as mythology still drives our thinking. Ronald Reagan of course rode the 'government as demon' wave for all it's worth and it's apparent that we still haven't fully recovered from the damage he wrought in doing so.

  • 4

    Wife and I are in our sixties, and both of us have living wills and durable powers of attorney. We have the same primary physician and plan to meet with him soon to discuss updates -- whether Medicare pays or not. Perhaps because her own mother died of a lingering case of cancer in her nineties, my wife is insistent on a death with dignity. I'm ambivalent, but I'll probably opt for much the same. Regardless, it's comforting to know that we get to have the last word and don't have to rely on the guesses of spouse or children.
    .
    There is, of course, nothing at all extraordinary about my situation, and having Medicare pay for the discussion with the doctor doesn't alter anything except the size of my estate when I die (if that). That this could be distorted into a government plan to kill old people is beyond reprehensible.
    .
    As one who has been there, I totally sympathize with your situation, Joe. To which I would add that there are untold millions of Americans in the same or similar positions. It is uniquely cruel to the people who must face such decisions to be told that they must avoid them lest Uncle Barack march them off to the gallows. It is uniquely necessary for the media to expose these lies. Thank God for such as you, who tell it straight.

    • 4.1

      I have been reading quite a bit from liberal bloggers for a few days now. I thought that it was supposed to be liberals and moderates who were ultimately good at communication, and that those "right-wing extremists" were those who failed at communication 101.

      I have not seen one piece or post which touches the central point of the conservative problem with government paying -- directly or indirectly -- for the medical care we will receive. The issue of "end-of-life" counseling is only indirectly related, by how it can be used to further the central fear.

      The central issue concerns who will get to make the final decision on what is a reasonable medical procedure for, say, an 80 year old woman who has broken her hip; or a 74 year old farmer whose knees are in bad shape; or a 64 year old who has had a major stroke and will require major medical attention to recover to an uncertain prognosis.

      I fully support "end-of-life" counseling by those who have no stake in the choices made, for those whose decisions are in the balance. But I think it is a rational thing to fear counseling by those who have an incentive to limit costs to "the system".

  • 5

    As someone who recently experienced the death of my mother, I can testify that the services offered through Hospice care, which is paid for by medicare, are invaluable. I do not think I could have handled the situation without their help.
    It is troubling to see so many protesters yelling about the evils of government run health care who do not seem to understand that the medicare benefits they rely upon come from the government. If health care was strictly private how many of them could afford the premiums? How many would be dropped for bogus reasons because they are sick?
    How many refuse to go on medicare because it is a government run program. If it is so bad why do they participate? Nobody is forcing them to go on medicare.

  • 6

    As much as the media has failed us with their timid, lazy, he said/she said reporting over the years, this has perhaps been their most poisonous hour. I deeply appreciate you engaging in facts and delivering unvarnished truth. Unlike your colleagues, you don't feel compelled to quote the Flat Earth Society in a story about the earth's shape. What a concept.

    • 6.1

      Sadly we've reached a point where mere corrective accuracy is completely ineffective. Most people regard news sources as fungible, and if thy see something scary in Tinfoil Online they weigh it equally against a contradiction in the NYT. The result is a random choice of what to believe, with resulting perpetuation of the lie.

      The only effective correction would come from putting a face on the right wing lies, and forcing the liars to acknowledge they have no honest basis for their political terrorism. Make Palin or Bachman or Inhofe PROVE what they claim – ask the follow-up question, and don't accept a dodge in place of an answer. Make them identify their sources. Make them acknowledge publicly they either don't know what they're talking about, or they don't care.

    • 6.2

      Excellent point, FlownOver. This tactic should also be used by congressmen at their town hall hatefests. I read recently a story of one congressman who, after being on the receiving end of a typical marxist/communist/fascist/etc. rant, calmly asked the concerned citizen for his suggestions to improve heath care. Stunned, he stood silently until one of his fellow constituents broke the silence by saying, "TORT REFORM!" to which the gentleman replied, "YEAH, TORT REFORM!"

    • 6.3

      Did you catch the part of McCaskill's meeting yesterday where she started talking about how awesome tort reform supposedly is, and all the baggers were sternly nodding in agreement?
      She then veered to noting that their state had already enacted tort reform, and calmly asked how many people's health care had gotten less expensive because of it.
      I swear you could hear the stupid whirring around in the baggers brains.

    • 6.4

      Ha - that's great. Now imagine if we got into a discussion about our "socialized" military...

  • 7

    I think it's all well and good to praise Joe for his 'exposure' of the lies and deceit, but isn't he just preaching to the choir? At what point does the MSM really step up and tell these fear mongers to stick a sock in it?

    I know we on the coasts, we latte liberal elites, poke fun at those 'real Americans', to whom Ms. Palin gives so much credence; but seriously, aren't you all starting to get at least a little frightened as to the shear gullibility of the people hanging our elected representatives in effigy at the townhall meetings?

    It appears these folks make up a fair number of our population, and I, for one, and scared to death that they may actually have some influence on this process.

    I hope the folks we elected to represent us are strong enough to withstand the assault, and do what is right by all - not just what's right for the money grubbers.

    But really my point is...why does the MSM feel compelled to give 'equal air time' in this (or any) argument? When did the job of the news hounds become nothing but regurgitation of what other people are saying? Aren't journalists supposed to get to the truth, and tell us what they find, whether they think it'll sell products and ad slots or not?

    • 7.1

      Although Joe Klein is a columnist and not a straight news reporter, hopefully he offers his colleagues some insight into such a transition. It wasn't long ago that Klein was a frustrating combination of Alan Colmes and Joe Lieberman - he simultaneously projected the timidness of the former and the smug superiority of the latter. Somewhere along the line (US Attorneys thing? Battles with Commentary?) he transformed into an essential read and my favorite political writer. He just writes clearly and tries to get at the truth. Here's to hoping that his colleagues embark on a similar journey.

  • 8

    Isakson had already flip-flopped before you wrote this.

    • 8.1

      Yeah, I just saw that. Isakson has already had his call-to-Rush moment and denounced himself earlier today.

    • 8.2

      Yeah, hopefully Joe updates this post. It seems as though Ezra just got Isakson drunk and was able to get him to speak "adult" for a few minutes.

  • 9

    Joe,
    It is so frustrating that we are in the situation where "New people" have the ability to report things that are so distorted. The reason that I commented though, is that I wanted to say how important it was for folks to actually get this counseling from a professional. This type of document needs to be VERY specific.
    My father has gone through three years of Cancer treatment and things were really bad for him during a series of surgeries this past winter. After surgery they wanted to put him on a respirator and a feeding tube. They wanted to do this temporarily, to help him get his strength back. This was not the normal going downhill, not going to get better situation- but I had a couple of family members that questioned whether he should have these inserted, as his wish was not to have them(in his living will). I had to go in and have a very painful discussion with him at a point where we all feared for his life.
    I am very happy to report that he is now cancer free, has gained his weight back and is back to his normal routine. I am thankful that he had some lucid moments to be able to have that conversation, but it was a terrible thing as I didn't want him to think I was giving up on him, or that I might know something he didn't. At that point I wanted him to fight and I literally was trying to will him my strength! My sister on the other hand, had lost her husband five years before, after a long battle with the EXACT SAME type of Cancer.
    I Know that it is important that these documents not be a simple statement that you do not want "extraordinary measures." There were lots of folks there placed on a breathing or feeding tube that later had them removed and left the hospital. Thanks for allowing me to share.

    Jean

  • 11

    Building on the previous statement, we've got the New York Times not writing stories that repeat over and over in clear language that the "death panel" rumor is 100% false, but rather stories about how the perception of "death panels" might end up impeding passage of the health care plan. One expects this from a gossip rag like Politico, but at least they admit to their prostitution. But the Times? My parents are fortunate enough to know better, but they have many well-intentioned friends who are scared to death right now because they simply aren't receiving the facts. It's so depressing.

  • 12

    Joe, I have the deepest sympathy for your situation as well as personal experience in dealing with end-of-life decisions for my mother. Fortunately, her brother was of great help & counsel in nudging her to prepare for the inevitable. She was willing to pay for the necessary legal services, but if your parents think these services are superfluous, why not indulge them & arrange for a lawyer "friend" to discuss these matters with them. I don't know what they pay you over there at Time, but I'll bet it's enough to pop for the necessary documentation to guide you in how to handle your family members' last days. Carrying out their wishes, even when you know what they are, will still be incredibly difficult.

    The Constant Weader at http://www.RealityChex.com

  • 13

    Joe thank you for this post.
    Your parents like mine lived through the depression and the second World War. My father had always controlled the finances and my mother had no idea nor us what the bank balance was.

    We really worried as his health deteriorated and tried to suggest a Power of Attorney. He held out until close till the end, when his doctor finally talked about these issues. We were very grateful as then our Mother did so as well.

    My parents passed away last year within months of each other. My father was able until the end with my sister's help to go to the bank and take care of his business.

    I am very disappointed that reporters did not jump on this issue, immediately. They only had to research the bill to put a stop to a story that was frightening our senior citizens.

  • 14

    Joe, there are two very simple reasons why this continues: money, and votes. As long as Rush can make money by ranting about socialists and conspiracy theories, he'll keep ranting. And as long as the Rs think they can scare up one or two more votes than they chase away, they'll keep fear-mongering and screaming. Those two things will ensure that the insanity continues.

  • 15

    Does anyone know how the congressional health plans handle end of life issues? Because that'd be a good place to start for a standard.

  • 16

    Notably, the idea that Medicare is not a government program has long been one of those funny anecdotal stories bandied about by members of the public opinion community. And yes, Paul Dirks, we've always attributed this phenomenon to the effective selling ability of Ronald Reagan. Sadly, this is what people do, especially among those of the older generation. Rather than believe someone who is an iconic figure, someone they've grown to trust is lying to them, as in the case of Reagan, they believe what we would assume is unbelievable, that the program they know is a government program must really be a secret private program.
    .
    This is why Madeoff got away with his ponzi scheme for so long and this is why con men target the elderly. It's not that they are intellectually challenged, although some can grow less sharp with age. However, the real cause is that the messages directed to them are framed to appeal to that sense of trust from days gone by, knowing full well once trust is established, even things that might sound suspicious on its face, sounds so much less so to the person whose been the victims of a con. It's the same reason Democrats kept hitting there head against a brick wall back in 2004, trying to convince the public that Bush was lying to them, they should have gone with incompetent that would have been easier to digest. I bring this up only to further magnify what has already been said here. I hear words like reprehensible, unconscionable and egregious and while they try to connote the depth to which these fear mongerers have sunk in order to gain political advantage. It just doesn't seem to capture my disgust with those individuals who take advantage of the elderly population with their lies. Yes I said the word lie, lie, lie, not mislead, falsehood, myth or inaccuracies, but deliberate, bald face, big fat sweaty lies. As for me, I agree with donovong and just use @#%$ to describe the architects of this terror strategy.
    .
    Personally, JK I can empathize with your situation. I just had a discussion this week with my 94 year old Dad about this very thing. And though I told him outright he does not have my permission to pass on, just in case he decides to be rebellious, there's some things that we needed to work out so that I couldn't continue my annoying habit of having the last word. You see my dad is somewhat less confrontational than my mom who wrote everything she wanted down in a letter to us and signed with a P.S. warning us that any deviations from her wishes would be met with instant and severe haunting. Lucky for me we have a tradition of humor in my family to help us to discuss difficult subjects, but like everyone else we were still procrastinating. Perhaps a letter from Medicare notifying a person of this new coverage might spark more to tackle this issue before it is too late and they become the political issue de jour a la Terri Schiavo.

  • 17

    This kind of inanity reveals just how far the FOX News-ization of media outlets has gone. As pflatley points out above, <i.The New York Times spends far more ink covering the effects of the "death panel" falsehood than it does debunking this garbage.

    And what doe the electronic media cover? The shouting. Period. Conflict sells. MSNBC must have been jumoing for joy when their camera operator spotted the guy with the gun strapped to his leg near the Obama rally yesterday. They even put the clown on with Chris Matthews.

    Blaming the media is easy, but we also get what we deserve. Simplistic nonsense rules the airwaves -- from inane reality shows to celebrity worship -- and the American public can't seem to get enough.

    No wonder the drug companies and the insurance giants and the financial industry can control what comes out of Washington. The public doesn't want to be bothered with details.

    Cheney/Bush made hay out casting every issue as black/white, good/evil with no shades of gray. They were simply playing to what the masses want.

  • 18

    And so much for proofreading before hitting post...

    One other point...

    I think an awful lot of the town hall shouters are folks who just cannot get over the fact that we elected an African-American president. The health care debate simply gave them an issue on which to hang their hats.

    • 18.1

      Yeah, one suspects that these cries of "I want my country back!" are not expressions of rage at the prospect of a public option.

  • 19

    The way this entire matter has been politicized explains why the Healthcare system is the shape that it is to date. Poliitics has trumped reason and so many who are hysterical do not even understand the proposed reform and are basing their rejection of same on "conjecture" and politically driven chaos. Bedlam deliberately unleashed to undermine an issue which should be logically and thoroughly analyzed.

    In dealing with the authorities to date in trying to apprehend Shay Riley of the "Black Female Interracial Marriage " and get justice for her ongoing criminality against me.

    Criminality she daily unleashes through illegal wiretapping of my phone and malevolently co-opting my life through activating my microphone as a listening device and using of Trojans and other spyware in a perniciously wicked manner to track, stalk and brutally assault me, I have found indepth investigations limited by certain regulations and politically imposed restrictions. Restrictions that have left this woman free to date.

    It seems politics is at the helm of our very lives and if it benefits the big businesses, then creating change becomes a lengthy and complex process.

    I know that Obama, like me and other people who seek change and justice, will forge ahead in doing the right thing.

  • 20

    I think about an old family friend who died a few months ago. He was a rough, tough old New Hampshire businesman who skiied, hiked, chopped wood, all those outdoory things, and was a pretty deep red Republican to boot. And when he got sick and went into the hospital, and the doctors asked him about life extending measures, he is quoted as saying "If you guys screw up my chance to go quickly and quietly, so God help me, I'll rise up out of this bed and strangle you!" He'd had a good full life (side note: complete with coming to terms with his daughter's "coming out") and didn't want to live in any kind of semi-comotose state. So it is worth noting that the idea of dying with dignity is not a partisan issue, that for many (not all) it is a profoundly humane act and should be nothing to get crazy about. Unless, of course, crazy is your normative state. The way this issue was demgogued off the table is another example of this country's inability to have a thoughtful conversation about the tougher issues. Thanks, again, Fox News.

  • 21

    It is always GUT WRENCHING to see the effects of politicizing issues which are deeply personal and private. The Conservative press have latched on to one issue which they believe will provide them the support required to prevent a real debate about the proposed reform.

    What amazes me the most is how so many people have allowed themselves to become swayed by rhetoric. I am willing to wager that most of those who scream the loudest at these town hall meetings have no idea about the full contents of the President's proposed reform.

    All I see on TV is brawling and shouting from people who harp on an issue(death panels) which many refuse to discuss in a logical manner.

  • 22

    Under the premise that any offer that "sounds too good to be true" probably is, the corollary is that any statement that "sounds too bad to be true" probably is as well. Oddly, people tend to be highly skeptical of the the "too good" statements, but fall entirely for the "too bad" statements, a habit that manipulative fear-mongers use to their greatest advantage.

    Despite my consistent efforts to at least have a durable power of attorney and some idea of health and property issues, my mother would not consider even discussing it. She was diagnosed with lung cancer and barely survived the surgery, and because I had no legal rights, but decisions still had to be made and bills paid, I went through the court process of becoming her legal guardian at my own expense, which made placing her in a personal care home, selling her home and her possessions and managing her care, as well as that of my disabled brother, much more expensive and time-consuming for me and for her. I am self-employed and can manage my time, but this was overwhelming and the time it takes to be a guardian instead of power of attorney is a constant drag on my finances. Any employer would rightly lose patience with the amount of time it takes to manage the lives of these two, so a day job is no solution.

    If a professional had come along and told my mother "you should do this", she eventually would have followed through with POA and other decisions. Generational and financial objections aside, no one likes to talk about this. However, if we don't make our wishes clear ahead of time, we might end up like Terry Schiavo who had her end-of-life decision splashed over all the media by grandstanding members of Congress with no means protecting herself, and we still wouldn't have the outcome we had in mind for ourselves.

  • 23

    "I can understand conservatives who oppose government activism as a matter of principle. They say they hold their beliefs as a matter of respect for the rights of the individual."
    .
    Good lord, Joe, what's that bone about? Are you saying that you don't know that it's all about money and power with these people and they are simply lying when they claim there's some principle behind it? Hard to take your outrage seriously when you throw out that sort of massively disproved garbage along with it.

  • 24

    The Republicans and other conservatives whackos DO have a free enterprise version of a medical and health care plan. It is called "Soylent Green."

  • 25

    Yes, FlownOver (#2)--why aren't people being asked for citations for their claims? Critics like to complain (probably appropriately?) that Congress members haven't even "read the bill," but I've not seen one asked whether he/she has read the bill and can provide evidence that his/her claims are true.

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