End-of-Life Counseling Had Bipartisan Support

WASHINGTON -- One of the most heated flash points in this year's health care debate — permitting Medicare to pay for end-of-life counseling — started out as a rare example of congressional bipartisanship.

The measure, contained in a House bill to overhaul health care, has been criticized by former Alaska governor Sarah Palin, a Republican, and others as laying the groundwork for a "death panel" that would push frail Americans into early graves. However, the provision had been a separate bill with Democratic and Republican support as recently as a few months ago.

Rep. Charles Boustany, R-La., a heart surgeon and a co-sponsor of the counseling bill, says the legislation is aimed at promoting important discussions between doctors and their patients about critical end-of-life issues, such as having a living will. He says those discussions are a "good medical practice," and doctors who spend time counseling their patients about their wishes should be reimbursed through the Medicare system, as the legislation allows.

Now, Boustany says proponents may have to "back off" and reconsider the issue "at some point when the temperature had cooled down."

"Frankly, this thing got really out of hand," he says.

Rep. Earl Blumenauer, D-Ore., sponsor of the measure, says he's flabbergasted at the turn the debate has taken. "It's just beyond bizarre," he said. "At every point along the process, I got broad agreement from Democrats and Republicans alike."

When Blumenauer introduced the legislation in April, his co-sponsors included Republican Reps. Patrick Tiberi of Ohio, Geoff Davis of Kentucky and Boustany.

However, many Republicans appear to be backing off since Palin warned on her Facebook page in late July that it would result in the creation of a "death panel."

Sen. Chuck Grassley, a key player in the health care talks as the ranking Republican on the Senate Finance Committee, said at an Iowa town- hall-style meeting last week that "we should not have a government program that determines if you're going to pull the plug on Grandma."

Rep. Tammy Baldwin, a Wisconsin Democrat who co-sponsored the Blumenauer bill, said she is "extremely disappointed" that Grassley would engage in such "a misrepresentation."

Baldwin said the House measure creates incentives for doctors and patients to discuss end-of-life care before the situation is critical. "The intent is to encourage these discussions about difficult subjects and to encourage them early in life," she said.

Grassley since has clarified his stance on the measure. He says he believes end-of-life directives are "a good idea" but that in the context of the House bill's efforts to cut costs, fears about the counseling are justified.

Boustany says several provisions added to the House health care bill have given some of his colleagues "heartburn." Among them: a provision allowing doctors to refer patients to legal service organizations. In the three states that allow physician-assisted suicide, those groups often refer people to doctors or practices willing to provide that service, Boustany says, and "that's alarming." The states are: Oregon, Washington and Montana.

"We have to make sure we're thinking through all the consequences of the language we're writing," he said.

Still, Boustany says health care changes should include reimbursement for doctors to counsel patients. He says he's been in many situations where a critically ill patient hasn't made his wishes clear, and family members are divided over what kind of medical treatment should be provided. "This happens every day, multiple times, in hospitals across the country," he says. "It's a very important issue."