Sen. Charles Grassley, who is one of just three Republicans negotiating some sort of health care compromise in the Senate Finance Committee, is drawing fire back home in Iowa for statements expressing concern about the end-of-life provisions that the Finance Committee has now dropped from its version of the bill. Yesterday Iowa Democratic Rep. Bruce Braley accused Grassley of “doublespeak” for “continu[ing] to repeat the ridiculous claim that paying doctors to discuss end-of-life care with their patients is somehow ‘pulling the plug on grandma,’ yet in 2003 he voted for a bill with a nearly identical provision allowing Medicare to reimburse doctors for end-of-life care consultations.”
Braley was referring to the 2003 Medicare Modernization Act, co-sponsored by Grassley, which Braley claims contains language just like the end-of-life provisions that Grassley now objects to. But Grassley says Braley has it all wrong. “I’m shocked that Congressman Braley would attack a fellow Iowan before getting all the facts,” Grassley said late Friday:
His statements over the past two days have been riddled with misinformation about what was said in my town meetings, and now he’s taking my vote in 2003 completely out of context. If Congressman Braley had actually listened to what I’ve said on this subject, he’d know that my support for the provisions in the Medicare Modernization Act (MMA) are in line with my long-held view that advanced care planning is a good thing for families to do. The MMA offers terminally ill patients a pain and care management evaluation and counseling about hospice care and other options. And it offers optional advice from a specialized hospice physician on advanced care planning. One could be assured that the provision of advice on advanced care planning in this context can be done in a correct manner and by an appropriate provider.
I can’t say the same thing about what would happen under the provisions in the Pelosi bill. Under the Pelosi bill, all physicians risk losing quality bonus payments unless they report on whether they provide advanced care planning and adherence to that plan. Congressman Braley also misses the larger point when he fails to realize that the concerns about the advanced planning provisions in the Pelosi bill are made because they are proposed in the context of a bill that is ostensibly working to save money by spending less on health care in health care reform, and in a bill that creates a government-run plan that will surely lead to rationing of health care just like has happened in other countries that have government-run systems. It’s plain to see why Iowans and others are legitimately concerned about the unintended consequences of the House bill.
Grassley’s point that doctors “risk losing quality bonus payments unless they report on whether they provide advanced care planning and adherence to that plan” will be an emerging argument in the health care debate.
