Those whose arguments are empty of fact are usually full of shit. --David Porter
Get it out there. Call, write, talk, inform.

Wednesday, September 23, 2009

DNC Sued By Man Ousted From Town Hall

Sounds like a "Frivilous Lawsuit" to me!
Read the Article at HuffingtonPost

Tuesday, September 15, 2009

Shit Spills out of Santorum as He Tries to Lie About Reconciliation

Santorum Ties Himself Into Knots Justifying Congress’ Use Of Reconciliation During The Bush Years

On an RNC conference call today, Politico’s Ben Smith asked former Pennsylvania Republican Sen. Rick Santorum why he believes it would be an “abomination” for Congress to use the budget reconciliation process — which requires 51 instead of 60 votes — to pass health care reform, considering that the Republican Congress also used it to pass bills, such as President Bush’s tax cuts.

Santorum tried to name every way he could think of that might justify his position, including: 1) unlike health care, a tax bill is a “revenue bill” and “affects the budget,” 2) health care is “major policy initiative,” and 3) the reconciliation process will make a “huge and complex” bill even “more complex.”

When Smith pointed out that Republicans used the reconciliation process to push through drilling in the Arctic National Wildlife Refuge — which is also arguably a major policy initiative that isn’t just a revenue bill — Santorum tried to argue that it wasn’t AS major, so it was accceptable:

SANTORUM: Well, again, you’re talking about a situation where, again, the biggest thing about drilling is certainly it has an impact on a small chunk of land in northern Alaska, and it has an impact on the federal revenue, but it’s not a particularly complex thing. You’re talking about drilling holes, as opposed to rejiggering and rewriting and reconstructing the entire health care system of this country. And the impact on the 350 million Americans for drilling a few holes in Alaska is fairly minor, as far as how it affects their daily lives. As opposed to — and by the way, it’s fairly minor on the economy, certainly in the short term, a little more in the long term. But again, nothing compared to what we’re talking about here with health care.

That’s not what Santorum argued at the time. In 2006, he wrote that Arctic drilling “has the potential to play a significant role in reducing our dependence on foreign oil.” Cantor also admitted that tax cuts would have more than a “minor” effect on the economy, saying in 2001, “There is nothing better that we can do for long term growth of our economy to lower these oppressive tax rates we have in place right now.” Basically, reconciliation is okay for any bill EXCEPT for Obama’s health care legislation — which is both too big and too small.

Congress has used reconciliation nearly 20 times since 1980 for everything from the State Children’s Health Insurance Program to student aid efforts, to expanding Medicaid eligibility. In 1995, Santorum was the GOP’s point person to push welfare reform through the budget reconciliation process. “This is a bill the president has absolutely no reason not to sign,” argued Santorum. He is also in no place to be lecturing Democrats on the proper use of reconciliation, considering that under Bush, Republicans fired two successive Senate parliamentarians who disagreed with what they were doing.

SANTORUM: You know, a tax bill, by definition, is a revenue bill; it affects the budget, and that’s what reconciliation was for. It was for doing things that have an impact on the balance sheet of the federal government. And health care reform — while certainly an aspect of health care reform will have that — this is a major policy initiative in an area that goes beyond the federal government’s balance sheet, and that to me, makes it an abomination that they would try to write a bill.

In my opinion, what makes it an abomination is because you have to write every provision of the bill score, otherwise it’s subject to the Byrd rule — those of you who hang around Washington know what that’s all about. And so you have to — as we — it’s a difficult thing to do, even with a tax bill. Imagine if you have to do with the government option or whole bunch of other things. You’re going to have to create very Rube-Goldberg kind of language that will make it — a bill that’s already going to be huge and complex — more complex because it has to get through the trip wire of the Byrd rule.

I just think that it’s taken an already difficult and overwhelming task of trying to rejigger the entire health care system of this country and now having to do it with the idea of every provision of the bill has to have some impact on the federal government. I just think makes it a wholly unworthy thing to try to accomplish.

SMITH: And reconciliation during the Bush years was also used for drilling in ANWR. Does that not have some of the same problems?

SANTORUM: Well, again, you’re talking about a situation where, again, the biggest thing about drilling is certainly it has an impact on a small chunk of land in northern Alaska, and it has an impact on the federal revenue, but it’s not a particularly complex thing. You’re talking about drilling holes, as opposed to rejiggering and rewriting and reconstructing the entire health care system of this country. And the impact on the 350 million Americans for drilling a few holes in Alaska is fairly minor, as far as how it affects their daily lives. As opposed to — and by the way, it’s fairly minor on the economy, certainly in the short term, a little more in the long term. But again, nothing compared to what we’re talking about here with health care.

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And 100% of Assholes are Against the Public Option

Most US doctors back public health option: poll
Published: Monday September 14, 2009

Most US doctors approve of a "public option" to supplement private health care insurance in the United States, as proposed by President Barack Obama, a poll showed Monday.

A total of 62.9 percent of physicians who participated in the survey by the prestigious New England Journal of Medicine (NEJM) said they favored a public option, or government insurance plan, against 27.3 percent backing a private system alone.

Another 9.6 percent favored a completely government-owned health care coverage system.

"It's clear that the majority of US physicians support both public and private options to expand coverage," NEJM said, noting that between 52 and 69 percent of Americans favor a supplemental public option.

The journal described physicians as "critical stakeholders" in health care reform.

Obama has vowed to pass legislation by the end of the year that would spread coverage to America's 47 million uninsured by making insurance obligatory and affordable for all.

But he has faced strong criticism, especially from Republicans, who have jumped on the 880-billion-dollar price tag and stoked fears that a mooted public option would lead to a federal takeover of health care -- anathema to many Americans who abhor the idea of big government.

The NEJM poll found that 58.3 percent of physicians favor expanding Medicare, the public government-run health insurance plan for seniors over 65 years old, to people aged 55 and over.

This option is among a set of proposals being considered by the Senate Finance Committee, which has played a key role in legislating the health reform plan.

In the traditionally more conservative South, 58.9 percent of US physicians favored a public option, compared to 69.7 percent in the generally more progressive Northeast.

NEJM surveyed 2,130 general physicians, specialists and surgeons who work in a private practice or with hospital groups.

A Washington Post-ABC News opinion poll meanwhile showed Americans remained almost deadlocked in their opinion of the health care initiative, with 46 percent of [sic]educated, well informed in favor of the proposed changes and 48 percent of [sic]uneducated, uninformed opposed.

Monday, September 14, 2009

Conservatives Fake Tea Party Crowd

"Tea party" photo shows huge crowd — at different event
By Catharine Richert
Published on Monday, September 14th, 2009 at 11:34 a.m.

...supporters of Saturday’s “tea party” protests against President Barack Obama were quick to highlight their big turnout. To bolster countless claims on blogs and Facebook, many posted a photograph that showed a gargantuan crowd sprawling from Capitol Hill down the National Mall to the Washington Monument.

But it turns out the photo is more than 10 years old, apparently taken during a 1997 Promise Keepers rally.

On Saturday, estimates about the crowd spread quickly through the conservative blogosphere. Many writers, including author Michelle Malkin, pegged the number of people between 1 million and 2 million. Those reports were largely based on information from people in the crowd.

Malkin, for example, updated her blog at 12:34 p.m. noting that, “Police estimate 1.2 million in attendance. ABC News reporting crowd at 2 million,” and she cited a Twitter post from Tabitha Hale, writer of Pink Elephant Pundit, who was in Washington for the protest.

Many bloggers said the media was unfairly reporting much smaller numbers, and many included the photo.

“I have no doubt that Washington Democrats are well aware of how many people turned out, even as their media outlets try to downplay the event,” said Power Line, a conservative blog that linked to the photograph from Say Anything, another conservative Web site.

“ 'Media’ estimates range from 60,000 to 500,000 to around 2 million (yes, 2,000,000),” wrote John G. Winder for the conservative blog Cypress Times. “Those estimates, the language employed, and the visuals chosen for use in reporting the rally and representing the people gathered, vary greatly based solely on bias.”

...Pete Piringer, public affairs officer for the D.C. Fire and Emergency Department, said the local government no longer provides official crowd estimates because they can become politicized. But the day of the rally, Piringer unofficially told one reporter that he thought between 60,000 and 75,000 people had shown up.

We asked Piringer whether there were enough protesters to fill the National Mall, as depicted in the photograph.

“It was an impressive crowd,” he said. But after marching down Pennsylvania Avenue to the Capitol, the crowd “only filled the Capitol grounds, maybe up to Third Street,” he said.

Yet the photograph so widely posted showed the crowd sprawling all the way to the Washington Monument, which is bordered by 15th and and 17th Streets.

There’s another problem with the photograph: It doesn’t include the National Museum of the American Indian, a building located at the corner of Fourth Street and Independence Avenue that opened on Sept. 14, 2004. (Looking at the photograph, the building should be in the upper right hand corner of the National Mall, next to the Air and Space Museum.) That means the picture was taken before the museum opened exactly five years ago. So clearly the photo doesn’t show the “tea party” crowd from the Sept. 12 protest.

Also worth noting are the cranes in front of the Smithsonian Museum of Natural History. According to Randall Kremer, the museum’s director of public affairs, “The last time cranes were in front was in the 1990s when the IMAX theater was being built.”

It appears that the photo was actually taken in 1997 at a rally for Promise Keepers, a group for Christian men. According to the group’s Web site, nearly 1 million people attended the event. Photos of the Oct. 4, 1997, event that were posted on various Web sites in 2003, 2008 and earlier this year show either the same picture or a similar photo that has identical tents and what appear to be TV screens in the same locations.

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Wednesday, September 09, 2009

GOP legislator describes affair with lobbyist on live mic

News sources in California have recently learned that a conservative Republican member of that state’s Assembly was recorded without his knowledge earlier this summer describing lurid details of his affair with a lobbyist.

Orange County Assemblyman Michael D. Duvall apparently didn’t realize that his mic had gone live just before a committee hearing. At the time, he was telling a Republican colleague, “We had made love Wednesday — a lot! And so she’ll, she’s all, ‘I am going up and down the stairs, and you’re dripping out of me!’ So messy!”

“So, I am getting into spanking her,” Duvall continued. “Yeah, I like it. I like spanking her. She goes, ‘I know you like spanking me.’ I said, ‘Yeah! Because you’re such a bad girl!’”

Duvall, a former president of the Yorba Linda Chamber of Commerce, is married with two children. According to R. Scott Moxley of OC Weekly, his paramour, with whom he has frequently been seen at restaurants and even at fund-raising events, is Heidi DeJong Barsuglia, a “hot blonde” 18 years his junior. Barsugla was hired last spring to lobby for a major energy company soon after Duvall became vice-chairman of the Utilities and Commerce Committee.

Duvall’s recorded comments reveal, however, that he is even cheating on Barsuglia. “She is hot!” Duvall said of this other woman, who is also a lobbyist. “I go, ‘You know about the other one [Barsuglia] but she doesn’t know about you.”

Moxley wrote on Tuesday, “Repeatedly asked to explain his recorded sexual boasting, a red-faced Duvall fled me and another reporter, Dave Lopez of KCBS in Los Angeles, three times this afternoon in capitol hallways. He also ignored three handwritten interview requests that were delivered to him on the floor of the assembly. Said one assembly employee who witnessed the scene, ‘It definitely looks like he is afraid of you guys.’”

In his own tv segment on the story, Lopez noted that sources told him Duvall “loves to talk about his ’sexual conquests.’ The source goes on to say, ‘It makes us all feel very uncormfortable, but it’s very difficult to get him to change the subject.’”

According to Lopez, Duvall even told this source at one point, “You know, you’ve got to be real careful what you say up here, because they could have microphones hidden in a salt shaker.”

Duvall has a reputation as a vocal opponent of gay marriage and announced last spring that he was working to protect “California families” from “constant assault in Sacramento.”

On that occasion, the president of the conservative Capitol Resource Institute — which was a major backer of the anti-gay marriage Proposition 8 — said of Duvall, “For the last two years, he has voted time and time again to protect and preserve family values in California. We are grateful for his support of California families.’”

This video is from KCAL 9 News in Los Angeles, broadcast September 8, 2009. It can also be viewed here.

By Muriel Kane
Published: September 9, 2009

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America Already has Rationing of Healthcare

America already has a bureaucrat standing between you and your doctor. It's called your Health Insurance Company. Health insurance bureaucrats deny medical treatments HUNDREDS of times a day because it's too expensive, and if your medical care is going to be really, really expensive the health insurance bureaucrats take away your medical care completely and leave you to die.

When Your Insurer Says You're No Longer Covered
Firms Defend 'Rescissions' as Fraud Control

By Karl Vick Washington Post Staff Writer Tuesday, September 8, 2009

LOS ANGELES -- The untimely disappearance of Sally Marrari's medical coverage goes a long way toward explaining why insurance companies are cast as the villain in the health-care reform drama.

"They said I never mentioned I had a back problem," said Marrari, 52, whose coverage with Blue Cross was abruptly canceled in 2006 after a thyroid disorder, fluid in the heart and lupus were diagnosed. That left the Los Angeles woman with $25,000 in medical bills and the stigma of the company's claim that she had committed fraud by not listing on a health questionnaire "preexisting conditions" Marrari said she did not know she had.

By the time she filed a lawsuit in 2008, she also got a diagnosis of pancreatic cancer and her debts had swelled beyond $200,000. She was able to see a specialist by trading office visits for work on the doctor's 1969 Porsche at the garage she owns with her husband.

"I've had about 10 visits," Marrari said of the barter arrangement that has proved more reliable than her insurance. "The car needs a lot of work."

Rescission -- the technical term for canceling coverage on grounds that the company was misled -- is often considered among the most offensive practices in an insurance industry that already suffers from a distinct lack of popularity among the American public. Tales of cancellations have fueled outrage among regulators, analysts, doctors and, not least, plaintiffs' lawyers, who describe insurers as too eager to shed patients to widen profits.

Those sentiments have become central to the health-care debate, as President Obama tries to tap into dissatisfaction with the insurance industry to build support for reform efforts. Each of the bills pending in Congress would prevent insurers from rejecting clients because of preexisting conditions.

No one claims to know how often policies are canceled -- in large part, congressional investigators say, because insurance companies are regulated by a patchwork of state laws and policies. But the practice is common enough to spur lawsuits and state regulatory action.

In the past 18 months, California's five largest insurers paid almost $19 million in fines for marooning policyholders who had fallen ill. That includes a $1 million fine against Health Net, which admitted offering bonuses to employees for finding reasons to cancel policies, according to company documents released in court.

"This is probably the most egregious of examples of health insurers using their power and their resources to deny benefits to people who are most in need of care," said Gerald Kominski, associate director of the Center for Health Policy Research at the University of California at Los Angeles. "It's really a horrendous activity on the part of the insurers."

Insurance company officials say they need to be able to cancel policies to control fraud, which by some estimates reaches $100 billion annually.

"We do not rescind a policyholder's coverage because someone on the policy gets sick," said Peggy Hinz, a spokeswoman for Anthem Blue Cross, a subsidiary of WellPoint. "We have put in place a thorough process with multiple steps to ensure that we are as fair and as accurate as we can be in making these difficult decisions."

Much of that process was a condition of settlements with state overseers, who fined Blue Cross $11 million over the past two years and required it, and all other major insurers in California, to restore canceled policies. Insurers still face court challenges, including a class-action suit targeting Blue Cross on behalf of 6,000 canceled policyholders.

"These cases are very, very good in front of a jury," said Bill Shernoff, whose Claremont law firm has settled 90 cases and has 130 cases pending. "I wish I could tell you the amount of money they throw at us just to make it go away and keep quiet."

In the only case to go to trial in California, an arbitration judge awarded $9 million to a beautician who had to stop chemotherapy for her breast cancer after Health Net dropped her policy. Company officials declined to comment.

In a pending case, Blue Shield searched in vain for an inconsistency in the health records of the wife of a dairy farmer after she filed a claim for emergency gallbladder surgery, according to attorneys for the family. Turning to her husband's questionnaire, the company discovered he had not mentioned his high cholesterol and dropped them both. Blue Shield officials said they would not comment on a pending case.

Officials from three insurance companies told a House Energy and Commerce subcommittee this summer they had saved $300 million by canceling about 20,000 policies over five years.

Critics charge that companies, rather than vetting applicants, wait until a claim is filed. "It only happens if you create this bill. Then they go back into your application," said Dev GnanaDev, president of the California Medical Association, which lobbied Democratic House leaders to include restrictions on cancellations in their legislation. "Costco doesn't let me take something back after 90 days," he said. "If they want to investigate, let them do it within 90 days."

Regulators say many omissions appear to be honest mistakes on forms that are needlessly complex. Others result from ambiguous conversations between patient and doctor.

Yvette Thomassian of Glendale, Calif., lost her Blue Cross policy because she did not declare a deviated septum. She questioned why a common misalignment of the nostrils would disqualify anyone but emphasized that her doctor never clearly indicated she had the condition. They spoke Armenian in the exam room, she said, where the physician's words were "You have a bone in your nose."

"It's been three years of hell," said Thomassian, whose suit over the $31,000 in bills is scheduled for trial in January. Blue Cross officials said they would not discuss specific cases.

For Teresa Dietrich, it was fibroids. The Northern California real estate agent was left to pay $19,000 after Blue Cross said she did not disclose a diagnosis of the benign uterine tumors. But Dietrich said the doctor who had written "fibroids" on her medical record never mentioned his suspicions to her. The bills destroyed her credit and cost her her home -- and, in a comically cruel twist, the surgery proved the doctor was wrong.

"They said I had a condition I didn't even have," Dietrich said. "And they canceled me."

If federal health-care reform bars companies from screening for preexisting conditions, insurers note that cancellations will no longer be an issue. But Melinda Beeuwkes Buntin, an economist at the Rand Corp., said that unless for-profit companies are compensated for taking higher-risk patients, the firms will continue to look for ways to unload them.

"They wouldn't be able to overtly kick you out, but that doesn't mean that they might not put, for example, more onerous preauthorization requirements on services that people who are at risk might need, and that might discourage you from re-enrolling next year," Buntin said.

She said one solution would be for Washington to subsidize insurers that take on higher-risk patients. The government does such "risk adjustment" for the private insurance provided through Medicare Advantage -- though Obama has called for ending those subsidies to finance reform.

"You can ban rescission," Buntin said, "but what we really want is a system under which insurers' incentives are aligned with treating all of their patients well, whether they're sick or healthy."

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Friday, September 04, 2009

Health Care Consumers Give Medicare Higher Marks Than Private Plans

Consider some results obtained by a Kaiser poll. When asked how much they trust various health care players "to put your interests above their own," respondents rank doctors (78 percent trust "a lot" or "some") and nurses (74 percent) at the top of the list.

Among those insured through Medicare, however, respondents liked and trusted "the Medicare program" (68 percent). Among those with private insurance, "your health insurance company" earns much less trust (48 percent).

Medicare is government run health care!

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The Unwitting Birthplace of the 'Death Panel' Myth

LA CROSSE, Wis. -- This city often shows up on "best places to live" lists, but residents say it is also a good place to die -- which is how it landed in the center of a controversy that almost derailed health-care reform this summer.

The town's biggest hospital, Gundersen Lutheran, has long been a pioneer in ensuring that the care provided to patients in their final months complies with their wishes. More recently, it has taken the lead in seeking to have Medicare compensate physicians for advising patients on end-of-life planning.

The hospital got its wish this spring when that provision was inserted into the health-care reform bill -- only to see former Alaska governor Sarah Palin seize on it as she warned about "death panels" that would deny care to the elderly and the disabled. Despite widespread debunking, those warnings have led lawmakers to say they will drop the provision.

"It's really distressing," hospital official Bud Hammes said. "These things need to be addressed."

President Obama's health-care initiative was nearly consumed by the furor over that provision, and Republicans continue to argue that the legislation would ration care for the elderly. The debate has underscored how fraught the discussion is on end-of-life care in a country where an optimistic ethos places great faith in technology and often precludes frank contemplations of mortality. That tendency has a price tag: A quarter of Medicare costs -- totaling $100 billion a year -- are incurred in the final year of patients' lives, and 40 percent of that in the last month.

But the controversy has had most resonance where it arguably took root, in this town of 52,000 where nearly everyone of a certain age has an advance-care directive.

La Crosse became a pioneer in addressing end-of-life questions in the mid-1980s, after Hammes, a native of the city who has a doctorate in philosophy from Notre Dame, arrived at Gundersen as the director of medical humanities, charged with educating resident physicians about ethics. He noticed a "troubling pattern," he said, in which family members struggled to make medical decisions, such as whether to continue dialysis after a stroke.

"We'd turn to the family and say, 'We need your input. If your mother or father could speak now, what would they tell you?' And the family would say, 'If we only knew,' " said Hammes, 59. "I could see the distress. They were going to have to live with themselves, with the worry about making a mistake. This was unacceptable."

The hospital began urging families to plan while people are healthy. For those who want help writing a directive, a physician will discuss the powers and limits of medicine and explain to family members what it means if they agree to serve as the "health-care agent." They will also help people define the conditions under which they would no longer want treatment. Hammes said people often define this as "when I've reached a point where I don't know who I am or who I'm with, and don't have any hope of recovery."

The directives are power-of-attorney forms that protect physicians and family members against liability, and the hospital makes clear to its doctors that they are expected to follow them. Today, more than 90 percent of people in town have directives when they die, double the national average.

The reliance on directives has an impact on the type of care people receive: Gundersen patients spend 13.5 days on average in the hospital in their final two years of life, at an average cost of $18,000. That is in contrast with big-city hospitals such as the University of California at Los Angeles medical centers (31 days and $59,000), the University of Miami Hospital (39 days, $64,000) and New York University's Langone Medical Center (54 days, $66,000).

Those disparities are not explained just by the hospital's end-of-life philosophy. Under Medicare formulas, Gundersen and other Upper Midwest hospitals receive lower reimbursements. The high-spending hospitals argue that they are also dealing with a more diverse and costly patient base.

Gundersen and other Upper Midwest providers are also less costly in general, partly because they follow a model of integrated care where doctors work closely together to minimize waste. At Gundersen, doctors receive a salary instead of being paid for each procedure they perform.

But locals say the city uses less health care in large part because of how people view the end of life. Some of this may be rooted in the down-to-earth sensibility of their German and Scandinavian forebears. (Hammes said his late mother, who had dementia, was a "pragmatic German" who thought that paying to keep herself alive was a "waste of her money.")

Mostly, though, locals say it is because Gundersen and the town's other hospital, Franciscan Skemp, have urged planning. "People here have their feet planted in the ground," said Barbara Frank, a retired teacher. "They're no-nonsense sorts of people, without a lot of illusion. That was the fertile soil upon which it was planted. But there's no question it was helped by the two medical centers taking the lead and saying, 'This is a good thing for you to do.' "

She and her husband, Donald, a retired train engineer, signed a directive 10 years ago, when they were in their 60s. "You increasingly realize that they're not going to make an exception in your case. We all die, and we want to do so with the most dignity and most control," she said. "It seemed a no-brainer. And it spares our children from making those decisions."

Over time, the practice caught on. "People talk to people who talk to people. They say, 'Do you have one?' 'Yeah,' or 'I have to get that done,' " said Ann Kotnour, a nurse whose 89-year-old mother is receiving care at home for her advanced Parkinson's after signing a directive in 2001 saying she did not want aggressive measures taken.

Financial planner Jeff Lokken's parents had met with their children and doctors in the mid-1990s to draw up directives, a step that was helpful a few years later, when he and his siblings needed to decide whether to keep their 77-year-old father on a ventilator after heart surgery. The living will also helped when his mother's health failed when she was 82. "There needs to be a conversation. In our case we had good conversations," he said.

But Gundersen staff members say those conversations take a lot of time -- a good hour, plus follow-up talks to alter directives as medical situations evolve. And Medicare does not reimburse doctors for the time spent on such discussions.

Backed up by a few other hospitals, Gundersen set out to change the federal rules to reward end-of-life planning. A Gundersen administrator testified on Capitol Hill last fall, and, with the help of a lobbyist, reached out to lawmakers such as Sen. Herb Kohl (D-Wis.), Sen. John D. Rockefeller IV (D-W.Va.) and Rep. Ron Kind (D-Wis.).

After sporadic bipartisan attempts in recent years to add consultation payments to Medicare, Rep. Earl Blumenauer (D-Ore.) submitted legislation this spring, with several Republican co-sponsors, that included a provision to reimburse doctors for consultations. A few months later, House Democrats tucked similar language into their health-care reform bill -- a legislative triumph for the small hospital in La Crosse.

Then the uproar began, capped by Palin's "death panel" remark. Gundersen officials and town residents were aghast. "It's totally absurd," Frank said. "It's just the opposite -- it's giving you a choice of how you want to be treated."

Gundersen officials were particularly upset when Sen. Charles E. Grassley (R-Iowa), whom they had considered an ally, said that the government should not "pull the plug on Grandma" and that the provision would be dropped. They were also dismayed when the provision was criticized by former House speaker Newt Gingrich (R-Ga.), who had been open about how much he appreciated the end-of-life care his father-in-law received at Gundersen.

Rep. Paul D. Ryan (R-Wis.) admires Gunderson generally but said it erred in pushing for Medicare to cover consultations. "It's right and proper for Gundersen to innovate in these directions, but it's a wholly different thing for the federal government" to endorse end-of-life planning, he said.

Gundersen officials are still fighting to keep consultation payments in the bill, with support from Sen. Mark Warner (D-Va.), who has become a leading advocate for such planning. But this week, word came that the White House is willing to drop the provision. The hospital officials are even less hopeful about more ambitious terms they sought to add -- changing Medicare payments for end-of-life care so that they are based not on the procedures a patient receives in the final months but on whether care complied with the person's wishes.

No matter what, they will keep trying to get payment for consultations into future legislation. "The [directive] itself doesn't really matter very much -- it's the clearly expressed belief and shared understanding that it represents," Hammes said. "The family members have to believe that what they do is not only legally right, but personally right. If Mom said, 'Don't do this or do do this,' it's much easier for them to say, 'I'm doing a loving thing,' and it's a decision you can live with."

The discussions do not promote less aggressive care, he said: "We're not trying to talk them into anything. We're trying to understand their values and goals, and tell them what medical science can and can't do." But many people do settle on less care. "In our community," he said, "people don't want to die hooked up to machines."

By Alec MacGillis
Washington Post Staff Writer
Friday, September 4, 2009

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