Often in legislation, you need to compromise away a minor point to achieve a major victory. Sometimes you need to compromise away a major point to win even a minor victory. It happens. Indeed, it should happen. That's what the process is about. But sometimes, the minor point contains the whole game. I believe we have reached one of those times, and the President should publicly declare that he will veto any health care bill that fails to provide Medicare payment for end-of-life consultation.
To be clear, I don't believe the hundred bucks the Doctor will get, or won't get is all that big an issue. I'm sure today that the end-of-life discussion goes on in medical offices all the time and one of two things happens. Either the Doctor decides she can afford to donate 20 minutes of her time to making sure her patient is informed and empowered to make decisions or, well, the discussion time gets coded as something along the lines of "education regarding the expected progression of the disease and various treatment options." As written, the bill would clarify that this time would get its own billing code and that it constitutes a valid medical expense. In fact as trifecta notes in this diary, the only thing the new bill proposes to do is extend an already existing medical service to apply to non-terminally ill patients as well as terminally ill patients. Nice. Good clarification. Worth getting, but not exactly a keystone legislative victory.
And I think President Obama should burn the house down if he doesn't get it.
Here's my thinking. Without this provision, we can't get health care reform. Without it, we can't get anything else either. And giving it up could cost the Democrats their majority in Congress.
Here's the thing. By invoking "death panels" the Republican's have asked the ulimate "when did you stop beating your wife?" question. They pointed to this minor, inoffensive little bit of clean-up legislation and said "This means the Democrats are murderers." There are really only two possible responses to an accusation that you want to kill old women and sick children. You can say "No I don't" or you can say "Yes I do, but I won't kill any while you are looking." Removing the language from the bill is the equivalent of the latter. Exactly how is the message supposed to work for passing the rest of the bill after this section is removed? "Now that we've removed the grandmother killing provisions of the bill, trust us, its fine, you should support it." Nonsense. This will make Harry and Louise look like kid stuff. Hell, it'll make the Daisy ad look like kid stuff. No way. If they want a bill, any bill, passed, the Democrats must scream from the rooftops that there was never a granny killing provision in the first place. Compromise on the issue is capitulation on the whole bill. Do it, and lose the whole thing in a wave of moral outrage.
The same argument holds for my next two concerns. Exactly why should the public support a Democratic approach to immigration reform when the bill was written by a bunch of murderers. The Republicans will have a field day with every piece of legislation proposed by the majority for the next 18 months. There will be "find the death panel" events for every bill. The entire Democratic legislative agenda could become a farce of false accusations, leading to the inevitable capitulation and leading to the obvious ad campaign. "Congressman Smith supported the health care bill with the child killing provisions in place. When he got caught, he agreed to remove them from the Health Care bill, but, sure enough, he tried to sneak them into Immigration Reform. Do we really want Congressman Smith representing us?"
So, there you go. The Democratic leadership is proposing to ditch the end-of-life provision in the face of the attacks. I'm sure there is a small army of advisors making clear that this is such a huge fight over such a small issue that the only thing to do is drop it and move on to more important things. And you know, they'd be right if it were about the end-of-life provisions. But its not. Its about whether or we brand ourselves as murderers in waiting, or we take up the fight and tell the R's to get bent. Congress should know this without any help, but they don't so it falls to the President. He should take up the reins and declare his unwavering support for end of life consultation and insist it be in the bill on pain of veto.