Grassley: was he for it before he was against it?

President Obama on Saturday suggested some Republicans — like U.S.Senator Chuck Grassley (R-New Hartford, Iowa) — have waged a "dishonest" debate about end-of-life care provisions in the health care reform packages moving through congress.  Duringa  town hall meeting in Colorado, Obama seemed to suggest Grassley and other Republicans are a bit like John Kerry circa 2004 – they voted for it before they voted against it.  Watch the president's remarks here.

Here's the text: "…Because there's no perfect solution, we can have legitimate debates about the public option that we just had.  That was a good, serious debate, and you can make a plausible argument as to why we shouldn't have a public option.  Now, I believe that we should on balance.  It's not perfect.  It's not going to solve every problem, but I think it actually would keep the insurance companies more honest.  You can have a honest disagreement with me on that.

"What you can't do — or you can, but you shouldn't do — is start saying things like, we want to set up death panels to pull the plug on grandma.  I mean, come on.  (Applause.)  I mean, I just — first of all, when you make a comment like that — I just lost my grandmother last year.  I know what it's like to watch somebody you love, who's aging, deteriorate, and have to struggle with that.  So the notion that somehow I ran for public office, or members of Congress are in this so that they can go around pulling the plug on grandma?  I mean, when you start making arguments like that, that's simply dishonest, especially when I hear the arguments coming from members of Congress in the other party who, turns out, sponsored similar provisions.

"Here's what this was about.  Here was the genesis of this little piece of information.  We had a provision in the House bill that would give the option — the option — of somebody getting counseling on end-of-life care or hospice care, and have it reimbursed by Medicare; the option — voluntary — so you'd have more information about how to deal with these situations.

"Turns out the biggest proponent of this was a Republican congressman who is now a senator and a colleague of Mr. Udall and Mr. Bennet.  Turns out in Medicare Part D, which was passed by a Republican Congress, they had the exact same provision.

"So when I have people who just a couple of years ago thought this was a good idea now getting on television suggesting that it's a plot against grandma or to sneak euthanasia into our health care system, that feels dishonest to me.  And we've got enough stuff to deal with without having these kinds of arguments.  (Applause.)

Grassley's staff sent out a response:

M E M O R A N D U M

TO:     Reporters and Editors
RE:     End-of-life care/counseling in health care legislation
DA:     Sunday, August 16, 2009

        Senator Chuck Grassley, Ranking Member of the Committee on Finance, issued the comment immediately below regarding remarks made last night by the President during a town meeting he held in Grand Junction, Colorado.

        "I've said for a long time and repeated last week that we all ought to consider how we want to be treated if we are struck by an incapacitating illness, and that advanced care planning is a good thing to do.  As far as legislation goes, it's not the case that provisions in the Pelosi health care reform bill this year are just like provisions Congress passed in the Medicare Modernization Act of 2003.  I've never called the Pelosi provisions a 'death panel.'  The issue is whether end-of-life provisions should be part of legislation that's about controlling health care spending, and which also creates a government-run health care program, as the Pelosi bill does.  Doing so escalates concerns about the rationing of health care, since government-run plans in other countries ration to control spending.  Putting end-of-life consultations alongside cost containment and government-run health care causes legitimate concern.  This context and the details of this year's proposal are different than the 2003 legislation, which covers advice from specialized physicians outside of any larger effort to control spending on health care.  It's not fair to Americans who are asking questions to gloss over those facts and, in fact, end-of-life provisions haven't been part of ongoing Senate Finance Committee discussions as a result of those realities and the possibility of unintended consequences.  On this subject and others, it's important that the debate is fair-minded and based on an accurate representation of the issues involved."

        In addition, statements issued by Senator Grassley on Thursday and Friday are below, for your reference.  Senators discussing a possible bipartisan Finance Committee bill took end-of-life provisions off the table weeks ago, not this week, as some have read the August 13 statement to say.

M E M O R A N D U M
TO:  Reporters and Editors
RE:  Information on 2003 provisions/end-of-life care and counseling
DA:  Friday, August 14, 2009

        Senator Chuck Grassley made the following comment in response to inaccurate information forwarded by Congressman Bruce Braley regarding legislation on end-of-life care and counseling.

        “I’m shocked that Congressman Braley would attack a fellow Iowan before getting all of the facts. 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.”

M E M O R A N D U M
TO:  Reporters and Editors
RE:  End-of-life care concerns, other concerns in House health care legislation
DA:  Thursday, August 13, 2009

        Sen. Chuck Grassley, ranking member of the Committee on Finance, today made the following comment on end-of-life concerns and other concerns prompted by the House committee-passed health care legislation.

        “The bill passed by the House committees is so poorly cobbled together that it will have all kinds of unintended consequences, including making taxpayers fund health care subsidies for illegal immigrants. On the end-of-life issue, there’s a big difference between a simple educational campaign, as some advocates want, and the way the House committee-passed bill pays physicians to advise patients about end of life care and rates physician quality of care based on the creation of and adherence to orders for end-of-life care, while at the same time creating a government-run program that is likely to lead to the rationing of care for everyone. On the Finance Committee, we are working very hard to avoid unintended consequences by methodically working through the complexities of all of these issues and policy options. That methodical approach continues. We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly. Maybe others can defend a bill like the Pelosi bill that leaves major issues open to interpretation, but I can’t.”