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Posted by on Sep 4, 2009 in Health, Media, Places, Politics, Society | 12 comments

The Town Where “Death Panels” Started

In a satire piece, “Obama’s Health Care Reform Will Decimate Our Population,” I posted a compilation of quotes by GOP and anti-healthcare reform officials, personalities and organizations. It started out as follows:

No wonder Americans are increasingly opposed to Obama’s socialist, radical vision of a nationalized health care system.

Just look at what Obama will do to you, to me and to our loved ones if we allow him to succeed with his downright evil plan.

Needless to say, it got a lot of responses, both disparaging and complimentary, both to its satirical content and to its perceived content.

The post included excerpts from a Sarah Palin statement—a statement that gave the “death panels” allegations added publicity and that poured more fuel to the furor over President Obama’s health care initiative.

Today, the Washington Post delves a little more into this myth—from a different perspective.

In “The Unwitting Birthplace of the ‘Death Panel’ Myth,” Alec MacGillis tells us about the biggest hospital in La Crosse, Wis.:

[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.

According to the article, the hospital got its wish this spring when House Democrats inserted such a compensation provision into the health-care reform bill. However, after former Alaska governor Sarah Palin seized on it and warned about “death panels” that would deny care to the elderly and the disabled, and “despite widespread debunking, such talk led lawmakers to say they will drop the provision.”

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

Why so many with advance-care directives? (More than 90 percent of people in La Crosse have directives when they die, double the national average). According to MacGillis:

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.

MacGillis further quotes Bud Hammes:

“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.”

And,

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.”

Because those “conversations” take a lot of time and Medicare does not reimburse doctors for the time spent on such discussions, Gundersen and other hospitals urged lawmakers to add such consultation payments to Medicare.

Eventually, Rep. Earl Blumenauer (D-Ore.) submitted legislation, 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.”

But then came the brouhaha fueled by Palin’s “death panel” comments:

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.

As a result of the controversy, Democrats are now willing to drop the provision.

No matter what, [Gundersen officials] 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.”

So now you know why La Crosse, Wis.—the city that often shows up on “best places to live” lists, and of which its residents say that it is also a good place to die—“landed in the center of a controversy that almost derailed health-care reform this summer,” as reported by the Washington Post here.

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