Scaring Grandma

Why everyone in the heath care fight—including Obama—plays on the anxieties of the elderly.

President Obama at the AARP town hall meeting

First came the “birthers.” Now, as President Obama makes a final push for health care reform, we have the deathers.

Many senior citizens are concerned that health care reform would mean cuts to Medicare. That much was clear at a town-hall meeting hosted Tuesday by the American Association of Retired Persons at which Obama fielded questions from seniors who don’t want to give up their benefits.

But one question stood out. It addressed what the host from the AARP called the “infamous” Page 425 of the House health care bill. (Read the bill here.) “I have been told there is a clause in there that everyone that’s Medicare age will be visited and told to decide how they wish to die,” said Mary from North Carolina. “This bothers me greatly, and I’d like for you to promise me that this is not in this bill.” The host elaborated: “As I read the bill, it’s saying that Medicare will, for the first time, cover consultation about end-of-life care, and that they will not pay for such a consultation more than once every five years. This is being read as saying every five years you’ll be told how you can die.”

“Well, that would be kind of morbid,” Obama said.

The audience laughed. Many observers aren’t so amused. To them, the House bill and health care reform in general are the legislative equivalent of euthanasia.

“Obama’s not going to say, ‘Let’s kill them,’ ” says Charlotte Allen, a conservative commentator and author of The Human Christ: The Search for the Historical Jesus. “But he seems to be perfectly comfortable with the idea that a lot more old people are going to die a lot sooner.”

Deathers point to several parts of the House bill as evidence that health care reform means letting old people die. Most prominent is the end-of-life consultation provision mentioned above. An article on World Net Daily argues that the proposal “specifically calls for the consultation to recommend ‘palliative care and hospice’ for seniors in their mandatory counseling sessions.” In fact, the bill says the meeting must include “an explanation by the practitioner of the end-of-life services and supports available, including palliative care and hospice”—not a recommendation of it. (Emphasis added.) Still, Obama pointed out that it’s not too late to remove the language: “If this is something that really bothers people, I suspect that members of Congress might take a second look at it.”

Another seemingly scary provision is one that permits “the use of artificially administered nutrition and hydration”—or, more accurately, the withholding of it. Betsy McCaughey, founder of the Committee To Reduce Infection Deaths and former lieutenant governor of New York, wrote an influential (and, to many, misleading) critique of Hillarycare in the New Republic 15 years ago. She told me that the provision is a disturbing example of the government making decisions for the patient. But the bill specifically says that an order to withhold, say, an IV drip, must be one that “effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual.” In other words, a doctor can’t make you do it.

Yet another bugaboo is “shared decision-making.” The House bill would establish a program that “provide[s] patients with information about trade-offs among treatment options, and facilitates the incorporation of patient preferences and values into the medical plan.” The legislation makes clear that this is an educational tool to help patients make informed decisions about whether a treatment is likely to help. To McCaughey, the decision-making is hardly shared. “This is coercion,” she said.

The president himself is not the only villain. “I have not read Obama’s personal views [on end-of-life treatment],” McCaughey told me. “But I have read Ezekiel Emanuel’s views, and I’d say he does not belong in position of decision-making.” She points to an article Emanuel wrote in June 2008 for the Journal of the American Medical Association in which Emanuel argues that doctors too often interpret the Hippocratic oath “as an imperative to do everything for the patient regardless of the cost or effects on others.” The same article has led some critics to compare Emanuel to Nazi doctors. Some conservatives also voiced concerns about statements made by Obama’s “science czar,” John Holdren. In 1977, Holdren co-authored a paper that explored possible methods of population control, including sterilizing people by spiking the water supply. (Holdren recently released a statement saying that population control isn’t the government’s job.)Equally upsetting to some is the proposed Independent Medicare Advisory Council, which would oversee cost containment for Medicare. The board’s membership, much less the board itself, is not final. But Allen believes they would belong to “a certain class of secularized intellectuals” who might prioritize saving money over extending life.

To be sure, there are plenty of legitimate reasons for seniors to be concerned about reform. Seniors already have universal health care in the form of Medicare. There remains the possibility that a broader universal plan will drain resources from a program they like as it is, thank you very much. Indeed, much of the overspending on health care occurs under Medicare. And a large portion of Medicare spending—about 30 percent—occurs in the last year of a patient’s life. Seniors have every reason to ask questions.

But scaring Grandma is irresistible. Even Obama is hardly immune to fear mongering. When a questioner voiced concerns about rationing under a new system, Obama posed a counterfactual: What happens if we don’t pass health care reform? “[The] thing that I would be most worried about right now is health care inflation keeps on going up and the trust fund in 10 years is suddenly in the red. And now Congress has to make some decisions: Are they going to put more money into Medicare, especially given the deficits and the debt that we already have? Or are they, at that point, going to start making decisions about cutting benefits, but not based on any science or what’s making people healthier—they’re just going to start making it based on politics?”

Mixing politics and health care? It sounds scary. But Obama’s answer—in fact, his entire town-hall meeting—shows that we’ve already crossed that line. The question is whether the fear is justified.