Via the Iowa Senate blog, I saw this post by Amy Sullivan at Time magazine’s Swampland blog. She re-read the 2003 Medicare prescription drug bill, which passed with the votes of most Republicans, including our own Senator Chuck Grassley:

Anyone want to guess what it provided funding for? Did you say counseling for end-of-life issues and care? Ding ding ding!!

Let’s go to the bill text, shall we? “The covered services are: evaluating the beneficiary’s need for pain and symptom management, including the individual’s need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning.” The only difference between the 2003 provision and the infamous Section 1233 that threatens the very future and moral sanctity of the Republic is that the first applied only to terminally ill patients. Section 1233 would expand funding so that people could voluntarily receive counseling before they become terminally ill.

At his Winterset town-hall meeting on Wednesday, Grassley said this:

You shouldn’t have counseling at the end of life.  You ought to have it done 20 years before you’re going to die.  You ought to plan these things out. I don’t have any problem with things like living wills, but they ought to be done within the family. We should not have a government program that determines you’re going to pull the plug on grandma.”

Some of the current draft health care reform bills would cover counseling to help people create living wills before they ever get sick, which is what Grassley says should happen. In contrast, the 2003 bill he voted for only covered such counseling for people who were already terminally ill.

How interesting that Grassley only recently, under fire from conservative Republicans, decided that counseling on end-of-life options might allow someone “to decide grandma’s lived too long.”

By the way, Grassley convinced Senate Finance Committee Chairman Max Baucus to drop the end-of-life provisions from that committee’s draft bill. I didn’t think it was possible for Baucus to prove himself to be any more of a tool for Republicans. Talk about negotiating from a position of weakness. I hope Howard Dean is right in predicting that those provisions will be restored in the final version of the bill.

Speaking of Grassley, he now has two likely Democratic opponents. Bankruptcy attorney and former State Senator Tom Fiegen announced his candidacy today and has a campaign website here. His priority issues are full employment and health care for those without. James Lynch interviewed Fiegen for this piece in the Cedar Rapids Gazette.

Bob Krause has been exploring a Senate bid for several months. You can learn more about his campaign at KrauseforIowa.com.

Neither Fiegen nor Krause is going to beat Grassley next year, but it’s important to have Democrats committed to making the case against him. That could reduce the number of Democratic and Democratic-leaning independents who cross over to vote for the incumbent, and we need as much straight-ticket voting in 2010 as possible.

UPDATE: Dueling statements from Representative Bruce Braley (IA-01) and Grassley are after the jump.

SECOND UPDATE: I missed this story on Wednesday–Grassley was promoting Glenn Beck’s book in Winterset. Great partner in constructive bipartisan negotiations!

FOR IMMEDIATE RELEASE

Friday August 14, 2009

Braley Statement on Grassley’s End-of-Life Care Doublespeak

Washington, DC – Rep. Bruce Braley (D-Iowa) issued the following statement today in response to media reports that Senator Charles Grassley and other Republican leaders supported a 2003 Medicare bill that included optional coverage for end-of-life care consultations between patients and their doctors.

“Senator Grassley continues to repeat the ridiculous claim that paying doctors to discuss end-of-life care with their patients is somehow ‘pulling the plug on grandma,’ yet in 2003 he voted for a bill with a nearly identical provision allowing Medicare to reimburse doctors for end-of-life care consultations.  It’s doublespeak like this that makes people cynical about Washington politicians.  Senator Grassley needs to stop the fear tactics and stick to the facts about healthcare reform.  We need a rational discussion so we can achieve much-needed reform in this country,” said Braley.

Late last night, Time reported that Senator Grassley had supported a 2003 Medicare bill including coverage for end-of-life care consultations.  LINK: http://swampland.blogs.time.co…

The 2003 Medicare Modernization Act (HR 1) passed by the Republican-controlled Congress and signed into law by President Bush allowed Medicare to fund end-of-life and advanced care planning consultations for terminally ill patients who had not yet elected hospice.  Senator Grassley was a main drafter of this legislation, and supported the bill.

See for yourself: HR 1 – The Medicare Modernization Act of 2003

Visit: http://thomas.loc.gov/cgi-bin/…

About halfway down the page in the link, you’ll see:

Conference Agreement

The conference agreement provides coverage of certain physician’s services for certain terminally ill individuals. Beneficiaries entitled to these services are those who have not elected the hospice benefit and have not previously received these physician’s services. Covered services are those furnished by a physician who is the medical director or employee of a hospice program. The covered services are: evaluating the beneficiary’s need for pain and symptom management, including the individual’s need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning. Payment for such services equals the amount established for similar services under the physician fee schedule, excluding the practice expense component. The provision would apply to consultation services provided by a hospice program on or after January 1, 2005.

Senator Grassley voted for the conference report on this legislation on 11/25/2003:

http://www.senate.gov/legislat…

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.”