An Interview With Sen. Johnny Isakson.
By Ezra Klein
Sarah Palin's belief that the House health-care reform bill would create "death panels" might be particularly extreme, but she's hardly the only person to wildly misunderstand the section of the bill ordering Medicare to cover voluntary end-of-life counseling sessions between doctors and their patients.
One of the foremost advocates of expanding Medicare end-of-life planning coverage is Johnny Isakson, a Republican Senator from Georgia. He co-sponsored 2007's Medicare End-of-Life Planning Act and proposed an amendment similar to the House bill's Section 1233 during the Senate HELP Committee's mark-up of its health care bill. I reached Sen. Isakson at his office this afternoon. He was befuddled that this had become a question of euthanasia, termed Palin's interpretation "nuts," and emphasized that all 50 states currently have some legislation allowing end-of-life directives. A transcript of our conversation follows.
Is this bill going to euthanize my grandmother? What are we talking about here?
In the health-care debate mark-up, one of the things I talked about was that the most money spent on anyone is spent usually in the last 60 days of life and that's because an individual is not in a capacity to make decisions for themselves. So rather than getting into a situation where the government makes those decisions, if everyone had an end-of-life directive or what we call in Georgia "durable power of attorney," you could instruct at a time of sound mind and body what you want to happen in an event where you were in difficult circumstances where you're unable to make those decisions.
This has been an issue for 35 years. All 50 states now have either durable powers of attorney or end-of-life directives and it's to protect children or a spouse from being put into a situation where they have to make a terrible decision as well as physicians from being put into a position where they have to practice defensive medicine because of the trial lawyers. It's just better for an individual to be able to clearly delineate what they want done in various sets of circumstances at the end of their life.
How did this become a question of euthanasia?
I have no idea. I understand -- and you have to check this out -- I just had a phone call where someone said Sarah Palin's web site had talked about the House bill having death panels on it where people would be euthanized. How someone could take an end of life directive or a living will as that is nuts. You're putting the authority in the individual rather than the government. I don't know how that got so mixed up.
You're saying that this is not a question of government. It's for individuals.
It empowers you to be able to make decisions at a difficult time rather than having the government making them for you.
The policy here as I understand it is that Medicare would cover a counseling session with your doctor on end-of-life options.
Correct. And it's a voluntary deal.
It seems to me we're having trouble conducting an adult conversation about death. We pay a lot of money not to face these questions. We prefer to experience the health-care system as something that just saves you, and if it doesn't, something has gone wrong.
Over the last three-and-a-half decades, this legislation has been passed state-by-state, in part because of the tort issue and in part because of many other things. It's important for an individual to make those determinations while they're of sound mind and body rather than no one making those decisions at all. But this discussion has been going on for three decades.
And the only change we'd see is that individuals would have a counseling session with their doctor?
Uh-huh. When they become eligible for Medicare.
Are there other costs? Parts of it I'm missing?
No. The problem you got is that there's so much swirling around about health care and people are taking bits and pieces out of this. This was thoroughly debated in the Senate committee. It's voluntary. Every state in America has an end of life directive or durable power of attorney provision. For the peace of mind of your children and your spouse as well as the comfort of knowing the government won't make these decisions, it's a very popular thing. Just not everybody's aware of it.
What got you interested in this subject?
I've seen the pain and suffering in families with a loved one with a traumatic brain injury or a crippling degenerative disease become incapacitated and be kept alive under very difficult circumstances when if they'd have had the chance to make the decision themself they'd have given another directive and I've seen the damage financially that's been done to families and if there's a way to prevent that by you giving advance directives it's both for the sanity of the family and what savings the family has it's the right decision, certainly more than turning it to the government or a trial lawyer.