Grassley raises specter of health care rationing at town hall

His spokeswoman says he was simply explaining why some people have concerns about government-run health care, but critics contend that when U.S. Sen. Chuck Grassley, R-Iowa, spoke last week about government “determining the value of life,” he was again making reference to the “death panels” meme.

U.S. Sen. Chuck Grassley, R-Iowa (Lauren Victoria Burke/WDCPIX.COM)

The senator has never directly discussed “death panels,” a debunked urban legend often cited by opponents of health care reform. But several comments he’s made throughout the debate of health reform, namely his now infamous “pull the plug on grandma” line, caused him to be connected to it.

The latest remarks came during a town hall forum in Estherville last week. A woman in in the audience expressed concerns about online medical records, saying “government wants to have all of the information on us so they will be the ones who decide whether we get care or not.” She said health care legislation established a special committee that will allow the government to be “between every doctor and every patient.”

That special committee, the Patient-Centered Outcomes Research Institute, was established by the recently passed health care reform legislation to research which medical treatments work better than others, a process called “comparative effectiveness.”

After explaining how comparative effectiveness works, Grassley said some people fear that it could be used “as it is in England.” As an example, he pointed to the National Institute for Health and Clinical Excellence (NICE), the independent agency that issues guidelines on what medicines, treatments and procedures are appropriate for coverage under the British National Health Service.

According to a transcript provided to The Iowa Independent, Grassley said:

The extent to which there is going to be, I guess you would call it an institute, set up to study different medical procedures and I suppose treatments and maybe even what medical devices might be used and what drugs might be used.  The extent to which they study that and that is, and they come forth with recommendations that this works better for this price than that does for that price.  Or maybe price isn’t necessarily a factor, what works best here, this doesn’t work so good over here. The extent for which it is just information for doctors to use, then I think it is a good thing.

But the extent to which people fear that this could be used as in England — and this is another term I can’t remember what the letters stand for because it is England and I don’t have to worry about England too much — is N-I-C-E.

There’s a part of the — I suppose it is part of the public health system over there, and I suppose you know it is government run, that determines value of life. And so, it determines value of life for so much. So, if you are 85-years old and presuming it is end of life, your life is not worth as much to spend on a certain procedure as when you are 35-years old. And then, it becomes a tool to determine treatment or not treatment, then for my judgment, that is political interference with the practice of medicine.

Critics of the Democratic health reform legislation, including Grassley, have often said it will lead to health care rationing, citing the use of comparative effectiveness as evidence. But as Pulitzer-Prize winning Web site PolitFact pointed out, Democrats took special care to require any findings based on comparative effectiveness to be advisory only. Medicare may take the research into account when deciding what procedures it will cover, so long as the new research is not the sole justification and the agency allows for public input.

Responding to the critics’ allegations of “death panels,” the law prevents the use of any findings “in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill.”

Comparative effectiveness has nothing to do with evaluating patients for “worthiness,” it is simply research to find out which treatments work better than others, according to the Kaiser Family Foundation.

Grassley’s critics say his latest remarks echo what he said last August about the late Sen. Edward Kennedy’s battle with cancer. At the time, Grassley said under government-run health care Kennedy would not get top-notch care because of his age, explaining “they’d say ‘well he doesn’t have long to live even if he lived another four to five years.’ They’d say ‘well, we gotta spend money on people who can contribute more to economy.’ It’s a little like people saying when somebody gets to be 85 their life is worth less than when they were 35 and you pull the tubes on them.”

Later that month, during a town hall in Winterset, Grasley told a crowed that Americans have every right to fear end-of-life counseling provisions in health reform legislation because they could open the door to government deciding when to “pull the plug on grandma.” He repeated the claim later the same day, but eventually began to distance himself from it.

By the end of 2009, Grassley was blaming the entire ordeal on some “commentators” who took his comments and twisted them as saying that health care reform would establish death panels.

“I said no such thing,” Grassley said in a letter to a constituent provided to The Iowa Independent. “As I said then, putting end-of-life consultations alongside cost containment and government-run health care causes legitimate concern.”

And just last week, in a letter to the Cedar Rapids Gazette, Grassley insisted that he “never spoke of death panels.”

“I gave Iowans information about unintended consequences with government health care programs when they are forced to ration care,” he said.

While some may think the senator was once again making the case the health care reform legislation could end up allowing government to decide who lives and dies, Grassley Communications Director Jill Kozeny said that’s not the case.

“Grassley’s comments were about England’s NICE board when he says, ‘It determines value of life. It determines treatment or not treatment,’” Kozeny said in an e-mail to The Iowa Independent, referencing a rough quote published in the Estherville Daily News. “His comment here (this quote) was about NICE, not the health care reform enacted in March.”

The senator was only trying to address a question, Kozeny said.

“The woman’s question was lengthy, really more of a statement, and it included two issues:  (1) making sure no one rations care for the elderly and (2) how hospitals treat medical records,” she said. “Sen. Grassley picked an issue to respond to and cited how England rations care and assigns a dollar value to a life to make its assessments. So his answer was a straightforward comment on an issue he was asked about, not more or less than that.”