What are the
Koch brothers going to think about Jeb Bush's idea of death panels on steroids? You remember death panels, Sarah Palin's bogeyman in Obamacare. The real proposal in the law was to allow Medicare reimbursement for doctors' discussions about end-of-life care with their patients, allowing physicians to have the time for this discussion, but also to incorporate research findings about appropriate end-of-life-care into their practice. That idea was abandoned by Democrats, but the myth lived on, and now might just be
reignited by a Republican, Jeb Bush.
In answering a question about what he might have learned from the Terri Schiavo case—where as governor he fought to keep a brain-damaged woman hooked up to machinery to keep her "alive" against the wishes of her husband—Bush expanded on the whole death panel idea.
"In hindsight, the one thing that I would have loved to have seen was an advance directive where the [Schiavo] family would have sorted this out," Bush said at a political forum in New Hampshire on Friday. "I think if we're going to mandate anything from government, it might be that if you're going to take Medicare, you also sign up for an advance directive where you talk about this before you're so disabled."
That's the kind of off-the-cuff, not-thought-out remark that can turn around and bite you. The most obvious reason to believe Bush hasn't thought this through is that Terri Schiavo was in her 20s, not on Medicare, and would not have been at all likely to have an advanced directive. It doesn't occur to most young people who don't have serious or terminal illnesses to have them. So it wouldn't have applied in this case at all. But maybe Bush is thinking even beyond Medicare to include Medicaid—that anyone who enrolls in these public healthcare programs has to have the advance directive in place in order to get the benefits.
That's a pretty damned radical proposal coming from anyone, much less a Republican, even if it only applies to Medicare. From a purely theoretical standpoint, yes, this is a smart way to deal with both trying to cut down the enormous costs that are spent in the last months of keeping people alive, but also with the difficult emotional process for individuals and families in the letting go of life. From a realistic standpoint, that's a pretty thorny area for the federal government to be entering, particularly with a mandate telling people they have to talk about how they want to die if they want to get medical care. That's not something that's going to go over too well with the average Republican primary voter.
If nothing else is clear, Bush has not been giving a whole lot of thought to healthcare reform or he wouldn't have dropped such a clumsy bombshell. But now that he has, are we going to have a serious discussion about this part of the healthcare debate? Of course not, it's primary season.