JIM LEHRER: Now, our look at the health care reform disputes over potential changes in Medicare payments. NewsHour health correspondent Betty Ann Bowser begins.
PROTESTOR: How dare you! How dare you!
BETTY ANN BOWSER: It sparked outbursts at town hall meetings.
PROTESTOR: They’re going to give us classes on euthanasia.
PROTESTOR: Adolf Hitler issued 6 million end-of-life orders.
GEORGE STEPHANOPOULOS, “This Week” Anchor: Good morning, and welcome to “This Week.”
BETTY ANN BOWSER: And impassionate debates on Sunday morning talk shows.
NEWT GINGRICH, former speaker of the house: Communal standards historically is a very dangerous concept.
GEORGE STEPHANOPOULOS: It’s not in the bill.
NEWT GINGRICH: You’re asking us to trust turning power over to the government when there clearly are people in America who believe in establishing euthanasia, including selective standards.
BETTY ANN BOWSER: What’s fueling the fire: a provision in the 1,200-page House health care reform bill that would allow seniors to seek what lawmakers call advance care planning consultation that provides end-of-life services, including palliative care and hospice. The counseling with a physician would be optional, and Medicare would pay for it once every five years.
Critics of the Democrats’ health care reform bills have seized on this on YouTube, e-mail chains, and blogs online.
Alaska’s former Republican governor, Sarah Palin, posted this entry on her Facebook page Friday: “The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their level of productivity in society, whether they are worthy of health care. Such a system is downright evil.”
Today, Palin urged people to engage in civil discourse when attending town hall meetings sponsored by Democratic members of the House who are home on recess. Those members have found many seniors across the country are confused and scared.
President Obama fielded this question from a caller at a town hall meeting at the AARP last week.
CALLER: I have heard lots of rumors going around about this new plan. 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. This bothers me greatly, and I’d like for you to promise me that this is not in this bill.
Obama Defends Medicare Reform
U.S. PRESIDENT BARACK OBAMA: You know, the -- I guarantee you, first of all, we just don't have enough government workers to send -- to talk to everybody, to find out how they want to die.
I think that the only thing that may have been proposed in some of the bills -- and I actually think this is a good thing -- is that it makes it easier for people to fill out a living will.
But, Mary, I just want to be clear: Nobody is going to be knocking on your door. Nobody is going to be telling you you've got to fill one out. And certainly nobody is going to be forcing you to make a set of decisions on end-of-life care based on, you know, some bureaucratic law in Washington.
The intent here is to simply make sure that you've got more information and that Medicare will pay for it. Medicare is saying, you have the option of consulting with somebody about hospice care, and we will reimburse it. That's putting more power, more choice in the hands of the American people, and it strikes me that that's a sensible thing to do.
BETTY ANN BOWSER: But at town hall meetings all over the country, some people aren't buying it.
The Obama administration is fighting back. Over the weekend, the president dedicated a considerable portion of his weekly radio address to the subject.
BARACK OBAMA: And let me start by dispelling the outlandish rumors that reform will promote euthanasia or cut Medicaid or bring about a government takeover of health care.
BETTY ANN BOWSER: And today, the White House launched a Web site called "Reality Check," with top Obama administration officials trying to put down what they say are wild rumors.
OBAMA ADMINISTRATION OFFICIAL: One of the worst that I've heard is that in some way this bill is going to force euthanasia. That's pretty hard to believe.
BETTY ANN BOWSER: Another provision being considered by Congress would save money by cutting fraud and waste in Medicare, but many seniors fear that might mean losing some of their benefits and rationed care. But President Obama has insisted any cuts will simply trim unnecessary spending.
BARACK OBAMA: ... $177 billion over 10 years is spent on subsidies to insurance companies under something called Medicare Advantage. There's no showing that seniors are healthier using Medicare Advantage than using regular Medicare. But, taxpayers, you fork over an additional $177 billion to them over 10 years.
BETTY ANN BOWSER: And today, the AARP launched its own ad campaign supporting health care reform legislation.
JIM LEHRER: Judy Woodruff takes it from there.
Advanced Directives Create Options
JUDY WOODRUFF: For a closer look at what health care reform might mean for senior citizens, we turn to Gail Wilensky, a former director of the federal agency overseeing Medicare and a former adviser to the first President Bush. She's a senior fellow at Project HOPE, a foundation for international health education.
And Joe Baker, president of the Medicare Rights Center, a national nonprofit advocacy group. He is a former New York state deputy secretary for health and human services.
Before we talk about this broadly, I want to deal with this charge that's out there. Gail Wilensky, to you first, this so-called euthanasia charge, that there's something in this proposal that will have somebody from the government go visit people and say, "You must decide right now how you're going to die." What's the truth of that?
GAIL WILENSKY, Project HOPE: That is just not true. There's enough to not like in the bills that are being considered by the Congress and proposed by the administration. This is not a right characterization.
What has been proposed is that, if someone wants to get counseling on hospice care, hospice care itself is, of course, a covered Medicare benefit. They would be able to have the physician or other practitioner paid for the counseling.
The idea is for people to be able to make known how they would like to be treated in the event of a terminal illness. We have advance directives now. It was actually first raised when I was running the Medicare program. If you go in to the hospital or a nursing home, you are supposed to be asked whether you have an advance directive and, if so, have it noted. This makes it easier.
JUDY WOODRUFF: This is how you would -- how you want your care to be handled in the event you are incapacitated in some way.
GAIL WILENSKY: Right. And if people don't want to have that service, they don't have to make use of it.
JUDY WOODRUFF: Joe Baker with the Medicare Rights Center, would you add anything to that? Do you agree that that's not there, not in this proposal?
JOE BAKER, Medicare Rights Center: That's absolutely right. Gail is absolutely correct. I mean, this gives actually people with Medicare more options, more information, more choices, as the president said, and puts them more in control at the end of life or beforehand as they plan for that kind of care.
So the mischaracterization of this has really been used to scare seniors and to drum up anti-reform efforts. And it's really a good thing overall, providing seniors and people with disabilities on Medicare more options and choices.
JUDY WOODRUFF: Well, Joe Baker, let me ask you this. Is health care for seniors in any way at risk as a result of this overall attempt to reform health care?
JOE BAKER: I don't believe it's at risk. I actually think the untold story here is a lot of good news for people with Medicare that is contained in this bill.
I mean, for example, there's elimination of the Part D donut hole, which is that part of the prescription drug coverage wherein seniors and people with disabilities get no drug coverage whatsoever and have to pay out of their own pocket. About 3.5 million beneficiaries are affected by this, and we get calls all the time about people cutting pills again in this area.
So the congressional bill, you know, out there now, the House bill, would get rid of that Part D donut hole and provide coverage and require...
Reimbursements Will Be Cut
JUDY WOODRUFF: And let me -- and I'm going to stop you there and ask Gail Wilensky about that.
JOE BAKER: Sure.
JUDY WOODRUFF: What about that? Would that be a positive, then, for seniors?
GAIL WILENSKY: That particular provision is a positive. The notion that you can cut $500 billion to $600 billion dollars out of the Medicare and Medicaid program and think that you don't risk affecting access for groups of seniors is simply incorrect. That is a whole different story.
What most of the ways to get money quickly, which is what you want if you want to use that money to expand insurance coverage for people don't have it, are sure ways that Congress will score as being a real saving, and that means whacking reimbursement.
They're going to lower reimbursements for a nursing home. They're going to lower reimbursements...
JUDY WOODRUFF: For nursing homes?
GAIL WILENSKY: ... for nursing homes, for home care. They're going to reduce the amount hospitals who have high re-admissions for certain illnesses have.
Now, do you want to go after some of these in reforming the delivery system? You do in careful and slow ways, but just whacking reimbursement, which is the only way to get quick savings upfront, is a whole different matter.
JUDY WOODRUFF: Joe Baker, what about that, this idea that reimbursements would be cut?
JOE BAKER: Well, I think that, you know -- right, and they will be in many instances, although it's not necessarily in every instance a cut. It's a slowdown in the increase to payments that would be made over the future years.
There's about $550 billion in cuts or savings in the Medicare program, but there are another $320 million in investments in the Medicare program. A lot of those for primary care physicians and other physicians, and many of the so-called cuts or reimbursement reform has been suggested by the Medicare Payment Advisory Commission and is recognized by some of the provider groups, who have stood with President Obama, as places where savings can be achieved in order to, you know, advance reform, particularly insurance coverage for those under 65, and expand things like the low-income assistance programs for people on Medicare.
JUDY WOODRUFF: So, Gail...
JOE BAKER: So it's a give-and-take here.