Blue Dog: Hey, this town-hall anger seems pretty real to me

posted at 8:30 am on August 22, 2009 by Ed Morrissey

Democrats may want to spin the August anger in their districts as nothing more than conservative Astroturfing against a popular health-care reform plan, but they’re whistling in the wind — and one of their own warns them to start paying attention.  Rep. Allen Boyd (D-FL) represents a Panhandle district, and when he sees his constituents taking time off of work in the sweltering heat to see a politican, he knows they’re unhappy.  They don’t trust Congress or the administration to get this right, and he didn’t need to see the stack of pink slips to figure it out:

But as he fended off gnats buzzing through the August humidity after a morning fending off angry constituents at a town hall meeting here, Boyd confided that the depth of the unease spurred by the health care debate had caught him by surprise.

“They may be in a minority, but they are a larger minority than we’ve seen in the 20-plus years that I’ve been doing this,” said Boyd of the standing-room-only crowds who have been showing up to shout, boo, mutter and, in one case, hand him an actual stack of pink slips since he returned home for recess. “I’ve never seen anything like this.” …

A visit to Florida’s 2nd District also is a bracing case study in the mounting political peril some Blue Dogs like Boyd may be facing. Boyd acknowledged that after coasting to victory in a string of elections, including when a popular President George W. Bush was on top of the ticket in 2004 and national Republicans actively plotted his ouster, he may face a real threat next year at the polls.

And his candor is borne out of his own up-close view from the past three weeks. While some of his colleagues took refuge in constituent-free codels and undisclosed private meetings, Boyd plunged headlong into a series of public forums throughout his district and discovered the sort of public unrest that doesn’t come around very often.

“People are scared,” Boyd said twice, trying to explain what would drive his constituents away from home and work and out into the broiling Florida sun in the middle of the week to see their congressman.

Why are people scared?  The government is about to take over one-sixth of the nation’s economy, even though soaring deficits make it clear that it can’t properly handle what’s on the plate now.  It just fumbled a stimulus package and a program to kill old cars, and somehow people have the notion that this competence will continue with something more vital — their health care.  They don’t want the government in charge of those decisions and invading their personal lives.  The only surprise here is that elected officials didn’t see this coming, although clearly the White House had an inkling — which is why they tried to rush the bill through to a vote.

The ones who should be scared are the incumbents heading back to Capitol Hill in a couple of weeks.  Boyd sounds like he at least got the wake-up call.

Michelle notes that people should check with the website Recess Rally to find any organized demonstrations near you.  Let’s keep sending the message until all of our elected representatives hear it loud and clear.


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People are scared,”

This jerk still doesn’t get it—-We are mad!

Herb on August 22, 2009 at 1:01 PM

Mad as hell and not going to forget it … It’s 1994 all over again.

tarpon on August 22, 2009 at 3:19 PM

This jerk still doesn’t get it—-We are mad!

Anger and fear go hand in hand my friend.

OK, since people are claiming the facts are not on my side, let’s look at the bill. No I have not read the entire thing. But I have read many of controversial sections. Let’s tackle death panels.

Here’s the section:

Section 1233. Advanced Care Planning Consultation [emphasis is mine]
`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include–
`(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State–
`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that–
`(I) ensures such orders are standardized and uniquely identifiable throughout the State;
`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;
`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
——————————
[More on "order regarding life sustaining treatment" in the same Section]
`(5)(A) For purposes of this section, the term `order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that–
`(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
`(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
`(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items–
`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
`(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
`(iii) the use of antibiotics; and
`(iv) the use of artificially administered nutrition and hydration.’.

I emphasized the part that people believe sets up death panels.

Here it is again:

(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

Not, what is guided by this coalition?

A program for orders for life sustaining treatment for a States described in this clause is a program that-

What is a program for orders for life sustaining treatment?

For purposes of this section, the term `order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that–
`(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
`(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
`(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items–
`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
`(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
`(iii) the use of antibiotics; and
`(iv) the use of artificially administered nutrition and hydration.’.

I highlighted this part:

effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual

This is very important. Any order for life sustaining treatment comes from the individual after a consultation with his or her practitioner (which is defined as a physician, nurse practitioner or physician’s assistant).

That board has no power in decided whether treatment is given to someone or not. As defined in this section of the bill, in terms of end-of-life planning and orders, the individual has sole power in making those choices. It’s the entire point of this section. To let physicians know the wishes of the patient in case they cannot communicate them.

Tom_Shipley on August 22, 2009 at 3:58 PM

That should be…

“Now, what is guided by this coalition?”” Not “not.”

Tom_Shipley on August 22, 2009 at 4:13 PM

Blue Dog: Hey, this town-hall anger seems pretty real to me

When he gets back to DC, Nancy Pelosi will make his angry constituents look like Christmas carolers.

She doesn’t care if some first term blue dogs don’t get reelected to get this liberal wet dream through the House.

Paul the American on August 22, 2009 at 8:00 PM

Re: Tom_Shipley’s quotation of proposed law.
Perhaps I’m alone in thinking as I do, however, I never thought of the ‘end of life’ counselling as being the ‘death panel.’ Rather, I thought the ‘death panel’ referred to the panel that will oversee the entire program. I thought the fear was that Rahm Emmanuel’s brother’s ideas [those of Dr. Ezekiel Emmanuel] about deciding how to ration care for the elderly vs. the young were what caused the ‘death panel’ references.
Ultimately the government will have to ration in some way.
As I’ve understood it, the seed of the rationin program was planted in the 787 billion dollar stimulus package that mandated a national computer system for doctors. My doctor told me that he is currently adapting his office to this system. I thought part of this system was meant, eventually, to tell doctors what treatments are approved and which are not approved.
I don’t remember the name of the panel that will be the American equivalent of the British rationing panel [NICE], but if our system follows Dr. Ezekiel Emmanuel’s thinking, a sixty-five year old will not get the amount of treatment that a twenty-five year old would get. As I understand Emmanuel’s explanation: it will not be ‘invidious’ discrimination to give a 65 year old less care than a 25 year old. His reasoning: the sixty-five year old person was once, after all, 25 years old. Had the 65 year old had the same condition at age 25, he would have gotten more care then. But at 65, his length and quality of future life would dictate he receive less care.
Mr. Shipley may well be right. Perhaps people think of the ‘counselling’ as constituting the ‘death panel.’ If so, they are wrong.
But will there be a ‘death panel?’ You betcha. When this whole Obama boondoggle evolves into a single payer system, no one will have a choice of other insurers and the top administrative panel will issue policies that – ultimately – make it the ‘death panel.
Jim Anderson

Jim Anderson on August 22, 2009 at 10:09 PM

Tom_Shipley on August 22, 2009 at 3:58 PM

…Doesn’t the fact you just had to go through all that crappy legalese mean that we should just throw out this bill? I mean Jiminy Christmas I wanted to strangle you just for putting in such a long section for us to read.

“EF” this Bill! “EF” it all to “H”!!!!!

-Wasteland Man.

WastelandMan on August 23, 2009 at 1:58 AM

Hey, I was glad Michelle reminded us to check for any recess rallys in my area. We had one in Salina, KS and about 125-150 people showed up. It was a pretty good meeting but I was more impressed at how people stayed after the meeting networking and planning what to do next. We can’t relax on pushing back the health care reform bill and the dreaded cap and trade.

ranzofola on August 23, 2009 at 2:13 AM

Name me ONE promise during the campaigns last year that was successfully carried out? Okay, now list the promises that we now know as lies. I am far from being scared and more like furious with the whole administration of lies and corruption. This is shocking to our politicians that America is upset?

With U-Tube, and the net in general their lies are haunting these politicians and educating the public as to the corruption of power. MSM fails to do this because of the same bias slant that is destroying the newspapers. Scared? Hardly!

mixplix on August 23, 2009 at 6:17 AM

Tom_Shipley on August 22, 2009 at 3:58 PM

You miss the whole point of that section. The point is that unless we die suddenly and unexpectedly, we will ALL end up in one of these sessions because the government won’t be willing to spend the money it will take to keep us alive. The reason they are setting up this process is to deal with all of the people who are told “Sorry, that procedure/medicine/surgery isn’t available to you”. Oregon found out if they just send a dieing cancer patient a letter saying “We’d be happy to pay a doctor to help you commit suicide but not for the medicine you need” tends to piss people off.

darwin-t on August 23, 2009 at 7:17 AM

Perhaps I’m alone in thinking as I do, however, I never thought of the ‘end of life’ counselling as being the ‘death panel.’ Rather, I thought the ‘death panel’ referred to the panel that will oversee the entire program. I thought the fear was that Rahm Emmanuel’s brother’s ideas [those of Dr. Ezekiel Emmanuel] about deciding how to ration care for the elderly vs. the young were what caused the ‘death panel’ references.

When Palin was asked what in the bill prompted her death panel comment, she said to look at section 1233.

And if I’m reading you correctly, you can’t name specific language in the bill that you think sets up a death panel? You just think there will be one eventually?

The comments that Emmanuel made about not guaranteeing care for people with dementia and guaranteeing service for children with learning disabilities was in an academic paper in which he was discussing different options for how to guarantee certain services through the government. One option he writes about (but doesn’t fully endorse) is setting up public forums to discuss as a nation what treatment should be guaranteed. Now, this is just In his writing about this option, no where does he write that a government panel should make those decisions and no where does he endorse this idea (he doesn’t write that a public forum should make those decisions, he just writes is as part of this option that’s been discussed. It’s also important to note that he’s just talking about “guaranteeing” basic services through the government. Under this options, private insurers still exist and people would be able to get insurance through them. The paper is a discussion about setting up a government system what would guarantee basic services for people in the country. It clearly states that people would be able to get other services through private insurers).

It’s also important to note that Emmanuel’s writings have NOTHING to do with this bill. He was not involved in writing any of it. Nor was his brother, nor was anyone in the White House.

The best I can see, the only proof that there will be death panels after this bill is passed is that they will be evolved to. Which is basically saying “well, they aren’t in this bill, but they’re coming!” Again, where’s the proof? There is NONE, because no one is trying to set up and “death panel.” And, even though there aren’t “death panels” in the UK system, the US system in this bill will most closely resemble the Swedish system. Though, it seems, out system would be pretty uniquely our own.

But I will thank you for saying this:

Mr. Shipley may well be right. Perhaps people think of the ‘counselling’ as constituting the ‘death panel.’ If so, they are wrong.

People do think that. Palin thinks that. That’s what started this whole death panel talk.

WastelandMan on August 23, 2009 at 1:58 AM

I hope, for your sake, that you’re a parody.

Tom_Shipley on August 23, 2009 at 7:42 AM

darwin-t on August 23, 2009 at 7:17 AM

No, the point of this section is to get more living wills. The section is really about this:

A Harvard study released earlier this year directly linked end-of-life counseling with lower health care costs and better quality of life for patients with advanced cancers. Researchers, who interviewed 603 advanced-cancer patients about whether they had end-of-life conversations with their physicians, found that patients who did had an estimated average of $1,876 in health care expenses during their final week of life, compared with $2,917 for those who didn’t. Patients also associated higher costs with a worse quality of death during their final week and typically did not live longer if they received intensive care.

It IS about saving money, but doing so by clarifying a patient’s wishes about the care they receive when they do reach the end of the road. It has nothing to do with anyone in the government decided who gets what care when. it’s about clarifying the individuals wishes, which has been shown to save money in the last week of care.

I find this funny (from the same article):

When the Bush administration expanded Medicare reimbursement to cover hospice care, which is less expensive than hospital care, hospice use grew 240 percent. Studies show people prefer hospice care but officials are concerned about people outside a patient’s family or doctor influencing the decision to give up on curative care.

People have been screaming about hospice care. That Obama wants to deny seniors treatment for their ailments and shove them in a hospice to die.

Well, i guess you should have been screaming while W. was in office.

Tom_Shipley on August 23, 2009 at 7:53 AM

The minority he sees are those that show up. I have been picketing and protesting since February 27th and have received an unbelievable number of congratulations for my efforts and very few challenges. But I am retired, so I have the time. I have yet to have anyone volunteer to join me when I tell them that I will be still picketing my congressman’s office the following day, but I do get encouragement to continue

So yes there is seemly a minority that shows up to complain, but as the polls show, they represent a majority.

amr on August 23, 2009 at 12:17 PM

I’m all for health care reform, just not this particular package. If the CBO says it is not deficit neutral, and it isn’t, then forget it. 9 trillion dollars in 10 years? NO THANKS!!!!!

elclynn on August 23, 2009 at 2:55 PM

“They may be in a minority, but they are a larger minority than we’ve seen in the 20-plus years that I’ve been doing this,”

Minority my ass.

I so hate democrats.

Squiggy on August 23, 2009 at 4:14 PM

I want to see an evil astroturfing monger.

Oh, that’s just Papa….

nondhimmie on August 23, 2009 at 8:26 PM

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