A means to ends?

The president is telling the truth: Nowhere in the 615 pages making up proposed legislation in the Senate, nor in the 1,017 pages of the dread H.R. 3200, the House health care reform bill, are there references to death panels, killing grandmas or pulling plugs. Nor are there references to government takeovers, care rationing or bankrupting the federal budget. And, by the way, he still doesn’t want to run the car industry and the recession is over.

This is the politics of back-alley car lots. Ignore the raps in the engine. Send the mobs home, pass the pens and let the signing begin. Objections and fine print are for fear mongers, loons and washed-out governors, doncha know. We hope Barack Obama will forgive our petulance, but we’d prefer a closer look before hopping aboard the nationalized health care train as it steams toward the precipice.

Some among the rubs:

Thorns and ostensible myth form in Section 1233 of the House bill. Doctors would be paid to provide end-of-life counseling every five years to Medicare patients. Patients diagnosed as terminally ill could get the counseling sooner. Obama dismisses as “boogeymen” the swelling fears that this provision will create what former Alaska Gov. Sarah Palin famously referred to as government “death panels.”

It’s untrue, he says, that government hopes to “basically pull the plug on Grandma because we decided it’s too expensive to let her live.” Georgia Sen. Johnny Isakson, a Republican no less, is more succinct. Palin’s rhetoric, he says, is just “nuts.” Federal law, in fact, prohibits Medicare money from being used to pay for euthanasia or assisted suicide or services that lead to those ends.

So why the hubbub?

Well, first, because interpretations vary wildly on whether Section 1233 requires the counseling. Supporters along with commentators such as The Washington Post’s Charles Lane – who chafes at the bill – insist it does not. A study of the section does little to clear the muddle. Emergency Physicians Monthly reads it this way: “[T]he Advance Care Planning Consultation does not permit the government to ‘order’ your end of life care, but only requires [emphasis added] that a physician discuss the matter with a patient and denote the patient’s preferences.”

Lane gets at points that cannot be disputed credibly: “Section 1233 ... lets doctors initiate the chat and gives them an incentive – money – to do so ... Patients may refuse, but many will bow to white-coated authority ... Section 1233 goes beyond facilitating doctor input to preferring it ... . Indeed, the measure would have an interested party – the government – recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations.”

Swirling about all of this is a reality that the president, and the bill itself, acknowledges that health care is costly and that factor must be mitigated if the government is to shoulder a share or all of the burden. That element considered against the expense of sustaining life stokes the sense of alarm over where this branch of reform might lead.

Obama and his allies respond that America should dismiss these worries as casually as he does. And they ensure with hundreds of pages of legislative claptrap, a political black veil over transparency, that only apoplexy rather than understanding will be evinced by an inspection of the text. This does not provide the confidence in reform that Obama seeks and expects but instead a feeling that the president is bent on taking the country to a place many of her people wish not to go.