Grassley voted for end-of-life counseling in 2003 (updated)

Via the Iowa Senate blog, I saw this post by Amy Sullivan at Time magazine’s Swampland blog. She re-read the 2003 Medicare prescription drug bill, which passed with the votes of most Republicans, including our own Senator Chuck Grassley:

Anyone want to guess what it provided funding for? Did you say counseling for end-of-life issues and care? Ding ding ding!!

Let’s go to the bill text, shall we? “The covered services are: evaluating the beneficiary’s need for pain and symptom management, including the individual’s need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning.” The only difference between the 2003 provision and the infamous Section 1233 that threatens the very future and moral sanctity of the Republic is that the first applied only to terminally ill patients. Section 1233 would expand funding so that people could voluntarily receive counseling before they become terminally ill.

At his Winterset town-hall meeting on Wednesday, Grassley said this:

You shouldn’t have counseling at the end of life.  You ought to have it done 20 years before you’re going to die.  You ought to plan these things out. I don’t have any problem with things like living wills, but they ought to be done within the family. We should not have a government program that determines you’re going to pull the plug on grandma.”

Some of the current draft health care reform bills would cover counseling to help people create living wills before they ever get sick, which is what Grassley says should happen. In contrast, the 2003 bill he voted for only covered such counseling for people who were already terminally ill.

How interesting that Grassley only recently, under fire from conservative Republicans, decided that counseling on end-of-life options might allow someone “to decide grandma’s lived too long.”

By the way, Grassley convinced Senate Finance Committee Chairman Max Baucus to drop the end-of-life provisions from that committee’s draft bill. I didn’t think it was possible for Baucus to prove himself to be any more of a tool for Republicans. Talk about negotiating from a position of weakness. I hope Howard Dean is right in predicting that those provisions will be restored in the final version of the bill.

Speaking of Grassley, he now has two likely Democratic opponents. Bankruptcy attorney and former State Senator Tom Fiegen announced his candidacy today and has a campaign website here. His priority issues are full employment and health care for those without. James Lynch interviewed Fiegen for this piece in the Cedar Rapids Gazette.

Bob Krause has been exploring a Senate bid for several months. You can learn more about his campaign at

Neither Fiegen nor Krause is going to beat Grassley next year, but it’s important to have Democrats committed to making the case against him. That could reduce the number of Democratic and Democratic-leaning independents who cross over to vote for the incumbent, and we need as much straight-ticket voting in 2010 as possible.

UPDATE: Dueling statements from Representative Bruce Braley (IA-01) and Grassley are after the jump.

SECOND UPDATE: I missed this story on Wednesday–Grassley was promoting Glenn Beck’s book in Winterset. Great partner in constructive bipartisan negotiations!


Friday August 14, 2009

Braley Statement on Grassley’s End-of-Life Care Doublespeak

Washington, DC – Rep. Bruce Braley (D-Iowa) issued the following statement today in response to media reports that Senator Charles Grassley and other Republican leaders supported a 2003 Medicare bill that included optional coverage for end-of-life care consultations between patients and their doctors.

“Senator Grassley continues to repeat the ridiculous claim that paying doctors to discuss end-of-life care with their patients is somehow ‘pulling the plug on grandma,’ yet in 2003 he voted for a bill with a nearly identical provision allowing Medicare to reimburse doctors for end-of-life care consultations.  It’s doublespeak like this that makes people cynical about Washington politicians.  Senator Grassley needs to stop the fear tactics and stick to the facts about healthcare reform.  We need a rational discussion so we can achieve much-needed reform in this country,” said Braley.

Late last night, Time reported that Senator Grassley had supported a 2003 Medicare bill including coverage for end-of-life care consultations.  LINK:…

The 2003 Medicare Modernization Act (HR 1) passed by the Republican-controlled Congress and signed into law by President Bush allowed Medicare to fund end-of-life and advanced care planning consultations for terminally ill patients who had not yet elected hospice.  Senator Grassley was a main drafter of this legislation, and supported the bill.

See for yourself: HR 1 – The Medicare Modernization Act of 2003


About halfway down the page in the link, you’ll see:

Conference Agreement

The conference agreement provides coverage of certain physician’s services for certain terminally ill individuals. Beneficiaries entitled to these services are those who have not elected the hospice benefit and have not previously received these physician’s services. Covered services are those furnished by a physician who is the medical director or employee of a hospice program. The covered services are: evaluating the beneficiary’s need for pain and symptom management, including the individual’s need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning. Payment for such services equals the amount established for similar services under the physician fee schedule, excluding the practice expense component. The provision would apply to consultation services provided by a hospice program on or after January 1, 2005.

Senator Grassley voted for the conference report on this legislation on 11/25/2003:…


TO:         Reporters and Editors

RE:          Information on 2003 provisions/end-of-life care and counseling

DA:         Friday, August 14, 2009

Senator Chuck Grassley made the following comment in response to inaccurate information forwarded by Congressman Bruce Braley regarding legislation on end-of-life care and counseling.

“I’m shocked that Congressman Braley would attack a fellow Iowan before getting all of the facts. His statements over the past two days have been riddled with misinformation about what was said in my town meetings, and now he’s taking my vote in 2003 completely out of context. If Congressman Braley had actually listened to what I’ve said on this subject, he’d know that my support for the provisions in the Medicare Modernization Act (MMA) are in line with my long-held view that advanced care planning is a good thing for families to do.  The MMA offers terminally ill patients a pain and care management evaluation and counseling about hospice care and other options. And it offers optional advice from a specialized hospice physician on advanced care planning. One could be assured that the provision of advice on advanced care planning in this context can be done in a correct manner and by an appropriate provider. I can’t say the same thing about what would happen under the provisions in the Pelosi bill. Under the Pelosi bill, all physicians risk losing quality bonus payments unless they report on whether they provide advanced care planning and adherence to that plan. Congressman Braley also misses the larger point when he fails to realize that the concerns about the advanced planning provisions in the Pelosi bill are made because they are proposed in the context of a bill that is ostensibly working to save money by spending less on health care in health care reform, and in a bill that creates a government-run plan that will surely lead to rationing of health care just like has happened in other countries that have government-run systems. It’s plain to see why Iowans and others are legitimately concerned about the unintended consequences of the House bill.”

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  • So, please tell me...

    Any response to these “9/12” Tea Party fruit loops? Where do you think they will be taking the dialogue at that time?  

    I would challenge you to ask your readers to make the trip to D.C. that week, and call up their Congressional reps offices and schedule face time with them that week.

    If we act fast, we could have our various grass roots interest groups scheduled for face time with Grassley, Boswell, and Harkin, and really screw shit up for these right wing nut jobs.  At least let our reps know we are paying attention to whom they are trying to climb into bed with.

    I know I can get into Harkin’s offices, and maybe Grassley.

    Lenny Boswell and I don’t get along so well…

    But I’ll make the trip if folks want to organize around this.

    P.S.> I glanced at the sponsor list for this Tea Party event and didn’t see FOX mentioned. Hmmm, maybe ol’ Rupert has had a change of heart? On second thought, nah, he’s just being modest, content to just helping shape the narrative of the Right.

  • I'm shocked, shocked to find that gambling is going on in here!

    Grassley is increasingly proving himself to be a gigantic tool.

    I read a transcript and watched the video of the Winterset town hall when Grassley was asked if the questioner was right to be worried about gov’t interference in her end-of-life issues.  Grassley told her she was right to be worried.  Yes, he weaseled around after that by describing the benefit of making end-of-life issues early (which is what the language in the bill would help people do, but our plain speaking senator didn’t bother to mention that part).  As the day went on, he just went deeper and deeper into the muck with all his clever quips about “pulling the plug on Grandma.”  Now he tries to turn to the trifecta of conservative bogeymen: “government-run plan,” “health care rationing,” and (da-da-daaaaaaaaaaa) PELOSI!

    • I'll be interested to see his approval ratings

      this fall. I will bet that the percentage of Democrats who have a favorable view of Grassley goes way down.

  • Why bother?

    I take issue with your comment:

    Neither Fiegen nor Krause is going to beat Grassley next year, but it’s important to have Democrats committed to making the case against him.

    I’m assuming Fiegen and Krause think they will beat Grassley next year. I’m assuming their supporters and contributors think so, too, or why would they bother to support them? Maybe I’m being unrealistic, but if 56% of Iowans want healthcare reform, and if Iowa went for Obama by twelve electoral votes, there is a chance that Grassley will be defeated. Grassley sure seems desperate to me, and those handful of rightwingers he attracts at town hall meetings aren’t representative of the majority of Iowans. Please correct me if I’m wrong.  

    • there are lots of reasons to run

      aside from expecting to win this campaign. They might be hoping to build name recognition statewide for a future race. They might be taking one for the team to help build support for Democrats down-ticket (which straight-ticket voting would do).

      Grassley’s approval rating has only dipped below 60 percent a handful of times in the last five years. Maybe his antics over health care will cause him to lose some support, but he is well outside the danger zone for an incumbent. He will also raise as much money as he needs to–corporate groups will be lining up to give him money.

      Ticket-splitting isn’t as common as it used to be, but it still happens. Several states Obama won by huge margins re-elected Republican governors or senators at the same time. There are also Democrats who win easily in states or districts that vote heavily Republican for president.

      I am not saying Democrats shouldn’t run a spirited campaign against Grassley. We just need to be realistic. We don’t have much chance of beating him.

  • Ditto above, that's what everyone said about Loebsack

    Grassley can be defeated.

    • I don't think this is comparable

      Leach barely held on in 2002, a big Republican year nationwide. He was representing a D+7 district, and Grassley is representing a D+1 state. Leach didn’t take money from PACs, and that couldn’t be further from the truth for Grassley. Leach was defeated in a Democratic wave election, and I do not expect 2010 to be a Democratic wave year.

  • Jim Leach took money from PACs...

    We’ll agree to disagree on Grassley but there’s one point that needs fine tuning.  In fact, John Deeth did a big write up a couple of years back on Republicans and PAC money hypocrisy.

    Jim Leach took money directly from the RNC (despite being independently wealthy) which is afterall PAC money.  But the burden of reporting how much a candidate receives is on the RNC and not the candidate.  At the time, and if my memory serves me correctly, you could go into “” and look at the amount of funds that Leach accepted (or any Republican).  The RNC posted a footer that read something like: reporting done by the RNC.  There may be a subscription required for “” at this point in time.  Again, this was about 2 years ago that I looked at it on their website.  

    • I stand corrected

      I thought Leach didn’t want the Republicans spending money in his district, but maybe that was the NRCC ads I’m thinking about.

  • I looked up Deeth's archive just in case I'm wrong on RNC PAC $$

    I hope this helps……  

    Wednesday, February 21, 2007

    Loebsack and PACs

    Dave Loebsack’s been in for a bit of right-wing baiting here on the internets for taking a few PAC contributions, and getting unfavorably compared to his predecessor who trumpeted a no-PAC pledge. The noise calls for a reasoned response.

    Civics 101: Present interpretations (Buckley vs. Valeo) hold that campaign spending is a form of free speech. And PAC is short for political action committee, a form of free association protected under the constitution. A PAC is just a mechanism to bundle smaller donations into larger ones, and a no PAC pledge just a buzzword.

    Rather than bashing the mechanism, it’s important to look at the details. Which PACs are we talking about? I recall Tom Harkin discussing labor PACs back in his presidential campaign days: if the boss writes a $5000 check, that’s OK, but if 1000 workers kick in 5 bucks each, that’s not? How is a donation from a corporate PAC worse than a donation of equal size from a “private citizen” CEO?

    And that appears to be what’s happened with Loebsack. The vast majority of his PAC contributions have been from organized labor. That’s a funding stream not generally available to Republicans, and it underscores the emptiness in Leach’s no-PAC stance. In 2006 Leach received $62,429 from persons listing an occupation of “president,” CEO,” “owner” or some combination of those. Compare that to no CEOs or presidents and $6,015 from “owners” for Loebsack (and they tend to be owners of things like the Lincoln Café in Mt. Vernon)

    Another source of Loebsack’s PAC money was candidate committees, largely presidential campaigns. Democrats supporting Democrats. What a shocker. (That’s also just about the only sort of national party support Dave got; by and large this was a locally funded and operated campaign.)

    Leach also, throughout his career, took indirect PAC money laundered through Republican Party committees and independent expenditures. That only amounted to $34,000 this cycle but was over $270,000 in the 2002 race. The Republicans who continue to trumpet “no PAC” ignore this hypocrisy.

    It should also be noted that Leach had a $187,000 debt to himself in October (a loan likely to be eaten since no one donates to defeated politicians). That’s a pittance by modern campaign standards, but well over a third of his total budget and well beyond the means of a professor at a small liberal arts college. It was easy for Leach to live with a no PAC pledge because he always had that personal wealth at his disposal.

    The Loebsack-Leach race was a model for voluntary spending restraint on both sides. Each spent roughly a half million – which pales in comparison to Bruce Braley’s $2.2 million, Mike Whalen’s $2.3 million, and Leonard Boswell and Jeff Lamberti’s $2.0 million each.

    Systemic campaign finance reform is needed, and ultimately public finance is the best and fairest solution. In the short run, the single greatest campaign cost is broadcast advertising, and some fair system of time allocation would reduce costs and financial demands.