A White House Week One Cave-In

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Back in October, I included this line in a blog post:

Political pressure and a seemingly paralyzing fear of bad headlines, however, appears to be guiding Administration policy this close to election day.

As if to prove the point, within an hour of publishing this line, I got a call from a White House press person vigorously complaining about my wording. Ridiculous, he said, the Administration would never let politics get in the way of good policy. “Paralyzing fear”? Come on!

Well, this week, it looks like the Administration let politics guide policy once again, deciding to scrap a provision quietly inserted into new Medicare regulations that would have paid doctors to talk to patients about end-of-life care. When a similar provision was included in the original House health reform bill, Sarah Palin and other Republicans seized on it, dishonestly implying it would mean the government could decide which elderly Americans could get care and which ones would be left to die. After the dustup became a “death panel” firestorm, the provision was dropped, only to be quietly inserted again a few months ago by newly installed Medicare and Medicaid chief Donald Berwick. Doctors, hospice groups and advocates who new about the reinsertion supported the move.

To the Administration’s dismay, the New York Times found out about the end of life counseling regulation—which was posted publicly in November but not in a way public comments could be accepted—and published a story about it on Dec. 25, 2010. Less than two weeks later, it was gone again.

By caving so quickly on such a small matter—Republicans seem more likely to focus their efforts in the 112th Congress on issues like the individual mandate than this tiny, already over-litigated provision—the White House risks sending a signal of weakness at the very start of Speaker John Boehner’s tenure. The White House claims it pulled the end-of-life provision because the process was bad; the public should have been allowed to comment on it for a longer period of time.

Berwick, a long-time champion of end of life planning and care that more closely follows the wishes of patients, still isn’t allowed to speak publicly and freely, but if he could, my guess is he’d express some serious frustration. It appears he was over-ruled by his bosses. After building a career out of making medical systems operate more efficiently, cheaply and safer, Berwick is now getting stymied by an Administration with, if not a paralyzing, than at least a healthy fear of bad press.