USCCB and Catholic Health Association Under Fire From Ultra-Conservative Catholics.

Yesterday, Deal Hudson wrote at the Catholic Advocate that the US Conference of Catholic Bishops has failed to effectively strategize it's opposition to the health care bill.

He also criticizes the USCCB for allowing the Catholic Health Association (CHA) to voice support for the bill. CHA represents the more than 600 Catholic hospitals, hundreds of long-term care and hospice facilities, and three of the top 10 HMOs (health management organizations) in the country. Hudson writes:

At present, the USCCB has not issued any statement directly opposing the Catholic Health Association or any of the Catholic groups supporting the Senate bill such as Catholics United and Catholics in Alliance for the Common Good.

The lack of such a statement allows the press, the White House, and the Congress to hold up these groups as providing official Catholic support to a public which largely does not know any better.

A direct rebuke from the USCCB towards the Catholic Health Association would not be in keeping with what I have termed its strategy of qualified support, but it would certainly keep wavering members of Congress from finding political cover from these groups willing to accept abortion funding.

With a vote on the bill coming as soon as Friday or Saturday, the USCCB is running out of time to get tough. The parish bulletin program emailed last Friday by the USCCB comes too late to have any serious impact on a vote this week.

The willingness of such an intimate partner with the USCCB to break with the bishops on the health care bill is just another aspect of its failure to negotiate powerfully with Congress and speak loudly and clearly to the media on this legislation. Its strategy of qualified support has put the USCCB in a weakened position and allowed the initiative to be taken over by groups with vested interests. CHA wants federal money for its hospitals, while Catholics United and Catholics in Alliance for the Common Good were created precisely to keep Democrats in power, even if it means further endangering the lives of the unborn.

It’s common sense that you can’t win a negotiation if you aren’t willing to walk away from the table. Thus far, the USCCB hasn’t shown that willingness. Bishop Thomas Wenski of Orlando understood this when he wrote a few days ago, “No health-care legislation is better than bad health-care legislation.”

Despite recent and vocal debunking of the accusation that the current bill provides federal funding for abortion, Hudson and Catholic Advocate, along with other Catholic-right organizations, have worked hard to push the conservative USCCB even farther to the right on health care. That the composers of both the Stupak and Nelson amendments deserve criticism for not being right enough and that they are allowing CHA to misrepresent Catholic opinion on health care is a blatant falsehood.

An October poll shows that a full 56% of Catholics think the USCCB should not take a position on health care reform and a majority support both the public option and funding for abortion (again, even though the latter is not included in the existing bill.)

While I'll agree that public opinion is too often falsely touted as the best way to achieve individual rights (historically, meaningful minority rights legislation has required both strong executive or legislative leadership AND public support) Hudson is asking the church hierarchy to take a much more conservative stance than it's parishioners. As we've seen throughout the debate, they certainly have. But that's not enough for Deal Hudson - and he's not alone; he is so far right of Catholic opinion on this issue that he makes the USCCB look more liberal than they really are.

"Rationing," "Death Panels," And Other "Pro-Life" Criticisms of Health Care Make a Come Back.

As the health care bill begins to again show sign of life, "pro-life" and anti-reform forces are again raising unfounded concerns about "government-funded abortion," "rationing," "death panels," and "conscience clauses."

Americans United for Life, a Christian group (part of what I call the Legal Right, a collection of "pro-life" "legal" organizations that work to pass religious laws regarding patients' rights) has reposted it's claims against the health care bill.

First, before I go into my debunking of those claims, let me say that I have no great love for this bill as it exists in its many forms. While it may constitute gains for millions of uninsured, it does little to advance the cause for meaningful health care reform unless great changes are made to it. Our health care delivery system, as it exists, is badly broken. This bill will only work as a band-aid on the larger structural problems; it does little to address necessary systemic reform. And it goes a long way to create challenges to that impending reform (changes will have to be made as the system continues to bankrupt us) in the future. Most notably, it damages the cause for meaningful reform by mollifying those who accept that the system is broken but think that government is appropriately addressing the crisis. And it complicates women's access to reproductive rights by compromising women's health needs for the sake of passage. Any support I give this bill is predicated on the un-guaranteed hope that it is a step in the right direction, one that can be expanded on in the very near future.

But back to Americans United for Life. Their claims and my refutations:

Further, the White House proposal dramatically increases funding – by 11 billion dollars – for “community health centers” which will include Planned Parenthood abortion centers. Because the proposal lacks a blanket prohibition on the use of federal funds for abortions, these new funds could be used to directly pay for abortions.

This is a response to Bernie Sanders (Vermont) amendment to the bill that, as Katrina Vanden Heuven explained at The Nation in the second week of December, when it was added:

Without fanfare, the good Senator from Vermont, Bernie Sanders, has continued to work behind the scenes to champion community health centers--something he has done for years (also here). These non-profit, community-based facilities provide primary healthcare, dental care, mental health services, and low-cost prescription drugs on a sliding scale. As amendments were added in recent days to win over the Liebermans and Nelsons of the "greatest [undemocratic]deliberative body" in the world, Sanders made sure that a $10 billion increase in funding for the health centers was included.

"This is not gonna solve all the problems of the world," Senator Sanders told me yesterday. "But expanding access to high quality primary health care, and low-cost prescription drugs, and mental health counseling, and dental care--which is a big issue--this is a very significant step forward. If you walk into a health clinic and you have no insurance at all they will treat you on a sliding scale basis. So, that's affordable healthcare."

AUL's opposition to this sensical amendment is that some of those community centers could be Planned Parenthood Centers, which provide, yes, abortion services, but also other women's reproductive services like birth control, pap smears, exams, treatment for STDs, etc. Laws already exist that prevent Planned Parenthood from using federal funds for abortion services. In other words, AUL is protesting more federal money from being used at PP Centers because in those same centers women are paying for their own abortions. Forget the other needs of women that have been marginalized by our current laws and health care system. The objective is to starve PP out of helping women at all, simply because they perform a legal service (abortion) in their clinics that AUL and others have religious objections to.

I would be very surprised to hear that the Sanders amendment rescinds that segregation of funds at PP centers, but even if it does, "no federal funding for abortion" is a misused and discriminatory term. The Hyde amendment, passed after the legalization of abortion under Roe v. Wade in 1973, only restricts use of Medicaid funds for abortion - not all federal funds. Even as misunderstood and misrepresented by "pro-life" groups, Hyde is basically a discriminatory law that preys on the poorest, most disadvantaged women in our society. If you can pay for an abortion yourself, the bill allows, go ahead. If you can't, you're forced into pregnancy.

First, the amendment provides inadequate conscience protection, because it does not prohibit any government entity or program (federal, state, or local) from discriminating against health care providers that do not want to participate in abortions.

While the current health care bill doesn't include provider refusal laws (so-called "conscience clauses"), other laws at the state and federal level already protect not only doctors and other providers but also institutions (like the 624 Catholic hospitals in the country) from providing abortion (or as with Coats, from teaching abortion at medical schools!) In other words, a web of "conscience" laws allows every denominational health care institution, every provider, doctor, or nurse, from denying you a legal, medically-sound service. And this can be done without informed consent (telling the patient what services are available and allowing the patient to make their decisions according to their own conscience) and without meaning referrals (telling a patient where to get the services they need). The AUL wants to keep the disastrous and discriminatory Bush "conscience clause" in place, the one the Bush administration enacted only weeks before leaving office, that allows virtually anyone in the medical research (lab workers) or delivery network (pharmacists) to deny patients' their right of informed health care decisions and access - without any provision for the patient at all.

Second, the amendment fails to address our concerns that under the Mikulski amendment (already accepted in the underlying bill), the Health Resources and services Administration (HRSA) has the power to require private insurance plans to include abortion coverage under the guise of “preventive care.”

Private health insurance policies already provide abortion services. About 85% of them. Preventing those policies from such coverage when included in the federally subsidized "networks" is a further extension of Hyde's original intent and again applies denominational health care discrimination to a pluralistic society. Restricting such coverage would further restrict access to legal, medically-sound service simply because a segment of society doesn't believe in that service. Poor, minority, or rural-living women would be most hurt by it.

Third, the amendment allows insurance plans that cover abortions to receive government subsidies, which is a radical departure from existing law (which is not allowed under the Hyde Amendment and the Federal Employees Health Benefits Program).

It's not radical, as I explained above. And the Weldon amendment, which in 2005 eliminated coverage of abortion in the health care plans for the Labor, Health and Human Services and Education departments of the U.S. government was itself a radical departure from the Establishment clause that should protect society from government endorsement of religious ideology. To be clear, Hyde and Weldon are both amendments that are renewed each year with the budget for their programs; but "pro-life" groups have made such a fuss about them that, as their language alters annually, they have become more restrictive and the question of their removal has become politically challenging. That doesn't mean that they represent good, non-discriminatory medicine. Again, claims that these laws currently prevent any "federal funding for abortion" are grossly exaggerated. There's no "radical departure" here as AUL claims.

Fourth, while the amendment allows states to “opt out” of allowing private plans that include abortion coverage to participate in their exchanges, this “opt out” provision makes abortion coverage normative. In other words, states will have to act to prevent subsidies from going to plans that cover abortions in their state, turning on its head the traditional federal approach to abortion.

Uh, abortion coverage is normative in the private sector. Though conservative groups largely oppose movement from health care coverage from the private sector to the federal government, they're going to fight tooth and nail to make certain that women's access to services they oppose (abortion, sterilization tubal ligation, condom access, fertility services, STD counseling) are as restricted as possible. Egalitarian health care access, they say is a false concept; health care is a commodity, you get what you pay for.

This new state "opt out" simply gives state legislatures yet another tool to impose denominational health care on a pluralistic society - with one quick action. And as to the dramatic defense of the "traditional federal approach" to abortion, Hyde and Weldon are discrimination, plain and simple. Other forms of discrimination could be - and have been - called "traditional." (See pending court case in California regarding Prop 8 where "tradition" is used to discriminate against gays.)

Fifth, the amendment fails to ensure federal funds will not go to assisted suicide and fails to address concerns that Comparative Effectiveness Research will lead to rationing of essential medical care.

Despite the relatively known aspects of the controversies surrounding the health care bill and women's rights, this last point by AUL is perhaps the most damaging. Their effort (abetted by the medical industry) to include elders in their coalition against health care reform (and this bill particularly) have proven that these groups will prey on society's and elders' fears of death without scruple.

In our current medical system, patients are pushed into ineffective, aggressive, futile care at the end of life by a culture that has turned hospice and palliative care into giving up on life. As Tim Cousounis writes:

Misconceptions about hospice and palliative care have abounded well before the latest efforts to refrom the health care system. How else to explain the persistent and continuing reticence to refer to, and accept hospice services, in most US communities. What's different today is that the skeptics of hospice and palliative medicine are more vitriolic than their predecessors, and their talking points (arguments) are more vivid - "death panels, socialized medicine".

Palliative care, making terminal patients comfortable and relieving their pain in the last months of life, is twisted maliciously into "rationing." Elders are fed unfounded fears of doctors and a preying government that want to kill them, infantilized by a paternalistic church and the medical industry into patients who are unable to make their own decisions. Seniors are uninformed about advance directives, living wills, state laws that could protect them, their options for end of life care. Doctors fail to discuss terminal diagnoses because they don't like doing it or because they aren't paid to do it. Seniors, who say they would like to die at home (80%) end up dying in medical facilities (75%). The government is drained by death-prolonging care in their last months (2/3rds of Medicare goes to the last two months of life). Families are bankrupted, emotionally and physically drained by the suffering inflicted through unnecessary services. And still, elder and terminal patients have no choice in how they die.

As to the egregious funding of assisted suicide AUL claims the bill will facilitate: Death with Dignity is legal in two states: Oregon and Washington. On New Years Eve, a third state, Montana, had their Supreme Court rule that the state constitution does not prohibit aid in dying. Laws already exist that prevent federal funds from being used to promote these services (and aid in dying advocates from using federal funds to promote it). This additional fear, compounded by claims of "rationing" and "death panels" works well for health care reform opponents but has little basis in fact. The costs of Death with Dignity are minimal. Those who use it (some few hundred in Oregon since 1998) tend to be wealthy, educated, and white. The AUL's concerns that federal funds will pay for Death with Dignity are grossly exaggerated.

Religious Tolerance and the Health Care Mandate.

Anabaptists have long eschewed public insurance policies for their own collective address of medical emergencies. Home owner's insurance and other plans designed to prevent catastrophic loss are seen by the more conservative members of the Anabaptist sect as intrusions. While car insurance was never much of a problem - if you own a car the chances are you're "worldly" enough to buy into insurance needs.

In fact, family story has it that my Mennonite grandparents left a more traditional church in Lancaster County when the pastor there criticized my grandmother's short bonnet strings (long ones were oh so much more pious) and my grandfather's insurance policies.

While the Amish and conservative Mennonite communities are now forced to provide their employees with workmen's compensation, they have stayed far away from health insurance, coming together to care for a broken arm or a dire prognosis like they would to build a barn.

The health care bill has many wary critics among these conservative Anabaptist sects, most hoping they will be able to receive exemption from the new mandated fees. David Mekeel writes:

UNLIKE MOST Americans, James B. Weaver has never really given much thought to health insurance.

An Old Order Mennonite living in Maxatawny Township, Weaver, 56, doesn’t subscribe to the idea of buying insurance of any kind.

He opts to rely on his community when it comes to handling the bur den of sickness.

“We sort of like to try to pull our own weight, and we’re very staunch believers that there is no free lunch, Weaver said of the Plain communi ties in Berks and elsewhere. “We take care of our own sick and infi rm.”

The same is true for the few Amish households in Berks County, which are mostly in the far western part of the county.

But the debate about a new na tional health care bill has forced the insurance topic to the forefront for many Amish and Old Order Men nonites.

Both the U.S. House and the Sen ate have passed health care reform bills, and the lawmakers are expect ed to work out the details of a fi nal bill early this year.

Each bill includes requirements that would force nearly every Amer ican to carry health insurance and make businesses provide it for employees.

Those who don’t have insurance would face fi nes.

Weaver suspects most members of Plain communities would balk at the idea of buying health insurance. But he said some younger members may not be as steadfastly against the idea.

“I think there’s going to be a lot of talk, a lot of dialogue in our circles about how we are going to deal with this,” Weaver said. “Unfortunately, I think quite a lot of our younger people might not be opposed to some form of it.

“The older generation, though, will probably try to work something out where they get exemptions.”

An unwelcome intrusion

In Plain communities, health insurance requirements are viewed as an unwelcome government intrusion.

“It’s basically a religious reason,” said Don Kraybill, professor of Anabaptist studies at Elizabethtown College in Lancaster County. “They feel the members of the church are responsible by their Christian faith to help each other and take care of people.

“They feel they shouldn’t be paying outside commercial entities to be taking care of them. That’s the responsibility of members inside the community.”

How Deals are Made in DC: Concessions.

The AP reports on some of the concessions given to Democratic senators who held out long enough on their votes on the health care bill:

Here's a look at some of the concessions lawmakers and interest groups won in the latest version of the Senate's health care overhaul bill:

___

LAWMAKERS:

SEN. BEN NELSON, D-NEB., who provided the critical 60th vote that Senate Majority Leader Harry Reid needed, received numerous benefits for Nebraska, along with tighter curbs on abortion. Among the Nebraska-specific provisions:

_The federal government will pick up the full cost of a proposed expansion of Medicaid, at an estimated cost of $100 million over 10 years.

_Blue Cross Blue Shield of Nebraska will be exempted from an annual fee on insurers; the exemption could also apply to nonprofit insurers in other states, possibly including Blue Cross Blue Shield of Michigan.

_Supplemental "Medigap" policies such as those sold by Mutual of Omaha are exempted from the annual fee on insurers, something that would help other companies selling such policies.

_A physician-owned hospital being built in Bellevue, Neb., could get referrals from doctors who own it, avoiding a new ban in the Senate bill that will apply to hospitals built in the future. Without mentioning Nebraska or other states by name, the Senate bill pushes back some legal deadlines by several months, in effect making a few hospitals near completion eligible to continue receiving referrals from the doctors who own them.

SEN. MAX BAUCUS, D-MONT., chairman of the Finance Committee and a key architect of the legislation, put in a provision to help the 2,900 residents of Libby, Mont., many of whom have asbestos-related illnesses from a now-defunct mineral mine. Under Baucus' provision, which never mentions Libby by name, sickened residents could sign up for Medicare benefits.

SEN. CHRISTOPHER DODD, D-CONN., who is facing a difficult re-election next year, added an item making $100 million available for construction of a hospital at a public university. The measure leaves it up to the Health and Human Services Department to decide where to spend the money. Dodd says more than a dozen sites could be eligible, but he hopes the University of Connecticut will be the beneficiary.

SEN. PATRICK LEAHY, D-VT., negotiated $600 million in additional Medicaid benefits for his state over 10 years. He said Vermont is due the additional benefits because the state already has acted to expand Medicaid eligibility to the levels now contemplated by the federal government. Vermont would be unfairly penalized if other states are now being helped with that expansion, he said. Massachusetts is getting $500 million in Medicaid help for similar reasons.

SEN. MARY LANDRIEU, D-LA., a key moderate, withheld her support from the legislation until she was able to procure Medicaid help worth at least $100 million in 2011 from the federal government.

SEN. BERNIE SANDERS, I-VT., who was angered after a new government-run health plan was dropped from the legislation to win over moderates like Nelson and Landrieu, held out on backing the bill until Reid, D-Nev., agreed to a $10 billion increase in support for community health centers.

SEN. BILL NELSON, D-FLA., pushed a provision he said will let about 800,000 Florida seniors enrolled in private Medicare Advantage plans keep their extra benefits. It also helps seniors in a handful of other states. Elsewhere, Medicare Advantage patients risk losing benefits because the private plans are a major target of planned cuts to Medicare.

___

STATES:

_Doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming will get paid more than providers in other states under formulas in the bill designed to help the so-called Frontier States.

___

INTEREST GROUPS:

_Longshoremen were added to the list of high-risk professions shielded from the full impact of a new tax on high-value health insurance plans. Electrical linemen were already shielded, along with policemen, firefighters, emergency first responders and workers in construction, mining, forestry, fishing and certain agriculture jobs. Sen. Jeff Merkley, D-Ore., took the lead in pushing for the longshoremen carve-out.

_Merkley also pushed for language that will exclude all but the very smallest construction industry companies from the bill's small business exemption. In general, the exemption says that companies with fewer than 50 workers aren't subject to penalties if they don't ensure their employees. In the construction business, under Merkley's change, only firms with fewer than five workers and a payroll under $250,000 would be exempt. Merkley's spokeswoman said the change was needed to ensure that construction contractors, which are overwhelmingly small businesses, provide insurance for their workers.

_Gun rights lobbyists pushed for language to ban collection of data on gun ownership in the bill.

_The American Medical Association announced its coveted endorsement Monday after Reid made a series of change to please doctors, including eliminating a 5 percent tax on elective cosmetic surgery procedures, replacing it with a 10 percent tax on indoor tanning services; eliminating payment cuts to specialty and other physicians that were to be used to pay for bonuses to primary care physicians and general surgeons in underserved areas (the bonuses remain); and dropping a proposed $300 fee (to be used to fight fraud) on physicians who participate in Medicare.

_Makers of brand-name biotech drugs — expensive pharmaceuticals made from living cells — won 12 years of protection against would-be generic competitors.

_Drugmakers fended off proposals to allow importation of cheaper drugs from Canada and other countries, and to let the government negotiate drug prices for Medicare recipients.

Conservatives Targeting AARP.

Last week I wrote about the new focus of conservative ire on AARP because of the organization's support of the health care reform bill. (The bill has also formally been endorsed by the AMA.)

Yet LifeNews continues to misconstrue the contents of the bill and to rally "pro-life" advocates against "euthanasia":

The nation's most prominent organization for seniors is expected to formalize its endorsement of the House health care reform bill today. The backing from AARP for the bill, which includes massive abortion funding, comes despite concerns about death panels and assisted suicide.

The House is expected to vote Saturday on the bill and, when it does, it will have the backing of the powerful seniors group.

"We started this debate more than two years ago with the twin goals of making coverage affordable to our younger member and protecting Medicare for Seniors," said AARP CEO Barry Rand in a written statement.

"We've read the Affordable Health Care for America Act and we can say with confidence that it meets those goals with improved benefits for people in Medicare and needed health insurance market reforms to help ensure every American can purchase affordable health coverage," Rand added.

But, pro-life advocates can say with confidence that the bill also presents a myriad of concerns for seniors.

The new bill, H.R. 3962, contains the controversial "death panels" panned in the previous legislation and direct taxpayer-funded promotion of assisted suicide in the states where it is currently legal.

HR 3962 contains two clear end-of-life provisions -- including one that requires insurance companies to distribute advance directives and other planning tools to all who are insured on the new government-run exchange.

The other allows Medicare reimbursement for optional end-of-life planning consultation.

Both provisions appear to exclude assisted suicide from the consultations and advance directives, but those exclusions have no meaning in the Washington and Oregon (and possibly soon in Montana) where assisted suicides are legal.

There, state law says that "death with dignity," the legal terms in those states for assisted suicide, does not actually constitute assisted suicide.

In both states, state law says actions under the assisted suicide statute "shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law."

As a result, in Washington and Oregon, Medicare reimbursed consultations could involve assisted suicide planning and advance directives or other planning materials distributed by mandate could include assisted suicide options. Thus, taxpayer-funded information provided under both provisions will include assisted suicide options in those states where it is legal.

If Steven Ertelt or other conservatives were to read the Death with Dignity bills in Oregon and Washington, they would find that both require that the patient bring up Death with Dignity. Doctors are prohibited from doing so. And in my prior blog, I note some of the issues, using GeriPal's post, of how our current system locks the elderly and the terminal into methods of end of life care that they don't want, that are costly, and that are inflexible.

Best practice panels, so-called "death panels" guarantee a standard of patient care that is currently unregulated. We accept that the government protect us from unsafe work standards, water, manufacturing practices and other corporate excesses. Why not regulate health care? And elders are most susceptible to a bloated and paternal medical industry.

Flaming fear among elders by protesting AARP and other senior organizations and by denouncing a bill that will only improve senior care is wreckless, irresponsible, and inhumane. The use of lies to feed care concerns among seniors only hurts them.