White House Cowardice on Health Care.

We've heard a lot in the last few days about how Democrats have developed a "bring it on" attitude toward Republican efforts to repeal the Affordable Care Act. They think the debate will allow them to talk about the popular things the law actually does and force Republicans on to the defensive when they charge (accurately) that if they want to repeal the ACA, it means they want to keep open the "donut hole" in Medicare prescription drug coverage (the ACA closes it), allow insurance companies to discriminate against you if you have a pre-existing condition, and so on. Sounds good! But then today we see this:

U.S. Alters Rule on Paying for End-of-Life Planning

WASHINGTON — The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.

The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1.

Many doctors and providers of hospice care had praised the regulation, which listed "advance care planning" as one of the services that could be offered in the "annual wellness visit" for Medicare beneficiaries.

While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House.

Rule No. 1: When you make policy decisions based on "The Republicans might attack us on this!" then you haven't just lost politically; you've betrayed the things you allegedly believed in.

What's particularly maddening about this isn't just the cowardice; it's the fact that this is a debate Democrats can easily turn to their advantage. First, it's important to note that unlike in many cases, the press has taken a pretty firm pro-truth position on this issue, which sets an important context for how whatever discussion there ends up being would play out. Reports about it have overwhelmingly declared the "death panel" line to be false. It was PolitiFact's 2009 "Lie of the Year." Seriously -- take a look at how it's been reported. The press has done a good job on this one. And the main proponent of the idea, Sarah Palin, is one of the most unpopular politicians in America.

And it's so, so easy to put Republicans on the defensive on this. After all, they're trying to get between you and your doctor! Every time two Congress members go on TV to debate it, the Democrat can turn to the Republican and say, "Jim, why do you want to prevent people from talking to their doctors about important life decisions? Why won't you let them do that? Why do Republicans insist on standing in the doctor's office door, shouting, 'No!' Democrats want people's care to be guided by the patient, their family, and their doctor. Republicans seem to want to take the power to make decisions away from patients and give it to whichever hospital bureaucrat happens to be in charge when the ambulance rolls in." When Congressman Jim starts blathering about rationing, you can say, "Jim, are you saying you stand with Sarah Palin on what every objective observer has called a lie, this 'death panel' garbage? You can stand with Palin, but Democrats want to stand with patients."

On the other hand, maybe what Democrats need is some more preemptive concessions.

-- Paul Waldman

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