Palliative medicine: politics and policy.

Diane E. Meier, M.D. (Moderator): I have been in Washington, D.C. since October 2009, to begin a health policy fellowship. I will be actually living in D.C. for a year. Right now, I am interviewing for placements, either in a member’s office or on one of the committees of jurisdiction for health care, like the House Committee on Ways and Means or the Senate HELP or Finance Committees. I am also interviewing with individual member’s offices, including Senators Wyden, Rockefeller, Warner, and others. It has been interesting to observe the reaction that people have when they read my resume and my cover letter—their reaction to the fact that I am a palliative care physician. Some are very positively engaged and ask a lot of questions about what palliative care is and how it is the same and different from hospice. Others make it perfectly clear that the issue is— and this is my language—radioactive. This second group sees a risk of becoming a target for certain elements in our society whose goal is to defeat health care reform, and influence the 2010 midterm elections. Some may feel that just having the term palliative care attached to my name and then being attached to a Hill office is a risk too great to take. That has been an interesting experience: to feel as if my welcome into some of these offices is influenced by the fact that I work in palliative care. I would say the majority of the responses though are not constrained by worries about the term palliative care but rather are anxious to correct the record after what happened in August 2009. That has been heartening. I am looking forward to learning as much as I can over the next year about how process and politics influence health policy. I hope to develop a more nuanced and sophisticated understanding of the process and the politics, so that when the year is over our influence on important policy priorities for palliative care will be more effective.