The Death Panels Are Coming (Not what you think)

First they said it was about end-of-life counseling, now they say it's about rationing. And it could be making a triumphant return.

Now that Healthcare.gov seems to be working reasonably well (at least on the consumer end), Republicans are going to have to find something else they can focus on in their endless war against the Affordable Care Act. So get ready for the return of "death panels."

They never really went away. Those who aren't immersed in the fantasy world in which conservatives move were reminded of that last week, when chronicler of changed games Mark Halperin, the embodiment of most everything that's wrong with contemporary political journalism, did an interview with the conservative news organization Newsmax. When the interviewer mentioned "death panels, which will be coming," Halperin responded, "I agree, it's going to be a huge issue, and that's something else about which the President was not fully forthcoming and straightforward." Halperin didn't explain what lie he imagines Obama told about death panels (perhaps he thinks that when Obama said the government wouldn't declare your grandmother unfit to live and have her murdered, he wasn't telling the truth), but what matters isn't Halperin's own ignorance of the law (after all, understanding policy is for nerds, right?), but the fact that it came up in the first place. Which, if you pay attention to places like Newsmax, it still does. A lot.

But wait, you say. Wasn't this all debunked years ago? Yes, it certainly was. But why should that matter?

It's important to remember the switcheroo conservatives pulled on the "death panel" issue. They started off complaining that one provision in the law constituted "death panels," then when their unequivocal lie was exposed and condemned roundly even by neutral observers, they switched to asserting that all along they had been talking about an entirely separate and unrelated provision, and when they say "death panels" they aren't talking about death, or panels for that matter, but about health care "rationing."

Here's how it happened. The ACA originally included a provision allowing doctors to get reimbursed by Medicare for sessions in which they counseled their patients about their end-of-life options and how to make sure their wishes were properly carried out. The problem is that most of the time, when a patient shows up in the hospital in crisis, the staff has no idea what the patient wants if they can't communicate. Do they want to be resuscitated, or intubated, or have every heroic measure taken until the moment they expire? All of us have different ideas about this, and it's important that we think about it beforehand. So the ACA said, if a doctor spends a half hour talking to a patient about it, they'll be paid for their time. It didn't say what they had to tell them, it just said they could get paid for doing it, because right now if they do that counseling, they're doing it for free, which makes it much less likely to occur, which is not only bad for the system but bad for individual patients.

So that part of the law said simply that doctors can bill Medicare for the time they spend doing that kind of counseling, just like they do for a physical exam or performing a procedure. To the people who supported it, the idea seemed commonsensical. Wouldn't you want doctors and patients to have those kinds of conversations? You'd think. But turning that into the "death panel" lie began, as a remarkable number of health care lies have in the last couple of decades, with policy fraudster Betsy McCaughey, who went on Fred Thompson's radio show in 2009 while the law was being debated and told his listeners, "Congress would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner." That would be terrible! It would also be terrible if our beloved elders were then hurled from hot air balloons hovering over volcanoes, but the law doesn't require that either.

Unlike most deceptions in politics, which can be justified by pleading that there was some misinterpretation of ambiguous language, or that what the speaker meant just got garbled in the articulation, this was a clear and specific lie—or two lies, in truth—that McCaughey simply made up in her attempt to subvert the law and then repeated multiple times. There was nothing mandatory or required about counseling, every five years or ever, for any patient, and the counseling was not about "how to end their life sooner."

To continue our story, then Sarah Palin took things the next step, turning a blatant lie (but at least one with some connection to what the law was about) and spinning it out into an extravagant fantasy one can only imagine came from some obscure 1970's dystopian sci-fi movie she saw at four in the afternoon one day while the snow fell gently in Wasilla. "The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s 'death panel,'" she wrote on her Facebook page, "so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil." And thus "death panels" were born.

And of course, the charge was picked up by Fox News, and Rush Limbaugh, and all the other far-flung outlets of the conservative media universe. But then the existence of any such panel was debunked and debunked and debunked again. The fact that the evocative phrase originated with Palin probably made it more difficult for conservatives to make it stick beyond their own self-contained world, since Palin is widely understood to be one of America's most celebrated nincompoops. In addition, cowardly Democrats removed the provision on end-of-life counseling from the bill (to their unending shame) so even the entirely worthy provision of the law was gone. In response, conservatives cast about, and decided that the "death panels" they so feverishly warned of never referred to end-of-life counseling, but to the Independent Payment Advisory Board (IPAB), which did end up in the final bill and which has the benefit of resembling an actual panel.

In brief: the IPAB is a group of 15 health-care experts appointed by the president and confirmed by the Senate who will make recommendations on how Medicare could save money. Those recommendations are due at the beginning of each year, and Congress has until August to overrule them. If Congress doesn't, the Secretary of Health and Human Services will implement the recommendations. But the IPAB only makes the recommendations if Medicare's growth exceeds certain target rates.

Now listen to this part carefully: the text of the ACA prohibits the IPAB from recommending that care be rationed. It also prohibits them from recommending other things, like increasing premiums or cutting benefits. And perhaps most importantly, if Medicare's growth is modest, IPAB won't make any recommendations at all. And if things go the way they've been going and the way they will if many of the other reforms contained within the ACA succeed (including steps to transition from a purely fee-for-service model in which sicker patients means more revenue for providers to one in which they have incentives to keep people healthy), the IPAB might never have to make cost-cutting recommendations. Although things could change of course, the Congressional Budget Office believes that for the next decade Medicare's growth is unlikely to be large enough to trigger any IPAB recommendations.

You may wonder why conservatives, who are constantly saying we need to control the cost of Medicare, are so vehemently opposed to the existence of a panel of experts whose job it is to come up with ways to control the cost of Medicare. That just shows how little you understand. IPAB, they will tell you, will ration care, which will kill your grandmother, no matter what the law says.

Just as a for instance, go on over to National Review and search for IPAB, and you come up with articles with titles like, "AARP Betrays Seniors By Supporting IPAB," and "IPAB, Obama, and Socialism," and "New England Journal of Medicine Supports Unamerican Expansion of IPAB." As I said, once they can no longer complain about healthcare.gov, and once those people who had their junk insurance cancelled turn out to be getting much better insurance, conservatives are going to have to turn somewhere, and I'm guessing "rationing" will be on all their lips.

So what started as "Obama is forcing doctors to encourage their patients to die," then became "Obama's death panel will assess individuals one by one and withhold treatment from those they find unworthy, leaving people like Sarah Palin's kid to plead for their very lives," ends up as "Obama's IPAB death panel will force health-care rationing on us."

I do think that the chances that renewing the "death panel" scare will successfully undermine the ACA are slim. The fact that they don't exist does matter. If you're a reporter wanting to write a story about someone who lost their junk insurance and will have to buy real coverage, at least there are individuals you can focus on, even if you do a poor job of telling their stories. But there's no one you can interview who went before a death panel, or whose relative went before a death panel. Because, to repeat myself, they don't exist. So this whole discussion is likely to remain very abstract. Eventually, conservatives will find something else to cry wolf about. Did you know that under Obamacare, if you kiss a person with herpes, you could get herpes? That's right: Obamacare will give you herpes. Pass it on.

Paul Waldman

JournoList

Paul Waldman, Author, was an identified member of JournoList - an email group of approximately 400 “progressive” and socialist journalists, academics and “new media” activists.

JournoList members reportedly coordinated their messages in favor of Barack Obama and the Democrats, and against Sarah Palin and the Republican Party. JournoList was founded in 2007 and was closed down in early 2010.

The American Prospect

In 2009 Paul Waldman was listed as a Senior Correspondent of The American Prospect. He is also a senior fellow at Media Matters for America.

The libs will never talk about the real reason for Death Panels: they “fix” SocSec and Medicare funding.

Every year sliced off the average lifespan is huge in the financial projections.

RE :”Here's how it happened. The ACA originally included a provision allowing doctors to get reimbursed by Medicare for sessions in which they counseled their patients about their end-of-life options and how to make sure their wishes were properly carried out. The problem is that most of the time, when a patient shows up in the hospital in crisis, the staff has no idea what the patient wants if they can't communicate. Do they want to be resuscitated, or intubated, or have every heroic measure taken until the moment they expire? All of us have different ideas about this, and it's important that we think about it beforehand”

there is a thing called a ‘living Will’ that specifies stuff like this.

Like my grandmother didnt want to be kept alive long term (say beyond a month) with tubes, she specified that in writing

But wait, you say. Wasn't this all debunked years ago? Yes, it certainly was.

No, actually, not one syllable of it was, and declaring it debunked isn't going to affect anything except in the minds of the already credulous.

Sarah Palin was right. Come on, say it, Paul. It won't kill you to speak the truth for a change and it might even start a habit.

They WILL use this against the opposition. You a conservative? We will wait till you die and then allow for medical care...ooops, to late.
That is how they will do it.

They never really went away. Those who aren't immersed in the fantasy world in which conservatives move..."

...are immersed in another kind of fantasy world:

After they limit care, you get end of life counseling. See, you are going to die, so why not protect your family and will your assets to “The One”, so you can have peace of mind.

Remember, not more than 10% of assets should be donated to the Democratic Party if the other 90% go to “The One”.

I guess they simply wouldn’t be leftists if they understood the first concept of economics -

demand is infinite,
resources are finite.

Some mechanism will occur that reconciles the two.

Like the Nazi trains to death camps the fascists are using the affordable care act as a vehicle to crush those that stand against them and to eliminate them. 10,000 baby boomer’s are retiring every day now and the bill has come due. The liberals have robbed the trust fund for so long and obamacare (death panels) is a way to eliminate this problem. The German people never did catch on to what was happening until after the fact. This will be their method of genocide, quietly done just as the Nazi’s. I told one of my long-term friends (ex girlfriend) not to ever write me again over the thanksgiving holiday. In Hungary, her father dragged and carried her for miles to get away from the communist. She took me to a Hungarian dance once where the “grand dame” of the dance was a noted (resistance) commie killer. For her to have voted for this man twice and to still be supporting him through all the lies was more than I could stand. Hope and change, boy he sure got that one right.

every insurance company has people who try
to pull the plug on old people.

we need to find out when that happens
to someone getting Obamacare
and make sure the whole world knows about it

Howard Dean in WSJ: IPAB ‘Essentially a Health-care Rationing Body’; Will He Share Palin’s 2009 ‘Lie of the Year’ Award?

every insurance company has people who try to pull the plug on old people.

Not just the insurance companies. Some doctors try too. When my first wife was in what turned out to be her last days, on a ventilator, the doctors wanted to pull the plug on her. I objected. Of course she did die a short time later, but I did what I could to give her a chance to recover.

Currently they are targeting their political enemies with the IRS and other federal agencies.
The ACA federalizes the medical industry.

baraq wasn’t kidding when he said they would punish their enemies and reward their friends.

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