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This is an old revision of this page, as edited by Hauskalainen (talk | contribs) at 22:22, 12 January 2011 (→NICE: removed text again. Link does not work and claim is in any case completely crazy.. Palin has not said this.). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Sarah Palin

"Death panel" is a political term coined in August 2009 on the Facebook page of former Governor of Alaska Sarah Palin suggesting that health care legislation being debated in the U.S. Congress would create an America "in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." There was no such term or explicit provision in the bill.[1] A provision including Medicare payments for voluntary counseling between a doctor and a patient on end-of-life issues and advance directives was the trigger for the 'death panel' concerns.

While some prominent conservatives supported Palin's allegation, PolitiFact.com called "death panels" the "Lie of the Year";[2] Palin said she had employed it as a metaphor for reduced access and diminished quality of care that she believed would follow the enactment of the federal legislation.[3]

The American Dialect Society, a group of English language scholars, reported that "death panel" was their "most outrageous" word for 2009.[4][5]

Origins

Betsy McCaughey

Prelude

Betsy McCaughey, a health care analyst who came to political prominence after she helped defeat the Clinton health care plan of 1993,[6][7][8] "got the ball rolling" in July and August 2009 when she called the bill "a vicious assault on elderly people" that will "cut your life short".[9] McCaughey was joined in spreading the idea by other pundits and conservative media that had had helped defeat the Clinton era legislation, including The Washington Times and The American Spectator.[6] According to The New York Times, McCaughey also falsely claimed that presidential advisor Dr. Ezekiel Emanuel thought that the disabled should not be entitled to medical care, which helped inspire Palin's warnings about "death panels".[10][11][12] Both McCaughey and Palin's remarks about what Palin called an alleged 'death panel' were based on opinions about Ezekiel Emanuel[13][14][15][16][17] and previous page 425 legislation.[15][16][18][19]

Emanuel is an opponent of legalization of doctor-assisted suicide or euthanasia.[20] FactCheck.org said, "We agree that Emanuel’s meaning is being twisted. In one article, he was talking about a philosophical trend, and in another, he was writing about how to make the most ethical choices when forced to choose which patients get organ transplants or vaccines when supplies are limited."[11][21] An article on Time.com said that Emanuel "was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources ... 'My quotes were just being taken out of context.'"[22] Regarding page 425 of a health care bill, Congressman Earl Blumenauer (who sponsored the legislation) said the measure would block funds for counseling that presents suicide or assisted suicide as an option, and called references to death panels or euthanasia "mind-numbing".[23]

According to Susan Dentzer, editor of Health Affairs, Congress' approval of $1.1 billion for comparative effectiveness research in the 2009 stimulus contributed to fear the research would "lead to government rationing" which "fueled the 'death panels' fury of summer 2009".[24]

Coining

On August 7, Palin coined the term on her Facebook page[25][26] stating:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. 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' 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.[8][27]

Spread during 2009

According to a study by Brendan Nyhan published in The Forum of Berkeley Electronic Press, during the period of July 16 through August 14, what he called the "'death panel' myth" was spread by

A BBC article interpreted conservative blogger Michelle Malkin's August comments as "explicitly re-affirming" Palin's assertion that "Obama wanted to create a 'death panel' to decide whether the elderly or disabled are 'worthy of health care'".[28] Mostly, the concept was spread by "conservative outlets on cable news, talk radio, and the internet".[8]

Provision identified by the charge

Rep. Earl Blumenauer, sponsor of a similar provision[29]
Main article: End-of-life care

When asked exactly what part of the proposed legislation[30] mandated death panels, Palin's spokesperson pointed to H.R. 3200, section 1233 Advance Care Planning Consultation.[18] On August 12, Palin wrote on Facebook that it was misleading for Obama to say the sessions were entirely voluntary; PolitiFact.com ruled that assertion false, writing that the sessions were voluntary.[31] The provision would have allowed physicians to receive payment from Medicare for voluntary counseling with patients regarding end-of-life issues so that personal preferences for care when the time comes would be known so that doctors and relatives would not have to make decisions about care on their behalf. The counseling would cover topics such as making living wills, enabling a close relative or a trusted friend to make health care decisions, hospice as an option for the terminally ill, and information about pain medications for chronic discomfort. The sessions would have been covered by Medicare every five years or more frequently for patients who became gravely ill.[29] The provision was inserted in the bill by Democratic lawmakers at the behest of La Crosse Wisconsin hospitals that had created a pioneering community program to get people who were not critically ill, to think about and choose the treatments they would want at the end of life.[32][33] Before H.R. 3200, Representative Earl Blumenauer (Democrat-Oregon) had submitted single purpose legislation with cosponsor Republican Charles Boustany (Republican, Louisiana), a cardiovascular surgeon, that similarly provided for Medicare payments for end-of-life counseling;[33][34] earlier bills in preceding years had also been submitted with bi-partisan support.[citation needed]

Consultation payments were removed from the Senate version of the bill[35] while remaining in the House version until November 2009, when they passed, but they did not pass in the final bill.[36] On December 25, 2010, The New York Times reported that effective January 1, a new Medicare regulation had been added for consultations during annual "wellness visits," instead of at 5 year intervals as the bill originally mandated.[36] Instead, on January 4, the The New York Times reported the payments would be struck from the regulations.[37]

Uses

A death panel sign with a Nazi reference at a Rep. Carol Shea-Porter town hall meeting

Health law and bioethics expert George J. Annas wrote that "the national discussion on death planning the president had hoped for focused instead on death denial. Make believe 'death panels' that would 'pull the plug on grandma' were used as a rhetorical device to block any rational discussion of either death generally, or end of life care in particular".[38] Brent J. Pawlecki, a corporate medical director, said the phrases death panels and "killing Grandma" were "used to fuel the flames of fear and opposition".[39][40] According to The Economist, the phrase was used as an "outrageous allegation" to confront politicians at town hall meetings during the August 2009 congressional recess.[41] According to The New York Times, the term became a standard slogan among many conservatives opposed to the Obama administration’s health care overhaul.[26]

Allegations of rationing

Main article: Healthcare rationing in the United States

The Christian Science Monitor reported that some Republicans used the term as a "jumping-off point" to discuss government rationing of health care services, while some liberal groups applied the term to private health insurance companies.[42] Newt Gingrich called Palin's language "explosive", but said her premise on rationing was correct.[43] Gingrich said that while technically, the proposed legislation (H.R. 3200) did not provide for government rationing of health care, the legislation was "all but certain to lead to rationing".[43] Brendan Nyhan wrote that although "efforts to reduce growth in health care costs under Obama’s plan might lead to more restrictive rationing than already occurs under the current health care system, that hardly justifies suggestions that reform legislation would create a 'death panel' that would deny care to individual seniors or disabled people".[8] Michael F. Cannon wrote that "[p]aying doctors to help seniors sort out their preferences for end-of-life care is consumer-directed rationing, not bureaucratic rationing".[44]

NICE

The British paper, The Telegraph noted that some critics of the US reform used Britain's National Institute for Health and Clinical Excellence or NICE, which uses cost-effectiveness analysis to determine whether new treatments and drugs should be available to those covered by the NHS, "as an example of the sort of drug rationing that amounted to a 'death panel'".[45]

NICE performs a variety of functions, but it is its role in deciding whether new treatments should be made available on the NHS on the basis of cost effectiveness that is regarded as an example of the sort of drug rationing that amounts to a "death panel".[46] NICE has been described by David Gratzer as being comparable to the Independent Payment Advisory Board (IPAB) created in the Affordable Care Act.[47][48]

NICE decisions recommending that the NHS should not fully fund expensive cancer treatments do not mean that the patients are denied access to these treatments. The NHS, which provides cancer drugs from its formulary free of charge,[49] now allows patients to "top up" their NHS coverage either out of pocket or with private insurance.[50] Private insurance for coverage against having to pay for cancer drugs costs about £50 a year for a 50 year old man (about US$80, or double this for a smoker). [50]

IPAB

The New York Times reported some Obama administration officials feared the Independent Payment Advisory Board could be "target for attacks of the 'death panel' sort";[51] Newsweek quoted Peter Orszag of the administration as saying "I think it's only in Washington, D.C., that a board created to help address our long-term fiscal imbalance while boosting quality in health care and that is specifically by law prohibited from rationing care could be called a death panel".[52] An October 2010 National Right to Life article wrote the IPAB was "a good candidate for the title of 'death panel'",[53] and a December 2010 Wall Street Journal editorial associated 'death panels' with the IPAB.[54]

Sarah Palin wrote in a different Wall Street Journal commentary that the National Commission on Fiscal Responsibility and Reform "implicitly endorses the use of "death panel"-like rationing by way of the new Independent Payments Advisory Board." [55] Palin said that it would make bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare." [55] Factcheck.org called her description as being wrong on three counts:

  • the board doesn’t have the power to ration health care;
  • board members won’t be all "bureaucrats" (since the law requires that it include medical professionals, other health care providers, medical researchers, experts in health care finance and actuarial science, employers representatives, and the elderly; and
  • board members will not be the "ultimate arbiters," since Congress has the authority to change or block their recommendations, although special legislative procedures make it more difficult than usual for Congress to act.[56]

Reactions and analysis

Jill Lepore characterized 'death panels' as a reborn "conspiracy theory" that is believed by a minority of the U.S. population after Roe v. Wade and the Karen Ann Quinlan case—that the federal government is conspiring to kill off its weakest members. Of the reform effort, Lepore said it was an "unwelcome reminder of a dreaded truth: death comes to us all"; of the uproar, Lepore said it rallied a party base against death, making "for a creepy sort of populism. But if harnessing the fear of death for political gain is a grotesque tactic, it may also be a savvy one". Lepore noted that after the story spread, when Obama was left saying he was not in favor of death panels, it was an example of being "catastrophically outmaneuvered".[57]

James Morone said that despite Democrats denying the charge and focusing on the facts, the term played a role in their loss of control over the public debate because they did not address the "underlying fears of big government". Morone called the death panel arguments "pungent, memorable, simple, and effective".[58]

Gail Wilensky, a health adviser to President George H.W. Bush and John McCain who has overseen Medicare and Medicaid, said the charge was untrue and upsetting.[2][59] She said "[t]here are serious questions that are associated with policy aspects of the health care reform bills that we're seeing ... And there's frustration because so much of the discussion is around issues like the death panels and Zeke Emanuel that I think are red herrings at best".[59]

Physicians

Geriatric psychiatrist Paul Kettl wrote

I wish we had death panels. I don’t mean that I’m in favor of some appointed group of erudite experts gathering to decide who lives or dies in a process controlled by the government, but rather the death panels that were originally proposed. I’m in favor of periodic discussions about advance directives that Medicare would pay for as medical visits.[60]

Kettl said his experience in a geriatric unit showed end-of-life discussions and reimbursements were "desperately needed" as these hour long conversations are "ignored in the crush of medication and disease management".[60] Kettl noted that the attention-catching phrase death panels became "a lightning rod for objections to a series of ideas about health care besides" end-of-life discussions, and that somehow, "the concept of physicians being paid for time to talk with patients and their families about advance directives ... generated into the fear of decisions about life and death being controlled by the government".[60] Kettl wrote that

Emotions and health care go together. That makes them an easy and consistent target for the media and for grandstanding commentators. We can expect more good medical ideas to be destroyed by sound bytes and needless concerns that will be exaggerated. It makes for good television, but bad medicine.[60]

Dr. Benjamin W. Corn, a cancer specialist, said the death panels controversy showed Americans were uneasy discussing topics related to the dying process and he argued that certain issues, such as whether experimental therapies should be reimbursed, the possible expansion of hospices, restoring dignity to the process of dying, and guidelines for physician assisted suicide, need to be addressed directly.[25] Dr. David Casarett, a physician and bioethicist who focuses on the care of dying patients,[61] was mystified by the talk about death panels and pulling the plug on grandma. Casarett told NPR, "It bears really no resemblance to what's in the provision of the health-care reform bill."[62] Dr. Atul Gawande, a surgeon who writes about medical topics, told NPR that end of life conversations in the health reform bill "got mutated into" being described as death panels.[63] Dr. C. Porter Storey Jr. thinks the term represents "fear that there ... is not enough money to do everything for everybody and that some mechanical, governmental method will be used to determine how much of our scarce health care resources will be applied to their situation".[64]

Politicians

U.S. Senator Lisa Murkowski (Republican-Alaska) told a crowd in Anchorage in August 2009, "It does us no good to incite fear in people by saying that there's these end-of-life provisions, these death panels". She added, "There is no reason to gin up fear in the American public by saying things that are not included in the bill".[65]

In a July 2010 National Public Radio segment entitled "The Politics Of Anger", U.S. Representative Bob Inglis, (Republican-South Carolina) said, "I think it's never a good strategy to travel on misinformation. Talking about death panels when there are no death panels is a disservice to the country and, long-term, to the conservative movement."[66]

U.S. Representative Earl Blumenauer (Democrat-Oregon) thought the "'death panels' episode" showed that the news media amplified misinformation and extreme behavior instead of simply reporting the facts, contributing to the persistence of the falsehood.[67] The New York Times reported an email sent in November 2010 by Blumenauer to supporters of consultation payments for "end-of-life planning", warning them that "This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the 'death panel' myth... We would ask that you not broadcast this accomplishment out to any of your lists, even if they are 'supporters'— e-mails can too easily be forwarded".[36]

Palin's responses

In a September 2009 speech in Hong Kong, Palin said the term was "intended to sound a warning about the rationing that is sure to follow if big government tries to simultaneously increase health care coverage while also claiming to decrease costs".[68] In November 2009 Palin said that Obama was "incorrect" and "disingenuous" when he called the death panel charge "a lie, plain and simple".[69] In the National Review she said

[t]o me, while reading that section of the bill, it became so evident that there would be a panel of bureaucrats who would decide on levels of health care, decide on those who are worthy or not worthy of receiving some government-controlled coverage ... Since health care would have to be rationed if it were promised to everyone, it would therefore lead to harm for many individuals not able to receive the government care. That leads, of course, to death.[2][70]

She explained that the term should not be taken literally, likening it to when President Ronald Reagan called the Soviet Union, the "Evil Empire".[70] "He got his point across. He got people thinking and researching what he was talking about. It was quite effective. Same thing with the 'death panels.' I would characterize them like that again, in a heartbeat", she said.[70]

Nearly one year later, Palin implied that what she had predicted was now occurring, and defended her use of the term, saying, "I was about laughed out of town for bringing to light what I call death panels .... I called it like I saw it, and people didn't like it."[71]

Palin used the term in a joke while speaking at the 2009 Gridiron Club dinner, saying "It is good to be here and in front of this audience of leading journalists and intellectuals. Or, as I call it, a death panel."[72][73]

Impact

Political

After about a week after the coining of the term, consultation payments were removed from the Senate version of the bill by the Senate Finance Committee.[35] Additionally, a TIME article wrote that "a single phrase—'death panels'—nearly derailed health care reform".[74] Journalist Paul Waldman of left-leaning The American Prospect, said, "that whole death panel argument almost brought down the whole bill".[75]

Johnathan Oberlander, a professor of health policy, said "[t]he administration ... was seemingly unprepared for the intense opposition and fury that erupted during town-hall meetings in the summer of 2009. The Democrats' focus group–tested mantra of 'quality, affordable health care' was drowned out by Republicans' false warnings of 'death panels' and a 'government takeover'".[76][77] Morone said the White House was not able to offer a "persuasive narrative to counter the Tea Party percussion", and "struggled to recapture public attention", contributing to Scott Brown's election.[58]

By mid-August 2009, the Pew Research Center reported that 86% of Americans had heard of the "death panels" charge.[8] Out of those who had heard the charge, 30% of people thought it was true while 20% did not know.[8] For Republicans, 47% thought it was true while 23% did not know.[8] In September 2010, six months after the passage of the Affordable Care Act, a BBC article stated that among the "sticky charges" that had stuck against the bill was the false charge of "government 'death panels' deciding who can get what sort of care".[78]

Professional

In the wake of the 'death panel' controversy, Atul Gawande, a physician who writes on health care topics for The New Yorker, was asked to refrain from writing about palliative care by physicians who were concerned the article might be manipulated to create another political controversy—and as a result, hurt their profession.[79][80]

Bishop et al. were fearful of how their publication on CPR/DNR would be received by the medical and bioethics communities. They were concerned because in "the era of rhetoric centered on fictional 'death panels'" their paper addressed "the quest for immortality implicit in US culture, a culture of 'life-at-all costs' that medical technology has advanced". Bishop et al. interpreted cautioning comments from their peers as a suggestion "that land mines of 'death panels' await us".[81]

Lie and word of the year

PolitiFact.com gave Palin's term its highest rating—"Pants on Fire!"—on August 10[82] and on December 19 it was named "Lie of the Year" for 2009.[2][83][84] "Death panel" was named the most outrageous word of 2009 by the American Dialect Society.[85] The definition was given as "A supposed committee of doctors and/or bureaucrats who would decide which patients were allowed to receive treatment, ostensibly leaving the rest to die".[5][85]

Post-Summer 2009 uses of term

Arizona restrictions on Medicaid coverage

When it became known in 2010 that Arizona had passed legislation restricting Medicaid recipients access to funding for life saving transplant operations, some of which had already been approved. Some in the media were quick to label the politicians denying care "a death panel" pinning the blame on the Republican governor Jan Brewer and the state's legislature.[86] The legislation was in support of a budget that had been planned before the passing of the Affordable Care Act 2010.[87] Arizona is not the only State to have cut Medicaid coverage but none other had gone so far as cutting transplant access, which are considered optional under federal law.[88]

Other mentions

In October 2010, The Philadelphia Inquirer highlighted the term in its "The Week in Words" article[89] after Barney Frank said the only death panels created by congressional Democrats were for troubled financial institutions under the authority of the Dodd–Frank Bill.[90] In the same month, Palin defended using the term in its original context.[71]

In November 2010, Paul Krugman said that no death panels would be needed to control Medicare and Medicaid costs "through consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care".[91]

See also

References

  1. ^ Ezra Klein (August 10, 2009). "Is the Government Going to Euthanize your Grandmother? An Interview With Sen. Johnny Isakson". The Washington Post. Retrieved 12 November 2010.
  2. ^ a b c d "PolitiFact's Lie of the Year: 'Death panels'". Politifact.com. December 19, 2009. Retrieved November 19, 2010.
  3. ^ Palin, Sarah (December 22, 2009). "Midnight Votes, Backroom Deals, and a Death Panel". Facebook. Retrieved December 14, 2010.
  4. ^ For the purposes of its polling, the society defined a death panel as "a supposed committee of doctors and/or bureaucrats who would decide which patients were allowed to receive treatment, ostensibly leaving the rest to die".
  5. ^ a b "'Tweet' 2009 Word of the Year, 'Google' Word of the Decade, as voted by American Dialect Society" (PDF). American Dialect Society. January 8, 2010. Retrieved October 8, 2010.
  6. ^ a b Jim Rutenberg and Jackie Calmes (August 13, 2010). "False 'Death Panel' Rumor Has Some Familiar Roots". The New York Times.
  7. ^ Dwyer, Jim (August 25, 2009). "Distortions on Health Bill, Homegrown". The New York Times. Retrieved 21 November 2010.
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  11. ^ a b FactCheck.org, ‘Deadly Doctor’?
  12. ^ FactCheck.org False Euthanasia Claims
  13. ^ New York Post, Betsy McCaughey, Deadly Doctors
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  18. ^ a b ABC News, Jake Tapper, August 7, 2009, Palin Paints Picture of 'Obama Death Panel' Giving Thumbs Down to Trig Cite error: The named reference "ABCTapper" was defined multiple times with different content (see the help page).
  19. ^ The new York Times, August 25, 2009, Distortions on Health Bill, Homegrown
  20. ^ Ezekiel Emanuel, March 1997, The Atlantic, Who's Right to Die?
  21. ^ FactCheck.org, False Euthanasia Claims
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  36. ^ a b c Robert Pear (December 25, 2010). "Obama Returns to End-of-Life Plan That Caused Stir". The New York Times.
  37. ^ Robert Pear (January 4, 2011). "U.S. Alters Rule on Paying for End-of-Life Planning". The New York Times.
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  46. ^ Allen, Nick and Hough, Andrew, [ http://www.telegraph.co.uk/health/healthnews/7948878/US-breast-cancer-drug-decision-marks-start-of-death-panels.html US breast cancer drug decision 'marks start of death panels'], The Telegraph, January 9, 2011
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  48. ^ Roe, Rep. Phil, A board Congress should nail, Washington Times, July 23, 2010
  49. ^ Free cancer drugs scheme begins BBC Jan 20, 2009
  50. ^ a b Victory for cancer patients as NHS ban on 'top-up' drugs is lifted The Telegraph, Nov 4, 2008
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  55. ^ a b Palin, Sarah, Why I Support the Ryan Roadmap, Wall Street Journal, December 10, 2010
  56. ^ Let the distortions begin, Factcheck.org
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  61. ^ David Jonathan Casarett: Description of Bioethics Expertise University of Pennsylvania Center of Bioethics. Retrieved November 19, 2010.
  62. ^ "Doctor On End-Of-Life Care" (Interview). All Things Considered. August 18, 2009. NPR.
  63. ^ "Dr. Atul Gawande: Make End Of Life More Humane" (Interview). Fresh Air. NPR. July, 29 2010. Retrieved November 19, 2010. {{cite news}}: Check date values in: |date= (help)
  64. ^ Meier DE, Casarett DJ, von Gunten CF, Smith WJ, Storey CP (2010). "Palliative medicine: politics and policy". J Palliat Med. 13 (2): 141–6. doi:10.1089/jpm.2010.9852. PMID 20043709. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
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  91. ^ Paul Krugman (November 17, 2010). "Death Panels and Sales Taxes". The New York Times.
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