Sarah Palin and Other Republicans Spread False Claims Regarding “Death Panels” and Euthanasia

After the preceding two posts on misinformation being spread by the right with regards to health care reform we have a real whopper from Sarah Palin:

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.

The creation of a “death panel” is totally untrue. Steve Benen notes the irony in Sarah Palin making up a claim such as this after all her demands that journalists “quit making things up” about her. He also quotes Karen Tumulty:

Yes, such a system would indeed be downright evil. Which is why no one is proposing anything like it. Let’s repeat: No one is proposing anything like it.

There is a lot of similar disinformation being spread by the right by distorting items which are in the proposed bills. This includes scare tactics about end-of-life counseling sessions. PolitiFact sets them straight:

According to the bill, “such consultation shall include the following: An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to; an explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses; an explanation by the practitioner of the role and responsibilities of a health care proxy.”

Medicare will cover one session every five years, the legislation states. If a patient becomes very ill in the interim, Medicare will cover additional sessions.

Jon Keyserling, general counsel and vice president of public policy for the National Hospice and Palliative Care Organization, which supports the provision, said the bill doesn’t encourage seniors to end their lives, it just allows some important counseling for decisions that take time and consideration.

“These are very serious conversations,” he said. “It needs to be an informative conversation from the medical side and it needs to be thought about carefully by the patient and their families.”

In no way would these sessions be designed to encourage patients to end their lives, said Jim Dau, national spokeman for AARP, a group that represents people over 50 that has lobbied in support of the advanced planning provision.

McCaughey’s comments are “not just wrong, they are cruel,” said Dau. “We want to make sure people are making the right decision. If some one wants to take every life-saving measure, that’s their call. Others will decide it’s not worth going through this trauma just for themselves and their families, and that’s their decision, too.”

Both Keyserling and Dau were particularly troubled that McCaughey insisted — three times, to be exact — that the sessions would be mandatory, which they are not.

For his part, Keyserling said he and outside counsel read the language carefully to make sure that was not the case.

“Neither of us can come to the conclusion that it’s mandatory.” he said. “This new consultation is just like all in Medicare: it’s voluntary.”

“The only thing mandatory is that Medicare will have to pay for the counseling,” said Dau.

Factcheck.org has also debunked conservative claims that the proposed bill will include forced euthanasia. Here is a small portion:

The accepted definition of end-of-life planning means thinking ahead about the care you would like to receive at the end of your life – which may include the choice to reject extraordinary measures of life support, or the choice to embrace them. For instance, the National Library of Medicine describes end-of-life services as “services [that] are available to help patients and their families deal with issues surrounding death.” This can include making decisions about treatment, designating a health care proxy, choosing a hospice program and putting together a living will, all of which the bill mentions explicitly as being part of an advance care planning consultation. In a 2003 study, the Agency for Healthcare Research and Quality found that “[p]atients who talked with their families or physicians about their preferences for end-of-life care had less fear and anxiety, felt they had more ability to influence and direct their medical care, believed that their physicians had a better understanding of their wishes, and indicated a greater understanding and comfort level than they had before the discussion.”

Furthermore, the bill would not make these sessions mandatory. It modifies section 1861(s)(2) of the Social Security Act, defining what services Medicare will pay for – if these definitions made treatments mandatory, seniors would all be required to get artificial legs and midwife services, too. In other words, this section of H.R. 3200 would require Medicare to pay doctors when they counsel their patients about such things as living wills, but no more frequently than once every five years, unless there’s a significant change in health status. “Both myself and our outside counsel have reviewed section 1233 of the House bill, and neither one of us can reach the conclusion that it is a mandatory consultation for Medicare and Medicaid beneficiaries,” Jon Keyserling, vice president of public policy at the National Hospice and Palliative Care Organization, told us. “The opportunity for the consultation is not only voluntary but patient-initiated.”

“As I understand it, the intent of the provision is to have patients be provided an opportunity to discuss with their own health care professional, probably the one they have been seeing for the past many years, what their treatment wishes might be as they approach the end of life,” said Keyserling, who stressed that consultations like this are treatment-neutral. Comparing this to forced euthanasia is like saying that a bill making retirement planning easier would force Americans to quit their jobs.

I can attest to the value to patients of open discussion of end of life issues. This comes both from experience with my patients and now to an even greater degree after seeing how my father handled this situation, having decided to discontinue life support eight days ago.

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30 Comments

  1. 1
    Pug says:

    The right has carried on for 40 years about hysterical anti-war demonstrators calling American troops “baby killers”.

    Well…who is screaming “baby killer” now? Hysterical “mainstream” Republicans.

  2. 2
    Eric Dondero says:

    I am Pro-Choice, and an actual supporter of Euthanasia (so long as it’s voluntary and non-government funded.)

    What Palin says here is entirely correct. Obama’s Health Care plan does call for an “Oregon style,” Death Panel to be set up, to decide who gets to live, and who will die.

    Just this week we learned of the Oregon case, of the guy who had cancer of the liver (I believe?), and was urged by the State of Oregon to choose the Hospice option, rather than the expensive – $600,000 – Chemotherapy treatments.

    If that’s not the definition of a Death Panel, than I don’t know what is. And I say this as someone who is on the Pro-Choice side of the issue.

  3. 3
    Ron Chusid says:

    No Eric, you have the facts totally wrong. See the two Fact Check articles, or simply read the actual legislation. Of course you have never let the facts come in the way of your claims.

  4. 4
    Nancy says:

    People, we can no longer afford to stand by and do nothing! The only way to get solid health care/health insurance reform is to continue to push for it – and not let up! To this end, I have set up a petition to have paid health care removed from our representatives in Congress until such time as they reform health care – to include a strong public option – for ‘we the people’ who they are supposed to represent.

    If you agree with what I am doing – I am going to ask you to do what I have been asking others to do…sign it, then spread the word to anyone and everyone you know!

    I am but one person – and cannot make a difference on my own…but there is strength in numbers and, if we work together, with assistance and determination, all things are possible! Please do what you can to help us further the cause of health care with a strong public option! Thank you!

    http://www.petitiononline.com/PubOp676/petition.html

  5. 5
    Eric Dondero says:

    Agreed Nancy, we need solid Health Care Reform Now! As in get the government completley out of the health care businss altogether.

    Phase out of Medicare and Medicaid should begin as soon as possible. Urge these patients to seek private alternatives.

    Repeal the idiotic Bush-backed program of Prescription Drug Benefits.

    Immediately cease and desist of any and all proposals to nationalize health care and use a failed Canadian or British style health care.

    Let Free Enterprise run health care, completely! Get the government the hell out of it.

    As a first step, at the very least, allow Americans to have Health Savings Account, and completely opt out of Medicare and Medicaid programs for good.

  6. 6
    Eric Dondero says:

    Question for ya Ron,

    Obama’s health care will be mandatory. Meaning you will not be able to choose to opt out of the system. Presumably this also means you will not be permitted to choose to obtain your health care in Mexico, of the Caribbean or somewhere’s else overseas.

    Would you support jail time or heavy fines for those of us who protest against Obama Care, and publicly state that we do not wish to participate in any manner, shape or form?

    Additionally, do you think it’s proper to send individuals who protest the Obama Care to “camps,” presumably to be “re-educated” to accept socialist principles?

  7. 7
    Sam says:

    Have you read Ann Althouse’s take on this issue?  She states,

    Yes, she used a colorful expression “death panel,” but it’s a good and fair polemical expression if in fact life-saving care will be rationed on this basis. I have found myself saying, in conversation, “I’m afraid Obama is going to kill me.” Now, I’m not picturing him or one of his minions coming over to murder me, but I am afraid that as I get older and need expensive care to keep me alive that I will be told I cannot have it, because at my age, in the government’s opinion, there’s not enough life left in me to be worth the money that I would take from the system that needs to pay for everything.

    William A. Jacobson also notes that Dr. Ezekial Emanuel (brother of Chief of Staff Rahm Emanuel  and Obama health care adviser) has written

    A young person with a poor prognosis has had a few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern the disproportionately large amounts of resources will be directed to young people with poor prognoses. When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable….

    It seems to me that Palin’s fears, while overstated and in overwrought language, are actually sound.

  8. 8
    Ron Chusid says:

    Sam,

    No, cherry picking quotations out of context does not make an irrational argument sound. What matters is what is being proposed.

  9. 9
    Pug says:

    The right has dragged any actual discussion of health care reform into the gutter with tactics like disrupting meetings and hurling incendiary rhetoric about “death panels” around. They have made it clear they don’t deserve to be part of the process. At this point, they are out of power and not even worth talking to anymore.

    The Democrats need to pass health care reform without them. The Republicans lost big in the last two elections and what is being proposed is nothing radical. Republicans, if they had 60 votes in the Senate, the White House and a big majority in the House, would ram through whatever they wanted. Democrats need to agree on a plan and pass it.

  10. 10
    Fritz says:

    Or maybe they are just looking a bit further down the road.  This is one battle in a fight to standardize the parameters for obtaining medical care.  It’s clear that the gross demand for health services, unfettered  by “can you pay for this” grossly exceeds the assets that can be devoted to medical care.   Eventually decisions will have to be made on the allocation of scarce resources, and since “ability to pay” will not be allowed as a factor, something else will be put in place.  I think “social utility” will likely beat out “lottery number”.

  11. 11
    Ron Chusid says:

    Fritz,

    They may be looking down the road, but what may or may not happen in the future is a different topic than what is actually contained in the current health care bill.

    If anything, the GOP opposition to sensible reform makes it more likely that such restrictions will be necessary in the future. The bill contains sensible and voluntary measures to reduce costs by simply discussing these issues with patients and families. It is far better to try to save money this way in the hopes of avoiding more undesirable solutions in the future.

  12. 12
    Fritz says:

    Ron, we’ve disagreed on this before.  I think it is completely appropriate to discuss where the proposals are taking us, and not just the specific language in this bill. 

    Again — if (and this is a major goal of reform) “ability to pay” is removed as the constriction point of access to health care then something will take its place, since “demand for health care” is huge.  I read that a French study put the demand for health care at significantly greater than the GDP.  So it’s not like Republicans or Libertarians or any other group will “force” resrictions by not getting on board the happy reform bus. 

  13. 13
    Ron Chusid says:

    Fritz,

    But it makes no sense to say that the proposal is taking us anywhere that is not contained in the bill. If anything avoiding sensible solutions just exacerbates the problem and makes the types of scare stories being promoted by Republicans more likely to occur if health care reform is not passed.

    If it is appropriate to take things out of the air which are not in a proposal it makes it quite easy to invent reasons to oppose any bill by inventing horror stories. The bill must be judged based upon what it does call for, not by simply making things up as the Republicans are doing.

    Was the French study from a credible source or just another source for right wing talking points?

  14. 14
    Ron Chusid says:

    Eric,

    First of all, it is not Obama’s plan which is mandatory. Obama opposed mandates. Unfortunately both many Democrats and the insurance companies (which means the Republicans in their pocket will go along) pushed for the mandates.

    The mandates to be covered do not in any way prevent someone from having treatment in Mexico or the Caribbean if this is what they wanted.

    There is not going to be jail time or re-education camps of any kind.

    It is also ridiculous to speak of socialist principles here. The plans strengthen private insurance coverage and will increase the number of people who have private insurance. The plans preserve the private practice of medicine. You might object to the plans, but they have nothing to do with socialism.

  15. 15
    Ron Chusid says:

    Eric,

    “Phase out of Medicare and Medicaid should begin as soon as possible. Urge these patients to seek private alternatives.”

    Sure, deny seniors and the disabled benefits which they have been paying for when working. (In a sense I do agree with eliminating Medicaid. Medicaid beneficiaries should be transferred to the public plan if it manages to survive in Congress.)

    Seek private alternatives? Medicare was established because of the lack of viable private alternatives. Bush tried to channel Medicare beneficiaries into private plans but it wound up costing 13% to 19% more to care for the patients in private plans as compared to the government plan.

    The individual insurance market in this country is collapsing. People in their 40’s or people with chronic medical problems already have a very hard time obtaining insurance coverage. The free market is unable to handle problems such as this, especially with the elderly, which is why every industrialized country in the world relies upon government for this.

    People can already establish tax advantaged health savings accounts. This is no replacement for insurance.

  16. 16
    Mike Licht says:

    In 2003, under G.W. Bush, the federal Agency for Healthcare Research and Quality published a report recommending Advance Care Planning, with detailed guidelines for practitioners. Nobody called that euthanasia.
    Advance Care Planning is legal in almost every state; the bill in question merely allows health care providers to be paid by Medicare for counseling patients on this matter, should the patient request this service – it would not be mandatory.
    See:
    http://notionscapital.wordpress.com/2009/08/07/obama-wants-to-kill-your-grandma/

  17. 17
    Fritz says:

    Ron, amusingly I am discussing this with a very liberal friend on Facebook.  He maintains that Medicare was never even disguised as an insurance plan and has always been billed as “pay as you go”.  Which I doubt, but if he is correct, today’s seniors were not being told they were paying for their own future health care through the Medicare tax so they shouldn’t expect Medicare now.

    Sort of an interesting whipsaw.

    As to the French study, I believe it was the French government.  I don’t doubt it.  If you asked people what health things they would like and told them not to worry about costs since it would be free to them, I can completely believe he costs exceeding GDP.  Hell, dental work alone…  And therapeutic massage.   And lasik.   

  18. 18
    Ron Chusid says:

    Fritz,

    Just try telling seniors who have paid Medicare payroll taxes their entire lives with the expectation of coverage that they shouldn’t expect Medicare now.  🙂

  19. 19
    Leslie Parsley says:

    You have that right, Ron. If someone tried to take away my Medicare, I’d turn into a banshee unlike none other.  I’ve earned every penny and I’m not too keen on becoming a street person.  Duck, Fritz.

  20. 20
    Fritz says:

    Which is why people are fighting tooth and nail against government healthcare being expanded.  Because once the government gets in, it will take an economic singularity to get back out.

  21. 21
    Eclectic Radical says:

    “Eventually decisions will have to be made on the allocation of scarce resources, and since “ability to pay” will not be allowed as a factor, something else will be put in place.  I think “social utility” will likely beat out “lottery number”.”
     
    Fritz, I’ve mentioned this before, but I do have to mention it again, broken record or not. Have you read CPR?
     
    The only health reform bill which would enact ‘rationing’ of care of any kind is one written by a conservative Republican.
     
    Now one can oppose Medicare on principle all they want… but what Judd Gregg is talking about is ‘rationing care’ for senior citizens based on ‘social utility’ on the premise that ‘social utility’ is served by getting them into the private insurance market.
     
    Considering this fact, that Republicans are actually the ones advocating the rationing of health care for senior citizens based on their own definition of ‘social utility’, it’s very disingenuous to take the claim that the GOP is being far-sighted in efforts to prevent it. They are the only people, anywhere in America, who are for it.
     
    CPR should practically be required reading for everyone who wants to take part in this debate. It shows just how completely bent the views of the right are on this issue. In order to prevent the rationing of care for American seniors based on ‘social utility’, they want to ration care for American seniors based on ‘social utility.’

  22. 22
    Fritz says:

    Eclectic, I’m not talking about what is in bills here.  I’m talking about the reality of demand outstripping supply when ability to pay is not allowed to play a part.
     
    Are you faulting the GOP for actually talking about economic reality?  That is atypical for you.

  23. 23
    barricade says:

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  24. 24
    barricade says:

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  25. 25
    Ron Chusid says:

    Fritz,

    But the topic here is how the Republicans are distorting the bill. Republicans aren’t simply talking about “economic reality.” The objection is to the Republicans outright lying about how health care reform would impact such issues and falsely claiming that this is a reason to oppose health care reform.

    As I previously noted, someone who is sincerely concerned about this (as opposed to the Republicans who are using it to distort the issue) should support rather than oppose the voluntary discussion of end of life issues contained in the House bill.

  26. 26
    Eclectic Radical says:

    The GOP is not talking about economic reality, if they were they would understand that the private insurance market is far less able to serve seniors’ medical needa than the government. They would not be claiming that the private market would be better for the people they wish to ration out of Medicare.
     
    In my opinion, the economic reality is fairly straightforward. American business cannot afford to keep subsidizing the bulk of American health care, and the people currently paying for their insurance through payroll deductions would be equally able to pay for national health care on the same basis through dedicated taxation. The cost sharing would be redirected into one pool rather than multiple pools, which would lower the premium rate per customer. American business would be freed of the de facto tax burden providing health care for their employees creates. This would decrease operating costs and allow for increased investment in productivity, without having to outsource to achieve the same results.
     
    That’s a signficant economic investment right there, and it’s better for everyone involved. Working Americans pay directly for their own health care out of their payroll taxes, as those with health insurance at work do now, but everyone who works would have access and the increasted cost sharing efficiency would lower costs. Business would be freed of an immense fiscal burden and would be able to compete freely for employees on a straight up basis of wages, vacations, and incentives… much more affordably.
     
    As for demand outstripping supply… we’re already dealing with this problem in the form of overcrowded emergency rooms. I don’t see a massive increase in the demand. There are currently rural clinics in my area operating below capacity because people know they would have to pay at point of service and so go to the hospital emergency room instead. If they were able to pay at point of service, the strain on emergency rooms would be decreased and the clinics would not be overstrained. I know it is much the same in urban areas from my experience in Los Angeles (can’t get much more urban than that) where emergency rooms are overburdened and urgent care clinics are underburdened because ‘urgent care’ clinics demand payment at point of service.
     
    If people who needed the emergency room went to the emergency room, people who needed ‘urgent care’ went to the clinic, and people who needed routine medical service called their doctor, the burden would be distributed more evenly and realistically. That is economic reality.
     
    I understand that nightmare scenarios are extremely entertaining to listen to, but we are actually experiencing the nightmare scenario now. The supply-exceeding-demand problem is happening in emergency rooms every day. It’s one of the reasons we need health care reform.
     
    Thoughtfully addressing the problem is how we reduce that burden.
     
     
     

  27. 28
    Fritz says:

    Eclectic — we are certainly in agreement that ER’s are the place you can get health care and ability to pay is not dealt with and demand outstrips supply and the gating factor is “how long can you wait”.  I am not convinced that extending the “ability to pay is not dealt with” model to more venues will ease demand.  I guess we will see.
     
    Ron, I absolutely believe that end of life issues should be discussed openly.  I just want through all of that with my mother before she died in February.  She had been openly talking about wanting the services of Dr. Kevorkian for two years.  When hospice care was finally provided, it made the ramainder of her life much more comfortable.

  28. 29
    Ron Chusid says:

    ER’s are not necessarily places where you can get health care and ability to pay is not dealt with. ER’s will still send bills for the uninsured, which may or may not get paid. ER’s also vary in how much they will do for someone who cannot pay. They might provide MediCenter type care and not be concerned about pay while in ER, or an ER might make sure someone has no life threatening problems and then send them on their way.

    It will help demand in the ER if people have coverage and a primary care physician where they can go instead. Having near universal coverage won’t eliminate improper use of ER’s but will greatly reduce it. Many insurance plans also take additional steps to reduce inappropriate use such as higher copays for ER visits or requiring approval to go from the primary care physician.

  29. 30
    Fritz says:

    MSFT has a really cool program — an 800 number for a consult and they will send a doctor out on weekends and evenings when your PCP office is likely closed.  Even that is cheaper for the company than getting billed for an ER visit.

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