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Sarah Palin and Death Panels: A Brief History

5:03 PM, Dec 23, 2009 • By JOHN MCCORMACK
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The Washington Independent's David Weigel writes:

There is a right way to cover Sarah Palin and her PR strategy. Greg Sargent, Ben Smith and Matt Gertz double-check Palin's claim (made on Facebook) that her infamous "death panel" post was a "metaphor" for how health care would be denied to the old or infirm. In the original post, it was pretty clear that Palin was talking about end-of-life counseling, not rationing.

Let's take a look at what Palin actually wrote in her original August 7 post:

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.

It is perfectly clear that Palin is talking about rationing in general. She specifically made the argument that the government's refusing to pay the cost of health care will lead to rationing care, and she also wrote that her "baby with Down Syndrome" could be affected by such rationing. How would "end-of-life counseling" for the elderly cause the death of a disabled baby?As Ben Smith notes, Palin's spokesperson did cite the end-of-life counseling provision as a specific example of rationing in the bill. But that was just one example, which, Palin argued could put pressure on the elderly.

Obama himself acknowledged at an August 11 townhall that the "underlying argument" made by Palin was that his health care bill would "mean rationing of care":

The rumor that's been circulating a lot lately is this idea that somehow the House of Representatives voted for "death panels" that will basically pull the plug on grandma because we've decided that we don't -- it's too expensive to let her live anymore. (Laughter.) And there are various -- there are some variations on this theme.

It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, et cetera. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they're ready, on their own terms. It wasn't forcing anybody to do anything. This is I guess where the rumor came from. [...]

Now, in fairness, the underlying argument I think has to be addressed, and that is people's concern that if we are reforming the health care system to make it more efficient, which I think we have to do, the concern is that somehow that will mean rationing of care, right? -- that somehow some government bureaucrat out there will be saying, well, you can't have this test or you can't have this procedure because some bean-counter decides that this is not a good way to use our health care dollars. And this is a legitimate concern, so I just want to address this.

We do think that systems like Medicare are very inefficient right now, but it has nothing to do at the moment with issues of benefits. The inefficiencies all come from things like paying $177 billion to insurance companies in subsidies for something called Medicare Advantage that is not competitively bid, so insurance companies basically get a $177 billion of taxpayer money to provide services that Medicare already provides. And it's no better -- it doesn't result in better health care for seniors. [...]

So I just want to be very clear about this. I recognize there is an underlying fear here that people somehow won't get the care they need. You will have not only the care you need, but also the care that right now is being denied to you [by insurance companies] -- only if we get health care reform. That's what we're fighting for.

If Obama recognized Palin was talking about rationing of care, why can't Politifact and other journalists understand that as well? On August 12, Palin responded to Obama and made an argument that the end-of-life counseling provisions could sway the decisions of the elderly. She quoted Charles Lane, who wrote: "So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would 'place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,' I don't think he's being realistic." Feel free to disagree with that argument, but it's not a lie.

It may have been a mistake to emphasize this one provision too much. There were other provisions--like the unelected Medicare cutting panel--that would more clearly cause rationing. And most important is the broader argument that Obama's big-government program cannot add 30 million people to the health care system and slash hundreds of billions of dollars from Medicare without causing rationing of care. Obamacare will put stress on the health care system, which will lead to delayed care.

Delayed care is denied care, and denied care will cause deaths. Conservatives have made this argument throughout the debate on Obamacare (for example, see Matthew Continetti and Ramesh Ponnuru). Tom Coburn addressed rationing in Obamacare in his recent Wall Street Journal op-ed.

And let's not forget that, in an April New York Times interview, it was Obama himself who raised the specter of rationing for the chronically ill and the dying in order to contain costs:

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here. ...

Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place.