Death Panels? Sarah Palin Was Right

PolitiFact.com gave Sarah Palin their “Lie of the Year” award for warning on August 7 that the Democrat’s idea of “cost containment” implied rationing by “death panels.”

The self-described fact-checking web site of the St. Petersburg Times claimed Palin was criticizing a provision in the House bill under which “Medicare would pay for doctors' appointments for patients to discuss living wills, health care directives and other end-of-life issues.”

The claim that Governor Palin confused one-on-one counseling between doctors and patients with any sort of “panel” was always ridiculous on its face.  Indeed, that claim should itself have been a leading candidate for “Lie of the Year.” Yet Palin’s critics kept on equating death panels with counseling throughout the year, as though they could not even begin to understand plain English.

In a column called “Reporting the Lies,” Washington Post blogger Ezra Klein wrote, “Before Sarah Palin talked about death panels, no one knew about Sen. Johnny Isakson's quiet crusade to persuade Medicare beneficiaries to adopt living wills."

Adopting a living will requires a lawyer, not a doctor, so there must have been more to the crusade than just that. There is some reason to wonder if the crusaders intended to promote penny-pinching advice like President Obama’s famous suggestion that perhaps grandma should skip the expensive operation and take a cheap pain pill instead (generic, of course).

In any case, no single physician's advice involves any panel, deathly or otherwise. Palin was clearly worried about rationing by some government-appointed group, panel or board of experts -- such the (currently) powerless panel that recently suggested fewer and later breast exams, or the Senate bill’s potentially more lethal Independent Payment Advisory Board

The shameless hoax that Palin had confused individual consulting with rationing by a panel was repeated endlessly.  By November, the Washington Post was treating this obvious canard as a established fact:  “Proposed health-care reform legislation includes a provision that allows Medicare to pay for "end-of-life" counseling for seniors and their families who request it. The provision -- which Sarah Palin erroneously described as "death panels" for seniors -- nearly derailed President Obama's health-care initiative.”

What Palin wrote about death panels clearly had nothing to do with counseling or with any other specifics in seminal House bill. What she wrote was: “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.”

How could anyone believe Palin’s sensible comment about rationing was, in reality, a senseless fear of counseling? To say so was no mistake; it was an oft-repeated big lie.

Rather than even mentioning the House bill, Palin linked to an interesting speech by “Rep. Michele Bachmann [which] highlighted the Orwellian thinking of the president’s health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff.”

Dr. Emmanuel’s varied and murky remarks about using panels of experts (like himself) to ration health care are less clear or less candid than those of another bioethicist, Peter Singer of Princeton. Singer's article, “Why We Must Ration Health Care," was a cover feature in The New York Times Magazine on July 15 -- shortly before Palin took the opposing side of this issue.

Singer’s argument (about an expensive anti-cancer drug) is that, “If there is any point at which you say, 'No, an extra six months [of life] isn’t worth that much,' then you think that health care should be rationed.” But the question itself is rhetorical trickery, sophistry. Even if there was certain knowledge about life expectancy with or without some treatment (which is never true), Singer has no right to any opinion about how much an extra six months of my life is worth (and vice-versa) unless he’s paying the bills.

But that, of course, is what makes the proposed expansion of  insurance subsidies and Medicaid so ominous.  Just as federal politicians imagine that a small minority stake in some bank entitles them to override all other stockholders when it comes to executive pay, federal politicians would surely claim that even small subsidies for anyone’s health insurance entitle them to, as Singer put it, set “limits on which treatments should be paid for.” And those politicians would surely appoint panels of experts as cover when some life-saving procedure, device or drug was ruled-out for those with insufficient quality-adjusted years left to live.

Singer wrote, quite correctly, that in “Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits. . . [and] low payments to doctors that discourage some from serving public patients.” [emphasis added]

Pending health care bills would make such government-mandated scarcity of health care much worse.  There would be massive shifting of money away from Medicare toward Medicaid.  But the extra Medicaid money would be spread around more thinly.  States would cut benefits to the poor in order to accommodate millions of new, less-poor people lured into Medicaid, at least half of whom (7 or 8  million by my estimate) currently have employer-provided health insurance.

The Senate health bill supposedly intends to slash Medicare payment rates for physicians by 21% next year and more in future years, with permanent reductions in payments to other medical services too.  It would also establish an Independent Payment Advisory Board which would be empowered to make deeper cuts which Congress could reject only with considerable difficulty.   If that’s not quite a “death panel” it would surely not be pro-life in its impact.

The Congressional Budget Office says, “It is unclear whether such a reduction in the growth rate could be achieved, and if so, whether it would . . .  reduce access to care or diminish the quality of care."

Actually, it's clear enough that the proposed Medicare cuts won't be achieved, but that efforts in that direction will nonetheless reduce access to care and diminish its quality.  The government can't boost demand and cut prices without creating excess demand.  And that, in turn, means rationing by longer waiting lines and by panels (rationing boards) making life-or death decisions for other people.

As Sarah Palin predicted, “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.”