Sarah Palin's "Death Panel" Lies
JUST LAW AND RELIGION
The devil may be the father of lies, but the "death panel" deception has Sarah Palin for a nursemaid.
Instead of engaging in honest and rigorous debate about the thicket of economic and policy issues related to health-care reform, the conversation has been stuck on so-called death panels and the fear of government bureaucrats saving money by letting grandma die. There are too many legitimate concerns about reform proposals floating around to let Palin's blatant falsehoods mire down the conversation. They should be condemned universally.
Palin poured fuel on the reform opponents' fire last week by saying, "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."
Death panels? Read the proposed legislation. There is nothing remotely resembling such a sinister control of human life. At issue is a provision tucked into one of the versions of reform legislation--Sec. 1233 Advance Care Planning Consultation--that would provide funds to physicians or other health care providers to help counsel patients on end of life planning issues such as how to create a living will or advanced directive.
How did this innocuous and humane provision generate such grist for the mill of reform opponents? Palin's Facebook note approvingly cited Rep. Michelle Bachmann's (R-MN) late July floor speech in which Bachmann warned of the eugenicist dangers supposedly posed by the President's advisers like Dr. Ezekiel Emanuel. Bachmann's speech was closely linked to a July 24 op-ed written by Betsy McCaughey, the former lieutenant governor of New York, who argued that underlying the cost-cutting in health care, particularly in Medicare, was Obama's goal of slimming down health care for seniors. The reformist programs of Obama's advisers can be boiled down to "Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy."
Just yesterday, even Sen. Chuck Grassley (R-IA) jumped on the bandwagon and warned a crowd of 300 that "in the House bill, there is counseling for end of life...You have every right to fear. You shouldn't have counseling at the end of life, you should have done that 20 years before. Should not have a government-run plan to decide when to pull the plug on grandma."
President Obama finally called out these lies for what they are in Wednesday's New Hampshire town hall, and made clear the intention of the provision in the draft bill at issue was intended to empower patients: "The -- 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...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."
Palin responded Thursday, citing the President's statement, and standing firm that the provision is not voluntary: "With all due respect, it's misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context."
The concern Palin cites is that Sec. 1233 "authorizes advanced care planning consultations for senior citizens on Medicare every five years," as well as provides patients with the option of more frequent consultations "if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program."
For Palin, these "more frequent" consultations at death's door, as "part of a bill whose stated purpose is 'to reduce the growth in health care spending,'" may be reasonably viewed "as attempts to convince [seniors] to help reduce health care costs by accepting minimal end-of-life care."
Interestingly, Palin's "response" to Obama contains little trace of the inflammatory rhetoric about "death panels." Her original post boldly scared people into thinking that Obama's minions would explicitly cut off funding, without input from the patient's. Yet in her follow-up, she coyly shifts the focus; she is now concerned that the consultation will shame grandma into rejecting robust end of life health care and just pass away peacefully to save the Feds some dough. That's a long way from cold-hearted, bureaucratic dispensers of death.
Of course, lost in this flurry of deceptiveness is a basic fact that the legislation is trying to address--patient choices about what care they want at the end of life are often inadequately known or implemented. A report by the Agency for Healthcare Research and Quality (part of Health and Human Services) offers a chilling assessment of the current problems with advanced planning and the negative impact this has on whether or not patient wishes are followed:
- Less than 50 percent of the severely or terminally ill patients studied had an advance directive in their medical record.
- Only 12 percent of patients with an advance directive had received input from their physician in its development.
- Between 65 and 76 percent of physicians whose patients had an advance directive were not aware that it existed.
- Advance directives helped make end-of-life decisions in less than half of the cases where a directive existed.
- Advance directives usually were not applicable until the patient became incapacitated and "absolutely, hopelessly ill."
- Providers and patient surrogates had difficulty knowing when to stop treatment and often waited until the patient had crossed a threshold over to actively dying before the advance directive was invoked.
- Language in advance directives was usually too nonspecific and general to provide clear instruction.
- Surrogates named in the advance directive often were not present to make decisions or were too emotionally overwrought to offer guidance.
Instead of scare-mongering and lying about funding advanced care planning for Medicare recipients, perhaps those like Palin who claim to be so concerned about patient autonomy might devote themselves to helping make sure these statistics improve greatly.
Then grandmas and grandpas across the land could determine whether or not hospice or experimental treatment makes sense for them, if they are ever unfortunate enough to have to make that decision. Then, we could go back to a real debate about real issues, such as how best to pay for this bold plan to provide health care for everyone.
Dr. Michael Kessler is Assistant Director of the Berkley Center for Religion, Peace, and World Affairs and Visiting Assistant Professor of Government at Georgetown University.
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