Palin's charge was preceded by similar distorting and incorrect claims from other opponents to the proposed health care reform, such as Betsy McCaughey, John Boehner and Michele Bachmann. While the preceding statements garnered some media coverage, Palin's charge created a media frenzy. Although the charge was debunked in newspapers, on television, by fact-checking organizations, and by some Republicans, other Republicans supported Palin's charge and a minority of Americans thought Palin's charge was true.
Politically, the phrase was used to rally opposition to the Obama administration health care reform, with conservatives using the charge at boisterous August 2009 town hall meetings. The uproar that the phrase produced was described by TIME Magazine and The Washington Post as almost taking down President Obama's health care reform. PolitiFact.com called "death panels" the "Lie of the Year". FactCheck.org referred to it as one of their "whoppers" of 2009, and the American Dialect Society said that "death panel" was their "most outrageous" word for 2009. The trigger for the debunked charge was a provision in the House of Representatives Bill 3200 of 2009 that would have reimbursed physicians for counseling Medicare patients about living wills, advance directives and other end-of-life issues.
In January 2011, the American Society of Clinical Oncology published a statement saying that the issue of funding discussions with patients had been "unfortunately politicized". They said that health care in the United States currently pays doctors well to treat paitents with chemotherapy and other medical technologies—unlike the payments for "conversations that are critical to establishing a patient's goals and preferences". Paying health care providers "for delivering this important aspect of cancer care ... [have] at their core a critical patient-centered societal interest and should be revisited".
, who cited McCaughey]] On July 24, McCaughey had an opinion piece published by The New York Post which falsely claimed presidential advisor Ezekiel Emanuel thought that the disabled should not be entitled to medical care, which was a precursor to Palin's eventual claim. The piece distorted the meanings of Emanuel's publications on medical ethics. On July 27, the article was partially read by Rep. Michele Bachmann (Republican-Minnesota) on the floor of the House of Representatives. Palin, when she later coined the phrase, based her post off of Bachmann's speech and cited her.
Representative John Boehner (Republican-Ohio), then the Minority Leader of the U.S. House of Representatives, was a leader in the spreading of unsubstantiated claims that Section 1233 would encourage euthanasia. Along with Representative and Republican Policy Committee Chairman Thaddeus McCotter (Michigan), Boehner stated in a July 23 statement that the provision "may start us down a treacherous path toward government-encouraged euthanasia". FactCheck.org referred to this as "a stretch" and Representative Earl Blumenauer (Democrat-Oregon) took issue with the claim. On July 28, on the House floor, Representative Virginia Foxx (Republican-North Carolina) said a Republican alternative to the Democratic reform proposals was "pro-life because it will not put seniors in a position of being put to death by their government". But no legislation existed to match Foxx's charge. On July 30, Newt Gingrich, who has praised the Gundersen Lutheran Medical Center for its end-of-life practices, told reporters after a speech at Gunderson Lutheran that the House bill had "a bias toward euthanasia for senior citizens and other people". Gundersen officials were dismayed after Gingrich was critical of Section 1233, which Gundersen helped craft, as Gingrich was satisfied with the end-of-life care his father-in-law received there.
The Washington Post noted on August 1 that
supported Palin on ABC]] According to the BBC, conservative blogger Michelle Malkin "explicitly" agreed with Palin's statement that death panels were mandated in Obama's proposed legislation. Former House speaker Newt Gingrich backed Palin during his August 9, 2009 appearance on This Week with George Stephanopoulos. He remarked that "the bill's 1000 pages" and "it has all sorts of panels". "You're asking us to trust turning power over to the government, when there clearly are people in America who believe in establishing euthanasia, including selective standards", he said. Health economist Uwe Reinhardt responded Gingrich should clarify that the health care bill's provision for reimbursing physicians for counseling on advanced directives was far removed from 'death panels' or an intent to shorten life, noting that Gingrich had previously supported the expanded use of advance directives.
At an August 12 town hall meeting, Republican Senator Chuck Grassley, said people
On August 12, Palin posted another note on her Facebook standing by her earlier claim and charging that "the elderly and ailing would be coerced into accepting minimal end-of-life care to reduce health care costs". Palin also wrote that it was misleading for Obama to say the sessions would be entirely voluntary. PolitiFact.com responded that Palin's assertion was false and that the sessions were voluntary.
, sponsor of a similar provision]] The provision was inserted in the bill by Democratic lawmakers at the behest of La Crosse Wisconsin hospitals, including Gundersen Lutheran, that 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. Before H.R. 3200, Representative Earl Blumenauer (Democrat-Oregon) had submitted single purpose legislation in April 2009 with Republican cosponsors—Charles Boustany (Louisiana), a cardiovascular surgeon, Patrick Tiberi (Ohio), and Geoff Davis (Kentucky)—that similarly provided for Medicare payments to doctors for end-of-life counseling with patients. In 1991 the Patient Self-Determination Act was enacted which required health care providers, including hospitals, hospices, and nursing homes to provide information about advance directives to admitted patients.
Consultation payments were removed from the Senate version of the bill while remaining in the House version until November 2009, when they passed, but they did not pass in the final bill. In late December 2010, a new Medicare regulation was reported that would consultations during annual "wellness visits," instead of at 5 year intervals as the bill originally mandated, effective January 1st. Instead, on January 4, the consultations were reported to be removed from the regulations.
Historian Ian Dowbiggin, who has published books on medical history, euthanasia and eugenics, said "the phrase invokes images of Nazi Germany" and was "an issue that's being exploited by political figures" opposed to the health care reform who are "trying to sensationalize the issue as much as possible to drum up opposition". Health economist Uwe Reinhardt said that it is possible to slightly bend the U.S. health care cost curve down through a lower volume of health care services "by more widespread use of living wills—an idea once actively promoted by Newt Gingrich. But those ideas were met in the past year by dark allusions to 'rationing', to Nazi-style death panels and to 'killing Granny'". Reinhardt said lowering health care costs require lowering health care incomes, and those reforms always end up being a political third rail.
The idea that "the only way to make [health care] cost less is to deny care" was called a myth that fits with "industry executives' financial interests" by Brian Klepper, a health care analyst, and David Kibbe, MD, MBA. Economist Uwe Reinhardt, noted that rationing health care on the basis of price has been going on for years in the United States, saying "free markets are not an alternative to rationing. They are just one particular form of rationing." He criticized reform opponents who "would have us believe that only governments ration things"; and when private insurers reject claims or have a high coinsurance rate that causes patients to forgo care, that the insurers are not rationing health care. He also described the main purpose of Obama's health care reforms as "to reduce rationing on the basis of price and ability to pay".
Michael F. Cannon of the Cato Institute wrote that "[p]aying doctors to help seniors sort out their preferences for end-of-life care is consumer-directed rationing, not bureaucratic rationing". 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. Newt Gingrich, a Republican, said that while technically, the proposed legislation (H.R. 3200) did not provide for government rationing of health care, he alleged the legislation was "all but certain to lead to rationing".
Brendan Nyhan, a health care policy analyst at the University of Michigan, 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", Palin's statement as a whole was unjustified and false. Nyhan also sees attempts to label institutions which deny "coverage at a system level for specific treatments or drugs" as attempts to move the goalposts of the debate as Palin's language required that a 'death panel' "would determine whether individual patients receive care based on their 'level of productivity in society'" which "was—and remains—false".
Health economist James C. Robinson said the "debate over so called death panels" showed how willing the public was "to believe the worst about perceived governmental interference with individual choices". Historian 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". Political scientist 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". Journalist Paul Waldman of The American Prospect, characterized the charge as a consequential policy lie, a falsehood that is not as condemned in media as an inconsequential personal lie.
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. 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". Susan Dentzer, editor of Health Affairs, said 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". The British paper, The Daily Telegraph noted that some critics of the US reform used the United Kingdom's National Institute for Health and Clinical Excellence (NICE), which, as one function, uses cost-effectiveness analysis (CEA) 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'". The Sunday Times, another British paper, wrote that Sarah Palin's use of the "death panels" term was a reference to NICE.
Geriatric psychiatrist Paul Kettl wrote 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". 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". Kettl wrote that
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. Dr. David Casarett, a physician who teaches palliative care at the University of Pennsylvania, responded to the 'death panels' and euthanisia charge by saying 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. 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".
In a July 2010 National Public Radio segment entitled "The Politics Of Anger", 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."
Representative Earl Blumenauer (Democrat-Oregon) called the references to death panels or euthanasia "mind-numbing" and "a terrible falsehood". He also 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. When a regulation for reimbursing consultation payments was upcoming, Blumenauer cautioned supporters that the "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".
Representative Darrell Issa (Republican-California) said he agrees with the perspective of his colleague, Representative Charles Boustany (Repulican-Louisiana), a surgeon. Referencing Boustany, Issa said that "'medical panels of people who care about what's best for their patients' and about appropriate procedures 'is good science and good medicine'". Issa also said that, "Republicans have to step back from the words 'death panels'".
In October 2010, Palin defended her use of the term in a Newsmax.com interview. Palin said she
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."
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'". 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.
By mid-August 2009, the Pew Research Center reported that 86% of Americans had heard of the "death panels" charge. Out of those who had heard the charge, 30% of people thought it was true while 20% did not know. For Republicans, 47% thought it was true while 23% did not know. 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". A survey by the Regence Foundation and National Journal released in 2011 showed 40% of Americans knew that the 'death panels' were not in the Affordable Care Act, while 23% said they thought the law allowed government to make end-of-life care decisions on behalf of seniors, and 36% said they did not know. Other findings from the survey included:
Atul Gawande, a physician who writes on health care topics for The New Yorker, said "that the whole death panel reduction and reaction to it" temporarily "shut down our ability to even have a national discussion about how to have the right [end-of-life] conversation" between doctors and patients.
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".
Megan Garber of the Columbia Journalism Review called the topic "irresistable" to reporters because it covered conflict, drama, innuendo, and Sarah Palin. Garber said it was "notoriously challenging for the press to deal with" because the old method of deligitmization—ignoring—was no longer workable. "Debunking rumors without simultaneously sanctioning them has always been a fraught endeavor, with the proliferation of niche media sites over the past several years only rendering that effort even more precarious," said Garber.
A study by Regina G. Lawrence, a communications professor, and Matthew L. Schafer, a JD/DCL/MMC candidate, found that "the mainstream news, particularly newspapers, debunked death panels early, fairly often, and in a variety of ways, though some were more direct than others". Of the journalists that reported the charge as false, 30% also presented information in a he said/she said style, often confusing readers. And of the reports that presented 'death panels' as false, 75% did not include an explanation.
In October 2010, The Philadelphia Inquirer highlighted the term in its "The Week in Words" article 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.
In November 2010, Paul Krugman was deliberately provocative on This Week, calling for "death panels and sales taxes" to fix the budget deficit. Krugman clarified that "health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they’re willing to pay for—not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care".
In his 2011 book, Mike Huckabee claimed that the Federal Coordinating Council for Comparative Effectiveness from the 2009 stimulus were the seeds from which "the poisonous tree of death panels will grow". Media Matters called this a "lie"; it reported that Huckabee mischaracterized the council and that it was eliminated in the 2010 health care reform. Paul Van de Water of the Center on Budget and Policy Priorities, said "Huckabee seems to be suggesting that we shouldn't do research to find out what medical procedures work best just because that research could conceivably be misused. The new law makes every effort to assure that won't happen."
A 2009 Foreign Policy article compared what they said was Palin's false death panel charge to three global health care policies. They each received a "death panel factor", or a score out of 100. Physician-assisted suicide programs in Switzerland, Luxembourg, Belgium, the Netherlands, and the U.S. state of Oregon garnered a 30. The Texas Futile Care Law received a 25. It "gives patients the right to dictate the kind of end-of-life care they would like to receive. But the law contains a provision allowing a hospital committee to arbitrate disputes between families and physicians. The boards can end life support for patients" if the services are deemed to be futile care. Britain's NICE, "which sets standards for its National Health Service by evaluating medications and approving those found to be cost-effective" received a rating of 15.
A 2011 editorial by USA Today said, "to the extent that death panels of a sort do exist, they're composed of state officials who must decide whether each state's version of Medicaid will cover certain expensive, potentially life-saving treatments".
Category:2009 in American politics Category:2010 in American politics Category:American political neologisms Category:American political terms Category:American political slogans Category:Conservatism in the United States Category:Dysphemisms Category:English phrases Category:Healthcare reform in the United States Category:Pejoratives Category:Political catch phrases Category:Political terms Category:Tea Party movement Category:Sarah Palin
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