Death Panels, End of Life Counseling, and the Media’s Continual Misrepresentation

It has been nearly a year and a half since Governor Palin wrote her now famous "death panel" Facebook post in which she spoke out against the rationing that would inevitably be a part of the Democrat’s health care reform. In part, she wrote:

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.

After all, one of President Obama’s health care advisers is Dr. Ezekiel Emanuel who once published an academic paper in the reputable medical journal Lancet on the "complete lives system" that stated the following(emphasis mine):

The complete lives system also considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern that disproportionately large amounts of resources will be directed to young people with poor prognoses.42 When the worst-off can benefit only slightly while better-off people could benefit greatly,allocating to the better-off is often justifiable.

Sounds like rationing based upon "level of productivity in society" doesn’t it?

Shortly following this post from Governor Palin, Medicare funded end-of-life counseling was removed from the Senate version of the health care bill in August of 2009. While Governor Palin’s Facebook no doubt had an impact on the removal of that section of legislation, it was not specifically what she first opposed, which was rationing of care based upon decisions of government bureaucrats. Governor Palin has continued to oppose "death panels" including most recently expressing opposition to Medicare’s Independent Payments Advisory Board in her op-ed support Congressman Ryan’s Roadmap.

It must be noted, however, that in the Fall of 2009 following the removal of the end of life counseling provision in the bill, Governor Palin did express opposition to such government funded counseling, even providing a written statement to the New York Senate Aging Committee which in part said:

I have been vocal in my opposition to Section 1233 of H.R.3200, entitled “Advance Care Planning Consultation.”[1] Proponents of the bill have described this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. That is misleading. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.

To understand this provision fully, it must be read in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.”[4] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As one commentator has noted, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones…. If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to ‘bend the curve’ on health-care costs?”[5]

Essentially what such legislation would do is provides physicians with a potential financial incentive to initiate end of life counseling discussions with patients. The argument against this counseling is if patients were to opt not to seek certain treatments at the end of their life, it would save Medicare money. This would be due to potential coercion rather than autonomous or solely family influenced decision making.

Fast forward to January 2011, as a likely part of the Obama administration’s plan to maximize the power of the executive branch, the Obama administration implemented a regulation that would enable Medicare funded end of life counseling starting January 1st. Just a few days later, the administration dropped end of life counseling from the Medicare regulation, as Ian already mentioned. In that New York Times article reporting this, the author makes an incorrect assertion:

During debate on the legislation, Democrats dropped a somewhat similar proposal to encourage end-of-life planning after it touched off a political storm. Republicans said inaccurately that the House version of the bill allowed a government panel to make decisions about end-of-life care for people on Medicare.

He then went on to cite Governor Palin’s and Congressman Boehner’s opposition to such provisions and also noted that decision was more political than ideological, essentially conceding that the Obama administration still approved of the regulation even though they weren’t implementing it. The end of life provision in the House bill that Governor Palin expressed opposition to in her written statement to the New York Senate was dropped from the bill, and she has not claim that it was still present in the bill later signed by President Obama. The Medicare advisory board that she referenced in her op-ed supporting Ryan’s Roadmap was in the final legislation, and she expressed opposition to that. In a piece entitled, "Sarah Palin Proves Lying Can Be Effective", the Washington Post parroted the misrepresentation from the New York Times.

Governor Palin was right in her opposition to both rationing via "death panels" or Medicare funded end-of-life counseling, and the media continues to fail to understand her opposition, nor the truth that lies in it. Her initial opposition and continued opposition is against undue influence by government who willingly admit that rationing is desired at the expense of quantity of care. However, her influence and truthful statements proved to have an impact on end of life counseling regulation and continues to be at forefront of everyone’s mind when health care reform and rationing are discussed.



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