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Death panel
From Wikipedia, the free encyclopedia
"Death panel" is a political term that originated during a 2009 debate about federal health care legislation to cover theuninsured in the United States. The term was first used in August 2009 by Sarah Palin, the former Republican Governor of Alaska, when she charged that the proposed legislation would create a "death panel" of bureaucrats who would decide whether Americans—such as her elderly parents or child with Down syndrome—were worthy of medical care. Palin's claim, however, was debunked, and it has been referred to as the "death panel"myth[1] as nothing in any proposed legislation would have led to individuals being judged to see if they were "worthy" of health care.[2] Palin specified that she was referring to Section 1233 of bill HR 3200 which would have paid physicians for providing voluntary counseling to Medicare patients about living wills,advance directives, and end-of-life care options.
Palin's claim was reported as false and criticized by mainstreamnews media, fact-checkers, academics, physicians, Democrats, and some Republicans. Other prominent Republicans and conservative talk radio hosts backed Palin's statement. One poll showed that after it spread, about 85% of Americans were familiar with the charge and of those who were familiar with it, about 30% thought it was true.[1] Due to public concern, the provision to pay physicians for providing voluntary counseling was removed fromthe Senate bill and was not included in the law that was enacted, the 2010 Patient Protection and Affordable Care Act. In a 2011 statement, the American Society of Clinical Oncology bemoaned the politicization of the issue and said that the proposal should be revisited.
For 2009, "death panel" was named as PolitiFact's "Lie of the Year", one of FactCheck's "whoppers", and the most outrageous term by the American Dialect Society.
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[edit]Origins
[edit]Background
Palin's claim that "death panels" were included in the proposed health care legislation was preceded by comments of other conservatives who criticized the same section of the bill.
On July 16, 2009, former lieutenant governor of New York, Betsy McCaughey, a longtime opponent of federal healthcare legislation[3][4] said Section 1233 of HR 3200 was "a vicious assault on elderly people"[5] because it would "absolutely require" Medicare patients to have counseling sessions every five years that would "tell them how to end their life sooner".[6] Conservative talk radio hosts including[7] Rush Limbaugh,[6] Sean Hannity and Laura Ingraham repeated McCaughey's claim.[8] The AARP, a non-profit lobby group for retired persons, responded that the sessions were in no way designed to encourage euthanasia, but would instead help seniors make better decisions and would help ensure that their wishes were followed.[6][9] PolitiFact said the proposal provided Medicare coverage for optional counseling sessions for patients who wanted to learn more about end-of-life-planning.[6]
On July 24, 2009, an op-ed by McCaughey was published in theNew York Post.[10] In the piece, which was titled "Deadly Doctors", McCaughey falsely asserted that presidential advisorEzekiel Emanuel believed the disabled should not be entitled to medical care, and quoted him out of context.[11][12] On July 27, excerpts from the McCaughey's op-ed were read, with approval, by Representative (Rep.) Michele Bachmann (R-MN) on the floor of the U.S. House of Representatives.[5][12] Within days, Rep.John Boehner (R-OH), then the Minority Leader of the House and Rep.Thaddeus McCotter (R-MI), the Republican Policy Committee Chairman, repeated claims that Section 1233 would encourage "government-sponsored" euthanasia[7][13][14] and Rep. Virginia Foxx (R-NC) charged that the proposal would "put seniors in a position of being put to death by their government."[15][16] On July 30, former Republican House Speaker Newt Gingrich, declared that the House bill had "a bias toward euthanasia".[17][18] The Washington Post reported on August 1, 2009 that the claim had been spreading via "religious e-mail lists" and internet blogs.[7] In early August, members of Congress heldtown hall meetings that were marked by hostility—including shouting, sporadic, physical altercations and comparisons between the proposed reforms and Nazi Germany.[19]
[edit]Palin's initial statement
Sarah Palin, who had been keeping a low profile after her July 3, 2009,resignation announcement as Alaska's Governor,[15][20] was the first to use the "death panel" term on August 7, 2009. In her first Facebook note, she said:[21][22][23]
[G]overnment 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.[24]
Though Palin's post did not identify a portion of legislation she believed mandated "death panels",[25] a spokesperson pointed to HR 3200, Section 1233,[26][27][28] and Palin herself followed up in an August 12 Facebook note clarifying her argument by discussing Section 1233.[25] However, neither Section 1233 nor any other provision in any health care bill provided for a system to determine if individuals were worthy of health care.[2]
[edit]Policy
Legislation providing for counseling patients on advance directives, living wills and end-of-life care had been on the books for years, however, the laws did not provide for physicians to be reimbursed for giving such counseling during routine physical exams of the elderly. The Patient Self-Determination Act (1991) requires health care providers, including hospitals, hospices and nursing homes to provide information about advance directives to admitted patients.[29][30] The Medicare Prescription Drug, Improvement, and Modernization Act began providing reimbursements for end-of-life care discussions with terminally ill patients in 2003.[31]
A bill to provide for reimbursement every five years for office visit discussions with Medicare patients on advance directives, living wills, and other end of life care issues was proposed by Rep.Earl Blumenauer (D-OR) in April 2009—with Republican cosponsors Charles Boustany (R-LA), a cardiovascular surgeon,Patrick Tiberi (R-OH), and Geoff Davis (R-KY).[32][33][34] The counseling was to be voluntary and could be reimbursed more often if a grave illness occurred. The legislation had been encouraged by Gundersen Lutheran and a loose coalition of other hospitals in La Crosse, Wisconsin that had had positive experiences with the widespread use of advance directives.[32][33][35][36] Blumenauer's standalone bill was tabled and inserted into the large health care reform bill, HR 3200 as Section 1233 shortly afterward.[32][37][38] Supporters of the Section 1233 counseling provision included the American Medical Association (AMA), AARP, the National Hospice and Palliative Care Organization, and Consumers Union; the National Right to Life Committee opposed "the provision as written."[39]It was removed from the Senate version of the bill due to the death panel controversy[40] and was not included in the reconciled and final bill which became law in March 2010 and which is known as the Patient Protection and Affordable Care Act.[13]
In an interview published in June 2009, Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, said that "The question is not whether we are going to ration; the question is whether we are going to ration with our eyes open."[41] [42]
