The conservative media are now labeling the Independent Medicare Advisory Board created by the Senate health care reform bill a "death panel," even though the board is explicitly prohibited from "modify[ing] eligibility," "restrict[ing] benefits," or "ration[ing] health care" and its recommendations can be overridden by Congress. In falsely declaring the existence of "death panels," right-wing media figures have previously pointed to the House bill's end-of-life counseling provision, out-of-context statements by Obama administration adviser Dr. Ezekiel Emanuel, general "rationing" purportedly instituted by the legislation, and nonbinding mammogram guidelines.
Conservative media settle on new target for "death panels" attack
Weekly Standard: "Paging Sarah Palin: the death panel is unkillable." In a December 21 Weekly Standard blog post, John McCormack wrote that Sen. Jim DeMint (R-SC) "pointed out that the Reid bill declares on page 1020 that the Independent Medicare Advisory Board cannot be repealed by future Congresses" [emphasis in original]. McCormack further wrote: "For any fearmongers out there tempted to call an unelected body that recommends Medicare cuts a 'Death Panel,' let me be clear. According to page 1004, IMAB proposals 'shall not include any recommendation to ration health care' -- you know, just like the bill says there's no funding for abortion. Paging Sarah Palin: the death panel is unkillable" [emphasis in original].
Fox Nation: "Reid Bill: Future Congresses Cannot Repeal 'Death Panel.' " On December 22, the Fox Nation linked to McCormack's Weekly Standard post with the headline: "Reid Bill: Future Congresses Cannot Repeal 'Death Panel.' " From the Fox Nation (accessed on December 23):
Morris: Medicare Advisory Board "is really the death panel that Sarah Palin was talking about." From the December 23 edition of Fox News' Fox & Friends:
MORRIS: The Medicare Advisory Board you speak about is a particularly dangerous thing, because it's going to set up for Medicare only -- for the elderly only -- protocols and standards of care where they are going to be saying no, you can't give this person a hip replacement; they are too old; and no, you can't treat this person with colon cancer with the best drug available. I know it increases his chance of dying but it's beyond the cost parameters that we are prepared to allow. And this will be done by this federal board which is really the death panel that Sarah Palin was talking about. That's an oversimplification, but the basic concept isn't far wrong.
Palin calls Medicare Advisory Board a "rationing 'death panel.' " In a December 22 Facebook post titled "Midnight Votes, Backroom Deals, and a Death Panel," Palin asserted that the advisory board "is a panel of bureaucrats charged with cutting health care costs on the backs of patients -- also known as rationing." She added that "Democrats are protecting this rationing 'death panel' from future change with a procedural hurdle" and wrote:
Though Nancy Pelosi and friends have tried to call "death panels" the "lie of the year," this type of rationing - what the CBO calls "reduc[ed] access to care" and "diminish[ed] quality of care" - is precisely what I meant when I used that metaphor.
In fact, board is not a "death panel," and provision prohibits "modifying eligibility," "restricting benefits," and "ration[ing] health care"
Independent Medicare Advisory Board is specifically prohibited from rationing health care or modifying benefits. According to the legislation, when the "projected per capita growth rate under Medicare" exceeds "the target growth rate for that year," the board is required to "develop and submit" to Congress a "proposal containing recommendations to reduce the Medicare per capita growth rate to the extent required by this section." But the legislation explicitly states that the board may not include recommendations to "ration health care," "restrict benefits," or "modify eligibility criteria." From Section 3403 of the Senate health care bill:
(ii) The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria.
Congress has authority to reject board recommendations. The bill requires the Secretary of Health and Human Services to enact the board's proposals, unless "Congress enacts legislation pursuant" to the procedures laid out in the bill.
CBO confirms advisory board provision "would place a number of limitations on the actions available to the board, including a prohibition against modifying eligibility or benefits." In its December 19 analysis, the Congressional Budget Office found that the advisory board provision "would place a number of limitations on the actions available to the board, including a prohibition against modifying eligibility or benefits":
The legislation also would establish an Independent Payment Advisory Board, which would be required, under certain circumstances, to recommend changes to the Medicare program to limit the rate of growth in that program's spending. Those recommendations would go into effect automatically unless blocked by subsequent legislative action. Such recommendations would be required if the Chief Actuary for the Medicare program projected that the program's spending per beneficiary would grow more rapidly than a measure of inflation (the average of the growth rates of the consumer price index for medical services and the overall index for all urban consumers). The provision would place a number of limitations on the actions available to the board, including a prohibition against modifying eligibility or benefits, so its recommendations probably would focus on:
- Reductions in subsidies for non-Medicare benefits offered by Medicare Advantage plans; and
- Changes to payment rates or methodologies for services furnished in the fee-for-service sector by providers other than hospitals, physicians, hospices, and suppliers of durable medical equipment that is offered through competitive bidding.
The right-wing media's ever-shifting explanation for creation of "death panels"
CLAIM 1: End-of-life counseling provision in House bill creates a "death panel." The term "death panel" originated with Palin's statement on her Facebook page that under Democratic health care reform, "my baby with Down Syndrome will have to stand in front of Obama's 'death panel.' " Palin's spokeswoman later clarified that Palin was specifically referring to the House bill's "Advance Care Planning Consultation" provision. Over the following days, conservative media figures widely adopted Palin's "death panel" term or advanced or expressed support for her assertion. Numerous media outlets subsequently debunked Palin's claim that the provision, which provides for voluntary, Medicare-subsidized end-of-life counseling sessions, created a "death panel." PolitiFact.com named Palin's statement the 2009 "Lie of the Year."
My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President's chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those "who are irreversibly prevented from being or becoming participating citizens. ... An obvious example is not guaranteeing health services to patients with dementia." Dr. Emanuel has also advocated basing medical decisions on a system which "produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated."
In a August 24 New York Times article, Jim Rutenberg explained that in a paper Emanuel wrote in 1996 for the Hastings Center bioethics institute -- which Palin cited in her Facebook post - Emanuel "laid out what he called a growing consensus among competing political philosophies about how a society should allocate health care services. In clinical terms, he said that consensus held that those who 'are irreversibly prevented from being or becoming participating citizens' should not be guaranteed the same level of treatment as others." Rutenberg went on to report that "Dr. Emanuel said he was simply describing a consensus held by others, not himself."
CLAIM 3: "Rationing" makes the entire bill a "de facto" death panel. Following the debunking of Palin's original claim, the right-wing media suggested that while the House bill did not contain actual "death panels," it would have the same effect as a "death panel" through "rationing" of end-of-life care: a "de facto death panel." For example, Fox & Friends featured a discussion with Morris about a column he wrote in the New York Post alleging that Democratic health care reform proposals amount to "one giant death panel." During the segment, on-screen text read: "Defacto Death Panels? Obama Plan Could Result in Rationing." Glenn Beck also said on his Fox News show that "[t]he death panel isn't a firing squad. Sarah Palin made a point -- I guess you could say in an inflammatory way. But when you implement a government health system, as they have found out in the U.K. and everywhere else on the planet, you are left with no other choice. That's just the way it is. Rationing is inevitable, and they know it." Rush Limbaugh and Mark Steyn also adopted the claim that the entire bill amounted to a "death panel."
CLAIM 4: Mammogram guidelines are a "death panel." On the November 18 editions of their respective radio shows, Beck, Limbaugh, and Sean Hannity all linked a task force's recommendation that fewer women younger than 50 receive regular mammograms to the widely debunked smear that Democratic health reform bills include "death panels." On November 19, Palin said that the recommendations are evidence of "the death panels of government bureaucrats." But the task force's recommendations are not legally binding. Moreover, the task force encouraged policymakers to include additional considerations and "individualize decision making to the specific patient or situation." In a Nightly News report on the task force recommendations, NBC chief medical correspondent Dr. Nancy Snyderman stated: "It's important to remember that these new recommendations from this independent task force are just that -- they're recommendations. They don't mandate any changes in who should get mammograms and when."