Will the Real Death Panel Please Step Forward?


Death panels are in the news again. But it’s confusing. First, here’s the proposal:

Federal health officials are proposing that Medicare begin paying doctors to discuss end-of-life issues with their patients, six years after the “death panel” controversy erupted in the early days of the debate over President Obama’s health-care legislation.

….Sarah Palin, the Republican vice presidential candidate in 2008, ignited a political firestorm in 2009 when she denounced a provision in the health-care legislation that would have allowed Medicare to reimburse doctors for discussing living wills and other end-of-life issues with older patients. She said it would create a “death panel” that could decide who received care. The provision was removed from the final Affordable Care Act legislation.

But is this really Sarah Palin’s “death panel”? Here’s what she actually said:

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.

Later on, Palin said that she was referring to the idea of paying physicians to discuss end-of-life preferences with older patients. But that sure doesn’t sound like what she was talking about. It sounds like she was talking about rationing care, and that’s always been code for the Independent Payment Advisory Board—IPAB—which was tasked with keeping Medicare costs below a certain target. Here is National Journal a few weeks ago:

If a “death panel” never rationed health care, did it really earn the name?

That’s the question for Congress this week: The House soon will vote to repeal the Independent Payment Advisory Board established by the Affordable Care Act, dubbed at various times a “death panel” and rationing board by its opponents.

….”These 15 political appointees will make all the major health care decisions for over 300 million Americans,” then-Rep. Michele Bachmann said in 2011 during one of the Republican presidential debates. “I don’t want 15 political appointees to make a health care decision for a beautiful, fragile 85-year-old woman who should be making her own decision.”

So which one is the real death panel? Neither one, of course. It was all nonsense from the start. But apparently federal officials are going to take a crack at bringing back the one we killed, while Congress is going to take a crack at killing the one we kept. So we could end up with two death panels or with none.

But wait! There’s more! You may recall that Republicans are also suspicious of evidence-based medical research. They were convinced that “comparative effectiveness” research was just a stealth measure to take treatment decisions out of the hands of local doctors and instead centralize them in the hands of green-eyeshade DC bureaucrats. In other words, a death panel. So there are actually three death panels. They’re everywhere!

But don’t worry about it. End-of-life counseling has always had bipartisan support, and only lost it in the frenzy of passing Obamacare. It’s bound to come back eventually. And IPAB is simply a board tasked with recommending ways to keep Medicare spending under legislative targets. It does no rationing, and everyone knows it. However, Medicare spending has been so low recently that the board has had nothing to do. That’s the only reason it might be killed off. (Though President Obama has promised to veto any attempt to get rid of it.)

For more on all this, check out Michael Mechanic’s explainer on the end-of-life controversy here.