A Project of The Annenberg Public Policy Center

Palin vs. Obama: Death Panels


Like many disagreements in the digital age, it all started with a post on Facebook. Last Friday, former Alaska Gov. Sarah Palin posted a note to her Facebook page and introduced a new term to the health care debate:

Palin, Aug. 7: 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.

Unsurprisingly, the phrase "death panel" does not appear in the health care bill that passed House committees last month. And Palin’s post did not make entirely clear what she might interpret as a "death panel." Nonetheless, the phrase stuck. It skyrocketed up the Google search index and was quoted by George Stephanopoulos while interviewing former Speaker of the House Newt Gingrich on ABC News’ "This Week." Republican Sen. Chuck Grassley of Iowa made similar claims while speaking out against "a government run plan to decide when to pull the plug on grandma” at a town hall on Wednesday.

President Obama addressed these concerns about death panels and unplugged grandmothers during a town hall meeting in New Hampshire on Tuesday. He said:

Obama, Aug. 11: The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for "death panels" that will basically pull the plug on grandma …  this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, et cetera. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready, on their own terms. It wasn’t forcing anybody to do anything. This is I guess where the rumor came from.

Obama is referring to Section 1233 of H.R. 3200, which is titled “Advance Care Planning Consultation.” As we explained a few weeks ago, it "would require Medicare to pay for some end-of-life planning counseling sessions with a health care practitioner." Our previous article was a response to the false claim that the health care bill would require forced counseling to push euthanasia. And it’s this provision on end-of-life counseling that’s the primary basis for Palin’s remarks.

On Aug. 12, Palin attempted to clear up her argument with a detailed Facebook post. She discussed Section 1233 and said that "it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients." Palin goes onto argue:

Palin, Aug. 12: The issue is the context in which that information is provided and the coercive effect these consultations will have in that 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.” 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?

The fact remains that the bill wouldn’t require patients to receive counseling sessions, nor would it require a doctor to offer one. Rather, it modifies Section 1861(s)2 of the Social Security Act, defining what services Medicare will pay for. So if a patient receives a counseling session from a doctor or health care practitioner, he or she doesn’t have to pay for it – Medicare will. As we pointed out in our earlier story, Medicare will also pay for prosthetic limbs, but that doesn’t mean that every recipient gets those, too.

And the concern that these sessions are "part of a bill whose stated purpose is ‘to reduce the growth in health care spending,’ " while true, is hardly the whole story. One of the bill’s other goals is to "provide affordable, quality health care for all Americans." The legislation is 1,017 pages long with sections that cut costs, some that increase care, and some that do both. In fact, the counseling sessions would add to government expenses since Medicare would have to reimburse doctors. The nonpartisan Congressional Budget Office estimates officially that Section 1233 will cost a net total of $2.7 billion over 10 years.

Furthermore, proposals to offer reimbursement for such counseling have attracted bipartisan support. Republican Sen. Johnny Isakson of Georgia, a sponsor of one such measure, gave an interview to the Washington Post on August 10, in which he discussed the benefits of these counseling sessions "both for the sanity of the family and what savings the family has." Isakson also commented on the recent confusion around the issue:

Isakson, Aug. 10: I just had a phone call where someone said Sarah Palin’s web site had talked about the House bill having death panels on it where people would be euthanized. How someone could take an end of life directive or a living will as that is nuts. You’re putting the authority in the individual rather than the government. I don’t know how that got so mixed up.

Palin also attempts to buttress her case by quoting some writings by Dr. Ezekiel Emanuel, a health policy adviser to the president. Here she’s echoing claims made elsewhere, twisting the meaning of Emanuel’s writings and taking them out of context. We examined those claims in an Ask FactCheck item we posted earlier today, and won’t repeat the details here.

Finally, for those inclined to get their information from Facebook postings, may we suggest  FactCheck.org’s own page?