Death panel

Death panel

"Death panel" is a term or phrase from a debunked 2009 partisan, political claim—the "death panel" myth. Repeated or editorialized by politicians, news media, and commentators from both TV and radio, it portrayed the United States government as attempting to ration health care on the basis of social worth.[1][2] The term originates with, and gained notoriety from, a Facebook post of former Governor of Alaska, Sarah Palin playing off the comments of former lieutenant governor of New York, Betsy McCaughey. Palin charged that government run healthcare put Americans, such as her parents or child with Down syndrome in a position of being denied treatment due to Obama's "death panel".[3] Both referred to section 1233 of HR 3200 which would have reimbursed physicians for counseling Medicare patients about living wills, advance directives, and end-of-life care options. The section was removed from the Senate bill and never became part of the 2010 Patient Protection and Affordable Care Act. The bill had the support of the Democratic President of the US Barack Obama.

Similar claims from other opponents, including conservative talk radio and prominent Republicans Representative (Rep.) John Boehner (OH), Rep. Michele Bachmann (MN) and Newt Gingrich, were made. Gingrich and Senator (Sen.) Charles Grassley (R-IA) made comments supportive of Palin's charge and ~30% of Americans thought it was true. The charge was presented as false by news media, fact-checkers, analysts, physicians, Democrats, and some Republicans including Sen. Johnny Isakson (R-GA), Sen. Lisa Murkowski (R-AK), and health policy expert Gail Wilensky. Politically, the "death panel" myth was used to rally opposition to the Obama administration health care reform, with protesters using it during town hall meetings in August 2009. Physician Atul Gawande said the term represented fear patients might be denied expensive life extending treatments, but he said the real issue was that expensive treatments were harming patients and a disconnect existed between treatment and patient goals. In a January 2011 statement, the American Society of Clinical Oncology (ASCO) bemoaned the politicization of the issue and recommended the proposal be revisited.[4]

Contents

Origins

Background

Betsy McCaughey

During a July 16 interview on the Fred Thompson Show, former lieutenant governor of New York, Betsy McCaughey, who campaigned against the Clinton health care plan of 1993,[5][6] said HR 3200 Section 1233 was "a vicious assault on elderly people" that "cut your life short."[7] She charged that the legislation would mandate counseling sessions for Medicare patients every five years to "tell them how to end their life sooner".[8] AARP, has stated that her claims were " 'rife with gross—and even cruel—distortions' of a provision" that would benefit seniors' decision making and health care.[9] The proposed counseling sessions were voluntary, and PolitiFact said McCaughey's charge that the sessions would "tell [seniors] how to end their life sooner" was an outright distortion.[8]

After McCaughey's interview, criticism of health care reform was broadcast on right-wing talk radio.[10] Rush Limbaugh repeated McCaughey's charge about mandatory counseling on his July 21 show[8] and hosts Sean Hannity and Laura Ingraham picked it up.[11] On July 24, McCaughey wrote an opinion piece for the New York Post[12] which claimed presidential advisor Ezekiel Emanuel thought the disabled should not be entitled to medical care, which was a precursor to Palin's eventual claim.[13] On July 27, the article was partially read by Representative (Rep.) Michele Bachmann (R-MN) on the floor of the House of Representatives.[7] Bachmann contended Emanuel was a " 'deadly doctor' who believes health care should be 'reserved for the nondisabled' ".[14]

Rep. John Boehner

Rep. John Boehner (R-OH), the then Minority Leader of the House of Representatives, repeated claims that Section 1233 would encourage euthanasia.[15] Boehner, along with Rep. and Republican Policy Committee Chairman Thaddeus McCotter (MI), on July 23 stated that the provision "may start us down a treacherous path toward government-encouraged euthanasia."[10][16] On July 28, on the House floor, Rep. Virginia Foxx (R-NC) charged that a Republican alternative to the Democratic reform proposals was "pro-life because it will not put seniors in a position of being put to death by their government."[17][18] On July 30, Republican Newt Gingrich, praised the Gundersen Lutheran Medical Center for its end-of-life practices. Speaking after a speech at the center he claimed that the House bill had "a bias toward euthanasia for senior citizens and other people."[19][20]

Email and blogs were conduits. The Washington Post reported on August 1 that on "religious e-mail lists and Internet blogs, the proposal has been described as 'guiding you in how to die', 'an ORDER from the Government to end your life', promoting 'death care' and, in the words of antiabortion leader Randall Terry, an attempt to 'kill Granny'."[10] In early August, members of Congress held town hall meetings that were marked by hostility—including shouting, comparisons between the proposed reform and Nazi Germany arose with some sporadic, physical altercations.[21]

Term cited or repeated

Palin's initial reference

Sarah Palin

Sarah Palin, who had been keeping a low profile after her July 3, 2009, resignation from Alaska's Governorship,[17][22] was back into the headlines after using the term as part of her first Facebook post on August 7, 2009.[23][24][25]

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.[2][26]

Newt Gingrich

The charge was debunked by PolitiFact, which stated "no panel in any version of the health care bills" judged "a person's 'level of productivity in society' to determine whether they are 'worthy' of health care."[3] After Palin's statement, multiple commentators backed its veracity including Glenn Beck on The Glenn Beck Program and Limbaugh on The Rush Limbaugh Show.[2] According to the BBC, conservative blogger Michelle Malkin explicitly agreed with Palin's statement that "death panels" were mandated in Obama's proposed legislation.[27] Former House speaker Newt Gingrich backed Palin during his August 9, 2009, appearance on This Week with George Stephanopoulos.[3] He said the bill was a thousand pages long, set up "45 different agencies", and created "all sorts of panels."[28][29] "You're asking us to trust turning power over to the government, when there clearly are people in America who believe in establishing euthanasia, including selective standards", he said.[3][30] Health economist Uwe Reinhardt said Gingrich should clarify that the provision to reimburse physicians for end-of-life counseling had no intent to hasten death, and he mentioned Gingrich's previous support for the expanded use of advance directives.[31]

At an August 12 town hall meeting, Republican Senator Chuck Grassley, said people "have every right to fear ... I don't have any problem with things like living wills, but they ought to be done within the family. We should not have a government program that determines you're going to pull the plug on Grandma."[17] Grassley later clarified that he did not think the provision would grant the government authority to decide who lives and dies.[32] Grassley's statements at the town hall meeting were a sign that he was not on board with reform, given his role on the Senate Finance Committee[33][34] as the top Senator of his party on health care.[35]

Legislation

Rep. Blumenauer (D-OR), sponsored the bill HR 3200.

Palin's initial August 7 Facebook post did not identify any portion of legislation.[36] When asked of the proposed legislation[37] mandated "death panels", a spokesperson pointed to HR 3200, Section 1233.[38][39] And Palin, in an August 12 Facebook post, attempted to clarify her argument by discussing Section 1233.[36] A few months prior to this, the provision was a separate bill with bipartisan support.[40] The provision would have allowed physicians to receive payment from Medicare for voluntary counseling with patients on end-of-life issues[41] which have been shown to improve the quality of life for dying patients and their families.[42] The discussions would have been about "living wills, making a close relative or a trusted friend a health-care proxy, ... hospice as an option for the terminally ill, and ... pain medications for people suffering chronic discomfort. The sessions [would have been] covered every five years, [or] more frequently if someone was gravely ill."[41] Supporters of the 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."[43]

The provision was inserted in the bill by Democratic lawmakers encouraged by a loose coalition of hospitals led by Gundersen Lutheran of La Crosse, Wisconsin, a hospital and community known for its widespread adoption of advance directives.[44][45][46] Before it became HR 3200 Section 1233, Rep. Earl Blumenauer (D-OR) had submitted the provision as separate bill in April 2009 with Republican cosponsors—Charles Boustany (LA), a cardiovascular surgeon, Patrick Tiberi (OH), and Geoff Davis (KY).[44][40][47] Related legislation was enacted in 1991, the Patient Self-Determination Act, which required health care providers, including hospitals, hospices, and nursing homes to provide information about advance directives to admitted patients.[48][49] In 2003, the Medicare Prescription Drug, Improvement, and Modernization Act provided reimbursements for end-of-life care discussion with terminally ill patients.[35]

Consultation payments were removed from the Senate version of the bill[50] while remaining in the House version until November 2009, when they passed, but they did not pass in the final bill.[15] In late December 2010, a new Medicare regulation was reported that would pay for consultations during annual wellness visits, instead of at five-year intervals as HR 3200 originally proposed, effective January 1.[15] Instead, on January 4, the consultations were reported to be removed from the regulations.[51]

Reaction

Protesters referencing the phrase "death panel" at a town hall meeting

The Economist said the phrase was used as an "outrageous allegation" to confront politicians at town hall meetings during the August 2009 congressional recess.[52] The New York Times said the term became a standard slogan among many conservatives opposed to the Obama administration’s health care overhaul.[24] Health law and bioethics expert George Annas wrote that "make believe 'death panels' that would 'pull the plug on grandma' were used as a rhetorical device to block any rational discussion of either death generally, or end of life care in particular."[53] Brent J. Pawlecki, a corporate medical director, said the phrases "death panels" and "killing Grandma" were "used to fuel the flames of fear and opposition".[54][55] Former Newsweek editor Jon Meacham said it was "a lie crafted to foment opposition to the president's push for reform."[56]

Ian Dowbiggin, a historian and published author on the history of medicine, euthanasia, and eugenics, said "the phrase invokes images of Nazi Germany" and was "an issue that's being exploited by political figures" who are "trying to sensationalize the issue as much as possible to drum up opposition."[17] Health economist Uwe Reinhardt said that it is possible to slightly bend the US health care cost curve down through a lower volume of health care services "by more widespread use of living wills—an idea once actively promoted by Newt Gingrich. But those ideas were met in the past year by dark allusions to 'rationing', to Nazi-style death panels and to 'killing Granny'."[57] Reinhardt said lowering health care costs require lowering health care incomes, and those reforms always end up being a political third rail.[57]

The idea that "the only way to make [health care] cost less is to deny care" was called a myth that fits with "industry executives' financial interests" by Brian Klepper, a health care analyst, and David Kibbe, a physician.[58] Michael F. Cannon of the Cato Institute wrote that "[p]aying doctors to help seniors sort out their preferences for end-of-life care is consumer-directed rationing, not bureaucratic rationing."[59] The Christian Science Monitor reported that some Republicans used the term as a "jumping-off point" to discuss government rationing of health care services, while some liberal groups applied the term to private health insurance companies.[60] Newt Gingrich, a Republican, said that while technically, the proposed legislation (HR 3200) did not provide for government rationing of health care, he alleged the legislation was "all but certain to lead to rationing."[61]

Brendan Nyhan, a health care policy analyst at the University of Michigan, wrote that although "efforts to reduce growth in health care costs under Obama’s plan might lead to more restrictive rationing than already occurs under the current health care system", Palin's statement as a whole was unjustified and false.[2] Nyhan also sees attempts to label institutions which deny "coverage at a system level for specific treatments or drugs" as attempts to move the goalposts of the debate as Palin's language required that a "death panel" "would determine whether individual patients receive care based on their 'level of productivity in society'" which "was—and remains—false."[62]

Academic and media

Ezekiel Emanuel

Bioethicist George Annas wrote that America has a "death denying culture that cannot accept death as anything but defeat." We will "prepare for any and every disease and screen for every possible 'risk factor', but we are utterly unable to prepare for death." Annas commends and quotes Boston Globe columnist Ellen Goodman, who wrote "I think that what our [healthcare] system may need is not more intervention, but more conversation, especially on the delicate subject of dying ... More expensive care is not always better care. Doing everything can be the wrong thing. The end of life is one place where ethics and economics can still be braided into a single strand of humanity." However, Annas says mythical "death panels" blocked exploring these issues, appearing to affirm Ivan Illich's 1975 Medical Nemesis, when he said " '[s]ocially approved death happens when man [sic] has become useless not only as a producer but also as a consumer. It is at this point that [the patient] ... must be written off as a total loss'."[53]

Health economist James C. Robinson said the debate over "death panels" showed how willing the public was "to believe the worst about perceived governmental interference with individual choices."[63] Historian Jill Lepore characterized "death panels" as a reborn conspiracy theory that is believed by a minority of the US population after Roe v. Wade and the Karen Ann Quinlan case—that the federal government is conspiring to kill off its weakest members. Of the reform effort, Lepore said it was an "unwelcome reminder of a dreaded truth: death comes to us all"; of the uproar, Lepore said it rallied a party base against death, making "for a creepy sort of populism. But if harnessing the fear of death for political gain is a grotesque tactic, it may also be a savvy one." Lepore noted that after the story spread, when Obama was left saying he was not in favor of "death panels", it was an example of being "catastrophically outmaneuvered."[64] Johnathan Oberlander, a professor of health policy, said the Obama administration was "seemingly unprepared for the intense opposition and fury that erupted during town-hall meetings in the summer of 2009."[65] Political scientist James Morone said that despite Democrats denying the charge and focusing on the facts, the term played a role in their loss of control over the public debate because they did not address the "underlying fears of big government". Morone called the "death panel" arguments "pungent, memorable, simple, and effective."[66] Journalist Paul Waldman of The American Prospect, characterized the charge as a consequential policy lie, a falsehood that is not as condemned in media as an inconsequential personal lie.[67]

Fox News analyst Juan Williams said "of course there is no such thing as any death panel."[68] Gail Wilensky, a health adviser to President George H.W. Bush and John McCain who has overseen Medicare and Medicaid, said the charge was untrue and upsetting, adding that "[t]here are serious questions that are associated with policy aspects of the health care reform bills that we're seeing ... And there's frustration because so much of the discussion is around issues like the death panels and [Ezekiel Emanuel] that I think are red herrings at best."[17][69] Susan Dentzer, editor of Health Affairs, said Congress' approval of $1.1 billion for comparative effectiveness research in the 2009 stimulus contributed to fear the research would "lead to government rationing" which "fueled the 'death panels' fury of summer 2009."[70] The British paper, The Daily Telegraph noted that some critics of the US reform used the United Kingdom's National Institute for Health and Clinical Excellence (NICE)—which, as one of its functions, uses cost-effectiveness analysis (CEA) to determine whether new treatments and drugs should be available to those covered by the National Health Service (NHS)—"as an example of the sort of drug rationing that amounted to a 'death panel'."[71] The Sunday Times, another British paper, wrote that Sarah Palin's use of the "death panels" term was a reference to NICE.[72]

Physicians

C. Porter Storey Jr. thinks the term represents fear that due to financial pressure "some mechanical, governmental method will be used to determine how much of our scarce health care resources will be applied to their situation."[73] Atul Gawande, a surgeon and writer, agrees that fear of missing out on an expensive life-extending treatment is behind the phrase, but he thinks framing the issue in this way completely misplaced. Gawande says "the trouble is not whether we're going to offer a $100,000 drug to help someone get 3 or 4 months"; our big trouble is that patients receive a $100,000 drug that not only yields no benefit—it also causes major side effects that shortens their lives. He said medicine has not "gotten good at making sure we are able to help people with their goals and decisions" without hurting people.[74] Gawande said doctor's schedules—of 20 minute appointments back to back—and a lack of payments were barriers to these hour long discussions, as is the emotional difficulty in conversations that require patients to acknowledge their mortality.[75] Geriatric psychiatrist Paul Kettl said his experience in a geriatric unit showed end-of-life discussions and reimbursements were "desperately needed" as these hour long conversations are "ignored in the crush of medication and disease management."[76]

The American Society of Clinical Oncology published a statement saying that the issue of funding discussions with patients had been "unfortunately politicized".

Currently, our system highly incentivizes delivery of cancer-directed interventions (chemotherapy, targeted therapy, and so on) over conversations that are critical to establishing a patient's goals and preferences and providing individualized care. Efforts to compensate oncologists and others for delivering this important aspect of cancer care were unfortunately politicized in the recent health care reform debates, but these efforts had at their core a critical patient-centered societal interest and should be revisited.[4]

In the Journal of the American Medical Association, Kettl wrote "I wish we had death panels. I don't mean that I'm in favor of some appointed group of erudite experts gathering to decide who lives or dies in a process controlled by the government, but rather the death panels that were originally proposed. I'm in favor of periodic discussions about advance directives that Medicare would pay for as medical visits."[76] Kettl noted that the attention-catching phrase "death panels" became "a lightning rod for objections to a series of ideas about health care besides" end-of-life discussions, and that somehow, "the concept of physicians being paid for time to talk with patients and their families about advance directives ... generated into the fear of decisions about life and death being controlled by the government."[76] Kettl wrote that "Emotions and health care go together. That makes them an easy and consistent target for the media and for grandstanding commentators. We can expect more good medical ideas to be destroyed by sound bytes and needless concerns that will be exaggerated. It makes for good television, but bad medicine."[76]

Benjamin W. Corn, a cancer specialist, wrote in the New England Journal of Medicine that the "death panels" controversy showed Americans were uneasy discussing topics related to the dying process. Corn supports the end-of-life care conversations, as he says that they can have an important positive effect on patients. Corn offered suggestions on how to present to conversations to patients, but he said some patients may not ever welcome them. Corn thinks certain issues, such as whether experimental therapies should be reimbursed, the possible expansion of hospices, restoring dignity to the process of dying, and guidelines for physician assisted suicide, need to be addressed directly.[23]

Politicians

Darrell Issa

Sen. Lisa Murkowski (R-AK) stated that "death panels" were a baseless charge that unnecessarily incited fear and detracted from real problems in the proposed legislation.[77] She said it was "bad enough that we don't need to be making things up". Sen. Johnny Isakson (R-GA), thought there was illogical confusion over "death panels"; he said advance directives put "authority in the individual rather than the government."[78] In July 2010 Rep. Bob Inglis, (R-SC) said that he thought it was counterproductive for the conservative movement for some to promote misinformation about death panels when they do not exist.[79] Rep. Darrell Issa (R-CA) said that he agrees with his colleague, Rep. Charles Boustany (R-LA), a surgeon. As quoted in The Wall Street Journal, Issa, referencing Boustany, said "medical panels of people who care about what's best for their patients ... is good science and good medicine."[80] Speaking for himself, Issa said "Republicans have to step back from the words 'death panels'."[80]

Rep. Earl Blumenauer (D-OR) called the references to "death panels" or euthanasia "mind-numbing" and "a terrible falsehood".[81] He thought that the news media contributed to the persistence of the myth by amplifying misinformation and extreme behavior.[82] When a regulation for reimbursing consultation payments was upcoming, Blumenauer cautioned supporters to keep things quiet, reasoning that Republican leaders would attempt to continue the myth.[15] President Barack Obama cited the charge—along with the citizenship conspiracy theories and "job-killing" allegations—as demagogy against him.[83] In testimony to the United States Congress Joint Select Committee on Deficit Reduction, Erskine Bowles (D), co-chair of the National Commission on Fiscal Responsibility and Reform, called "death panels" "a kind of crazy stuff" and added that end-of-life care in the U.S. needed reform.[84]

Palin reaction

On August 12, five days after her initial Facebook note, Palin posted another, defending her debunked charge. She charged that "the elderly and ailing would be coerced into accepting minimal end-of-life care to reduce health care costs"[81] so it was misleading for Obama to say the sessions would be entirely voluntary. PolitiFact responded that Palin's assertion was false and that the sessions were voluntary.[38] On August 12 she also charged on Twitter that Britain's NHS was an evil "death panel", leading to so many replies from British citizens defending the NHS that Twitter crashed.[85] Disabled professor Stephen Hawking led the responses, saying "I wouldn't be alive today if it weren't for the NHS."[85]

In a September 2009 speech in Hong Kong, Palin said the term was "intended to sound a warning about the rationing that is sure to follow if big government tries to simultaneously increase health care coverage while also claiming to decrease costs."[86] In November 2009 Palin said that Obama was "incorrect" and "disingenuous" when he called the "death panel" charge "a lie, plain and simple."[87] In the National Review she said

"[t]o me, while reading that section of the bill, it became so evident that there would be a panel of bureaucrats who would decide on levels of health care, decide on those who are worthy or not worthy of receiving some government-controlled coverage ... Since health care would have to be rationed if it were promised to everyone, it would therefore lead to harm for many individuals not able to receive the government care. That leads, of course, to death."[17][88]

She explained that the term should not be taken literally, likening it to when President Ronald Reagan called the Soviet Union, the "Evil Empire."[88] "He got his point across. He got people thinking and researching what he was talking about. It was quite effective. Same thing with the 'death panels'. I would characterize them like that again, in a heartbeat", she said.[88] Media Matters stated that "Palin's claim of 'death panels' comprised of bureaucrats deciding who is 'worthy of health care' is simply false, regardless of whether she meant it literally or figuratively."[89]

In December 2009 Palin warned on Twitter that a merged health care bill could have the "death panels" restored.[90] In October 2010, Palin defended her use of the term in a Newsmax.com interview. Palin said she

"... spoke a lot about the rationing of care that was going to be a part of Obamacare, and, you know, I was about laughed out of town for bringing to light what I call death panels, because there's going to be faceless bureaucrats who will—based on cost analysis and some subjective idea on somebody's level of productivity in life—somebody is going to call the shots as to whether your loved one will be able to receive health care or not. To me, death panel. I called it like I saw it, and people didn't like it."[91]

Palin used the term in a joke while speaking at the 2009 Gridiron Club dinner, saying "It is good to be here and in front of this audience of leading journalists and intellectuals. Or, as I call it, a death panel."[92][93]

Impact

Political

Consultation payments were removed from the Senate version of the bill by the Senate Finance Committee.[50] TIME wrote that "a single phrase—'death panels'—nearly derailed health care reform".[94] The Washington Post wrote that "President Obama's health-care initiative was nearly consumed by the furor" over the end-of-life care provision that would allow physician reimbursement for counseling.[44]

By mid-August 2009, about a week after Palin's initial Facebook note, the Pew Research Center reported that 86% of Americans had heard of the "death panels" charge.[2] Out of those who had heard the charge, 30% of people thought it was true while 20% did not know.[2] For Republicans, 47% thought it was true while 23% did not know.[2] Oberlander said the false warnings of a government takeover and "death panels" from Republicans drowned out the "Democrats' focus group–tested mantra of 'quality, affordable health care' ".[65] Morone said the White House was not able to offer a "persuasive narrative to counter the Tea Party percussion", and "struggled to recapture public attention", contributing to Republican Scott Brown's election.[66] The election of Brown in the special Senate election in Massachusetts was a surprise victory for Republicans[95] and a setback for the chance of health care reform under Democratic leadership; Brown won the historical Senate seat of the late Democrat Ted Kennedy, ending the Democrat's supermajority of 60 in the Senate.

In September 2010, six months after the passage of the Affordable Care Act, a BBC article stated that among the "sticky charges" that had stuck against the bill was the false charge of "government 'death panels' deciding who can get what sort of care".[96] A survey by the Regence Foundation and National Journal released in 2011 showed 40% of Americans knew that the "death panels" were not in the Affordable Care Act, while 23% said they thought the law allowed government to make end-of-life care decisions on behalf of seniors, and 36% said they did not know.[97] Other findings from the survey included:

  • 78% thought palliative care and end-of-life issues should be in the public discourse;
  • 93% thought those decisions should be a top priority in the US health care system;
  • 70% agreed with the idea that "It is more important to enhance the quality of life for seriously ill patients, even if it means a shorter life" while 23% placed more importance on extending life through any possible medical treatment;
  • Doctors, family, and friends were highly trusted sources for end-of-life care information while only 33% trusted elected officials or political candidates for accurate information.[97]

Social

Atul Gawande, a physician who writes on health care topics for The New Yorker, said "that the whole death panel reduction and reaction to it" temporarily "shut down our ability to even have a national discussion about how to have the right [end-of-life] conversation" between doctors and patients.[98]

When investigating for his article "Letting Go", Gawande was asked to refrain from writing about palliative care by physicians who were concerned the article might be manipulated to create another political controversy—and as a result, hurt their profession.[99][100] Professor Harold Pollack wrote that given the "anxieties captured in the crystalline phrase 'death panel,' I would not commence a national cost-control discussion within the frightening and divisive arena of end-of-life care."[101]

Bishop et al. were fearful of how their publication[102] on CPR/DNR would be received by the medical and bioethics communities. They were concerned because in "the era of rhetoric centered on fictional 'death panels' " their paper addressed "the quest for immortality implicit in US culture, a culture of 'life-at-all costs' that medical technology has advanced".[103] Bishop et al. interpreted cautioning comments from their peers[104] as a suggestion "that land mines of 'death panels' await us".[103]

PolitiFact.com gave Palin's claim its lowest rating—"Pants on Fire!"—on August 10[3] and on December 19 it was named "Lie of the Year" for 2009.[17][105][106] "Death panel" was named the most outrageous term of 2009 by the American Dialect Society.[107] The definition was given as "A supposed committee of doctors and/or bureaucrats who would decide which patients were allowed to receive treatment, ostensibly leaving the rest to die".[108][107] FactCheck called it one of the "whoppers" of 2009.[109]

Media analysis

Megan Garber of the Columbia Journalism Review called the topic "irresistable" to reporters because it covered conflict, drama, innuendo, and Sarah Palin.[110] Garber said it was "notoriously challenging for the press to deal with" because the old method of deligitmization—ignoring—was no longer workable.[110] "Debunking rumors without simultaneously sanctioning them has always been a fraught endeavor, with the proliferation of niche media sites over the past several years only rendering that effort even more precarious," said Garber.[110]

A study by Regina G. Lawrence, a communications professor, and Matthew L. Schafer, a Juris Doctor candidate, found that "the mainstream news, particularly newspapers, debunked 'death panels' early, fairly often, and in a variety of ways, though some were more direct than others."[111] Of the journalists that reported the charge as false, 30% presented information in a he said/she said style, often confusing readers.[111] Of the reports that presented "death panels" as false, 75% did not include an explanation.[111] Lawrence and Schafer said that "the dilemma for reporters playing by the rules of procedural objectivity is that repeating a claim reinforces a sense of its validity—or at least, enshrines its place as an important topic of public debate. Moreover, there is no clear evidence that journalism can correct misinformation once it has been widely publicized. Indeed, it didn't seem to correct the death panels misinformation in our study."[111]

Brendan Nyhan concluded his study on the "death panel" myth with two recommendations to improve future media performance.

"... [U]ntil the media stops giving so much attention to misinformers, elites on both sides will often succeed in creating misperceptions, especially among sympathetic partisans. And once such beliefs take hold, few good options exist to counter them—correcting misperceptions is simply too difficult. The most effective approach may therefore be for concerned scholars, citizens, and journalists to (a) create negative publicity for the elites who are promoting misinformation, increasing the costs of making false claims in the public sphere, and (b) pressure the media to stop providing coverage to serial dissemblers."[2]

In contrast to the above statements suggesting there is no good method to correct misinformation in the minds of the public, MIT professor Adam Berinsky has found some success when people are exposed to corrective information from sources that belong to the same political party as the misinformer.[1]

Continued use

In response to legislation in Arizona which cut Medicaid funding for previously approved transplants,[112] E.J. Montini of The Arizona Republic used the term,[113] as did Keith Olbermann of MSNBC.[114] Montini referred to Republican Governor Jan Brewer as "Governor Grim Reaper" and both Brewer and the Republican-controlled legislature as a "death panel".[115] An editorial by USA Today said, "to the extent that death panels of a sort do exist, they're composed of state officials who must decide whether each state's version of Medicaid will cover certain expensive, potentially life-saving treatments."[116]

Rep. Phil Gingrey

Palin applied the term to the IPAB.[117] After the National Commission on Fiscal Responsibility and Reform released its recommendation to strengthen the IPAB, she charged in the Wall Street Journal that the board was " 'death panel'-like".[118] FactCheck found her characterization of the board wrong on three counts.[119] Representative Phil Roe (Republican-Tennessee), who has twice sponsored bills to eliminate the IPAB, said he would associate the term with the IPAB.[117] Roe was described by the The Washington Post as "a kindred soul by the medical industry" in part for his legislative efforts against the IPAB and a "magnet during the last election for more than $90,000 in contributions from medical professionals from across the country".[120][121] Rep. Phil Gingrey (Republican-Georgia), an OB/GYN, issued a factually inaccurate statement, described by PolitiFact as outrageous,[122] that was in line with the "death panels" narrative.[123][124]

In October 2010, The Philadelphia Inquirer highlighted the term in its "The Week in Words" article[125] after Barney Frank said the only "death panels" created by congressional Democrats were for troubled financial institutions under the authority of the Dodd–Frank Bill.[126]

In November 2010, Paul Krugman was deliberately provocative on This Week, calling for "death panels and sales taxes" to fix the budget deficit. Krugman clarified that "health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they’re willing to pay for—not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care."[127]

In his 2011 book, Mike Huckabee claimed that the Federal Coordinating Council for Comparative Effectiveness from the 2009 stimulus were the seeds from which "the poisonous tree of death panels will grow."[128] Media Matters called this a "lie"; it reported that Huckabee mischaracterized the council and that it was eliminated in the 2010 health care reform.[129][130] Paul Van de Water of the Center on Budget and Policy Priorities, said "Huckabee seems to be suggesting that we shouldn't do research to find out what medical procedures work best just because that research could conceivably be misused. The new law makes every effort to assure that won't happen."[129]

See also

References

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