Despite Dismissive Media, Palin's 'Death Panels' Resurface in WH Rationing Schemes

April 27th, 2010 7:29 PM

PolitiFact called it the Lie of the Year, and journalists left and right (but mostly left) dismissed the claim as hyperbole at best, and fear-mongering propaganda at worst.

But Sarah Palin's "death panel" comment may not be as off the mark as so many have claimed. Don't take her word for it. White House budget director Peter Orszag apparently agrees.

Well, Orszag didn't specifically address Palin's claim, but his description of Medicare's new Independent Payment Advisory Board tried to cast health care rationing in nice rosy terms.

Speaking at the Economic Club of Washington, Orszag stated (video below the fold):

The only real solution to our long-term fiscal imbalance, because it's driven disproportionately by the rate at which health care costs grow, is to move towards a health care system that is based on quality and efficiency, rather than quantity

Everyone agrees that we can no longer afford to just pay for quantity. That is a fee for service system where doctors and hospitals are reimbursed based on volume. I think folks have not really focused on the Medicare commission, the Independent Payment Advisory Board that's created. This institution could prove to be far more important to the future of our fiscal health than for example the Congressional Budget Office. It has an enormous amount of potential power…

So this Independent Payment Advisory Board has the power and the responsibility to put forward proposals to hit a pretty aggressive set of targets over the long term. And furthermore, the proposals take effect automatically, unless Congress not only specifically votes them down but the President signs that bill. So the default is now switched in a very important way on the biggest driver over long-term cost, which is the Medicare program…

Again, a lot will depend on whether it realizes its potential, and how the culture develops, but it has statutory power to put forward proposals to reduce health care cost growth overtime and improve quality, and those proposals take effect automatically if Congress ignores them, or if Congress votes them down and the President vetoes that bill. So in other words, inertia now plays to the side of this independent board.

So health care costs disproportionately drive our fiscal train wreck of a federal budget into the red, and this panel -- made up of unelected non-doctor bureaucrats -- has been charged with meeting "a pretty aggressive set" of financial targets by reducing the quantity of medical care Americans receive.

Boy, that sounds a lot like rationing. In fact, that's pretty much the definition of the word: to "restrict the consumption of a relatively scarce commodity." It doesn't matter if care is being rationed "for the public good" or who the bureaucrats are that populate the panel, or what they do (unless they are doctors, but in this case they aren't). Care will be rationed.

Now, the bill claims otherwise. It states that the Medicare panel "shall not include any recommendation to ration health care ... or otherwise restrict benefits or modify eligibility criteria." Phew. Disaster averted. Palin marginalized. But wait, just a couple paragraphs further, the bill demands that the panel "give priority to recommendations that extend Medicare solvency."

Well Orszag just informed us that the federal budget is plummeting towards fiscal catastrophe, and Medicare is the primary driver. So if Medicare itself is to remain solvent, deep, deep cuts need to be made. Orszag seems to realize this fact -- hence the "pretty aggressive" targets.

Reducing Medicare costs is the only way to keep the system solvent, and Orszag has just informed us that reducing the quantity of care is the way to do that. He is not the first administration official to say so. Reducing costs takes precedence over the legislation's "rationing" restrictions, so as long as Medicare is up to its eyes in red ink, rationing will be a cause for concern.

The bill also requires the panel "include recommendations that target reductions in Medicare program spending to sources of excess cost growth." As you may have expected, the panel, not Medicare patients and their doctors, determines what constitutes "excess cost growth."

Now, there is the question of whether or not the Medicare board can or should be called a "death panel," but that is a question of style, not substance.

Palin wrote in her recent book "Going Rogue,"

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…

The term I used to describe the panel making these decisions should not be taken literally.

In other words, there is no euthanasia involved, but by limiting the options available to American health care consumers with the explicit goal of saving on costs, the panel -- again, not populated by doctors -- is necessarily hindering the quality of care patients can receive. For the patient who is denied treatment in the name of Medicare's solvency, it is indeed a "death panel."

PolitiFact did not return a request for comment regarding its Lie of the Year. But the watchdog site was far from the only outlet to disregard Palin's concerns.

MSNBC's Lawrence O'Donnell gleefully proclaimed the former Alaska Governor "Palinocchio." The Washington Post's Ceci Connolly called the "death panel" debate a "sideshow … from a very serious debate." The Nation's Richard Kim claimed the entire issue was bred from "hysteria."

But with Orszag's statement, it seems well within reason that the new bill -- though we're still in the process of deciphering its contents -- will create a Palinian death panel, not to "euthanize granny," but simply to ration care. Of course he is not the first administration official -- nor the first journalist -- to laud the necessity of health care rationing.

This panel will decide which treatments will be offered or covered by insurance companies. If you relied on a treatment that is no longer covered, well, best of luck to you.