“The Death Panels Are Coming”: Conservatives Are Going To Have To Turn Somewhere, And I’m Guessing “Rationing” Will Be On Their Lips
Now that Healthcare.gov seems to be working reasonably well (at least on the consumer end), Republicans are going to have to find something else they can focus on in their endless war against the Affordable Care Act. So get ready for the return of “death panels.”
They never really went away. Those who aren’t immersed in the fantasy world in which conservatives move were reminded of that last week, when chronicler of changed games Mark Halperin, the embodiment of most everything that’s wrong with contemporary political journalism, did an interview with the conservative news organization Newsmax. When the interviewer mentioned “death panels, which will be coming,” Halperin responded, “I agree, it’s going to be a huge issue, and that’s something else about which the President was not fully forthcoming and straightforward.” Halperin didn’t explain what lie he imagines Obama told about death panels (perhaps he thinks that when Obama said the government wouldn’t declare your grandmother unfit to live and have her murdered, he wasn’t telling the truth), but what matters isn’t Halperin’s own ignorance of the law (after all, understanding policy is for nerds, right?), but the fact that it came up in the first place. Which, if you pay attention to places like Newsmax, it still does. A lot.
But wait, you say. Wasn’t this all debunked years ago? Yes, it certainly was. But why should that matter?
It’s important to remember the switcheroo conservatives pulled on the “death panel” issue. They started off complaining that one provision in the law constituted “death panels,” then when their unequivocal lie was exposed and condemned roundly even by neutral observers, they switched to asserting that all along they had been talking about an entirely separate and unrelated provision, and when they say “death panels” they aren’t talking about death, or panels for that matter, but about health care “rationing.”
Here’s how it happened. The ACA originally included a provision allowing doctors to get reimbursed by Medicare for sessions in which they counseled their patients about their end-of-life options and how to make sure their wishes were properly carried out. The problem is that most of the time, when a patient shows up in the hospital in crisis, the staff has no idea what the patient wants if they can’t communicate. Do they want to be resuscitated, or intubated, or have every heroic measure taken until the moment they expire? All of us have different ideas about this, and it’s important that we think about it beforehand. So the ACA said, if a doctor spends a half hour talking to a patient about it, they’ll be paid for their time. It didn’t say what they had to tell them, it just said they could get paid for doing it, because right now if they do that counseling, they’re doing it for free, which makes it much less likely to occur, which is not only bad for the system but bad for individual patients.
So that part of the law said simply that doctors can bill Medicare for the time they spend doing that kind of counseling, just like they do for a physical exam or performing a procedure. To the people who supported it, the idea seemed commonsensical. Wouldn’t you want doctors and patients to have those kinds of conversations? You’d think. But turning that into the “death panel” lie began, as a remarkable number of health care lies have in the last couple of decades, with policy fraudster Betsy McCaughey, who went on Fred Thompson’s radio show in 2009 while the law was being debated and told his listeners, “Congress would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.” That would be terrible! It would also be terrible if our beloved elders were then hurled from hot air balloons hovering over volcanoes, but the law doesn’t require that either.
Unlike most deceptions in politics, which can be justified by pleading that there was some misinterpretation of ambiguous language, or that what the speaker meant just got garbled in the articulation, this was a clear and specific lie—or two lies, in truth—that McCaughey simply made up in her attempt to subvert the law and then repeated multiple times. There was nothing mandatory or required about counseling, every five years or ever, for any patient, and the counseling was not about “how to end their life sooner.”
To continue our story, then Sarah Palin took things the next step, turning a blatant lie (but at least one with some connection to what the law was about) and spinning it out into an extravagant fantasy one can only imagine came from some obscure 1970’s dystopian sci-fi movie she saw at four in the afternoon one day while the snow fell gently in Wasilla. “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,'” she wrote on her Facebook page, “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.” 11 The quotation marks were a nice touch, since we in the English-speaking world use them to denote actual quotes from a specific person or document, not just something you make up. For instance, I could write, “I wouldn’t like to go to Sarah Palin’s house, where ‘heroin is given to children’ and ‘homeless men are hunted for sport.'” But that would be extremely misleading, since as far as I know, no one has said those things about Sarah Palin’s house, least of all Palin herself. And thus “death panels” were born.
And of course, the charge was picked up by Fox News, and Rush Limbaugh, and all the other far-flung outlets of the conservative media universe. But then the existence of any such panel was debunked and debunked and debunked again. The fact that the evocative phrase originated with Palin probably made it more difficult for conservatives to make it stick beyond their own self-contained world, since Palin is widely understood to be one of America’s most celebrated nincompoops. In addition, cowardly Democrats removed the provision on end-of-life counseling from the bill (to their unending shame) so even the entirely worthy provision of the law was gone. In response, conservatives cast about, and decided that the “death panels” they so feverishly warned of never referred to end-of-life counseling, but to the Independent Payment Advisory Board (IPAB), which did end up in the final bill and which has the benefit of resembling an actual panel.
In brief: the IPAB is a group of 15 health-care experts appointed by the president and confirmed by the Senate who will make recommendations on how Medicare could save money. Those recommendations are due at the beginning of each year, and Congress has until August to overrule them. If Congress doesn’t, the Secretary of Health and Human Services will implement the recommendations. But the IPAB only makes the recommendations if Medicare’s growth exceeds certain target rates.
Now listen to this part carefully: the text of the ACA prohibits the IPAB from recommending that care be rationed. It also prohibits them from recommending other things, like increasing premiums or cutting benefits. And perhaps most importantly, if Medicare’s growth is modest, IPAB won’t make any recommendations at all. And if things go the way they’ve been going and the way they will if many of the other reforms contained within the ACA succeed (including steps to transition from a purely fee-for-service model in which sicker patients means more revenue for providers to one in which they have incentives to keep people healthy), the IPAB might never have to make cost-cutting recommendations. Although things could change of course, the Congressional Budget Office believes that for the next decade Medicare’s growth is unlikely to be large enough to trigger any IPAB recommendations.
You may wonder why conservatives, who are constantly saying we need to control the cost of Medicare, are so vehemently opposed to the existence of a panel of experts whose job it is to come up with ways to control the cost of Medicare. That just shows how little you understand. IPAB, they will tell you, will ration care, which will kill your grandmother, no matter what the law says. 22These kinds of claims, and a general feeling of hysteria around end-of-life issues, circulates relentlessly throughout the conservative world. You may remember that during the 2012 presidential primaries, Rick Santorum told an audience that in the Netherlands, which has a tightly regulated system of physician-assisted suicide, “people wear different bracelets if they are elderly. And the bracelet is: ‘Do not euthanize me.’ Because they have voluntary euthanasia in the Netherlands but half of the people who are euthanized—ten percent of all deaths in the Netherlands—half of those people are euthanized involuntarily at hospitals because they are older and sick.” This was about as true as if he had said that all Portugese people have ESP or that Mongolia is ruled by a parliament made up of dogs and cats. But he didn’t get his fantasy bracelets and fantasy statistics from nowhere—the idea surely arrived to him via the cretinous version of the “telephone” game that is the conservative information bubble, where such things circulate and mutate until they come out the mouths of candidates for president. Just as a for instance, go on over to National Review and search for IPAB, and you come up with articles with titles like, “AARP Betrays Seniors By Supporting IPAB,” and “IPAB, Obama, and Socialism,” and “New England Journal of Medicine Supports Unamerican Expansion of IPAB.” As I said, once they can no longer complain about healthcare.gov, and once those people who had their junk insurance cancelled turn out to be getting much better insurance, conservatives are going to have to turn somewhere, and I’m guessing “rationing” will be on all their lips.
So what started as “Obama is forcing doctors to encourage their patients to die,” then became “Obama’s death panel will assess individuals one by one and withhold treatment from those they find unworthy, leaving people like Sarah Palin’s kid to plead for their very lives,” ends up as “Obama’s IPAB death panel will force health-care rationing on us.”
I do think that the chances that renewing the “death panel” scare will successfully undermine the ACA are slim. The fact that they don’t exist does matter. If you’re a reporter wanting to write a story about someone who lost their junk insurance and will have to buy real coverage, at least there are individuals you can focus on, even if you do a poor job of telling their stories. But there’s no one you can interview who went before a death panel, or whose relative went before a death panel. Because, to repeat myself, they don’t exist. So this whole discussion is likely to remain very abstract. Eventually, conservatives will find something else to cry wolf about. Did you know that under Obamacare, if you kiss a person with herpes, you could get herpes? That’s right: Obamacare will give you herpes. Pass it on.
By: Paul Waldman, Contributing Editor, The American Prospect, December 2, 2013
“If Preventing Hospital Layoffs Is So Important”: Maybe Republicans Should Stop Blocking Obamacare Medicaid Expansion
If you received an email this week from your angry uncle who watches Fox News all day, outraged by reports that “Obamacare” is causing layoffs at the Cleveland Clinic, let him know he can relax.
On November 25, The Daily Caller published an article titled, “Top U.S. hospital laying off staff due to Obamacare.” On Fox Business’ Markets Now, host Connell McShane reported on the “massive layoffs.” America’s Newsroom host Bill Hemmer claimed that the Cleveland Clinic was going to “shed workers.” Later, during the America’s News HQ, Fox reporter Chris Stirewalt claimed that the layoffs “rocked the community there in northeastern Ohio.”
But there’s one problem: the Cleveland Clinic is not laying off any employees.
Imagine that. After conservative media ran with this, Media Matters talked to Eileen Sheil, the Cleveland Clinic’s Executive Director of Corporate Communications, who said, “There have been several mis-reports and they keep mentioning that we’re laying off 3,000 employees. We’re not.” The medical facility is offering voluntary retirement to 3,000 eligible employees, but those aren’t “massive layoffs,” and blaming the Affordable Care Act for staffing decisions that have happened elsewhere for years is a stretch.
Indeed, Sheil added that the Clinic supports the law conservative media is so eager to denigrate: “We believe reform is necessary because the current state is unsustainable. The ACA is a step toward that change and we believe more changes will come/evolve as there are still many uncertainties. Hospitals must be responsible and do what we can to prepare and support the law.”
And while this incident offers another reminder about the reliability of conservative media outlets, there’s another angle to keep in mind. Though it doesn’t get as much attention as it should, Medicaid expansion is incredibly important to state hospitals, which will struggle badly in Republican-led states that reject the policy. Indeed, in some states, hospitals may end up closing their doors altogether, at least in part due to the political decision.
And when state hospitals close, there are actual “massive layoffs,” which affect the employees and the economy. It’s one of the reasons so many hospitals lobby Republican officials in “red” states to be more responsible on Medicaid expansion, though their appeals are generally ignored.
So here’s the question for conservative media: when hospital staffs are laid off because Republicans blocked Medicaid expansion, and it’s “Obamacare” that could have saved those jobs, how many reports will we see chastising GOP officials for their callousness and economic recklessness?
Probably not too many. Call it a hunch.
By: Steve Benen, The Maddow Blog, November 27, 2013
“Exploiting Consumers”: Republican Obamacare “Fix” Is Junk, Just Like The Junk Insurance Plans It Protects
In an effort to cynically score political points, the Republicans have taken up the cause of people who have received health insurance “cancellation” notices. The problem is that the Republicans aren’t helping these people, they are exploiting them. They’re peddling a “fix” that will stick consumers with lousy insurance policies, put the insurance companies back in charge of our health care and deceive people who deserve a straight answer about what’s going on with their health coverage.
If you’re one of the people who received a notice, it’s unsettling and confusing to say the least — and you don’t need a political party to play politics with your life. You need to know the truth and learn the available options.
People are receiving cancellation notices because they were sold health insurance policies that provide bare-bones coverage and expose them to financial ruin if they get sick or injured. Insurance companies sold these plans knowing full well that consumers could not keep them after the Affordable Care Act (ACA) standards are fully implemented on Jan. 1. The insurance companies didn’t tell their clients that they couldn’t keep the plans they sold them, and they certainly didn’t tell them that the plans were junk. Now the Republicans want to allow the industry to continue to sell these policies for another year in the name of letting people keep the plans “they like.” This is hypocrisy and politics at its worst, not to mention terrible policy.
There are roughly 15 million Americans who buy health plans in the individual market, and they represent 5 percent of people with private insurance. About half of them got cancellation notices, which naturally leaves people anxious to find out what they’ll do next year.
Instead of passing a law allowing insurers to keep selling bad policies that provide little for their premium money, we should tell people what their coverage options are and how much better they’ll do under the ACA. Because the enrollment web site HealthCare.gov has yet to work properly, most folks don’t realize they will save money and get better insurance if they shop in the new insurance marketplaces and take advantage of generous instant tax credits that will drastically cut their premiums.
People can save a lot of money when they buy their insurance through the online marketplaces: Seventeen million people will qualify for tax credits to reduce the cost of their insurance. As many as 7 million people may have no premium costs at all. Six of 10 uninsured Americans will pay $100 or less in monthly premiums. While it sucks to get canceled, the vast majority of those folks will see that getting coverage through the ACA marketplaces is a better deal.
The GOP-led legislation is bad public policy. It will disrupt the insurance market and make things worse now and in the future. You can’t mend our broken health insurance system if millions of people can opt out of participating in it. That’s how we got into this mess in the first place.
Allowing inferior insurance plans to exist alongside quality ACA policies will destroy the economic foundation of the law — the idea that financial risk must be spread and shared — and give our health care back to the insurance companies. Nothing could be worse for the health and the pocketbooks of everyday Americans.
For example, the Republican proposal would prompt younger, healthier people to opt out of enrolling in the marketplace plans, meaning the ACA policies will cover mostly older and sicker people who are more costly to insure. As a result, marketplace premiums would spike and millions of Americans would lose out on health coverage they can afford. People would be denied insurance or charged sharply higher premiums because of their medical history. Consumers would be at the mercy of the health insurance companies. That’s not why we enacted health reform. America reformed our health insurance system so everyone could have insurance with real benefits — not benefits that are only revealed to be phony in the middle of a medical crisis. We did it based on the simple principle that we all do better when we all do better.
The Republican bill would be a disaster for consumers. As we learned during the drive to pass the ACA, junk policies cause nothing but trouble. There are millions of stories of bankruptcy filings, homes and jobs lost, college educations abandoned and dreams deferred because someone with fake insurance got sick and was overwhelmed by medical bills. We can’t go back to those days.
The GOP is using overhyped cancellation stories as a pretext to destroy the ACA, a law they have attacked with a single-minded fervor never before seen in American politics. When the Republicans’ bill, H.R. 3350, reaches the floor, it will be the House GOP’s 46th vote to repeal Obamacare.
Any fixes to the Affordable Care Act should be judged by whether they help people and improve the law. The Republican-led proposal does neither.
By: Ethan Rome, HCAN Blog, November 14, 2013
“The Impoverished Republican Poverty Agenda”: Republicans Don’t Know Where They Are Headed Or What They Can Sell
What are Republicans for? We know they are against health-care reform. They voted en masse against it, shut down the government to stop it and have voted nearly 50 times to defund it. We know they are against government spending. They’ve voted for House Budget Committee Chairman Paul Ryan’s draconian budgets, which would slash spending so deeply that even some Republicans are in increasingly open revolt. But those budgets don’t go anywhere. So what do Republicans propose that actually addresses the challenges facing the nation or its people?
Republican leaders are clearly concerned that their policy house is largely vacant. In his dissection of the lost 2012 campaign, Republican National Committee Chair Reince Priebus noted that Republicans suffer a “major deficiency” – the “perception that the GOP does not care about people.” He urged a renewed effort to become “the champion of those who seek to climb the economic ladder.”
All that advice was lost in the anti-Obama venom that unifies Republicans. But after the government shutdown sent Republican poll numbers plummeting to new depths, a new effort – or at least a new public relations push – has been launched. The early reports make the administration’s botched health-care takeoff look smooth by comparison.
Politico noted that Republicans trooping into House Majority Leader Eric Cantor’s office received a paper titled “Agenda 2014.” The paper was blank. As of now, Politico reported, details are scant, but Republicans seem to be focused more on identifying the problems than the solutions. “The beginning should always be what are the problems we’re trying to fix,” said Republican policy chair James Lankford (Okla). Or as a GOP aide involved in the planning sessions was quoted: “Cantor wants to take us in a new direction, which is good. The problem is that we don’t know where we are headed, and we don’t know what we can sell to our members.”
Luckily, Cantor isn’t the only game in town. The Post published an adoring article on Ryan, Mitt Romney’s former running mate. The Post reported that Ryan and his staff have been “quietly” visiting “inner-city neighborhoods” and conservative think tanks, looking for creative ways to address poverty that can replace the “bureaucratic top-down anti-poverty programs” that Ryan’s budget would gut.
But the new ideas can’t include any new taxes or new spending – Ryan is staunchly against both. That doesn’t leave much. According to The Post, “his idea of a war on poverty so far relies heavily on promoting volunteerism and encouraging work through existing federal programs, including the tax code.” He’s repackaging private-school vouchers. And Ryan assumes that charity might take the place of the food stamps he’s cutting. “You cure poverty eye to eye, soul to soul,” he told a Heritage Foundation forum. “Spiritual redemption: That’s what saves people.” Prayer is good, but when it comes to public policies, as The Post story concluded, “Ryan’s speeches have been light on specifics.”
Some of those “specifics” are being offered by the tea party. Ryan and Cantor may be casting about for ways to look compassionate, but the tea party remains on the hunt. Politico detailed that Rep. Tim Heulskamp (Kan.) and a group of conservatives are gearing up for yet another assault on health-care reform. Assuming that the budget negotiations don’t reach an agreement by the December deadline, Congress will have to pass a continuing resolution by mid-January to keep the government open and funded. Huelskamp and his allies think that’s a perfect time to cut $20 billion out of Medicaid and transfer it to the Pentagon. That would eliminate Medicaid expansion – the one part of Obamacare that is working well – and placate Republicans worried about the cuts the military faces next year.
Cut health protection for the working poor and give the money to a Pentagon that is the largest center of waste, fraud and abuse in the federal government? Or slash food stamps while fending off every effort to close the tax dodges that allow companies like General Electric to avoid paying any taxes? The Republican “war on poverty” looks a lot like a war on the poor. It will take a lot of charity and volunteers and a lot more than “messaging” and “rebranding” to erase that indelible “deficiency.”
By: Katrina vandel Heuvel, Opinion Writer, The Washington Post, November 26, 2013
“Rooting For Failure”: Hard To Remember A Time When A Major Political Party And Its Media Arm Rooted For Fellow Americans To Lose
I just spent 15 minutes on my local health care exchange and realized that I could save a couple hundred dollars a month on my family’s insurance. Of course, I live in Washington State, which has a very competitive market, a superbly functioning website and no Koch-brothers-sponsored saboteurs trying to discourage people from getting health care.
California is just as good. It’s enrolling more than 2,000 people a day. New York is humming as well. And Kentucky, it’s the gold standard now: More than 56,000 people have signed up for new health care coverage — enough to fill a stadium in Louisville.
This is terrible news, and cannot be allowed to continue. If there’s even a small chance that, say, half of the 50 million or so Americans currently without heath care might get the same thing that every other advanced country offers its citizens, that would be a disaster.
But not to worry. The failure movement is active and very well funded. You probably know about the creepy Uncle Sam character in ads financed by the Koch brothers. Sicko Sam is seen leering over a woman on her back in a hospital exam room, her legs in stirrups. This same guy is now showing up on college campuses, trying to get young people to opt out of health care. On some campuses, he plies students with free booze and pizza — swee-eeet!
The Republican Party started a failure campaign earlier this year, but then the strategy got sidetracked in a coercive government shutdown that cost us all $24 billion or so. With the disastrous rollout of the federal exchange, Republicans now smell blood. A recent memo outlined a far-reaching, multilevel assault on the Affordable Care Act. Horror stories — people losing their lousy health insurance — will be highlighted, and computer snafus celebrated.
Ron Paul, the nuttier of the two political Pauls, recently suggested to a crowd in Virginia that “nullification” of the health care law might be the best way to kill it. I’m not sure what he meant by that, but it sounds illegal.
It’s hard to remember a time when a major political party and its media arm were so actively rooting for fellow Americans to lose. When the first attempt by the United States to launch a satellite into orbit, in 1957, ended in disaster, did Democrats start to cheer, and unify to stop a space program in its infancy? Or, when Medicare got off to a confusing start, did Republicans of the mid-1960s wrap their entire political future around a campaign to deny government-run health care to the elderly?
Of course not. But for the entity of the Obama era, Republicans have consistently been cheerleaders for failure. They rooted for the economic recovery to sputter, for gas prices to spike, the job market to crater, the rescue of the American automobile industry to fall apart.
I get it. This organized schadenfreude goes back to the dawn of Obama’s presidency, when Rush Limbaugh, later joined by Senator Mitch McConnell, said their No. 1 goal was for the president to fail. A CNN poll in 2010 found 61 percent of Republicans hoping Obama would fail (versus only 27 percent among all Americans).
Wish granted, mission accomplished. Obama has failed — that is, if you judge by his tanking poll numbers. But does this collapse in approval have to mean that the last best chance for expanding health care for millions of Americans must fail as well?
Does this mean we throw in the towel, and return to a status quo in which insurance companies routinely cancel policies, deny health care to people with pre-existing conditions and have their own death panel treatment for patients who reach a cap in medical benefits?
The Republican plan would do just that, because they have no plan but to crush the nation’s fledgling experiment. Sometimes they bring up vouchers, or tort reform, or some combination of catchphrases. Here was Sarah Palin, who is to articulate reason what Mr. Magoo is to vision, on the Republican alternative, as she told Matt Lauer:
“The plan is to allow those things that have been proposed over many years to reform a health care system in America that certainly does need more help so that there’s more competition, there’s less tort-reform threat, there’s less trajectory of the cost increases. And those plans have been proposed over and over. And what thwarts those plans? It’s the far left.”
Yes, it is a big and legitimate news story, for a presidency built on technical expertise, that the federal exchange is not working as promised. Ditto Obama’s vow that people could keep their bottom-feeder health care policies.
But where were the news conferences, the Fox News alerts, the parading of people who couldn’t get their lifesaving cancer treatments under the old system? Where was the media attention when thousands of people were routinely dumped once they got sick? When did Republicans in Congress hold an oversight hearing on the leading cause of personal bankruptcy — medical debt?
All of that is what we had before. And all of that is what we will return to if some version of the Affordable Care Act is not made workable. Republicans have a decent chance, in next year’s elections, of killing the dream of progressive presidents going back to Teddy Roosevelt. But they shouldn’t count on it. What’s going against them, or any party invested in failure, is that Americans are inherently optimistic. That alone may be enough to save Obamacare.
By: Timothy Egan, Contributing Op-Ed Writer, The New York Times, November 28, 2013
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