(Originally posted on What’s Wrong with the World)
This, just up, from Sarah Palin on her Facebook page (with footnotes too!):
Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly, and the disabled would suffer the most under such rationing; and that under such a system these “unproductive” members of society could face the prospect of government bureaucrats determining whether they deserve health care.
The President made light of these concerns. He said:
“Let me just be specific about some things that I’ve been hearing lately that we just need to dispose of here. 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 because we’ve decided that we don’t, it’s too expensive to let her live anymore….It turns out that I guess 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, etc. 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.” [1]
The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” [2] With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.
Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual … or upon admission to a skilled nursing facility, a long-term care facility… or a hospice program.” [3] During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services. [4]
Now put this in 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.” [5] 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? As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones…. If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” [6]
As Lane also points out:
Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.
Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic. [7]
Even columnist Eugene Robinson, a self-described “true believer” who “will almost certainly support” “whatever reform package finally emerges”, agrees that “If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.” [8]
So are these usually friendly pundits wrong? Is this all just a “rumor” to be “disposed of”, as President Obama says? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:
Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives…. It is egregious to consider that any senior citizen … should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. [9]
Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens….An obvious example is not guaranteeing health services to patients with dementia.” [10] Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” [11]
President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.
[1]See http://blogs.abcnews.com/politicalpunch/2009/08/president-obama-addresses-sarah-palin-death-panels-wild-representations.html.
[2]See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[3]See HR 3200 sec. 1233 (hhh)(1); Sec. 1233 (hhh)(3)(B)(1), above.
[4]See HR 3200 sec. 1233 (hhh)(1)(E), above.
[5]See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[6]See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html].
[7]Id.
[8]See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.html].
[9]See http://www.nysenate.gov/press-release/letter-congressman-henry-waxman-re-section-1233-hr-3200.
[10] See http://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf
[11]See http://www.scribd.com/doc/18280675/Principles-for-Allocation-of-Scarce-Medical-Interventions.
August 13th, 2009 | 3:59 pm
Despite what Secondhand Smoke says about Palin’s choice of words, I think she nailed it!
Many criticized Pope John Paul II for calling ours a “culture of death” for, primarily, countenancing legalized abortion. They thought it made him sound like an extremist. At the very least, such language was politically incorrect! (Embarrassing to have a pope who is politically incorrect, no?)
However, over time it has become obvious that the Pope nailed it. This latest initiative–socialized health care–is of a piece with a culture of death, and we may as well call it what it is.
August 13th, 2009 | 5:05 pm
I hate to point out the obvious, but – it does seem fairly self-evident that she didn’t write this, if only based on the vocabulary used compared to her other public statements.
August 13th, 2009 | 6:04 pm
Steve, and I assuming you wrote your own remarks, which is perhaps a naive assumption on my part, perhaps Palin did not write her own post. I am willing to go through it with a gold pen and a red pen and separate out the sources (more colors will be used if needed). If we can locate the P(alin) source, perhaps we can get to the heart of what she really thinks.
August 13th, 2009 | 6:30 pm
Steve,
Don’t be a pompous ass. It is quite common for people to speak and write with a different vocabulary and style and even to use a different style depending on the effect they wish to have. If you think she is wrong, say why.
August 13th, 2009 | 8:02 pm
Guy,
Palin is wrong on the facts; she’s taking Emmanuel’s words out of context. And while many people do have one voice for speaking and another for writing, it’s rare that one sounds intelligent and the other stupid. Not that she’s actually saying anything intelligent either way. Encouraging — not mandating but encouraging people to decide what sort of medical treatment they want at life’s end is setting up “death panels”? Even if she thinks those meetings would pressure seniors to forgo expensive care, that inflammatory language is highly irresponsible in that it’s going shed heat and not light. The woman’s a disgrace.
August 14th, 2009 | 2:59 pm
“that inflammatory language is highly irresponsible in that it’s going shed heat and not light.”
Are you saying she acted stupidly, and they ought to shut up and get out of the way?
August 14th, 2009 | 5:43 pm
Nive try, Francis. :) I’m saying that when she isn’t lying she doesn’t know what she’s talking about.
We need calmly reasoned discussion and debate. Sarah Palin has yet to demonstrate that she knows what those are.
August 14th, 2009 | 9:48 pm
“We need calmly reasoned discussion and debate.”
Does that mean that we should avoid inflammatory rhetoric such as, ” I’m saying that when she isn’t lying she doesn’t know what she’s talking about”? Or, “The woman’s a disgrace”?
August 15th, 2009 | 8:53 am
Robert, facts are facts. Palin has demonstrated that she’s more interested in stirring people up than in studying the issues, more interested in making them mad at Obama (in this case by taking Emmanuel’s words way out of context) than in informing them. What we all need right now is actual information, not fight songs.
If more people on both sides were interested in fighting fair, it would clarify the debate to call out and marginalize people like Palin who, to use her own words, “make stuff up.” (I would love to see the conservative Church acknowledge Palin’s shameful behaviour and disassociate themselves from her instead of cheering her on). Unfortunately, a lot of people on both sides of can’t bring themselves to fight fair.
August 15th, 2009 | 6:31 pm
Ken: You say “Facts are facts,” but your comments seem free of facts. They contain assumptions and assertions ((Sarah Palin is stupid, she is wrong about the facts, she is interested in stirring people up). You provide no support for anything you say. This is in contrast to the statement by Sarah Palin that the original post referenced in which she has toned down the rhetoric and made a reasoned argument, citing a variety of sources to back her position.
Can you see the irony of someone who favors greater government involvement in health care arguing that those on the other side “need calmly reasoned discussion and debate”? The goal of the Obama administration was to rush this program through Congress with minimal discussion and debate, as they did with the stimulus package and the House cap and trade bill.
I think your intense dislike for Sarah Palin, for whatever reason it exists, clouds your judgment in this case.
August 15th, 2009 | 9:23 pm
Robert, you didn’t ask me for chapter and verse on Palin’s relative ignorance (not stupidity, though as a public speaker she can sound dumb) and propensity for character assasination in place of argument, and I didn’t set out to prove them to you. I think they’re well known. Check The New Republic for what she was like in public office before McCain picked her. Read Vanity Fair, among other sources, for what she was like on the campaign trail last year. Recall her attempts to tie Obama closely with people whose offensive views he never shared. Recall her mockery of him at the convention. Google “the odd lies of Sarah Palin.” No doubt the woman has fine character qualities, but as a public figure she simply lacks integrity. VP candidates often attack harshly, and Palin the “pit bull with lipstick” was a natural in that role. I fail to see how that jibes with her profession of Christianity, and I fail to understand why more Christian conservatives don’t seem to care.
Yes, she attempted an argument (or someone attempted one in her name, who knows?) in her Facebook response. But her argument is false. Under the proposed language, the end of life care discussions must be paid for if they take place, but they need not take place. Whether they do is up to the patient. “The goal of the Obama administration was to rush this program through Congress with minimal discussion and debate” because they knew that while they were elected to reform health care, many Republicans would oppose anything they proposed. They rushed like Bush rushed, for the same reason he rushed: the good, as each saw it, of the country. Yes, I see your irony, but it’s shallow, and two wrongs don’t make a right anyhow. Palin is still lying.
I’m leaving town early tomorrow and won’t have Internet access. I will leave this page bookmarked to see your response, if you make one, when I return later in the week.
August 16th, 2009 | 1:43 pm
Ken: With politicians one can always find articles that present the negative case–they are called “hit pieces.”
You seem to allude to the “palling around with terrorists” line. It is based on the following:
Fact 1: Bill Ayers and Bernadine Dohrn were leaders of the Weathermen.
Fact 2: The Weathermen advocated and performed acts of criminal violence, including bombings aimed at citizens, for political ends.
Conclusion: Ayers and Dohrn were terrorists.
Fact 3: Barack Obama had professional ties to, and socialized with, Ayers and Dohrn, or “palled around with them”
Conclusion: Obama palled around with terrorists,
What part of the argument is faulty? (I spent the years 1968-1970 at a university that was a hotbed of radicalism, experiencing the loony left up close. The fact that Obama was as closely tied to Ayers/Dohrn as he was appalled me and, in my opinion, more than anything else showed he should not have been elected president. People who did not share my experience may not understand that reaction, especially if they believe the romanticized view of the period that is widely circulated. Life experience trumps everything.)
“Recall her mockery of him at the convention.” Yes, I thought it was effective and well within the bounds of political discourse–as you say, VP candidates often attach harshly. Is there something wrong with mocking politicians? If anything, the reluctance of the mainstream media to criticize or mock Obama has been unsettling. And nothing Sarah Palin gave compares to what she took from the left blogosphere. For example, the day after she was picked, this appeared on the dailykos (it quickly went down the memory hole after getting over 1000 comments):
http://ingrimayne.com/spp/sarahPalinPregnant.html
The immediate, over-the-top reaction of the left to Palin is, as far as I know, unprecedented in American politics. One of those who still clings to the belief that Sarah Palin was not the mother of her fifth child is the source of “the odd lies of Sarah Palin.” He suffers from an extreme case of PDS and you lose credibility by using him as a source. How would you react to criticism of Obama from someone who doubts that he was born in the U.S.? Your comments seem to echo a lot of the PDS that has been circulating in the left blogosphere.
As for the end of life decisions, see Obama’s statements:
http://online.wsj.com/article/SB10001424052970203863204574348222870510340.html?mod=rss_opinion_main
Simple economics says that making the marginal cost of something zero means that a method of non-price rationing must be found. My experiences in the wonderful world of economics tell me that today it will be based on some sort of utilitarian calculation, which is what Obama is implying in his answers. Palin was raising a valid point in a politically effective way. Camile Pagalia thinks it was effective, and James Taranto thinks she won. See http://www.salon.com/opinion/paglia/2009/08/12/town_halls/index1.html and http://online.wsj.com/article/SB10001424052970204409904574350400852801602.html?mod=rss_opinion_main
There are lots of unanswered questions that surround Palin (Why does a private citizen written off as politically dead by so many pundits continue to attract the obsessive interest of the left?), but I think I know why she has begun to write about health care. Some things have to be experienced to be understood. Parenthood is an example. I share something with Palin–I too had mentally-handicapped child. That experience took me places and gave me perspectives that I otherwise would never have had. I was fortunate to find medical help for my child. In the world that so-called health-care reform will give us, I doubt if that care, which was extensive and extremely expensive, would be available. Again, life experience trumps everything. As the mother of a Down Syndrome child, private citizen Palin has walked in steps that most people have not, and she has gotten perspectives that most people do not and perhaps cannot understand.
Finally, you undercut your credibility by arguing that the Republican opposition was the reason to rush this through. Here are the facts: Senate: 60 Democrats, 40 Republicans. House: 256 Democrats, 178 Republicans. The Republicans can provide no more than token opposition to anything that the Democrats want. Right now the Democrats own everything–they deserve the credit when they pass things we like and the blame when they pass things we do not like. The left seems unwilling to accept the accountability that goes with these numbers–some are so used to blaming Republicans (which was valid in the early part of the Bush presidency when the Republicans controlled House and Senate) that they cannot stop.
August 21st, 2009 | 10:50 pm
Robert,
I can see we’re not going to agree on anything. I’m familiar with hit pieces. You seem to suggest that to identify them is to dismiss them, which is of course not the case, and you seem to think that by shooting the messenger you can dismiss them, which is of course not the case. I agree that Sullivan lost perspective when he accused Palin of not being Trig’s mother (a charge he not longer makes), but those lies he lists are documented. She’s a nasty woman according to quite a few former friends and allies. On the other hand, it is clear Obama was born in Hawaii.
I’m old enough to remember the Weathermen, and Ayers and Dohrn’s role in it. But there are several problems with your characterization of Obama’s “ties” with them. Obama’s professional association with the guy consisted of serving on boards to which he and Ayers were appointed for the purpose of improving education. There is clearly nothing wrong with that, and remember that a prominent Republican or two served on those boards as well. Any socialization Obama had with them was under similar circumstances: they were both academics; they were not friends. Ayers held a fundraising coffe for him, lending his support to Obama, not the other way around. Obama accepted help from a _former_ terrorist, now so well-respected for his help on education that he was the Chicago Citizen of the year in 1997. This is all a matter of record. One can plausibly fault Obama for accepting that fundraising coffee (I don’t for reasons given), but the events were nothing like the picture painted by Sarah Palin. She is . . . a liar. It just flabbergasts me that you guys embrace her as one of your own and don’t expect the world to see you as rank hypocrites, willing to play by worldly rules for the sake of power.
Also, although the word terrorist is technically accurate because they did intentionally frighten people, its inaccurate in that it implies that they killed people, which they did not do, and which they took precautions not to do, and that they’re still making and setting off bombs, which is not true.
I se nothing wrong with mocking politicians for things they’ve done wrong in order to rob them of some of their power. I find mocking anyone for service to their community appalling. And as for the leftie blogosphere attacking Palin, two wrongs don’t make a right. Also, you have a false parallel: Jim Wallis and friends are not out there making excuses and cheering on whatisname Markos. You guys are cheering Palin. I think it’s clear why the Left continues to attack her. On the one hand it’s bloodsport, which I don’t condone (although a lot of what you call PDF is just healthy disgust), but on the other, she could very well be a viable national candidate again in a few years.
And I’m sorry, while theoretically Palin would gain some wisdom from having a handicapped child, in practice she was willing to take on an extremely demanding job with that child and four others (while the family values crowd cheered her). I’ve seen nothing but ambition and erratic behavior from her, nothing to suggest she knows anything and anything in life.
And Republican opposition made a lot of Democrats from not so liberal or mixed states (Blue Dogs, as you know) unable to just go along with Obama’s plans. His rush was meant to preclude that.
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