Palin still insists that death panels are a reality:

Former Alaska Gov. Sarah Palin refused to retreat from her debunked claim that a proposed health care overhaul would create “death panels,” as the growing furor over end-of-life consultations forced a key group of senators to abandon the idea in their bill.

Sen. Chuck Grassley, R-Iowa, one of six lawmakers negotiating on a Senate bill, said Thursday they had dropped end-of-life provisions from consideration “entirely because of the way they could be misinterpreted and implemented incorrectly.”

In a Facebook posting titled “Concerning Death Panels,” Palin argued Wednesday night that the elderly and ailing would be coerced into accepting minimal end-of-life care to reduce health care costs based on the Democratic bill in the House.

But there will be no “death panels” under the legislation being considered. In fact, the provision in the bill would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health care proxy, learning about hospice as an option for the terminally ill, and information about pain medications for people suffering chronic discomfort.

The sessions would be covered every five years, more frequently if someone is gravely ill.

The American Medical Association and the National Hospice and Palliative Care Organization support the provision.

In her posting, Palin wrote: “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,” and added, “It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing.”

This is a deliberate strategy by Palin, to force the result described above – to pressure the Senate into dropping the provision entirely. As the wire article notes, nowhere in the bill is there any coercive element to the end-of-life counseling, something that is absolutely clear from a reading of the relevant section of the bill. Here is what the bill (the draft version passed by the House) says (Section 1233 of H.R.3200):


Advance Care Planning Consultation

`(hhh)(1) … the term `advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include–
`(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State–
`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that–
`(I) ensures such orders are standardized and uniquely identifiable throughout the State;
`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;
`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.


Note that a “living will” or “advance care directive” is not the same thing as a “do not resuscitate” (DNR) order. A DNR is one type of advance directive, but as the page on advance directives at the National Institutes of Health makes clear, your advance directive is a choice to either accept or refuse medical care. The counseling described above is to give the patient the information they need to make that choice.

Note that the above description of “Advance Care Planning Consultation” is essentially an addendum (hhh) to an already large list of other “medical and health services” defined in Section 1861 of the Social Security Act, specifically section s(2), which defines specific things that are eligible for reimbursement ranging from the generic (hospital services) to the mind-numbingly specific (blood clotting factors for hemophilia patients). There is no coercive language whatsoever – only a list of what may be covered (and ONLY what may be covered. If it isn’t listed, it isnt covered.)

It is clear that Sarah Palin knows full well that there is no way the proposed changes can be “misinterpreted” as Sen. Grassley claims. The bottom line is that Palin is deliberately lying in order to curry favor with the “pro-life” movement, which as we saw in teh Terry Schiavo case abhors the idea of euthanasia at all costs. With Schiavo, the decision to end care was made by her husband, in the absence of a directive from Terry Schiavo herself. All the legislation is trying to do is to reimburse doctors for time spent discussing living wills with the patients, so that the patients are more likely to have a living will in place. Having a living will is a choice, and some people will choose DNRs and others will not. But that should be up to the patient in the ideal case – and knowing their wishes explicitly and legally is the best way to avoid a horrible trauma and agony for the surviving famikly members as well as ensure that the patient’s own wishes are truly respected.

Republicans claim that the Democrats are trying to deny choice, even though in this case it is they who are denying it, by scaremongering over an issue which was supposed to help patients retain their rights to make decisions about their own care. It is hypocrisy of the highest order.

The fact that Palin is outright lying on one hand about death panels, and then on the other arguing that people should “stick to the issues” on health care, is just further evidence of her intentions to try and sandbag genuine debate. And she has succeeded.

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