Grassley & McCain shamed on "death panels"

The media backlash against the "death panel"/euthanasia myth continued on Sunday as CBS Face the Nation host Bob Schieffer and ABC This Week host George Stephanopoulos pressed prominent Republicans on the issue.

First, watch Grassley squirm as he tries to defend his false claim that the government could decide to "pull the plug on grandma" under proposed health care legislation in Congress (via ThinkProgress and Paul Krugman):

SCHIEFFER: Senator Grassley, you have talked as Senator Conrad has about a bipartisan approach. But you really caught some Democrats off guard, a couple weeks ago, when you said this the other day. Listen to this.

(BEGIN VIDEO CLIP)

GRASSLEY: We should not have a government program that determines you’re going to pull the plug on grandma.

(END VIDEO CLIP)

SCHIEFFER: Now, Democrats say there is nothing in this legislation that would pull the plug on grandma, or even require people to discuss it. Why did you say that, Senator Grassley?

GRASSLEY: I said that because — two reasons. Number one, I was responding to a question at my town meetings. I let my constituents set the agenda. A person that asked me that question was reading from language that they got off of the Internet. It scared my constituents. And the specific language I used was language that the president had used at Portsmouth, and I thought that it was — if he used the language , then if I responded exactly the same way, that I had an opposite concern about not using end-of-life counseling for saving money, then I was answering –

SCHIEFFER: All right.

GRASSLEY: And relieving the fears that my constituents had, and from that standpoint, remember, you’re talking about this issue being connected with a government-run program which a public option would take you with. You would get into the issue of saving money, and put these three things together and you are scaring a lot of people when I know the Pelosi bill doesn’t intend to do that, but that’s where it leads people to.

SCHIEFFER: Well, that’s what I was trying to get from you this morning. You’re not saying that this legislation would pull the plug on grandma, you’re just saying there are a lot of people out there who think that it would. Or do you want to say this morning that that is not true, that it won’t do that?

GRASSLEY: It won’t do that, but I wanted to explain why my constituents are concerned about it, and I also want to say that there is an $8 billion cost with that issue, and if you’re trying to save money and you put an $8 billion of doctors giving you some advice at the end of life, doctors are going to take advantage of earning that $8 billion and constituents see that as an opportunity to save some money.

It just scares the devil out of people. So that ought to be dropped. And by the way, some newspaper people were saying that we dropped it from the Senate Finance Committee because of the hullabaloo that you just played, and that’s not true. We got this out of our bill a long time ago, and Sen. Conrad will tell you that I was in conversation with people on the Finance Committee way back in March, that we weren’t going to have any of this end-of-life stuff in our bill because it scares people.

Similarly, Stephanopoulos repeatedly challenged McCain on his misleading suggestion that the health care bill in Congress would create "groups that actually advise people as these decisions are made later in life":

STEPHANOPOULOS: The president also says that the debate has been infected by falsehoods. And probably the most notorious one is the one made by your former running mate, Sarah Palin, who said that his bill would encourage death panels that would encourage euthanasia. He called that an extraordinary lie and he is right about that, isn't he?

MCCAIN: Well, I think that what we are talking about here is do – are we going to have groups that actually advise people as these decisions are made later in life and …

STEPHANOPOULOS: That's not in the bill.

MCCAIN: But – it's been taken out, but the way that it was written made it a little bit ambiguous. And another thing …

STEPHANOPOULOS: I don't think that's correct, Senator. The bill, all it said was that, if a patient wanted to have a Medicare consultation about end-of-life issues, they could have it at their request and the doctor would get reimbursed for it, no panel …

MCCAIN: There was a provision in the bill that talks about a board that would decide the most effective measures to provide health care for people, OK? Now, we had amendments, we republican have said that in no way would that affect the decisions that the patients would make and their families. That was rejected by the Democrats and the health committee.

STEPHANOPOULOS: But that's not a death panel.

MCCAIN: So what does – what does that lead to? Doesn't that lead to a possibility, at least opens the door to a possibility of rationing and decisions made such are made in other countries?

STEPHANOPOULOS: Well, every single independent group that looked at it said it just wasn't true.

MCCAIN: Well, then why did the Democrats turn down our amendments that clarified that none of the decisions that would be made by this board would in any way affect depriving of needed treatments for patients? I don't know why they did that then.

STEPHANOPOULOS: So you think Sarah Palin was right?

MCCAIN: Look, I don't think they were called death panels, don't get me wrong. I don't think – but on the best treatment procedures part of the bill, it does open it up to decisions being made as far – that should be left – those choices left to the patient and the individual. That's what I think is pretty clear, which was a different section of the bill.

It's going to take this sort of a confrontational approach to scare people away from promoting misinformation. People won't change their behavior without strong reputational incentives to do so.

Comments

[Rob]

Naming and shaming Brendan for propagating the "myth" myth hasn't worked. So let me suggest a Gedankenexperiment. Let's imagine that the President and Congress announced their determination to bend down the cost curve of higher education--not just the government portion, but the total spending for the sector. As part of the solution, a panel would be created to establish best practices in higher education, and institutions that failed to adopt those best practices would be excluded from the federal government largesse (including scholarship funds and research grants) that funds a very significant portion of higher education budgets. In addition, the government would act to limit the compensation and perks paid to providers of educational services, such as professors, and would promote the use of cost-efficient teacher-practitioners rather than more expensive Ph.D.'s.

How would Brendan feel about that? Would he have concerns that the quality of the education that is delivered would suffer? Would he believe that government interference would undermine the independence of educators? Would he worry about whether innovation would suffer? Would he be troubled by the possibility that the most talented individuals would in the future be less inclined to become educators?

Or would he dismiss such concerns as a myth and ridicule those who raised them?

[Howeard Craft]

Why does the formation of an advisory panel (in this case, in education) automatically result in mandatory pay limits and new hiring practices?

You are presenting it as though the existence of such a panel will result in these mandates, as though it was inevitable.

*****

Let me suggest a Gedankenexperiment. Suppose the Federal Government was to oversee and administer the air traffic control system. Their conservative restrictions would cause massive airport delays, a reduced availability of flights and skyrocketing ticket costs. American industry would be gravely impacted as business travel becomes much more prohibitive, airlines would fail and the domestic tourist industry would be reduced to train travel.

Has that happened?

One could apply the same type of "doom and gloom" prognostication to the activities of the Food and Drug Administration, OSHA, automotive crash testing, the Cost Guard, water quality standards, etc., etc.

Looking to improve the efficiency of the medical system on a national level does not require "death panels".

Just because you can imagine something does not mean it is mandated or planed. To present such a scenario as likely or probable without evidence is a fabrication. To present such a scenario as an integral part of the legislation is a falsehood.

[Jay Vos]

Half-assed excuses from both senators, which are really shameful. If Grassley's constituents were scared, then he should have told them the truth about what was actually in the bill. As for McCain, in a typical defense maneuvre he tries to change the subject to something totally unrelated and didn't even come clean.

[bnyhan]

Rob, it's fine to be concerned about potential unintended consequences or perverse incentives resulting from an emphasis on cost reduction, but Palin, Grassley et al. are simply not making a nuanced claim of that sort. They are claiming that government would create a "death panel," "pull the plug on grandma," etc. And those claims are (a) widely believed and (b) false. That's why I call it a myth.

[Rob]

Brendan, my problem is when you dismiss legitimate concerns about whether cost-cutting will lead to rationing of life-saving treatment and rationing of quality of life treatment by treating them as all part of a "euthanasia myth." That serves to stifle the kind of very difficult democratic conversation the President once called for. And it sure ain't nuanced. Neither is pretending that Sarah Palin's reference to death panels did not implicate Dr. Emanuel's notions of level of productivity in society as a determinant of who should receive scarce medical resources.

Howard Craft, I set up as a thought experiment the government promoting best practices in education, then I further speculated that "in addition" the government could limit compensation to educational providers. You seem to have missed the "in addition" part and assumed the limit on compensation would follow from best practices. They're separate components of a hypothetical cost-cutting drive, just as the promotion of best practices in medical care and the limiting of compensation to pharmaceutical companies, hospitals and doctors are separate components of the effort to bend down the curve of medical care costs.

[bnyhan]

Rob, Emanuel's writings are being exaggerated and distorted -- see Factcheck.org on this. I'm happy to exclude from my criticism those people who oppose the Obama plan for nuanced, careful reasons. But in my observation they are very much the exception rather than the norm in the national debate right now.

[R.B. Glennie]

Sorry, Professor, if you were really interested in `correcting myths' you would be going after ALL the falsehoods in the debate.

For example, your President has made claims that because surgeons receive higher fees for surgery than for other sorts of treatments (according to your President that is), they will opt for the surgery over other treatments.

He said that surgeons make us$30 or $50,000 for such procedures, but the American college of Physicians and Surgeons had to step in correct him: these figures are just completely false.

They were uttered by the man with the Bully Puplit, not some failed vice-presidential candidate.

I've seen nothing on this blog about these and other lies propagated by the pro-`reform' camp. Perhaps you are interested in that, but I see no evidence of it.

No, only `falsehoods' uttered by Republicans deserve your attention apparently.

[Howeard Craft]

The argument Rob makes is that if the Federal Government looks to cut costs there is telling how far they will go.

Therefore any attempt to institutes "best practices" can be considered a "death panel", because (apparently) a "death panel" is a way to cut costs.

Hypothetically.

*****

RB Glennie repeats a statement the President made - that the health care system is oriented more toward dealing with drastic outcomes than toward preventative care (which may actually cost less) - and tells us that the president is accusing doctors of electing to perform an amputation when less dramatic treatments are available. RB also tells us that this is explained by the President as occurring because the physician wants to receive higher reimbursement.

Whatever the true cost to remove a foot or a leg, you misrepresented the actual comment that was made.

[David]

To predict what will happen based solely on the words of a draft bill is naive. E.g., I can imagine some fact-checker in 1913 saying, "It's a lie to claim that the income tax rate will exceed 3%," because 3% was then the proposed rate.

Consider two statements:

1. Nothing in the bill specifically says the government will pull the plug on Grandma

2. The government will pull the plug on grandma.

I agree with Brendan that #1 is true. OTOH #2 is also probably true, if we take "pull the plug on grandma" to mean "limit end-of-life care." Unless end-of-life care is limited, the cost curve will rise ever more sharply and health care cost will bankrupt the government.

P.S. I will comment here on the update to Brendan's 8/21 post. Brendan says, "Krauthammer also admitted that 'there are no "death panels" in the Democratic health-care bills, and to say that there are is to debase the debate.'" (emphasis added)

I don't know whether Krauthammer had previously asserted that there are death panels in the democratic health-care bills. If he hadn't, then the word "admitted" is unjustified spin.

[Jinchi]

your President....

I don't know why R.B. Glennie has an opinion on this subject, since he's apparently not an American citizen.

[Jinchi]

So let me suggest a Gedankenexperiment...

We don't need to perform a Gedankenexperiment regarding government-run health care for old people, because we already know what government-run health care for old people looks like.

There are no death panels. Care isn't rationed, seniors don't lose health care coverage when they fall ill, or lose their job and aren't denied it due to pre-existing conditions (Only those of us still under 65 need to worry about all of that). And of course, the only people talking about throwing out that system of guaranteed coverage happen to be Republicans.

So, before we take your thought experiments seriously, you should at least be able to explain to the rest of us why these horror scenarios didn't take place sometime over the last 40 years.

[Rob]

Jinchi, the reasons that rationing of health care based on age and societal value is pertinent now are as follows:

(1) Unlike the experience with Medicare over the last 44 years, in which costs have grown at a substantial rate, we now have an Administration that has repeatedly announced its determination to bend down the curve of health care costs. Moreover, the President has stated that if Medicare continues on its current course, it will bankrupt the country. It would be nice to imagine that computerizing medical records and choosing the less expensive of two equally effective pills would be sufficient to solve the problem, but that seems pretty unlikely. If the government is serious about achieving the goal of bending down the cost of medical care, far more difficult decisions are going to be necessary, including potentially the limiting of life-saving treatments and quality of life treatments.

(2) One of the President's chief advisors on health policy has written admiringly about allocating scarce medical resources based on age and ability to participate fully in society.

(3) Rather than address these issues candidly and thoughtfully, the Administration has sought to evade them and pretend they doesn't exist. That makes some people nervous that it's a subject the Administration doesn't want discussed.

BTW, just because R.B. Glennie is Canadian doesn't mean he's not welcome to express his opinion here, at least in my view. Where's your big-hearted American welcome to a friendly neighbor to the north?

[Jinchi]

1.) We now have an Administration that has repeatedly announced its determination to bend down the curve of health care costs.

This is nothing new. Every president since Ronald Reagan has repeatedly announced their determination to bring down health care costs, particularly with respect to Medicare.

(2) One of the President's chief advisors on health policy has written admiringly about allocating scarce medical resources based on age and ability to participate fully in society.

This has been debunked so frequently, that I'm beginning suspect your concern is insincere.

(3) Rather than address these issues candidly and thoughtfully, the Administration has sought to evade them and pretend they doesn't exist.

Obama has addressed them repeatedly, so it's absurd say he pretends the concerns don't exist. And beyond saying we have no intention of rationing health care and rationing isn't in the bill, any discussion of them is completely academic.

R.B. Glennie is Canadian doesn't mean he's not welcome to express his opinion here

Who said he was? I just wonder why someone living under the "socialist" Canadian system is wasting his time nitpicking quotes from an American president instead of rallying the forces of good against the reality at home.

[David]

Jinchi, all health insurance is limited, including Medicare. E.g., just today my wife and I talked to a sales rep about buying an expensive medical apparatus. Although the device will do my wife some good, the sales rep explained that Medicare will pay for (most of) it only if her condition is serious enough and the apparatus will help her by a sufficient amount, as measured by certain specific standards. (BTW I don't object to these standards. I'm just pointing out that they exist.)

Another personal example: lasik surgery (which I highly recommend) has limited coverage under Medicare and also limited coverage under private health insurance.

It's true that politicians aren't talking about throwing out Medicare. OTOH Medicare is dying and few of them are talking seriously about how to preserve it. Medicare cannot continue in its current form. Its costs aren't sustainable. (Obama does talk about Medicare's unsustainability, but his Health Care proposal will make the government's fiscal problem considerably worse.)

[Jinchi]

Medicare is dying and few of them are talking seriously about how to preserve it. Medicare cannot continue in its current form. Its costs aren't sustainable.

This is a constant mantra on the right. Personally, I don't subscribe to the Malthusian notion that medical care is a scarce and limited resource. Or that it's costs are destined to increase faster than inflation. That's the same logical fallacy that convinced people that home prices could climb several times faster than wages, forever.

But it seems to me that the people who are furious and outraged that Obama has a secret plan to ration health care through cost cutting are the same people who insist that we need to repeal, restrict or privatize Medicare because it's unsustainable.

[Raleighite]

Yes, Jinchi! Exactly right. Conservatives can't have it both ways: Complain that Medicare is unsustainable (even having sponsored legislation only a few years back to cut it), AND complain that Medicare recipients might be the victims of cuts.

[David]

Jinchi, it's not just the right who says Medicare is unsustainable. President Obama makes the same point. It's not that medical care is scarce, but that useful medical procedures are expanding due to improved technology and due to the aging of the population.

One way to make medical care more affordable would be to reduce the money going into research for improved medicines and medical technology. Some argue that this will be an unintended consequence of the US going to a government health care system.

Raleighite, I agree with you. Conservatives are now making political use of seniors' unwillingness to give up any health benefits. However, in the long run benefits for seniors will have to be curtailed. Conservatives ought to be the ones helping them to face that reality.

[Jinchi]

It's not that medical care is scarce, but that useful medical procedures are expanding due to improved technology and due to the aging of the population.

Again, this makes no sense. You're arguing that someday our medical care will be so good that nobody will be able to afford it.

in the long run benefits for seniors will have to be curtailed.

So the deal conservatives are offering is either:

A.) You can keep your lifetime coverage, but you'll be stuck with the level of care you get in 2009.

or:

B.) We're going to make huge strides in health care research, but you don't get any.

Good luck selling plan B.

[David]

Jinchi please pay attention to quantifiers. I didn't say, "We're going to make huge strides in health care research, but you don't get any." I said, "We're going to make huge strides in health care research, but you don't get all of it." That's still a great deal. We're living longer, healthier lives. However, some specific changes will need to be made in Medicare, because under that program seniors do get pretty nearly all the health care we want.

Incidentally, on your 7:52 post you rejected Medicare's unsustainability as a logical fallacy promoted by conservatives. I want to stick up for my fellow actuaries. Please take a look at the Annual Report of the Social Security and Medicare Boards of Trustees This report is based on a study looking 75 years into the future. It's done by a large group of highly trained professionals who devote their entire career to making these projections. When they say the programs are unsustainable, that should be good enough for anyone.

[Jinchi]

I didn't say, "We're going to make huge strides in health care research, but you don't get any."

I was paraphrasing the conservative argument, not your quote. But nonetheless, seniors aren't worried that they'll be stuck with the health care they have today. They're worried that their health care coverage will be cut.

That's the accusation that Palin and Grassley are making against the president, and yet that's also the proposal Republicans are making and have been making as a solution to the health care crisis for years now.

[David]

OK, Jinchi. you weren't wrongly paraphrasing me, but I think you were wrongly paraphrasing the conservative argument.

Nevertheless, I agree with you that Republicans have switched from their traditional position. The Democrats have too. Who would have imagined that we would see Dems supporting a cut in health services for seniors (albeit an unacknowledged cut) and the Reps opposing that cut.

[Jinchi]

Who would have imagined that we would see Dems supporting a cut in health services for seniors (albeit an unacknowledged cut) and the Reps opposing that cut.

See now, this is where we fundamentally disagree.

Democrats aren't supporting a cut in health services for seniors.

The fact that you can't conceive of a way for health care reform to work without that happening doesn't mean that the Democrats agree with you on that point.

[Nalakilla]

Democrats aren't supporting a cut in health services for seniors.

The fact that you can't conceive of a way for health care reform to work without that happening doesn't mean that the Democrats agree with you on that point.
-Jinchi

I love you man! Wonderful posts.

[David]

Jinchi --

It's not my job to figure out how to give health coveage to lots more people without adding to the deficit. It's the job of Obama and Nancy Pelosi and the others writing this bill. They haven't done it. There's nothing in the bill or the proposals that will avoid increasing the deficit, unless health benefits are somehow restricted.