What a Death Panel Isn’t
In tonight’s debate, you might hear more claims that the Affordable Care Act (ACA) introduces rationing into the U.S. health system. The concept became nationally famous when Sarah Palin posted on Facebook, “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’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care.”
Many fact checkers quickly debunked the claim, but that doesn’t mean the sentiment disappeared. While the Death Panel talking point is now mostly limited to truly conspiratorial conservative circles, rhetoric implying the ACA introduces rationing can still be found in mainstream conservative dialogue. That doesn’t make it any more true—while the ACA uses multiple boards of experts in an attempt to improve care and rein in costs, rationing and new denials of care are nowhere to be found. But that hasn’t stopped conservatives from contorting different parts of the law so that held up to a funhouse mirror, they maybe-kinda-sorta look... well, you know.
Exhibit A: Living Will Counseling
Palin’s comments pushed to the center of the conversation an ACA provision funding living will counseling. But her claim didn’t match reality. The provision merely offered full Medicare reimbursement to doctors for time during an appointment they spent discussing living wills. These documents allow patients to record their wishes on which treatments they do and do not wish to receive, should they be incapacitated. Living wills do not involve denying patients care they desire; on the contrary, they ensure patients receive exactly the sorts of care they want, or designate the individuals they want making care decisions. However, amid the firestorm of conservative rhetoric, the provision was removed from the bill.
Exhibit B: PCORI
With the living will language gone, conservatives targeted a different provision as the source of rationing: the Patient-Centered Outcomes Research Institute (PCORI). This myth is most pervasive in the conservative blogosphere, though similar sentiments can be found elsewhere.
PCORI has nothing to do with rationing, either. Instead, it’s an independent non-profit organization established by the ACA to fund and gather data on which medical treatments actually work. PCORI’s research should prove a valuable tool for patients and doctors in determining which care methods are most effective, but the institute is barred from considering cost in evaluating treatments, and its data has no bearing on what care methods receive government funding.
Exhibit C: USPSTF
You’d think an office established in 1984 would be safe from the Death Panel label. But in a Wall Street Journal column, venture capitalist Tom Perkins argued, “A highly taxed and highly regulated economy leads to ‘Death Panels,’ like the U.S. Preventative Health Service.”
Picking on an office that was established during Ronald Reagan’s presidency is a stretch—you’d think Americans would have noticed government-run Death Panels by now if they’ve been around for over 25 years. Rather than condemning Americans to death, the U.S. Preventive Services Task Force (USPSTF) to which Perkins referred offers non-binding, evidence-based recommendations on the effectiveness of different preventive health care services. The only services it suggests eliminating are ineffective ones—even if doctors follow its recommendations, no true care is rationed.
Exhibit D: IPAB
Most recently, in the Presidential debate on October 3, Mitt Romney claimed the ACA “puts in place an unelected board that's going to tell people, ultimately, what kind of treatments they can have.”
Romney artfully hinted at the rationing idea without coming out and saying it, but that doesn’t make his claims any more true. Romney’s referring to the ACA-established Independent Payment Advisory Board (IPAB), a team of experts tasked with bringing down the long-term costs of Medicare to keep the program solvent. However, IPAB is explicitly prohibited from rationing care, raising costs for Medicare beneficiaries, raising revenue in any form, or changing Medicare eligibility standards, and Congress can reject any of its recommendations and replace them with other cost-saving measures. As health economist Len Nichols put it in the Wall Street Journal, “IPAB is not going to tell [a hospital] how to practice medicine. IPAB is going to say ‘Here’s how we’re going to pay you and you figure it out.’” IPAB is a Medicare cost-saving board forbidden from issuing recommendations regarding what kinds of treatment patients receive.
That’s four strikes by conservatives trying to locate rationing in the ACA. Does that mean rationing doesn’t exist in the United States?
Not so, writes Wendell Potter, former head of corporate communications for CIGNA: “[D]eath panels do exist in the United States… [T]he real death panels that operate in this country are not run by a bunch of government bureaucrats but by a bunch of corporate bureaucrats who work deep inside U.S. insurance companies… who will never face real patients and their families.” Potter argues insurance companies repeatedly look for ways to deny claims, especially for patients who are very sick and carry potentially massive medical bills. Dr. Giuseppe Del Priore agrees, explaining insurance companies will run out the clock by repeatedly requesting more information, hoping the patient dies in the meantime without receiving the treatment; call for an expert review, then pay an outside doctor to deny a claim; or dub a procedure “experimental” to avoid funding it. If you’re looking for care rationing, look no further.
Conservatives continue implying rationing is found somewhere in the ACA, but their inconsistency on exactly where that is speaks volumes. The truth is, they’re looking in the wrong place.