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WASHINGTON, D.C. - Sometimes it’s good news when a story isn’t news.
Such was the case when Medicare announced in early July that it intended to reimburse physicians for time spent counseling patients about choices for their “advanced care,” that is, medical treatment when they are very sick and near the end of life.
The announcement didn’t get much news coverage and didn’t stir up much controversy. Why should it? Of course doctors should be reimbursed for these most important conversations. Of course patients and their families want and need this sort of help from their doctors. It’s common sense. It’s not an issue.
Well, the last time a proposal like this came up, it became a monster issue that spawned a grotesque campaign of lies and scare tactics about government sanctioned “death panels.”
That hasn’t happened this time, thank goodness, despite some malevolent efforts to resurrect what was a truly shameful chapter.
Let’s go back for a moment.
In 2009, a similar provision to the one just announced was included in the Affordable Care Act legislation. It was intended partly to encourage informed discussion of end-of-life issues but mostly to ensure doctors would be reimbursed for their time. Obviously, doctors have always done this. Congress had voted for similar measures in the past. It wasn’t controversial.
But by the summer of 2009, the rabid anti-Obamacare machine was oiled and geared up. Betsy McCaughey was a leader of the opposition. She played a similar role fighting against Bill Clinton’s health care reforms in 1990s and rode that brief, wonkish celebrity into a brief stint as New York’s lieutenant governor.
In the summer of 2009, she went on talk radio and said the ACA contained a “vicious assault on elderly people and the boomer generation” that “absolutely required, that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner.”
This was ludicrous, of course. The fact-checking operation Politifact wrote, “McCaughey isn’t just wrong; she’s spreading a ridiculous falsehood.”
But fact-checking didn’t stand a chance against fear-mongering.
It was Sarah Palin, fresh off her failed campaign to be vice president, who turned the heat up to nuclear.
“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,” Palin wrote.
The myth of “death panels” was born.
“We should not have a government program that determines if you’re going to pull the plug on Grandma,” warned the veteran GOP Senator from Iowa, Charles Grassley.
Speaker of the House John Boehner, then the minority leader, put out a statement declaring that the legislation "may start us down a treacherous path toward government-encouraged euthanasia.”
Voters whipped into needle-fearing frenzy mobbed members of Congress at town meetings. AARP was swamped with phone calls from seniors scared they were being forced to "choose how they want to die," according to the spokesman at the time.
The pump had been primed long before the flood came.
A strand of extreme anti-abortion conservatism had long been paranoid about what it saw as a “culture of death” in America, especially among doctors and liberals. In his 2004 book “What’s the Matter With Kansas,” Thomas Frank wrote “Movement literature now abounds in lurid tales of the medical profession gone mad, of doctors giving the thumbs-up to infanticide and euthanasia, of abortionists trafficking in fetal body parts, and of deranged scientists manufacturing embryos from which stem cells can then be harvested.”
A few weeks after Obama’s inauguration, a hideous editorial in the conservative Washington Times said of the philosophy behind Obama’s reforms, “This notion is fully in the spirit of the partisans of efficiency but came from a program instituted in Hitler’s Germany.”
By the fall of 2009, the little provision that would reimburse doctors for counseling their patients was gone. The Affordable Care Act passed without it.
But six years later, in March 2015, a poll by Vox found that 26 percent of Republicans still believe that “a government panel helps make decisions about patients’ end-of-life care.”
You can’t keep a good lie down. But you can tame it.
A few days after Medicare’s announcement this summer Betsy McCaughey was back at it. “Look out, Grandma: Medicare said on Wednesday it wants to start paying for end-of-life counseling,” she wrote in the New York Post. “It’s being sold as ‘death with dignity,’ but it’s more like dying for dollars. Seniors are nudged to forego life-sustaining procedures…”
No one is taking the rancid bait this time. There is no “death panel” tsunami on Twitter. That is a rare bit of good news to recall this week as Medicare celebrates its 50th birthday.