The phrase “death panels” became part of America’s political vocabulary in 2009, when Republicans were trying to stop the legislation that eventually became the Affordable Care Act.
Although the details of the argument evolved over time, the gist was always the same: “Obamacare” would ration treatments for society’s most vulnerable members, like the disabled and the elderly, because their lives wouldn’t be deemed worth the expense of saving.
The claim was so outrageous that Politifact named it the “lie of the year.”
Now another national debate is taking place. It’s about how to open up businesses in the country amid a coronavirus pandemic that has already killed more than 102,000 people, many of them elderly and unwell, and is sure to kill many more.
There are difficult trade-offs and ambiguous medical evidence to weigh. But on one side of the argument is a group of people who act as if ― and occasionally even say ― that returning to normality requires tolerating mass deaths among some of society’s most vulnerable groups.
And wouldn’t you know it? It’s the same crowd that was screaming about the specter of death panels a decade ago.
Political opportunism helps to explain the apparent shift. In 2009, Republicans and conservatives were trying to block legislation from then-President Barack Obama. Now they are trying to promote and defend President Donald Trump, who has been agitating to end social distancing to open businesses and revive the economy.
But upon closer inspection, the conservative positions then and now have a common theme. It’s about whose lives deserve the protection of government programs. And whose don’t.
Death Panels In The Age Of Obamacare
The death panel concept first got attention in July 2009, when Elizabeth McCaughey, an analyst and former lieutenant governor of New York, told a conservative radio host she had discovered an explosive feature of the Democratic health care proposal Congress was considering.
The proposal, she said, “would make it mandatory ― absolutely require ― that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.”
McCaughey, already notorious for dishonest attacks on President Bill Clinton from a decade before, was engaging in wild distortion. The provision merely required that Medicare pay for counseling sessions on how to write advance directives. That way, physicians would be able to carve out the time for seniors who wanted help making decisions about end-of-life care in the future.
Among the provision’s chief proponents was Sen. Johnny Isakson (R-Ga.), who thought the incendiary portrayals of it were “nuts.”
But McCaughey’s claim fit the broader narrative about health care reform that the right was constructing ― namely, that the proposed legislation would limit care for the medically vulnerable. Soon Sarah Palin, the former Alaska governor and 2008 GOP vice presidential candidate, made her own version of the argument.
“Government health care will not reduce the cost; it will simply refuse to pay the cost,” she posted on her Facebook page. “And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course.”
Palin, who has a child with Down syndrome, went on to say, “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. Such a system is downright evil.”
Palin was and remains a beloved figure to many parents with special needs children. But her claim about the health care legislation was as off-base as McCaughey’s.
The closest thing to what Palin was describing was a proposed commission on Medicare spending. But it was hardly a “death panel.” Its job was to make broad changes in how the program paid for medical services, not sit in judgment of individual patients or their merits.
That didn’t stop Republicans in Congress from warning that legislation would “pull the plug on Grandma,” lead to “government-encouraged euthanasia” and result in the elderly getting “put to death by their government.”
These attacks were especially galling to reform proponents because it was the opposite of what they were trying to do.
A primary goal was to help people likely to struggle with medical bills because of their physical condition or finances ― which is why, for example, Democrats wanted to prohibit insurers from denying policies to people with pre-existing conditions and to improve coverage of prescription drugs for seniors.
They succeeded. The Affordable Care Act, for all of its inadequacies and flaws, helped tens of millions of those Americans get care. A big reason Republican efforts to repeal the law failed was that it would have rolled back this progress.
Among those who fought hardest against the Republicans’ repeal efforts were organizations representing people with disabilities, people with serious diseases and the elderly.
They understood that the death panel charge had always been a lie ― that it was Obamacare’s opponents, not its supporters, who were threatening the medically vulnerable.
Death Panels In The Age Of Coronavirus
Now there’s a new debate, about the effect of COVID-19 on public health and the economy ― and how to respond.
Although scientists are still learning about the novel coronavirus and its effects, they have known from the beginning that the groups most likely to suffer severe, life-threatening symptoms are the elderly and people with serious underlying medical conditions.
Back in March, this epidemiological reality prompted Dan Patrick, the Republican lieutenant governor of Texas and a prominent Trump supporter, to suggest that risking the health of people in his generation (he just turned 70) was a worthwhile price for allowing businesses to return to operating normally.
“Those of us who are 70-plus, we’ll take care of ourselves, but don’t sacrifice the country,” he said, adding that he was “not living in fear of COVID-19. What I’m living in fear of is what’s happening to this country.”
Glenn Beck, the conservative pundit, made a similar case on his radio show: “I would rather have my children stay home and all of us who are over 50 go in and keep this economy going and working, even if we all get sick,” said Beck, who is 56. “I would rather die than kill the country. ’Cause it’s not the economy that’s dying, it’s the country.”
Another conservative pundit, Ben Shapiro, was even more direct: “If somebody who is 81 dies of COVID-19, that is not the same thing as somebody who is 30 dying of COVID-19,” Shapiro said, adding later, “If grandma dies in a nursing home at age 81, that’s tragic and it’s terrible, also the life expectancy in the United States is 80, so that is not the same thing.”
Statements like these are just rhetoric. But they are consistent with a long-standing approach to policy ― promoted by conservatives, implemented by Republicans ― in which protecting the elderly and the frail has been a secondary priority, at best.
Just to take one example, experts have warned for years that underpaid, overworked staff and weak inspection regimens put nursing home residents at greater risk of infection. But since taking office, the Trump administration has been rolling back safety regulations. As recently as three weeks ago, even as COVID-19 was continuing to ravage nursing homes, administration officials were defending that effort.
More recently, some prominent Republicans have seemed less than concerned about the plight of another vulnerable group in this crisis: workers at meatpacking plants. They, too, would be suffering less with more testing, protective gear, attention to their working conditions and leeway to stay home if they are at higher risk.
But in Iowa last month, conservative Republican Gov. Kim Reynolds resisted calls to shut down plants with severe coronavirus outbreaks. Patience Roggensack, the conservative chief justice of the Wisconsin Supreme Court, questioned the state’s shutdown order because the big spike in illness was among meatpacking workers (often immigrants), and not and “the regular folks.”
Reynolds’ rationale on the meatpacking plants and the Wisconsin court’s thinking on the stay-at-home order, like the logic behind the broader push from some conservatives to ease social distancing rules, is that the costs of lockdown are too severe. Sacrificing the well-being of some more vulnerable populations is necessary, this argument goes, in order to alleviate the hardships on the rest of the population.
Those hardships are real. People who can’t pay their bills go hungry, lose their homes and can’t pay their medical bills. That is why even public health experts want to come up with smart, careful ways to relax pandemic restrictions.
But a severe economic downturn was inevitable because people scared of the virus aren’t going to engage in commercial activity like they did before. The actual choice policymakers face is whether or not to have the government provide for the population during this crisis ― by guaranteeing that people have money, food, housing and health insurance.
And once again it is a subset of conservatives and Republicans resisting these steps, by seeking to end extensions of unemployment benefits and fighting aid to state and local governments that would finance other public services.
The generous explanation for these positions is that Republicans and their supporters have a principled opposition to government, for reasons that are philosophical, practical or both. The not-so-generous explanation is the suffering of vulnerable populations, such as the elderly and meatpacking plant workers, simply doesn’t matter that much.
Either way, it’s a lot more like a death panel than anything Democrats and their supporters ever tried.