by Whitney Pitcher
An article at Forbes today discusses a Accountable Care Organizations (ACOs) in health care, which are created to, as the author says, ” which gather doctors and other caregivers under one umbrella and are paid byMedicare and private insurers to treat groups of patients.” ACOs are non-government organizations that work to treat older patients and assist with end-of-life care using Medicare payments. There is nothing in ACOs that is government mandated or legislated in their structure other than Medicare as the payor. As a whole, the article talks about Donald Berwick, formerly head of Medicare under President Obama, as a proponent of care coordination. However, Berwick is a proponent of full blown government coordinated healthcare, which is completely different.
Beyond the crux of his misguided argument, the author, Bruce Jaspen, decides to build and attack a strawman of Governor Palin’s actual criticism of Obamacare:
A key part of Dr. Donald Berwick’s approach to health care delivery is outlasting intense criticism from Sarah Palin, the former 2008 Republican vice presidential candidate who contributed much-publicized demagoguery in regard to advanced directives to forego life-sustaining care.
As many in the media have done before, the author misrepresents Governor Palin’s criticism of President Obama’s version of healthcare reform. In her famous “death panel” Facebook post, she wrote (emphasis added):
The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. 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.
It is pretty clear that Governor Palin is talking about rationing of care as a general health care construct, not end-of-life care as a specific medical discussion. However, as many have done, the Forbes author criticizes the Governor for an argument that she never made. When the New York Times more than two years ago tried to make a similar argument as Forbes today, I wrote:
Shortly following this post from Governor Palin, Medicare funded end-of-life counseling was removed from the Senate version of the health care bill in August of 2009. While Governor Palin’s Facebook no doubt had an impact on the removal of that section of legislation, it was not specifically what she first opposed, which was rationing of care based upon decisions of government bureaucrats. Governor Palin has continued to oppose “death panels” including most recently expressing opposition to Medicare’s Independent Payments Advisory Board in her op-ed support Congressman Ryan’s Roadmap.
It must be noted, however, that in the Fall of 2009 following the removal of the end of life counseling provision in the bill, Governor Palin did express opposition to such government funded counseling, even providing a written statement to the New York Senate Aging Committee which in part said:
I have been vocal in my opposition to Section 1233 of H.R.3200, entitled “Advance Care Planning Consultation.” Proponents of the bill have described this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. That is misleading. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.
To understand this provision fully, it must be read in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As one commentator has noted, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones…. If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to ‘bend the curve’ on health-care costs?”
Essentially what such legislation would do is provides physicians with a potential financial incentive to initiate end of life counseling discussions with patients. The argument against this counseling is if patients were to opt not to seek certain treatments at the end of their life, it would save Medicare money. This would be due to potential coercion rather than autonomous or solely family influenced decision making.
He then went on to cite Governor Palin’s and Congressman Boehner’s opposition to such provisions and also noted that decision was more political than ideological, essentially conceding that the Obama administration still approved of the regulation even though they weren’t implementing it. The end of life provision in the House bill that Governor Palin expressed opposition to in her written statement to the New York Senate was dropped from the bill, and she has not claim (sic) that it was still present in the bill later signed by President Obama. The Medicare advisory board that she referenced in her op-ed supporting Ryan’s Roadmap was in the final legislation, and she expressed opposition to that. In a piece entitled, “Sarah Palin Proves Lying Can Be Effective”, the Washington Post parroted the misrepresentation from the New York Times.
Governor Palin was right in her opposition to both rationing via “death panels” or Medicare funded end-of-life counseling, and the media continues to fail to understand her opposition, nor the truth that lies in it. Her initial opposition and continued opposition is against undue influence by government who willingly admit that rationing is desired at the expense of quantity of care. However, her influence and truthful statements proved to have an impact on end of life counseling regulation and continues to be at forefront of everyone’s mind when health care reform and rationing are discussed.
Not only does Jaspen misrepresent Governor Palin’s argument, he also tries to promote end-of-life care, advanced directives and the like coordinated without government involvement, other than Medicare being the payor, and without financial incentive.Actually, Governor Palin supports this general principle as well, as she wrote in August of 2009:
I agree. Last year, I issued a proclamation for “Healthcare Decisions Day.”  The proclamation sought to increase the public’s knowledge about creating living wills and establishing powers of attorney. There was no incentive to choose one option over another. There was certainly no financial incentive for physicians to push anything. In fact, the proclamation explicitly called on medical professionals and lawyers “to volunteer their time and efforts” to provide information to the public.
More than three and a half years later, the media and pundits continue to try to misrepresent the Governor, but it’s rare that the media’s argument is so convoluted that they ultimately end up agreeing with the Governor without even realizing it.
Steve Flescher at C4P has a good post up on this article as well. See here.