Death panels: Republicans warn they'recoming; Democrats say such a thing is unimaginable.
Something about the health-care debate gets people arguing about improbable scenarios, such as the United States turning into Canada or the government killing grandmas. But in the case of death panels, the overheated rhetoric has some historical truth. For a decade, there actually were death panels in this country. And it was big government that ended them.
Before World War II, there was no cure for chronic kidney disease. If your kidneys stopped cleansing your blood of toxins, you died. But in the late 1930s and early '40s, a Dutch physician, Willem Kolff, hit upon an ingenious solution: pumping the blood of patients suffering from end-stage renal failure through a machine that eliminated waste. Using 50 feet of sausage casing wrapped around a wooden drum that rotated in a tank of water and salts, Kolff invented the first dialysis machine.
Kolff's device wasn't perfect (in part, perhaps, because at the time he was also busy organizing Europe's first blood bank, participating in the Dutch resistance to the Nazis and hiding a Jewish boy in his home). The first 16 people he hooked up to his machine died anyway. But in 1945, Kolff finally got his "artificial kidney" working correctly. After the war, he moved to the United States, where he and other scientists quickly made significant improvements to the machine. By the early 1960s, researchers in Seattle had perfected a Teflon shunt that allowed patients with chronic kidney disease to be on dialysis indefinitely, dramatically extending their lives.
But there was a problem: money. At the time, dialysis for one patient cost more than $10,000 a year. The University of Washington Hospital, which had put up the money to support the first dialysis patients, saw an impending crisis as more and more people lined up for treatment, and administrators decided not to admit anyone else until additional funding was secured.
In 1962, with help from a $100,000 foundation grant, Seattle's King County Medical Society opened an artificial kidney clinic at Swedish Hospital and established two committees that, together, would decide who received treatment. The first was a panel of kidney specialists that examined potential patients. Anyone older than 45 was excluded; so were teenagers and children; people with hypertension, vascular complications or diabetes; and those who were judged to be emotionally unprepared for the demanding regimen. Patients who passed this first vetting moved on to another panel, which decided their fate. It soon gained a nickname -- the "God committee."
Born of an effort to be fair, the anonymous committee included a pastor, a lawyer, a union leader, a homemaker, two doctors and a businessman and based its selection on applicants' "social worth." Of the first 17 patients it saw, 10 were selected for dialysis. The remaining seven died.
In the fall of 1962, Life magazine published a story about the "life and death committee." In Washington, D.C., the deputy surgeon general fired off a memo to the secretary of health, education and welfare, warning that "strong pressure for some federal action" from the public might ensue.
It didn't. Instead, as the technology spread, medical centers in other cities struggled to serve large numbers of patients with limited numbers of dialysis machines. The rise of home dialysis reduced the number of people excluded from treatment, but panels across the country still met to decide who would receive access to the life-saving treatment. Supply was one limitation. Money was another, and the ability to pay often meant the difference between life and death.
Finally, in 1972, Congress decided to step in and provide federal funding for dialysis through the recently created Medicare program. The availability of treatment exploded. Today nearly half a million Americans suffer from end-stage renal disease, and dialysis is helping keep 340,000 alive.
So what does this tell us about what universal heath insurance might mean? It tells us that, if history is any guide, the government will expand access to health care, not curtail it. Federal involvement has never led to death panels. It has only ended them.
Benen: THERE'S NO NEED TO 'CHANGE THE RULES'....
It recently became clear that the Senate's reconciliation process may play a role in health care reform. And the moment it did, word apparently went out to the media that reconciliation is something radical, abusive, and dangerous.
While Republicans and political reporters started labeling reconciliation the "nuclear option" this week, Fox News went just a little further yesterday.
Fox News anchor Jamie Colby falsely characterized Senate Democrats passing health care reform legislation with a simple majority through a process known as reconciliation as "potentially changing the rules with the nuclear option."
Yes, if senators follow Senate rules, they're now changing Senate rules.
Labeling reconciliation the "nuclear option" is itself ridiculous, but to argue to a national television audience that using the process would be "changing the rules" is insane.
This would be a perfectly fair description of the actual "nuclear option." In 2005, Senate Republicans, outraged by Democratic efforts to block some of Bush's far-right judicial nominees, came up with a scheme to change the rules in the middle of the game. The Senate can change its rules with 67 votes, but Trent Lott & Co. thought they'd try it with 51 votes. Senate Dems, at the time, threatened all-out political war over this, which is why Lott referred to his underhanded scheme as the "nuclear option." (It was never executed, and the Gang of 14 struck a deal that let conservative judicial nominees get confirmed.)
Reconciliation, in contrast, is part of the existing Senate rules. No one's talking about changing anything -- just following the process that's already in place. It's a process that Republicans have used and endorsed many times.
Nevertheless, the "nuclear option" nonsense is catching on. In addition to just about every Fox News personality with access to a microphone, it's being used on CNN, and yesterday, MSNBC.
The right can't govern, but when it comes to message dissemination, they're Propagandists Extraordinaire.
- Yglesias: The History of the Reconciliation Process
It doesn’t have specific bearing on the viability of using the budget reconciliation process to enact substantial health care reform, but this bit of history from Pete Davis helps us understand the context:
When the Budget Act was enacted in 1974, reconciliation was envisioned as the final accounting at the end of the fiscal year containing spending cuts and tax increases to bring the budget deficit back to the level approved in the original budget resolution. The idea was to circumvent the normal impediments, like the Senate’s filibusters and never ending amendments, to achieve deficit reduction. The first reconciliation bill at the end of 1980 fit that conception, as tiny as it was, but the next reconciliation bill, President Reagan’s 1981 tax cut used reconciliation to enact the largest tax cut in U.S. history. Former GOP Congressman and OMB Director David Stockman’s brain child, using reconciliation to expand the deficit with massive tax cuts to take away the federal government’s credit card, worked like a charm legislatively, but spending took off anyway, particularly for defense, leaving record high peacetime deficits that persisted until 1997.
The point is not to praise Reagan or to condemn him, but simply to note that by and large that 1981 reconciliation bill was “the Reagan Revolution.” And since that time there just haven’t been any comparable huge structural shifts in the direction of US domestic policy. It’s not really clear that modern conditions leave any other feasible route to such legislation until such time as some Senate majority decides to change the filibuster rule.
This Modern World What if Democrats behaved more like Republicans?
Benen: MCCAIN DEFENDS BOGUS 'DEATH PANEL' ARGUMENT....
How far gone is Sen. John McCain (R-Ariz.)? He isn't even willing to reject the "death panel" nonsense pushed by his former running mate.
As promised, McCain appeared on ABC News' "This Week" and George Stephanopoulos asked whether he could defend Sarah Palin's most infamous and scurrilous attack on health care reform. Would the self-described "maverick" take a stand in support of reality? Take a wild guess.
Asked about the "death panel" lie, McCain said he doesn't endorse the phrase, but argued the government, under reform measures, would "have groups that actually advise people as these decisions are made later in life." When Stephanopoulos noted the phrase of the month -- "That's not in the bill" -- McCain said the language in the legislation "made it a little bit ambiguous." To his credit, Stephanopoulos pressed further.
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.
It's a good thing McCain was invited back onto another Sunday morning public affairs show -- his 11th appearance since January, and his second on "This Week" since May -- or we may have missed insightful policy analysis like this.
Benen: REPORT POINTS TO END OF BIPARTISAN OUTREACH....
This week, the New York Times reported that Democratic policymakers "now say they see little chance of the minority's cooperation in approving any overhaul, and are increasingly focused on drawing support for a final plan from within their own ranks." A Politico piece added that White House officials realize they will "probably will have to pass health reform with Democratic votes alone."
And yesterday, Bloomberg News reported something similar.
President Barack Obama is likely in September to end Democratic efforts to work with Republicans on health-care legislation and press for a party-line vote if the stalemate on the issue in the U.S. Senate persists, a person close to the White House said.
The president and his advisers have started devising a strategy to pass a measure by relying only on the Democratic majority in each house of Congress, said the person, who spoke on condition of anonymity.
It's hard to say how seriously we should take the remarks of someone "close to the White House," but at a minimum, it's more evidence to suggest Democratic leaders have run out of patience.
Former Senate Majority Leader and HHS nominee Tom Daschle (D-S.D.) told Bloomberg, after meeting with President Obama, "He's waited and waited. He has indicated, much to the chagrin of people in his party, that virtually everything's on the table. And he's gotten almost nothing in return for it."
Daschle added that Obama hasn't made a firm decision to abandon a bipartisan approach, "it's important to put policy ahead of process. And at some point he has to make that decision."
The sooner, the better. It's not like opponents of reform are going to suddenly change their minds -- GOP leaders have already said the party will oppose reform no matter how many concessions Democrats make, and two of the three Republican negotiators are prepared to vote against their own compromise.
What more would it take?
- Aravosis: 80 votes?
Reader Annita writes:
You know, Chuck Grassley and company are making the case that heath care reform is such an important issue that it really won’t be a worthwhile bill if it can’t get at least 80 senators to vote for it. As I recall, the “Authorization for Use of Military Force Against Iraq Resolution of 2002” passed in the Senate by a vote of 77 to 23. I’d say going to war was a rather weighty, important decision. Gee, I wish we’d known back in October of 2002 that we should really be requiring an 80 to 20 vote!
How can anybody with the intelligence of a six year old actually still believe the republicans are actually still interested in health care reform?
DougJ: Kruggers on Ambers
Not to beat a dead horse, but I think that Marc Ambinder’s “the hippies were wrong to be right” post is such a classic that it merits further discussion. Here’s Paul Krugman:
But I’d like to return to one point: even after retracting his statement about people who correctly surmised that terror warnings were political being motivated by “gut hatred” of Bush, he left in the bit about being “reflexively anti-Bush”. I continue to find it really sad that people still say things like this.
Bear in mind that by the time the terror alert controversy arose in 2004, we had already seen two tax cuts sold on massively, easily documented false pretenses; a war launched with constant innuendo about a Saddam-Osama link that was clearly false, and with claims about WMDs that were clearly shaky from the beginning and had proved to be entirely without foundation. We’d also seen vast, well-documented dishonesty and politicization on environmental policy. Oh, and Abu Ghraib was already public knowledge.
Given all that, it made complete sense to distrust anything the Bush administration said. That wasn’t reflexive, it was rational.
The rules of modern day punditry are almost as complex as those of modern day wingnuts (minus the boycotts, I guess). Whether or not something is rational is of no relevance. Arcane mixtures of “balance”, deference to power, and “seriousness” have completely replaced common sense.
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