Death Panels, Palliative Care, and the Dangers of Modern McCarthyism

By  |  August 20, 2009 |  13 

It’s time to fight back. The “death panel” nonsense is not a harmless and amusing political canard – it is modern McCarthyism: the shameless, heinous use of lies and distortions to scare and confuse people. The tide will only turn if all of us begin speaking up for the truth.

Read this morning’s NY Times piece on palliative care, and you get a sense of the power and beauty of the modern movement to provide patients and families with information and support at the end of life. The piece chronicles the decline and ultimate death of Deborah Migliore, a former topless dancer from the Bronx, from metastatic carcinoid, and the efforts of palliative care specialist Sean O’Mahony to support the patient and her husband through her painful final weeks. The article describes palliative care providers this way:

They are tour guides on the road to death, the equivalent of the ferryman in the Greek myth who accompanied people across the river Styx to the underworld. They argue that a frank acknowledgement of the inevitability of death allows patients to concentrate on improving the quality of their lives, rather than lengthening them, to put their affairs in order and to say goodbye before it is too late.

This has been precisely my experience working with our extraordinary palliative care team at UCSF. So I was pleased to see some support for palliative care embedded into the early versions of health reform legislation.

Then came Sarah Palin and the other hypocritical asses who have managed to take a serious, even profound, issue and turn it into a mockery. Read Joe Klein’s article in this week’s Time magazine to get your blood boiling. Klein begins with a poignant discussion of the end-of-life issues he’s grapping with for his elderly parents, but then – after the obligatory “there are still a few reasonable Republicans out there… somewhere” riff – gets to the point:

… But they have been overwhelmed by nihilists and hypocrites more interested in destroying the opposition and gaining power than in the public weal. The philosophically supple party that existed as recently as George H.W. Bush’s presidency has been obliterated. The party’s putative intellectuals — people like the Weekly Standard’s William Kristol — are prosaic tacticians who make precious few substantive arguments but oppose health-care reform mostly because passage would help Barack Obama’s political prospects. In 1993, when the Clintons tried health-care reform, the Republican John Chafee offered a creative (in fact, superior) alternative — which Kristol quashed with his famous “Don’t Help Clinton” fax to the troops. There is no Republican health-care alternative in 2009. The same people who rail against a government takeover of health care tried to enforce a government takeover of Terri Schiavo’s end-of-life decisions. And when Palin floated the “death panel” canard, the number of prominent Republicans who rose up to call her out could be counted on one hand.

Is this modern McCarthyism? Klein argues that it may be worse, because in those times:

… the crazies were a faction — often a powerful faction — of the Republican Party, but they didn’t run it. The neofascist Father Coughlin had a huge radio audience in the 1930s, but he didn’t have the power to control and silence the elected leaders of the party that Limbaugh — who, if not the party’s leader, is certainly the most powerful Republican extant — does now. Until recently, the Republican Party contained a strong moderate wing. It was a Republican, the lawyer Joseph Welch, who delivered the coup de grâce to Senator McCarthy when he said, “Have you no sense of decency, sir, at long last?” Where is the Republican who would dare say that to Rush Limbaugh, who has compared the President of the United States to Adolf Hitler?

Good on you, Barney Frank, for silencing the loony woman at his town hall meeting after she made such a comparison. As for our President, it is time for him to channel a little Barney Frank – and Machiavelli – and get tough. There can, and should, be reasonable disagreements about health reform, but the Fox News/Town Hall crowd is not interested in negotiation, or progress, or bettering the lives of our citizens – they are ideologues hell bent on destruction, gamesmanship, and Neilsen ratings. It is time to use all the tools at the Administration’s disposal to out the truth and fix what’s wrong with American healthcare.

It can be done, but it’ll take a fight. So let’s have one.


  1. Ada C Rahn,M.D. August 21, 2009 at 3:45 am - Reply

    Tell me how to start fighting back. I am ready and able!

  2. James Lin August 21, 2009 at 6:29 am - Reply

    The success of the “death panels” meme suggests two things: that Americans have quite a lot of confidence in the way end of life care is handled today, and that we also have a deep insecurity that reform proposals might somehow interfere with the sacred relationship between patient and physician.

    I’d argue that the hysteria over death panels is representative of the high level of uncertainty about just what the reform proposals will entail, both for day to day care and for the highly emotionally charged end of life situations in which patients and their families feel most vulnerable.

    So the question I’d ask is: Is it possible based on the level of specificity in the health care reform proposals offered thus far to offer a reasonable disagreement, not on abstract hyperboles like “socialism” and “naziism” but on the basis of how likely it is that an 85 year old with condition X would be given the option of getting treatment Y?

  3. geriatricdoc August 21, 2009 at 12:38 pm - Reply

    Thank God that there yet exists some sanity in America. The rise to power of an uneducated politician from the North with her cheer leaders from Fox News and the loud mouth Limbaugh has energized the crazies who have been coached and supported to disrupt meetings that should foster debate on healthcare not lies and distortions of truth.
    Unfortunately O’Reilly, Hannity and the other liars they feature have become the intellectual dessert of many an American.
    Should reform fail they will awaken with a pain so severe that the back lash against these merchants of untruths will shut them up. It may then be too late.
    God Help America

  4. EmilyC August 21, 2009 at 8:42 pm - Reply

    {Sorry, bit of a rant} I absolutely agree with everything in this post about the travesty that the end-of-life care conversation has become, and I wish I could share your optimism that a shift in tactics by the administration could change things. But I’ve become so depressed by what I’ve seen of this, the most recent chapter in nearly a century’s failed attempts at government-led reform, that I’ve concluded we have to start thinking about another way. A few months after Hurricane Katrina I attended a presentation by the head of a New Orleans hospital system, and he described the experience of watching helicopters lift off the roof of neighboring hospitals and realizing that he and his patients were being left behind. The most important message he could leave us with, he said, was this: You probably think that if catastrophe strikes, the government will come and save you. You’re wrong. No one is coming to save you. You have to start thinking now about how you’re going to save yourself.
    Every ten or twenty years we realize how bad things have gotten in the health care system, and a movement to reform health care through the government begins, and we think to ourselves, ‘they have to pass something this time, because nobody could tolerate letting the system stay this bad, although at least it couldn’t possibly get worse’, and every time we’re proven wrong on all three counts. I’m starting to think that waiting for the government to save us isn’t going to work, not because government is evil or incompetent (I’m a progressive and I voted, volunteered and donated money for Obama) but simply because it didn’t work the last five times.
    It’s time for us, as providers and as people who understand how the health care system works because we live it, to ask: how can we save ourselves? What can we do, without relying on federal action, to fix the system and make things better for our patients? For example, what are we doing in our facilities and communities to standardize and improve access to end-of-life counselling today, that doesn’t rely on the hope of payment reform? Because I don’t think anyone is coming for us (or our patients) this time, either.

  5. Bob Wachter August 22, 2009 at 7:38 pm - Reply

    Several people have sent me the Jon Stewart skewering of Betsy McCaughey and asked me to post it. Here it is:–1

    The fact that our society gives people like this (and Sarah Palin) megaphones… well, God help us all. And, while I have his ear, God bless Jon Stewart.

  6. adblouky August 23, 2009 at 1:55 pm - Reply

    I’ve heard that somewhere in Oregon a sign is posted which reads the following: “Oregon health-care–affordability, availability, quality. Pick any two”.

    Most reasonable people intuitively understand that this simple slogan captures the conundrum that faces health-care reform. They are suspicious of politicians who promise them all three without encouraging a meaningful dialogue on just how this miracle might come off.

    It is not encouraging for the President to suggest that pediatricians perform unnecessary tonsillectomies to generate income.

    It is not conducive to a civil debate to accuse dissenters of being McCarthyites and Nazis.

    Perhaps the best interests of the country would be served if the party in power stops trying to ram this legislation through on a contrived timetable. If the majority of Americans were wise enough to elect Obama in the first place, perhaps we should give them ample time to sort out all the rhetoric and arguments and come to a reasonable decision based on facts.

  7. MKirschMD August 24, 2009 at 7:59 pm - Reply

    Bob, I agree that the ‘death panel’ issue was beyond the pale, but propaganda has not been limited to the political right. The left’s portrayal of the public option has ranged between false and disingenuous. It is clear to many of us that this is not the panacea promised, but a transparent effort to move the country toward a full government takeover of health care. To believe otherwise is to suspend one’s credulity, particularly since the option is championed by those who have pledged fidelity to single payer, such as the president himself. While this may not rise to the level of McCarthyism, it is duplicitous. Health care reform has as much to do with politics as it does about health.

  8. SandralpsRN August 30, 2009 at 12:36 pm - Reply

    Why denigrate those whose opinions differ from your own? Ascribing motives to the people at town hall meetings without proof other than accusations by Pelosi and her supporters is just as bad as those on the right ascribing motives to the left. The hypocrisy is amazing. What I see in these town hall meetings is not some right-wing plot but Americans who fear their health care may suffer under this new policy. Rather than name calling and accusing them of being servants of Rush Limbaugh, perhaps one could address their questions and fears with actual detailed answers instead of platitudes. The American people are not too stupid to understand the details.

  9. Marshall Maglothin August 30, 2009 at 8:02 pm - Reply

    While the artificial rage (“The lady doth protest too much, methinks”) of the town hall meetings has focused the media’s attention, the administration quietly launched a $1.2B commitment – HITECH’s EHR initiative – to move our great, but paper-bound,  health care system into the electronic support age.

    The single most frequent comment I have heard after 6 months from the physician groups where I have implemented EMR is “My god, I could never go back to practicing medicine without it.”

    So let the Rove/ Limbaugh glee club re-focus their terror-generating and divisive hate tactics from Islam to Obamacare.

    Information (bits and bytes) and interoperability through HITECH’s EHR initiative will drown them in useful information and provide the platform for an informed national health care plan  – – despite their prejudicial hate and their ultimate terror of their own mortality.

  10. TennesseeMD September 1, 2009 at 9:27 pm - Reply

    I completely agree with the article. Propaganda and opinion are one thing, but slander, defamation and libel are quite another. I would think that a strong case could be made agianst some of the emails going around, Rush Limbaugh and Fox News. Let them defend their actions in a court of law rather than an environment where they have total control. Something has to be done to return some degree of honesty to these media.

  11. adblouky September 6, 2009 at 11:46 pm - Reply

    There’s a chill wind blowing….

  12. Bob Wachter September 7, 2009 at 8:04 pm - Reply

    One of the leading propagators of death panel myths is Betsy McCaughey, the founding head of something called the “Committee to Reduce Infection Deaths.” You may have seen her being skewered, not quite Jim Kramer-like but close enough, on the Daily Show a couple of weeks ago (here are Parts I and II of the interview).

    Although she’s become something of a caricature, she — like Sarah Palin — actually seems to have generated an audience for her nonsense among True Believers, which is why it’s worth reading the excellent piece on her by Michael Millenson, the medical journalist turned healthcare consultant, on The Health Care Blog.

  13. laustinmd December 30, 2009 at 5:42 pm - Reply

    I would not consider myself clearly aligned with either party in our country. I would consider myself in favor of any group who can formulate a reasonable, ethical and fair system of healthcare for all. If that is President Obama, then I will support that. What is more worrisome to me as a physician is the sentiment of a general public who is so distrustful of physicians as a group that they assume that public pollicy would influence our integrity as a profession in determining end of life care decisions. Dissenters and those seeking to advance their own agenda never find solutions to anything. They are too busy spewing out self-satisfying dreck. To be quite honest, I don’t know that i want to hear from a politician, political pundit or anyone not directly functioning in the healthcare arena. To have meaningful dialogue, we first need to start with respected professionals in their field. I do not include the right or left-leaning media in that statement.

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About the Author: Bob Wachter

Robert M. Wachter, MD is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. He is also Chief of the Division of Hospital Medicine. He has published 250 articles and 6 books in the fields of quality, safety, and health policy. He coined the term hospitalist” in a 1996 New England Journal of Medicine article and is past-president of the Society of Hospital Medicine. He is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He is also a national leader in the fields of patient safety and healthcare quality. He is editor of AHRQ WebM&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive nearly one million unique visits each year. He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety and quality. He has been selected as one of the 50 most influential physician-executives in the U.S. by Modern Healthcare magazine for the past eight years, the only academic physician to achieve this distinction; in 2015 he was #1 on the list. He is a former chair of the American Board of Internal Medicine, and has served on the healthcare advisory boards of several companies, including Google. His 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller.


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