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Of all the falsehoods and distortions in the political discourse this year, one stood out from the rest.
The claim set political debate afire when it was made in August, raising issues from the role of government in health care to the bounds of acceptable political discussion. In a nod to the way technology has transformed politics, the statement wasn't made in an interview or a television ad. Sarah Palin posted it on her Facebook page.
Her assertion — that the government would set up boards to determine whether seniors and the disabled were worthy of care — spread through newscasts, talk shows, blogs and town hall meetings. Opponents of health care legislation said it revealed the real goals of the Democratic proposals. Advocates for health reform said it showed the depths to which their opponents would sink. Still others scratched their heads and said, "Death panels? Really ?"
The editors of PolitiFact.com, the fact-checking Web site of the St. Petersburg Times , have chosen it as our inaugural "Lie of the Year."
PolitiFact readers overwhelmingly supported the decision. Nearly 5,000 voted in a national poll to name the biggest lie, and 61 percent chose "death panels" from a field of eight finalists. ( See the complete results .)
This is the story of how two words generated intense heat in the national debate over health care.
• • •
The former governor of Alaska had been out of the headlines since she announced her resignation on July 3; the Facebook message instantly brought her back to the political stage.
"As more Americans delve into the disturbing details of the nationalized health care plan that the current administration is rushing through Congress, our collective jaw is dropping, and we're saying not just no, but hell no!" Palin wrote.
"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 wasn't the first time opponents of the Democratic plans for health care had raised the specter of euthanasia. In February, the conservative editorial page of the Washington Times compared plans for more funding for health information technology with eugenics programs instituted in Nazi Germany.
Democrats in the House introduced a bill July 14 that closely mirrored President Barack Obama's campaign promises on health care. The bill increased regulation of insurance companies, proposed a national health insurance exchange where individuals and small business could shop for plans, expanded health programs for the poor, and gave incentives to doctors and hospitals for efficiency and improved care. It did not promote euthanasia.
On July 16, Betsy McCaughey, the former lieutenant governor of New York and a conservative health care commentator, suggested that the Democratic plan included a measure requiring seniors be told how to end their lives. "Congress 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," she said on a radio show hosted by conservative Fred Thompson.
PolitiFact gave McCaughey a Pants on Fire rating for that statement. There were no mandatory sessions proposed. Instead, for the first time, Medicare would pay for doctors' appointments for patients to discuss living wills, health care directives and other end-of-life issues. The appointments were optional, and the AARP supported the measure.
Nevertheless, Republican officials began amplifying McCaughey's comments.
House Republican Leader John Boehner issued a statement July 23 that said, "This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law."
Rep. Virginia Foxx, R-N.C., said on the House floor July 28 that a Republican alternative for health reform was "pro-life because it will not put seniors in a position of being put to death by their government."
Palin's statement then launched the health care debate into overdrive. The term was mentioned in news reports approximately 6,000 times in August and September, according to the Nexis database. By October, it was still being mentioned 150 to 300 times a week.
• • •
The phrase "death panels" appears to be original to Palin. A search of news databases showed no use prior to her Facebook posting.
History professor Ian Dowbiggin, who has written several books on medical history, euthanasia and eugenics, said he had never heard the term before Palin used it. He said the phrase invokes images of Nazi Germany, which denied life-saving care to people who were not deemed useful enough to broader society. Adolf Hitler ordered Nazi officials to secretly register, select, and murder handicapped people such as schizophrenics, epileptics, disabled babies and other long-stay hospital patients, according to Dowbiggin.
"It's not far-fetched to make the historical argument that as you get government more and more involved in health care, you create an environment that is more hospitable to the legalization of forms of euthanasia," Dowbiggin said. "But the Nazi example should be used very advisedly."
"This is an issue that's being exploited by political figures who are opposed to the health care legislation," he added. "They're trying to sensationalize the issue as much as possible to drum up opposition."
On Aug. 10, PolitiFact rated Palin's statement Pants on Fire. In the weeks that followed, health care policy experts on both the right and the left said the euthanasia comparisons were inaccurate. Gail Wilensky, a health adviser to President George H.W. Bush, said the charge was untrue and upsetting.
"I think it is really unfortunate that this has been raised and received so much attention because there are serious issues to debate in health care reform," she said at a forum on Sept. 3.
But some prominent Republicans didn't reject the death panels claim.
Sen. Charles Grassley of Iowa, the senior Republican on the Finance Committee, told people at a town hall meeting on Aug. 12 that people "have every right to fear. You shouldn't have counseling at the end of life; you ought to have counseling 20 years before you're going to die. You ought to plan these things out. And I don't have any problem with things like living wills, but they ought to be done within the family. We should not have a government program that determines you're going to pull the plug on Grandma."
Former House Speaker Newt Gingrich, asked about the issue on This Week with George Stephanopoulos , said, "You are asking us to trust turning power over to the government, when there are clearly people in America who believe in establishing euthanasia, including selective standards."
• • •
Democrats responded by saying the accusation wasn't true and highlighting the actual Medicare provision and what it said.
That wasn't necessarily an effective strategy, said Drew Westen, a psychologist who studies political communication and advises Democrats on messaging. "Instead of stopping and asking themselves, 'What are Republicans trying to appeal to?' the Democrats rolled their eyes and said, 'Isn't this stupid,' " he said. "On one level, it was stupid, but on another level, it was hitting seniors very close to where they live."
People intuitively understand that health care reform is about lowering costs, and end-of-life care can be quite costly, he said. The "death panels" claim exploited fears that people already had. Rather than just saying the claim wasn't true, Westen said, a better response would be that there already are "death panels" — run by insurance companies.
"That's the response that should have been there, from the first day the attack was made," Westen said. "You never let an attack like this stand or go unresponded to in any 24-hour cycle."
The charge was raised repeatedly during August town hall meetings. The claim particularly caught the attention of seniors, said John Rother, a health policy expert with the AARP. "That's who's most sensitive to any suggestion of denial of necessary care or being told you can't get the care you need from your doctor," he said.
The town hall meetings highlighted the partisan divisions when it came to death panels. The claim, along with the Tea Party movement, excited the Republican base to mobilize a vocal opposition, Rother said. "If your start-out stance is being distrustful of government, then this fit right into your worldview." Though nonpartisan, AARP has generally supported Democratic efforts to pass health care legislation.
• • •
Two independent polls showed that about 30 percent of the public believed death panels were part of health care reform, both the week after Palin made the comment and a month later.
Yet seniors were no more likely to believe it than other age groups. The polls showed a closer correlation by party, with Republicans more likely to say that death panels were part of the plans pending in Congress. It's not clear whether Palin's comments swayed anyone who was undecided or unsure about health care reform.
"It touched a nerve of anxiety, and then there was a big response from the press and from experts that assured people that euthanasia wasn't anywhere near this debate," said Robert Blendon, a Harvard University researcher who studies public opinion on health care. "Most people, at the end of the day, did not believe it was being proposed."
As the furor over the phrase settled down, Democrats used it as evidence that Republicans were unreasonably opposing health reform.
President Obama rebutted the claim in a major health care address on Sept. 9: "Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple."
The phrase has been mentioned in the Congressional Record about 40 times since Palin's Facebook posting, but virtually all were Democrats citing it as an example of Republican intransigence.
"You know, GOP used to stand for Grand Old Party," said Rep. Edward Markey, D-Mass., on Nov. 7. "Now it stands for Grandstand, Oppose, and Pretend. They grandstand with phony claims about nonexistent death panels. They oppose any real reform." The House voted in favor of health care legislation the same day.
• • •
Rep. Earl Blumenauer, the Oregon Democrat who promoted the provision that allowed Medicare to pay for doctor appointments about end-of-life counseling, said he sees both positives and negatives from the controversy.
On the positive side, he said he's optimistic the Medicare provision will make it into the final version of health care reform, which is still pending in the Senate, and people had more conversations about making their wishes known for things like living wills or do-not-resuscitate orders.
"It really did energize people who deal with palliative care," he said. "Ultimately, it helped advance the cause of giving people more control over end-of-life decisions."
On the other hand, he said, the episode suggests that political distortions need to be confronted faster and more forcefully.
"It's a sobering prospect that political discourse is going to resemble hand-to-hand combat for the foreseeable future," he said.
That doesn't bode well for keeping average citizens involved in the political process, especially those who are independent or not particularly partisan.
"I think they're losing their appetite to wade through the vitriol, and I'm in the same boat," Blumenauer said. "We are moving to a point where we drive normal people away, and everybody else gets their news and increasingly opinion prescreened, going for days never hearing an opposing viewpoint. That gives me pause."
• • •
As for Palin, she told the conservative National Review in an interview on Nov. 17, the same day her bestselling memoir Going Rogu e was released, that she didn't regret her comments. (PolitiFact's calls and e-mail to Palin were not returned.)
"To me, while reading that section of the bill, it became so evident that there would be a panel of bureaucrats who would decide on levels of health care, decide on those who are worthy or not worthy of receiving some government-controlled coverage," she said. "Since health care would have to be rationed if it were promised to everyone, it would therefore lead to harm for many individuals not able to receive the government care. That leads, of course, to death."
"The term I used to describe the panel making these decisions should not be taken literally," said Palin. The phrase is "a lot like when President Reagan used to refer to the Soviet Union as the 'evil empire.' He got his point across. He got people thinking and researching what he was talking about. It was quite effective. Same thing with the ‘death panels.' I would characterize them like that again, in a heartbeat."
Sarah Palin on Facebook, Statement on the Current Health Care Debate , Aug. 7, 2009
U.S. Government Printing Office, HR 3200 (health care reform legislation), July 14, 2009
Interview with Ian Dowbiggin of Prince Edward Island University
Congressional record, remarks by Rep. Ed Markey , Nov. 7, 2009
The Alliance for Health Reform, Panel: The Next 100 Days: Some Final Hurdles to Health Reform , Remarks of Gail Wilensky, Sept. 3, 2009
Interview with Rep. Earl Blumenauer
Interview with Drew Westen of Emory University and Westen Strategies
The Huffington Post, Why the President Has Been Losing on Health Care, and What He Needs to Say , by Drew Westen, Sept. 7, 2009
The New York Times, False ‘Death Panel’ Rumor Has Some Familiar Roots , Aug. 13, 2009
The New York Times, My Near Death Panel Experience , by Rep. Earl Blumenauer, Nov. 14, 2009
Interview with Robert Blendon of Harvard University
Interview with John Rother of AARP
House Republican Leader John Boehner, Statement by House GOP Leaders Boehner and McCotter on End-of-Life Treatment Counseling in Democrats’ Health Care Legislation , July 23, 2009
The Washington Times, Health 'efficiency' can be deadly , Feb. 11, 2009
Congressional Record, statement by Rep. Virginia Fox, July 28, 2009
The National Review, Interview with Sarah Palin , Nov. 17, 2009