The rank-and-file Deathers, even more so than the Birthers, are victims of a well-worn conservative strategy: any effort in the direction of universal health care, or even universal health insurance, MUST cross the hurdle of establishing normative levels of care across a wide range of hair-trigger medical issues -- or, at the very least, establishing a process for determining such normative[1] levels of care. And medical issues are personal, and none is so personal, nor so universal, as death.
The prospect of a universal health care debate, before 1994 and going into 2009, had the conservative punditocracy salivating. They knew we gotta talk about economics and death together in one deliberative process -- we gotta -- and as soon as we did, they had us. Certainly enough to create an emotional smokescreen behind which any actual progressive policies could be dismantled.
That this is all capitalized on with a degree of anger, fear, and rancor not seen for a long time, is only a side effect of having elected our first non-white President. See Hunter's excellent diary on this postmodern racism. But the strategy that results in the "Deathers" was already in place.
After being astonished at the wacko claims, repeated over and over by the Right Wing Noise Machine, that a reformed health care system under this administration will counsel elders to allow themselves to be euthanized, or ration care for special needs children, I have been pleased to see these lies fully debunked:
Many others seemed to share my astonishment at how firmly this meme took hold.
Here are just a couple of the manifestations of this meme. Usually there is a germ of something true that sparks these things. The wildest conspiratorial conclusions always have some basis in fact. The soil may be skepticism and ignorance (Moon landing), shock and dismay (JFK assassination), fear and ignorance (chemtrails), racism (Obama) -- but there must be seeds, too, however spurious. What were the seeds for this claptrap?:
Betsey McCaughey on the WSJ oped page:
"...legislation now being rushed through Congress—H.R. 3200 and the Senate Health Committee Bill—will reduce access to care, pressure the elderly to end their lives prematurely, and doom baby boomers to painful later years."
Glenn Beck in 2006 criticizing Clintoncare for slippery slope toward euthanasia:
"Don't you think we, as human beings, as Americans, we should draw the line at making life-and-death decisions based on money, especially for the weakest and most fragile among us? In the name of all that is good and holy, I ask you, what kind of monsters are we prepared to become in the name of a buck?"
[Funny, my kid asked me the same thing when I said I could only afford to buy them the $250 bicycle.]
Sarah Palin:
"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.... Rep. Michele Bachmann highlighted the Orwellian thinking of the president's health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff, in a floor speech to the House of Representatives. I commend her for being a voice for the most precious members of our society, our children and our seniors."
Something about Betsey McCaughey's claims, and the references to Dr. Emanuel, caught my eye. It didn't take long to find the offending passage in Emanuel's complete Hastings Center Report:
"This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity -- those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations -- are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason."
If you Google a portion of that quote, you get 11,000 hits, most of them right-wing blogs and forums where this is being spun and fertilized.
The rest of the paper is not long, and it's quite interesting. The key points to dispense with right away are:
- Of course the quote is taken out of context. It is a theoretical memorandum, typical for think tanks, whose general purpose is obviously benevolent: how does a society provide the greatest good (best, most care) for the greatest number?
- While Emanuel does seem to come down on the side of deliberative democracy, the quoted passage is, in itself, purely analytical, and conditional. If approach A is taken, then consequences B may be inferred.... He is inviting debate.
- Further, he is inviting participation in precisely the kinds of deliberations that the Deathers say he would shut them off from. Which services should be guaranteed, and why? Let's decide, he is saying. The naysayers don't really have an issue with the specific illustrations he proposes -- they don't want to decide at all. They don't want the deliberative democracy. They reject the entire premise.
- Lastly, his argument is being deliberately misread (in several ways). Some commentators may actually be this stupid, but I am willing to bet that neither McCaughey nor Beck is dumb enough to think that if a medical service is "not socially guaranteed" that is the same as it being "denied." (In today's health care system, if you are under 65, NO medical service is socially guaranteed, except, nominally, trauma care in ER.) Their audiences, however, don't get the benefit of parsing the original statement. They get the full-blown lie, with a slimy allusion to "Obama's health reform czar, brother of Rahm Emanuel." Nepotism, sounds like Nazism....
To the credit of some conservatives (perhaps more of those with a libertarian streak), the meme is being knocked down in some unusual places. The site of the Pennsylvania Firearms Owners Association (PAFOA) has a thread from 2008 with a wonderfully cogent and intelligent "Philbert" carefully and repeatedly debunking the euthanasia myth with facts and reason. (There IS hope! I LOVE the internet.)
I'm getting back to Sarah Palin, majorette for the Michele Bachmann zombie parade.
In this post on a Tea Party blog, they simply omit the last sentence of the Hastings paper quote:
"This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity — those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberation — are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia."
Here's another one that omits the last sentence, and in addition, draws the worst of illogical and false conclusions from the text:
"July 21, 2009 (LPAC)-- Ezekiel Emanuel, the top healthcare adviser at Obama's Budget Office and brother of his chief of staff, believes it is 'obvious' that people with Alzheimer's or other forms of dementia (estimated as one of three people who live beyond the age of 65) should be denied health-care, since they are 'irreversibly prevented from being or becoming participating citizens.'"
Now we really get to appreciate Hunter's outrage (dKos) on the Palin version of this meme. Because it is, in fact, based on a grotesquely stupid misreading of the Emanuel quote. Let's look again at the original last two lines:
"An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason."
I am convinced that Bachmann and Palin read this as two sequential examples of types of services that would not be guaranteed: services for patients with dementia, and neuropsychological services for learning disabled children. But of course it is not only nothing of the sort -- a correct reading demolishes the Deather's premise. Emanuel is actually suggesting that under a system that values deliberative democracy, neuropsychological services would be guaranteed to learning disabled children. WOULD. Can you just say yes, Sarracuda?
As Fred Clark said recently on Slacktivist in another context: "This is incomprehensible, but it's what happens when you read stories as though they were check lists. Sometimes illiteracy is a choice."
George Soros's Death in America Project:
"The concern of George Soros, the billionaire financier, for improving the American way of death came from a personal experience. His beloved father, who had saved the family from the Nazis, died in 1968, and Soros recalls that he did not even hold his hand. "I refused to face the fact that he was dying. I think it was a tragic mistake on my part. I think our whole society is somehow operating in a state of denial and distortion. We have been told all about sex, but very little about dying."
'I did not even hold his hand. I think it was a tragic mistake on my part'
After his father's death, Soros read Elisabeth Kubler-Ross's books on dying and as a result he approached his mother's death very differently. She died quietly at home, surrounded by her family. "She was a believer, and she actually saw the gates of heaven. It was a very touching thing. I was holding her hand, and she described it to me. She got very worried. She didn't want to take me with her. Very touching. I said, 'Don't worry, my feet are on the ground.' That was when she lost consciousness."
We all know that Soros is a super special demonic antichrist, so it should be no surprise that his Death in America Project (DIAP) has been the lightning rod for a lot of this euthanasia noise. Here's one mild but very biased critique of Soros and the DIAP by blogger Mike Kriskey.
The comment thread from the above link includes a few swerves into pretty rational territory:
"I suspect -- though I don’t know for sure -- that the Church would not regard it as sinful if a doctor erred on the side of too much pain medication rather than too little. I’m not talking about a wink-wink 'accident,' but an honest judgment as to the level of pain the patient is experiencing, when our loved ones are in a truly hopeless state. (If that makes sense. I’m sure I’m wording that clumsily.) And all these decisions need to be made by families with the advice of physicians, and should never be made a government policy."
And of course, that's exactly where such decisions are made, and will be made. Only the economic landscape may change, with a public option, in that more people will have more choices with fewer devastating financial consequences. The devastation of the death of a loved one will remain the same. Sometimes it seems as if these naysayers, these Deathers, don't even really believe there is such a thing as death. Ignore that man behind the curtain! We're all living forever, as long as we can cry out "Don't Tread on Me!"
In a way, the critique of the naysayers has a weird self-fulfilling germ of truth:
- Soros, Emanuel, and others believe that a (political) barrier to universal health care is the knee-jerk reaction in the US to questions surrounding death and EOL care
- The US cannot afford universal health care if it fails to address death and EOL care issues
- Sensitivity and education must be opened up to deliberative democracy so that humane EOL strategies can be incorporated into legislation for universal health care
- Initiatives such as DIAP are carried forward to pursue (3)
- New health care program proposed, incorporating (2)
- Opponents of universal health care use (5) as a foothold for their scare tactics, reconfirming (1)
Wash, rinse, repeat....
Why? Why are conservatives against universal health care?
"Yet, a hardcore "work makes right" Republican mentality must ultimately reach the conclusion that such people are of no use to society and thus have no right to its support. The idea that being worthy of health care is based on one's level of productivity in society is actually the sort of idea that Ayn Rand ranted about. It is a conservative ideal."
-- James Paton Walsh on dKos
As a country, we have to get better at discussing topics like end-of-life issues. It takes compassion to see the issues in the first place, courage to take their measure, and constant, compassionate, incisive care to tease the issues apart and grapple appropriately with the medical, legal, economic, and political dimensions of each.
Those who would deny the discussion a place at all are not even getting to 1st base. And when they do it by denying the compassion of those who are trying to hold the discussion, they show themselves to be monsters themselves, unable and unwilling to acknowledge the humanity of those unlike themselves.
* * *
[1]Disclaimer: in general I'm not going overboard trying to define my terms. "Normative care," for example, is already troublesome. Does it imply care that must be dispensed with? May be dispensed with? Care that may be paid for? Will be paid for? Treatment regimens that must be applied? May not be applied? Is it divided into "basic/guaranteed," "optional," and "premium" tiers? Etc. But that is the point -- the answer has to come from a deliberative process in a democracy, and for that to happen, deliberations must occur. Yes, we'd all prefer not ever to get old and die, but ignoring it won't stop it being a social issue.