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Commentary: Death panels and the politics of spin

This article first appeared in the St. Louis Beacon, Feb. 13, 2011- If you are pining for an allegory for the schism that divides our country, two recent death panel fiascoes provide instructive insights.

The "death panel" known far and wide was conjured during the health care summer of 2009. This invented Obama venality became a national fad because Republicans understood that reality can be a shoddy substitute for effective political theater. They knew that when outrage is telegenic, no misrepresentation is so extreme that it precludes the devoted credulity of millions of uninformed voters.

Encouraged by Republican elites, congressional town meetings became outlets for distortion and political opportunity. Sarah Palin suggested that her family should not have to confront "Obama's 'death panel' so his bureaucrats can decide -- whether they are worthy of health care." Sen. Grassley of Iowa opined that we should "not have a health care plan that determines if you're going to pull the plug on grandma" while Rush Limbaugh warned that Obama's health care logo was "right out of Hitler's playbook."

The naissance of the death panel invention was a subsequently discarded health bill provision that would have facilitated voluntary end-of-life discussions between Medicare patients, families and doctors. If you have ever had an incapacitated parent on life support, you can appreciate the agonizing decisions that beckon. If you did not know your parents desires, you can empathize with the poignant urgency of informed prior discussion. But vitriol was effective and empathy irrelevant.

Typical of other data, an NBC poll found 45 percent agreement that the Obama plan would "allow the government to make decisions about when to stop providing medical care to the elderly." The death panel fiction was arguably the defining progenitor of doubts that persist today about health care reform. It validated Republican strategy.

Fast forward now to Arizona where Medicaid funding for organ transplants has been severely curtailed. Faced with a $2.6 billion deficit, the Republican Arizona legislature and governor have banned the use of state Medicaid funds for seven transplant types, including all lung and pancreatic transplants and many heart, liver and bone marrow transplants. The projected savings of $4 million to $5 million, 0.19 percent of the deficit, has removed 98 Arizonans from the transplant list. At least two have died so far.

The rationale was that transplants are of uncertain efficacy and, as articulated by Arizona Gov. Jan Brewer, "the state only has so much money and we can only provide so many optional kinds of care." Optional? If potentially life-saving treatments for desperately ill patients are optional, where are the compulsory therapies?

Our data at the Washington University Medical School indicate that among 3,131 pediatric heart transplants performed globally over 16 years, 1-year survival is 87 percent and 5-year survival is 78 percent. Have we reached a nadir where politicians expect voters to endorse the denial of such treatments if the spin is on target, the alternative may be more tax dollars, and the abandoned patients are poor?

It's easy to blame a calculating Sarah Palin or a callous Jan Brewer. It's easy to fault cautious Democrats who permit invented death panels to become a national outcry while the real McCoy remains obscure outside of Arizona. But in truth, this tale of two death panels is coauthored by millions of voters whose distorted knowledge base and pliant logical universe help guide the strategy of every political pro.

When Dwight Eisenhower warned in his farewell address of the dangers of the military industrial complex, among his central themes was that a thriving democracy requires "an alert and knowledgeable citizenry." Eisenhower understood that as in millennia long past, politics will always attract a fusion of dedicated public servants and unprincipled captives of that aphrodisiac called power. He knew that a flourishing democracy is sustained by an aroused and informed electorate that punishes demagoguery and is unyielding before sophistry.

But it can't happen when millions view 9/11 as an inside job or Obama as a non-citizen. You can't have intelligent public debate when the Pew Research Center reports that only 34 percent know that TARP (the Troubled Asset Relief Program) was a Bush administration initiative and that two weeks after November's election, 46 percent knew that Republicans had won a House majority.

So politicians of every moral pedigree become spin doctors. By day, they extol the enduring wisdom of the American people. And in the covert recesses of the night, they plan deceptive attack ads and clever applause lines to attract uninformed and frustrated voters who are putty before Madison Avenue duplicity.

That's why fictitious death panels can shape our debate, why bumper sticker talking points and angry accusations replace serious discourse. It's why even principled politicians hear sirens from the abyss. They read the tea leaves and assess their constituents. And the conclusion is inescapable: With distressing frequency, the abyss wins elections.

Ken Schechtman is a freelance writer and a professor at the Washington University School of Medicine.