a citizen’s journal by Thomas Nephew


Posted by Thomas Nephew on August 12th, 2009

I got one of the health care e-mails that have been ricocheting around the Internet yesterday.  It was forwarded by a dear relative of mine, with the subject line “FW: SENIOR DEATH WARRANTS.” I’ve posted it on my Google Docs site — of course, without any identifying information, and without editing.  I want to respond to various claims made in that e-mail.

Throughout the discussion below, I’ll link to relevant parts of proposed legislation to back up what I’m saying.  I’ll usually be referring to the text of H.R.3200, also known as “America’s Affordable Health Choices Act of 2009” — this is one of the main House bills.  The link leads to an “all about H.R.3200” web page at that enables links to very specific parts of the bill.  However, readers with slow browsers or older computers may be better off consulting the text version of the bill.

The email begins by recounting a conversation with a doctor:

…He then asked how old I was, and when I replied 70, he said that if this legislation goes through as intended by the powers that be, that I probably would not be able to get [a cancer treatment] next year, as that would be money better spent on someone else with greater longevity. I would be referred to someone to “counsel” me.

REPLY: FALSE. This and other parts of the e-mail appear to misconstrue Section 1233 (“Advance care planning consultation”) of the bill.  As a fact sheet by Rep. Blumenauer summarizes,

The provision merely provides coverage under Medicare to have a conversation once every five years if – and only if – a patient wants to make his or her wishes known to a doctor. If desired, patients may have consultations more frequently if they are chronically ill or if their health status changes.

I asked him why the AMA had recently endorsed the plan. He replied that only about 15% of the nation’s doctors were members of AMA, and most of them were not really on the front lines of doctorhood but in some other areas of medicine. […]

REPLY: NOT RESPONSIVE. It’s true that the AMA has endorsed a health care reform plan; given the organization’s opposition to health care reform in the past, that’s big news.  The main reason, according to reporter Jeffrey Young of The Hill, is that the bill envisions a “permanent fix to a Medicare payment system that annually calls for doctors fees to be cut.”

This was potentially an expensive gift to doctors; so if the doctor is advocating keeping annual fee cuts intact, I’m right there with him.

SENIOR DEATH WARRANTS: In England anyone over 59 cannot receive heart repairs or stents or bypass because it is not covered as being too expensive and not needed.

REPLY: FALSE. First, while it’s too bad, no major health care reform bill advocates a health care system anything like England’s.  But second, the statement is flatly wrong. actually contacted the U.K. Department of Health and and an English nonprofit group advocating for older persons about this claim:

[A spokesman] said medical procedures in the U.K. are not routinely denied for older people. The National Health Service, the U.K.’s public health care service, has a constitution which prohibits discrimination on the basis of age and other factors. “The NHS Constitution states that the NHS provides a ‘comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief,’ “ the spokesman said.

We also contacted a nonprofit group, England’s Age Concern and Help the Aged, which works to stop age discrimination in various facets of life, including employment and health care. Age Concern’s press office had never heard of any kind of prohibition on heart surgery for those 60 and older.

Obama wants to have a healthcare system just like Canada ‘s and England ‘s.

REPLY: SADLY, NO. First, it would be impossible to have a healthcare system “just like Canada’s and England’s” because they have different systems.  Canada has a “single payer” health care system, in which health care costs are negotiated between health care providers and the government or an independent agency — a kind of “Medicare for all” instead just for older persons.  Another country with a successful kind of single payer health care system is France — according to that left wing magazine Business Week.

For its part, England takes things a step farther with a socialized system in which the government directly employs health care providers.  There’s no rationing, and excellent health care; one of the excellent hospitals there recently cared for quadriplegic* Stephen Hawking, no matter what you’ve heard differently on that score.  In a 2000 World Health Organization report, the US ranked well behind England, France and Canada* in overall health system performance and health levels.

Of these two models — ‘single payer’ system and ‘socialized’ system — Obama has in the past spoken favorably of a “single payer” model, especially in 2003.  During the 2008 campaign, he said that was the system he’d go with if he were building a health care system “from scratch,” but when asked “Why not single payer?” responded:

“People don’t have time to wait,” Obama said. “They need relief now. So my attitude is let’s build up the system we got, let’s make it more efficient, we may be over time—as we make the system more efficient and everybody’s covered—decide that there are other ways for us to provide care more effectively.”

He essentially reiterated this at a town hall meeting on Tuesday in New Hampshire:

I have not said that I was a single-payer supporter because, frankly, we historically have had a employer-based system in this country with private insurers, and for us to transition to a system like that I believe would be too disruptive.

To weigh in on the controversy this caused: the transcript shows his questioner had already made the point that Obama supported single payer in the past. I don’t think he meant anything other than that in the current debate, since taking office, he has not said he’s for a single payer plan.

To me that was and is a disappointment, and it makes the claim that he wants a Canada-style system (let alone an English one) seem especially far-fetched.  He should, but he doesn’t. It’s been said the U.S. doesn’t have a health care system, it has a risk management system.  That system is designed to extract profits by minimizing the amount it pays out for health costs; that’s achieved by not insuring people who might cost a lot, and by reneging on payments when people actually do cost a lot.

So: Obama doesn’t want a single payer system? That’s a shame; I’m as disappointed as you are.

Please do not let Obama sign senior death warrants. […]

REPLY: VERY MISLEADING. To restate what’s written above, most of the claims about this misunderstand or misrepresent something completely different: the idea that many people want to make their own plans about how long to stay on life support if there’s no chance of recovery, rather than leave that up to anyone else.  That takes time, some expert advice, and therefore some money to understand the choices involved; the bill simply authorizes that such time and resources are allowable — not required, but allowable — Medicare expenses, every five years, or more often if the person has a life-threatening illness.

There will be no senior death warrants.  I promise.  But no need to take my word for it — here’s what Republican Senator Johnny Isakson (GA) has to say about it in a Washington Post interview on Monday:

I just had a phone call where someone said Sarah Palin’s web site had talked about the House bill having death panels on it where people would be euthanized. How someone could take an end of life directive or a living will as that is nuts. You’re putting the authority in the individual rather than the government. I don’t know how that got so mixed up.

Most of you know by now that the Senate version (at least) of the “stimulus” bill includes provisions for extensive rationing of health care for senior citizens.”

REPLY: AGAIN, FALSE. The stimulus bill (H.R. 1) contains no mention of rationing whatsoever, ‘extensive’ or otherwise.  The claim appears to echo** a February article by one Betsy McCaughey that claims, If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face … rationing.

Instead, Title VIII of that bill simply authorized the Agency for Healthcare Research and Quality to conduct “comparative effectiveness research” (a.k.a. “CER”) — essentially, studying which alternative treatments got the most health care bang for the buck.  Nothing in the bill requires doctors to blindly adopt any particular medical treatment.

More to the point, the Senate Health, Education, Labor and Pensions (HELP) Committee “Affordable Health Choices Act” actually prohibits such medically unsound use of comparative effectiveness research findings.  As Senator Barbara Mikulski put it,

If you go to page 323 of the actual bill, where it says ‘Incorporation.’ We absolutely prohibit that this, anything related to the Center For Health Outcomes, otherwise known as comparative effectiveness, that there “shall not be construed as mandates for payment, coverage, or treatment.” It is in the bill. Page 323, lines 5 through 7.

No need to take her word for it, either — have a look at page 323 of the HELP bill for yourself.  This (non)issue got quite a bit of attention when the stimulus bill was being discussed.  To watch a good review of McCaughey’s claims by CNN’s Elizabeth Cohen, click here.

The author of this part of the bill, former senator and tax evader, Tom Daschle was credited today by Bloomberg with the following statement: Bloomberg: Daschle says “health-care reform will not be pain free. Seniors should be more accepting of the conditions that come with age instead of treating them.”

REPLY: BADLY MISQUOTED. The miracle of Google reveals that Daschle said only the first sentence attributed to him here — the second, concluding double quote should have come after the words ‘pain free.’  The whole passage is actually from the same article by conservative pundit Betsy McCaughey***; the rest of the ‘quote’ is her characterization of what she believes Daschle is implying, not a direct quote of what he actually says.  Go ahead, see for yourself.

Moreover, Ms. McCaughey herself told Politifact (a fact checking column in the St. Petersburg Times) that the second sentence — “Seniors should be more accepting…” — “was her paraphrasing of an argument in Daschle’s book in which he quotes David Mechanic, a health care policy expert at Rutgers University, saying, “more and more of what were once seen as social, behavioral, or normative aspects of every day life, or as a normal process of aging, are now framed in a medical context. … Whether wrinkles, breasts, or buttocks, impotence or social anxieties, or inattention in school, they all have become grist for the medical mill.” (via

To use that quote in the way Mccaughey did was exceptionally dishonest.  As Politifact put it, ” Not treating wrinkles is one thing. Not treating, say, heart disease, is another.”

If this does not sufficiently raise your ire, just remember that our esteemed Senators and Congress men have their own healthcare plan that is first dollar or very low co-pay which they are guaranteed the remainder of their lives and are not subject to this new law if it passes.

REPLY: PARTLY TRUE, PARTLY FALSE. The Senators and Congressmen do have their own healthcare plan, which they share with thousands of other federal employees.  As the “Urban Legends” site wrote about an earlier draft of the same email:

Members of Congress (along with all other federal employees — everyone from the President to postal workers) are eligible for the Federal Employee Health Benefits Program (FEHBP), which is not a single health care plan but rather a collection of many different private health insurance plans from which enrollees can choose. In general, the FEHBP offerings are similar to Medicare but provide significantly better medical coverage and benefits than many Americans have ..

…perhaps most significantly, no “pre-existing conditions”: once a federal employee is hired, any illness or injury is covered regardless of prior health status.

I can’t confirm or rebut the claim that members of Congress can keep this coverage after they leave Congress.  According to Tom Philpott of, they pay premiums set to cover 28% of health care costs.  As the new law does not compel anyone to join any specific health care insurance plan, it’s misleading to speak of anyone — Congressmen included — as being somehow “subject” to it.

…we have the ability to address and reverse the dangerous direction the Obama administration and its allies have begun and in the interim, we can make their lives miserable.

REPLY: HERE’S WHAT I THINK IS DANGEROUS: more than 26,000 Americans die every year because they lack access to medical care. A million families declare bankruptcy each year due to medical costs—62% of all bankruptcies. America spends 16% of GDP on health care, about twice as much as any other country, and if we do nothing, those costs will rise to 37% by 2050.  People are camping out by the hundreds when they have a chance to get free health care.

I understand very well opposing an occupant of the White House — I felt that way myself for eight years. But I didn’t make up stuff about my opponents or their plans, I did my best not to relay stuff before I’d tried to check it out, and when I was wrong I said so.

We’re all entitled to our own opinions, but we’re not entitled to our own facts. We should all check what we write — and check what we read.

CROSSPOSTED to American Street, DailyKos.
CREDITS: In the course of drafting this, I discovered that beat me to parts of it with a long debunking of a prior draft of this email (one mentioning Natasha Richardson’s death).  I arrived at many of the same conclusions myself (see, e.g., the McCaughey/Daschle quote mixup), but cite Snopes for the FEBHP reply.
The stats in the final reply are via Kathy Flake, from an excellent roundup of the health care debate at this point.
EDITS: 8/13: footnote on Stephen Hawking added; France has a “successful kind” of single payer system in that everyone has a basic Medicare-like coverage, and people supplement that coverage with personal insurance, often through their employers (thanks, Kathy).  8/14: “Moreover, Ms. McCaughey told” paragraph and links added.
UPDATES: 8/13: Welcome, OpenCongress readers!  8/14: “False ‘Death Panel’ Rumor Has Some Familiar Roots” (Rutenberg, Calmes, NYTimes): “Rather, [the death panel rumor] has a far more mainstream provenance, openly emanating months ago from many of the same pundits and conservative media outlets that were central in defeating President Bill Clinton’s health care proposals 16 years ago, including the editorial board of The Washington Times, the American Spectator magazine and Betsy McCaughey, whose 1994 health care critique made her a star of the conservative movement.”

* Stephen Hawking suffers from a “variant of the disease known as amyotrophic lateral sclerosis (or ALS, a.k.a. Lou Gehrig’s disease),” so that he has lost the use of “his arms, legs, and voice, and is now almost completely paralysed.” This loss of use of arms and legs broadly fits the definition of ‘quadriplegic’, though it’s not the usual kind of ‘injury to the spinal cord.’
* WHO year 2000 rankings on overall health system performance, out of 191 countries: France 1st, UK 18th, Canada 30th, and USA 37th out of 191 countries. Rankings on health level per se: France: 3rd, Canada: 12th, UK: 14th, USA: 24th.  See the report for definitions.
** True, others may have said the same thing, but the next paragraph is definitely from the McCaughey article, so the simplest conclusion is that both claims were prompted by that article.
*** It turns out that McCaughey has a very long history of, um, making demonstrably false claims about health care proposals.

UPDATE, 4/21/10: More Malarkey About Health Care (Henig,

12 Responses to “Re: Fw: SENIOR DEATH WARRANTS”

  1. eRobin Says:

    Well done! I’m going to print it out and bring it with me to my next public panel discussion. I’m organizing four in my county in August. You can check out the coverage here and an editorial that mentions the Monday event here.

    I debunk this nonsense by going straight to the section of the Social Security Act, which it amends. That’s b/c the big thing around here is that if only the words “voluntary” and “mandatory” appeared in that section, everything would be okay b/c at least then we’d know for sure if Medicare wants to kill gramma. Sec. 1861 of the SocSec Act defines services and institutions covered by Medicare – there’s no place there for “voluntary” and “mandatory”. It’s just a list and description of covered items and institutions. I’m thinking of writing a post about that but it won’t be as classy as yours.

  2. Twitted by DCDrinkLib Says:

    […] This post was Twitted by DCDrinkLib […]

  3. eRobin Says:

    duh – I didn’t leave a link to the coverage and I’m too busy now to find it. Maybe later.

  4. Thomas Nephew Says:

    I think I found one of them: Separating fact and fiction on health care (JO CIAVAGLIA Bucks County Courier Times), apparently from Monday of this week. Great work!

    Did you get the video of the people camping out in Virginia downloaded?

  5. Nell Says:

    Obama: for us to transition to a system like that I believe would be too disruptive.

    Uh huh. Too disruptive to my fundraising.

    Sorry, couldn’t resist. I really appreciate all the work you and ERobin and others are doing. I’m unable to take on two big issues at once, particularly when what I’d be fighting for is such crap*. But I recognize the importance of not letting the shriekers stop this, or we’ll never accomplish one thing for the next three years and experience a right-wing election resurgence.

    *2013 before I could sign up on a public plan? Another four years after that I’ll qualify for Medicare. Aside from the human cost for me and and the other 40 million of us in the meantime, that looks a lot like electoral blackmail. A lot like it.

  6. Thomas Nephew Says:

    eRobin is the one who’s actually working, I’m just scribbling in a blog. Oh, and I went to a single payer demonstration at the Capitol on my lunch hour a couple of weeks ago.

  7. American Street » Blog Archive » Re: Fw: SENIOR DEATH WARRANTS Says:

    […] halfway around the world before the truth gets its boots on.  So I’m crossposting this from, in hopes it will help readers respond immediately to this chain email and ones like […]

  8. » Blog Archive » Grasstroturf, hopeandchange, and Inglewood, CA Says:

    […] Thomas Nephew on Re: Fw: SENIOR DEATH WARRANTS […]

  9. LicensesToKill Says:

    Emanuel has known since at least 1988 that Advance Directives give power to kill to the doctors. Check out this 2003 article.
    Gregory W. Rutecki, M.D.

    Emanuel 29 followed nursing home patients for two years after the completion of an advance directive. After medical record review and physician interview, the authors concluded that in many cases the patient’s choices were overridden because their physician disagreed with the wisdom of their choice. On occasion, the override represented the withholding of treatment because the physician decided it would not benefit the patient. End-of-life choices through vaguely worded advance directives may be primarily relegated to physicians who lack a consensus about what it means to be human”. “With increasing governmental and third party intrusion into the contemporary contract model of medical care, will advance directives become a coercive tool that rations end-of-life care by offering euthanasia as a cheaper alternative to life?”
    29. op. cit., Emanuel, E.J., et al., 1988.

  10. LicensesToKill Says:

    Americans need to understand the “type” of health care they will receive from the government might end their life. Americans attending town meetings and having the right to speak is the only way that “The People” can take their country back.

    It is said that nurses work for the hospital not for the patient.
    The PLAN: This video will give you history and an understanding of what has been going on in our world.

    The government has been working on a giant data base for 10 years that will hold as much information on American citizens as they can gather from all information sources including school and police records.

    This Information Technology (IT) data base will contain from the cradle to the grave information on each US citizen.

    In 2004, President Bush signed into law “Project Bioshield Act of 2004,” which authorizes the secretaries of the DHS and the Department of Health and Human Services (DHHS) to take virtual control of the bodies of all American citizens during a national emergency. Health officials are empowered to compel everyone to receive state-mandated medications, vaccinations or devices (implants).

    [A note from the owner of this web site:
    THE FULL TEXT OF THIS VERY, VERY, VERY LONG COMMENT MAY BE READ HERE. Mr./Ms. LicensesToKill, you should get your own blog for drafts of this length; alternatives can be found at and
    — Thomas Nephew.]

  11. Thomas Nephew Says:

    Re your first comment (“Emanuel has known…”): First and foremost, to repeat — there is nothing in any proposed legislation that requires end of life planning; the proposals simply make such planning *eligible* for payment. See the Blumenauer fact sheet for the author’s intent, and revisit the text of Section 1233 of H.R.3200 to confirm that his intent is preserved.

    Second, it seems to me what Emanuel *may* have found — there’s a pay wall to actually read his article, and I guess I’m too cheap to fork over $11 for it — is at least in part that inadequately drafted directives weren’t followed. It therefore seems to me that you should applaud Blumenauer’s proposal, since it would result in more professionally done directives than those Emanuel may have been looking at nearly 20 years ago.

    Third, the author’s “op. cit.” citation itself gives me pause, because of the date. As the original reference (end note 13) shows, the Emanuel paper was published in 1992, not 1988; it shares that end note with another reference that appears more germane to the statement Mr. Rutecki makes, and that was published in 1988. All that would mean is that Mr. Rutecki should have written “Uhlman et al followed nursing home patients…” By itself, that wouldn’t undermine your point, but it would take the lightning rod name “Emanuel” out of it.

    Finally, it seems to me that with “power to kill” rhetoric you’re edging over into the opinion that any advance directives whatsoever are wrong. For many of us, that’s a danger in the other direction, as illustrated (for me, at least) by the Terry Schiavo case: unrelated people butting in to a extremely personal decision not to prolong a vegetative state.

  12. Thomas Nephew Says:

    Re much of your second comment (“Americans need to understand…”): we’re pretty deeply into the weeds at this point. I’m willing to go back and have a look at the Uniform Anatomical Gift Act 2006 and other legislation you point to; like you, I value the privacy and autonomy of medical decisions. I think the the health care legislation being discussed now is separable from those concerns; if there’s something too sweeping about the UAGA, let’s fix that — but let’s not make that a precondition for providing access to reasonable medical care to people who don’t have that.

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