Clearly Sarah Palin has a new Facebook speech writer. But the crazy still shines through.

Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly, and the disabled would suffer the most under such rationing; and that under such a system these “unproductive” members of society could face the prospect of government bureaucrats determining whether they deserve health care. (He did not exactly respond to Palin's statement, but rather the irrational fear that it created.)

The President made light of these concerns. He said:

“Let me just be specific about some things that I’ve been hearing lately that we just need to dispose of here. The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma because we’ve decided that we don’t, it’s too expensive to let her live anymore....It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, etc. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready on their own terms. It wasn’t forcing anybody to do anything.” [1]

The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” [2 ] With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.

Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program." [3] During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services. [4] (This, of course, is already something that happens with EVERYBODY'S current health insurance plan. The idea is to determine what is the best course of action for the patient and if it is covered by the insurance company. But it is disingenuous to say that a health insurance plan offered by the government would be less likely to cover certain procedures than an insurance plan whose CEO makes millions of extra dollars a year if he can keep costs low.)

Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” [5] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? (They will only wonder that if unscrupulous ex-governors and other GOP operatives misrepresent the data to scare the hell out of them.) As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones.... If it’s all about alleviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” [6]

As Lane also points out:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic. [7] (The problem with this argument is that it relies on a built in mistrust of government as a whole. It preys on people who believe that the DMV likes to make you wait for hour upon hour in line. Or that the post office reads all of your magazines before delivering them to you. Or that our government is actually spying on our citizens. Well that one is actually true, thank you George Bush. But the facts are that insurance companies, are far more likely to treat you like a disposable human being once you are no longer paying premiums than is the United States government, who is not interested in making a profit, but rather in keeping health care costs manageable and affordable.)

Even columnist Eugene Robinson, a self-described “true believer” who “will almost certainly support” “whatever reform package finally emerges”, agrees that “If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.” [8] (Eugene Robinson also said: It's irresponsible for politicians, such as Sarah Palin, to claim -- outlandishly and falsely -- that there's going to be some kind of "death panel" to decide when to pull the plug on Aunt Sylvia.)

So are these usually friendly pundits wrong? Is this all just a “rumor” to be “disposed of”, as President Obama says? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:

Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives.... It is egregious to consider that any senior citizen ... should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. [9]

Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens....An obvious example is not guaranteeing health services to patients with dementia.” [10] Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” [11]

President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.

Okay well I read the "offending" portion of this bill and I can assure you that it does not, in any way, read as if it is designed to encourage ANYBODY to quickly give up on their life and sign it away to make room for the younger more vibrant Americans who need care. That is a COMPLETE misrepresentation of the facts.

Now let me admit something. If this were a bill that was created and encouraged by the Bush administration, then I too would be very, very paranoid. But that is because the Bush administration really DID treat the American people as if their rights simply did not matter.

And if Sarah Palin were an outspoken advocate for a Bush administration bill, after hundreds of Alaskans died under her leadership, then of course I would be terrified of what might be hidden within its many pages.

But this is not a bill drawn up by the same guys who spied on us after 9/11, and tortured people on our behalf, and lied us into an unnecessary war. But the people who DID do that are now using the ginormous mistrust they created to generate panic about this health care reform.

It is almost like the unscrupulous security firms that burglarize your house one day and show up the next to offer to sell you an alarm system. The Republicans frightened the American people and are now mining that fear to protect their benefactors, the insurance companies.

So do yourself a favor, and actually read the proposed bill. And once it is passed if you do not want to sign up for it, then just stick with your current health insurance plan. I mean let's face it. If nothing else, this is going to bring ALL health insurance costs down in order to stay competitive. And that benefits ALL of us.

And here is a helpful tip. Sarah Palin is a compulsive liar. If she tells you something, you can bet the farm that the opposite is in fact true.

Trust me, I would know.

Update: Gawker was also quick to realize that our dear Sarah could not have written this.