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Hello, readers! Today’s edition of The Breakdown starts with a political memory that’s burned into my brain. It’s from a battle during the early Obama era—an episode that, among other things, gave an early glimpse of how misinformation online could twist debates about policy. It has an uncanny echo in something happening today, for reasons I explain.
Today’s edition also has a slightly different format than usual: Instead of one essay, it’s three distinct items with a loose connection tied to today’s news. You can think of it as my homage to JVL and The Triad—though, to be clear, it’s more like two-and-a-half items, or 2.5 if you prefer, which felt fitting as we celebrated America’s 250th birthday.
Speaking of which, I hope you had a good July Fourth! We are marking the holiday weekend with a special sale, with year-long Bulwark+ memberships available for $86. It’s the support of readers that makes this kind of journalism possible, and something tells me we’ll need it in year 251 just as much as we do now. Fourteen percent off, but the sale ends Sunday night. Declare your independence.
–Jonathan
Donald Trump Is Bringing Back ‘Death Panels’
There’s a good kind and a bad kind, and it looks like we’ll be getting both.
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Blast from the Past
Back in the long-ago days of 2009, when Barack Obama and the Democrats were in the middle of their grueling fight to pass what would eventually become the Affordable Care Act, they adopted a proposal under which doctors who sat down to discuss end-of-life planning with patients could bill Medicare for the time.
It was a bipartisan, seemingly innocuous, plan. The idea was to make these conversations easier to arrange, so that people would have more agency over how they spend their final days. Then a conservative commentator named Elizabeth McCaughey discovered the provision in the legislative text.¹ And all hell broke loose.
McCaughey went on Rush Limbaugh’s show and insisted the provision would “absolutely require” doctors to meet with patients, advising them on how to “decline nutrition, how to decline being hydrated, how to go into hospice care . . . all to do what’s in society’s best interest or in your family’s best interest and cut your life short.” She went on to write a New York Post column called “Deadly Doctors” in which she claimed Obama health care adviser Ezekiel Emanuel, who supported the idea, wanted to ration care for people with Parkinson’s, cerebral palsy, and other disabilities.
The swipe at Emanuel, an oncologist and bioethicist who had been writing about how to help the kind of families he had seen as a practitioner, was as egregious as the description of the provision was dishonest. But McCaughey’s argument took on a life of its own in the right-wing universe, especially after former GOP vice presidential candidate Sarah Palin got involved and started talking about how the legislation was allegedly proposing to create “death panels.”² Eventually Democrats removed the end-of-life provision entirely. But the smear campaign had a lasting impact. Polling from the research organization KFF found that in 2010, when the Affordable Care Act became law, four in ten Americans still believed it had death panels.³
I am writing about that history now because death panels are back—only this time, it’s not coming from the Democrats. It’s coming from Donald Trump and his top health care advisers.
A new regulatory proposal from the Trump administration, ...
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