THE ‘REAL DEATH PANELS’…. Arguably the most offensive and outrageous political lie of 2009 was the notion that the Affordable Care Act included “death panels.” It didn’t — the provision in question was a bipartisan measure related to reimbursements for consultations on directives and living wills — but unhinged, right-wing hacks wanted the public to believe bureaucratic bean-counters would start denying care to Americans in need.

We know they were lying. What’s less well known is the fact that something akin to “death panels” actually exist, and not just with insurance company bean-counters who’ve been playing this role for years.

The American Enterprise Institute’s Norm Ornstein explained today that the “real” death panels were created by “Republican administrations in states such as Arizona and Indiana.”

In Arizona, the government headed by Gov. Jan Brewer summarily stopped approving Medicaid payments for many organ transplants in October; one man had a liver virtually snatched away while he waited to go into the operating room. He couldn’t get it unless he came up with $200,000 to pay for the procedure. In Indiana, the state Medicaid program denied a lifesaving operation last year to a 6-month-old boy who lacked a thymus gland, which generates cells that the body uses to fight infection. The Indiana Family Social Services Administration said the procedure was “experimental” – even though it had been successful in 43 of the 60 cases in which it had been applied. The state twice denied the family’s appeals, but fortunately the publicity caused by this case prodded two health-care companies to pay for the $500,000 operation. These are real death panels. They are far from the Affordable Care Act’s provision for end-of-life counseling for families to enable them to make rational decisions about their loved ones outside of the awful stress in a hospital or hospice. But these decisions are not being made by evil people reveling in the anguish of patients on Medicaid; they are the result of painful choices made by state governments struggling with a sluggish economy, balanced budget requirements and soaring Medicaid costs. States have to react, and one solution to their constraints is rationing care. In other words, the nightmares of conservatives bitterly opposed to health reform are coming true on two fronts, but with zero relation to the reform bill they opposed.

Oddly enough, some of the same right-wing Republicans who were hysterical about “death panels” and “rationing” in 2009 haven’t had much to say about developments in Indiana and Arizona. I wonder why that is.

What’s more, this is a problem that’s likely to get worse this year.

Ornstein added:

The dilemmas of state governments are here now. The same kinds of pressures have been building for years in nearly all public- and private-sector health programs as rising costs have to be met by measures to contain them, which means some form of rationing, whether done by employers, health insurers or others. The Affordable Care Act was spurred by these mounting pressures and included, in one form or another, nearly every idea for containing costs without resorting to the blunt instruments Arizona and Indiana are using. Those cost-retarding programs and vehicles are near the top of the incoming House Republicans’ hit list for the health-reform legislation. They may want to rethink their repeal efforts even as their counterparts in states are rationing up a storm.

Right. Throughout the debate over health care reform, Republicans said the initiative didn’t do enough to cut costs, and would instead lead to things like rationing and “death panels.” More than a year later, those identical Republicans want to reverse Democratic efforts to cut costs, while cheering on states that are already rationing and implementing their own versions of “death panels.”

And for the incoming House GOP majority, there’s no contradiction here at all.