PolitiFact named Sarah Palin's "death panels" claim as its inaugural "Lie of the Year," and now Palin is back at it: in a post to her Facebook page that responds to her "Lie of the Year" distinction, Palin elaborates on the "death panels" accusation once again:

...Senator Jim DeMint spotted one shocking revelation regarding the section in the bill describing the Independent Medicare Advisory Board (now called the Independent Payment Advisory Board), which is a panel of bureaucrats charged with cutting health care costs on the backs of patients - also known as rationing...

In other words, Democrats are protecting this rationing "death panel" from future change with a procedural hurdle...

Though Nancy Pelosi and friends have tried to call "death panels" the "lie of the year," this type of rationing - what the CBO calls "reduc[ed] access to care" and "diminish[ed] quality of care" - is precisely what I meant when I used that metaphor.

The advisory board would make recommendations on how to control or cut Medicare spending, but not on a patient-by-patient bases (as the term "death panels" generally implies). Here's how Ronald Brownstein explained it in a November post on this site that praised Senate Majority Leader Harry Reid's bill in its late-November incarnation:

Finally, the Reid bill maintains the two powerful institutions the Finance legislation proposed to promote these reforms and develop new ones. The one that's attracted the most attention is an independent "Medicare Advisory Board." Under the Senate bill, that board would be required to offer cost-saving proposals when Medicare spending rises too fast; Congress could not reject its proposals without substituting equivalent savings. Since the board would be prohibited from offering changes that raise taxes or "ration care," and since the legislation initially exempts hospitals from its recommendations, it could choose to promote the sort of payment reforms the bill establishes. (More prosaically it might also clear away some of the expensive coverage mandates that Congress imposes on Medicare under pressure from different elements of the medical industry).

Palin has defended the "death panels" attack all along, most notably in an op-ed published in The Wall Street Journal in September, and The Plum Line's Greg Sargent finds some discrepancy in those defenses: first, she seemed to be talking about coverage of end-of-life counseling under Medicare; now, she's talking about the advisory board.

It appears Palin will defend this claim to the death. At this point, softening would seem an admission of a lie.

Palin has made her case that the "death panels" were a broad metaphor for the rationing of medical care, which she feared (rightly or wrongly) would occur under Democratic health reforms. The use of the term "metaphor" is, itself, and admission that there are no literal death panels; it was a dangerous claim because some people probably took it more literally than that.

She originally made the claim three days after the Club for Growth began running a TV ad that depicted elderly British patients and warned that, in Britain's version of "government-run health care," the government decided to pull the plug on elderly patients for whom it would cost more than $22,750 to keep alive.

Political rhetoric is rife with metaphors and exaggerations to make points. Was Palin trying to mislead people, picking out a thin shred of fact in the end-of-life counseling provision and twisting it to frighten people about Obama's health care plans? Or was she constructing a broader metaphor to describe the dangers of those reforms, perhaps playing off the Club for Growth's own (probably misleading) warning about the slippery slope of government-run health insurance?

Let's go to the tape. Here's how Palin phrased her "death panel" allegation/metaphor originally, in the Facebook post in August where she first used the term:

And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil.

Palin will probably never back down, and she's shown that she's unwilling to let any accusation that she lied hang in the ether without a response. But many people are certain that she did intentionally mislead, and they'll certainly keep accusing her of it. The upshot is: we can expect these back-and-forth episodes over the "death panels" to play out again in the future.

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