In 2009, Sarah Palin posted on Facebook that the Affordable Care Act would create “death panels” that would decide whether sick Americans were “worthy of healthcare.” The claim was false. PolitiFact named it the Lie of the Year. There were no panels. There were no deaths. There was, in fact, a provision allowing Medicare to reimburse doctors for end-of-life counseling conversations, which is the kind of thing a compassionate society does for elderly people and their families, and which Palin transmuted, through a process available only to her, into government bureaucrats deciding who deserved to live.
The American public was horrified at the concept of death panels.
They then elected the people who actually built them.
This is worth sitting with. Not for too long, because the list of what needs examining is substantial and we have ground to cover, but for a moment. The people who said “death panels” as the most damning phrase in their political vocabulary, who held it up as the ultimate evidence that the left wanted to play God with human life, have spent the last several years enthusiastically applauding the construction of the most prolific series of actual death panels in modern American political history. They have done this with a cheerfulness that is, depending on your constitution, either fascinating or nauseating, and in many cases both simultaneously.
Let us go through them. Methodically. In the manner of a health inspector who has just entered a kitchen and would like to document everything before the building is condemned.
Panel One: ICE and the People It Kills
The United States Immigration and Customs Enforcement agency has, under the current administration, shot American citizens. Renee Nicole Good and Alex Pretti were bystanders. They were not suspects. They were not threats. They were standing near an immigration enforcement operation and they were killed, and the administration described them as domestic terrorists, and the MAGA right nodded along.
This is a death panel. It is a panel that has decided, without trial, without evidence, without due process of any kind, that certain people in certain proximity to certain operations are acceptable losses. The panel does not convene in a room. It convenes in a policy memo and an operational culture that treats human life as an acceptable variable in a political performance.
And when that performance results in dead American citizens, the audience applauds.
The same ICE apparatus has detained American children, legal residents, and documented immigrants and in several cases returned them to countries they have never lived in. Several people have died in ICE custody under conditions that subsequent investigations described as medically negligent. The administration has responded to each of these deaths with the same energy it brought to the Renee Nicole Good situation, which is to say it has explained why the dead person had it coming.
A death panel does not need a conference table. It just needs a policy and a press secretary.
Panel Two: USAID and the People Who Were Eating
The United States Agency for International Development was, before Elon Musk’s DOGE operation shuttered it in the opening weeks of 2025, the largest single provider of humanitarian food assistance on earth. It fed approximately 40 million people in acute food crisis across multiple continents. It delivered emergency nutrition to children under five in famine conditions. It kept tuberculosis treatment programs running in countries where tuberculosis was otherwise a death sentence. It funded malaria prevention. It funded maternal health. It funded the kinds of interventions that prevent the specific, unglamorous, invisible deaths that happen to people in places that American cable news does not cover.
DOGE cut it with the enthusiasm of people who had never met anyone who needed it.
The projected death toll from USAID’s dismantlement, per public health researchers who study these things professionally, runs into the hundreds of thousands over the next several years. These are not hypothetical deaths. They are actuarial certainties. They are children who will not receive the nutrition interventions that would have kept them alive, and TB patients who will not complete the drug courses that would have cured them, and mothers who will die in childbirth in facilities that no longer have the supplies they needed.
This is a death panel operating at a scale that Sarah Palin’s Facebook post could not have imagined even as a fever dream. It is a panel that convened in a government efficiency meeting, decided that feeding dying people was wasteful spending, and then took a victory lap about the savings.
The MAGA right called it fiscal responsibility.
Panel Three: The War on Health Science
The administration that brought you all of the above has also spent considerable energy attacking the infrastructure that keeps Americans alive in more domestic ways.
RFK Jr., the Secretary of Health and Human Services, has suggested that vaccines cause autism, a claim that has been studied more thoroughly than almost any medical question in modern history and found, each time, to be false. He has overseen cuts to the CDC, the FDA, and the NIH at a scale that public health professionals describe as generational damage. He has questioned the basic science of germ theory. He has, on multiple occasions, suggested that the solution to chronic disease is to stop eating processed food, which is advice that would be more useful if his boss did not eat exclusively processed food and his department was not simultaneously dismantling the regulatory apparatus that governs processed food safety.
Vaccines, in the time since their introduction, have prevented more deaths than almost any other medical intervention in human history. Measles alone killed approximately 2.6 million people annually before the vaccine existed. The return of vaccine-preventable diseases, which public health officials began documenting in 2025 as vaccination rates declined, is not a side effect of the administration’s health policy. It is a foreseeable, predicted, modeled consequence of it.
The panel, in this case, is a philosophy. The philosophy is that the science is suspect, the experts are corrupt, and the deaths that follow from abandoning both are someone else’s fault. The panel meets every time a child is not vaccinated because a parent was told by a cabinet secretary that the shot was dangerous. It adjourns when the child recovers or doesn’t.
Panel Four: The Iran War
The administration launched military strikes on Iran in the spring of 2025, hitting more than eighty targets. American service members have died. Iranian civilians have died, including, by multiple credible accounts, a significant number of children, because Iranian military infrastructure is located in proximity to residential areas in the way that military infrastructure in every country on earth is located in proximity to residential areas.
The strategic rationale for the war has shifted several times. The stated objectives have been achieved, then re-declared, then modified. The ceasefire was announced, celebrated, and then this week, at a NATO summit in Ankara, Trump announced it was over. He did this in the same press conference in which he called Iran “the Islamic Republic of Japan” and referred to the Ukrainian president as Putin, which suggests that the decision-making architecture behind the war may have some structural vulnerabilities worth examining.
American soldiers are dying in a war whose objectives the Commander in Chief cannot consistently articulate, in a press conference in which he cannot correctly identify the country the war is being fought against.
This is a death panel with a podium and a flagpole behind it.
The MAGA right, which spent years furious about wars in the Middle East when a Democrat was prosecuting them, has greeted this one with the enthusiasm of people who have discovered that war is fine actually when the right person orders it.
Panel Five: Epstein and the Protected Class
Here is where the hypocrisy becomes something darker and more specific.
The MAGA right, which cheers when ICE shoots a bystander and shrugs when USAID cuts kill a hundred thousand invisible children, has also spent considerable energy protecting a specific category of human being from accountability. The Epstein files, which the current DOJ has declined to release in any meaningful form, contain the documented records of a sex trafficking operation that processed children. The clients of that operation are, in all likelihood, among the most powerful men in the world. The files have not been released. The investigation has not been meaningfully pursued. The administration that built the death panels for brown people and poor people and sick people has constructed a very different kind of panel for the men who paid Jeffrey Epstein.
That panel keeps people alive. Comfortable. Unindicted.
The same movement that cheers the death of a migrant in custody, that applauds the defunding of a food program that fed forty million people, that celebrates a war it cannot coherently explain, has decided that the men in those files deserve the full protection of the government they now control.
Death panels, it turns out, have a VIP lounge.
Panel Six: The Insurance Company in the Room
There is one death panel that predates Trump, predates MAGA, predates Palin’s Facebook post, and has been operating continuously, profitably, and with the full legal protection of the American government for decades. It meets in actuarial departments and claims processing centers and prior authorization queues. It employs people with titles like “utilization review specialist” and “medical necessity coordinator,” which are the human resources department’s way of saying “the person who decides whether your doctor’s recommendation is real.”
The American health insurance industry denies claims. It denies them at scale, systematically, using algorithms that have been specifically designed, as litigation and reporting have repeatedly confirmed, to maximize denial rates rather than to assess medical necessity. It denies chemotherapy. It denies insulin. It denies psychiatric hospitalization for people in active crisis. It denies physical therapy that a physician has prescribed, a surgeon has recommended, and a patient has begged for, because a non-physician reviewer sitting in a cubicle in another state has determined, via software, that the claim does not meet the threshold for coverage.
People die from these decisions. Not metaphorically. Not statistically in the abstract. Specifically, individually, with names and families and medical records that show exactly what was denied and when and what happened next.
Luigi Mangione became a folk hero in December 2024 for reasons that a significant portion of the American public found entirely legible, which is itself a data point worth sitting with. When a man who shoots a health insurance CEO is greeted with sympathy by millions of ordinary Americans, what that reflects is not a culture of violence. It is a culture of people who have spent years watching the panel operate and have run out of other ways to express what it costs them.
The MAGA right, which has called Obamacare a death panel since 2009 and has voted to repeal it in whole or in part more than seventy times, has never once directed comparable energy at the insurance industry’s denial apparatus. The party that cannot stop talking about government bureaucrats coming between you and your doctor has also consistently opposed every legislative attempt to prevent insurance company bureaucrats from coming between you and your doctor. They blocked a federal prior authorization reform bill. They have proposed no meaningful regulation of algorithmic claim denial. They have, in the current administration, moved to cut Medicaid, which is the program that covers the people least able to afford the alternative.
The insurance company death panel is the one Palin’s voters interact with most directly and most personally. It is the one that has denied their parents’ cancer treatments and their children’s mental health admissions and their own post-surgical physical therapy. It is the one that sends letters explaining, in careful bureaucratic language, that the thing their doctor said they needed is not medically necessary according to the company that profits from not providing it.
And it is the one that the movement that invented the phrase “death panel” has spent thirty years protecting.
The panel was always in the room. They just made sure it stayed private.
The Hypocrisy, Assembled
Sarah Palin was afraid of a Medicare provision that allowed doctors to have honest conversations with dying patients about their wishes. She called it a death panel because it involved the government, death, and a panel-adjacent administrative structure, and she wanted people to be afraid of it, and they were.
The same political movement has since built panels that kill migrants, panels that defund the feeding of the world’s most vulnerable children, panels that dismantle the vaccine infrastructure that keeps measles from returning, panels that send soldiers into wars whose objectives the president cannot remember, panels that protect the documented clients of a child sex trafficking operation from any accountability whatsoever, and panels that have spent thirty years ensuring that a private industry can override your doctor’s judgment and send you home to die with a denial letter.
They are not afraid of death panels. They are running them.
The only death panels they ever objected to were the ones that might have saved someone they did not want saved.
Palin named them. She just got the team wrong.