Remember when Sarah Palin’s “death panels” conspiracy theory almost sunk the Affordable Care Act?

“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.'” — Gov. Sarah Palin (R-AK), August 7, 2009

People were understandably upset with the idea that people’s healthcare, and therefore their lives, could be taken away because they had become too costly. Of course, it was complete nonsense. There was initially a provision in one of the health care reform bills to pay physicians to discuss end-of-life care with their patients and write down their decisions, but that was removed because of Palin’s fearmongering. It would have saved a great deal of money.

Fast-forward to 2025, and we’re finding out who is actually doing death-panel things: private health insurance companies.

The Guardian reported that health insurer UnitedHealth Group paid nursing homes to change some of their residents’ status to “do not resuscitate” or “do not intubate” in order to prevent costly hospital admissions.

Internal emails show, for example, that UnitedHealth supervisors gave their teams “budgets” showing how many hospital admissions they had “left” to use up on nursing home patients.

The company also monitored nursing homes that had smaller numbers of patients with “do not resuscitate” – or DNR – and “do not intubate” orders in their files. Without such orders, patients are in line for certain life-saving treatments that might lead to costly hospital stays.

Two current and three former UnitedHealth nurse practitioners told the Guardian that UnitedHealth managers pressed nurse practitioners to persuade Medicare Advantage members to change their “code status” to DNR even when patients had clearly expressed a desire that all available treatments be used to keep them alive.

End-of-life care is expensive and often does not generate value in terms of quality-adjusted life years (QALYs). According to Kaiser Familly Foundation, “In 2014, beneficiaries who died at some point during the year accounted for 4% of all beneficiaries in traditional Medicare, but 13.5% of traditional Medicare spending.”

But patients deserve to make their own healthcare decisions about end-of-life care and not to have anyone — the government or private health insurance companies — make it for them.

It’s not clear whether any patient was actually denied lifesaving care as a result of UnitedHealth’s practices, but if anyone did die as a result of this status being flipped, I would recommend charging everyone involved with first-degree murder.