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Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security, talks with USA TODAY’s Jayne O’Donnell about isolation, reopening and COVID-19 vaccines.

USA TODAY

Palin’s death panels were fake. Today’s would be real. But there is a practical path to protecting people as we restart our economy. Let’s choose it.

In 2009, during the surge in the Tea Party movement’s prominence and the fight over what became known as Obamacare, Sarah Palin reemerged as a potent political force. The former Alaska governor and 2008 Republican vice presidential nominee told us that the federal government would use “death panels” to determine who would and who would not receive care under expanded coverage. She explicitly mentioned her own son and elderly parents as examples of individuals who would be threatened by the Affordable Care Act.

Put aside that her argument was provably false: It resonated with a large swath of America and almost tanked the chances of passing the ACA, and it certainly contributed to widespread electoral losses by Democrats in 2010 and beyond. In the years since passage, the ACA has provided coverage to millions of Americans and improved the fiscal sustainability of Medicare.

Fast-forward to today and we have numerous pundits, politicians and supposed experts coming up with an actual plan for what might as well be called “death panels.”       

The most vulnerable among us 

While the coronavirus continues to kill thousands of Americans every day, these pundits have focused on “surgically” protecting the most vulnerable segment of society while the rest are more quickly exposed. In the past week alone, David KatzAvik Roy and others have rallied around the dangerous idea that we can carve out the most vulnerable among us and allow the remainder to resume full-time work, education and play. 

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This approach rests on two premises: 1) We can readily identify the most vulnerable individuals since they are either old or have high-risk conditions and 2) We can protect those individuals from harm once they are identified.

While it is true that fatalities have disproportionately affected the oldest among us, the median age of hospitalized COVID-19 patients in one large study is 63, indicating that half or more of such patients are of working age.

And while it is also true that many of the sickest patients have additional chronic conditions, obesityhypertension and diabetes are highly prevalent in the general population. In fact, the Centers for Disease Control and Prevention reports that 42% of American adults are obese, with rates as high as 45% among Hispanics and 50% among black adults. Hypertension affects nearly half of adult Americans, 54% of blacks. 

Even if we identify those who fit into these higher risk categories, how do we “surgically” protect them? How can we open up a municipality, university, entertainment venue if half or more of their workforce is at heightened risk? How do we protect vulnerable family members, even if the employee is healthy and young? How do we provide safe care to nursing homes, hospitals and other centers with vulnerable populations if we allow high rates of disease prevalence to circulate among our service workers?

A path to put people ahead of it

Those who think there is no alternative need only look to peer nations, such as South KoreaNew ZealandTaiwan and Germany. All took this very seriously from the beginning. All emphasized aggressive testing, contact tracing and isolation/quarantine, and all seemingly have been able to weather the outbreak during a finite period of time leading to reopening of their economies. None of this should be difficult for a nation that had a “Manhattan Project,” put a man on the moon and has laid claim to being the greatest on earth. 

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The political success of Sarah Palin was not that she encouraged us to have a discussion about a topic of great importance. No such discussion about potential death panels happened then or since. Her success was that she convinced a large portion of America that there was a nefarious plot to allow the most vulnerable among us to die and then used the political power of this group to support a new Republican coalition.

Today, we have a real threat to our oldest and our most marginalized. Coronavirus is not just disproportionately affecting the old, it is also hitting communities of color, the disabled and those of limited means the hardest. And they are dying in vast numbers. We have a path forward that emphasizes testing, tracing and isolation: It minimizes harm, restarts our economy and puts people ahead of politics. Why would we want to pivot to death panels? 

Dr. Howard P. Forman is a Yale professor of management, public health, economics and radiology. Follow him on Twitter: @thehowie

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