Palin's statement then launched the health care debate into overdrive. The term was mentioned in news reports approximately 6,000 times in August and September, according to the Nexis database. By October, it was still being mentioned 150 to 300 times a week.

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The phrase "death panels" appears to be original to Palin. A search of news databases showed no use prior to her Facebook posting.

History professor Ian Dowbiggin, who has written several books on medical history, euthanasia and eugenics, said he had never heard the term before Palin used it. He said the phrase invokes images of Nazi Germany, which denied life-saving care to people who were not deemed useful enough to broader society. Adolf Hitler ordered Nazi officials to secretly register, select, and murder handicapped people such as schizophrenics, epileptics, disabled babies and other long-stay hospital patients, according to Dowbiggin.

Idaho is what a state looks like when it fails to flatten the curve. As in other Mountain States, beds are running out. In response to the crush of patients, which is not expected to slow anytime soon, the Idaho Department of Health and Welfare (DHW) last week activated crisis standards of care. When implemented by hospitals, these plans, first formulated in April 2020 with the hope they would rarely need to be used, help guide overwhelmed medical workers on how to ration scarce resources.

The crisis standards apply to all patients — not just those with COVID-19. “There are already many patients who’ve had to delay surgery or other treatments, and if you end up in a hospital, you may receive treatment in a waiting room or a hallway,” said DHW Director Dave Jeppesen. “Each nurse and doctor will be taking care of more patients than usual. You may have to wait much longer than normal for care. You may even have to be transferred to a care facility that could be hours away.”

Last Thursday, the day the crisis standards were first activated, one older adult came into a hospital after she suffered a stroke. In normal times, she would be held overnight for monitoring, but instead she was discharged that same day. The woman was Jeppesen’s own mother.

“Not only was it stressful that my mom had a stroke, there was added worry about the availability of healthcare when she went to the ER,” he said. “Things were different in the ER. There were other patients receiving care in the waiting area.”

If things truly reach their worst in Idaho, the crisis standards guide doctors in triaging which patients receive care and which won’t. They involve a complex calculation of health factors in order to save the most lives possible. In the event of a tie, doctors may have to resort to a lottery system. Hospitals may even institute a universal do-not-resuscitate order for all patients who suffer cardiac arrest — although this has not yet happened in Idaho and would never apply to children.