Palin's death panel comment where about passive euthanasia not active euthanasia. All the uproar was directed at the end of life panning provisions. That was over the active euthanasia and removed from the Senate bill. Palin's comment about passive euthanasia are not out of the bill. Mainly due to the fact it was never directly in the bill. It has always been a likely consequence of the bill. In can happen in two ways. One, you dump several million more in to the system but don't add any more doctors, nurses, hospital or clinics. There is the same amount of heath care and more people. Logically that means less for everyone. Who gets what? Who makes that call? Death panel?
Second, is the slow single payer take over. Why slow? They know they just can't pass it. They can set up (by reducing the people using it) the private insurance to become to expensive (a free market kiss off). They could put in so many rules to make it fair that they can't make any money( populist strangulation). It is possible they only partially do either of those and pass legislation latter to finish the job.The less apparent option, leave the door open for HHS, blue ribbon panels or the "smart" people to make some of the rules. "After much deliberation" they enact rules, under the authority of the final bill (buried on page xyz) to enact rules that have the same effect.