A few weeks ago, before Newt Gingrich had taken his turn at the top of the Ferris wheel, I laid out in this space an issue where he had been even more jarringly hypocritical and mercurial than most others: reducing the cost of end-of-life care. The short version of it was that Gingrich had for years praised to the skies a hospital in La Crosse, Wisc. where his wife Callista's father died in 2006, singling it out in particular for its emphasis on advance-care directives that allow people's final months to be spent in accordance with their wishes -- and that, not surprisingly, result in far lower health spending. Gingrich was publicly praising this model as recently as July 2009, and the hospital, which had been leading a nationwide effort to get Medicare to reimburse hospitals for counseling patients on advance care directives, was a paying client of Gingrich's for-profit health-policy outfit, the Center for Health Transformation. But in August 2009, Sarah Palin used the word "death panels" to describe the language being sought by Gundersen Lutheran in the Affordable Care Act to provide Medicare reimbursement for advance-care counseling. Within days, Gingrich had flipped on the issue, warning that the proposed language could lead to "euthanasia." To the hospital's dismay, he invoked its succcess with advance care directives, and his father-in-law's experience at the hospital, as an argument against the language that the hospital itself was seeking. The hospital's confusion over Gingrich about-face was renewed two months ago when he invoked "death panels" again at a debate. Bud Hammes, who oversees the hospital's advance-care directives, called the comment "distressing."

Well, what Hammes knew at the time but could not say publicly is that Gingrich's continued talk of death panels was particularly perplexing given that...the Center for Health Transformation is about to release a book touting the Gundersen Lutheran approach to end of life care. The Center just announced that the book, "Having Your Own Say: Getting the Right Care When It Matters Most," will be out next month. Hammes has even co-authored a new op-ed with the Center's director on the Center's Web site, which includes this line:

There have been hyper-political debates about the role of the federal government in the doctor-patient relationship. Putting aside the debate about so-called "death panels" or argument over the new health care law and its cuts to Medicare, the proper place for these highly personal decisions is with your family and your doctors.

Yes, and those hyper-political debates were fueled in part by the man who founded and profits from the entity publishing this book.

There have been several good attempts in the past week, most recently by Mark Schmitt, to distinguish Mitt Romney's flip flops from Gingrich's, and explain why it is that Gingrich is getting more of a pass from conservatives for his own apostasies. The overriding theory is that Romney's shifts are more damning because they are so tortured and evasive, whereas Gingrich's are so brazen and arbitrary that they are not taken entirely seriously. The secret to Newt's "say anything" conservatism, Schmitt writes, was that "he didn’t really mean any of it. He didn’t stick with any initiative long enough to confront the conflicts and contradictions between them."

I think there's definitely something to this. But it's worth noting that Gingrich's capriciousness does not come without a cost. Please: read my initial take on all this, and imagine the reaction of the hospital officials who had been fighting for years for proper reimbursement for their cost-saving, pioneering efforts on end of life care -- only to see themselves betrayed by the very man who just weeks earlier had been on their side, and would jump back to their side (and their payments to his for-profit think tank) as soon as the storm blew past.