The Truth About …By
Since the outset of the current healthcare reform debate in this country, a lot has been said on talk radio, cable news outlets, assorted print media, the blogosphere, and thousands of other internet outlets. Not to mention every corner drugstore and coffee shop in America. The available information ranges from “just the facts” to honest attempts at decoding government speak, from inadvertent misinformation to deliberate distortion, and from demagoguery to outright lies. There is no shortage of opinion to be found out there, and no shortage of people, on both sides of the argument, who are willing to twist the facts to represent their predetermined point of view. But how does one go about sifting through the fact and the fiction to arrive at an informed judgment?
It’s a good question. Another is how this new phenomenon—the ability to spread misleading information at rapid speed through chain e-mails, blogs, text-messaging and “tweets”—will affect the reform debate.
“What we’re seeing is a flood of viral content that distorts the Obama effort to reform health care,” says Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania, who codirects www.FactCheck.org, a website that examines questionable claims from all sides of the political spectrum. Today’s opposition tools are very different from those used against previous attempts at health care reform in the Clinton era. Then, the key means of attack available were television advertising and direct-mail campaigns, which were expensive and took time to organize.
“Extremists and people who are so locked into their own ideology that they’ll distort anything have been out there forever,” Jamieson says. “But they haven’t had a way to reach out to as many people as efficiently as they have now.”
To be fair to the opponents of health-care reform, the lies and exaggerations they’re spreading are not made up out of whole cloth—which makes the misinformation that much more credible. Instead, because opponents demand that everyone within earshot (or e-mail range) look, say, “at page 425 of the House bill!,” the lies take on a patina of credibility. Take the claim in one chain e-mail that the government will have electronic access to everyone’s bank account, implying that the Feds will rob you blind. The 1,017-page bill passed by the House Ways and Means Committee does call for electronic fund transfers—but from insurers to doctors and other providers. There is zero provision to include patients in any such system.
Here are several other myths about healthcare reform that just won’t die:
You’ll have no choice in the health benefits you receive.
The myth that a “health choices commissioner” will decide what benefits you get seems to have originated in a July 19 post at blog.flecksoflife.com, whose homepage features an image of Obama looking like Heath Ledger’s Joker. In fact, the House bill sets up a health-care exchange—essentially a list of private insurers and one government plan—where people who do not have health insurance through their employer or some other source (including small businesses) can shop for a plan, much as seniors shop for a drug plan under Medicare part D.
The government will indeed require that participating plans not refuse people with preexisting conditions and offer at least minimum coverage, just as it does now with employer-provided insurance plans and part D. The requirements will be floors, not ceilings, however, in that the feds will have no say in how generous private insurance can be.
Senior citizens seem to be a particular target for these liars. A lot of the mythology about health reform is designed to scare them, like another lie spread across the country: the president’s proposal will lead to cuts in the coverage seniors receive for prescription drugs. Rep. Tom Cole (R-OK) said as much on July 21st when he claimed that the Democratic proposal would cause “millions of seniors to lose their coverage for prescription medicine.” In fact, health insurance reform will save seniors hundreds of dollars on their prescriptions because it cuts the cost of drugs by half, once they reach the Part D coverage gap. Moreover, it begins phasing in the end of the “donut hole.”
No chemo for older Medicare patients.
The threat that Medicare will give cancer patients over 70 only end-of-life counseling and not chemotherapy—as a nurse at a hospital told a roomful of chemo patients, including the uncle of a NEWSWEEK reporter—has zero basis in fact. It’s just a vicious form of the rationing scare. The House bill does not use the word “ration.” Nor does it call for cost-effectiveness research, much less implementation—the idea that “it isn’t cost-effective to give a 90-year-old a hip replacement.”
The general claim that care will be rationed under health-care reform is less a lie and more of a non-disprovable projection (as is Howard Dean’s assertion that health-care reform will not lead to rationing, ever). What we can say is that there is de facto rationing under the current system, by both Medicare and private insurance. No plan covers everything, but coverage decisions “are now made in opaque ways by insurance companies,” says Dr. Donald Berwick of the Institute for Healthcare Improvement.
Senator Mitch McConnell (R-KY) was on Fox News last month saying that the president’s proposals would be paid for “on the backs of seniors through Medicare cuts.” That’s a lie. This refers to proposed decreases in Medicare increases. That is, spending is on track to reach $803 billion in 2019 from today’s $422 billion, and that would be dialed back.
Even the $560 billion in reductions (which would be spread over 10 years and come from reducing payments to private Medicare advantage plans, reducing annual increases in payments to hospitals and other providers, and improving care so seniors are not readmitted to a hospital) is misleading: the House bill also gives Medicare $340 billion more over a decade. The money would pay docs more for office visits, eliminate copays and deductibles for preventive care, and help close the “doughnut hole” in the Medicare drug benefit, explains Medicare expert Tricia Neuman of the Kaiser Family Foundation.
As the Alliance for Retired Americans points out, Medicare will benefit from cost-containment across the entire health care system. Furthermore, President Obama has proposed ending the wasteful overpayments currently given to private Medicare Advantage plans. That reform will help ensure that Medicare resources benefit all Medicare participants, and are not diverted to insurance companies.
Illegal immigrants will get free health insurance.
The House bill doesn’t give anyone free health care (though under a 1986 law illegals who can’t pay do get free emergency care now, courtesy of all us premium paying customers or of hospitals that have to eat the cost). Will they be eligible for subsidies to buy health insurance? The House bill says that “individuals who are not lawfully present in the United States” will not be allowed to receive subsidies.
The claim that taxpayers will wind up subsidizing health insurance for illegal immigrants has its origins in the defeat of an amendment, offered in July by Republican Rep. Dean Heller of Nevada, to require those enrolling in a public plan or seeking subsidies to purchase private insurance to have their citizenship verified. Flecksoflife.com claimed on July 19th that “HC [health care] will be provided 2 all non US citizens, illegal or otherwise.” Rep. Steve King of Iowa spread the claim in a USA Today op-ed on August 20th, calling the explicit prohibition on such coverage “functionally meaningless” absent mandatory citizenship checks, and it’s now gone viral. Can we say that none of the estimated 11.9 million illegal immigrants will ever wangle insurance subsidies through identity fraud, pretending to be a citizen? You can’t prove a negative, but experts say that Medicare—the closest thing to the proposals in the House bill—has no such problem.
Death panels will decide who lives.
When Sarah Palin writes that President Obama is going to set up “death panels” to decide whether her child with Down syndrome, or elderly parents, are going to live or die, she is spreading a lie. That’s a disgrace and she is not alone. On July 16th Betsy McCaughey, a former lieutenant governor of New York and darling of the right, said on Fred Thompson’s radio show that “on page 425,” “Congress would make it mandatory…that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition.” But it was Sarah Palin who coined the term “death panels” in an August 7 Facebook post.
This lie springs from a provision in the House bill to have Medicare cover optional counseling on end-of-life care for any senior who requests it. This means that any patient, terminally ill or not, can request a special consultation with his or her physician about ventilators, feeding tubes, and other measures. Thus the House bill expands Medicare coverage, but without forcing anyone into end-of-life counseling.
The death-panels claim nevertheless got a new lease on life when Jim Towey, director of the White House Office of Faith-Based Initiatives under George W. Bush, claimed in an August 18 Wall Street Journal op-ed that a 1997 workbook from the Department of Veterans Affairs pushes vets to “hurry up and die.” In fact, the thrust of the 51-page book, which the VA pulled from circulation in 2007, is letting “loved ones” and “health care providers” “know your wishes.” Readers are asked to decide what they believe, including that “life is sacred and has meaning, no matter what its quality,” and that “my life should be prolonged as long as it can…using any means possible.” But the workbook also asks if readers “believe there are some situations in which I would not want treatments to keep me alive.” Opponents of health-care reform have selectively cited this passage as evidence the government wants to kill the old and the sick.
Rep. Virginia Foxx (R-NC) went on the House floor to state that the GOP opponents of health care reform “would not put seniors in a position of being put to death by their government.” The idea that the president and supporters of health insurance reform want to put people to death is an outrageous lie. As the Los Angeles Times noted on August 10th, “This has become one of the most misleading, inflammatory claims made in the health care debate, advanced repeatedly by conservative commentators such as Rush Limbaugh and Sean Hannity and Republican lawmakers working to stoke fears among seniors.”
In fact, as the Times notes, under the proposal, Medicare would start to cover voluntary doctor visits to discuss living wills and advance directives for care, which would be used only if a person becomes seriously ill and unable to make medical decisions. As is currently the practice, advance care decisions would still be made by the individual. There is nothing mandatory or coercive in the proposal, which was proposed initially by Republicans in Congress.
The government will set doctors’ wages.
This, too, seems to have originated on the Flecksoflife blog on July 19. But while page 127 of the House bill says that physicians who choose to accept patients in the public insurance plan would receive 5 percent more than Medicare pays for a given service, doctors can refuse to accept such patients, and, even if they participate in a public plan, they are not salaried employees of it any more than your doctor today is an employee of, say, Aetna. “Nobody is saying we want the doctors working for the government; that’s completely false,” says Amitabh Chandra, professor of public policy at Harvard’s Kennedy School of Government.
To be sure, there are also honest and principled objections to health-care reform. Some oppose a requirement that everyone have health insurance as an erosion of individual liberty. That’s a debatable position, but an honest one. And many are simply scared out of their wits about what health-care reform will mean for them. But when fear and loathing hijack the brain, anything becomes believable—even that health-care reform is unconstitutional. To disprove that, check the commerce clause: Article I, Section 8.
So what are we supposed to do about it?
All across the country, the opponents of health care reform are spreading misinformation about almost all the proposals to improve health care coverage for Americans. We shouldn’t be surprised by that. The insurance companies, the right-wing radio hosts, the K-Street lobbyists and the Republican leadership who are spreading the misinformation have a vested interest in keeping the status quo. And they are willing to lie to protect industry profits.
It’s troubling to see that so many well-meaning citizens are listening to the lies and believing them. One has only to watch a handful of angry questioners at some televised town-hall meeting to know that some of these questioners are good people who are troubled by what they are hearing. They want to know the facts. But all too often, they are denied answers by the rabble that eschews the truth by shouting others down. The opponents of health care reform are pulling out all the stops to kill the reform that millions of Americans need to improve our health care. They’re spreading falsehoods and creating chaos. They know what they are doing.
All of us need to work together to break through the lies and shouts and slurs. We need to make sure that our friends and neighbors know the truth, and can separate the lies from the facts about health insurance reform. Educate yourself. Learn what is true and what it not. And when you hear someone spreading misinformation and lies, knowingly or unwittingly, don’t let it go unchallenged. Correct it. Do your part to set the record straight. There have been few times as important as now to stand up and speak the truth.