I blogged previously about Mitt Romney's claim that ObamaCare creates “an unelected board that’s going to tell people ultimately what kind of treatments they can have.” President Obama conceded the point when he responded that the Independent Payment Advisory Board “basically identifies best practices and says, let’s use the purchasing power of Medicare and Medicaid to help to institutionalize all these good things that we do.” The president admitted the whole point of IPAB is to let a bunch of experts decide what practices are "best," and to stop paying for what isn't.
I am not aware of a single fact-checker who has grasped that basic point. Not PolitiFact, not the Associated Press, not FactCheck.org, not The Washington Post's Fact-Checker, not this Washington Post health reporter. The Los Angeles Times called Romney's claim "erroneous" and writes:
This is a myth advanced repeatedly by critics of the Affordable Care Act and debunked consistently by independent fact-checkers...the panel is explicitly prohibited from cutting benefits for people on Medicare. And there is no provision in the law that empowers the advisory board to make any decisions about what treatments doctors may provide for their patients.
The media "fact check" business is incredibly tiresome given how pedantic and downright inaccurate it is, but I wanted to weigh in on this one before it hardens. The LA Times somehow thinks that the ACA (aka Obamacare) will have no effect on determining what care patients can get, and consequently dings Romney for saying it will. There isn't a single honest health economist out there who agrees with the LA Times on this one.
Bhattacharya explains that IPAB will be able to influence care by cutting payments to providers. But that's not the half of it. IPAB has the power to do exactly what the fact-checkers think it can't: deny specific treatments to Medicare enrollees. It can even raise taxes and do other things the fact-checkers think it cannot.
I explain why the fact-checkers are wrong at this Cato Institute policy forum at noon on Thursday (October 11). Join us. Pre-register now at that link.
Why am I only hearing about President Obama's gob-smacking "I haven't raised taxes" claim today, and from Reason?
On CBS News’s “60 Minutes” Sunday night, President Obama said, “Taxes are lower on families than they've been probably in the last 50 years. So I haven't raised taxes.”
As of Monday morning, neither the Washington Post’s Pinocchio-awarding Fact-Checker, nor the Annenberg Public Policy Center’s FactCheck.org, nor the Tampa Bay Times’ Pulitzer-Prize-winning Politifact.com had risen to this opportunity...
Unbelievable. I just checked those websites, and they still haven't.
Fortunately, Ira Stoll has. He leaves out a number of taxes President Obama has enacted, though, including raising the Medicare payroll tax on high-income earners, applying the Medicare payroll tax to non-payroll income for high-income earners, limiting the tax exclusion for flexible spending accounts, increasing the penalties on certain health savings account withdrawals, the "Cadillac tax" on high-cost health plans...
During last night's GOP presidential debate, Rick Santorum and Mitt Romney had a polite disagreement over Romneycare's impact on free-ridership in Massachusetts. The short version: Santorum was right. Romney and even FactCheck.org disputed Santorum's claim, but they misunderstood it.
The exchange comes 2:15 into this video from Kaiser Health News:
Here's the Kaiser Health News transcript:
SANTORUM: Just so I understand this, in Massachusetts, everybody is mandated as a condition of breathing in Massachusetts, to buy health insurance, and if you don't, and if you don't, you have to pay a fine.
What has happened in Massachusetts is that people are now paying the fine because health insurance is so expensive. And you have a pre-existing condition clause in yours, just like Barack Obama.
So what is happening in Massachusetts, the people that Governor Romney said he wanted to go after, the people that were free-riding, free ridership has gone up five-fold in Massachusetts. Five times the rate it was before. Why? Because...
ROMNEY: That's total, complete...
SANTORUM: I'll be happy to give you the study. Five times the rate it has gone up. Why? Because people are ready to pay a cheaper fine and then be able to sign up to insurance, which are now guaranteed under "Romney-care," than pay high cost insurance, which is what has happened as a result of "Romney-care."
ROMNEY: First of all, it's not worth getting angry about. Secondly, the...
ROMNEY: Secondly, 98 percent of the people have insurance. And so the idea that more people are free-riding the system is simply impossible. Half of those people got insurance on their own. Others got help in buying the insurance.
Romney is right. The percentage of insured residents in the state went up from 93.6 percent in 2006, the year the law was enacted, to 98.1 percent in 2010. And data from the state Division of Health Care Finance and Policy show a 46 percent decline in the number of free care medical visits paid for by the state’s Health Care Safety Net. The number of inpatient discharges and outpatient visits under the program went from 2.1 million in 2006 to 1.1 million in 2010 (see page 12)...
A Santorum campaign spokesman pointed us to a Wall Street Journal column by Michael F. Cannon of the libertarian Cato Institute, who stated that “Massachusetts reported a nearly fivefold increase in such free riding after its mandate took effect.” But that doesn’t square with official data just cited. Cannon didn’t specify the time period and so may have referred to some temporary or transitory bump in free riders. We will update this item if we are able to get more information from Cannon.
Speaking of facts, here's a fun one: both Kaiser Health News and FactCheck.org unnecessarily flank "Romneycare" with quotation marks when it appears within a quote from Santorum. As if Santorum had used quotation fingers. Adorable. But I digress.
Romney and FactCheck.org failed to consider that there are different types of free riding. One type happens when government guarantees access to emergency-room care: people show up to get care, and they don't pay. Another type happens when government guarantees people the ability to purchase health insurance at standard rates no matter how sick they are: people wait until they are sick to purchase health insurance and drop it right after they get the care they needed. These free riders pay far less than they would in a free market, which would not allow such behavior. Romney and FactCheck.org assumed Santorum meant the former type of government-induced free riding, when he was clearly talking about the latter.
The data that Santorum and I cite come from a report by the Massachusetts Division of Insurance. See this June 2010 blog post, where I quote the Boston Globe:
The number of people who appear to be gaming the state’s health insurance system by purchasing coverage only when they are sick quadrupled from 2006 to 2008, according to a long-awaited report released yesterday from the Massachusetts Division of Insurance.
The result is that insured residents of Massachusetts wind up paying more for health care, according to the report.
“The active members subsidize some of the costs tied to those individuals who terminate within one year,” the report says...
The number of people engaging in this phenomenon — dumping their coverage within six months — jumped from 3,508 in 2006, when the law was passed, to 17,177 in 2008, the most recent year for which data are available.
Actually, it more than quadrupled: 17,177/3,508≈4.9. But whatever. Santorum was right.
One might object that these numbers seem like small potatoes compared to the apparent drop in visits paid from the Commonwealth's Health Care Safety Net program. Fair point. But the type of free riding Santorum identified is incomparably worse than the kind that happens in hospital emergency rooms. When people can wait until they are sick to purchase insurance, overall premiums rise so high that the health insurance market collapses in an "adverse selection death spiral." That’s how Obamacare destroyed (and is destroying) the market for child-only coverage in dozens of states. It’s why Obamacare’s CLASS Act collapsed years before it collected a single premium. It’s happening very slowly in Massachusetts, but it is happening. And it will happen to all private health insurance under Obamacare. In contrast, as I mention in my Wall Street Journal piece, the ER-type of free riding increases health insurance premiums by “at most 1.7 percent,” according to the Urban Institute. That’s not ideal, but it’s not catastrophic.
One might also object that this latter type of free riding can't be a problem since Romneycare has increased the number of Massachusetts residents with health insurance coverage. Also a fair point. But not only can adverse selection occur at the same time that coverage is expanding, it has the potential to completely undo those coverage gains over time. Moreover, some of Romneycare's supposed coverage gains might be people who are actually uninsured but conceal that fact from government surveys rather than admit to unlawful behavior. These are the ultimate free riders: they're not even paying the fine. In this Cato Institute study, Aaron Yelowitz and I found evidence consistent with such concealment behavior in the Census Bureau's Current Population Survey.
Defending ObamaCare in federal court yesterday, the Obama administration's acting solicitor general, Neal K. Katyal, peddled the widely discredited claim that the uninsured increase your and my health insurance premiums by $1,000:
“When people self-finance their health care,” Katyal contended, “that raises the cost of health care overall by $43 billion a year, and that raises the average family’s premiums by $1,000 a year. That will price untold numbers of people out of the market.”
[Obama] said "the average family pays a thousand dollars in extra premiums to pay for people going to the emergency room who don't have health insurance." That's from a recent report by Families USA, a group that lobbies for expanded government coverage. But another study for the authoritative Kaiser Family Foundation thinks that figure is far too high.
Serendipitously, the same day that Kaytal was repeating this discredited claim in federal court, USA Today reported:
Jack Hadley, senior health services researcher at George Mason University in Fairfax, Va...has found that privately insured individuals don't end up paying higher premiums to make up for the uninsured because hospitals that serve lower-income families don't have a lot of patients with insurance. He said the government pays about 75% of those unpaid hospital bills either by direct payment or through a disproportionate payment of Medicaid. (emphasis added)
The Obama administration spent your tax dollars on a pro-ObamaCare ad, featuring Andy Griffith, that FactCheck.org found uses "weasel words" to "mislead" seniors about how that law would affect them. (As I blogged previously, FactCheck.org understated the case.) Nonetheless, over at Medicare.gov, the administration is still running that dishonest ad.
They should take the ad down.
An article in today's The USA Today titled, "With Many Still in Dark, Groups Shed Light on Health Care Law," aims to correct misinformation about ObamaCare. Ironically, the article is itself a monument to misinformation.
True or false: The new health care law will cut Medicare benefits for seniors. It will slash Medicare payments to doctors. It will ration health care.
In three polls conducted last month, large percentages of Americans answered "true" to each statement. All three are false.
In fact, two of the three statements are 100-percent true.
First, ObamaCare will cut payments to the private health insurance companies that provide coverage to the 20 percent of Medicare enrollees who participate in the Medicare Advantage program. That will eliminate many types of coverage for seniors in Medicare Advantage. That should be painfully obvious, but if you require confirmation, visit FactCheck.org. ObamaCare will also ratchet down the price controls that Medicare uses to pay hospitals and many other health care providers. It should likewise be obvious that that will reduce access to services that are ostensibly "guaranteed" to all enrollees. But again, if you need confirmation, check in with Medicare's chief actuary, who works for President Obama. We can debate whether that's good or bad. What's not up for debate: ObamaCare in fact "will cut Medicare benefits for seniors."
Second, it is also true -- ipso facto -- that ObamaCare "will ration health care." To ration is to limit consumption. When ObamaCare reduces coverage for Medicare Advantage enrollees and reduces access to care for all Medicare enrollees, it limits seniors' consumption of medical care. We can debate whether that's good or bad. What's not up for debate: that is rationing.
Finally, yes, it is technically false that ObamaCare "will slash Medicare payments to doctors." But since current law will slash Medicare payments to doctors if Congress does nothing, and since an earlier version of ObamaCare would have eliminated those cuts, but ObamaCare's architects dropped that provision so as to make ObamaCare appear deficit-neutral... well, perhaps the public can be forgiven if it confuses "eliminating a provision that would have prevented cuts in Medicare payments to doctors" with "slashing Medicare payments to doctors."
USA Today continues:
The debunked idea raised by opponents during congressional debate that "death panels" could make end-of-life decisions is seen as real by nearly half of those surveyed.
I'll rate this statement misinformed and misleading.
First, Sarah Palin's claim about "death panels" was true at the moment she said it, even if she didn't know why.
Second, by rationing Medicare enrollees' access to medical services (see above), ObamaCare will effectively make end-of-life decisions for seniors. According to Medicare's chief actuary, ObamaCare could force one in six hospitals to stop accepting Medicare patients. If ObamaCare results in there no longer being a hospital bed waiting for Grandma at the end of her life, that's an end-of-life decision. It wasn't a personalized decision. It's not even necessarily the wrong decision. But let's drop this nonsense about ObamaCare not making end-of-life decisions for seniors. And ObamaCare did create a panel that will make many of these implicit rationing decisions. It's called the Independent Payment Advisory Board.
But my guess is that people tell pollsters that ObamaCare will make end-of-life decisions because they understand the Golden Rule, and that he who pays the piper calls the tune. So long as the government purchases medical care, it will be the government that decides who receives it and who doesn't. And ObamaCare gave government a lot more of the gold.
USA Today packed a lot of misinformation into this one sentence:
The National Council on Aging posed 12 questions about the law to 636 seniors and found that fewer than 17% of them knew half the answers.
Actually, it's NCOA that doesn't know the answers. Here are a few of their poll's true-false questions:
- “The new law will result in future cuts to your basic Medicare benefits.” A plurality of seniors (42 percent) responded "true." And they're right: as Medicare's chief actuary has explained and as NCOA should know, ObamaCare will reduce access to care for Medicare enrollees. That's a benefit cut, unless you think "coverage without care" counts as a benefit. Yet according to NCOA, the correct answer is "false." Just 22 percent of seniors agreed.
- “Under the new health reform law, Medicare Advantage plans will cut benefits and increase premiums.” NCOA says the correct response is "don't know," and that's the answer that 56 percent of seniors gave. Perhaps seniors haven't read the chief Medicare actuary's report, which found that ObamaCare "will result in less generous benefits packages" in Medicare Advantage and "when the MA provisions will be fully phased in, enrollment in MA plans will be lower by about 50 percent." But NCOA should have read that report, and should therefore know that the correct answer is "true."
- “The new law is projected to increase the federal budget deficit over the next ten years and beyond.” Again, a plurality (49 percent) responded "true." Again, they're right. Yet NCOA thinks the correct response is "false." No doubt NCOA would point to the Congressional Budget Office projections that ObamaCare will reduce the deficit. But those projections are valid only if ObamaCare "remain[s] unchanged throughout the next two decades, which is often not the case for major legislation." The CBO wrote this would particularly be a problem with ObamaCare, which "would maintain and put into effect a number of policies that might be difficult to sustain over a long period of time." So one could reasonably interpret the CBO to have projected an increase, not a decrease in the deficit. Alternatively, seniors could have been thinking about former CBO director Douglas Holtz-Eakin, who projected in The New York Times that ObamaCare "would raise, not lower, federal deficits, by $562 billion." There are lots of reasons why "true" is in fact the correct answer. (One of them is that NCOA used the passive construction "is projected.") Only 14 percent of seniors agreed with NCOA.
- “As a result of the new law, the solvency of the Medicare Trust Fund will be extended by about 9 years to 2026.” A majority of seniors responded "don't know" (54 percent), while another 22 percent responded "false." Either answer is more correct than NCOA's preferred answer ("true"). There are no assets in the Medicare "trust fund." Thus there is no date by which those non-assets will be exhausted. Indeed, the "trust fund" has absolutely no effect on Medicare's solvency. The very premise of this question is a fraud. Someone needs to educate seniors about the Medicare trust fund, but NCOA is not the group to do it.
- “The health care reform law will cut Medicare payments to doctors.” A plurality of seniors responded "true" (45 percent), while only 14 percent of seniors gave NCOA's preferred response ("false"). But again, perhaps seniors can be forgiven on this one (see above).
USA Today should have dug a little deeper.
More than four in 10 people in the Kaiser poll wrongly believe the law included a government panel to make end-of-life decisions for Medicare patients.
Again, ObamaCare does include a panel that would implicit rationing decisions, including for Medicare patients at the end of life (see above).
More misinformation still:
As the Department of Health and Human Services issues the regulations needed to implement the law, it's trying to get the facts out through its website, healthcare.gov. The Centers for Medicare and Medicaid Services is helping, most recently with a cable TV ad featuring Andy Griffith.
FactCheck.org found that Andy Griffith used "weasel words" to "mislead" seniors about ObamaCare. How is USA Today not aware of that?
FactCheck.org says that in an ad purchased with your tax dollars, actor Andy Griffith (a.k.a., the sheriff of Mayberry and Matlock) used a "weasel word" to mislead Medicare enrollees about how ObamaCare will affect them:
Griffith tells his fellow senior citizens, "like always, we’ll have our guaranteed [Medicare] benefits." But the truth is that the new law is guaranteed to result in benefit cuts for one class of Medicare beneficiaries — those in private Medicare Advantage plans...
[T]he term "guaranteed" is a weasel word — a qualifier that sucks the meaning out of a phrase in the way that weasels supposedly suck the contents out of an egg. It may sound to the casual listener as though this ad is saying that the benefits of all Medicare recipients are guaranteed to stay the same — and that may well be the way the ad’s sponsors wish listeners to hear it. But what the administration is really saying is that only those benefits that are guaranteed in law will remain the same.
FactCheck.org neglects to mention that ObamaCare will weaken the guarantee behind those "guaranteed" benefits, too. Medicare's chief actuary Richard Foster notes that ObamaCare ratchets down Medicare's price controls, which will "possibly jeopardiz[e] access to care for beneficiaries." That's not to say that the old price-control scheme is any better than the new one. It just means that the Obama administration is being even less honest and more weaselly than FactCheck.org says.
And they're dragging Matlock down with them.