Brendan Nyhan

Health care reporting failures begin

We’re just getting started on the health care debate, and political journalists’ lack of substantive knowledge and devotion to “he said”/”she said” reporting is already resulting in misleading coverage:

-Media Matters flags a Politico story that quotes Senator Lamar Alexander (R-TN) saying “‘Washington takeover’ are two words we’ve been hearing a lot from the Obama Administration these days” without pointing out that the phrase has not been used by the White House — it’s actually a poll-tested GOP catchphrase.

-ABC reporter Byron Wolf repeated a misleading Republican talking point as fact in describing John McCain’s criticism of a Democratic bill:

McCain pointed to a nonpartisan [Congressional Budget Office] cost estimate of $1 trillion over ten years for the major portion of healthcare reform suggested in a bill floated by Sen. Edward Kennedy’s Health Committee and said the cost was too high for American taxpayers, especially since the nonpartisan review foresaw 23 million would lose their current insurance plans under the proposal.

in fact, as Matthew Yglesias pointed out in criticizing a similar claim by Michael Tanner of the Cato Institute, the Congressional Budget Office report (PDF) did not state that 23 million would “lose their current insurance plans.” CBO found that “15 million fewer” people “would be covered by an employment-based health plan” but 10 million of those would be choosing a subsidized plan from an insurance exchange over employment-based coverage. (The additional estimated decline of eight million people would be the result of shifts from Medicaid, CHIP, and nongroup coverage to the insurance exchanges — not lost coverage.)

-Media outlets like the New York Times are covering the CBO report without explaining why the bill was found to be relatively ineffective at expanding coverage:

The rush to trim costs came as Senate Democrats and the White House struggled to respond to an initial financial analysis by the budget office showing that an alternate proposal, developed by the Senate health committee, would cost $1 trillion over 10 years but could still leave 36 million Americans uninsured.

The analysis by the nonpartisan budget office showed Democrats falling far short of their goal, which is to provide insurance to all Americans and offset the expense of doing so with new taxes or cost savings. Republicans quickly seized on the figures to charge that the Democrats’ efforts would fail.

The Democrats aren’t “falling far short of their goal” — they didn’t try to get there in the bill that the CBO analyzed. Ezra Klein provides the context that’s missing from the Times report:

A couple of months ago, the Health, Education, Labor, and Pensions Committee sent the CBO a sketch of a draft of its legislation. And the CBO sent the members back a stab at an outline of an estimate. It was all very early, and very rough. But CBO’s response was encouraging. The total cost was a bit higher, but the number covered was much higher. More like what you’d expect. More like what health reform is trying to achieve.

The draft the CBO examined last week, however, was in certain respects even less complete than the outline they were given months ago. In an effort to buy some extra time to negotiate with Republicans on the committee, the Democrats on HELP left out some of the more controversial policies in the hopes of reaching a bipartisan agreement sometime this week. The public plan, the employer mandate and the individual mandate were all absent from the proposal the CBO examined. The employer and individual mandates — the first of which pushes employers to offer coverage and the second of which force individuals to purchase coverage — are particularly key to increasing the number of Americans with health insurance.

You might ask what the HELP Committee was thinking, sending Swiss cheese legislation to CBO. Well, the HELP Committee’s expectation was that the CBO, in crafting its preliminary score, would assume something similar to the outline it had seen months before. The CBO didn’t. In fact, it did the opposite. CBO ran its estimates with no employer mandate and an individual mandate with a laughably small penalty.

Members of HELP were thus shocked by yesterday’s score. The specific provisions of the bill that the CBO examined did not look like the bill HELP intends to write. Which means that the numbers aren’t correct. If HELP is writing a bill with a strong employer and individual mandate, and CBO scores a bill with no employer mandate and a weak individual mandate, that’s not a useful estimate.

By Monday night, members of the HELP Committee were scrambling to give the CBO something closer to the final legislation to examine — this time including rough details of the employer mandate and the individual mandate. They’re hoping to have a new set of estimates by Friday, though that’s probably ambitious. Either way, I wouldn’t put too much stock in these numbers.

There’s just no way to responsibly report on the CBO analysis without making clear that three key Democratic policy provisions (public plan, employer mandate and individual mandate) were excluded (update: actually four). And yet many outlets have done so. It’s not an encouraging sign.