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December 28, 2010

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There's also plenty of amnesia going around about what it was that Palin's original Facebook post was referring to--amnesia that afflicts the media who are reporting on the latest supposed "death panel" controversy and perhaps even our genial host Brendan.

As always on this point, I disagree with our genial friend Rob -- see http://www.brendan-nyhan.com/blog/2010/08/continuing-efforts-to-justify-false-death-panels-claim.html. Key paragraphs:

Palin's language suggests that a "death panel" would determine whether individual patients receive care based on their "level of productivity in society." This was -- and remains -- false. Denying coverage at a system level for specific treatments or drugs is not equivalent to "decid[ing], based on a subjective judgment of their 'level of productivity in society,' whether [Palin's parents and baby with Down Syndrome] are worthy of health care" (see also Cato's Michael Tanner). Those who try to redefine "death panels" in this way are attempting to move the goalposts in the debate. It's the equivalent of pointing to buried Iraqi chemical shells from the 1980s as evidence for the Bush administration's claims about WMD.

Finally, defining "death panels" as rationing of any sort is totally nonsensical. By that standard, there are government and private "death panels" throughout the health care system already. It's true that Obama's proposal is likely to increase rationing, but so would every other proposal to control the unsustainable trajectory of future health care spending. Under Rep. Paul Ryan's Medicare voucher plan, for instance, CBO projects that "[b]eneficiaries would... be likely to purchase less comprehensive health plans or plans more heavily managed than traditional Medicare" (my emphasis). Unfortunately, hysteria over "death panels" is preventing a necessary debate over which approach would be most effective and fair.

Evidently the Dems in Congress thought that end-of-life counseling was something like a Death Panel, because they removed this provision in reponse to the original charges that the bill included Death Panels.

The fact that end-of-life counseling was administratively added to health care after Congress had specifically excluded it shows that we have no guarantee of what the final law will look like. Administrative regs will make all sorts of changes. IMHO Health Care is likely to eventually include some limitation on end-of-life care based on some cost/benefit evaluation. There won't be enough resources to provide every possible care to every person.

P.S. It should be a scandal that this administrative decision was kept secret for political reasons.

After learning of the administration’s decision, Mr. Blumenauer’s office celebrated “a quiet victory,” but urged supporters not to crow about it.

“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed...”

Moreover, the e-mail said: “We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ — e-mails can too easily be forwarded.”

Democracy is thwarted when government administrators keep their policies secret in order to prevent the people's elected representatives from being involved.

Putting aside the debate about whether it's nonsensical, as Brendan contends, to regard rationing choices as death panels, the fact remains that Sarah Palin's initial Facebook post about death panels was about rationing, not about end-of-life counseling. Members of Congress and others, including to a degree Palin herself, may later have used the term in discussing end-of-life counseling, but the idea that it was Palin who started the ball rolling by calling end-of-life counseling "death panels" is simply wrong. Yet that's what you're told in media stories about the latest controversy, and it's what you'd infer from Brendan's link to a (sadly flawed) PolitiFact article about Palin's initial Facebook post. That's the amnesia--amnesia about what Palin was talking about in Facebook, which was rationing, not end-of-life counseling.

Fair enough -- I will clarify in post above -- but Palin herself cited the end-of-life counseling provision as additional support for her initial post about the dangers of rationing only a few days after the initial statement:

http://www.facebook.com/note.php?note_id=116471698434

Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” [5] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care?

From there, the two claims became intertwined in the public debate.

Brendan ,

Let's stipulate that Obamacare does not officially establish anything that resembles a 'death panel'.

However, I've never understood how you can claim your opinion that Obamacare will not ultimately produce something akin to 'death panels' as a 'fact', but other's opinion that it will, a 'myth'.

Neither is 'fact' or a 'myth', only opinion.

Brendan – Thanks for the link to your article on Death Panel myth. I’ve had the chance to read though it and I believe I finally understand your approach on this “fact” vs. “myth” business I mention above.

You state clearly in the paper that you define “political misperceptions to include both demonstrably false claims AND (emphasis yours) unsubstantiated beliefs about the world that are contradicted by the best available evidence and expert opinion.”

This definition (any opinion deemed “unsubstantiated” or “contradicted by expert opinion” is just as un-true as false facts) contains one of the weakest logical arguments (“appeal to authority”) and will be too arbitrary in practice (who determines “best”, “unsubstantiated” and “expert”?). This weakens your analysis accordingly.

But at least I better understand now that your definition of “false” and “myth” is significantly broader and more arbitrary than I understood it to be before.

I have other comments on your paper, but this is probably not the place to discuss at length.

Marty - It's a copout to say that misleading and implausible claims about a future outcome are simply "opinion," particularly when they're not phrased as such. Palin didn't say "while it's not in the bill, I'm concerned that health care reform will create rationing leading to x, y, and z over time." She said "my parents or my baby with Down Syndrome will have to stand in front of Obama’s 'death panel.'”

(I welcome any other comments you have on the paper by email.)

To quote Palin in context, she wrote, "The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." That seems like a rhetorical flourish, similar to "this was the moment when we began to provide care for the sick and good jobs to the jobless; this was the moment when the rise of the oceans began to slow and our planet began to heal; this was the moment when we ended a war and secured our nation and restored our image as the last, best hope on earth." Hint: When a politician begins a sentence with "the America I know and love," what follows is rarely a literal statement of fact.

Now, if you want a misleading and implausible claim about a future outcome, how about "If you like your health care plan, you can keep your health care plan"? Maybe my memory is failing me, but I can't remember Brendan ever treating that assertion as a myth, a misperception, a falsehood or even a little fib.

IMHO as an insurance expert, the likely rationing and the inability to keep one's prior coverage are not the biggest problems. The real risk is that the entire Plan just won't work as the designers hoped.

E.g., the High Risk Pools are not working out as predicted Few people have signed up and the cost is unaffordable for many who need the coverage. WaPo goes on to say:

According to some health-policy researchers, the success or failure of the pools also could foreshadow the complexities of making broader changes in health insurance by 2014, when states are to open new marketplaces - or exchanges - for Americans to buy coverage individually or in small groups.

We never should have expected this Plan to work. Normally an extremely complex new system would be tested piecemeal over a long period of time. Adjustments would be made based on actual test results. Even with the utmost of testing, new systems don't always work properly.

This Plan wasn't tested at all. In fact, Dem leadership made it impossible to even debate the thousands of pages of specific provisions. As Nancy Pelosi famously said, “We have to pass the bill so you can find out what is in it.” Without testing, without debate, this bill created in a back room deal among special interests is likely to be a disaster.

David in Cal: For a little context on Pelosi's "famous" remarks, let's take a look at what she actually said: "You've heard about the controversies within the bill, the process about the bill, one or the other. But I don't know if you have heard that it is legislation for the future, not just about health care for America, but about a healthier America, where preventive care is not something that you have to pay a deductible for or out of pocket. Prevention, prevention, prevention—it's about diet, not diabetes. It's going to be very, very exciting. But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy." (My emph.) In other words, she was commenting on the fact that once the bill was passed, the media would actually start reporting on what is in it as opposed to treating it as a "he-said/she-said."

David in MO, I agree that the media should have done more to report on the contents of the bill before it was passed. However, Pelosi and Read should have done more as well.

They should have allocated several months to debating the terms of this momentous bill. Instead they rushed it through. They got the bill passed via legilative log-rolling, not by making negotiated improvements. I believe that a lengthy debate focusing on the terms of the bill would have resulted in a more workable Plan.

Read and Pelosi should have prepared a thorough précis of the bill before it was passed, so the public would understand it and buy into it. A summary like that would have helped the media to explain the bill.

BYW in that same speech, Pelosi went on to say:
This legislation alone will create 4 million jobs, about 400,000 jobs very soon.
As we now know, after this bill was signed into law the private sector didn't gain jobs. Instead, it lost millions of jobs.

I don't think I wrote anything about it - I should have done more. But I have research in the works testing misperceptions about that very claim; hope to have more to report soon...

Brendan –

Thanks for the response.

But even if implausible or misleading (which is something that must be argued to determine), they are still just opinions - they are not provable one way or the other - and cannot be simply labeled "false" or a "myth". I simply don’t accept the premise they belong in the same class of "misleading" as mis-stated facts which don’t require analysis of the arguments for and against before disregarding them.

Using your example above: 'Palin's language suggests that a "death panel" would determine whether individual patients receive care based on their "level of productivity in society." This was -- and remains -- false.'

This is only false if she claims this “death panel” is provided for in Obamacare and is intended to work this way on passage of the law, but that is not clear in my reading of her statements.

It is neither true nor false if she is opining that this is where Obamacare will eventually lead. You may think her conjecture is ridiculous and either ignore it or present arguments against, but how can an unknown be labeled true or false?

On the other hand your documentation of some of Betsy M’s fact distortion seems spot on.

As always, thanks for being thought provoking.

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