New article on health care misinformation

I have a new article on health care misinformation in The Forum that may be of interest (link requires free registration; ungated copy here):

Why the "Death Panel" Myth Wouldn't Die: Misinformation in the Health Care Reform Debate

Both Bill Clinton and Barack Obama struggled to overcome widespread and persistent myths about their proposals to reform the American health care system. Their difficulties highlight the influence of factual misinformation in national politics and the extent to which it correlates with citizens' political views. In this essay, I explain how greater elite polarization and the growth in media choice have reinforced the partisan divide in factual beliefs. To illustrate these points, I analyze debates over health care reform in 1993–1994 and 2009–2010, tracing the spread of false claims about reform proposals from Bill Clinton and Barack Obama and analyzing the prevalence of misinformation in public opinion. Since false beliefs are extremely difficult to correct, I conclude by arguing that increasing the reputational costs for dishonest elites might be a more effective approach to improving democratic discourse.

The article covers several topics I've discussed here such as Betsy McCaughey, death panels, and naming and shaming in much greater depth. It also includes a new empirical analysis of survey data on misperceptions about the Clinton and Obama plans -- here's the key graph showing the perverse relationship between perceived and actual knowledge of the plans among opposition partisans (the y-axis is the predicted level of belief in the listed misperception):

Please read my article to find out more. (Note: It's part of a special issue of The Forum on health care reform that's worth checking out.)

Comments

[Rob]

I admire Brendan's scholarship, but I fear that the alacrity with which he labels as misperceptions or myths propositions with which he happens to disagree undermines the validity of the results.

For example, Brendan regards as a misperception an affirmative answer to this question concerning the Clinton health care plan:

From what you have heard, do you think that if the (President Bill) Clinton health care plan is adopted, you would be able to keep seeing that doctor (your own doctor), or wouldn’t it be possible?

As Brendan's article points out, under the Clinton plan a patient might not have been reimbursed for seeing his own doctor, but he could continue to pay for it out of his own pocket. Accordingly, the survey question could legitimately be regarded as an empirical question that would turn on how large the differential would be between fee-for-service insurance and managed care, how many employers would choose to pay that differential and whether a respondent with non-employer provided health insurance would be able to pay that differential. An affirmative answer to that empirical question is hardly a misperception.

With respect to the Obama health care plan, Brendan regards as a misperception an affirmative answer to this question:

If Obama’s plan became law, do you think senior citizens or seriously-ill patients would die because government panels would prevent them from getting the medical treatment they needed?

But even Brendan acknowledges in his article that "efforts to reduce growth in health care costs under Obama’s plan might lead to more restrictive rationing than already occurs under the current health care system," and it hardly seems fanciful for a respondent to conclude that such rationing could result in the death of some patients. Someone might easily believe that government panels would make categorical decisions about what kind of care is appropriate for reimbursement (e.g., denying payment for very expensive drugs that extend the life of terminal cancer patients for only a brief time). That wouldn't be an evil decision by the government panel, it would be a rational, even an arguably societally desirable decision. But according to Brendan, someone who believes such a scenario and therefore answers the question in the affirmative is guilty of a misperception.

Apart from the specifics of Brendan's analysis, his conclusion is frankly troubling, because it raises the specter that this article and others like it will be used to provide a scientific justification for the suppression of dissenting views. The New York Times already makes highly suspicious news judgments that shield its readers from inconvenient news (e.g., the Van Jones controversy, the John Edwards scandal story); the President, Democrats in Congress and most left-wing pundits rail against the Supreme Court upholding the freedom of political speech in the Citizens United case; the global warming establishment tries to prevent skeptics' views from being published in peer-reviewed journals; our little friend Sean Penn even wants to send journalists to prison for calling Hugo Chavez a dictator. As one who places enormous value in the marketplace of ideas, I react viscerally to any suggestion that the media should be pressured to stop providing coverage to those who are out of step with the opinions of the academic and media elite. Brandeis wrote, "If there be time to expose through discussion the falsehood and fallacies, to avert the evil by the process of education, the remedy to be applied is more speech, not enforced silence." Silence enforced by the media elite is somewhat less perverse than silence enforced by the Government, but only somewhat. Let us hope that Brendan's article will not sow the wind.

Full disclosure: I read and commented on a draft of Brendan's article, and his addition of the sentence concerning rationing (which I use here to attack his conclusion that an affirmative answer to the death panel question is a misperception) was at least partly at my behest.

[David]

Brendan's theory of why people believe myths may be fine in general, but I think it leaves out the main reason for the persistance of the Death Panels belief -- namely, that phrase means different things to different people.

Brendan carefully presents definitions by McCaughey and Palin that are (arguably) incorrect. However, those definitions are not necessarily what other people mean when they say they believe in Death Panels. The name has persisted, but not any one definition of what that name means.

E.g., quite a few people have taken "Death Panels" to be panels that decide what treatments should or should not be covered under what circumstances. Under this definition, the law certainly does include Death Panels, but there's no scandal or embarassment. Every insurance plan, governmental or private, has some limitatations on coverage and some group that chooses where the limits should be set.

As Rob pointed out so cogently, guessing how a plan will actually work is not really a myth, even something that isn't specificaally called for in the law. E.g., I think it was not unreasonable to expect that doctors meeting with terminally ill patients might encourage them to cease further treatment. Calling such (hypothetical) encouragement "pressuring" doesn't make the belief unreasonable.

A clearer example of beliefs contrary to the actual law regards the new Arizona law regarding illegal immigrants. Most liberals seem to believe that this law allows non-Americans to have their immigrant status checked in an unreasonable way. That's exactly contrary to the law, which specifies that stops must be reasonable.

Furthermore, the law provides that immigrant status can only be checked when the individual has already been stopped by the police for some other reason. So, it's a myth that Hispanics will be stopped "if they're walking their dog around a neighborhood, if they're walking their child to school."

I'll be happily surprised if Brendan publishes an article applying his model to liberal myths involving the application of Arizona's illegal immigrant law.

[Herbert]

It seems to me that if one (1) does not care about the opinion of the mainstream media (and has other means of getting out a message) and (2) does not care about the opinion of politicians on the other side -- there is no penalty for lying. Why not just lie as much as possible?

[Lewis Carroll]

`When I use a word,' Humpty Dumpty said in rather a scornful tone, `it means just what I choose it to mean -- neither more nor less.'

`The question is,' said Alice, `whether you can make words mean so many different things.'

`The question is,' said Humpty Dumpty, `which is to be master - - that's all.'

Alice was too much puzzled to say anything, so after a minute Humpty Dumpty began again. `They've a temper, some of them -- particularly verbs, they're the proudest -- adjectives you can do anything with, but not verbs -- however, I can manage the whole of them! Impenetrability! That's what I say!'

`Would you tell me, please,' said Alice `what that means?`

`Now you talk like a reasonable child,' said Humpty Dumpty, looking very much pleased. `I meant by "impenetrability" that we've had enough of that subject, and it would be just as well if you'd mention what you mean to do next, as I suppose you don't mean to stop here all the rest of your life.'

`That's a great deal to make one word mean,' Alice said in a thoughtful tone.

`When I make a word do a lot of work like that,' said Humpty Dumpty, `I always pay it extra.'

`Oh!' said Alice. She was too much puzzled to make any other remark.

`Ah, you should see `em come round me of a Saturday night,' Humpty Dumpty went on, wagging his head gravely from side to side: `for to get their wages, you know.'

(Alice didn't venture to ask what he paid them with; and so you see I can't tell you.)

`You seem very clever at explaining words, Sir,' said Alice.

[Jess]

@David - why don't you get your own blog and sing the praises of Arizona's emerging police state there?

I didn't come here to read your ode to fascism, American-style; I came here to read Brendan's article on the death panel myth (though "lie" might be a more accurate word for it) and reactions to it.

I don't agree with Rob, either, but at least he stayed generally on-point.

[Howard.Craft]

Without looking at the merits of the Arizona bill...when did Joe Scarborough become a liberal? Or is that just a way to make a counter argument stronger (by labeling the position a "liberal" myth)?

I'm also at a loss to see how the News Busters article contradicted Scarborough's view. They reported that in NYC the police are able to stop and question hundreds of thousands of individuals a year (over half a million) without needing to show any cause. There is no accountability on the part of the police for wrongly stopping and questioning anyone. That was exactly Scarborough's point.

[David]

Jess, I think that political bias in selecting which myths to expose is on point. YMMV.

Your impression of the Arizona law is inaccurate. See link

The Arizona law specifically states that in any encounter with police, when a person produces a valid Arizona driver's license (or, for non-drivers, other forms of ID listed in the law), that person is immediately presumed to be in the United States legally.

A driver's license can only be demanded if one is in some sort of encounter with police in which police are acting lawfully That is also specified by the new law.

BTW since the 1940s, federal law has required non-citizens who are in the United States permanently to carry on their person, at all times, the official documents proving that they are here legally -- green card, work visa, etc. That has been the law for 70 years, and the new Arizona law does not change it.