The persistence of the death panels myth

The Washington Post reports on a new Kaiser poll showing that the "death panel" myth that plagued debate (PDF) over health care reform is still a significant problem:

The poll found that misconceptions about the legislation persist, including the "death panel" falsehood propagated by opponents of the legislation.

"A year after the town meeting wars of last summer, a striking 36% of seniors said that the law 'allowed a government panel to make decisions about end of life care for people on Medicare', and another 17% said they didn't know," Kaiser Family Foundation chief executive Drew Altman wrote.

Here's the question Kaiser asked:

I’m going to read you a list of specific ways the new health reform law may or may not impact Medicare. For each, please tell me if you think it is something the law does or does not do... Would you say the law does or does not allow a government panel to make decisions about end‐of‐life care for people on Medicare?

The question references the charge, made originally by Sarah Palin, that the health care reform bill would create a "death panel” in which bureaucrats decide whether seniors are "worthy of health care." However, even experts who opposed the plan said the charges were false. While the health care reform law does create an independent board that will make proposals to Congress to restrain Medicare costs, the legislation specifically states that "The proposal shall not include any recommendation to ration health care... or otherwise restrict benefits" (as Media Matters points out). Moreover, these would be systemwide policy changes for Medicare, not specific decisions about end-of-life care for individual patients as Palin suggested.

Here are the crosstabs from the poll in graphical form -- it turns out that seniors have somewhat more accurate perceptions than those under 65:

Among the population as a whole, 41% said they believed the law does allow a government panel to make decisions about end‐of‐life care for people on Medicare and an additional 16% said they didn't know. The corresponding figures were 43% and 16% for those under 65 and 36% and 17% for those who are 65 years or older.

As expected, motivated reasoning appears to play an important role in the persistence of the misperception. Kaiser found that "those [seniors] with an unfavorable view are ... more likely to incorrectly think the law includes cuts in benefits or that it allows a government panel to make end‐of‐life care decisions." 55% of seniors with an unfavorable view of the law believed in the death panel myth, while only 17% of those with a favorable view did so.

For more analysis of the development of the death panel myth and the reasons it is so difficult to correct, see my article "Why the 'Death Panel' Myth Wouldn't Die: Misinformation in the Health Care Reform Debate (PDF) from a recent issue of The Forum.

[Cross-posted at Pollster.com]

Comments

[David in Cal]

It's double-talk for the law to say, "The proposal shall not include any recommendation to ration health care... or otherwise restrict benefits." Every insurance plan restricts benefits. That is, there are always things they don't cover.

Any insurance plan, including government health, can only cover what their income allows. E.g., the UK National Health is making deep cuts what it covers:

Among the changes to be made include rationing of most common surgeries, including hip and knee replacements, cataract surgery, and orthodontic procedures; reduction in services for the terminally ill; closure of nursing homes; and a reduction in the number of hospital beds available for acute care, including those for the mentally ill.

When a US government panel decides that Medicare won't pay for some expensive treatment, most of us won't be rich enough to pay for it ourselves. However, the good news is that those who die because of the lack of such treatment can go to their graves happy in the knowledge that on paper the government was prohibited from restricting their benefits.

[MartyB]

Sigh....

If I give you my word that I won't do something, but our relationship is structured in many ways so I am incented to do the very thing I have promised not to do, which outcome is more likely?

Easy answer - it's a Myth that I would do what I said I wouldn't do....

[smartalek]

@ David in Cal:

Yes, you are obviously completely correct -- as long as we define "restrict[ing] benefits" to include clear terms up front that certain conditions won't be covered (and for many conditions that are covered, there will be certain medications and/or treatments that won't be covered).
But as you yourself indicated, "Every insurance plan restricts benefits."
And, as we all know, many of the private insurance firms don't stop at "restricting benefits" in these particular ways, they also routinely engage in shenanigans such as the infamous "rescission" process, by which insurance purchasers suddenly find themselves without coverage just when they present a high-cost health problem -- though whatever excuse the insurance firms use in such cases to rationalize the rescission, clearly didn't keep them from happily collecting premiums for however many years they were doing so.
And, this being the case, I'm not quite sure what your larger point is.
Is it that the gummint should not have done anything by way of health-insurance reform? If so, I'm sure that, as you said, "those who die because of" their lack of insurance coverage after having had their policies rescinded (possibly after their paying into such policies for many, many years) "can go to their graves happy in the knowledge that" it wasn't " the government," but a profitable commercial entity, that was "restricting their benefits."

[David in Cal]

smartalek, my point is that if "Death Panels" are defined as indicated above, namely government panels that ration health care...or otherwise restrict benefits, then they're not a myth. They're simply a routine feature of any government benefit. Health care opponents are not justified in making a fuss over them. OTOH those who label the Death Panels a "myth" are wrong to do so.

In particular, having a phrase in the law saying that no government panel will restrict coverage is baloney. Under this law, government panels will decide what will and won't be covered, so of course they'll sometimes be limiting benefits.

SmartAlec -- the question you raise of whether the health bill will be good policy is far more important than whether "death panels" are or are not a myth. However, Brendan's post is not about the overall value of the health reform, nor is my response.

[REO]

Sorry David in Cal, have to call bullsh*t.

Perhaps you are simply a contrarian or somehow think you have hit upon an important intellectual nugget but whether you are a conservative stooge or not, your point is, well, pointless.

As you note, and others noted regarding your point, any health care system makes practical decisions, either directly or indirectly, as to what will be covered and what won't. Whether it is end of life care or birth control or preventive care, all have the potential to ultimately determine whether you live X or Y amount of years (and with what quality of life). For that matter, research and development of new treatments is predicated upon need within the population, often based upon profit. Hence the government does step in to support "orphan drugs" for rare conditions that would otherwise not be pursued. (I wish this last point would have come up more regularly in the HCR debate.)

So, given that this is the case prior to HCR, now, and forever, one is left to wonder whether your argument is simply immature or knowingly disingenuous. The critique of the "Death Panel" promotion did not largely trade upon that it was erroneous to believe that cost/benefit analysis of healthcare spending would be done but rather that the critics suggested there would be a specific "Star Chamber"-like prospective process for individual cases; this is patently untrue. Furthermore, the use of inflammatory rhetoric in regards to the government's role was intended to cause specific animus to HCR and yet the same "Death Panels" exist at Cigna, Wellpoint, your local hospital, within your physicians group and among your family members. You become your own Death Panel when you decide to forgo life-extending care. Based upon your post, you appear to understand this and yet, somehow, the "Death Panel" label remains logically meaningful to you and not merely the sophomoric rhetorical dodge that it is.

I, myself, would much prefer evidence-based government assessments than profit-motivated private decision-making in regards to provision of my treatment. I may not like it either way (and in either case, I am free to pursue whatever my separate means allow) but I would rather accept a data-based consensus than a management team trying to hit a certain number. At worst, to the government, I am just a neutral statistic (and often the government, and the people that make it up, views me with a bit more importance) but to a private company, I am always a liability when I am costing them money.

Having been around the Internet for some time, I'm sure you are inclined to respond that I haven't, in fact, negated your central argument. 'Tis true under the highly limited scope you have set but, in the real world, definitional arguments don't cut it. You need to ask yourself: "If Death Panels aren't a myth under my reasoning, does that really mean anything?"

It doesn't.

[Rob]

We've tried so often to explain to Brendan why there is legitimate concern over government panels making decisions that restrict care, resulting in patients' deaths, that there's little point in continuing to do so. He's so locked into his misperception that Death Panels are a myth that no amount of correction will change his mind; somebody ought to write an article about this phenomenon.

But wrongly dismissing concerns about the ultimate effect of a law is nothing new. In 1964 Hubert Humphrey, a leader in the fight for the Civil Rights Act of 1964, denounced as "nightmarish propaganda" the claim that the law would permit preferential treatment of an individual or group because of race or racial "imbalance" in employment. For Humphrey, that sort of claim was a myth, a misperception, and he inveighed mightily against it. A few short years later, the nightmarish propaganda Humphrey dismissed was a fact, with legal authority grounded in the Civil Rights Act of 1964.

Those who claim to know with certainty how laws will be interpreted and administered in the future are playing a fool's game. Yesterday's myth or nightmarish propaganda can easily become tomorrow's reality.