Grading PolitiFact: Health care rationing equivocation

Fact checking ought to root out and expose incidences of equivocation. Not aid and abet them.


Fact-checking the fact checkers

The issue:

Howard Dean stated "There's no rationing in any of these bills."

PolitiFact takes issue with Dean, claiming "There's rationing in health care now, and there still would be under reform bill."


The fact checkers:

Robert Farley: writer, researcher



Analysis:

The key to analysis of Farley's work occurs in paragraph number 20:

John Holahan, the director of the Urban Institute Health Policy Research Center, said he has not seen anything in any of the plans that will result in explicit rationing, but "if you define rationing as 'people can't get everything they want,' it's true. But it's also true today."

"People can't get everything they want" does represent the definition of "rationing" used in Farley's piece.

It follows from Barack Obama's defence of his bill (as cited by Farley):

Even Obama acknowledged the reality of health care rationing in a town hall on health care on Aug. 16:

"When we talk about reform, you hear some opponents of reform saying that somehow we are trying to ration care, or restrict the doctors that you can see, or you name it," Obama said. "Well, that's what's going on right now. It's just that the decisions are being made by the insurance companies.

"Now, in fairness, we probably could not construct a system in which you could see any doctor anywhere in the world any time, regardless of expense. That would be a hard system to set up. So if you live in Maine, you know, we're going to fly you into California, put you up. I mean, you can see — and I'm not trying to make light of it — you can just see the difficulty.

"So any system we design, there are going to have to be some choices that have to be made in terms of where you go to see your doctor, what's going on, et cetera. That's being done currently in the private marketplace. All we're trying to do is to make sure that those decisions that are being made in the private marketplace aren't discriminating against people because they're already sick; that they are making sure that people get a good deal from the health care dollars that they are spending."

In other words, rationing is just a fact of life in a world with limited resources.

The same definition of "rationing" occurs in a New York Times story cited by Farley, "Health care rationing rhetoric overlooks reality," by David Leonhardt.

As a result, Farley's story only serves to muddy the water, albeit in a way that helps President Obama while giving Howard Dean a slap on the wrist.

The working definition Farley uses entirely misleads the reader.

Rationing is the controlled distribution of resources and scarce goods or services: it restricts how much people are allowed to buy or consume. Rationing, for whatever reason, controls the size of the ration, one's allotted portion of the resources being distributed on a particular day or at a particular time.

In economics, it is often common to use the word "rationing" to refer to one of the roles that prices play in markets, while rationing (as the word is usually used) is called "non-price rationing." Using prices to ration means that those with the most money (or other assets) and who want a product the most get the largest amount, whereas non-price rationing follows other principles of distribution. Below, we discuss only the latter, dropping the "non-price" qualifier, to refer only to marketing done by an authority of some sort (often the government).

(statemaster.com)

Farley erases the distinction that ought to be made between price rationing and other forms of rationing. As a result, his story manifests the fallacy of equivocation. In other words, "rationing" in usual parlance does not refer to price rationing. Farley followed the conventions of others in ignoring the customary usage in favor of one that included price rationing.

And what are the implications for Mr. Dean's claim?

It's hard to say. Dean may be correct that rationing is not explicitly spelled out in any of the relevant bills.

Farley treats only the effectiveness research provision and the separate Independent Medicare Advisory Council proposed by President Obama.

Effectiveness research by itself does not result in rationing of services. It does, however, pave the way toward such rationing as illustrated by the British parallel, NICE (PolitiFact has denied the parallel, for no apparent reason).

As for IMAC, Michael F. Cannon, Farley's source from the CATO Institute, detects in it the power to ration services.

Under this analysis, Dean might be given a "half true" rating--recognizing that he is technically correct that rationing is not specified in health care reform bills, but misleading in that rationing may very well result because of implicit provisions in the bills.

In contrast to this, Farley's effort simply takes the rationalizations of the Obama White House--like the one in the video below--and utilizes them to punish the irrelevant Dean while burnishing the Obama glow. But Obama's argument, based as it is on shameless equivocation, shouldn't rate any better than "half true" either.



Insurance companies do not ordinarily engage in the ordinary understanding of "rationing." They contract with the insured to pay for certain types of services (and up to certain dollar amounts) and charge according to the assumed risk. In contrast, the Canadian single-payer system caps expenditures at a given amount for the fiscal year and cuts off services after that amount is reached. That is real rationing in the normally understood sense, and whether the "public option" will ultimately follow a similar course remains unclear.

Yes, some type of rationing is inevitable no matter what system is used. But the type of rationing we normally mean may be implicit in the health care reform bills under consideration. The Obama administration and its congressional supporters mislead the public by shifting to a different meaning of "rationing." And PolitiFact aids that effort.


The grades:

Robert Farley: F
Bill Adair: F



*****

Additional note:

Farley made unfortunate use of a quotation from John Holahan, the director of the Urban Institute Health Policy Research Center:

(Holahan) said that Medicare is much less likely to deny a health service than a private insurer.

"That's the argument you hear people making (that the reform bills would lead to government rationing)," Holahan said. "But I think they have it backwards."

According to this report published by the AMA, it seems that Holahan may be the one who has it backwards. Over about a year's time, Medicare denied 6.85 percent of "claim lines." The worst of the private insurers surveyed was slightly better than that, at 6.8 percent. Most of the rest surveyed were in the 2-3 percent range.

Did Farley bother double-checking Holahan's statement before quoting it as though it was true?