Grading PolitiFact (Florida): Dan Fanelli's ObamaCare ad

The ad:

(Still not sure why the videos fail to appear on the main page--click the title above or "Read more" below to see it)

The issue:

The fact checkers:

Amy Sherman: writer, researcher
Sergio Bustos:  editor

These two work for the Miami Herald, for what that's worth.

Analysis:

PolitiFact's deck material presents two general ways one might interpret the Fanelli ad.  The version shown first, "the elderly will be denied care when they 'have passed the age limit for treatment,'" operates on a literal reading of the dramatization.  The doctor in the video does state that the patient has been found too old for treatment.  The second version presented in the deck is a broader interpretation, and itself might be taken more than one way.  For example, "cut off treatment for elderly" might make it sound like no patients old enough to qualify for Medicare would receive treatment.  Since they are "elderly" their treatment will be cut off.  At the more charitable end, the video suggests that it will be up to the government whether to pay for treatment where the elderly are concerned.

Writer Amy Sherman offered some hints that she would evaluate the charitable take on the video:

Will the new health care bill approved by Congress translate to denying treatment to sweet old men like the one featured in the video? Will somber-faced doctors be telling grandpa that he is too old for treatment? We had to check this out.

 The first sentence in her paragraph leaned toward the charitable interpretation.  The second sentence focused on a narrower interpretation, that being the portion of the video specifying denial of treatment based on age.

From this point, Sherman's narrative follows her attempts to get Fanelli to substantiate the ad along with her use of interview material to undermine various notions regarding the health care reform bill, primarily the idea of an age limit on benefits:

We sent links to Fanelli's video to experts on the health care bill: (Steve) Ullmann at the University of Miami; Alwyn Cassil, director of public affairs for the Center for Studying Health System Change, a nonpartisan research organization; and Len Nichols, Director for the Center for Health Policy Research and Ethics at George Mason University. All three said there is nothing in the bill that would cut off treatment based on an age limit.

The video "has no basis in reality whatsoever," Cassil said. "There is nothing in that bill that I am aware of, or certainly every reporter who has combed every inch of it that mentions anything about 'age limits.' ''

OK, so there's nothing in the bill that limits benefits based on age.

Sherman:

When we asked about whether Fanelli had read about an age cutoff in news articles, he replied: "I have been at lectures." He heard one from a brain surgeon. "I don't remember the name. I wasn't anticipating getting a phone interview on this." We contacted him again the next day to clarify if he had read any news articles about an age limit and he said: "There are various articles. I can't quote verse, page and date. ... We arrived at the claim because there is not enough money generated in tax revenue to pay for the current expenses for the U.S. government and this is going to be an additional expense."

One of the commonsense rules of charitable interpretation involves accepting a reasonable explanation from the person making the statement, at least to the point of granting the explanation the benefit of the doubt in a close contest of most plausible explanations.

The statement from Fanelli explains the video as an expression of the idea that the government will end up choosing who receives expensive treatment and who does not, with the elderly heading the risk list.

The explanation from Dr. John Meisenheimer, who appeared in the video, jibes with Fanelli's:

"It can be a very slippery slope. It's not going to happen like in the commercial,'' said Meisenheimer, whose office website states that he accepts Medicare patients. "Doctors will have to make a decision: where is the best use of money? Do I use it for a 95-year-old who has skin cancer or for somebody younger? ... There is not enough money there in the can for everybody."

Sherman gives no sign of taking the explanation seriously, as it does not figure in the final ruling:

So to recap, Fanelli's ad offers a dramatic scene that has no solid facts behind it. He claims it portrays "Obamacare," but he cannot cite any provisions in the health care bill -- other than vague fear of a European system -- that could cause such a tragic scene. He referred us to his wife's dermatologist -- who also happens to be the star of the commercial -- but the dermatologist did not produce any conclusive evidence, either.

So the ad has lots of melodrama but no facts. We find the claim Pants on Fire.

Sherman's concluding paragraph reads like a fallacious appeal to ignorance.  If Fanelli and Meisenheimer fail to offer conclusive evidence then the claim is supposedly false.  False, supposedly, to the point of being a ridiculous ("Pants on Fire") claim.

In the attempt to treat Sherman fairly, she took the trouble to contact experts who were dubious about the video--but their incredulity was apparently based on the age criterion for limiting benefits.  Fanelli and Meisenheimer said that wasn't the point.  As a result, the quoted testimony of the experts fails to address the reasonable charitable interpretation of the video.

Reading Sherman charitably, by including the evidence from the experts in her logic, we still end up with a fallacious argument: the straw man fallacy.  The straw man argument takes something less than the best argument of the opposition and addresses that.  The best argument is safely ignored.

The elephant in the room: Somehow, Sherman and Bustos failed to take any note of the new Independent Payment Advisory Board created under the new health reform legislation.

As part of the health care reform legislation, and in an effort to help restrain growth in Medicare expenditures, Congress has created the Independent Payment Advisory Board, which has the authority to develop proposals that will become law if Congress fails to enact alternative proposals.

It must be noted that the bill places restraints on the IPAB:

Congress specified that IPAB proposals shall not include any recommendation to ration health care, raise revenues, raise Medicare beneficiary premiums, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance and copayments) or otherwise restrict benefits or modify eligibility criteria.

So the IPAB is tasked with keeping costs low but restricted in the means it may use to achieve its objective.

Suppose the IPAB decides that it will not grant the OK for treatment on persons with low life expectancy.  Would that be a form of rationing?  Suppose that Congress does not act on the proposal.  The policy would become a potentially illegal law.  What happens then?

On the other hand, suppose that Congress conscientiously keeps the IPAB from implementing any law that creates any form of rationing.  What laws could the IPAB concoct that would fill that bill?

The IPAB seems tasked with defying the law of non-contradiction.

The most obvious way of controlling costs falls right in with the name of the board:  limiting payments to providers.  The method used historically--reducing reimbursement for fee-for-service treatment, creates economic pressure to utilize services more heavily while creating a disincentive to provide health care.

The second most obvious method of controlling costs would involve changing from the fee for service reimbursement model to something else (such as the model used at the Mayo clinics).  It isn't clear that such models would avoid rationing, so it will fall to the judgment of Congress and perhaps later the court system to make that determination.

The grades:

Amy Sherman:  F
Sergio Bustos:  F

It was unconscionable for PolitiFact to fail to deal with the best of Fanelli's case.


Afters:

While I'm faulting Sherman and Bustos for failing to focus on the IPAB, I might as well fault Fanelli for not mentioning that feature of the bill in his defense.

It is worth noting that PolitiFact mentioned their choice of Sarah Palin's "death panel" comment as their "Lie of the Year" for 2009.  As I argued in an older post, Palin was best taken to refer to exactly the type of government control that will probably result from the IPAB.