Grading PolitiFact: Dan Coats and Medicare creep

The issue:

The fact checkers:

Angie Drobnic Holan:  writer, researcher
Bill Adair:  editor


Analysis:

This item caught my eye because the claim from Republican senate candidate Dan Coats seems rather innocuous.  What would PolitiFact check, I wondered?  The use of "force" to get seniors to accept the ObamaCare version of their health care?  The "government-run" aspect of health care reform?  Either option seemed a bit like nailing Jell-O to the wall, yet PolitiFact had the flames of untruth burning in the nearby "Truth-O-Meter" graphic ("Pants On Fire").


PolitiFact writer-researcher Angie Drobnic Holan spins the tale:

(A)n ad in the Indiana Senate race makes the novel claim that seniors will now be forced into "Barack Obama's government-run health care program."

That sounds like a scary prospect -- until you realize that seniors are already in a government-run health care program, Medicare, and have been for 45 years. The law wouldn't force them to join any plan they aren't already in.

Drobnic is trying to make it seem that Coats is claiming that the health care reform bill forces seniors to participate in Medicare.  Is that a fair interpretation?  And is it a "scary prospect" for those who want, for example, nationalized healthcare?

Here's the ad:



PolitiFact provides a text version (yellow highlights added):

"Congressman Brad Ellsworth said he would protect seniors. But when he got to Washington, Congressman Ellsworth voted for the largest cuts in Medicare history - over $500 billion. That's right, Ellsworth voted with Nancy Pelosi to force seniors into Barack Obama's government-run health care program, reducing the protection Medicare provides. That's wrong. Dan Coats will fight to strengthen Medicare and protect seniors."

Drobnic makes her case by drawing an equivalency between Medicare before and after the health care reform bill.  If Medicare is a "government-run health care plan" before reform as well as after reform then nothing has changed.  That would amount to a ridiculous claim.  Wouldn't it?

The answer requires separating the literal statement from the underlying argument, because Medicare is not "Barack Obama's government-run health care program."  Medicare existed before Obama was even elected to the Senate.  Medicare did not in any relevant sense turn into "Barack Obama's" until the reform bill was passed.  But PolitiFact does not separate the underlying argument.  Instead, Drobnic's story devolves into the detail of coverage provided for in the reform bill.  With respect to Coats' claim that's only relevant if she is checking whether the bill ends up "reducing the protection Medicare provides."  But PolitiFact isn't grading that claim in this item.

It takes a few paragraphs for Drobnic to get back to her supposed topic, and by that time we're approaching the conclusion of the story:

The ad is nonsensical in two ways. It says that "Ellsworth voted with Nancy Pelosi to force seniors into Barack Obama's government-run health care program." But there's no such requirement in the law. Seniors are not "forced" into a government plan any more than they have been.

So Drobnic's trying to nail down both types of Jell-O.  But Drobnic's case here is itself nonsensical.  As noted above, Medicare is not "Obama's." regardless of whether it is government-run before and after passage of the health care bill.  The bill remains unpopular, and the ad connects Coats' opponent, Ellsworth, to the bill for that  reason.  Seniors are forced into Obama's version of Medicare by that vote.  There is no other reasonable way to interpret the ad.  But the term "forced" does need some justification.

Perhaps the fact that seniors were the demographic "most skeptical" of the health care reform bill (click image to enlarge)?

When a plurality thinks a bill will make things worse, isn't it fair to refer to a bill as being "forced" on that demographic?  Obviously it isn't true for all of the demographic, but it's a fair use of normal English.  If liberals disagree then think about something like "Bush tricked the United States into war with Iraq."  If Bush could be said to have truly "tricked" a plurality into supporting the Iraq War then it is a reasonable expression of that idea.

Coats' use of "forced" is thus a reasonable way--not to exclude exaggeration--to express passage of the reform bill over the opposition from the senior demographic.  PolitiFact may be blind to the obvious meaning because of heightened sensitivity to a health care issue that has provided a good number of fact check cases.

That's one pretty sensible bit of supposed nonsense.  So what of Drobnic's other judgment?

Also, Medicare is already a government-run health care program. It has been for 45 years, ever since President Lyndon B. Johnson signed the law creating it in 1965. Under Medicare, the government pays most of the health care bill for virtually every person over 65 in the United States, even when they see private physicians and visit private hospitals. The government determines what it pays those health care providers, and it sets the rules for what's covered and what's not. Indeed, when liberal supporters of a universal, single-payer health care system make their case, they often describe such a system as "Medicare for all." Obama specifically rejected such a plan during the presidential campaign as too dramatic a change from the current system.
(blue highlights added)

Drobnic's presentation is marvelously simplistic.  The government's determinations of what it will pay have changed over the years. When Medicare first started out, it worked like the regular insurance of the time. A full reimbursement of a service determined by a physician exerted very little control over a senior's health care.

Another original principle of the program was that it would not interfere with the practice of medicine. Payments were designed to be as much like the standard insurance policies then in place as possible. But costs for the program rose rapidly almost from the beginning, and in the mid-1970s it became clear that the government needed to slow spending growth. This was done largely through application of new payment policies.

(Medicare - A Brief History And Overview - Age, Nursing, Physician, Social, Care, Program, Persons, Insurance, Hospital, and Services)

 Over time, Medicare payment policies have had a dramatic effect on the overall practice of medicine:

The hospital payment system for Medicare now pays a flat rate to a hospital, based on the patient's diagnosis. While hospitals with varying characteristics may be paid somewhat different rates, this was a major move away from a system in which the costs reported by the hospital were simply reimbursed by Medicare. This new system has encouraged hospitals to be more efficient, although it has also resulted in some premature discharges. Over time, however, this payment system has been judged to be relatively successful. It has helped to encourage movement away from long inpatient stays and to more care being delivered outside of hospitals. Medicare has been credited with contributing to an array of changes that affect the health care system in general.

(Medicare - Changes In Payment Policies)

In the world of PolitiFact, Medicare might as well have been exactly the same since its inception:

The new health care law cannot "force" seniors into a government-run health care program to which they already belong. We asked the Coats campaign about this point, and they said Medicare may have already been a government-run health care program, but it wasn't Barack Obama's government-run health care program until the health care law went into effect. That argument doesn't make sense to us because we don't think that a major government program that's been in place for 45 years becomes a new program when a president passes legislation that affects it.

Again I am reminded of segment from "The Princess Bride," this time a scene from the Fire Swamp, shortly before Wesley was viciously attacked by one of the rodents of unusual size (ROUS):

PRINCESS BUTTERCUP:  "What about the ROUS's?"
WESLEY:  "Rodents of unusual size?  I don't believe they exist."

PolitiFact's skepticism, like Wesley's, is sadly misplaced.  Of course changes to a program make it a different program, with the degree of difference depending on the amount of change implemented.  And the Affordable Health Care for America Act makes big changes to the health care system at large well as substantial changes to Medicare:

After weeks of talk, the White House began circulating draft legislation Wednesday spelling out President Barack Obama's proposal that Congress surrender much of its authority over payment rates for Medicare to a new executive agency. 

The proposed five-member Independent Medicare Advisory Council would be charged with making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health and durable medical equipment. Congress could block the recommendations only if lawmakers agreed within 30 days on a resolution, and the greater veto power would lie with the White House itself. 

(Politico.com)

If that strikes you as a marked increase in government control of Medicare, particularly on the part of the executive branch, you're right.  And you've got something in common with Dan Coats.

Defenders of the system, and we can include PolitiFact in that category, like to point out that the law prevents the IMAC (called the Independent Payment Advisory Board or IPAB under the new law) from making recommendations that would ration care.  That restriction is akin to the one that prevents Congress from passing legislation that is unconstitutional:  We can expect to see exceptions.

To put a point on it, Drobnic's reasoning on these two points is absurd.  And so is her conclusion:

Maybe you could make a case that some people in Medicare Advantage will see their programs changed. But Medicare Advantage programs changed their offerings from year to year before the health care law passed. And if seniors are being forced into regular Medicare, a government-run health care program, it's one they've collectively been forced into for 45 years. Ellsworth's vote did nothing to change that. The ad is capitalizing on confusion about the nature of the Medicare program and making a ridiculous claim. Pants on Fire!

"Some people in Medicare Advantage will see their programs changed."  And that's health care reform?

Ridiculous.

The grades:

Angie Drobnic Holan:  F
Bill Adair:  F

A story built on uncharitable interpretation, distortion and omission makes for poor fact checking.

Afters:

The PolitiFact argument in this item brought the old frogs-in-the-pot analogy to mind.  Put frogs in a pot of cold water and they're pretty happy.  Put them in a pot of hot water and they'll struggle.  Put frogs in a pot of cold water and gradually heat it up and the frogs will cook up nicely without a struggle.

Is nobody at all at PolitiFact aware of incrementalism?  That seems very hard to believe.