Saturday, December 18, 2010

PolitiFact's "Lie of the Year" for 2010 another study in irony (Updated)

PolitiFact, with some self-produced fanfare, announced its "Lie of the Year" for 2010.

Like the supposed "Lie of the Year" for 2009 (Sarah Palin's "death panel" remark), PolitiFact's choice itself represents a case study in disinformation.

The winner?  The oft-repeated word choice of Republicans in labeling Obama's health care reform as a "government takeover" of health care.

On to PolitiFact's reasoning:
In the spring of 2009, a Republican strategist settled on a brilliant and powerful attack line for President Barack Obama's ambitious plan to overhaul America's health insurance system. Frank Luntz, a consultant famous for his phraseology, urged GOP leaders to call it a "government takeover."

"Takeovers are like coups," Luntz wrote in a 28-page memo. "They both lead to dictators and a loss of freedom."
It's worth examining the context in this case, because Luntz made many recommendations in the memo:
“Washington Takeover” beats “Washington Control.” Takeovers are like coups – they both lead to dictators and a loss of freedom. What Americans fear most is that Washington politicians will dictate what kind of care they can receive.
The recommendation occurred at the end of a set of three bullet points where Luntz advised Republicans to use the most effective words in making the case against the Democrats' health care reform plans.

The line stuck. By the time the health care bill was headed toward passage in early 2010, Obama and congressional Democrats had sanded down their program, dropping the "public option" concept that was derided as too much government intrusion. The law passed in March, with new regulations, but no government-run plan.
Apparently it is PolitiFact's opinion that Luntz's line was responsible for sinking the public option concept.  Except that it was the failure of Democratic solidarity that caused the exclusion of the public option.  Sen. Joe Lieberman (I-Del.), for example, opposed it.  Was Lieberman snookered by the "government takeover" language?  That's very doubtful.  PolitiFact makes its case without backing evidence, which helps mark the story as opinion-drenched news analysis.  PolitiFact has no fact-based case for the importance of its chosen "Lie of the Year."

PolitiFact again:
But as Republicans smelled serious opportunity in the midterm elections, they didn't let facts get in the way of a great punchline. And few in the press challenged their frequent assertion that under Obama, the government was going to take over the health care industry.
Speaking of not letting the facts get in the way, what are the facts that justify claiming that the facts didn't get in the way?

PolitiFact editors and reporters have chosen "government takeover of health care" as the 2010 Lie of the Year. Uttered by dozens of politicians and pundits, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats' shellacking in the November elections.
If dissatisfaction with the health care plan was such a big factor in the November elections then perhaps PolitiFact could have found a "Lie of the Year" in a claim that Democrats would be able to run on the passage of health care reform and/or keep control of the House of Representatives.  But I digress.  We return to PolitiFact's reams of evidence that Luntz's characterization is false:
By selecting "government takeover' as Lie of the Year, PolitiFact is not making a judgment on whether the health care law is good policy.

The phrase is simply not true.

Said Jonathan Oberlander, a professor of health policy at the University of North Carolina-Chapel Hill:  "The label 'government takeover" has no basis in reality, but instead reflects a political dynamic where conservatives label any increase in government authority in health care as a 'takeover.' "
Hmmm.  Could this be the same Jonathan Oberlander who wrote an advocacy piece in favor of the Democratic health care reform bill, published in the New England Journal of Medicine back in March?

The possible taint on Oberlander's objectivity aside, is it true that "government takeover" has no basis in reality?  Oberlander's own words suggest that he contradicts himself.  Does the legislation provide for increased government authority as he appears to grant?  And isn't an increase in government authority a takeover of that realm of authority, given that the authority came into existence with the passage of the legislation?  Oberlander appears to simultaneously affirm and deny that the terminology has a basis in reality.

PolitiFact sets aside a section under the heading "An inaccurate claim," which suggests evidence will follow.
"Government takeover" conjures a European approach where the government owns the hospitals and the doctors are public employees. But the law Congress passed, parts of which have already gone into effect, relies largely on the free market:
To the politically aware, "Government takeover" should equally suggest an approach where the government exerts overpowering control over health care via regulation.  Comprehensive regulation makes formal ownership unnecessary.  Odd that the fact escapes PolitiFact's notice?

The list of evidences:
Employers will continue to provide health insurance to the majority of Americans through private insurance companies.

• Contrary to the claim, more people will get private health coverage. The law sets up "exchanges" where private insurers will compete to provide coverage to people who don't have it.

• The government will not seize control of hospitals or nationalize doctors.

• The law does not include the public option, a government-run insurance plan that would have competed with private insurers.

• The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.
Addressing the bullet points in order:

1)  Private insurance will come under greater government control through the new legislation, and it is fair to call newly instituted regulatory powers as a taking.

2)  "Contrary to the claim"--contrary to what claim?  Apparently PolitiFact is hard at work stomping the straw man of socialized medicine.  As noted above, sufficient government regulation renders ownership superfluous as a means of government control.  All insurance could be provided privately yet at the same time fall under strict government regulation.  There's no necessary contradiction.

3)  The bill does give the federal government increased control over doctors and hospitals.  Seizure and nationalization are not the issues unless we're only interested in the socialized medicine straw man.
The majority of physicians (60%) said health reform will compel them to close or significantly restrict their practices to certain categories of patients. Of these, 93% said they will close or significantly restrict their practices to Medicaid patients, while 87% said they would close or significantly restrict their practices to Medicare patients.
(The Physicians Foundation 2010 survey)

(P)roviders for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and, absent legislative intervention, might end their participation in the program (possibly jeopardizing access to care for beneficiaries).
(Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended)

4)  The lack of a "public option" is irrelevant.  As noted above, sufficient regulatory control of private insurance makes the creation of acquisition of a government-owned entity superfluous to government control of the industry.

5)  Methods of payment are irrelevant in excusing the increase in government control, especially when the example actually shows an increase in government control of the methods of payment.  The example accomplishes the opposite of its apparent intent.

Note that the list of evidences completely fails to eliminate the basis in truth for the claim that the government will take over health care:  The government does, in fact, take a substantially more significant role in regulating health care.  Any damage to the socialized medicine straw man remains beside the point.

Having run through its impotent supporting evidences, PolitiFact turned to other journalistic authorities for help within a section titled "'Can't do it in four words.'"
Other news organizations have also said the claim is false.

Slate said "the proposed health care reform does not take over the system in any sense.'
Daniel Gross' Slate commentary shares PolitiFact's blind spot for the role of regulation in conferring effective control of a business sector.  Gross also resembles Oberlander in that his comments result in apparent self-contradiction as he goes on to state that the government increased its control of health care simply on the basis of an increased share of health care costs borne by the government.
In a New York Times economics blog, Princeton University professor Uwe Reinhardt, an expert in health care economics, said, "Yes, there would be a substantial government-mandated reorganization of this relatively small corner of the private health insurance market (that serves people who have been buying individual policies). But that hardly constitutes a government takeover of American health care."
Reinhardt overlooks the new requirements for all health insurance policies, such as the elimination of insurance companies' ability to limit their risk by refusing coverage of pre-existing conditions.  There are many such requirements that are not relegated to individual policy market.  The claim that increased government control does not constitute a government takeover amounts to Reinhardt's opinion., an independent fact-checking group run by the University of Pennsylvania, has debunked it several times, calling it one of the "whoppers" about health care and saying the reform plan is neither "government-run" nor a "government takeover." has a deserved reputation as the best of the lot when it comes to fact checking political statements, so this appeal to authority does carry some weight at first blush.  Unfortunately, makes an error similar to PolitiFact's by assuming that "government-run" means a single-payer system like the systems in Canada or the United Kingdom.  There's nothing to prevent a government takeover from utilizing multiple payers.  Each story cited from commits that type of error.

And about that "four words" bit:
"If you're going to tell the truth about something as complicated as health care and health care reform, you probably need at least four sentences," said Maggie Mahar, author of Money-Driven Medicine: The Real Reason Health Care Costs So Much. "You can"t do it in four words."

Mahar said the GOP simplification distorted the truth about the plan. "Doctors will not be working for the government. Hospitals will not be owned by the government," she said. "That's what a government takeover of health care would mean, and that's not at all what we"re doing."
With all due respect to the progressive Century Foundation's Mahar, government ownership is not required for government control, and four words can contain substantial truth about a complicated subject even if they cannot encapsulate the entirety.

PolitiFact's subsequent section, "How the line was used," does little to contribute to the fact checking process other than to provide evidence counter to PolitiFact's conclusion.  The last paragraph from the section:
In rare cases when the point was questioned, the GOP leader would recite various regulations found in the bill and insist that they constituted a takeover. But such followups were rare.
It doesn't make much sense to blame the GOP for the failure of journalists to ask followup questions.  But it does make sense to credit with truthfulness (to at least some degree) those GOP figures who explained exactly what they meant by "government takeover" by citing specifics from the bill.  Particularly in those cases it makes little sense to charge that Republicans were working to mislead people into thinking that the reform bill instituted a single-payer system or socialized medicine.  Yet PolitiFact misleads its readers toward that very conclusion.

The next section of the story carries the heading "An effective phrase" and treats Luntz's communications strategy:
The memo begins with "The 10 Rules for Stopping the 'Washington Takeover' of Healthcare.”  Rule No. 4 says people "are deathly afraid that a government takeover will lower their quality of care – so they are extremely receptive to the anti-Washington approach. It's not an economic issue. It's a bureaucratic issue."

The memo is about salesmanship, not substance. It doesn't address whether the lines are accurate. It just says they are effective and that Republicans should use them. Indeed, facing a Democratic plan that actually relied on the free market to try to bring down costs, Luntz recommended sidestepping that inconvenient fact:

"The arguments against the Democrats' healthcare plan must center around politicians, bureaucrats and Washington ... not the free market, tax incentives or competition."
"It doesn't address whether the lines are accurate."  Actually, it does:
Nothing else turns people against the government takeover of healthcare than the realistic expectation that it will result in delayed and potentially even denied treatment, procedures and/or medications.
Where Luntz refers to the "realistic expectation" about denied or delayed health care treatment he is asserting that the point his language recommendations try to effectively communicate is a legitimate (accurate) concern.

Aside from the above PolitiFact-crafted lie, the section also features DNC Chairman Howard Dean making a statement that appears to contradict Mahar's claim from the preceding section:
Dean grudgingly admires the Republican wordsmith. "Frank Luntz has it right, he just works for the wrong side. You give very simple catch phrases that encapsulate the philosophy of the bill."
Dean's statement appears to leave ample room for four words to carry significant truth ("encapsulate the philosophy") about a complex subject.  PolitiFact fails to note the discrepancy.

PolitiFact's tone-deaf approach holds true through the last section, "A responsive chord."
By March of this year, when Obama signed the bill into law, 53 percent of respondents in a Bloomberg poll said they agreed that "the current proposal to overhaul health care amounts to a government takeover.”
If PolitiFact's analysis is accurate, then doesn't that mean that 53 percent of respondents came to believe that the health care reform bill represents socialized medicine or a single-payer plan?  The PolitiFact story emphasized again and again that "government takeover" can only mean that type of thing.

Probably no survey data will ever surface to support anything approaching a 53 percent belief that the 2010 health care reform instituted a single-payer system or socialized medicine.  And it should have occurred to PolitiFact to view the Bloomberg poll as a potential refudiation of its operating assumption.  I would expect survey data to show that "government takeover" ended up communicating the Republican position that the health care reform bill placed too much control of the health care market in the hands of the federal government.

PolitiFact failed to ask the obvious followup question regarding the poll results.


As with the 2009 "Lie of the Year," the cure is worse than the disease.

PolitiFact created the fantasy that "government takeover" can only mean socialized medicine or a single-payer plan.  Though that is a ridiculous notion, it occurs repeatedly in a story featuring a veritable chorus of experts from the political left.

The story never makes a credible case that Luntz's phraseology does other than take successful advantage of the negative connotations of words to raise awareness (and concern) about the reasonably anticipated results of the health care reform bill.

On top of that, PolitiFact makes a very weak case for the importance of the phrase in public debate over the course of the year.  The reform passed early in the year, after all, and PolitiFact provided no solid evidence that any misconception about the effect of the bill, such as the belief that it represented either a single-payer system or socialized medicine, had a significant impact on the 2010 elections.

Horrible work, PolitiFact.


PolitiFact also got around to publishing a lie about last year's "Lie of the Year" from Sarah Palin:
Rep. Earl Blumenauer, an Oregon Democrat whose provision for Medicare end-of-life care was distorted into the charge of "death panels" (last year's Lie of the Year), said the Republicans' success with the phrase was a matter of repetition.
Look up the FaceBook post that Palin used in making her "death panel" comment and you'll find nary a word about the end-of-life counseling championed by Blumenauer.  Instead, it was all about the inevitability of government bureaucrats making what amount to life-or-death decisions.

The claim from PolitiFact doesn't even jibe with its original evaluation of Palin's "death panel" remark:
Palin's claim sounds a little like another statement making the rounds, which says that health care reform would mandate counseling for seniors on how to end their lives sooner. We rated this claim Pants on Fire ! The truth is that the health bill allows Medicare, for the first time, to pay for doctors' appointments for patients to discuss living wills and other end-of-life issues with their physicians. These types of appointments are completely optional, and AARP supports the measure.
That's ineptitude, pure and simple.


Karl from Hot Air's "Green Room" published a parallel criticism of PolitiFact's "Lie of the Year" several hours before mine.  Karl's version makes an important point not found in my version:
As Michael Kinsley (founding editor of Slate, which PolitiFact relies upon as an authority) asked about ObamaCare:
If the government requires insurers to accept all customers and charge all the same price, regulates all aspects of their marketing to make sure they aren’t discriminating, and then redistributes the profits to make sure that no company gets penalized unfairly, in what sense is the industry still “private”?
Karl goes on to point out (citing that the CBO judged that government regulation of medical loss ratios throughout the health insurance industry were set just below the threshold at which private insurance should be considered "an essentially government program."

C'mon.  That quotation of the CBO has to be out of context, doesn't it?

'Fraid not:
A proposal to require health insurers to provide rebates to their enrollees to the extent that their medical loss ratios are less than 90 percent would effectively force insurers to achieve a high medical loss ratio. Combining this requirement with the other provisions of the PPACA would greatly restrict flexibility related to the sale and purchase of health insurance. In CBO’s view, this further expansion of the federal government’s role in the health insurance market would make such insurance an essentially governmental program, so that all payments related to health insurance policies should be recorded as cash flows in the federal budget.
The CBO report talks about rebates for MLRs above 90 percent.  the PPACA set the rebate threshold at 80 percent for the small group market and 85 percent for the group market.

Oopsie.  PolitiFact forgot to mention it.

Many thanks to Redstate for the connecting URL and additional analysis.

Dec. 21, 2010:   Added a connecting link for Karl's excellent critique of PolitiFact.  Apologies to Karl for the tardy action.

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