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By: Patricia Barry
Now
it’s getting down and dirty. As expected, the gloves are off in
President Obama’s push for health care reform. Democrats and
Republicans are battling over how to fix a system they all agree is
broken—that’s how Congress is supposed to work.
But
this summer something new has entered the political arena—a tsunami of
rumors, myths, fear-mongering and misinformation about the proposals
that surges around the Internet in nanoseconds. “I’m totally confused
about what’s going on,†one reader wrote to the AARP Bulletin. “How do I know who to believe?â€
Misinformation spreads at rapid speed
It’s
a good question. Another is how this new phenomenon—the ability to
spread misleading information at rapid speed through chain e-mails,
blogs, text-messaging and “tweetsâ€â€”will affect the reform debate.
“What
we’re seeing is a flood of viral content that distorts the Obama effort
to reform health care,†says Kathleen Hall Jamieson, director of the Annenberg Public Policy Centerwww.FactCheck.org, a website that examines questionable claims from all sides of the political spectrum. at the University of Pennsylvania, who codirects
Today’s
opposition tools are very different from those used against previous
attempts at health care reform in the Clinton era. Then, the key means
of attack available were television advertising and direct-mail
campaigns, which were expensive and took time to organize.
“Extremists
and people who are so locked into their own ideology that they’ll
distort anything have been out there forever,†Jamieson says. “But they
haven’t had a way to reach out to as many people as efficiently as they
have now.â€
Understanding the proposals
Health
care reform has “serious consequences to people’s lives, and it would
be useful if as many people as possible actually understood what the
proposals are about,†Jamieson says. But the rise of the Internet and
the decline of the mainstream press as a prime source of information,
she adds, put that prospect at risk.
To
add to the confusion, Obama, while talking up his overall goals for
reform, has left it to Congress to work out the details. The result: a
number of committees, each developing and announcing scores of
proposals, which change as negotiations progress. “This process has not
been a success in garnering public support for reform, and has left
people nervous,†says Robert Blendon, professor of health policy and
political analysis at Harvard University’s School of Public Health. “So the headlines every day, because the bills are different, scare different people.â€
Could
the rumormongering affect the outcome? Recent angry exchanges and
violent interruptions at lawmakers’ town hall meetings during the
August recess suggest that it might. Members of Congress faced a
barrage of questions based on the same Internet-spread myths.
If
a disproportionate number of constituents who believe the rumors show
up at meetings, while those who are happy with health reform stay home,
what then? “Does that skew the member’s sense of public opinion?â€
Jamieson asks. “Does it send the member back [to Washington] saying,
‘I’m going to lose the election if I vote for this thing?’ â€
Blendon,
though, thinks most voters, especially the independents, ultimately
won’t be swayed by the myths. “The real debate for them is: What
happens to me and my family out of this thing?†he says.
As
proposals are refined into a single bill, which could happen this fall,
Americans will get a better handle on what matters to them—whether
their own health care costs would rise or fall under reform, whether
taxes would increase to pay for it, and what impact it would have on
the deficit, Blendon says.
Meanwhile,
here are some of the persistent myths about health care reform, how
they arose, and what the three leading current proposals—a House bill,
a Senate health committee bill and a set of options still being
considered by the Senate Finance Committee—actually say about those
issues:
Q. Will the government take over health care so we end up with socialized medicine?
No.
Neither the president nor the congressional committees have suggested
anything remotely resembling a government takeover of health care.
Obama
has specifically rejected the idea of a “single payer†system, like
Canada’s, in which the government insures all citizens. None of the
leading proposals in Congress even considers going down this road—a
fact that has brought strong protests from some consumer and doctor
groups that favor this approach. And although Sen. Edward Kennedy,
D-Mass., has long called for a “Medicare for All†program, this is not
included in proposals from the Senate health committee that he chairs.
Even
further off the table is the concept of “socialized medicineâ€â€”in which
the government not only runs health care but also owns hospitals and
pays doctors’ salaries. Great Britain has this kind of setup, as do the
Veterans Affairs and Department of Defense health programs in the
United States.
Where did this myth come from? Opponents of reform constantly use the term “government-run health
care†to disparage the reform proposals, despite the popularity and
success of existing government-run programs like Medicare. The tactic
often works. Even some Medicare beneficiaries say they’re worried about
a “government takeover†of Medicare.
What do the proposals say? Obama has proposed setting up a single “public planâ€â€”available only to
those without employer insurance—to provide a voluntary alternative to
the many private plans that offer individual health insurance. The
House and Senate health committee bills propose a national public plan
to compete with these plans and meet the same requirements. The Senate
Finance Committee is expected to exclude a public plan. Lawmakers are
also considering state-run community health co-ops as an option.
No.
Obama and the congressional committees say their objective is to build
on the current system—keeping employer-sponsored group insurance and
giving more consumer protections to people who are employed by small
businesses or buy insurance as individuals.
Supporters
of a public plan option argue that it would act as a safety net for the
uninsured, provide competition for private insurers and, in Obama’s
words, “keep them honest.†Opponents of the public option, including
the health insurance industry, contend that it would ultimately destroy
private insurance because the government could offer lower payment
rates to doctors and hospitals, as Medicare now does.
Where did this myth come from? Currently 177 million people have employer or individual insurance. The issue caught fire after the Lewin Group, a research consulting firm owned by UnitedHealth Group, estimated that 119 million of them would switch to a public plan, if everybody were allowed to join it. But the proposals actually exclude
those with employer insurance from the public plan. On that basis, the
group estimates that 34.9 million would exit private insurance—but it
was the high 119 million figure that ricocheted around the Internet.
Another public policy group, the Urban Institute, calculated that after reform, 161 million (or 91 percent) would still enroll in private plans. A third group, the Economic Policy Institute,
examined how employers would react to a “pay or play†mandate, which
would require them to either provide coverage or contribute up to 8
percent of payroll to cover the uninsured. Fears of a mass exodus from
employer insurance “are overblown,†the study found. “Millions of
workers will keep the employer-sponsored insurance they have today.â€
What do the proposals say? Each of the proposals calls for national or regional heath insurance
exchanges that would allow people without employer or public insurance
and small employers to choose from a menu of private insurance plans
(and a public option, if there is one), with online information to help
compare them.
Subsidies
would be available for people unable to afford the premiums, on a
sliding scale according to income. And under the House bill, people
with employer insurance would be eligible for government help if their
premiums exceeded 11 percent of their income. Small businesses would
also get subsidies.
People
with existing insurance would be able to keep it after reform begins.
But after that date, new individual policies could no longer be sold
unless they met required standards of benefits. After five years, all
plans—including group employer insurance—would have to meet those
standards.
Q. Will the government encourage euthanasia to save costs?
No.
This false but scary idea—now surging around the Internet in blogs and
e-mails—claims that the House bill would require Medicare beneficiaries
to have mandatory classes every five years to decide how to end their
lives earlier. Typical e-mails add: “They’re going to push suicide to
cut Medicare spending!†All identify page 425 of the bill as their
source.
Where did this myth come from? On July 16, Betsy McCaughey, a former Republican lieutenant governor of New York, appeared on a conservative radio show. Citing page 425, she said: “Congress would make it mandatory … that
every five years, people in Medicare have a required counseling session
that will tell them how to end their life sooner … all to do what’s in
society’s best interest.â€
On July 23, Rep. John Boehner of Ohio, leader of the House Republicans, issued a statement saying: “This provision may start us down a treacherous path toward
government-encouraged euthanasia if enacted into law.†On Aug. 7,
former Alaska governor Sarah Palin described the proposal as setting up a “death panel.â€
What does the proposal say? The clause on page 424 (section 1233) would require Medicare to pay
doctors for their time if beneficiaries chose to consult them for
information on advance care planning, such as making a living will,
appointing a health proxy, and hospice care (already covered by
Medicare). Medicare would pay for these sessions only once every five
years.
AARP described McCaughey’s claims as “rife with gross—and even cruel—distortions†of
legislation that “would not only help people make the best decisions
for themselves [on end-of-life care], but also better ensure that their
wishes are followed.â€
Republican
Sen. Johnny Isakson of Georgia, who has sponsored a bill that would
also allow Medicare to cover end-of-life planning, characterized the death panel talk as “nuts.â€
Q. Will Medicare be eliminated or gutted to pay for reform?
No.
It’s inconceivable that any lawmaker would commit political suicide by
proposing to get rid of Medicare. But the rumor has fast gained ground.
Where did this myth come from? Dick Morris, a political commentator, posted an article on his blog that began: “Obama’s health care proposal is, in effect,
the repeal of the Medicare program as we know it.†Morris claimed that
the proposals “will totally gut Medicare and replace it with
government-managed care and rationing.†His article was picked up
within days on some 281,000 websites.
What do the proposals say? It’s true they all seek to save billions from Medicare costs—not by
cutting benefits, but by setting up new ways to pay doctors more fairly
and to reward providers for quality of care instead of (as now) paying
them a fee for each separate service; reducing waste and fraud; and
reducing preventable hospital readmissions.
All
the proposals would cut the amount of subsidies now paid to Medicare
Advantage private health plans, which cost an average of 14 percent
more per person than traditional Medicare does. Without subsidies, the
private plans could become more efficient, or they could raise
premiums, reduce benefits or withdraw from Medicare.
The proposals also add benefits to Medicare—such as covering more preventive services and narrowing the Part D “doughnut hole.â€
Q. Will the government ration care?
No.
But the specter of “rationing†is the battle cry of reform opponents.
They say people in their 90s, 80s or even 70s will be deemed “too oldâ€
for joint replacements and cancer care—and even, in one persistent
rumor, that “Obama​care†would deny treatment to people going blind in
one eye as long as their other eye still works.
Where did this myth come from? It’s part of the “government takeover†argument, playing on often
inaccurate beliefs that countries with national health systems severely
ration care. In a widely circulated memo, political consultant Frank
Luntz offered Republicans language that he believed would most resonate with Americans to defeat the
Democrats’ push for reform. He suggested they say: “In countries with
government run healthcare, politicians make your healthcare decisions. They decide if you’ll get the procedure you need … We can’t have that in America.â€
What do the proposals say? In fact, they seek to prevent denial of care. Under every proposal, insurance companies would no
longer be able to deny coverage on the basis of current health or
preexisting medical conditions.
The
proposals also would require plans to offer benefits packages with a
comprehensive range of medical services equal to those in typical
employer-sponsored plans. An independent advisory board, removed from
political influence, would recommend new specific services to be
covered based on scientific evidence. Annual or lifetime limits on
coverage would be prohibited. None of the bills places any age limits
on receiving medical care.
Where to go for the facts on health care reform proposals:
The following websites are run by nonpartisan organizations with no stake in the proposals:
- The Kaiser Family Foundation's side-by-side comparison of the details of the leading proposals
- The Annenberg Public Policy Center's fact checker
- Politifact.com's Truth-O-Meter
An AARP Bulletin senior editor, Patricia Barry writes about health care and Medicare issues.
