By: Patricia Barry | Source: AARP Bulletin Today | August 14, 2009
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?”
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 “tweets”—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 Center at the University of Pennsylvania, who codirects www.FactCheck.org, a website that examines questionable claims from all sides of the political spectrum.
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.”
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.”
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?” Jamieson asks. “Does it send the member back [to Washington] saying, ‘I’m going to lose the election if I vote for this thing?’ ”
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 medicine”—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 plan”—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.
Q. Will private insurance be outlawed or wither on the vine?
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.”
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.”
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.”
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.”
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.”
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.”
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 old” for joint replacements and cancer care—and even, in one persistent rumor, that “Obamacare” 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.”
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.
source: http://bulletin.aarp.org/yourhealth/policy/articles/health_care_reform2.1.html
No comments:
Post a Comment