JONATHAN CHAIT APRIL 8, 2010
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A few weeks ago, I wrote a post entitled "The Doc Fix Myth And The Right's Misinformation Feedback Loop." I used the example of a medium-sized claim that's demonstrably false, but has recirculated endlessly among conservatives, most prominently rising star Paul Ryan. The false claim is that the Affordable Care Act uses mythical savings from the "doc fix" in order to offset the cost of expanding coverage. Jeffrey H. Anderson, who has been writing about health care for National Review, the Weekly Standard, the Washington Times, the American Spectator, and Investor's Business Daily, has written a reply. His reply utterly vindicates my thesis. Indeed, it suggests that I understated the case. These people really, really don't know what they're talking about.
Let me first explain the underlying issue. It's not very complicated. In 1997, Congress tinkered with the formula for reimbursing doctors who treat Medicare patients. Congress bungled the formula, accidentally creating a massive cut. Congress takes back the cut on a year-by-year basis, a ritual known as the "doc fix." But technically, the cut remains on the books for future years. In other words, there are hidden costs in the budget.
Numerous conservatives, led by Ryan, have tried to claim that the cost of the doc fix is a hidden cost of the Affordable Care Act. Obama's numbers aren't real, they say, because they don't account for the money needed for future doc fixes. Of course, fixing this problem isn't part of the Affordable Care Act at all. It's a cost that would have occurred whether or not the Affordable Care Act was passed. Indeed, Ryan's own health care plan, as well as the main House Republican plan, did nothing to address the doc fix. The Affordable Care Act simply did not use imaginary physician reimbursement cuts to pay for coverage expansions. I've pointed this out numerous times, most recently in the item mentioned above.
Anderson, in his reply, first objects to my description of Ryan as a "conservative icon":
In truth, Congressman Ryan isn’t an icon, but a uniquely articulate champion of limited government, fiscal responsibility, and liberty, and thus is completely in step with the mounting concerns of the vast majority of American voters — conservatives, libertarians, and independents (and even some liberals) alike.
I thought "conservative icon" summarized the same basic sentiment in a pithier way, but it seems I have inadvertently given offense. Let me rephrase my thesis in Anderson-approved terms: Uniquely Articulate Champion Of Limited Government, Fiscal Responsibility, And Liberty Paul Ryan has been spreading demonstrable untruths about the Affordable Care Act.
Anderson proceeds to cite the Congressional Budget Office as evidence that the cost of the doc fix is being used to help fund the Affordable Care Act. He writes:
The CBO begs to differ: “The provisions that would result in the largest budget savings include these: permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector . . . yielding budgetary savings of $186 billion over 10 years.” That’s the physician pay cut.
Anderson provided no link or citation for this quote. It turns out to come from a December 19 CBO letter (page 10) to Harry Reid, assessing the cost of the Senate health care bill, which is not actually the final version. But never mind that. Anderson, if you noticed, inserts an ellipses into the quote from the CBO. Here is the entire quote. I've bold-faced the part omitted by Anderson:
Permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector (other than physicians’ services), yielding budgetary savings of $186 billion over 10 years.
Did you catch that? Anderson used ellipses to remove the part of the quote that disproves his entire claim. He removed the part that says "other than physicians' services," and then wrote, "That's the physician pay cut." But it's not the physician pay cut. The physician pay cut is simply not part of the financing of this law. By the way, I'm not merely going off my own interpretation on this. I checked this with Paul Van de Water, a budget expert with years of analytical experience at the Congressional Budget Office and other places. He's the one who tracked down the Reid letter for me.
Van de Water was astonished at the brazenness of the tactic used by Anderson, or whoever is feeding misinformation to Anderson. I wasn't. Real budget wonks who circulate among genuine experts often fail to understand the degree to which the public debate is driven by pure hacks. I'm not picking on some marginal figure here. Anderson has been writing about health care for nearly all the major conservative publications. Very few conservatives follow health care reform in any detail. They have a general hostility to government and proposals formulated by Democrats, and since they reject the overwhelming majority of actual health care experts on ideological grounds, they have relied on a tiny handful of self-styled conservative pseudo-wonks to fill in the details for them.
But figures like Anderson are simply not up to the job. And once some factual misapprehension has made its way into the right-wing echo chamber, it's nearly impossible to dislodge. The same basic phenomenon can be seen is debates over climate change, supply-side economics, and other issues. You have a whole ideological movement that, to a substantial degree, relies upon the pseudo-expertise of cranks and hacks.
13 comments
"You have a whole ideological movement that, to a substantial degree, relies upon the pseudo-expertise of cranks and hacks." I think you meant to say "... cranks, hacks, and liars." The third term best applies to Anderson. The omission of that key phrase from the CBO's letter was not the result of his insufficient expertise in health care policy, but rather his surfeit of expertise in deceipt.
- Fishpeddler
April 8, 2010 at 5:03pm
[I really gotta stop typing this stuff while at work. The spelling errors are getting embarrassing.]
- Fishpeddler
April 8, 2010 at 5:16pm
It's evident that conservatives/Republicans are ... goat-fucking paedophiles.* * Fill in the elipsis.
- icarusr
April 8, 2010 at 5:38pm
I have to agree; that's not ignorance, it's a lie. Unless you assume that he didn't understand what the words "other than physicians’ services" meant, and truly thought it was vital to save the space of those four words. But a more general question: Why is it necessary to rely on letter summaries to resolve the issue of whether items such as physician pay cuts are, or are not, included in the CBO scoring. Does the CBO not release it's actual calculations?
- Oberdier
April 8, 2010 at 6:58pm
Chait again is wrong - if the goal is to understand the total cost of Obama HealthCare Refore. It extends beyond the recently passed bill. Simple analogy -- if you remodel a house to be more energy efficient (where benefits outweight costs) and don't include the costs of fixing the roof where you mount the solar panels --- you have simply made an error. Doc fix is analogous to the roof that needs repair whether or not you remodel. You can't just exclude the cost of the roof repair (doc fix) when totalling the cost of Healthcare reform. This is a common project scoping tactic used to hide true costs. Healthcare reform under Obama = the set of bills that he managed to jam through (which will include doc fix)
- mr_rationale
April 8, 2010 at 7:40pm
"Very few conservatives follow health care reform in any detail" Are you serious? Do you believe Doctors are liberal? Hospital Administrators? Health insurance executives? The only non-conversative health care experts are mostly public sector parasites/chattering class entertainers
- mr_rationale
April 8, 2010 at 7:43pm
Mr_Rationale, maybe somebody else can understand your point because it seems you are assuming a fact not in evidence. In your remodeling example, a cost that exists regardless of whether remodeling is or is not undertaken would not be considered a cost of the repair. Chait's point is that the Doc Fix is not part of the savings calculation because it is a number that isn't affected by the new law and, therefore, not addressed in analyzing the impact of the ACA.
- Nusholtz
April 8, 2010 at 10:17pm
Are you on about the house analogy *again*? You'll have to do better than paste in your comments from related threads without at least pretending to refute the arguments against them. But thanks for the timely example of an information-proof closed loop.
- frippo
April 8, 2010 at 10:17pm
Okay, so I'm making my home repair budget for next year. I know I need to replace my roof for $1000. I also have the option of paying $800 to install solar panels, which will save me $1200 on my electric bill. To me, that looks like a net $400 gain. But you're saying I need to factor in roof replacement into that consideration? Solar panels : (1000 + 800) - 1200 = $600 total cost No solar panels : $1000 total cost I've got to ask mr rationale to clarify, because honestly, taken at face value, his argument seems almost too dumb. I must be misunderstanding something.
- ratnerstar
April 8, 2010 at 10:35pm
Actually, ratnerstar, I think your analogy gives mr_rationale too much credit. A better comparison might be: I've got a kitchen stove that needs replacing and I want a microwave as well. I go to get an estimate for installing the microwave. The estimator hands me an estimate that says "$800 for stove plus $400 for microwave. Total $1200." I protest. "I didn't ask you for an estimate of the stove. I know I need a new one, but for now, just give me an estimate for the microwave." I am then handed an estimate that says "$1200 for microwave (with new stove included)." I scratch my head. Is the man not listening? Or his he trying to con me? When it comes to conservatives and the doc fix/Obamacare syndrome, it is either deaf or con. No other options available.
- timteeter
April 8, 2010 at 10:56pm
You almost have to admire mr_rationale for coming back again and again with the same meaningless, smokescreen-style non-arguments.
- ironyroad
April 8, 2010 at 11:47pm
"You almost have to admire mr_rationale for coming back again and again with the same meaningless, smokescreen-style non-arguments." I would admire him for persistence, except that in the of case most of the chattering class of the conservative movement (whom mr_rationale is wont to echo), repeating something that is demonstrably false or misleading represents not dogged principled persistence in the face of opposition, but a calculated tactic to change the terms of public debate in their favor at whatever cost to truth or reason. This is the age of re-incarnation of "the big lie" theory of forming public opinion. And, unfortunately for everyone who wishes our policy to grounded in fact and reason, "the big lie" often works
- IowaBeauty
April 9, 2010 at 7:46am
I'm late here, but this is a notably excellent takedown featuring quality research and crushing erudition, second only to ratnerstar's brilliant hypothetical in comments (with an unwitting assist from mr. impregnable). I dare say the DNC should take note of both, and definitely the latter, for use against this inane GOP argument. Two snaps up for the both of you.
- I Majorajam
April 9, 2010 at 10:34am