As the battle for healthcare reform rages on, many of the myths that I once expected to quietly die have instead become stronger and more entrenched. In particular, the degree of misunderstanding surrounding the “public plan” portion of healthcare reform proposals continues to astound me, both on the Right and the Left. I addressed some of those concerns in a post last week entitled “All About the Public Plan” and I think some of the misconceptions I discussed in that article have pertinence to the discussion of alternate reform mechanisms as well. Especially in regards to Co-ops, I think misunderstandings on the part of the Left have hobbled any chance at real discussion of this viable public plan alternative. So hopefully this will help clear some things up:

What is the Healthcare Co-op?

First off, it’s important to know that when we’re talking about co-ops, we’re not talking about the local health insurance co-operatives found in states like Wisconsin. CNN recently wrote an entire article while apparently operating under this misunderstanding, and pretty much all of the statements deriding co-ops that have come from Gov. Tom Pawlenty recently also fall into this category. We are talking about a single, national co-operative or small group of cooperatives, given special permission to compete nationally across state lines to provide competition to the overly-consolidated private health insurance markets. To fully understand this type of co-op, you should first go back and read “All About the Public Plan” if you haven’t already. Seriously, you won’t understand this article without it. I’ll wait… Okay, are you done? Do you understand what the Public Plan is? The Co-op is exactly the same, except administered by elected board members rather than government appointed officials. Literally, that is the only difference I have been able to come up with.

Disadvantages of the

Healthcare Co-op

Now I should clarify that the Co-op idea has the potential to be exactly the same as public plan proposals, and would likely function almost exactly like the public plan, but since no bill has actually been written up with a co-op component, we can’t say for sure yet exactly what it would be like. Sen. Kent Conrad, one of the first to propose co-ops in the context of the current healthcare reform debate has said that they could operate on a state level, a regional level, or a national level. It’s a national healthcare co-op that would function like a public plan. State or regional co-ops would probably be beneficial but would not have nearly the same strength in bargaining power as a national co-op or a public plan and thus would be a less formidable competitor to private insurers. So this remaining ambiguity is certainly one disadvantage to dumping the public option in favor of a co-op.

The only other reasonable argument I’ve heard against the healthcare co-op is that since administrators would not be appointed by the government, it’s not a guarantee that the co-op would remain dedicated to its original mission of lowering America’s insurance premiums. There’s not much to prevent the administrators of the co-op from pursuing the interests of their organization over those of the American people should they ever come into conflict. The primary situation in which that might occur would be if the co-op became too successful and threatened the fabric of our private insurance industry. In that situation, those not participating in the healthcare co-op would not have any direct input into its operations, while those who are members would have only an incentive to increase the size of their organization to grow their risk pool. Of course we’d still have some control over the co-op through legislation, but as we’ve seen that can be a slow and arduous process. In other words, a government administered program would theoretically give the American people (through our elected officials) somewhat more direct and time-sensitive control over how the plan operates.

Advantages of the

Healthcare Co-op

While I’ve stated several times in the past that I believe it to be very unlikely that a public plan would bankrupt private industry, it’s impossible to say that it could never happen. With that in mind a state or regionally based healthcare co-op plan would essentially eliminate that risk, which should ease the minds of conservative reform opponents.

But I think the primary advantage is political. It’s clear that, due to unfortunate naming, insurance company smear tactics, and the white house’s perplexing decision to sit back and let the wings define the debate for the first several months, the public plan has become a very, very controversial proposal. To many conservatives it has become synonymous with “Socialized medicine” and a “government takeover of healthcare”. If a strong, national, healthcare co-op would give us nearly the same result without the controversy then it seems like the logical choice.

I know some are frustrated with that option because they see it as a sign of giving in to misinformation. Yes it’s true that the Public plan has been unfairly smeared and is almost universally misunderstood. Yes it’s true that if it were abandoned, healthcare reform opponents would trumpet from the hilltops that they were clearly right all along and that their protests and screaming had succeeded in averting socialism. The liars would be gratified and the screamers would not learn their lessons, and that would be frustrating. But there will always be liars and there will always be screamers. One win or loss on one item of policy will not change that. Are we willing to accept no reform at all in place of a healthcare system with a strong national co-op, or even strong regional co-ops, for reasons that essentially amount to pride?

Unfortunately I’ve found that this is a frequent occurance in politics. Idealogues often get their way because they’re loud and more than willing to lie their faces off. But if anything is going to be accomplished then somebody has to compromise, and it won’t be them. And in the end, I think it’s less about who believes they won or lost and more about the end result for the American people. I think the most noble policy makers are those who pragmatically seek the best result for their constituents. They’re rarely anyone’s hero, they don’t often make the news, and they don’t have a rabid fan base since they’re not out there boldly and defiantly waving some ideological banner. But they’re the one’s we can thank for most of the positive change that has actually been enacted over the years.

Conclusion

So is the co-op the way to go? If that’s what we have to do to get a bill passed, then I say yes. And all signs from the Senate say that the public plan is a no-go there. I’m all in favor of a public plan, I think it’s the superior choice. But not by so much that healthcare reform is worthless without it. I think it’s wise to push the public plan as much as we can and fight the misunderstanding that’s out there. But when it becomes clear that it will not succeed, we need to accept the co-op and move forward as quickly as possible, before the next smear campaign has time to gain momentum. I really liked what Pres. Obama had to say about this subject in his healthcare address last week actually. and I’ll let his words close out this article.

“It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated – by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.”

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Ok, those who have been following the healthcare reform battle have surely noticed that things have gotten nasty in the last couple of weeks.  And I mean seriously nasty.  I’ll admit, I’m still young, and I’ve only been following politics with intensity for the last 5 years or so, but I’ve done a fair amount of research on controversies of the past and I feel I’m fairly informed about the history of American politics over the course of the last century.  But the healthcare debate that’s going on now seems to be shaping up to be among the most vitriolic policy battles of recent history.  And along with that vitriol has come a slew of misinformation and purposeful misrepresentations that have far exceeded anything I would have expected to see in modern America.  With the advent of the internet and increased access to original sources, it’s perplexing to me how these smears can spread so quickly, and maintain such staying power.

And the pervasiveness of these myths is likewise surprising.  I’ve been watching videos of town hall protesters lately and it is extremely rare to see a protester carrying a sign that isn’t littered with false claims about the healthcare bills.  And some of them are so shockingly confused as to deal a serious blow to my faith in humanity (A sign I saw recently reading “keep your government hands off of my medicare” comes to mind).  And in casual conversations I’ve had with others about the bill I have yet to talk to an opponent who has actually cited something that’s really in the bill as justification for their opposition.  Once again, to be clear, every single person I’ve talked to who opposes the bill, when asked about their reasons, has cited nothing but provisions that are not actually in this bill.

So for the last few days I’ve been working on this article:  a feeble attempt on my part to correct 7 outlandish myths that are out there about healthcare reform.  In reality there are several claims being thrown about that are probably more shocking than these, but I tried to pick 7 that were both blatantly false, and commonly held.  Even many of the moderates in the audience may be unaware that the things mentioned below are, in fact, untrue.  I’ve tried to cite original sources wherever possible.  And for those who aren’t familiar with the methods of internet bloggers, the underlined text indicates a hyperlink to a source for the underlined statement.  This article is quite long, but I believe its topic is vitally important.

In the interest of full disclosure I should also point out that I’m currently a voting delegate to the California Medical Association (CMA) and American Medical Association (AMA), and I hold positions on the CMA’s Council on Legislation and the AMA’s House Coordinating Committee.  While these positions have certainly helped increase my understanding surrounding this bill and healthcare policy in general, I am speaking purely for myself in this article and nothing I say should be construed as reflecting the positions of those organizations or committees.

Myth #7 – This Healthcare Reform Plan = Socialized Medicine

I’ll talk about this one first because it’s probably the most pervasive of all the myths I’ve heard so far.  And it isn’t all that crazy when you get down to it.  In the public mind the terms “universal healthcare”, “socialized medicine”, “public plan”, and “single-payer healthcare” are all kind of viewed as the same communistic policy but they are, in reality, very distinct and different ideas.  Let’s do a little bit of defining.

Socialized Medicine – a medical system in which the healthcare providers work for the government, healthcare facilities are owned by the government, and the government is the sole payer of healthcare costs.  There are actually few modern examples of true “socialized medicine” with the UK and Spain being two of the only industialized countries to employ such a system.  There are currently no groups in the US that are advocating for a system of this nature in the US.  Literally even the furthest left-wing healthcare reform advocates are shooting for Single-Payer, described below. (Definition at MedTerms)

Single-Payer Healthcare - a system in which healthcare facilities are privately owned, healthcare providers work for themselves or for hospitals, and the government is the sole insurance company.  This could alternatively be called a “socialized health insurance system”.  This type of healthcare system is more common and can be found in Canada, Australia, and Taiwan.  There are groups in the US, most prominently the PNHP, that advocate for single-payer healthcare, and Dennis Kucinich proposed such a system, but honestly these groups aren’t taken seriously by mainstream liberal politicians. (Definition at MedTerms)

Universal Healthcare - is just a general term for any system in which all or very nearly all of the populace in a given country has either private health insurance or government provided healthcare.  There are as many ways to achieve this as one can think of.  There are both market-based and regulation-centered reforms that could potentially lead the US to “universal healthcare”.  Most countries that ensure universal healthcare do so through a mixture of public programs and private industry.  Many of the best healthcare systems in the world are organized in this manner such as those in France or Greece.  The US is the only industrialized country in the world that doesn’t have some form of universal healthcare.

Public Plan – The public plan, as described in the House’s initial draft of their healthcare reform bill would not provide free healthcare to anyone and nobody would be required to use it under any circumstances.  It would compete with private industry in much the same way that the USPS competes with UPS, FedEx, and others in the package delivery business.  But unlike the Postal system it would not be funded with taxpayer dollars but would be required to be financially self sustaining.  Many countries with mixed public/private systems have a similar plan. (Fact Sheet on Public Plan)

Now that we have some basic definitions lets see which one’s apply to the reform plans currently in congress. Well, according to CBO predictions (pg. 13), the healthcare bill would reduce the number of Americans without health insurance by 37 million, leaving about 17 million uninsured and would have only a minor impact on the number of people currently using private insurance companies.  So it wouldn’t even provide universal coverage and since our healthcare insurance system would still stay predominantly private, it brings us no closer to single-payer healthcare and keeps us multiple levels away from anything resembling socialized medicine.

I suppose the argument remains that it’s a “socialized” plan because it moves us closer to the “socialism” side of the spectrum.  I would say that’s barely true, but then we’re just playing games with words.  By the same token I could label any deregulation proposal “anarchic medicine” because it’s inching us ever closer to anarchy and it would be equally valid.  One of the most basic ways that politicians and pundits try to influence the debate on an issue is through controlling the language used and opponents have done a very efficient job associating healthcare reform with socialism.

These ideas are reinforced by partisan news organizations who use headlines like “Would Americans accept socialized care?” or who put polls on their site asking “do you think American taxpayers should pay for universal healthcare?”, both of which are irrelevant questions when considering the healthcare legislation currently in congress.  I saw an example of this recently when a news organization featured an article discussing the merits and pitfalls of Canada’s system, implying that it had pertinence to the US healthcare debate, when in reality Canada’s system is nothing like the reform being proposed.  But they know that the more they make the association, the more ingrained that perception becomes.

In fact it’s probably already so ingrained that many of you probably have difficulty coming to terms with the idea that the impending healthcare reform bills do not represent anything close to socialized medicine, despite the clear and simple facts.  Which is a testimony to the power of “source amnesia” (discussed here) and a lesson in the importance of choosing information sources without an agenda, and who don’t attempt to manipulate your psyche.

Myth #6 – A Public Plan Would Crowd Out Private Insurers

This was one of the first criticisms of Obama’s initial healthcare plan, and it was first made way back before any bill-writing even began.  And at the time it was actually pretty valid.  In those days no one knew exactly what was meant by a “public plan”, only that it was to be designed to compete with private insurance.  If the public plan had been designed such that it was subsidized by tax funds, then it would be perfectly reasonable to worry that it would bankrupt private industry, since its competative advantage would be enormous.  Similarly, before projections were released regarding the impact the public plan might have, or the effects of the bill’s employer mandates, some fear regarding how big the public plan might become was warrented.

But thankfully we now live in more enlightened times and we’ve got enough information to falsify this claim several times over.  First of all, as addressed above, the public plan will compete as a non-profit entity with private insurance and will do so without help from taxpayers. They will have to stay in the black through setting and regularly adjusting their premiums like everyone else.  They will NOT be allowed to dip into the general fund.  Thus there’s no reason to think that the public plan would be able to draw a substantial number of currently insured people away from their private plans unless it were somehow able to provide far better services at a far lower price.  While part of its goal is to operate efficiently and thus create some semblance of a ceiling on premium prices, it’s not really reasonable to think they would have the ability to draw enough customers away from the large private insurance companies to put them in financial jeopardy.

Secondly, the CBO has already analyzed the situation and determined that while there would be some small amount of migration from private plans to the public plan, the vast majority of new public plan purchasers would be currently uninsured individuals. And ten years from implementation they show private industry with a slightly smaller market share, but still going strong and holding steady.

Finally, most of the people who make this claim now act as if that’s somehow the government’s secret plan all along; that this is some underhanded way to move us to a single-payer healthcare system.  As someone who used to be a supporter of single-payer healthcare, I can tell you that it’s really not very popular amongst democrats in congress and a large majority of them are actively opposed to such a system.  So that kind of shoots a hole in that conspiracy theory.  It is to nobody’s benefit to undermine private insurance.  The best healthcare systems in the world are those where public and private healthcare coexist in equilibrium.  If the make-up of the congress was as it is now and the public plan ever did threaten the integrity of private firms, I can nearly guarantee that they’d scale it down to give private insurance room to make new gains.

Myth #5 – The Healthcare Reform Bill Would Force You Onto the Public Plan and Ban Private Insurance

Ok, now we’re getting to the crazy stuff.  This claim first arose just a few days after the full text of the bill was released.  It started with an article on the site Investors Business Daily that made this claim (link here):

“It didn’t take long to run into an “uh-oh” moment when reading the House’s “health care for all Americans” bill. Right there on Page 16 is a provision making individual private medical insurance illegal.

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:

“Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.”

Now those of you who have attempted to read congressional bills on your own can probably testify that they can be confusing, but pages 16 and 17 of this bill are actually rather clear (relatively speaking) so it’s hard for me to understand how they could have come to this conclusion unless they were purposefully trying to distort its meaning (see the text of the bill here).  These pages talk about how all plans offered after the bill is enacted need to conform to the regulations laid out in the bill.  It does indeed say. “Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of the year the legislation becomes law.”  But what they neglect to address is that “this paragraph” then goes on to describe the new regulations the bill applies to health insurance companies (no denying people for preexisting conditions or dropping them when they get a chronic disease etc) starting from page 19 onward.  So what the bill is saying is that any contract entered into before the date the legislation is enacted will continue in its agreed-upon form until its expiration, but any new contract signed after the bill becomes active must conform to the new regulations laid out in the bill.  Pretty standard boilerplate.  Politifact, The Kaiser Family Foundation, Rep Waxman, and even the conservative Heritage foundation all called them out on their misrepresentation.

A variant of this claim is sometimes made in which the offender says, “You will not be able to keep your current plan for more than a year after the legislation is enacted” or “if your employer drops your insurance you won’t be able to get your private plan back”.  These claims are even more deceptive because they’re just playing off of the fact that all private health insurance plans will change once the legislation is enacted so technically no plan that existed previous to the bill will continue to exist after the bill in the same form.  So yes, you’ll keep your plan, but technically, when your contract is renewed in the year following the enactment of the bill it would be a “different plan” because its provisions would have changed.  So it’s technically true that your “current plan” will be gone and unavailable, but what they don’t tell you is that it will be replaced by one that’s exactly the same but better.

As an aside, IBD had another embarrasing moment in their healthcare coverage when they claimed in a July 31st article, “People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.”   Of course what they apparently aren’t aware of is that Stephen hawking was born, raised, and currently lives in the UK.  His response to the editorial was, “”I wouldn’t be here today if it were not for the NHS,” he told the Guardian. ”I have received a large amount of high-quality treatment without which I would not have survived.”  Indeed, the fact that Stephen Hawkings has survived longer than almost anyone else in history with ALS, all the while under NHS care, seems to demonstrate that IBD is just making things up, both when it comes to basic facts, and their health policy analysis.  It just goes to show that just because someone has a website, and an official sounding name, and an audience, it doesn’t mean they know anything about what they’re talking about.

Myth #4 – A Public Plan Would Lead to Rationing and Long Lines

This is another one of those myths that’s just out there in the ether.  There’s no part of the bill cited when someone makes this claim, and there’s no particular line of reasoning used to justify it that I’ve found.  The myth seems to be driven by a general association between healthcare reform, universal healthcare, socialized medicine, and rationing and long lines ala Canada.

Long Lines

The truth, if you want to call it that, behind this myth is that Canada does indeed have a single-payer, government-financed healthcare system. And they do indeed have longer wait times than we do on elective surgeries (though you rarely hear anyone comment on the associated implication that their wait times are shorter on essential ones).  And for some reason Canada has become the posterboy (girl?) for universal healthcare despite that fact that, once again, every other industrialized country in the world has some kind of universal healthcare.  And many of them have shorter wait times than we do in the US.  As an aside, all this complaining about Canada in connection with universal healthcare is really an impressive accomplishment in selective statistics considering many countries with universal healthcare beat us in nearly every important statistic relating to healthcare quality and healthcare outcomes.  The World Health Organization didn’t rank our system 37th in the world for nothing.  But I’m digressing here.

I suppose the reasoning goes, “Canada has socialized healthcare (single-payer actually but close), Obama wants to institute socialized medicine (not even close), Canada has long wait times (on non-essential surgeries), therefore this healthcare reform plan will lead us to longer wait times.”  It’s a simple line of reasoning and would make sense if not for the detail that every assumption along the way is factually flawed.

Rationing

As for rationing, I have heard some people cite the “comparative effectiveness research” provisions in the bill to support this idea.  Comparative effectiveness research (CER) describes studies that are done for the purpose of determining which procedures are most effective for a given condition. (definition from free dictionary) I think everyone should be able to agree that this is vitally important and it comes as a surprise to a lot of people to know that very little of this kind of research is done.  Obviously for a given treatment there is extensive research available that includes its effectiveness for a condition, but for treatments that address a problem in different ways, or when dealing with combination treatments, those studies aren’t always directly comparable.  So research designed specifically to compare treatment methods is important.

A subset of comparative effectiveness research involves determining which treatments or tests provide more effectiveness for the money.  In other words, in a given diagnostic situation an MRI might cost 20x more than a Chest X-Ray, and CER would be commissioned to determine whether that MRI gives you something like 5 times the accuracy, or a paltry 2% accuracy boost.  If it’s the latter then it would probably be a good idea to reserve that expensive MRI for only those situations in which that extra accuracy is of vital importance.  But it’s this kind of CER that some people say could lead to rationing since, now that they’d have info on which treatments are expensive, they’d refuse to allow the elderly, or otherwise infirm access to those treatments because they’re expected to die soon anyway and they wouldn’t be deemed important enough to waste all that money on.  Apparently this assumes that the American value system has also been drastically altered.

So obviously there’s a large logical leap between funding CER and that kind of heartless rationing.  And I don’t know anybody in the healthcare policy arena who is seriously concerned that CER could lead to something like this.  Both the non-partisan CBO and the Institute of medicine have released reports wholeheartedly endorsing CER and I would suggest that anyone interested in this topic read those two documents as a starting point.

But even if the unthinkable happened, and the public plan started only paying for certain procedures based on some formula that determined who was or wasn’t fit for care, then couldn’t you just change to a private insurance company instead?  Or couldn’t you just pay for the procedure yourself?  The answer is, of course, yes.  Yes you could.  So unless you assume that private insurance is also nonexistant (see myths #5 and #6) this could never really catch on.  And the bill is very clear that the CER findings will be available publicly, but that the information would not be used to force physicians’ hands.  But even if they wanted to, there’s just really no avenue in our current system for enforcing CER findings on physicians since they operate autonomously.

The only situation in which this apocalyptic prediction would be remotely plausible would be if we were in a system in which we had true socialized healthcare (see the definitions in myth 1) and as has already been discussed, there is zero chance of that happening anytime in the foreseeable future.

Myth #3 – This Bill Would Encourage the Elderly to Kill Themselves!

As far as I know, this claim started with Betsy McCaughey on the July 16th epidode of the Fred Thompson radio show.  This was her claim: “Congress would make it mandatory — absolutely require — that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.”  She says the language can be found on page 425 of the health care bill, Sec. 1233, labeled “Advance Care Planning Consultation”.  Once again, click here to read the bill yourself.  The claim was then parroted by Rush Limbaugh, and has since made its way around through conservative circles.  Notably, I don’t think I’ve heard any actual politicians repeat this one.

First some context, everyone should have in place a document describing their preferences for end-of-life care, a “living will” or “Advanced care directive”.  It should specify whether or not they want to be kept on ventilation, whether they want to be given artificial nutrition, whether they want to be intubated or resuscitated, etc.  And it should be reviewed regularly.  Of course most people do not have such a document. These decisions are not as easy as they might seem on the surface (why wouldn’t you want all possible treatments?).  Many people are concerned about the burden on their families if they’re left in a vegetative state or in an untreatable coma for years, they’re not willing to undergo the trauma of intubation or artificial ventilation, or some simply want to die in a bed surrounded by their families and not “full of tubes” with doctors pounding on their chest while their family watches from another room.  While an advanced directive detailing one’s preferred care is important for everyone to have, it’s especially important for seniors. These are critical issues that come up regularly in care of the elderly and it’s obviously difficult to ascertain the patient’s wishes on this subject once they are in a coma or otherwise incapacitated.

Of course these are difficult subjects to discuss (no one wants to sit down and dwell on their mortality or the possible method of their death) but it is generally agreed upon that it’s best for patients to sit down with their family doctor, who they are comfortable with, to discuss these things while still healthy.  Unfortunately, because medicare and most private insurance plans do not compensate doctors for time spent counseling patients on these issues, and because these kinds of visits tend to be long and FP doctors have crowded schedules, they are not done as often as they need to be.  This means that elderly patients are forced to make these complex decisions in the Emergency room, without time to thoroughly consider their options, or in the prep room immediately before facing surgery.  This adds a huge unnecessary burden to patients at a time when they need it the least and creates tension and uncertainty for families.  In fact many in medicine, especially those who work with the elderly, consider it a tragedy that so many of our seniors have to spend those moments running through a list of unseemly and complex questions about their possible death instead of spending that time with loved ones.

So for years the AMA has been lobbying for medicare to cover these counseling sessions so they can be done properly.  This bill finally gives medicare the power to compensate doctors for these counseling sessions once every five years per patient, or more often if the patient becomes very ill.  These sessions are absolutely NOT mandatory as this radio show suggests (the relevant portion of the bill is a modification of medicare, all of which is voluntary).  They are absolutely NOT designed to advocate for patients to “end their life” sooner or “do what’s in the best interests of society”.  They are for the patients’ benefit, so they can have the opportunity to make their wishes known about how they want to be treated.  They would NOT be performed with a “government agent” but with one’s family doctor.  The counseling sessions discussed in this bill are exactly the same as the counseling sessions that are occurring now, at your doctor’s expense, all across the country.  It’s just that now medicare will pay for them.

It’s worth noting that it was the AARP, amongst others, that lobbied for the inclusion of this provision and after this radio segment was released, this was the response of their national spokesman, “In no way would these sessions be designed to encourage patients to end their lives.”  And he said that McCaughey’s comments are “not just wrong, they are cruel.”  I agree.  While I’m often frustrated by the massive volumes of misinformation being propagated about the current healthcare bill this particular claim infuriates me more than most.  This is something that seniors, and those who advocate for them, have been fighting for for years and to use deceit to encourage fear surrounding this provision in the name of “protecting seniors”, as Betsy McCaughey does here, is pretty despicable.

Myth #2 – The Healthcare Reform Bill Would Force Taxpayers to Pay for Abortions!

Ok, this is a really sneaky one.  And it’s become quite popular amongst the furious town hall crowd (Regarding Healthcare Town Hall Protesters).  As far as I can tell, this rumor was started by the Family Research Council and Focus on the Family (this used to be their website but it seems to be partially taken down now) shortly after the first iteration of the house bill was released.  And it was quickly repeated by John Boehner and echoed in town halls across the country.  The argument goes like this, “sure, the House bill doesn’t contain any mention of abortion, but that’s just the trick.  Because it’s not expressly forbidden, those wily democrats are going to ensure that the public plan covers abortion on demand and then we’ll all be paying for these immoral procedures.”

Now that should come off as a bit of a stretch in and of itself.  But it’s shown to be an outright distortion when we consider the facts.  First off, I think Republicans often make the mistake of assuming all democrats are pro-choice, which is clearly not the case.  Democrats are not nearly as united on abortion issues as republicans are and even NARAL points out that despite the healthy democratic majorities in both houses, anti-abortion legislators still outnumber pro-abortion legislators in each.  So the assumption that Democrats are out to promote abortion at every opportunity is questionable to say the least.

But there are more problems with the assumption that the bill’s silence on the subject indicated a pro-abortion agenda.  In the finals days leading up to the production of the initial version of this bill, talk about what to include about abortion started to bubble up.  At the time Nancy Pelosi was quoted saying that they didn’t want to try to tackle abortion through healthcare reform and that their goal with that bill was to simply leave things the way they are now.  And Obama himself, in a CBS interview said, “As you know, I’m prochoice. But I think we also have a tradition of, in this town, historically, of not financing abortions as part of government-funded health care. Rather than wade into that issue at this point, I think that it’s appropriate for us to figure out how to just deliver on the cost savings, and not get distracted by the abortion debate at this station.”  Indicating pretty clearly that subversively introducing something as contentious as tax-payer funded abortions was not the goal at all.  It’s also worth noting that the federal employees health insurance program, which this reform is based on, does not allow tax dollars to be spent on abortion.

So we’ve established that the assumption that the bill’s silence on abortion was a signal of a coming abortapocalypse is a shaky one, but even if by some chance the public plan ends up covering abortion this myth still wouldn’t make any sense.  Because as I indicated earlier, the Public Plan, despite its name, is not funded with taxpayer money.  It’s self sustaining.  So whether or not the public plan covers abortion is irrelevant.

A “smarter” version of this myth was popular amongst republican members of the house and senate who were basically arguing that since tax credits would be given to millions of Americans to purchase healthcare, and some of those people will choose to purchase private insurance plans that cover abortion, taxpayers will end up funding abortion through that convoluted means.  The democratic response to this was to ask, “what about the grant money we give to students?  The tax credits for new home buyers?  The salaries of government employees?  Should we be monitoring these things to make sure none of that money is used to fund abortions?”  One democratic senator asked, with no small amount of sarcasm, “should we ban women from driving to abortion clinics lest our taxpayer-funded roads facilitate an abortion?”  The point being that there has to be a limit to how many levels out we can go while still labeling something “tax-payer funded abortion”.  I tend to agree that trying to ensure that nobody uses tax credits to purchase a private insurance plan that might pay for somebody’s abortion is going a little far.

But, as evidence of their moderation on abortion issues, the democrats in the House disagreed with me, and Rep. Bart Stupak, D-Mich. offered an amendment to the House health care proposal shortly after it was completed that would have prohibited the use of public money “to cover any part of the costs of any health plan that includes coverage of abortion.” The amendment was narrowly defeated.  But soon after, Rep. Lois Capps, D-Calif. introduced an amendment that did pass (found here).

From Politifact.com:

Under the Capps amendment:

* Abortion coverage would not be part of the required minimum benefits package. In other words, insurers would not be required to offer, or be prohibited from offering, abortion services in order to participate in the exchange.

* The public plan could include abortion coverage, but the cost of the additional coverage could not be paid through public subsidies (tax dollars), only through the premiums paid by the insured. And with private plans in the exchange, again, federal subsidies could not be used for abortion coverage.

* Public funding would only be permitted for abortions allowed under the Hyde Amendment — in cases of rape, incest or when the mother’s life is in danger.

* At least one plan in every region must offer full abortion coverage; and one must not.

* Any insurance plan participating in the exchange cannot discriminate against hospitals or other health care facilities (such as Catholic hospitals) that are unwilling to provide abortions.

* The plan will not pre-empt any state laws regarding abortion, such as parental notification laws.

It should be noted that the Hyde Amendment referenced there has been in place since 1976, and forbids federal funds from being used for abortions through Medicaid except in cases of rape, incest or when the mother’s life is in danger.  So the Capps amendment essentially ensures that nothing will change in regards to abortion and tax-payer funds.  Of course the House bill is still in flux, and will eventually be combined with the Senate bill.  But considering the fact that this amendment easily passed in the more liberal House, it’s hard to imagine it will not be included, or even made more restrictive in the final bill.

Of course the eventual passage of this kind of amendment surprised nobody, since this was the stated goal of DC leaders from the beginning.  But these organizations took advantage of the few days between when the bill was completed and the amendment was passed to present their forced and contradictory conspiracy theory, knowing that the general public would be immediately enraged.  It’s apparent that their goal is defeat of the healthcare reform bill for political reasons and they knew that by shifting the debate to something as contentious as abortion, they could rally their troops.  It worked wonderfully and now here we are, weeks after abortion foes have won the amendment they wanted, and posters claiming that healthcare reform will lead to federally funded abortion are still a mainstay of town hall protests.

Myth #1 – Death Panels

When I began planning this article I was going to make this whole “Death panels” thing a humerous bonus at the end.  You know, something so far out there that nobody would take it seriously.  But then it actually caught on!  It is thrown around now by elected officials!  This one was started by none other than Sarah Palin, in a rant on her Facebook page of all places.  She said:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil,..Rep. Michele Bachmann highlighted the Orwellian thinking of the president’s health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff, in a floor speech to the House of Representatives. I commend her for being a voice for the most precious members of our society, our children and our seniors.”

The first thing that should set off alarm bells here is her endorsement of Michele Bachmann.  Whether republican or democrat we should all be able to agree that Michele Bachmann is crazypants.  As far as I’m aware, she has the Politifact record for highest number of “False” or “Pants on fire” ratings at 6/6. And they haven’t even gone after some of her craziest ones like her claim that “The stimulus carries a provision that would force kids into reeducation camps”. I mean we talk about extremists making poor predictions, well she’s as extreme as they come and I have yet to see one of her predictions pan out in any form.

The second thing that should set off alarm bells is that it’s all obviously made-up.  Understandably, everybody seemed initially baffled when Palin put this out, and even conservatives didn’t react kindly.  David Brooks dismissed her comments as “crazy” adding that “the crazies are attacking the plan because it will cut off granny. That is simply not true, that simply is not going to happen.”  And GOP Rep Jack Kingston (GA) said “It’s a scare tactic, no question about it,” adding that there are clearly no death panels.  And Republican Senator Johnny Isakson called her assertion “nuts” in a washington post interview. But a few short days later Newt Gingrich endorsed this idea.  While he carefully avoided saying that he thought her statement was accurate, he expressed sympathy for the idea and encouraged a kind of generalized fear around anything government related.  Then Senator Chuck Grassley stepped forward endorsing the idea as well.  Once again, he didn’t want to go on record using the terms “Death panel” or anything like that but he defended Sarah Palin’s claim and told an audience, “you have every right to fear” in reference to end-of-life counseling.  That’s all it took to turn “Death Panels” into the new headline on certain news stations, to inspire several frothing-at-the-mouth death panel rants from Glenn Beck, and to turn the phrase into the new claim de jour on protestors’ signboards across the country.

After numerous fact checking organizations demonstrated that Palin’s statement was pure fiction (with the trusty politifact.org calling it “a Sci-Fi Scenario not based on reality”), Palin slammed her critics (as is her wont) in a new statement.  But this time made a different claim, stating that while it might not be in the bill, one obscure, misunderstood quote from someone on Obama’s staff validates everything she said.  Unfortuantely for her this claim is also demonstrably false.  And unfortunately for America, nobody in the mainstream media is bothering to correct her.

But her claim did get her a daily show clip based off of her comments, which ended up being pretty hilarious.  So I leave you with this clip as a conclusion, and as a reward for making it through this enormous mass of text.  Feel free to skip to 1:30 in the video if you want to skip right to the death panel discussion, and bypass some censured cursing:

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So California’s budget woes have been going on for months now but the time for action is quickly growing near.  Unfortunately, while everyone agrees that action is necessary, nobody can agree on what those actions should be.  We’ve got a 26.3 Billion dollar gap still to close and accomplishing that in a bi-partisan way is looking to be nearly impossible.  Of course listening to statements from either side makes it seem so easy, “Just cut out our wasteful spending already!” or “Just raise taxes on the rich to where they belong!”.  But when you find out that if we were to, for example, cut all state funding for the UCs and CSUs it would still only save us 1.5 Billion or that raising corporate income taxes would only net us 430 million, it starts to look a little more complex.  Obviously a mixed approach will be necessary, at least until the economy begins to recover and the state’s income returns to normal levels.

The LA times has a very interesting little program on its website that allows you to try your hand at solving CA’s budget crisis.  It can be found here:

You Balance the Budget – LA Times

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Screenshot from real life political computer game: "Take Back Illinois"

Well the Monday night deadline for CA politicians to agree on a budget came and went so Schwarzenegger was forced to send out 10,000 layoff notices to state employees.  The reason for the stall?  They were one vote short in the state senate.  California has a very unusual arrangement that requires a two-thirds majority in both houses of congress for a budget to be passed.  And after months and months of negotiations and concessions to republicans (the bill now consists of millions more in spending cuts than tax hikes) they were only able to entice 2 of the necessary 3 GOP senators to support the bill.

So when everyone woke up the next day and 10,000 more Californians were facing unemployment, did any of the senators who had voted against the bill, have second thoughts?  Did they acknowledge in anyway that thousands of CA families would now be suffering (and not to mention on the unemployment and/or welfare roles of the state) because of their posturing?  Nope.  In fact they gave a big raspberry to bi-partisanship and ousted the senate minority leader who helped negotiate the compromise bill.  The reason for these legislators’ ire?  The bill still contains tax hikes.  Literally, many of them will not vote for the legislation if it contains any tax hikes at all.

Unfortunately, CA is facing a 42 billion dollar deficit that absolutely cannot be fixed by spending cuts alone.  Governor Schwarzenegger recognizes this:

“If you think that you can do this budget without any increase in revenues then you have a big math problem because you can’t erase a $42 billion deficit without revenue increases,” Schwarzenegger said. “I hate taxes, but you when you are faced with that kind of reality, that’s what you have to do. We can only solve this problem with additional revenues and with spending cuts.”

We slashed 11 billion from the budget last year and the current budget has 15.2 billion in further spending reductions in the works.  I don’t think we can cut our way to solvency without unconscionably…canceling basic state services.  I respect the small government perspective, I really do, but now is not the time for extremism on this issue!  If the current budget is passed we will experience the largest reduction in the size of CA government in history as far as I’m aware.  Isn’t that enough?

Of course this isn’t only about tax hikes or spending cuts.  Being the holdout gives you great power and awesome negotiating rights.  You can ask for whatever you want while holding the collapse of the state as your ace in the hole.  And the negotiations began today.  Senators are coming forward and saying they’ll vote for the bill if certain conditions are met.  Sen. Abel Maldonado is one of them.  Does he want some substantive change to the bill?  Does he want lower taxes?  Does he have a new idea for streamlining state government? No, he wants two particular amendments added to the state constitution for him. One of which ironically punishes legislators for not meeting budget deadlines.  Now these amendments may or may not be a good idea but that’s not the point.  What’s upsetting is that Sen. Maldonado and others are using this bill as a lever.  They’re holding out on the budget as a legislative technique, a way to exercise disproportionate power.  He’s putting us at risk so he can try to force the legislature’s hand on an unrelated constitutional issue.  These are the political games I’m talking about.

Of course our state legislators are just mimicking their national counterparts.  After massive concessions were built into our federal stimulus bill (30-something% tax relief when anything over 20% is irresponsible in my book) stimulus opponents complained loudly of lack of input until that number was bumped up to 42% in the senate compromise.  This number was very close to the 46% that Rush Limbaugh proposed for America but it still wasn’t enough!  Republicans knew they could hold out indefinitely and concession after concession would have to be made to appease them, while they could accuse the other side of a lack of bi-partisanship.  When it was apparent that the bill would pass they complained even louder.  They could use even more inflammatory rhetoric now because their opposition had no real world consequences.  It just made them more popular with their conservative base.

Many governors are now in a similar position.  The national governors’ association came out strongly in favor of the stimulus bill but as soon as provisions were added to the bill allowing state legislatures to accept the stimulus funding even if the governor opposed it, governors all across the country started speaking against it.  Because they can now appeal to their conservative base, and come off like small government heros, all the while knowing that their state will receive the federal funds it needs regardless of what they say.

Obviously the Right doesn’t have a monopoly on these methods by any means.  I think to some degree its the natural tendency of the minority party to pull these kinds of stunts.  But I guess I had hoped that in these dire times we would pull together at least to some degree (as we did during september of 2001) and refrain from this kind of posturing.  Instead it feels like while Americans are losing their jobs,  legislators are busy playing a political game that uses our livelihood as the pieces and the media as the board.  And as long as tactics like this are alive and well in American politics, bi-partisanship will continue to be a pipe dream.

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One last stimulus post and then I promise I’ll take a break.  I have been utterly amazed at the creative reading skills of stimulus opponents over the last few weeks.  As they say a lie can travel halfway around the world before the truth has finished putting its shoes on.  And the four outrageous claims discussed here have been passed around virtually unchallenged for a while now.

ACORN Nuttiness

The idea that there was money for ACORN in the stimulus was first invented by Fox news in the run up to the stimulus debate and its since been parroted by republican legislators including John Boehner and David Vitter.  In reality, of course, ACORN is not mentioned at all in the bill but what worries republicans is that 4.2 billion is set aside for local governments and (gasp) non-profit organizations to help them buy up foreclosed homes, fix them up, and sell them or rent them out.  So the logic goes 1.There is money in the bill for non-profits to buy up homes,   2. ACORN is a non-profit organization that does things vaguely housing related   3. The democrats are trying to sneak money to their buddies at ACORN!!!!!

Lest you think I’m exaggerating here is a quote from Louisiana Republican David Vitter on the subject: ”$4.2 billion dollars would be available to organizations like ACRON for so-called neighborhood revitalization. That’s just political payoff, quite frankly, not in spite of their voter registration fraud activity, really because of it, in my opinion, in terms of support from some of the liberals in Congress.”  … Wow.   That’s quite a conspiracy theory he’s put together there.  Never mind the fact that “ACORN Housing” is an entirely different organization than the ACORN that committed voter fraud, never mind that ACORN housing has never purchased a foreclosed home in its history and has no plans to do so, and never mind that…no liberal politicians benefitted in any way from the poorly conceived voter fraud committed by low-level ACORN employees.  Of course David Vitter and John Boehner know all that, but providing that kind of context would hurt their case.

Field Mouse Fiasco

This one originated with Rep Steve King of Iowa but was also picked up by the illustrious John Boehner, and has been featured on the Drudge report.  It all started with this memo from the house, brought to you via Politifact.com:

“Appropriations Republicans, concerned with this irresponsible process and possible abuse of taxpayer funds, have asked various federal agencies how they intend to spend the windfall of cash that Congress may approve in the ‘stimulus’ bill,” said a memo posted to the site. “One peek behind the bureaucratic curtain has yielded the following examples of hidden program information that isnot included in the language of the bill or report. These are programs which various federal agencies have privately indicated they will fund with ‘stimulus’ money.”

The memo lists a number of projects, including up to $37.5 million for “wetland restoration in the San Francisco Bay Area – including work to protect the Salt Marsh Harvest Mouse.”

Basically, unable to find pork in the bill, House republicans decided to ask states and federal agencies what they were planning on using their money for.  On a list of possible projects put forward by CA was this wetland restoration project, a small portion of which focused on protecting this marshy rodent.  Of course with Ms Pelosi being the rep from San Francisco her name was quickly attached to this project as the originator of this trumped up “pork”.  An article yesterday in the Washington Times was headlined ”Pelosi’s mouse slated for $30M slice of cheese.”  and included the blatant falsehood that the stimulus bill, ”includes $30 million for wetlands restoration that the Obama administration intends to spend in the San Francisco Bay Area to protect, among other things, the endangered salt marsh harvest mouse.”

This is really a good example of how many of the “pork” rumors about the stimulus have been invented.  Once again, the creativity evident here is impressive.

Banning Prayer

And of course a great way to get Americans frothing at the mouth is to push the old “democrats are silencing religion” button.  This myth seems to be sole property of South Carolina Senator Jim DeMint, perhaps because its so ill-conceived that no one else wants to be associated with it.  Basically the stimulus contains standard boilerplate prohibiting federal funds going to colleges from being used to refurbish “buildings used for religious worship”.  Sen DeMint has (willfully?) misinterpreted this to mean that students would be barred from praying in their dorm rooms.  Of course there’s oodles of Supreme Court precedent that says otherwise and phrases exactly like this one have been included in hundreds of spending bills gone by without the world crashing down.  I think that’s all that needs to be said about that one.

The Stimulus will Override Your Doctors and Kill Your Parents!

Of all the myths surrounding the stimulus bill this one is perhaps most widespread right now, and simultaneously most insane.  The stimulus smartly establishes a “Health Technology Czar” to oversee the much-needed and long-overdue national transition to electronic health records.  There was a bloomberg article posted a few days back (found here) in which the author used a combination of astonishingly poor reading skills and skillful alarmism to claim that the Health Tech Czar would be empowered to review the decisions of all doctors in America, overrule their diagnosis, and enforce efficiency.  I’m not kidding.  Conservative pundits immediately ran with the story, before checking to see if her claims were correct.

Ann Coulter said Health and Human Services “bureaucrats will soon be empowered to overrule your doctor” and “cut off treatments that merely prolong life.” She also claimed, “Doctors who don’t comply with the government’s treatment protocols will be fined.”  Lousiana Republican John Fleming went on Glenn Beck’s show and said the ”health technology czar” will “oversee what procedures doctors are doing and help decide at what point in life they will receive certain treatments and perhaps what treatments are acceptable and not acceptable for payment.”  Beck, disappointingly, didn’t challenge those claims but made this “outrage” the focus of the remainder of his show.  This culminated in an article in the Washington Times two days ago that ran a story about how the stimulus was leading us towards Nazi-Era Eugenics and it featured a large picture of Hitler.   The story has since been picked up by The Drudge Report, Lou Dobbs, Fox News Anchor Bill Hemmer, and Rush Limbaugh.  All this from one little poorly-researched article that nobody bothered to double check.

But the author’s one mistake was that she provided references to the page numbers in the stimulus that “supported” her claims.  While all those pundits were apparently too busy to glance over them, I found five minutes to look them up.  And I would invite you too as well.  I read the indicated pages with curiosity and found them to be very clear in saying nothing of the sort.  All of the Health Tech Czar’s powers related to enforcing adoption of electronic medical records and nothing more.  But I wasn’t the only one.  One of CNN’s medical correspondents had a similar experience:

When challenged the bloomberg author’s reaction was essentially that the wording of the bill may not actually say anything like that but it leaves that possibility open because it doesn’t specifically rule it out.  All the talk of the elderly and sick being euthanized is just extrapolation from the author’s apocalyptic fantasy.  Believe me, if anything like this was going to be happening, the AMA would be going nuts.  Nobody, democrat, republican, or canadian wants to see government dictating healthcare decisions.  Besides, that role is already filled by your friendly neighborhood insurance company.

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I thought these seven minutes were some of the most important of Obama’s speech and they can serve here as a springboard for discussing two important topics.  The first is the issue of partisanship.  I have been thoroughly impressed with Obama’s calm demeanor and mature perspective in regards to bipartisanship.  He has reached out across the aisle in an unprecedented way and he has been repeatedly slapped in the face by congressional republicans.  Yet he doesn’t turn on them, he doesn’t denounce them and give up, he talks about how his efforts are a long-term investment.  And he says he’s going to continue reaching across the aisle because its going to take a long-term investment to change the culture of washington.  That demonstrates humility and maturity that we have long expected of our neighbors and friends but which we, for some reason, have not expected of our politicians for a long time.  

He could easily use recent events to score political points against republicans, blaming the lack of bipartisanship on them, especially in light of all the political points they’ve been scoring on him lately.  But I like to think that he has more confidence in the American people.  He knows we can look at an issue rationally and won’t be deceived by strategist commentaries and media blowhards.  He trusts that we can judge a situation based on facts and long-term results and not on quotes and smears.  In short, he’s taking the high road, the same high road he stuck to during his campaign and that goes a long way in my book.

The second issue he talks about is pork.  I think its hilarious how conservative pundits have been able to redefine the word pork so that they can label this stimulus bill as such.  Or it would be hilarious if…it weren’t such a serious issue, if they weren’t playing political games with our country’s future.   I’ve read the bills (contrary to republican senators’ complaints they are a very quick read) and there is not a single earmark or pet project in the bunch.  Where are the celebrations for that unheard of achievement?  It is completely devoid of pork.  What it has is plenty of useful spending that will smartly inject needed cash into the economy, promote job growth, while pursuing projects that invest in our future.  But many conservatives consider all spending useless and have thus deemed these projects “pork”.  

Now I can see why they are upset about some of these programs, and it can certainly be argued that some of them, while still valuable, should be presented in later bills, but labeling these items “pork” when that word has previously been reserved for earmarks and pet projects is deceptive.  It’s hard to see it as anything but a deliberate effort to falsely characterize the stimulus package in the minds of the American people.  And frighteningly, that effort is succeeding.

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