Tuesday, October 8, 2013

Todd Rokita Attempts to Defend His Claim That Obamacare is “Insidious”

For the record, I don’t really like using the term Obamacare. I think that it is a loaded term that was coined more as a pejorative than as an honest short-hand descriptor for the Affordable Care Act. However, given that the term has seemingly become the de facto term for the Affordable Care Act and given the public confusion over the terms, I have reluctantly been using the term Obamacare with greater frequency.

Todd Rokita, Official Portrait, 112th Congress.jpgSo, with that out of the way, let’s move on to Rep. Todd Rokita (R-IN). I’ve was highly critical of Rep. Rokita last week both for his condescending behavior toward CNN anchor Carol Costello, his use of his own child’s illness as a political ploy to reopen certain healthcare elements of the government at the same time that he tries to eliminate healthcare for others, and for his claim that Obamacare is “one of the most insidious laws known to man”. I (and others) have pointed out the evil fallacy of equating Obamacare with truly insidious laws like the Fugitive Slave Act, Nuremberg Laws, Jim Crow laws, Apartheid, and other similar examples of man’s inhumanity to man that were codified into law. But rather than walking back his statement, let alone apologizing for the inappropriate and offensive description, Rep. Rokita decided to double-down and try to defend his claim that Obamacare is “insidious”. To be fair, I’ll reprint Rep. Rokita’s explanation in its entirety:

ObamaCare: One of the Most Insidious Laws Ever Devised

Insidious:

  1. Intended to entrap or beguile: an insidious plan
  2. Stealthily treacherous or deceitful; an insidious enemy
  3. Operating or proceeding in an inconspicuous or seemingly harmless way but actually with grave effect: an insidious disease

The Affordable Care Act is one of the most insidious laws devised. That is because it is built around a series of lies, which are now being exposed. Lies such as Americans can keep the health care they have, and that the law would make health care more affordable.

Lost Jobs:

Hospital systems like Indiana University Health have cut employees and hours due to changes forced upon the system by ObamaCare.

Fewer Hours

Schools – both K-12 and college – are reducing support staff and part-time teacher hours because of new requirements under ObamaCare

Lafayette School Corporation, Hancock and Benton County Schools cut their part-time employees to a max of 29 hours per week.

Morgan, Clay, DeKalb, Floyd, and Marshall Counties schools cut their part-time employees to 28 hours per week.

Indiana University, and Ivy Tech Community College, our statewide community college system, capped part-time hours at 29.  At Ivy Tech, this includes part-time instructors classroom  hours, limiting the access to instructors for some of our students that need it the most.

Lost Insurance:

UPS, one of Indiana’s biggest employers, cut insurance for 15,000 spouses.

Soaring  Healthcare Costs

I’ve had countless letters and emails from constituents who’ve had their insurance premiums and deductibles jump.  For example:

  • Larry Cooley in Wheatfield, Indiana reports his 2014 insurance package through Medicare Advantage saw a premium jump 86% and a deductible increase by $500.00.  His prescription costs jumped 25% too and he lost coverage on several drugs.
  • Real people like Angie May, who operates a small family farm with her husband in Indiana.  Their premiums jumped 280% from $325 per month in 2012 to $906 per month beginning in 2014.
  • In so many cases, Americans are not able to stay on the plan that they liked, despite the President’s promise.

Government Will Have More Control Over Every American:

ObamaCare is forcing millions of Americans on to government run health plans, and therefore putting the government in charge of our health care decisions.

Health care represents 1/5th of our national economy, to bring it under government control is to radically change how our private economy works

Most importantly, as Harry Reid and other Democrats have said, the real goal is to get to a “single payer” system where only the government pays for health care.  When only the federal government pays for health insurance, only the federal government will get to decide what care you receive.

ObamaCare Is A Driver Of Our Exploding Debt:

Over the next 10 years, ObamaCare will spend $1.9 trillion that we do not have.

By the end of the decade, ObamaCare spending will exceed $200 billion annually.

Already every child born today inherits over $55,000 in debt, and according to the Congressional Budget Office, federal spending on major health care programs is projected to increase significantly as a share of the economy in coming decades.

  • In 2013, federal spending on health programs will amount to 4.6 percent of gross domestic product (GDP) – by 2038, thanks to ObamaCare, federal spending is projected to rise to 8 percent of GDP.

Note: It appears that Rep. Rokita sourced his definition of the word “insidious” from Dictionary.com. Perhaps because he is a member of Congress he is of the belief that he can simply copy material from another source without attribution.

Obviously, the core of Rep. Rokita’s claim that Obamacare is “insidious” is this statement: “[I]t is built around a series of lies, which are now being exposed”. Oh, really? And what does Rep. Rokita cite as evidence for this “series of lies” that are being “exposed”. First he tells us that “Hospital systems like Indiana University Health have cut employees and hours due to changes forced upon the system by ObamaCare.” But is his statement true? Remember, it is Rep. Rokita that talks about a “series of lies”. Perhaps he needs to look in the mirror before he starts accusing others of lying. For example, a story in the Indianapolis Business Journal about the job cuts at Indiana University Health mentions many factors, but Obamacare is not one of the reasons cited:

After strong growth for years, admissions at Indiana University Health hospitals in the first half of the year suddenly dipped 4.3 percent.

So IU Health executives, who were already looking for ways to cut $1 billion in expenses, decided to give pink slips to 800 employees, according to an announcement Thursday morning.

Meanwhile, however, IU Health's business is stronger than ever, with income from operations shooting up nearly 20 percent in the first half.

“With more than 50 percent of our costs related to labor, and in the face of declining reimbursements and fewer people being admitted to the hospital, we have regrettably concluded that a work force reduction is necessary,” said Jim Terwilliger, CEO of IU Health’s flagship hospital, Methodist. “This is not a decision that we have reached easily or taken lightly, and comes after great consideration.”

IU Health currently had 36,000 employees, although many of those work part-time schedules. It’s full-time equivalent workforce totals 27,000. For all of 2012, IU Health had revenue of $5.6 billion.

IU Health’s decision comes less than three months after Indianapolis-based St. Vincent Health laid off 865 workers in late June, which was part of a 5,000-worker layoff by its parent organization, St. Louis-based Ascension Health Alliance.

Hospitals around the country have been doing the same, as they worry that fewer patients and lower payments will no longer support the expensive operations they built up during a long boom.
“I believe that, as an industry, we have been inefficient,” IU Health CEO Dan Evans said during an April interview in which he announced the $1 billion cost-cutting goal.

IU Health has been able to offset its decline in hospital admissions with an 8-percent price increase and by receiving more patient visits to its outpatient facilities.

Excluding one-time items, IU Health income from operations rose 19 percent in the first half of 2013 compared to the same period in 2012. IU Health pulled in $186.3 million during those six months, compared with $156.6 million the year before.

Inpatient admissions—those that involve an overnight stay—had been climbing consistently throughout 2012. But then, in January, they started to fall.

Total inpatient admissions in the first six months totaled 68,952, down from 72,057 during the same period last year, according to data IU Health released to bond investors last month.

The steepest declines came at IU Health’s downtown hospitals—Methodist, University and Riley Hospital for Children—where inpatient visits fell 6.3 percent.

Even though IU Health saw fewer patients staying overnight in its hospitals, the total days those patients stayed did not fall until the second quarter. And IU Health posted a slight increase in total patient days for the first six months this year.

IU Health outpatient visits—anything that does not require an overnight stay—rose 1.9 percent during the first six months of 2013. At IU Health’s suburban Indianapolis hospitals in Avon, Carmel, Fishers and Tipton, outpatient visits soared 13.4 percent during the first half.

“We think that the future is going to be around population health. How do you keep people healthy?” Terwilliger said. And that means keeping more patients out of the hospital.

Indeed, the federal Medicare program and private insurers are pushing hospitals like IU Health to enter new kinds of contracts in which they can earn bonuses for keeping patients out of the hospital but could suffer penalties if they spend too much to take care of patients.

That’s one factor pushing down hospitalizations nationwide. In addition, persistently high unemployment and the increasing prevalence of high-deductible health insurance plans have left more patients exposed to the high cost of a hospital visit.

What really has IU Health scared, however, is that the federal Medicare program has been reducing payments to hospitals—and private insurers are likely to follow suit. Whereas hospitals for years have claimed that Medicare payments ran about 20 percent below their costs, hospitals now are desperately trying to cut costs to make money on Medicare.

IU Health’s cost-cutting goal of $1 billion would reduce its annual expenses about 20 percent.
“Our foresight is that reimbursement rates will approximate Medicare,” Terwilliger said.

In addition to cutting jobs, IU Health also has been trying to reduce expenses by closing and consolidating programs. For example, it closed pediatric and cardiac rehabilitation programs at Methodist hospital, and now sends patients to similar programs at Riley and at its suburban hospitals.

IU Health also consolidated multiple lab facilities into a downtown facility.

“We continue to root out expenses that do not add value to our patients,” Terwilliger said.

The job cuts will be focused on IU Health's three downtown hospitals as well as its hospitals in Carmel, Fishers, Muncie and Tipton. The 800 cuts will occur in all areas of those hospitals' operations, including clinical and administrative staff.

The cuts will come from layoffs and possibly from some early retirement buyouts—something IU Health has never done before. Laid-off workers will be notified by Oct. 1 and will have their last day with IU Health near Dec. 1.

IU Health officials said they would provide outplacement services, spiritual support and severance. They declined to detail the severance packages.

Hmm. If Obamacare was to blame, don’t you think that Terwilliger might have mentioned that or that the reporter for the Indianapolis Business Journal might have done so? US News & World Report also looked at the broader claim that Obamacare was causing hospitals to cut jobs.

Cleveland Clinic officials announced this week that they would be offering 3,000 buyouts in an effort to cuts costs, citing financial pressures from health care reform as one of the reasons for their decision. More than a dozen hospitals across the country are taking similar measures, due in part to health care reform requirements, but also because of the $9.9 billion in government sequester cuts to Medicare, hospital debt and states’ refusal to expand Medicaid, the government’s health insurance program for the poor.

“For hospitals in general this is kind of the new normal,” says Eileen Sheil, executive director of corporate communications for the Cleveland Clinic. According to most recent estimates from the Bureau of Labor Statistics, the hospital sector lost about 4,400 jobs in July. In May, hospitals shed 9,000 jobs, the worst month for the industry in a decade.

Ron Stiver, senior vice president of engagement and public affairs for Indiana University Health, which plans to cut 800 employees, says the assertion that health care reform is the reason behind hospital cuts is “overly simplified.” IU Health is making cuts partially because of the health law, he says, but also because the state has not expanded Medicaid, the hospital system has fewer inpatient volumes, and payment rates for its services have been declining.

Vanderbilt University Medical Center in Nashville, Tenn., plans to cut 1,000 positions, citing an aging population, lower reimbursement rates, a reduction in National Institutes of Health grant funding and a lack of Medicaid expansion in Tennessee.

In 2012 the Supreme Court ruled that state legislatures could opt out of increasing the number of people who are eligible for Medicaid, and North Carolina is one of 22 states that has done so, a decision that resulted in Vidant Pungo Hospital in Belhaven, N.C., closing down, according to hospital officials.

Democratic Congressman Charles Rangel from New York, the main sponsor of the health reform bill, says organizations have several other tools they could use to reduce costs, and that many businesses are blaming health reform for actions for which they don't want to take responsibility. “U.S. health costs have been the highest in the world, yet our quality measures were middling at best,” he says. “While there is no doubt that [health reform] has helped slow health care cost growth, which is beneficial to both national and household budgets, there is nothing in the law that tells hospitals to reduce staff. The fact is that patients are paying less, not more, as a result of the [health law].”

The Office of the Actuary for the Centers for Medicare & Medicaid Services predicted that decreases like these would occur, stating in a 2010 memo that by 2019 it expected hospitals, skilled nursing facilities and home health agencies would undergo a 15 percent reduction.

For a sector that employs more than 5.5 million people, according to the American Hospital Association, the numbers are likely to get worse. The pattern of layoffs and buyouts has already begun. SouthCoast Hospital Group in Florida cited federal health reform when it laid off 100 employees in mid-September. John Muir Health in California is offering staff voluntary buyouts. NorthShore University HealthSystem in Illinois will lay off 1 percent of its workforce, and Covenant Health in Texas laid off 49 employees.

The requirements that hospitals must meet in order to receive full Medicare reimbursements are having a large impact. Hospitals once were able to bill insurance companies and the federal government for services rendered, but now they have to demonstrate that those services help keep patients healthy.

The government is capping reimbursement rates for specific diagnoses and having hospitals pay to fix their own medical errors, including hospital-acquired infections. The plan is to lower inefficiencies, thereby lowering costs. “We want hospitals to do things more efficiently,” says Dr. Ross Koppel, professor of sociology and affiliate professor of medicine at the University of Pennsylvania. “We don't want to redo tests or subject people to hideous radiation because exam records have been lost, for example. There may be some inefficient practices that were money makers, but with a more efficient system hospitals can't get away with them.”

Hospitals with excessive numbers of readmissions for Medicare patients will face large penalties, and hospitals that serve the poor will be particularly vulnerable.

Still, hospitals are not responsible for a significant amount of the recidivism they see, according to research published in 2011 by the University of Toronto, which revealed that only a quarter of hospital readmissions were preventable.

“Hospitals have very little control over what patients do when they leave the hospital, so in that case there is an unfairness in penalizing hospitals,” Koppel says. “The hospitals may do a good job and tell patients what to do when they get home, but then the patient goes back to drinking, smoking and eating cupcakes all day.”

Sheil said hospitals will be getting paid less and still have to do more. “Nobody is immune to that, not even Cleveland Clinic,” she says.

The news appeared to be particularly devastating to a hospital system that President Barack Obama applauded only four years before for delivering exceptional care at costs well below the national norm. Still, Cleveland Clinic officials were attributing its most-recent cuts to a number of factors, and pointed out that it was continuously developing ways to be more efficient. “There are many factors, and any one isn't going to tip us over,” Sheil says.

“We're not blaming health care reform. We think it is very necessary,” she adds. “Something had to give because costs are going to continue to rise and it's unsustainable.”

I will acknowledge that in the US News & World Report article, an official from Indiana University Health does blame “health care reform” in part (he doesn’t identify either Obamacare or the Affordable Care Act by name…) but he also blames the State of Indiana for refusing to expand Medicaid, fewer inpatients, and declining payment rates. He says that blaming “health care reform” is “overly simplified”. But  not to Rep. Rokita who ignores everything else to blame Obamacare for the layoffs.

So, what do you think now about Rep. Rokita’s claim that “Hospital systems like Indiana University Health have cut employees and hours due to changes forced upon the system by ObamaCare.” Is that an example of the “insidious” nature of Obamacare … or an insidious exaggeration (or outright lie) by Rep. Rokita?

Next, let’s take a look at another one of Rep. Rokita’s claims.

UPS, one of Indiana’s biggest employers, cut insurance for 15,000 spouses.

Well, that one is actually true … kinda. But the omission of an enormously important detail is illustrative of the way Obamacare opponents like Rep. Rokita play “fast & loose” with the facts. So, yes. UPS is cutting insurance for approximately 15,000 spouses — but only spouses who work and are eligible for healthcare insurance from their own employer. It’s probably worth noting the likely source for Rep. Rokita’s half-truth. As Politifact noted in a fact check of the fake filibuster staged by Sen. Ted Cruz [R-Texas]:

Cruz said: “Just a few weeks ago, UPS sent a letter to some 15,000 employees saying, ‘We are dropping spousal health insurance because of Obamacare.’ That is 15,000 UPS employees who had insurance for their husbands and wives, and suddenly those husbands and wives are left without health insurance and being told, ‘Go on an exchange with no employer subsidy.’”

Politifact found Sen. Cruz’s claim to be false:

Cruz said that by dropping spousal health insurance for 15,000 employees, UPS left employees’ spouses “without health insurance” and told them to, “go on an exchange with no employer subsidy.”

But Cruz ignores that the only spouses being kicked off the UPS plan would be the ones who already had access to an employer-sponsored plan in their own job. This means they wouldn’t be “without health insurance” and wouldn’t have to find coverage on an Obamacare marketplace. We rate the claim False.

Rep. Rokita didn’t repeat Sen. Cruz’s false claim in its entirety, but he did omit a critical limiting element. So which is “insidious”? A plan to extend healthcare to millions of uninsured or a lie designed to frighten people into thinking that Obamacare was forcing people to become uninsured?

Rep. Rokita also describes the “countless letters and emails from constituents who’ve had their insurance premiums and deductibles jump” and then he proceeds to identify … two. I know that Rep. Rokita may not be a rocket scientist, but I would have presumed that “countless” would be a number higher than two.* In any event, I’m not going to attempt to fisk this sort of claim; I have no idea what letters and emails he has and hasn’t received; I have no idea if the stories he relays are accurate or if those relaying the stories have their facts straight in the first place; and I have no idea how many other constituents may have encountered completely different results.

Now, before I go any further, I will acknowledge that I’ve made no attempt to fisk Rep. Rokita’s claims concerning schools cutting jobs, insurance premiums going up or how Obamacare will impact the national debt. For one thing, these are very, very complicated issues (especially the debt); for another thing, there is data all of the map on these issues. For example, I’ll acknowledge that just today the State of Indiana and 17 (mostly rural?) schools have sued the IRS over applying the employer mandate to schools. Similarly, some premiums are certainly increasing, but its not clear if those increases are result of Obamacare or a continuation of the rise in premiums that we’ve seen for years (and, for that matter, has Obamacare slowed the increase in premiums?). Similarly, some projections show that Obamacare will add to the debt; yet others show that it will reduce the debt. For example, here is what Politifact said in a June 2012 examination of Mitt Romney’s claim that Obamacare would add trillions to the national debt:

[F]or claims about deficits, we consider the Congressional Budget Office, often called the CBO, to be the standard by which we fact-check claims.

The CBO said this about the health care law back in 2010: It lowers the deficit, by about $124 billion over 10 years.

And in 2011, when Republicans offered a bill to repeal the health care law, the CBO said that increased the deficit, by about $210 billion over 10 years.

In any event, what you need to remember is that Rep. Rokita used the issues of school layoffs, premium increases, and the debt as an explanation for why Obamacare is “insidious”. The issue isn’t whether Obamacare is a good law or a law that should be repealed, tweaked, or fully implemented. The issue raised by Rep. Rokita is whether Obamacare is “one of the most insidious laws known to man”.

Rep. Rokita claims (without citation) that Obamacare will $200 billion annually. Maybe yes, maybe no. I don’t have any idea. But you can’t simply divorce the cost of the program from what that money will be paying for. Obamacare gives states the option to expand their Medicaid rolls (thus offering healthcare to more of those who live in poverty) and the federal government will pay all of that cost for a few years before transferring ten percent of the cost to the states. Is that expensive? Absolutely. But the question is not just cost; the question is whether we the people think that spending that money for the purpose of providing healthcare to the poor is a good expenditure. Similarly, Obamacare will provide subsidies to assist families who are required to purchase insurance. Once again, that is also expensive. But once again, the question is not just the cost; we also have to look at the social benefit of having more people insured. Finally, Rep. Rokita’s discussion of the cost omits any discussion of savings or of increased job creation and the resulting tax revenue. If Obamacare is “insidious” because it is expensive, then I suppose that Social Security, Medicare, the CIA, and Pentagon are also “insidious” — at least by Rep. Rokita’s formulation.

These are all important issues to discuss. And they were discussed when the law was passed. They were discussed in town hall meetings across the country. They were litigated in the 2010 mid-term elections. And, most importantly, they were critical issues in the 2012 presidential elections. And you know what? President Obama ran on Obamacare and he won. By contrast, Mitt Romney ran on a platform that included the repeal of Obamacare and he lost. It’s also worth noting that while Republicans do have a majority in the House of Representatives, they did not win a majority of the votes cast for the House of Representatives. In fact, they lost by about 1,700,000 votes (about 1.9%), but because of gerrymandering Republicans have a majority in the House.

Anyway, Rep. Rokita wants us to think that these cost claims make the law “insidious”.

And that brings me to the last point from Rep. Rokita’s statement that I want to discuss. Remember that Rep. Rokita includes as a part of his definition of the word insidious: “Stealthily treacherous or deceitful” and calls the law “a series of lies”. With that in mind, recall these claims from Rep. Rokita’s statement (emphasis added):

ObamaCare is forcing millions of Americans on to government run health plans, and therefore putting the government in charge of our health care decisions.

Health care represents 1/5th of our national economy, to bring it under government control is to radically change how our private economy works[.]

Does Rep. Rokita really want to talk about being treacherous or deceitful or a “series of lies”? Really? Let’s turn again to Politifact and the winner of the award for 2010 “Lie of the Year”:

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

“Takeovers are like coups,” Luntz wrote in a 28-page memo. “They both lead to dictators and a loss of freedom.”

The line stuck. By the time the health care bill was headed toward passage in early 2010, Obama and congressional Democrats had sanded down their program, dropping the “public option” concept that was derided as too much government intrusion. The law passed in March, with new regulations, but no government-run plan.

But as Republicans smelled serious opportunity in the midterm elections, they didn’t let facts get in the way of a great punchline. And few in the press challenged their frequent assertion that under Obama, the government was going to take over the health care industry.

PolitiFact editors and reporters have chosen “government takeover of health care” as the 2010 Lie of the Year. Uttered by dozens of politicians and pundits, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats’ shellacking in the November elections.

Readers of PolitiFact, the St. Petersburg Times’ independent fact-checking website, also chose it as the year’s most significant falsehood by an overwhelming margin. (Their second-place choice was Rep. Michele Bachmann’s claim that Obama was going to spend $200 million a day on a trip to India, a falsity that still sprouts.)

By selecting “government takeover” as Lie of the Year, PolitiFact is not making a judgment on whether the health care law is good policy.

The phrase is simply not true.

Said Jonathan Oberlander, a professor of health policy at the University of North Carolina-Chapel Hill: “The label ‘government takeover’ has no basis in reality, but instead reflects a political dynamic where conservatives label any increase in government authority in health care as a ‘takeover.’”

An inaccurate claim

“Government takeover” conjures a European approach where the government owns the hospitals and the doctors are public employees. But the law Congress passed, parts of which have already gone into effect, relies largely on the free market:

Employers will continue to provide health insurance to the majority of Americans through private insurance companies.

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

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

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

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

PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. We have concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers.

It’s true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.

Republicans who maintain the Democratic plan is a government takeover say that characterization is justified because the plan increases federal regulation and will require Americans to buy health insurance.

But while those provisions are real, the majority of Americans will continue to get coverage from private insurers. And it will bring new business for the insurance industry: People who don’t currently have coverage will get it, for the most part, from private insurance companies.

Consider some analogies about strict government regulation. The Federal Aviation Administration imposes detailed rules on airlines. State laws require drivers to have car insurance. Regulators tell electric utilities what they can charge. Yet that heavy regulation is not described as a government takeover.

This year, PolitiFact analyzed five claims of a “government takeover of health care.” Three were rated Pants on Fire, two were rated False.

‘Can’t do it in four words’

Other news organizations have also said the claim is false.

Slate said “the proposed health care reform does not take over the system in any sense.” In a New York Times economics blog, Princeton University professor Uwe Reinhardt, an expert in health care economics, said, “Yes, there would be a substantial government-mandated reorganization of this relatively small corner of the private health insurance market (that serves people who have been buying individual policies). But that hardly constitutes a government takeover of American health care.”

FactCheck.org, an independent fact-checking group run by the University of Pennsylvania, has debunked it several times, calling it one of the “whoppers” about health care and saying the reform plan is neither “government-run” nor a “government takeover.”

We asked incoming House Speaker John Boehner's office why Republican leaders repeat the phrase when it has repeatedly been shown to be incorrect. Michael Steel, Boehner’s spokesman, replied, “We believe that the job-killing ObamaCare law will result in a government takeover of health care. That’s why we have pledged to repeal it, and replace it with common-sense reforms that actually lower costs.”

Analysts say health care reform is such a complicated topic that it often cannot be summarized in snappy talking points.

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

Mahar said the GOP simplification distorted the truth about the plan. “Doctors will not be working for the government. Hospitals will not be owned by the government,” she said. “That's what a government takeover of health care would mean, and that's not at all what we"re doing.”

How the line was used

If you followed the health care debate or the midterm election — even casually — it’s likely you heard “government takeover” many times.

PolitiFact sought to count how often the phrase was used in 2010 but found an accurate tally was unfeasible because it had been repeated so frequently in so many places. It was used hundreds of times during the debate over the bill and then revived during the fall campaign. A few numbers:

• The phrase appears more than 90 times on Boehner’s website, GOPLeader.gov.

• It was mentioned eight times in the 48-page Republican campaign platform “A Pledge to America” as part of their plan to “repeal and replace the government takeover of health care.”

• The Republican National Committee’s website mentions a government takeover of health care more than 200 times.

Conservative groups and tea party organizations joined the chorus. It was used by FreedomWorks, the Heritage Foundation and the Cato Institute.

The phrase proliferated in the media even after Democrats dropped the public option. In 2010 alone, “government takeover” was mentioned 28 times in the Washington Post, 77 times in Politico and 79 times on CNN. A review of TV transcripts showed “government takeover” was primarily used as a catchy sound bite, not for discussions of policy details.

In most transcripts we examined, Republican leaders used the phrase without being challenged by interviewers. For example, during Boehner’s Jan. 31 appearance on Meet the Press, Boehner said it five times. But not once was he challenged about it.

In rare cases when the point was questioned, the GOP leader would recite various regulations found in the bill and insist that they constituted a takeover. But such followups were rare.

An effective phrase

Politicians and officials in the health care industry have been warning about a “government takeover” for decades.

The phrase became widely used in the early 1990s when President Bill Clinton was trying to pass health care legislation.  Then, as today, Democrats tried to debunk the popular Republican refrain.
When Obama proposed his health plan in the spring of 2009, Luntz, a Republican strategist famous for his research on effective phrases, met with focus groups to determine which messages would work best for the Republicans. He did not respond to calls and e-mails from PolitiFact asking him to discuss the phrase.

The 28-page memo he wrote after those sessions, “The Language of Healthcare 2009,” provides a rare glimpse into the art of finding words and phrases that strike a responsive chord with voters.
The memo begins with “The 10 Rules for Stopping the ‘Washington Takeover’ of Healthcare.” Rule No. 4 says people “are deathly afraid that a government takeover will lower their quality of care — so they are extremely receptive to the anti-Washington approach. It’s not an economic issue. It’s a bureaucratic issue.”

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

“The arguments against the Democrats' healthcare plan must center around politicians, bureaucrats and Washington … not the free market, tax incentives or competition.”

Democrats tried to combat the barrage of charges about a government takeover. The White House and House Speaker Nancy Pelosi repeatedly put out statements, but they were drowned out by a disciplined GOP that used the phrase over and over.

Democrats could never agree on their own phrases and were all over the map in their responses, said Howard Dean, former head of the Democratic National Committee.

“It was uncoordinated. Everyone had their own idea,” Dean said in an interview with PolitiFact.
”The Democrats are atrocious at messaging,” he said. “They've gotten worse since I left, not better. It’s just appalling. First of all, you don’t play defense when you’re doing messaging, you play offense. The Republicans have learned this well.”

Dean grudgingly admires the Republican wordsmith. “Frank Luntz has it right, he just works for the wrong side. You give very simple catch phrases that encapsulate the philosophy of the bill.”

A responsive chord

By March of this year, when Obama signed the bill into law, 53 percent of respondents in a Bloomberg poll said they agreed that “the current proposal to overhaul health care amounts to a government takeover.”

Exit polls showed the economy was the top issue for voters in the November election, but analysts said the drumbeat about the “government takeover” during the campaign helped cement the advantage for the Republicans.

Rep. Earl Blumenauer, an Oregon Democrat whose provision for Medicare end-of-life care was distorted into the charge of “death panels” (last year's Lie of the Year), said the Republicans’ success with the phrase was a matter of repetition.

“There was a uniformity of Republican messaging that was disconnected from facts,” Blumenauer said. “The sheer discipline … was breathtaking.”

So did you get all that? More importantly, do you see what Rep. Rokita has done? In order to defend his use of the word “insidious” — a word that he defines as meaning “stealthily treacherous or deceitful” — and to support his claim that Obamacare is “built around a series of lies” — he repeats a 3-year-old lie. And not just any lie. Nope. That wouldn’t be good enough. He repeats the lie of the year in order to prove that something else is built on a lie.

Still want to talk about things that are insidious?

And it probably goes without saying, but Rep. Rokita focuses only on the cost and perceived downsides of Obamacare to argue that it is insidious. Did you see anything in his statement recognizing that it prohibits insurance companies to deny coverage for pre-existing conditions, prohibits lifetime caps on coverage, prohibits cancellation of coverage when a person becomes ill, permits children to stay on their parent’s plan until 26, requires insurers to give rebates if they overcharge or don’t expend earned premiums to treat those they insure, requires certain preventive care to be included in plans without the payment of an associated deductible, and many other benefits? You see, Rep. Rokita can’t possibly argue that any of those aspects of Obamacare are insidious, especially because he knows that people like those parts of the law (even those who claim to “hate” Obamacare seem to like the things that the law actually does) and because he knows that despite the Republicans’ grandstanding votes to repeal Obamacare 40 or more times, the Republicans have not offered a real plan to replace Obamacare and provide these patient and consumer protections. Rep. Rokita may claim that the law is insidious, but he can only do so by ignoring all of the good that it is intended to do.

One final point. Yes, many Democrats would like a “single payer” system of healthcare. But single payer doesn’t, as Rep. Rokita suggests, mean that “only the government pays for health care”; rather it means that the government pays for healthcare but that doesn’t prohibit individuals from paying additional premiums for supplemental care. In other words, a “single payer” system is essentially the same as Medicare, but for everyone instead of just the elderly. But to Rep. Rokita, adopting an intermediate, market-run plan while still hoping to eventually adopt a more far-reaching plan is insidious.

No, Rep. Rokita. The Fugitive Slave Act was insidious. The Nuremberg Laws were insidious. Jim Crow, Apartheid, and similar laws were insidious. But Obamacare, while it may be controversial and may be expensive, is not insidious. On the other hand, the use of half-truths and blatant lies (including a previous “lie of the year”) to support your argument … now that is insidious.

Rep. Rokita: Your words have brought shame upon yourself and upon the state and constituents you represent.


*Of course I could be wrong here. After all, then-Secretary of State Rokita testified to a Federal Court that he was unaware of any incidents of in person voter fraud in Indiana but then later testified to Congress that in person voter fraud “does exist” and that it’s “happening in Indiana”. So maybe he does have difficulty counting to numbers higher than zero.

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1 Comments:

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