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Truth vs. Hypocrisy and Spin in the Health Care Debate

In the vortex of partisanship and spin, at the onset of an Astroturf uprising and an AFL-CIO counterattack it is in everyone’s best interest to sort through the hype vs. the facts as it relates to the ongoing debate about health care reform.

 

Presented below, courtesy of Health Care for America Now is an analysis of the rhetoric vs. actual cites from the Health Care Reform Bill:

 

Here are the facts. Anyone can verify them by reading the bill at http://www.opencongress.org/bill/111-h3200/text

Actual itemized contents of the Health Care Reform Bill:

"Page 22: Mandates audits of all employers that self-insure!"

TRUTH: This is not an "audit," it's a study. Moreover, the bill states (pp. 22-23) that the report will "include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers." This is almost directly the opposite of the email's claim.

"Page 29: Admission: your health care will be rationed!"

TRUTH: Page 29 continues to define the "essential benefits package" and discusses limits on what Americans will have to spend on health care under this minimum standard. In no way does this section stipulate the rationing of care.

"Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)" 

TRUTH: Page 30 begins to describe the Health Benefits Advisory Committee which establishes certain minimum standards for health insurance plans. In no way does this committee deny treatments and benefits to Americans with health insurance.

"Page 42: The 'Health Choices Commissioner' will decide health benefits for you. You will have no choice. None." 

TRUTH: Page 42 begins to describe the Health Choices Commissioner's duties. The idea that this person will decide what benefits Americans receive is patently false, given that most Americans will keep their current plans under reform, and Americans within the exchange will have the choice of purchasing many different kinds of health plans. Rather, the Commissioner will establish minimum standards to protect Americans.

"Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services."

TRUTH: Pages 50-51 contain a provision stating that discrimination will not be allowed in the provision of health care services. Nowhere does the bill state that non-US citizens will be provided free health care services. The bill prohibits federal dollars from being used for undocumented immigrants.

"Page 58: Every person will be issued a National ID Healthcard." 

TRUTH: Page 58, in the context of a discussion of administrative standards, mentions that "determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility...may include utilization of a machine-readable health plan beneficiary identification card." In no way does the bill state that such a card would be national, or that it would be issued to every person, or that it would, in fact, be used at all.

"Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer." 

TRUTH: Page 59 continues the discussion of administrative standards, and authorizes electronic transfers of money within the government. In no way does this provision grant the government access to individual bank accounts.

"Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)" 

TRUTH: Here's what page 65 says: "Not later than 90 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall establish a temporary reinsurance program to provide reimbursement to assist participating employment-based plans with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses and dependents of such retirees." No mention is made of unions or community organizations.

"Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange." 

TRUTH: That's true! Plans have to have a minimum standard of benefits, bat can offer other plans as well. But that's fair, isn't it? Private insurers can continue to operate outside the exchange if they wish - should the government establish no standards for the exchange? In that case, how could reform end insurance industry abuses and help to control costs?

"Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)" 

TRUTH: This section says is that if private health care plans want to operate in the Exchange, they must provide a basic benefit package. 

"Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens"

TRUTH: Some American citizens are more comfortable speaking a language other than English, especially in a sensitive situation like a consultation with their doctor. This provision in no way opens the door for coverage of undocumented workers.

"Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan." 

TRUTH: Page 95 makes no mention of ACORN and Americorps; all it says is that the Commissioner can conduct outreach to vulnerable populations, making them aware of their options.

"Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter."

TRUTH: People who are eligible for Medicaid will not have to face the burdens of paperwork and other bureaucratic struggles. Far from depriving people of choice, this measure will ensure coverage.

"Page 124: No company can sue the government for price-fixing. No 'judicial review' is permitted against the government monopoly. Put simply, private insurers will be crushed."

TRUTH: This section describes rate-setting under the public health insurance plan option, which will compete with private insurers, who can set their own rates. Because of inherent advantages like their established administrative and provider frameworks, private insurance companies will not be "crushed" by government competition.

"Page 127: The AMA sold doctors out: the government will set wages." 

TRUTH: The government will negotiate rates with providers under the public health insurance plan option. However, private insurers will continue to pay their own rates.

"Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives."

TRUTH: This is simply not true. Employers with more than 20 employees aren't even eligible to participate in the exchange, let alone the public plan, until several years after the exchange launches in 2013. Moreover, no employer will be forced to participate in the public plan.

"Page 146: Employers MUST pay healthcare bills for part-time employees AND their families."

TRUTH: Employers are required to pay some benefits for part-time employees on a basis proportional to what they pay for full-time employees. No language on this page or the next stipulates coverage for the families of part-time employees.

"Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll"

TRUTH: The payroll penalty applies to employers with payroll over $500,000 who do not provide insurance to their employees. The percentage for employers with payroll from $500,000 - $750,000 is 6%. Employers do not have to offer the public option to avoid this penalty, they can offer private insurance if they wish.

"Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll"

TRUTH: This is false, see above.

"Page 167: Any individual who doesn't' have acceptable healthcare (according to the government) will be taxed 2.5% of income."

TRUTH: Pages 167-173 detail what "acceptable health care" means (basically, insurance coverage) and also allow for many different kinds of exceptions to this rule.

"Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them)." 

TRUTH: Non-resident aliens do not have to pay the penalty for not having health insurance, nor will the receive federal assistance, because they are not required to purchase health insurance. They are not exempted from individual taxes generally.

"Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records."

TRUTH: This is a gross overstatement. For the purposes of determining affordability credits for Americans who need financial assistance in purchasing health insurance, employees of the Health Choices Administration will have access to tax information that the federal government already keeps. As is clearly stated on page 196, "Return information... may be used by officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, only for the purposes of, and to the extent necessary in, establishing and verifying the appropriate amount of any affordability credit described in subtitle C of title II of the America's Affordable Health Choices Act of 2009 and providing for the repayment of any such credit which was in excess of such appropriate amount.''

"Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that."

TRUTH: This quote is taken out of context, and is in fact referring to a calculation used in the bill. Full context of quote: "'(4) NOT TREATED AS TAX IMPOSED BY THIS CHAPTER FOR CERTAIN PURPOSES.-The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.''

"Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected." 

TRUTH: This section has nothing whatsoever to do with reducing services.  It makes much needed changes to the way in which physician reimbursement is recalculated every year.  The bill will, in fact, create much more opportunity for seniors and the poor to receive necessary care.

"Page 241: Doctors: no matter what specialty you have, you'll all be paid the same (thanks, AMA!)" 

TRUTH:  Page 241 does not say this.  Nowhere does it say this.  It does say that physicians will be grouped into certain categories regardless of specialty.  These categories merely determine if the physician is engaged in primarily therapeutic or preventative care.

"Page 253: Government sets value of doctors' time, their professional judgment, etc."

TRUTH: There is no good response to this assertion as it appears to have been made up completely. The section deals with 'misvalued codes' meaning that the government is potentially not paying an acceptable rate for a specific service.  This will allow the government to, for example, pay more for services that require more payment, such as high-overhead procedures.  The author of these criticisms  separately attacks the bill for paying the same rate to all doctors, then attacks again for paying different rates.

"Page 265: Government mandates and controls productivity for private healthcare industries." 

TRUTH: This section amends the Social Security Act to include productivity measures.  There is no mandate or control of anything.  This merely updates the way in which doctors and hospitals are paid through Medicare.

"Page 268: Government regulates rental and purchase of power-driven wheelchairs." 

TRUTH: This is simply not true.  This slightly amends existing guidelines for payments for medical equipment, in this case power-driven wheelchairs.  This section introduces no 'regulations' that are not in the Social Security Act.

"Page 272: Cancer patients: welcome to the wonderful world of rationing!"

TRUTH: Overusage of the hot-button word "rationing" is a way to deflect attention away from the actual language of the bill and incite unjustified fear.  This section only compares costs incurred by cancer hospitals to costs incurred by similar hospitals, and adjusts payments to reduce the possibility of fraud and abuse.

"Page 280: Hospitals will be penalized for what the government deems preventable re-admissions." 

TRUTH:  This is almost correct.  The section is one of the first efforts at targeting excessive readmissions.  Excessive readmissions are physically and emotionally damaging to patients, while simultaneously putting them, and the health care system, in far more financial risk than is necessary.  The American Hospital Association recommended reduced payments for avoidable readmission in testimony to Congress.


"Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government." 

TRUTH: This is patently false.  The section is about possible methods that the Secretary of Health and Human services might consider in order to address the growing problem of patient readmission.  This section does not, in any way, create a penalty, nor does it even mandate policy.  It merely provides examples of recourses that might be considered.

"Page 317: Doctors: you are now prohibited from owning and investing in healthcare companies!"

TRUTH: This provision only limits Doctor's investments in health care facilities that they refer patients to  The effort to limit self-referral has been ongoing for many years as an effort to reduce fraud and abuse.  This is, essentially, the medical community equivalent of insider trading.  Limiting this incentive works to put the patient's health above all other considerations.  Doctors remain free to engage in investment opportunities in areas that don't create a significant conflict of interest.

"Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval."

TRUTH: This section regulates physicians' investment in hospitals to make sure that physicians are not unfairly benefiting from their power to refer patients to hospitals they have a stake in. The section does not prohibit hospital expansion.

"Page 321: Hospital expansion hinges on 'community' input: in other words, yet another payoff for ACORN."

TRUTH: In the ongoing effort to demonize community-based groups such as ACORN, every instance of the word "community" has become associated with that group's efforts.  In reality, this provision allows for anyone to provide input.  This includes homeowners, religious leaders, neighborhood groups, and others.  There are no payoffs.  There is no money exchanged in any way.

"Page 335: Government mandates establishment of outcome-based measures: i.e., rationing." 

TRUTH: This provision is included in order to allow the government to base payments on practices that work.  Nowhere does it say health care will be rationed.  The attempt to isolate what works and what does not work in Medicare Advantage plans only benefits the health care system in general.

"Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc."

TRUTH: The government can disqualify some Medicare Advantage Plans from receiving some additional payments, but only if those plans are not meeting necessary requirements.

"Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals." 

TRUTH: This section only deals with how to handle special needs individuals who need to enroll outside of the open enrollment period.  Almost every type of plan operates with open enrollment periods.  This section does not create more restrictions.

"Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone)."

TRUTH:  This section merely expands existing Telehealth programs, which supplement but do not replace other health coverage, and provide a vital resource to Americans in rural and remote areas.

"Page 425-430: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?; Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time; Government provides approved list of end-of-life resources, guiding you in death; Government mandates program that orders end-of-life treatment; government dictates how your life ends; Advance Care Planning Consult will be used to dictate treatment as patient's health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT; Government will decide what level of treatments you may have at end-of-life." 

TRUTH: All of these hysterical claims have been debunked elsewhere. HR3200 provides for the reimbursement of a voluntary session of end-of-life counseling with your physician once every five years. This in no way means the government will make decisions for patients or encourage doctor-assisted suicide. Counseling simply makes patients and their families aware of their options.

"Page 469: Community-based Home Medical Services: more payoffs for ACORN." 

TRUTH: ACORN is not a Community-Based Medical Home.

"Page 472: Payments to Community-based organizations: more payoffs for ACORN."

TRUTH: This is clearly still referring to community health groups, not ACORN. 

"Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage."

TRUTH: Covering marriage and family therapy, as many private insurance plans do, does not mean that the government "intervenes in your marriage." The types of individuals who are recognized as therapists are clearly defined on page 491; in brief, professionals only, not bureaucrats.

"Page 494: Government will cover mental health services: defining, creating and rationing those services."

TRUTH: This section expands government coverage for mental health services under various government programs, and ensures that all mental health services will be offered by qualified professionals.

 

 

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A 21st Century Ghost Dance: Rush Limbaugh, The Radical Right and the Politics of Obstruction

In the closing days of the 1880s, beset by far reaching societal change, the Indians of the American West embraced a messianic practice called the Ghost Dance. The Ghost Dance religion, put forth by a Paiute medicine man named Wovoka, foretold of the destruction of the existing world and its replacement with the old order where only the Indians would occupy the landscape. The buffalo would return in great numbers and those Indian warriors who had died fighting the white man would be resurrected. This new world order would be hastened by the performance of the Ghost Dance ritual and the wearing of shirts blessed to repel the bullets of the American Army.

Listening to the rhetoric flowing out of CPAC 2009 one could conclude that the Conservative Movement has embraced its own version of a 21st Century Ghost Dance, led by its own modern day Wovoka in the person of Rush Limbaugh. It is as if by reiterating ideology, invoking the memory of Reagan and maligning the Obama recovery effort as “socialist”, that Conservatives will somehow forestall imminent political change. In an attempt to heighten alarm Limbaugh lays claim to the idea that life, liberty and freedom are under assault. He states that Barack Obama will eliminate capitalism and individual liberty as the cornerstone of American life. Limbaugh makes such a claim in spite of the historical fact that the government has been intimately involved in economic affairs since 1819 with no appreciable loss of personal liberty to date. Nonetheless Limbaugh has put the failure of the Obama recovery program at the top of his personal political agenda because he thinks that such failure will bring about a return to a glorious (imagined) past. Limbaugh defiantly rejects the 2008 election as proof positive that Americans want a change in direction because the electoral results don’t square with his vision of America. All this from a man who, somewhere on the spectrum between ideological purist and buffoon, doesn’t know the Declaration of Independence from the Constitution when it comes to a quote regarding life, liberty and the pursuit of happiness. Somehow talk of “true patriotism” rings hollow coming from a man who had more draft deferments during the Vietnam War than some soldiers had combat action medals. As CPAC continued, Mike Huckabee claimed, “Lenin and Stalin would love the Obama program” leading one to believe that the former presidential candidate knows less about history than does Sarah Palin. Anyone who thinks that the Obama recovery plans bear any resemblance to Soviet economic polices of the last century is either irresponsibly playing with words for the sake of incitement or just lacks the background required to engage in intelligent political discourse.

Beyond Limbaugh and CPAC the hysteria over the “slide into socialism” continues unabated in conservative media. Harry R Jackson, Jr. intones that: “a war for the soul of the nation” is raging. Pat Buchanan declared the Obama budget a “declaration of war on the Right.” The latest piece from Dick Morris is entitled “Waging War on Prosperity.” Limbaugh’s own brother David has gone so far as to say that media attacks leveled at Rush are really aimed at those who support him, the “true patriots” that oppose Obama’s “Marxist agenda and Stalinist tactics.” Newsmax suggests some on the Right may consider armed violent resistance to the Obama Administration, which to me represents a new high watermark in rightwing hysteria surpassing the previous one left behind by the Terri Schiavo case. The “patriot game” was of little use to Republicans in the last election cycle and except for the low- information voter should prove equally useless this time around.

Progressive political thinkers might ask themselves what intellectual ammunition would be of use in countering this 21st Century Ghost Dance. My suggestion is to start with facts. Socialism is defined as the “collective or government ownership and administration of the means of production and distribution of goods.” That definition encompasses the entirety of economic activity. While the present breakdown in the economy has necessitated a large degree of government involvement in economic affairs, nowhere is there any evidence that Barack Obama is advocating government oversight of economic activity beyond those sectors where the free market has failed. Ironically, it was House Republicans that advocated a partial socialization of banking in the financial bailout of 2008. How hypocritical to oppose the very ideas they once promoted. Having dispensed with the allegation that the Obama Administration aims to affect a wholesale socialization of the economy we can skip past the Stalinist / Leninist rhetoric altogether.

Conservative media is obsessed with the idea that Barack Obama wants to punish success and has declared a war on prosperity. For all of the Conservative rhetoric regarding government policy and the economy, it is an established fact that in the post World War II period the economy has generally done better under Democrats than Republicans. Democratic administrations have outperformed their Republican counterparts across the board on average in terms of annualized job creation, GDP and GDP per capita growth rates. Despite all of the talk of taxing the wealthy and its effect on the economy, under Democratic administrations the wealthiest have done almost as well as they have under Republicans. It is noteworthy that Barack Obama won the majority of those earning over $200,000.00 in spite of the fact that Republicans constantly warned voters of the prospect of higher taxes. While Conservatives bend over backwards in arguing for lower tax rates for the rich and businesses, they remain silent on the subject of tax fairness. In 1980 the amount of national wealth received by the top one percent of wage earners was eight percent of the total wealth created in the United States whereas in 2008 it was twenty six percent. Changes in tax laws since the Reagan era have led to the shifting of the national tax burden from wealth to labor resulting in the largest redistribution of wealth upwards since the 1920s. Likewise, the past eight years have seen the percentage of national wealth that accrues to the working American fall to the lowest percentage on record. Median family income, based on Census Bureau findings, actually declined between 2000 and 2007 when adjusted for inflation while at the same time productivity, profits and executive compensation registered strong gains. That said, what are the real arguments to be made for maintaining the status quo with regard to tax policy and the distribution of income as it relates to the economic well being of the people who actually go to work every day and create the goods and services of a modern economy? Somehow, Conservative thinking as it relates to tax policy and prosperity has either missed or ignored eighty percent of the population while obsessing on the well being of the business community and entrepreneurs. Owing to the fact that the “prosperity” of the past eight years was largely fueled by financial engineering, debt accumulation and the housing bubble rather than income growth, where in this time period can we find evidence of the validity of a conservative economic theory which promotes growth through lower taxes?

In their nostalgia for the Reagan era, Conservatives have adhered to an image of the man based on his rhetoric as opposed to his actual record in office. The federal government actually grew under Reagan as he added a new cabinet level department and various other executive level bureaus. While he argued the virtues of limited spending he embarked on a massive military buildup, much of it in excess of what the threat level of that time required. Large-scale military buildups are public spending just the way bridge and highway projects are, it’s only the products that differ. Both ultimately aid overall economic activity. In spite of supposed strength of conservative economic theories, the recession of 1981-1983 was the worst downturn since the Great Depression, until today, with unemployment topping ten percent. While Reagan talked tough with the Soviets he reached out to them and successfully concluded an arms treaty. He was far more bipartisan than are the Republicans of today. He was largely silent on the issue of abortion.

While those in the pro-Obama mainstream media, along with Rahm Emanuel and his Democratic allies, will continue to publicly bait Limbaugh for their own obvious benefit, there is a growing chorus of concern among Republicans inside and outside of government as to how to defuse the extremists on the far right. Former Republican Congressmen Tom DeLay and Vin Weber have been quick to point out that Limbaugh is not the head of the GOP nor is he its spokesman. Former Republican Congressman and talk show host Joe Scarborough has pointed to a need for the GOP to formulate a constructive strategy for the future and to ignore Limbaugh altogether. Former RNCC Chairman Tom Cole of Oklahoma summed up the GOP’s current predicament with the following observation: “The politics of the country are changing profoundly and rapidly, much as they did in 1932 and 1980.” While Rush Limbaugh intones that Conservative principles are essentially unalterable and forever, moderate Republican observers will argue that those principals need to be modernized or else Republicans are looking at a future with their party in permanent minority status.

Limbaugh and his CPAC acolytes argue that “Americans are conservative by instinct”, but empirically it is hard to make such an argument. A November 2008 poll by Pew Research would show that only 38 percent of Americans identify as conservatives. More importantly the most recent NYT/CBS tracking poll of political identification shows only 28 percent of Americans consider themselves Republican. On a county-by-county basis the 2008 presidential election reveals a significant shift towards the Democratic Party, even in many of the states that went for McCain. With the exception of an arc running roughly from Oklahoma through Arkansas, Tennessee and into Appalachia, most of the rest of the country shows an overall rise in the numbers of people who voted Democrat. Current opinion polls also show that in the face of stubborn opposition from the Right, Obama’s overall approval ratings remain high. With a 60 percent favorable rating overall, the President does even better when polling becomes more specific. On topics like withdrawing from Iraq or whether the economic crisis is his fault or inherited, his ratings exceed 80 percent, whereas for Republicans 56 percent of respondents say they are playing politics rather than standing on principles. In terms of the direction the country, 41 percent say it is on the right track, up from 12 percent who felt that way in October of 2008. Currently, Congressional Republicans have an approval rating below that of their Democrat counterparts. Meanwhile among those below the age of 40, Mr. Limbaugh receives a paltry 11 percent approval rating. His audience and his appeal among independent voters is essentially nonexistent.

While this modern day Conservative Ghost Dance wends its way across the political landscape, its ultimate destination remains a mystery. Given the current political climate it does not seem that Rush Limbaugh, his acolytes and his defacto, if not unwilling, Republican allies will return to majority status or the seat of power anytime soon. While Conservatives are venerating an imagined past, the number of people identifying with the Republican Party or willing to vote for its program is shrinking. The GOP is seen more and more as the party of the South and one that is only gaining adherents among the less educated living in the most rural regions of the country. While the core beliefs and principles of the Right seem out of date or inapplicable in this current climate of worldwide economic crisis, there has to be more to the movement than the politics of obstruction. Absent a new message and a program that attracts independents, the only hope that Conservatives and Republicans have is to bank on Democratic failure, which is neither creative nor compelling in the eyes of the voters. Beyond this paucity of new ideas the more immediate concern is that Limbaugh, the Radical Right and the politics of obstruction will derail the GOP’s electoral chances altogether in the next election cycle. After all 2010 will be here before we know it.



Steven J. Gulitti
New York City
March 5, 2009
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