Mad Over Myths
August 18th, 2009 . by economistmomAnother psychology lesson for health care reform:
When people get really worked up over far-fetched ideas, often the worst thing one can do is to point out that what they’re upset or angry about isn’t real. It just pisses them off more…
In the health care reform debate, myths abound:
Nearly half of Americans believe that a proposed overhaul of the health care system means the government will decide when to stop providing medical treatment to senior citizens, according to the latest polling by NBC News released this evening.
Some 45% said they believe the plan is likely to include such a provision that has become known as “death panels” despite bipartisan efforts by President Barack Obama and the provision’s author, Republican Georgia Sen. Johnny Isakson to dispel the idea. (Isakson, in a recent interview with the Washington Post called the confusion “nuts.”)…
The AARP tries to “intervene”:
There are special interest groups trying to block progress on health care reform by using myths and scare tactics. Like the notion that health care reform would ration your care, hurt Medicare or be a government takeover. Actually, these are false statements.
All of the health care reform plans currently being debated in Congress would ensure that you and your doctor are the ones making decisions about your health. The majority of working Americans will continue to receive their health care through their employer. In addition, health care reform will strengthen Medicare by eliminating billions of dollars in waste while lowering prescription drug prices.
Throughout the debate on how to fix what’s broken about our health care system, AARP pledges to help you cut through the noise and find the facts about what health care reform means for you and your family. When we see special interests using scare tactics, we’ll make sure you’re given the facts so you can make informed decisions about health care reform…
And this is the thanks they get:
(CBS) CBS News has learned that up to 60,000 people have cancelled their AARP memberships since July 1, angered over the group’s position on health care.
Elaine Guardiani has been with AARP for 14 years, and said, “I’m extremely disappointed in AARP.”
Retired nurse Dale Anderson has 12 years with AARP and said, “I don’t wanna be connected with AARP.”
Many are switching to the American Seniors Association, a group that calls itself the conservative alternative…
Obviously, honesty isn’t always the best policy if you care about making money. The myths make for “mad members,” and while you might try to take the membership out of the madness, you often can’t take the mad out of (much of) the membership.
Nearly half of Americans believe that a proposed overhaul of the health care system means the government will decide when to stop providing medical treatment to senior citizens, according to the latest polling by NBC News released this evening.
Some 45% said they believe the plan is likely to include such a provision that has become known as “death panels” despite bipartisan efforts by President Barack Obama and the provision’s author, Republican Georgia Sen. Johnny Isakson to dispel the idea. (Isakson, in a recent interview with the Washington Post called the confusion “nuts.”)…
I agree that the whole “death panels” thing is a myth. However, there was an interesting editorial in the New York Times recently titled “Health Care’s Generation Gap”. Following are the first couple of paragraphs:
IN the 1980s, I worked as a respiratory therapist in intensive-care units in the Midwest, taking care of elderly, dying patients on ventilators. I remember marveling, along with the young doctors and nurses I worked with, over how many millions of dollars were spent performing insanely expensive procedures, scans and tests on patients who would never regain consciousness or leave the hospital.
When the insurance ran out, or Medicare stopped paying, patients and their families gave the hospital liens on their homes to pay for this care. Families spent their entire savings so Grandma could make yet another trip to the surgical suite on the slim-to-none chance that bypass surgery, a thoracotomy, an endoscopy or kidney dialysis might get her off the ventilator and out of the hospital in time for her 88th birthday.
Hence, there are already times when insurance and, according to the author, Medicare stop paying. In any event, the editorial brings up one of the very difficult topics that we face in health care. To a medical professional, it may be clear when a such cases are pretty much hopeless and that expensive medical procedures are unwise. However, it’s likely often not clear to the patient’s family. If we are going to really reform health care and hold costs down, it would seem that we need to be able to openly analyze and discuss these very difficult issues. Of course, there will not be “death panels” that arbitrarily stop all treatment. But we need to look at possible ways in which these difficult situations can be addressed.
Maybe people are smarter than you think and they know that “death panels” =bureaucratic panels that will decide where the limited resources allocated to health care will be most effectively spent - effectively spent for society not the individual.
It commonly acknowledged that older people are worth less than younger people in insurance settlements / lawsuits in cases of accidental death.
In a very simple example if you were going to spend x dollars and you can keep 10 year olds or 70 year olds healthy which would give you a greater return over the individuals lifetime?
Although I agree that cost-benefit analysis has a crucial role to play in any government-funded program, including Medicare, this post is just plain wrong.
The AARP says “The majority of working Americans will continue to receive their health care through their employer.” This is a claim, not a fact. Megan McArdle has explained why people don’t believe it at http://meganmcardle.theatlantic.com/archives/2009/08/slapping_the_camels_nose.php
In brief, proponents intend to work tireless toward a single-payer system, just as abortion opponents will work toward a complete ban on abortions. In both cases it’s foolish to look at only any single proposal without considering its effect in advancing toward the ultimate objective.
If you are complaining that people are fighting against the ultimate objective and that they should accept this baby step at face value, you are the one who is out of touch with reality. Incrementalism is basic politics, for both advocates and opponents on any issue. We’ve all seen this movie several times, so nobody’s fooling anyone.
Diane,
Re:
Obviously, honesty isn’t always the best policy if you care about making money. The myths make for “mad members,” and while you might try to take the membership out of the madness, you often can’t take the mad out of (much of) the membership.
Are you calling AARP’s spin in that video “honesty” and concurring with their labeling of “myths”? I sure wouldn’t. Yes, there are myths, misconceptions and wild exaggerations among people and arguments opposing healthcare “reform”, but there are some legitimate concerns along the general lines of those expressed by opponents, and there is also obvious, misleading spin by advocates — including in that video, as well as by the Obama Administration and others.
One would take away from that video that through healthcare “reform” everyone will get more for much less, that (1) no Medicare beneficiary has to worry that “reform” will ever adversely affect his/her quality or access to healthcare — indeed he/she can rest assured he/she will get improved quality and access — AND (2) that we will very substantially lower federal spending on healthcare through “reform”, AND, although not stated in the video, everyone knows that this “reform” is also intended to (3) provide federal health coverage for another 47 million people. And all of the above in the context of an already unsustainable projected fiscal imbalance, driven largely by Medicare spending growth and made significantly worse by this “reform”, that will eventually necessitate substantial reductions in spending per Medicare beneficiary and/or reduced eligibility for Medicare.
Wouldn’t you say that the idea that “reform” will do all of the above (as the AARP video and Obama imply) is a “myth”?
Are you saying that it is “far-fetched” to think “reform” will mean, directly or indirectly, sooner or later, some reduction in quality/access of care provided (funded) through Medicare that would not occur under current policies? For “reform” to really “bend the curve” of federal healthcare spending significantly downward (and do so despite expanding coverage to 47 million more people), reductions in healthcare quality/access for Medicare beneficiaries could (and likely will) include reductions in coverage, increased denial of authorization for some tests and treatments, reduction in medical innovation, reduction in supply and quality of providers, etc., plus a narrowing of Medicare eligibility (raising retirement age and means-testing).
Alternatively, “reform” will mean much higher federal spending on healthcare, not much less as claimed/implied by the video and the Obama Administration.
So who is throwing out more/bigger myths and fewer legitimate arguments/concerns — The AARP in this video or the people they are responding to? Tough call.
To be clear, what I’m saying above is not an argument against “reform” of one sort or another. And sooner or later, at least a substantial portion (and possibly all) of those receiving federal healthcare coverage are going to have to do with less than they would receive if we continued current policies (harmless efficiency gains alone won’t suffice), meaning there will (and should) impose some sacrifices (vs. current policies) in terms of healthcare quality and outcomes, because we just can’t afford to continue current policies. All I’m doing above is pointing out that, IMHO, there is bullsh*t on both sides, and grains — or more than grains — of truth in the general concerns of both sides. And some of the bullsh*t includes calling one’s bullsh*t “truth” and the the other side’s claims “bullsh*t” (”myths”), a rhetorical tactic reminiscent of George Carlin’s take on “your stuff” vs. other people’s “stuff” http://www.youtube.com/watch?v=MvgN5gCuLac
If one fears an eventual single-payer system, opposing the current proposal is simply preventative care.
Unfortunately for me, I favor a system that is politically impossible: bare-bones public insurance for catastrophic expenses that clear an extremely high cost-benefit hurdle. In no time, Congress would reduce that hurdle and give us a single-payer system. Voters will demand and get an unsustainably generous health care system, just as they have always demanded and gotten unsustainable combinations of spending and taxes.
Wherever would they get such a far-fetched “mad” idea?
Maybe from Obama’s top health advisors, like Ezekiel Emanuel (Rahm’s brother), who’s openly endorsed the idea of triaging the old and seriously ill out of care that would be, well, let’s admit it, wasted on them:
Maybe from the fact that other government-run health care systems that take over cost control, such as Britain’s, overtly do exactly that — Britain not paying for more than £30,000 of treatment per “quality adjusted” year of life … even after its politicians promised they would never resort to such rationing when first selling their system to the public, just like our politicians are now?
Maybe from the fact that while Obama has promised big spending cuts, he has offered no way to achieve them.
So, one might reaonably wonder, since Medicare costs are heavily concentrated in expensive interventions during the last two years of life, where are the big cuts going to come from? What alternative is there?
Obama’s mistake — he promised big cost savings with no plan to create any cost saivings.
(In fact, there is no Obama health reform plan. All that exists are a bunch of unreconciled ideas in differernt House committees with the Senate clearly heading to something very different yet, but nobody knows what. So how can AARP’s leaders honestly make any promises about what the final program will or will not do?)
Are AARP members really such mad fools to be concerned about all this? (I don’t know if Feldstein is an AARP member, but is he a mad fool? )
(Now, if one wants to talk about AARP members actually acting like mad fools who will believe anything, one might recall how one electoral cycle ago they mobbed Republican town hall meetings claiming Bush and the Republicans wanted to “Destroy our Social Security!”. What was the reward for “honesty” then? How many on the left stood up for honesty and civil discussion, and against the mob that time around?)
BillSmith wrote:
Maybe people are smarter than you think and they know that “death panels” =bureaucratic panels that will decide where the limited resources allocated to health care will be most effectively spent - effectively spent for society not the individual.
What is ironic is that some of the proposals (such as end-of-life counseling and living wills) that prompted the charge of “death panels” may have been the best way to avoid such panels. By the time that a patient is gravely ill and/or on a ventilator, it is often to late for such measures. If they are unconscious, their wishes cannot be determined. Even if they are conscious, they may be judged to be too depressed or unfocused to make such decisions. Their family will then tend to do what they think they should do and not what the patient would wish. In any event, none of these proposals involved decisions being made by bureaucratic panels. But if families are stripped of any tools to make reasonable decisions, such panels may become necessary.
In a very simple example if you were going to spend x dollars and you can keep 10 year olds or 70 year olds healthy which would give you a greater return over the individuals lifetime?
One example that I often think of is posed by the following question: If you could extend your life by one week, how much would you pay to do it? Would you pay a million dollars? If the answer is yes, then would you be willing to spend less and/or earn more over your entire life to pay for it? If the answer is no, how much would you pay? Of course, this question is overly simplistic. Many of the medical decisions that people face are much more complicated. There may be a very slim chance of a much longer recovery. The point is that, it is a fallacy to pretend that no such difficult decisions exist and to label any suggestion that they do as a call for “death panels”. The best that we can do is to openly discuss and prepare for such decisions.
B Davis,
Re:
the following question: If you could extend your life by one week, how much would you pay to do it? Would you pay a million dollars? If the answer is yes, then would you be willing to spend less and/or earn more over your entire life to pay for it? If the answer is no, how much would you pay?
That is indeed a very thoughtful and appropriate question. And I’d add a twist to relate the question a bit more, I think, to our choices of public policies to support: Same question, but on behalf of someone else or “others”. In other words, how much more would you be willing to pay in taxes now (this year or for the next few years or some other time period) so that X number of people with terminal or life-threatening conditions can have Y additional months of quality life? For most of us, we can’t be assured that, if we pay more in taxes for the next several decades to extend (quality) time for others, future taxpayers will do the same for us, so the policy question is more of a “do unto others” nature, although your question is still a very good one, particularly for followers of the Golden Rule.
the following question: If you could extend your life by one week, how much would you pay to do it? Would you pay a million dollars? If the answer is yes, then would you be willing to spend less and/or earn more over your entire life to pay for it? If the answer is no, how much would you pay?
That is indeed a very thoughtful and appropriate question. And I’d add a twist to relate the question a bit more, I think, to our choices of public policies to support: Same question, but on behalf of someone else or “others”. In other words, how much more would you be willing to pay in taxes now (this year or for the next few years or some other time period) so that X number of people with terminal or life-threatening conditions can have Y additional months of quality life? For most of us, we can’t be assured that, if we pay more in taxes for the next several decades to extend (quality) time for others, future taxpayers will do the same for us, so the policy question is more of a “do unto others” nature, although your question is still a very good one, particularly for followers of the Golden Rule.
As I recall, the Golden Rule is “Do unto others as you would have them do unto you”, not “Do unto others as they do unto you”. Hence, the possibility that future taxpayers will not likewise “do unto us” would not directly affect my opinion on how we should treat current people with terminal or life-threatening conditions. What might affect my opinion is whether or not current policies are sustainable. If they are not sustainable, then it becomes very likely that I and other future people with such conditions will not receive such care. At the very least, this would cause me to save more to prepare for the case where medical care that I supported for others is not forthcoming for me.
Still, I think that your rewording of the question is very important since that is the actual situation that we face. Although I think that the Golden Rule is a very good guideline for what our policies should be, it can be very difficult to know for certain how you will “have others do unto you” when the situation actually arises. I believe that I would pay very little, if anything, to lie in a hospital bed, semiconscious and on a ventilator, for an additional week of life. I would obviously pay a great deal more for an additional week of quality life. What’s a little more difficult to figure out is how much I would pay for a small, difficult-to-measure chance at some small amount of a additional quality life. That’s why I greatly prefer that these decisions be left to the patient and family as much as possible and that we just work to make it as easy as possible for them to make rational decisions. The one main restriction that I would favor is that whatever policies we follow must be sustainable for future generations. Still, I do think that taxpayers have a right to questions policies that they believe do not follow the Golden Rule or are otherwise flawed.
By the way, I don’t think that the cost of end-of-life care is the entire problem with health care costs. Many of the other factors that are often brought up (such as insurance companies, defensive medicine, and patient overuse) may also play major roles. On this count, it would be useful to see a breakdown of where all of the health care dollars are going. That would give us a better idea of which factors are the highest priority.
B Davis,
Re:
As I recall, the Golden Rule is “Do unto others as you would have them do unto you”, not “Do unto others as they do unto you”. Hence, the possibility that future taxpayers will not likewise “do unto us” would not directly affect my opinion on how we should treat current people with terminal or life-threatening conditions.
You misunderstood. I was saying what you just said — that for followers of the Golden Rule, the question of what we should “do unto others” is the same as the question of how we would want others to do unto us, and that’s why, as I said, although the policy question is a “do unto others” question, your question “is still a very good one, particularly for followers of the Golden Rule.”
By the way, I would amend the above just to note that applying the Golden Rule in choosing policy in this case is imperfect, since different people would attach different relative values in the trade-off you present. I may be willing to give up an extra couple of months at the end to have X degree higher standard of living for most of my life, but someone else may prefer that extra time. Or vice versa.
One could also raise and apply the more general ideological/philosophical question of what choices involving this trade-off government should force upon people (as opposed to more individual choice, responsibility, allocation of resources, etc.) and to what extent and for what purposes government should confiscate redistribute income. But that’s a whole other can of worms.
Re:
That’s why I greatly prefer that these decisions be left to the patient and family as much as possible and that we just work to make it as easy as possible for them to make rational decisions. The one main restriction that I would favor is that whatever policies we follow must be sustainable for future generations.
And there’s the rub. The patient, in conjunction with family and physicians, may choose their preferred level and type of care, but they are doing so with other people’s money — current and future taxpayers, as well as beneficiaries of other types of spending or even of that same category of spending who may suffer from spending cuts/limitations necessitated by the cost of care for that patient and others in a similar situation. That’s why we face the very tough, very important question you raised.
Re: your last paragraph, yes, breakouts are important. I’ve seen some stats, but don’t have any links handy. Certainly it is often said that a very substantial portion of total healthcare spending is “end of life care”, however defined (and of course, only known with certainty and precision after the fact in each case, as I discussed here http://economistmom.com/2009/05/how-health-care-reform-is-sort-of-like-a-costco-membership/#comment-2847 ).
Regarding insurance companies, in all the political rhetoric they may be getting unfairly criticized in terms of their impact on healthcare cost. (1) Official data (see Table 12 at http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf ) shows that the “net cost” (difference between premium revenue and claims expense — i.e., administrative [including marketing, underwriting, claims processing and all other operations] PLUS profit) for private insurance in 2007 was only 12.2% of premium revenues. (2) If the $13 billion profit figure for 2007 cited by Factcheck.org is at least roughly correct, that is only 0.6% of “all health care spending” per Factcheck.org (apparently including government health insurance spending in addition to private, the total of which was $2.2 trillion) http://www.factcheck.org/2009/06/pushing-for-a-public-plan/ , or 1.7% of total private health insurance premiums, which were $775 billion in 2007 (see prior link, Table 12). And bear in mind that private insurers are reportedly much better at reducing “waste, fraud, and abuse” than is Medicare. Also bear in mind that the oft-cited (by advocates of single payer and public option) “lower” administrative cost of Medicare (vs. private insurance) is largely due to the fact that this cost is expressed as a percent of claims paid, and the Medicare population has much higher claims per capita than do those covered under private insurance (thus making Medicare’s administrative cost as a percent of claims deceptively low), and Medicare apparently doesn’t apply resources to catching as much “waste, fraud and abuse”.
By the way, I would amend the above just to note that applying the Golden Rule in choosing policy in this case is imperfect, since different people would attach different relative values in the trade-off you present. I may be willing to give up an extra couple of months at the end to have X degree higher standard of living for most of my life, but someone else may prefer that extra time. Or vice versa.
One could also raise and apply the more general ideological/philosophical question of what choices involving this trade-off government should force upon people (as opposed to more individual choice, responsibility, allocation of resources, etc.) and to what extent and for what purposes government should confiscate redistribute income. But that’s a whole other can of worms.
I agree that it’s a whole other can of worms. Still, the basic principle that I would try to apply to both questions is that the government programs limit themselves to a minimal level of benefits that is generally accepted as “necessary”. As an extreme example, Social Security should not mandate that people to save enough (actually, that workers pay enough in taxes) so that retirees can travel the world during their retirement. It should only mandate enough taxes to provide that minimal level of benefits that is generally agreed to be necessary. That would address the first question in that it would not provide a greater benefit to someone simply because they desired a greater benefit. And it would address the second question in that the government would create mandates and redistribute income only to provide these “necessary” benefits.
Of course, there will be disagreement about what is necessary and the level of benefits that is deemed necessary will likely vary according to various factors like location and circumstances. This disagreement will likely be all the larger for the difficult decisions presented by medical care. Still, this principle does provide a starting point.
On a side note, it seems like our current system does give a good amount of weight to the demands of the patient. I have noticed that doctors often recommend a minimal level of tests. But if you so much as question the need for an additional test, the doctor often seems very quick to agree. I have wondered to what degree this is simply to please the patient and to what degree if may be defensive medicine. In any event, it suggests that the system may undertreat some very passive patients and may overtreat very complaining patients.
Regarding insurance companies, in all the political rhetoric they may be getting unfairly criticized in terms of their impact on healthcare cost. (1) Official data (see Table 12 at http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf ) shows that the “net cost” (difference between premium revenue and claims expense — i.e., administrative [including marketing, underwriting, claims processing and all other operations] PLUS profit) for private insurance in 2007 was only 12.2% of premium revenues. (2) If the $13 billion profit figure for 2007 cited by Factcheck.org is at least roughly correct, that is only 0.6% of “all health care spending” per Factcheck.org (apparently including government health insurance spending in addition to private, the total of which was $2.2 trillion) http://www.factcheck.org/2009/06/pushing-for-a-public-plan/ , or 1.7% of total private health insurance premiums, which were $775 billion in 2007 (see prior link, Table 12).
I agree that insurance companies are fairly easy targets and my be getting unfairly criticized. They are undoubtably affected by the fact that they make higher profits on healthy people than they do on very sick people. Hence, there does need to be some sort of regulation to keep them from not covering or unfairly dropping people as soon as they become sick. But I don’t know how you can mandate that they cover all people, regardless of their current condition, without combining that with some mandate that healthy people carry some minimal level of necessary insurance. We obviously can’t have a system under which everyone goes without insurance while they’re healthy but that requires insurance companies to cover them as soon as their required care exceeds their premiums.