Self-appointed independent fact checkers continue to miss the boat on the GOP’s Medicare plan. And not just small misses, but big belly flop misses.
The immediate result has been fact-check assessments that ding Democrats for overstating how radical the GOP plan is and give political ammunition to Republicans to use against Democrats. But at a deeper level the misguided fact-checking — almost always the result of insufficient expertise on Medicare specifically, and health insurance more broadly — threatens to skew the public policy debate in ways that obscure the truth and complicates the effort to provide the public with a clear assessment of the GOP’s plan on the merits.
The list of fact-checker errors and thin analysis is steadily growing but they fit broadly within three general categories. We take them one by one and have the experts weigh in:
MISTAKE #1: The GOP Plan Doesn’t End Medicare
This is the single biggest bone of contentions for fact checkers, and it’s based on a category error: Specifically, that if you replace one health insurance scheme with a different health insurance scheme, but call both of them “Medicare,” then you haven’t really “ended” anything.
A widely cited Monday piece by Washington Post fact-checker Glenn Kessler takes Democrats to the mattresses for three different claims they made about the plan in a recent web petition — the biggest being that Republicans want to scrap the current Medicare program. “[T]he DSCC essentially says: The House Republican budget plan would eliminate Medicare.”For this, and other sins which we’ll address momentarily, Kessler gives Dems a dreaded Four Pinocchios.
But even if you disagree with the politically charged way partisans talk about the GOP plan — indeed, even if you support the GOP plan on the merits — it’s hard to claim that Dems are reaching new frontiers of dishonesty.
Here’s Tom Scully — former Bush administration director of the Center for Medicare and Medicaid Services — on the Republican plan, in an interview with me. “It gets rid of — and I would do that — gets rid of the current Medicare program where the government is the insurance company and the government sets the prices.”
Scully supports the concept of — in his words — privatizing Medicare. The GOP plan is modeled in many ways after the Medicare Prescription Drug Benefit, of which Scully was a key architect. He certainly doesn’t think it would be the end of the world for current or future seniors. But he acknowledges that it would constitute “a fundamental structural change in the program.”
The DSCC uses harsher words: “The radical GOP has not given up on its drive to kill Medicare,” the petition reads.
In an email, Princeton professor Uwe Reinhardt — perhaps the foremost health care economist in the country — won’t go so far as to say the GOP plan kills Medicare but argues that there’s no doubt that it fundamentally changes the nature and purpose of Medicare. The Republican plan, Reinhardt tells TPM, “would change [Medicare] from a defined benefit to a defined contribution plan,” and that contribution would be “much lower than the rate of growth of per-capita health spending.”
“In my view, the Ryan plan does not kill Medicare, but it would substantially alter the social decades-old contract between the government and the elderly for those now 55 or younger,” Reinhardt says, “…In short, Medicare will not disappear – i.e., get killed — but it will be a much more meager program for most of the elderly.”
In response to a query from TPM, Kessler stood by his fact check.
“There is a big difference between ‘kills Medicare’ and ‘radical new vision,'” he writes. “The DSCC might have done better if it had said ‘Kill Medicare as we know it” but it didn’t even have that caveat. … ‘Radical new vision’ suggests they want to change the program but still keep intact the notion of providing some form of health care support for the elderly. ‘Kill Medicare’ sounds like they want to end health care for elderly.”
Kessler also stipulates that a different line of attack from Democrats would’ve met his muster, composing the following hypothetical attack ad:
The GOP has not given up on its drive to produce a radical new vision of Medicare, which even might mean a relatively small number of seniors now on Medicare would lose some benefits. Senate Minority Leader Mitch McConnell is trying to tie the debt ceiling vote to a bipartisan agreement on overhauling the finances of Medicare. Sign below and demand that Republican Senate candidates side with seniors, not GOP party leadership.
In assessing claims about the GOP plan, the fact checkers have tended toward an over-literalism which ignores the 40-plus-year political fight over Medicare that forms the backdrop for the current debate. You can trace it all the way back to Ronald Reagan’s admonition in 1961 on behalf of the American Medical Association that Medicare was nothing more than socialism.
For Republicans who have long considered Medicare a radical program, killing Medicare is precisely the goal, even if the broad political support for the program requires tempering their rhetoric. The fact checkers start from the premise that everyone owes it to the Republicans to take their tempered rhetoric at face value, notwithstanding this history.
MISTAKE #2: The GOP Budget Does Not Cut Benefits For Current Seniors
The Medicare plan, as written, would attempt to preserve fee-for-service Medicare for people in or near retirement. But the overall GOP budget would also repeal the new health care reform law, which is already providing new benefits for current retirees — including a rebate for those who fall into the so-called “donut hole” for prescription coverage and free annual checkups for all seniors. Those benefits would disappear if the GOP budget were implemented.
Democrats translate this by saying Republicans want “to take needed health care coverage away from our seniors.” One can quibble over the word “needed,” but as Reinhardt notes, “Had Democrats done such a thing it would be decried as rationing” — i.e. government rescinding Medicare benefits to save money.
The Post mostly grants this, but says it’s wrong for Democrats to place so much focus on it. “In any case, it is a stretch to focus on this provision (and a couple of other issues) and then make a sweeping claim that leaves the impression that all seniors would be affected immediately. A repeal of the health law (which Obama would veto) could have some effect on some seniors in Medicare, but Republicans are right that the core of Medicare — government-run health care for the elderly — would remain unaffected for people over 55 for many years to come.”
Therein lies the third most common mistake of the fact checkers.
MISTAKE #3: The GOP Plan Preserves Medicare For Current Seniors
This one’s a bit trickier for fact checkers to navigate because there’s nothing in the GOP plan that would change the basic structure of Medicare for current seniors by fiat. So, for example, fact checker PolitiFact asserts unreservedly that “Ryan’s plan leaves Medicare as is for people 55 and older.” Set aside the immediate cuts listed above, though, and this still isn’t a complete assessment given actuarial realities.
As seniors in traditional Medicare aged and died, the size of that program — and thus the health of its risk pool and its purchasing power — would diminish under the GOP plan, for it would close the door on Medicare as a single-payer plan for people under 55. Thus as time wore on, the traditional Medicare program would incur higher costs per patient, and have a harder and harder time finding providers willing to serve its dwindling number of beneficiaries. In short, traditional Medicare would unravel economically. As Paul Krugman notes, eventually it would unravel politically, too.