Health Care Reform: Sorting Facts From Fiction

BILL ADAIR: Yeah, I think that's a good - that's a good question. I don't know - and we've checked a lot of these - I don't know that we've seen any proof or even evidence suggesting that's the case. I know there've been some allegations like that in the blogosphere. But interestingly, I think the root of many of the things that we check that often ultimately gets onto talk radio or into the cable news debate are things that originate in blogs.

And so for instance, there was one blogger who did a very detailed commentary, really - not an analysis; I wouldn't characterize as an analysis - a detailed commentary of the bill. It contained some things that we found were false, some things that we found were more, sort of, in our half-true range on our Truth-O-Meter on PolitiFact.

But what happened then was, his analysis then got twisted and distorted and others commented on his commentary and the result of that was a chain e-mail that circulated very widely. Now, there's nothing that we've seen that indicates any of that originated with any big AstroTurf campaign. It really seems to be more sort of the netroots and these things sort of bubble up, but so many of them are just dominated by falsehoods.

BETTY ANN BOWSER: Have you all been surprised by how fired up this has made people?

JULIE ROVNER: This is Julie. You know, I think a lot of this - I covered this issue the last time, you know, during the Clinton administration and it is something - you know, having been covering health care for nearly 25 years now - it's something that affects everybody and it's something that affects everybody intimately. So people do get excited by it.

But I think, you know, really to go back to the last question too, what happens - and I may be dating myself here - when we were kids, you used to play that game where somebody would whisper something into the next person's ear and they would whisper it into the next person's ear. And of course, you know, by the time you got to the end of the line, it was completely garbled. And I think that's really what happened here and the Internet really makes it even worse.

And it happens with members of Congress, too, is that they hear something and at first, it may have had a grain of truth and by the time it gets, you know, repeated and repeated and repeated, it bears no resemblance to the truth anymore. You lay that on top of something that's a very emotional issue and then you lay that on top of people when you have opponents who are, you know, who are anxious to really scare people because they would like to defeat this.

You are then at the point where you have, absolutely, a ready-made soup for the kind of debate that we're seeing now, which is a lot of things that aren't true, a lot of scare tactics and a lot of people who are very upset and very angry and people who are afraid of change. So you know, on the one hand, could this have all been predicted? Yeah, I guess probably so.

BETTY ANN BOWSER: Angie, what do you think?

ANGIE HOLAN: I'm not that surprised. I think there was a lot of positive feelings among the country when Obama was elected, for a number of reasons - the first African-American president and that sort of thing. But during the campaign, there was a level of vitriol out there and it surrounded some of the things about Obama. Some people said he was a Muslim -- one of our more popular items debunked. Oh, and I should add he is not a Muslim; he is a Christian.

One of our more popular items - that he took the oath of office on the Quran. That also was not true. He took his oath of office for the Senate on a Bible. But there was this level of anger and not willing to consider facts and evidence during the campaign. And I think maybe there was a lull during the first part of this year but we've seen some of those sorts of e-mails and disregard for evidence and facts come back right now in the health-care debate.

BETTY ANN BOWSER: Do you think health-care reform is just a symptom of something deeper?

ANGIE HOLAN: You know, I think that's very hard to say. I just - I'm not sure what the answer is to that. I think we're just going to have to keep watching.

JULIE ROVNER: This is Julie again. I mean, certainly, we have seen some Republicans say that defeating health reform is a way to defeat President Obama and set back his administration. I mean, there are Republicans who have said that and not been, you know, been very up front about that.

BETTY ANN BOWSER: Bill, anything else you'd like to add?

BILL ADAIR: I think that's just the rules of engagement in the modern age that we have just these ferocious - when you sort of get a major issue and it could just as easily be the cap-and-trade bill coming out now before the Senate. When you get these major issues, I think the battle lines get drawn and each side, you know, each side grabs their ammunition and they just really go at it.

And I just think with the Internet, you have a megaphone that amplifies things even more than we saw back in '93, '94 with the Clinton health-care proposal - that the - whereas back then, they had to contend more with Harry and Louise on cable television, now, they've got to deal with a million of Harrys and Louises who all have blogs.

JULIE ROVNER: Oh, this is Julie. In fact, the way the program is designed, Congress isn't trying to exempt itself as much as it's going to exempt the other 160 million people who have insurance through their employers. The idea, at least in the House bill, is that the only people who will be allowed to get plans through this new exchange are people who don't have access to other insurance, who don't have Medicare, or Medicaid, or employer-provided insurance - that these quote, unquote, "exchanges" will only be open to small business who have trouble providing insurance for their employees and to the people who are uninsured or the people who are self-employed.

And that is rather purposeful to prevent what a lot of the opponents are warning of, which would be the government taking over the health care system. It's done very purposefully. So Congress is not trying so much to exempt its own members as it is to avoid what some of the biggest opponents are concerned the most about.

BILL ADAIR: And I think what he might be referring to is an attempt that Republicans have made with some amendments that would force members of Congress to accept the public option as their health care, and in all cases, that has been voted down, primarily with a Democratic - with Democrats voting against it. And the Republicans have done the - something of some mischief to say, well, you know, "If you guys are so excited about the public option, you guys should have to abide by it, and have to use it for your health care plan."

And so I think the root of what he's saying may be that, but I think it's based on a misconception about the plan that it is not - as Julie was saying - I mean, this is not an overall government-run health-care program and that's been a falsehood that's been repeated many times and at PolitiFact, we have debunked, you know, six or seven different ways.

BETTY ANN BOWSER: That leads me to the next question, which is the whole idea of is this a - does this represent a government takeover? The question comes from Renea Yodie of Hagerstown, Md. The question is, "Related to the question about whether a government plan will eventually take over health care, isn't this, in fact, true, because shortly after a public plan is implemented, employers will begin dropping their expensive health care benefits, leaving the government's plan as a safety net to catch them?"

ANGIE HOLAN: That's an interesting one that we've looked at and it is one of the critiques that kind of posits a slippery slope. There are a few things in the plan that would act as a brake on that. There is, in some of the bills, a requirement that employers offer insurance so that the bills don't seek to dismantle that employer-based system. There are also rules that say that a public plan has to be self-supporting - that it won't have access to an endless stream of tax revenues.

Now, having said that, there are other people, presumably on the other side of the political spectrum on the left, who want a single-payer tax system who are very up front in saying that they hope a public plan will get in place and it will prove itself to the American people that a government-run plan could do a good job and that could eventually become a single-payer system.

So there are people on the other side of the political spectrum who see that same scenario and are heartened by it. But again, time will have to tell, and just to emphasize because of the confusion, the public option right now is one choice on a health care exchange where it will compete with private insurers.

BETTY ANN BOWSER: Do you all find that, in general, that public is very confused about all this stuff?

JULIE ROVNER: Well, I think, you know, the public actually has a right to be confused about all this stuff. This, of course, is why the president was so anxious to have the House and the Senate each vote on their bills before the August recess. This is what the president desperately did not want, which was to go into the August recess with a whole bunch of different committee proposals, which is, of course, what happened.

So we've got, you know, three slightly different House versions and one-and-a-half Senate versions. And for heaven's sake, no wonder the public is confused. I'm confused. It's very hard to keep up with all of this.

ANGIE HOLAN: Yeah. I was looking at - this is Angie with PolitiFact - I was looking at polling data over the weekend that showed that - it showed - it asked people what is the public option. It gave them several choices, only one of which could be considered technically correct. And roughly 35 percent picked the right option, which was about the same as if they just guessed randomly.

JULIE ROVNER: I'm surprised it was that high.

ANGIE HOLAN: Yeah, so there is - I mean, I think there's polling evidence that shows that people don't particularly understand the plan, especially in its particulars, which get very arcane sometimes.

BILL ADAIR: But it also seems like the - neither Congress nor the White House has done a thorough job of explaining what the elements are of the bill and even giving it a name. We were talking last week that - what's the name of this program? And we couldn't think of it. (Laughter.)

And it seems that, that exemplifies that there really is a failure to communicate the overall goals of it and the - and how it would achieve that in a simple way because when you boil it down to its components, the health-care exchange, an individual mandate, mandates for large employers. You know, there's some basic concepts that I think we can all understand but it's - we've had to sift through the weeds to get those. It's not like they have communicated those to the American people.

ANGIE HOLAN: You know, I was looking - I've been looking at the small-business provisions in the bill and I should add right now, there's a House bill and then we have about half of the Senate bill and even within each bill, sometimes they treat small business very differently.

Like in the House bill, sometimes the small business is categorized as such by its payroll and other times by its number of employees. And I should say if the employer mandate passes, which is in question - it's a bit of a controversial point on the plan. But let's say that an employer mandate passes right now, the - these in the House bill are considerably stiffer than the ones in the Senate bill. And it's depending on how you figure it.

So I think it gets very complicated and it's hard to tell, but in the House bill, payrolls at around $400,000 and up will be taxed. And in the Senate bill, employers with their first 25 workers are exempted. So that just gives you a little bit of the flavor of how complicated it is.

JULIE ROVNER: But it does sound - I mean, this particular business, I think, would probably be small enough to qualify for some help paying for its workers. So I don't think it would just be - if the employer didn't provide insurance that he would be fined, it sounds like he would get some tax breaks in order to help pay for the insurance for his workers.

BETTY ANN BOWSER: The next question - we got a lot of questions about Medicare from seniors for obvious reasons. This one comes from John Ladasky of El Dorado Hills, Calif. And he says, "My wife and I are 63 years old and pay $1,100 a month for Kaiser health insurance. We are looking forward to age 65 when we expect our Medicare premiums will be about $200 a month. Can you explain how the Obama proposal to use present Medicare subsidies to insurance companies to pay for his plans will likely impact the cost and availability of my Medicare?"

JULIE ROVNER: I will take a stab at that. Of course, it's hard to say exactly how this will affect it. It shouldn't really affect your base subsidies, the Part B premium that you get. Of course, everything that happens to Medicare spending impacts what that premium will be. There's a new estimate from the Congressional Budget Office - for instance, it says that premiums for the drug coverage are likely to go up a little bit, but that overall drug spending is likely to come down.

Now, the proposal is to cut the subsidies for private insurance companies that serve Medicare. So if you were to join a Medicare HMO or some other Medicare private plan, you would likely have to pay higher premiums and maybe get fewer benefits because, at the moment, those plans are being overpaid to the tune of about - it varies but it's somewhere in the neighborhood of 20 percent. So that little gravy train that the insurance companies have been riding for the past few years would come to an end if this were to pass.

In other ways, if Congress were to reduce some of the payments to health-care providers, then your premium could, in fact, come down because as Medicare spending comes down, overall, the premium that you pay would come down. So it's hard to tell about all of the interactions, but generally to the extent that Medicare spending comes down, the premium would come down with it, and vice versa.

BETTY ANN BOWSER: When the president says that he can get two-thirds of what he needs to pay for health care reform by squeezing Medicare and Medicaid, do you think that would really have any impact on the level of benefits people get?

JULIE ROVNER: Well, it depends, obviously, how he does it, but yeah, there are certainly studies that fill libraries -- fill rooms -- that talk about a lot of the inefficiencies. And it's not just in Medicare; these are inefficiencies in the entire health care system and many of them are the same kinds of inefficiencies in the way care is delivered. But for Medicare in particular, because of how big it is and how much of the health-care system it's responsible for, the hope is that if you can change some of the incentives in how health care is delivered - through Medicare - that it will then trickle down into the rest of the health care system.

We've seen this time and again in how Medicare pays hospitals a little bit less, but hopefully now going forward into how Medicare pays doctors. And if you can find ways to increase the efficiency of the system through Medicare, you could then, perhaps, increase the efficiency of the system overall. That's the hope, and that's what they talk about when they talk about "bending the curve."

And the idea of that would not reduce benefits in any way for either current seniors or seniors who would come into the program later. In fact, to the contrary - it would presumably preserve the program for people who would be coming along - particularly those baby boomers, who start qualifying for the program next year. That's at least the anticipation. Now, whether they can figure out how to do that and whether they can do it successfully remains the big unanswered question.