Bob Schieffer’s Face the Nation interview of Sen. Dick Durbin, discussing health care reform, is another example of how a misinformed and lazy media misrepresents the issues and confuses the public.
Schieffer first confuses what Obama said in the campaign. McCain proposed to tax all employer-provided health insurance benefits, then give everyone tax credits to purchase private insurance. Obama opposed that proposal because it would have threatened the entire structure of employer-sponsored health insurance, without putting an affordable, effective alternative in its place.
But Schieffer falsely equated the McCain proposal with Sen. Baucus’ limited proposal to tax only the additional benefits above a very high price – such as benefits costing more than $12,000 or so, which the Administration hasn’t endorsed yet. He repeats this false comparison twice.
Then Schieffer reveals he doesn’t understand the basic debate. Obama and leading Dems want to reform the incentive structure so that Medicare’s actual costs are lower while providing equal or better care than we have today. Strong federal oversight of the Medicare payment incentive structure – not just lowering fee-for-service payments – is the key, coupled with open access to a public option (e.g., Medicare or something like it) to both expand these reforms and put pressure on private plans to follow suit and “keep them honest.”
If we fix these and similar incentive issues, the argument goes, then the federal government’s payments to Medicare and drug makers can go down – not because we’ve cut benefits to consumers but because the actual cost of treating people will be lower. The quality of health care improves for those with coverage, and more people will get coverage via open access to the public option using the same approach.
Schieffer seems unaware of any of this, even though it’s the heart of the health care reform debate. And he doesn’t seem to learn from any of Durbin’s patient answers. Watch/listen to how confused this becomes with Bob Schieffer:
[After showing the clip of Obama arguing against McCain’s proposal . . .] “So, I have to asked you, Senator Durbin. Does the President still stand by the words and what he said during the campaign?”
Unfortunately, instead of telling Schieffer he’s confused and is falsely equating two different proposals, Durbin repeatedly ducks the question.
“Well, will the President just leave Senator Baucus out there on the limb, then? Is he gonna say at the start, ‘that’s a no go, that’s a non-starter?’ I mean, how’s he gonna say . . . what’s he gonna say when this becomes part of the plan, because every indication we have is that it is gonna be part of the plan?”
At this point, Schieffer’s misrepresentation is complete. The “it” that is “gonna be part of the plan” is now misdefined as the same across the board tax proposal McCain proposed and Obama opposed. We’ve lost track of the very limited proposal to tax only excessive benefits, which is still on the table.
Having confused himself and misled his audience, Schieffer now becomes argumentative, both in tone and in choice of words:
“. . . let’s talk about what the President said yesterday. He said that he is going to be able to do all this health care reform without adding to the deficit. Now some people are saying this is going to cost as much as $1.6 trillion. Isn’t that just straining credulity to say he can do that without adding to the deficit?” . . .
“But isn’t it, again, we’ve all lived through rosy scenarios and all that kind of thing where all these savings can be made, and somehow it never comes true, and in this thing yesterday, where he’s talking about all these savings . . . he’s talking about reducing federal subsidies to hospitals, in some cases by as much as 75 percent. I mean, is that feasible? Does anyone really believe you can do that and maintain health care at the levels it is now?”
Note that Schieffer expresses his own bias against reducing “subsidies” to hospitals without asking what they’re for; are subsidies warranted, unjust profits, or the result of having to cover inflated costs under the perverse incentive system? Instead, it’s OMG, Obama wants to reduce payments to hospitals, which is exactly how it will be played by reform opponents. E.g., see WaPo headline and this lead paragraph:
President Obama yesterday outlined measures to trim spending on federal health programs for the elderly and the poor by an additional $313 billion over the next decade.
Only now does Durbin explain a part of what the President actually said and meant about changing the compensation structure and its perverse incentives. The "subsidies" Obama mentioned are simply payments to hospitals to reimburse them for providing emergency care to uninsured patients; if more people are insured, the "subsidy" payments can be reduced.
But instead of following up to show he understood what Durbin just explained, Schieffer moves on to drug payments and repeats the same misconception about drug costs.
“Well another thing he says is he’s gonna realize $75 billion in savings by lowering the costs of drugs. Well, again, that’s a lovely thing to say, but he doesn’t give any explanation as to how he’s gonna lower the cost of drugs. Don’t we need a lotta detail on that before we can even take that seriously?”
Memo to Dems: If you hope to win, when you hear patently false framing, call it out; don’t just answer the question as though we’re in some polite debate. The other side is usually lying [see more below], and the media pretends it doesn’t know or matter. Tell Schieffer his premise is wrong and ask why he’s spreading confusion.
It’s also clear Bob Schieffer isn’t following the health care reform debate, didn’t understand what Obama said and wasn’t listening to Durbin. Yet he’s the senior CBS newsman, who has covered Washington for decades, and he’s now responsible for interviewing the most important newsmakers of the week.
“Why oh why can’t we have a better press corps” — Brad DeLong et al.
More:
To his credit, Schieffer does slightly better in his interview with Mitch McConnell. He pushes back against McConnell, who repeats Luntz’ talking points — Washington in between patients and doctors, Canadian care is bad and causes delays, Obama wants "a national rationing board," waiting in line for government permission, lie, lie, lie.
He asks McConnell about proposals to reduce hospital subsidies by up to 75 percent, but Schieffer never explains what Obama meant and never clarifies the difference between a percent reduction in the amount of the subsidy, and a percent reduction in the total payments including the subsidies. They’re not the same thing. And of course, Mitch McConnell exploits this confusion by concern trolling the likely opposition to 75 percent cuts.
They never stop.
Updates:
Digby, endures John King/CNN coverage
John Amato/Crooks and Liars, catches video of CNN’s Sebelius interview; more here.



14 Comments




is there any systematic research on this?
Dunno, but I assume they’re referring to the practice concepts in the Gawande article. It would be interesting if someone took the numbers of average US costs, determined the percentage of plans/hospitals/population in the “low-cost, high-quality” systems, and then multiplied the difference between average and low cost, times the non-conforming systems, times some percentage penetration rate of success (e.g., 75 % conversion within 10 years — to see how close you get to the Administration’s estimates for “cost savings.” I’ll bet that’s how the Administration came up with their numbers.
the gawande article was very intriguing, but do we have reason to conclude that all / most / some of the regional differences can be explained by that? or are there other reasons?
without that kind of research, making assumptions about cost savings — and budgeting for them — is way premature. actually nuts imo.
more evidence based policy please.
otoh, maybe the research has been done and i just don’t know about it.
I think many intitutions — e.g., Dartmouth — have been doing comparative studies for years. There’s probably tons of data. Also, see Dartmouth Atlas Project
http://www.rwjf.org/healthrefo…..p?id=21656
http://www.usatoday.com/news/h…..osts_N.htm
And of course, the Commonwealth Fund health web site – lots of studies and charts.
http://www.commonwealthfund.org/
i have seen reference to years of data on massive differences in per capital medicare costs — but not on any systemic (let alone conclusive) studies on what the causes are and what policy changes affect that. but i haven’t really looked either.
my main point is that the budget numbers for cost savings should be based on that kind of analysis… and so far i haven’t seen any reference to that.
….
p.s. the reinhardt lecture i referred to in a previous thread cited some of the recent studies, but the impression i got was that the reasons for the variation were not yet understood.
Despite the strong desire by some people for a single-payer system which government controls from A-Z, there’s also a strong opposition to a government public option. It’s proving to be a lightning rod.
So, some people suggested the idea of co-operatives which aren’t gov’t run. Leaving aside the fact that a public option might be defined by gov’t, but merely contracted out to private firms, I wonder how much impact co-ops could have. If the purpose is to insure more people (ones who don’t have employer-based insurance) it could be helpful, but if it’s to control costs, then it might not be especially useful.
The experience with co-ops has naturally been limited to some states and only to states. If we’re going to step out of the stone-age and begin using computers for things like the Exchange then I wonder if we could combine these two things and have naturally occurring co-ops created automatically when a large number of people buy into a certain health plan of a company.
To this end I wonder how many companies (and plans) offer insurance on a national basis. If you have a limited number of options on a state-by-state basis, then there won’t be enough competition (despite what George Will says). Could we ‘qualify’ firms for offering insurance via the Exchange on a national basis (with appropriate oversight & regulatin) to push for more firms and more plans being in the competition?
If I go to the Exchange via the Internet and sign up for a policy and if there are enough other people who also sign up, then could we have a co-op created automatically to allow us to get a better group rate?
Or, are we going to continue in the stone age?
Now what does it say about the politicians when hey aren’t clever or courageous to speak out about mis-representations and clarify the issue raised by the misinterpretation?
NONE of the talking heads are particularly smart or witty. Just amazes me.
What seems to be being referenced re ‘cutbacks’ is the use of MRI’s etc. for diagnostic purposes; ‘over diagnosis’ and the Repub’s response is to try and invoke medical malpractice tort reform in response.
Goes back to the ’specialists’ as contrasted to ‘general practioners’.
trying to clarify my comment @ 6
without conclusive research into the causes of the massive regional differences in per capital medicare costs (and effectiveness of policy changes that might be implemented), budgeting cuts based on hoped for savings may very well end up being cuts in benefits.
at this point, i am happy to advocate budgeting for the necessary research — but NOT budgeting for the cuts themselves.
we have a right to demand evidence based policy. especially when it comes to cutting medicare and medicaid.
we have a right to demand evidence based policy. especially when it comes to cutting medicare and medicaid.
My problem with what is considered evidenced based policy is that the structure of the medical research/FDA processing, misrepresentational advertising, etc. means that we come out with the same old, same old
Big Pharma dictation of what’s valid and not experimental and therefore
deniable. The issue is that until there is some way to stop that dictation of health care policy and practice, there will be many, many treatments that are vital for functional improvement and even survivability that will be denied. Case in point is the use of IVIG for autoimmune diseases, including neuropathy’s Chronic Inflammatory Demyeliznating Neuropathy and Guillain Barre Syndrome; but it’s also been shown to be effective for severe diabetic neuropathy. There are also other
CAM (complementary/alternative medicine)treatments that are no longer approved for Medicare payments even though they have been shown to be effective in reversing and not just masking symptoms. Then there’s the whole issue of Functional Medicine which looks at and treats the whole person and not just isolated symptoms and insists on wholistic treatment approaches. I says that pills and cutting aren’t the only way to practice medicine. Big Pharma and its co-conspirators can’t afford to lessen any of their controls of the same old, same old ways of practicing medicine that, if not actually killing us (which it often does), then certainly precludes our doing anything more than loosely “managing” chronic conditions.
Blessings to all
Scarecrow, relative to the Schieffer/Durbin interview: we used to say it never ceases to amaze me when….. What I’ve been saying for ages is, I am always amazed when there is any significant level of intelligence and comprehension by any of the pundits and interviewers. There ought to be a law guaranteeing competency and fairness…… Well that’s not going to happen, and even if it were, it wouldn’t be enforceable.
But thanks for reporting on the ongoing insanity of the official/public “dialogue”.
Blessings to all,
What’s lacking on the Sunday shows in this health care debate are people who know what they are talking about. Why isn’t Dr. David Himelstein or Dr. Margaret Flowers on? Why as Jay Rosen lamented on Bill Moyers is the debate narrowed down to the far right and the center right? The Washington punditry keeps the focus on “the point of conflict” between our mediocre congress critters like McConnell and Durbin. While the really bright people are all on the sidelines pulling their hair out.
Did you see the news on Durbin and insider trading that hit on Saturday? Durbin Cashes Out During Big Stock Collapse
amen. thank you for cutting the heart of the matter.
from the nyt today:
http://www.nytimes.com/2009/06…..f=politics