PolitiFact’s Lie of the Year: ‘A government takeover of health care’
In the spring of 2009, a Republican strategist settled on a brilliant and powerful attack line for President Barack Obama’s ambitious plan to overhaul America’s health insurance system. Frank Luntz, a consultant famous for his phraseology, urged GOP leaders to call it a “government takeover.”
“Takeovers are like coups,” Luntz wrote in a 28-page memo. “They both lead to dictators and a loss of freedom.”
The line stuck. By the time the health care bill was headed toward passage in early 2010, Obama and congressional Democrats had sanded down their program, dropping the “public option” concept that was derided as too much government intrusion. The law passed in March, with new regulations, but no government-run plan.
But as Republicans smelled serious opportunity in the midterm elections, they didn’t let facts get in the way of a great punchline. And few in the press challenged their frequent assertion that under Obama, the government was going to take over the health care industry.
PolitiFact editors and reporters have chosen “government takeover of health care” as the 2010 Lie of the Year. Uttered by dozens of politicians and pundits, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats’ shellacking in the November elections.
Readers of PolitiFact, the St. Petersburg Times‘ independent fact-checking website, also chose it as the year’s most significant falsehood by an overwhelming margin. (Their second-place choice was Rep. Michele Bachmann’s claim that Obama was going to spend $200 million a day on a trip to India, a falsity that still sprouts.)
By selecting “government takeover’ as Lie of the Year, PolitiFact is not making a judgment on whether the health care law is good policy.
The phrase is simply not true.
Said Jonathan Oberlander, a professor of health policy at the University of North Carolina-Chapel Hill: “The label ‘government takeover” has no basis in reality, but instead reflects a political dynamic where conservatives label any increase in government authority in health care as a ‘takeover.’ ”
An inaccurate claim
“Government takeover” conjures a European approach where the government owns the hospitals and the doctors are public employees. But the law Congress passed, parts of which have already gone into effect, relies largely on the free market:
• Employers will continue to provide health insurance to the majority of Americans through private insurance companies.
• Contrary to the claim, more people will get private health coverage. The law sets up “exchanges” where private insurers will compete to provide coverage to people who don’t have it.
• The government will not seize control of hospitals or nationalize doctors.
• The law does not include the public option, a government-run insurance plan that would have competed with private insurers.
• The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.
PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. We have concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers.
It’s true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.
Republicans who maintain the Democratic plan is a government takeover say that characterization is justified because the plan increases federal regulation and will require Americans to buy health insurance.
But while those provisions are real, the majority of Americans will continue to get coverage from private insurers. And it will bring new business for the insurance industry: People who don”t currently have coverage will get it, for the most part, from private insurance companies.
Consider some analogies about strict government regulation. The Federal Aviation Administration imposes detailed rules on airlines. State laws require drivers to have car insurance. Regulators tell electric utilities what they can charge. Yet that heavy regulation is not described as a government takeover.
This year, PolitiFact analyzed five claims of a “government takeover of health care.” Three were rated Pants on Fire, two were rated False.
‘Can’t do it in four words’
Other news organizations have also said the claim is false.
Slate said “the proposed health care reform does not take over the system in any sense.’ In a New York Times economics blog, Princeton University professor Uwe Reinhardt, an expert in health care economics, said, “Yes, there would be a substantial government-mandated reorganization of this relatively small corner of the private health insurance market (that serves people who have been buying individual policies). But that hardly constitutes a government takeover of American health care.”
FactCheck.org, an independent fact-checking group run by the University of Pennsylvania, has debunked it several times, calling it one of the “whoppers” about health care and saying the reform plan is neither “government-run” nor a “government takeover.”
We asked incoming House Speaker John Boehner’s office why Republican leaders repeat the phrase when it has repeatedly been shown to be incorrect. Michael Steel, Boehner’s spokesman, replied, “We believe that the job-killing ObamaCare law will result in a government takeover of health care. That’s why we have pledged to repeal it, and replace it with common-sense reforms that actually lower costs.”
Analysts say health care reform is such a complicated topic that it often cannot be summarized in snappy talking points.
“If you’re going to tell the truth about something as complicated as health care and health care reform, you probably need at least four sentences,” said Maggie Mahar, author of Money-Driven Medicine: The Real Reason Health Care Costs So Much. “You can”t do it in four words.”
Mahar said the GOP simplification distorted the truth about the plan. “Doctors will not be working for the government. Hospitals will not be owned by the government,” she said. “That’s what a government takeover of health care would mean, and that’s not at all what we”re doing.”
How the line was used
If you followed the health care debate or the midterm election – even casually – it’s likely you heard “government takeover” many times.
PolitiFact sought to count how often the phrase was used in 2010 but found an accurate tally was unfeasible because it had been repeated so frequently in so many places. It was used hundreds of times during the debate over the bill and then revived during the fall campaign. A few numbers:
• The phrase appears more than 90 times on Boehner’s website, GOPLeader.gov.
• It was mentioned eight times in the 48-page Republican campaign platform “A Pledge to America” as part of their plan to “repeal and replace the government takeover of health care.”
• The Republican National Committee’s website mentions a government takeover of health care more than 200 times.
Conservative groups and tea party organizations joined the chorus. It was used by FreedomWorks, the Heritage Foundation and the Cato Institute.
The phrase proliferated in the media even after Democrats dropped the public option. In 2010 alone, “government takeover” was mentioned 28 times in the Washington Post, 77 times in Politico and 79 times on CNN. A review of TV transcripts showed “government takeover” was primarily used as a catchy sound bite, not for discussions of policy details.
In most transcripts we examined, Republican leaders used the phrase without being challenged by interviewers. For example, during Boehner’s Jan. 31 appearance on Meet the Press, Boehner said it five times. But not once was he challenged about it.
In rare cases when the point was questioned, the GOP leader would recite various regulations found in the bill and insist that they constituted a takeover. But such followups were rare.
An effective phrase
Politicians and officials in the health care industry have been warning about a “government takeover” for decades.
The phrase became widely used in the early 1990s when President Bill Clinton was trying to pass health care legislation. Then, as today, Democrats tried to debunk the popular Republican refrain.
When Obama proposed his health plan in the spring of 2009, Luntz, a Republican strategist famous for his research on effective phrases, met with focus groups to determine which messages would work best for the Republicans. He did not respond to calls and e-mails from PolitiFact asking him to discuss the phrase.
The 28-page memo he wrote after those sessions, “The Language of Healthcare 2009,” provides a rare glimpse into the art of finding words and phrases that strike a responsive chord with voters.
The memo begins with “The 10 Rules for Stopping the ‘Washington Takeover’ of Healthcare.” Rule No. 4 says people “are deathly afraid that a government takeover will lower their quality of care – so they are extremely receptive to the anti-Washington approach. It’s not an economic issue. It’s a bureaucratic issue.”
The memo is about salesmanship, not substance. It doesn’t address whether the lines are accurate. It just says they are effective and that Republicans should use them. Indeed, facing a Democratic plan that actually relied on the free market to try to bring down costs, Luntz recommended sidestepping that inconvenient fact:
“The arguments against the Democrats’ healthcare plan must center around politicians, bureaucrats and Washington … not the free market, tax incentives or competition.”
Democrats tried to combat the barrage of charges about a government takeover. The White House and House Speaker Nancy Pelosi repeatedly put out statements, but they were drowned out by a disciplined GOP that used the phrase over and over.
Democrats could never agree on their own phrases and were all over the map in their responses, said Howard Dean, former head of the Democratic National Committee.
“It was uncoordinated. Everyone had their own idea,” Dean said in an interview with PolitiFact.
“The Democrats are atrocious at messaging,” he said. “They’ve gotten worse since I left, not better. It’s just appalling. First of all, you don”t play defense when you”re doing messaging, you play offense. The Republicans have learned this well.”
Dean grudgingly admires the Republican wordsmith. “Frank Luntz has it right, he just works for the wrong side. You give very simple catch phrases that encapsulate the philosophy of the bill.”
A responsive chord
By March of this year, when Obama signed the bill into law, 53 percent of respondents in a Bloomberg poll said they agreed that “the current proposal to overhaul health care amounts to a government takeover.”
Exit polls showed the economy was the top issue for voters in the November election, but analysts said the drumbeat about the “government takeover” during the campaign helped cement the advantage for the Republicans.
Rep. Earl Blumenauer, an Oregon Democrat whose provision for Medicare end-of-life care was distorted into the charge of “death panels” (last year’s Lie of the Year), said the Republicans’ success with the phrase was a matter of repetition.
“There was a uniformity of Republican messaging that was disconnected from facts,” Blumenauer said. “The sheer discipline . . . was breathtaking.”
By: Bill Adair, Angie Drobnic Holan, PolitiFact-December 16th, 2010
Commerce Clause Conundrum–Will The Hudson Ruling Stand?
In declaring unconstitutional the new requirement for Americans to buy health insurance, federal Judge Henry Hudson rests his decision on one of the most widely applied clauses in the Constitution.
Does his interpretation hold up?
Hudson ruled Monday that the Commerce Clause does not give Congress the authority to make people buy something. The Clause itself serves as the basis for a vast swath of federal regulatory statute, and it states, simply, that:
The Congress shall have Power … To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes
The Commerce Clause has been interpreted quite broadly over the years, to the point where “interstate” holds little distinctive meaning in the eyes of judges. Courts have so thoroughly established the precedent that one economic action by one person, even if it happens only within one state, can affect the broader economy of any good in question, that the Commerce Clause generally applies to all economic activity.
Hudson’s problem with the federal government’s argument is that this is a novel application of the Commerce Clause, in that it actually forces people to buy something.
Earlier in this opinion, the Court concluded that Congress lacked power under the Commerce Clause, or associated Necessary and Proper Clause, to compel and individual to involuntarily engage in a private commercial transaction, as contemplated by the Minimum Essential Coverage Provision [i.e., the requirement to buy insurance]. The absence of constitutionally viable exercise of this enumerated power is fatal to the accompanying sanction for noncompliance. …
A thorough survey of pertinent constitutional case law has yielded no reported decisions from any federal appellate courts extending the Commerce Clause or General Welfare Clause to encompass regulation of a person’s decision not to purchase a product, notwithstanding its effect on interstate commerce or role in a global regulatory scheme. The unchecked expansion of congressional power to the limits suggested by the Minimum Essential Coverage Provision would invite unbridled exercise of federal police powers. At its core, this dispute is not simply about regulating the business of insurance–or crafting a scheme of universal health insurance coverage–it’s about an individual’s right to choose to participate.
There are more ins and outs, including whether or not the individual mandate is enforced by a “tax” or a “penalty,” but that’s the crux of Hudson’s ruling: a lack of precedent for forcing people into commercial engagement.
There is, however, some precedent.
As Georgetown constitutional law professor Louis Michael Seidman pointed out, the 1964 Civil Rights Act forced businesses into economic engagement when it outlawed racial discrimination in business. Some restaurants didn’t want to engage in commerce with black people, but the federal government forced them to (coincidentally, this was the portion of the law to which Sen.-elect Rand Paul objected).
In another case, Wickard v. Filburn, the federal government tried to penalize a farmer for growing wheat on his own property simply for him and his family to eat. He wasn’t selling it. But the federal government wanted to drive up the price of wheat, and the Supreme Court ruled that the government was within its powers to penalize him for this noncommercial activity and force him, instead, to buy his wheat from the interstate wheat economy, which Congress governs. That decision was handed down in 1942, but the Supreme Court reaffirmed it (cited it to support the logic of a ruling) in 2005, in its ruling on the Raich medical marijuana case.
Judges can decide on their own how directly those ruling apply, and the Supreme Court can always go back on previous decisions if the justices feel it appropriate.
But those are the relevant decisions in which a vaguely similar issue was confronted, in case you were wondering if there’s any historical context for the issue that’s now being forced.
By: Chris Good, Associate Editor –The Atlantic, December 13, 2010
A World Without an Individual Mandate: Careful What You Wish For GOP
Health economist Jon Gruber runs the numbers on a world in which the individual mandate is struck down and not replaced by anything:
-Repeal of the requirement to buy insurance would mean more people would wait until they get sick to buy insurance in the new nongroup exchanges, which would increase the average premium by 27 percent in 2019.
-Retaining the law’s insurance reforms, but repealing the subsidies as well as the requirement to purchase insurance, would further discourage people from buying insurance when they’re healthy. Premiums in 2019 would cost twice as much as projected under the law as a result.
-Retaining the law but repealing the mandate would newly cover fewer than 7 million people in 2019 rather than the 32 million projected to be newly covered by the law. Federal spending, however, would decline by only about a quarter under this scenario since the sickest and most costly uninsured are the ones most likely to gain coverage.
-Retaining only the insurance reforms in the law — repealing both the mandate and the subsidies — would not increase the number of people with insurance, leaving 55 million people uninsured in 2019.
By Ezra Klein | December 13, 2010;
Individual Mandate: Cutting Off Your Policies to Spite Your Opponents
To step outside the latest Supreme Court case, it’s worth remarking on the long-term damage conservatives are doing their cause by focusing their fire on the individual mandate.
The political case for their strategy is clear: The individual mandate, like most taxes, is unpopular. In fact, it’s one of the only unpopular elements of the whole bill. But it’s also one of very few ways to have a health-care system where everyone has coverage but private insurers dominate. In the long run, it may be the only way. That’s why Republicans originally thought up the idea, and why it’s mainly been associated with a Republican health-care bill. Mitt Romney, Chuck Grassley, Orrin Hatch, Bob Dole, Judd Gregg and Mike Crapo are just a few of the prominent Republicans who’ve cosponsored legislation with individual mandates.
More internationally, you may have heard of the conservative affection for Singapore’s health-care system. Here’s how the journal of the American Enterprise Institute describes Singapore’s structure in a gushing article: “In Singapore’s system, the primary role of government is to require people to save in order to meet medical expenses they don’t expect.” Another term for the government forcing you to put money into a vehicle that helps protect you from a health-care crisis is, well, an individual mandate.
Switzerland and the Netherlands also use individual mandates to sustain universal health-care systems that are less centralized than single-payer arrangements. It’s a pretty common device. But if Republicans get it ruled unconstitutional in America, they’d be wise to ask themselves what other options they have: After all, the constitutionality of Medicare is not in question, and that’s really the other model we could eventually trend toward. As Matt Miller put it in a column a few months back:
Conservatives, either from confusion, or for the sheer fun of taking a political bite out of Democrats, are fighting the one measure that’s essential if private insurance is to retain its central role in American health care … [But] be careful what you wish for. By fighting the mandate needed to make private insurance solutions work, and doing nothing to ease the health cost burden on everyday Americans, you’ll hasten the day when the public throws up its hands and says, “Just give us single-payer and price controls.” Don’t think the anti-government wave this fall won’t reverse itself on health care if the most private sector-oriented health care system on earth keeps delivering the world’s costliest, most inefficient care.
By Ezra Klein | December 13, 2010
Charles Krauthammer Is the Fraud
Charles Krauthammer says that Obama has conned Republicans into agreeing to a second stimulus even bigger than the first. Democrats are too stupid to see this (and Republicans are even more stupid, presumably, since they are the victims).
Barack Obama won the great tax-cut showdown of 2010 – and House Democrats don’t have a clue that he did. In the deal struck this week, the president negotiated the biggest stimulus in American history, larger than his $814 billion 2009 stimulus package. It will pump a trillion borrowed Chinese dollars into the U.S. economy over the next two years – which just happen to be the two years of the run-up to the next presidential election. This is a defeat?
He’s right about the Democrats’ stupidity, but this is not Krauthammer at his most lucid.
Yes, Democrats are fools to tear their hair out over this deal, which gives them most of what they wanted: the middle-class tax rates, unemployment benefit extension, payroll-tax cut, and so on. They compound the idiocy by advertising higher taxes on the rich as their core objective. Forget relieving poverty, widening access to health care, improving opportunities for the disadvantaged. What matters more than any of that is sticking it to “millionaires and billionaires” (two-earner households making more than $250,000). You bet, the Democrats are acting like fools.But this stimulus is not bigger than the first, not even close. Two-thirds of its “cost” is keeping tax rates where they currently are. There is no new stimulus in failing to put taxes up–in forgoing a drastic fiscal tightening that nobody wanted and nobody expected. Unlike Krauthammer, I think further short-term stimulus makes sense, so I welcome the $300 billion (over two years) or so of extra stimulus in the deal. Oppose this if you like, but please don’t call it a bigger stimulus than the first.
In any event, the key question is this: does Krauthammer oppose the deal? Having declared Obama guilty of a massive swindle, and recalling that he is opposed to all of Obama’s sinister purposes, Krauthammer is obliged by his own logic to say what a bad thing the agreement must be. So what exactly did he want to happen? Presumably, raise everybody’s taxes next month, with an especially steep rise for $250,000+ households. Has he previously advocated this policy? Maybe he has, and I missed it; if so, I apologize. But if he agrees it makes sense for now to keep taxes where they are, which has been the Republicans’ defensible position, what is so bad about what just happened? Krauthammer is left opposing it because Obama was in favour. It is not every day that Krauthammer is backed into an absurd and dishonest position by his own logic.
What about the long-term deficit? This deal, if temporary, has little effect on that either way, and could easily be deficit-reducing if it avoids a second dip (as Krauthammer seems to concede it might). Obviously, the long-term deficit remains a huge concern. Tackling that requires prolonged Bowles-Simpson-type efforts that were not on the agenda for this deal. They should have been, but they weren’t. Was that a reason for rejecting the deal and letting taxes rise next month? I think not. Again, if that is the outcome Krauthammer wanted, then all right. But if that is not his position, then he is the fraud.
Read David Brooks instead.
BY: Clive Crook, Senior Editor of The Atlantic-December 11, 2010
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