Be prepared for the battle of misinformation

Yesterday’s monumental Supreme Court (SCOTUS) decision assured us that there indeed would be an ongoing health reform effort in this country through the Patient-Protection Affordable Care Act. Dr. Mark Ryan has written extensively about the decisions of yesterday also on this site, and rather than go into this in detail as well, I want to take a different stance on the issue.

The other thing that yesterday’s decision assured us is that with the upcoming elections this November, healthcare and politics will intersect in ways that we have not seen in a number of years. While healthcare has always been a hot button political topic, yesterday’s decision intensifies this debate and will force our nation to examine healthcare under a very skewed microscope. To this end, it is important that as we move forward with the next stages of healthcare reform implementation and the political elections, we be armed with good information we can use to dispel myths and combat misinformation.

There are a few points to make here:

First, yesterday’s decision reinforced that Medicaid will continue to be used as a political tool. From the Hill’s Healthwatch: “The ruling creates a dilemma for states, which can now decide whether to participate in the law’s expansion of Medicaid — a decision laden with political overtones for Republican governors who oppose the healthcare law.” As we have already seen with some states, Governor’s use the healthcare law to say “no” to federal dollars for healthcare expansion. The SCOTUS decision will make this one even more interesting to see which states decide to try and stay away from the expansion altogether. Playing politics with Medicaid is nothing new.

From Laura Katz Olson’s Politics of Medicaid:

“Superimposed on an already inequitable healthcare system that placed profits over patient care, Medicaid sustained and at times exacerbated many of the system’s inherent flaws. Regardless, it offered vital and sometimes life saving medical services to many indigent families and elders that would not have been obtained otherwise.”

Throughout Dr. Katz Olson’s book she describes ways that states often leverage Medicaid as a political tool with some politicians running on it as a platform and taking advantage of it to provide lucrative contracts to healthcare entities when it may bring political gain.

Regardless of what happens with Medicaid and the expansion, we all must be aware that at the state level Medicaid will be used as a heavy political tool.

Second, the amount of misinformation already coming out about healthcare is impressive. Just one example (there are probably hundreds by now),  Presidential candidate, Governor Mitt Romney stated:

“Obamacare was bad policy yesterday. It’s bad policy today. Obamacare was bad law yesterday. It’s bad law today. Let me tell you why I say that. Obamacare raises taxes on the American people by approximately $500 billion. Obamacare cuts Medicare, cuts Medicare, by approximately $500 billion. And even with those cuts, and tax increases, Obamacare adds trillions to our deficits and to our national debt and pushes those obligations on to coming generations.”

Statements like these can be hugely misleading for the public (especially those who do not work in healthcare). PPACA nowhere cuts $500 billion from Medicare. What it does do is end the costly Medicare Advantage program (which many have estimated costs the government a lot with minimal return on investment). In addition, PPACA doesn’t add “trillions to our deficits”  but rather works towards deficit reduction over the next decade. Also, PPACA works to reduce overall healthcare spending by the federal government.

However, on the surface, broad sweeping comments like this can be very dangerous for the public trying to decide on who our next leader will be.

Paul Krugman wrote yesterday:

“At one level, the most striking thing about the campaign against reform was its dishonesty. Remember “death panels”? Remember how reform’s opponents would, in the same breath, accuse Mr. Obama of promoting big government and denounce him for cutting Medicare? Politics ain’t beanbag, but, even in these partisan times, the unscrupulous nature of the campaign against [health] reform was exceptional. And, rest assured, all the old lies and probably a bunch of new ones will be rolled out again in the wake of the Supreme Court’s decision.”

Which brings me to my third point, we should all be prepared to talk lots about healthcare and money. James Surowiecki nailed this one in the New Yorker:

“Yet, strange as it may sound, the federal government does not have a spending problem per se. What it has is a health-care problem. The cost of most budget items typically rises at a reasonable rate, if at all, but the cost of Medicare, Medicaid, and the tax subsidy for employer-provided insurance has been rising much faster than everything else: in the past forty years, Medicare costs increased 8.3 per cent annually. If they’re not controlled, Medicare and Medicaid will eventually be by far our biggest expense. Preventing that is the key to getting our fiscal house in order.”

In some ways, PPACA tried to start to address this cost issue; however, it was well established that PPACA did not go far enough.

We must know that healthcare is unsustainable in its current form.

We must be able to describe some of the reasons why healthcare is so costly.

We must have a few solutions in our back pocket to discuss.

Fourth, with all this talk of healthcare policy, we cannot lose site of the patient for the system. Period.

We must remember why we are doing what we are doing in healthcare in the first place. We must never forget who the healthcare system is intended to serve.

It will be very important for all of us to have our facts straight about healthcare as we enter into the fall elections. Regardless of your politics, there are certain truths about healthcare that cannot just be “made up.” Please become informed around issues such as healthcare so we can have an informed debate.

Here at Occupy Healthcare, we will continue to take on these healthcare policy issues and offer up information that can hopefully be used in our national dialogue.

Be prepared and be informed.

Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

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  • Gary Oftedahl

    Thoughtful comments, and reflective of what both causes me “bemusement” and at the same time, a sense of angst at what will likely become of this decision. When initially asked by someone for my thoughts on the decision, I responded that it was too early to tell, but that I could guarantee the questioner ( a non health care person, but a concerned citizen) that they would be surprised if not astonished by the different takes on the decision.

    It reflects our ability (likely too kind a term) as humans to inflict our personal beliefs into interpretation of statements and decisions. Jonah Lehrer, in his book How We Decide, describes the phenomena seen in research of giving identical information to two people with different philosophical perspectives and obtaining often diametrically different interpretations….and that’s just due to our beliefs.

    Here, you are superimposing those with political and economic interests, who on top of personal philosophies are more vested with achieving their agenda rather than concern for the citizens who are patients/families/caregivers, and the ones we really should attend to.

    The politicization of health care, always a major topic, may be accelerated by the increased heat of passion generated by having a decision which either reinforced our beliefs, or absolutely flew in the face of our belief system. In both situations, the emotional responses, overlaid on a non-compromising, polarized public will challenge all of us committed to making true change–the occupation becomes a more challenging and risky activity. But, forward.

    • Ben Miller

      Gary, as always your thoughtful comments challenge. Thank you. And also, as always, I agree with you that this issue has multiple layers and is inherently complicated (it is healthcare, after all).

      The passion that we are seeing from certain communities will not be able to withstand the passion of all of us when we join together and work towards creating the system we all deserve. This is not about one person’s agenda, as Nate discussed yesterday, but rather this is about doing what is right for us all. But yes, the passion will carry us forward (hopefully in a direction that leads to substantive change).

      Many thanks, Gary!

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