How to bungle reporting on Medicare!


New York Times, meet Howard Dean: Medicare has come center stage. So has massive confusion.

How hapless has the discussion been? Let’s discuss the New York Times—and let’s discuss Howard Dean.

On Tuesday, we complained about a news report concerning the claims of Candidate Romney. On the front page of the Times, Adam Nagourney penned a hapless report which kept repeating Romney’s basic charge in this area (see THE DAILY HOWLER, 8/14/12).

Nagourney made no attempt to provide basic context or background information. One day later, Robert Pear did a follow-up report in the Times.

Pear was hapless too.

How pitiful was Pear’s report? Early on, he restated the charge Romney has been making. This is paragraph 4 of his useless report:
PEAR (8/15/12): ''You paid into Medicare for years, every paycheck,'' the [Romney] advertisement says. ''Now when you need it, Obama has cut $716 billion from Medicare. Why? To pay for Obamacare. So now the money you paid for your guaranteed health care is going to a massive new government program that's not for you.''
According to Romney, Obama has taken $716 billion from Medicare. He has used this large amount of money to pay for Obamacare. It sounds like Medicare recipients are ebing hurt by his conduct.

Those sound like serious charges. But how serious is the situation? Consider some of the things you don’t learn in Pear’s report:

How much money is $716 billion? Pear never tells us how many years are involved in these alleged “savings.” He never tells us how much money will be spent on Medicare over the period at issue.

How much is that $716 billion? Is it one percent of total Medicare spending? Is it maybe 50 percent? Incredibly, Pear never gives readers any idea.

As everyone knows, giant numbers have little meaning absent such basic context. In this situation, it’s hard to know if we’re talking about a very large chunk of Medicare spending, or perhaps not so much.

You have to put big numbers in context! From tenth grade up, every journalist understands this point—except those at the Times.

Pear gives readers no real way to understand the size of these reductions/cuts/savings. Incredibly, there’s something else he makes no attempt to explain.

If future spending has been reduced, will that produce a reduction in Medicare services? In paragraph 5, Pear quotes an Obama spokesperson making a claim:
PEAR (continuing directly): Lis Smith, a spokeswoman for the Obama campaign, said, ''Mitt Romney's Medicare ad is dishonest and hypocritical.'' The savings, she said, ''do not cut a single guaranteed Medicare benefit.''
No benefits will be cut? (Sorry—no guaranteed benefits.) You’d almost think Pear would want to examine that claim, which is central to this topic.

If you thought that, you were wrong. Pear only returns to this point in paragraph 24, one paragraph from the end. When he returns, his work is a hopeless muddle:
PEAR: Mr. Ryan and Mr. Romney would limit the government's current open-ended financial commitment to Medicare. The government would contribute a fixed amount of money on behalf of each beneficiary, and future beneficiaries could use the money to buy private insurance or to help pay for coverage under the traditional Medicare program.

The new health care law, by contrast, will reduce projected Medicare payments to health maintenance organizations, hospitals and many other health care providers. As a backstop, to ensure savings, the law creates a Medicare cost control board. Cuts recommended by the board would take effect automatically unless Congress voted to block or change them.

Mr. Romney and Mr. Ryan would abolish the panel, which they describe as a tool for rationing health care.
Is that why the reductions in spending won’t lead to cuts in benefits? Is it because the reductions will come out of the pockets of health care providers? Pear never explains—and he never makes any attempt to examine the plausibility of such a claim. (If we knew what percentage of future spending is involved, we might be able to make a seat-of-the-pants judgment—although such judgments are no substitute for actual competent journalism.)

By the way: Do you understand the “backstop” Pear describes in that passage? According to Pear, “cuts recommended by the board would take effect automatically unless Congress voted to block or change them?”

Are we talking about cuts in payments here? Are we discussing cuts in services? As usual, Pear doesn't say.

We don’t understand that highlighted passage. Neither does anyone else.

Pear’s whole report is a ball of confusion. But then, the American journalistic elite is one of the least competent professional elites on the planet. As we’ve long said:

If engineers constructed bridges the way the Times writes news reports, all our cars would be in the Chesapeake Bay. These people can barely remember their names, let alone explain topics like this.

Nagourney’s report was the work of a clown. Pear, if anything, made matters worse. And then, last night, good God—Howard Dean!

Our pundit elite spills out of clown cars on the TV machine thingy each night. We’ll postpone Dean’s grotesque performance until we return to this topic.


  1. I think some kind of spam filter is blocking me here.

    Anyway, the data is available online. Google "July 14 CBO Bohner" and you'll find the Congressional Budget Office's charts and summaries. Democrats are citing the last page, Republicans Table 1. Overall it seems most of those savings they make come from changing the Fee For Services, but the actual equation there isn't explained from what I can see. Wikipedia says the ACA aka Obamacare establishes Fee For Service, meaning a doctor is paid for the service he does. Assuming the other proposal is in the Wikipedia entry, doctors are instead payed a flat fee, I guess by the hour, thereby putting more expensive tests on them to come up with the money (a boon to insurance companies?).

    I expect Demorats to take the bait and say, no we're just not increasing Medicare as much (citing the last page), when they could simply cite the part that says all this is all uncertain math. What isn't certain is that Republicans are trying to change the Affordable Care Act in other ways too, like cutting 11 million people off from Medicaid.

  2. This is one of the many formerly ironic instances under the Obama Presidency where the Republican becomes the Democrat and the Democrat the Republican.

    Does anyone seriously believe that if over $700B are cut from Medicare, then no services to patients are negatively affected? Once upon a time, it was Democrats who would be skeptical of such an argument, pointing out that it's pretty damn implausible that so much pure "fat" might ever be located in a program like Medicare, which has already gone under many decades of intense scrutiny.

    Even if it is hospitals, and not direct "guaranteed" services that are hit by this cut, who can believe that Medicare services won't be indirectly hit, and perhaps extensively so? Where does this money go now, so that no important health service can possibly be affected?

    I call Bullshit on this. I just don't believe it.

    But, because it's Obama's program, Democrats are making the classic Republican argument against government "waste", and the Republicans are gladly taking up the Democrats' old argument, and making an only too effective popular appeal.

    1. You're invited to look at the publicly available letter from the CBO to Bohner from July 14th and call bullshit on whatever you want with the facts to support you.

    2. H_A, The way I have read it (albeit a couple of years ago), is that the money would still be there because they planned to limit future price increases by hospitals, providers, etc.

    3. Lewis and CececilaMc,

      Maybe some day I'll get down into the weeds of this issue, but that day is not today.

      I repeat my most basic point: $700B is a LOT of money. I simply don't believe in some magic trick whereby that money goes away, yet nothing important is affected. I don't believe it when Republicans make that claim about government services, and I don't believe it now that it seems to be a politically very convenient argument for Obama Democrats. Waive your your hands how you may regarding reining in price increases elsewhere, I just don't believe that there will be no real cost imposed. I have very little doubt but that Republicans could set up a similar "fat cutting" scheme in another government program they might wish to target, with similar language. And, in that case, I have very little doubt, Democrats would be quick to realize that it was smoke and mirrors designed to cover a drastic reduction in services.

    4. H_A, I wasn't suggesting that there are no possible ramifications from this plan, only that this is what I think it entails (just what I had read).

      The ins and outs are most certainly a matter for ongoing analysis, if the media can tear itself away from their usual psychoanalysis.

    5. And one further point.

      One of the more depressing aspects of this proposed $700B reduction is that there is no one who has any incentive really to get to the bottom of what it really implies. Democrats don't want to be honest about its consequences, because it's important for them to pretend that nothing is lost. Republicans have no interest in the issue apart from their very immediate desire to use it as a cheap political trick; when the election is over, the issue will likely be buried by them.

      Who is looking to give an honest account of the matter? No one, that I can see.

    6. One point that was mentioned in a comments thread here the other day was that the providers and the AARP agreed to Obama's 700B "cut" to Medicare because the AARP was satisfied that it won't affect benefits and the providers were convinced that they would recoup the loss through an influx of newly insured patients courtesy of the Affordable Care Act. I think the only part to balk was the insurance companies who didn't want to see and end to there Medicare Advantage boondoogle.

    7. There are several other points missed here.

      Yes, some doctors cut off taking new patients, but medicare patients are a huge market, and a guaranteed growth market.
      Few businesses will survive by turning away the largest segment of their customers.
      Some new doctors are willing to work for large clinics rather than go through the hassle of private practice or limited partnerships.

      Smart businessmen LOVE price discrimination. They want the marginal income that would be lost with a single price schedule.

      Drug companies sell their products at whatever price the market will bear as long as it covers costs.
      In other words, if somebody is willing to pay you a 400% profit, take their money.
      If someone else will only pay a 40% profit, take their money, too.

      Hospitals would much rather get patients that pay a guaranteed rate of return rather than ones that pay nothing.

      We have to look beyond financing a clumsy, inefficient, overpriced system and fix the broken system itself.

      That isn't the current task of the government, but it can certainly come up with solutions to cut the cost of medical care and medicine.

      We need to think about the costs of medical school, malpractice, malpractice lawsuits, malpractice insurance, excessive and unneeded lab work and imagery, billing, record keeping and bureaucracy in general.

      Do two doctors really need two aides, two PACs, two receptionists, and three or four claims clerks?
      Obviously not, because many do without. If some can streamline, why not all?

      Don't blame Medicare or liberals for problems that few of us have bothered to address.

    8. Speaking of businessmen, why not let in immigrant doctors and let the competition for these high paying jobs bring the price down?

      Why not establish single payer and gut the plethora of insurance systems, I assure you, with marketing budgets and their bottom line to worry about. We have a government that has a projected deficit of trillions of dollars, no corporation in the world could do that. The public can decide health now is an investment.

      I don't mean to steal your thunder. But really, I'm not one to trust the market explicitly because the insurance industry is driving this backlash right now.

      After thinking about this some more, I realize the choice is between a government buerocracy (sp) and an insurance one, or just an insurance one. That's what the policies are, that's what at least should be hashed out. It's important to note which one has some measure of public control, and that both parties are in the pocket of insurance companies.

      Maybe I figured this all wrong, so please correct me, but over 400 billion of their projected savings is from changing the Fee For Service. The current law is Fee For Service, which means doctors don't have to come up with the money for expensive tests, insurance companies do. Repealing the Affordable Care Act means the government "saves" hundreds of billions of dollars right into the pockets of the insurance companies, while we get doctors who now think twice before providing more expensive cures. It also means 11 million people are kicked from Medicaid.

      All that said, I'm only a 22 year old janitor who dropped out of high school. Maybe I'm wrong about all this.

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