MEDICARE MUDDLE: Gupta’s explainer!


Part 2—O’Brien and "expert" stage fraud: When Medicare came center stage in the White House campaign, so did a series of charges.

Mitt Romney began saying that Obama “stole” $716 billion from Medicare, using the money to pay for Obamacare.

In turn, Obama said that seniors would pay $6400 more per year under terms of Paul Ryan’s Medicare plan.

Are these charges accurate? In a rational world, journalists would be busting their butts to help you get clear on that question.

You don’t live in that world! In your world, the New York Times avoids such tasks like the plague (see THE DAILY HOWLER, 8/20/12). On TV, actors are paid millions of bucks to impersonate competent journalists.

They spend their days in make-up and hair. By night¸ they stage utterly useless pseudo-discussions—the kind of discussion which occurred on Anderson Cooper 360 last Tuesday night.

Soledad O’Brien sat in as guest host. As she started, she played videotape of two party spokesmen repeating the claims about Medicare which have come center stage.

Then, she introduced one of CNN’s "policy experts." Please don't let the kids watch:
O'BRIEN (8/14/12): Social Security turned 77 today. But it's Social Security's younger cousin, Medicare, that's been getting all the headlines. Medicare's not so healthy. And there's a political battle over how to fix it. You probably heard of some of it.

WASSERMAN SHULTZ (videotape): Actually, if Mitt Romney and Paul Ryan became president and vice president of the United States, they'd be able to end the Medicare guarantee, shred the health care safety net that Medicare has provided for more than 50 years, and turn Medicare into a voucher program. Leaving seniors really out in the cold.

SUNUNU (videotape): Medicare has had $760 billion taken from it and put in Obamacare and with all due respect to your analyst that said some of it went back to Medicare, a very small amount went back to Medicare. About $700 billion was taken away which reduces payments to providers and reduces services.

O'BRIEN: So tonight, we're setting aside the partisan back and forth. Instead, we've called in a specialist, 360 M.D. Sanjay Gupta, to help make sense of President Obama and Mitt Romney's medicine for Medicare.
Hurrah! Dr. Gupta was going to help us make sense of the candidates’ plans! On the down side, he and O’Brien were going to “set aside the partisan back and forth!”

Why would they want to do that? For ourselves, we would have liked to see Gupta evaluate “the partisan back and forth.” How accurate are those dueling charges? Surely, CNN viewers could use some help in working that out.

Instead, O’Brien said that Gupta would “help make sense” of the two candidates’ plans.

Unfortunately, nothing of the sort occurred as Gupta spoke with O’Brien. O’Brien was thoroughly useless this night. Gupta was much worse.

O’Brien distinguished herself this night by asking largely useless questions. Her first question was quite imprecise. This occasioned a sprawling reply:
O’BRIEN (continuing directly): Hey, Sanjay! First, let's talk Medicare. Compare the president's plan to the Ryan plan.

GUPTA: The latest iteration is the Ryan-Wyden plan—there was a Ryan plan, but then he co-authored this plan with the senator from Oregon, Ron Wyden—and basically, I think the best way to describe this is that, for people who are 55 and younger, this is who it's going to impact. So about 10 years from now, when those people start getting to retirement age, there's going to be a different sort of option. People can opt to get a stipend, which right now is projected to be about $8000, and use that money to buy into the private health care industry. So they can say “Look, you know, I want to do Medicare, instead I want to use this money and buy my own insurance.” Before, there was no Medicare option as part of that. Now you can still opt to stay in Medicare. So that's an important point because they're not saying they're getting rid of Medicare, they're just making other options available, believing that that competition will drive down prices.

People talk a lot about these “cuts.” And what they're really talking about is capping the amount that Medicare can grow over the next 10 years. And when they figure, when they do the projections, they figure that they cap the growth at just a half a percent over normal Gross Domestic Product, that will be about $700 billion in lost money. Both the Ryan-Wyden plan as well as the Affordable Care Act, Obamacare, do the same thing. They both have those sorts of caps in place. So there's a similarity there as well, Soledad.
If you choose to watch the tape, you will see that Gupta’s rapid-fire delivery adds to the confusion inherent in this sprawling reply. Trust us: Very few viewers had any idea what Gupta was talking about in this sprawling address. But then, he had been given a very general question to work with.

As he started, Gupta tried to describe the Ryan-Wyden plan, which he described as “the latest iteration” (of something). Watch the tape, and see if you can follow what he is saying. Indeed, do you even understand what Gupta means as you read his words today? Even with all the time in the world, do you understand what he says?

One specific question:

Will seniors be able to continue in traditional Medicare under this latest iteration of the Ryan plan? Gupta certainly made it sound that way in the highlighted passages, if you could follow his rapid speech. But is that what he actually meant? And would that statement be accurate? O’Brien made no attempt to clarify this point, although Gupta seemed to suggest that Ryan’s plan will force no change on anyone at all!

If true, that’s a very significant fact. O’Brien let it go.

Back to that sprawling response: In the second part of his rambling answer, Gupta gave a jargonized account of what he called “those cuts.” Trust us: No one had the slightest idea what he was talking about—and if our own understanding is correct, what he said just wasn’t accurate. As he continued, he made a statement about “lost money,” a statement which may have sounded a bit scary—but very few viewers had any idea what he was saying in this long, rambling, rapid-fire answer.

After Gupta completed this ball of confusion, O’Brien was forced to speak again. At this point, she could have tried to ask a more specific question. She could have asked this, for example: Did Obama really take $700 billion from Medicare? Did he really use that money to pay for Obamacare?

Those are the charges Romney is making. Why not ask if these charges are accurate, using them as the framework for explaining Obama’s plan?

Alas! Instead, O’Brien adopted a form of halting speech, seeming to signal how hard she was thinking. Out of this mental struggle, she produced a halting second question, and Gupta blathered again:
O'BRIEN: So where, then, does that money come from? That $700 billion that everybody's been talking about?

GUPTA: Well, it's interesting. So as part of the Affordable Care Act, and this has been one of those things that has been very controversial, but people talk about this thing known as the Independent Payment Advisory Board. And essentially this is a 15-member board that looks at Medicare costs, health care costs overall, and says, “OK, we're projected to go over now, so we got to figure out some places to make cuts.”

As far as the Ryan-Wyden plan, it really has more to do with this belief that if you engage the private sector, it's going to bring the Medicare costs down overall and they're going to be able to accrue those, you know, $700 billion or whatever the number is finally after 10 years, as a result of that.
O’Brien’s question was halting, but relevant; Gupta’s answer was awful. An actual expert could have told O’Brien how the Affordable Care Act reduces future Medicare spending by that $716 billion. Indeed, to see Sarah Kliff explain the basics of this point, just click here.

There are serious problems with Kliff’s rhetoric. But she answers that question with ease.

Please note: Kliff’s rundown appeared on Wonkblog on that same day, August 14, three hours before Gupta went on the air. Simply put, Gupta didn’t seem to be well-informed about this point, or about much of anything else. Nor was he clear or coherent.

In her third and final question, O’Brien continued to struggle and strain. By now, she was barely speaking English—and Gupta continued the bafflegab which defined this useless segment:
O'BRIEN (continuing directly): If you get that money, then if it's coming from that direction, where does it go eventually?

GUPTA: With regard to the Affordable Care Act, if you look through it and I've read through this a couple of times now, all 2000-some pages, you find that, you know, the idea of providing preventive services, for example, for free, meaning no co-pays, no additional charges, completely free, all that costs money. And a lot of the money that they, you know, get as a result of the cap in Medicare growth actually goes back to provide some of those services, to provide some of those services under the Affordable Care Act.

We don't see that in the Ryan-Wyden plan. You don't see where that money goes. But the idea that that money would go back into Medicare, back into the safety net, back into the federal entitlement to protect people who are 65 and older, there's not evidence of that right now in the Ryan-Wyden plan.
Presumably, O’Brien wanted to know what is done with the $700 billion “that everyone’s been talking about.” She may have been wondering if Obama spend that money on Obamacare, as Romney has been charging?

The answer is actually rather simple. There’s no sign that Gupta knew it, although he praised himself for having read the entire health care law.

Might we return to our starting point? Some basic charges were being advanced about the candidates’ Medicare plans. Most specifically, Romney was charging Obama with “stealing” $716 billion from Medicare, then using the money to pay for Obamacare.

A competent TV star would have known how to examine the truth of that high-profile charge. But O’Brien wasn’t competent this evening, and Gupta was massively worse.

Alas! You live in a world where TV performers of this type are paid millions of dollars to go on the air and pretend to stage discussions. In truth, O’Brien is on the air because she’s pleasant and likeable. Gupta is on the air because his title and his appearance give the impression that he must be very smart.

In fact, O’Brien’s work was hapless this evening; Gupta’s performance was worse But nothing would stop the charming host from declaring her mission accomplished. The garbled session ended with this Kafkaesque exchange:

O'BRIEN (continuing directly): All right. Sanjay Gupta, thank you for walking us through that explainer. Appreciate it greatly!

GUPTA: You got it, Soledad! Any time, thank you.
O’Brien pretended that an “explainer” had occurred. Gupta threatened to do it again. But none of their viewers had any idea whether those charges were actually accurate—the charges which had started this segment, presented on videotape.

We’ll be discussing the Medicare muddle all week. Tomorrow, we will start to discuss the accuracy of Romney’s charges against Obama. That said:

In a rational world, O’Brien and Gupta would be long gone, fired for transparent incompetence. But you don’t live in that world.

In your world, O’Brien is suitably perky and likable; Gupta seems like he’s smart. Night after night, you’re handed their cons. They get rich in the process.

O’Brien and Gupta should be off the air. We liberals are too weak to say that.

Tomorrow: Kliff enables Mitt


  1. An explanation of Medicare in terms of dollars is bound to fail, because Medicare is defined by services. Take the example of my wife's lymphademia.

    Today, a medical specialist is available to her at Stanford University, although there's a very long wait for appointments. The doctor is covered by Medicare, but with co-pays. Some of her various treatments are covered; some are not.

    Our questions, under any proposal (including doing nothing right now), would be

    1. Will the same quality of doctors be available?
    2. How long will the wait be for appointments?
    3. What will happen to the co-pays?
    4. Which of the various treatments will have to come from non-covered sources?
    5. How will the changes affect the development of new treatments and other medical advances?

    One cannot expect CNN to answer these questions. Yet, these are the questions that need answers.

    1. You questions are primarily about the ratio of doctors to patients.

      Questions that need answers are why did Stephen Helmsley, CEO of UnitedHealth Group, the largest provider of Medicare advantage coverage, take home a salary of $42 million last year?

      What effect do corporate profits have on the overall cost of healthcare in general and Medicare in particular?

      Why does Medicare need to channel taxpayer money through insurance companies at all? Why don't they pay the providers directly for ALL benefits?

      Why don't politicians and journalists talk about this more than 45 minutes twice a year?

    2. Why does Medicare need to channel taxpayer money through insurance companies at all? Why don't they pay the providers directly for ALL benefits?

      gravymeister -- I think you meant "Obamacare", rather then "Medicare".

      I agree that channeling Obamacare payments through insurance companies doesn't make a lot of sense. Obama and the Dems are totally responsible for this inefficient system, since they passed Obamacare with almost no Republican votes.

    3. Most of Medicare Advantage payments for doctors and medicine are subsidized by MEDICARE.

      I have a document sent to me by UnitedHealthcare Group that goes over those expenditures line by line.

      At this point in time, most "Obamacare" money goes to pay what was formerly MEDICAID expenses, and expanding coverage to those that were excluded from Medicare for one reason or another.

      In one of the most flagrant displays of hypocrisy in modern times, Republicans in the House and Senate made sure ACA was FUBAR with amendments, then they voted against it anyway.

      I guess you "misremembered" that part.

      And you're partly right, channeling ANY government healthcare benefits through insurance companies makes sense only to insurance companies and their willing water carriers.

  2. And:

    Why does healthcare in the USA cost so much more, let's admit it, TWICE as much more, as in other parts of the western world?

    We know it isn't because we get better outcomes. They get outcomes just as good or better.

    We know it isn't because we have "too much government involvement and not enough market competition." They've got more government involvement then we do.

    Why *are* we getting ripped off here in the good old US of A?

    1. We pay twice as much for medicine as countries with socialized systems, but we also pay twice as much as countries without socialized systems. Furthermore, our system is hardly free market. Even without Obamacare, what with Medicare, Medicaid, SCHIP, etc., I believe the government pays for around half the health care in the country. And, it regulates the other half quite a bit.

      It's just not the case that simply switching to some government system will automatically make our health care more efficient and more affordable.

    2. If you can't answer the question, David, just say so.

      No one said "simply switching to some government system" except you.

      The idea is to look at what's working elsewhere in the world -- which yes, unfortunately for you and your fellow free-market cheerleaders, involves what you would consider significantly more government involvement -- and see how we can apply that here in the USA.

      But religiously committed idiots (they call themselves believers in free market of competition, or sometimes, hilariously, libertarians) always say the same two idiotic things:

      1) "there's no magic government answer" (no one said there was, idiot) and

      2) "our system isn't very free market" (it's more so than the others, which work better, you fraud)

  3. It's just unfathomable to me that someone could be so economically illiterate to think that you can cut payments without cutting benefits. It's like if a struggling family said "We're going to balance our budget next year by cutting our payments to the electric company." Sure, it sounds great - until the electric company shuts your power off. If you really believe this, why not just reduce Medicare payments to ZERO! That would totally balance the budget, and only a lying liar would suggest that you're cutting benefits - duh, idiot, we're not cutting benefits we're just reducing payments.

    1. Maybe it's unfathomable because you don't know what you're talking about:

      "Most of the proposed savings come from reducing overpayments to Medicare Advantage and reducing reimbursement rates to hospitals.

      What should you know about these changes?

      Medicare Advantage is a 15-year failed experiment in privatization. Running Medicare through private insurance companies was supposed to save money through the magic of the marketplace; in reality, private insurers, with their extra overhead, have never been able to compete on a level playing field with conventional Medicare. But Congress refused to take no for an answer, and kept the program alive by paying the insurers substantially more than the costs per patient of regular Medicare. All the ACA does is end this overpayment."