How Can We Have a Debate When People Base Decisions on Lies?

In my recent posts on the healthcare debate and the town hall protests, a point that I've tried to make is that the functioning of our democratic system is premised, in part, on a healthy, open, and honest debate about issues. I've expressed worry and concern that lies are controlling the current debate over healthcare.

There are legitimate arguments both for and against reform and both for and against some of the current reform proposals. What will it cost? How will that cost be paid for? What will be the impact, if any, on employers? Will people be entitled to choose their own doctor? These are just a few of the legitimate concerns that should be discussed (I won't take the time to list the reasons to support healthcare reform; I think that I've done that previously.)

But so long as much of the "debate" is focused on falsehoods (and rebutting those falsehoods), then we're not spending our time actually debating the real issues. I suspect that is precisely the plan of those who are involved in helping to orchestrate the astroturf opposition to healthcare reform: If we keep the discussion from the real merits of the proposals, then we can scare people and make them oppose those proposals which they might support if they knew the truth.

Well, now there is evidence to support the concern that people are basing their decisions on healthcare reform, at least in part, on Sarah Palin's fears of "death panels" and of other falsehoods that have become opposition talking points. According to a new NBC Poll: Myths Endure on Health Care, Highlighting Doubts on Overhaul:

Nearly half of Americans believe that a proposed overhaul of the health care system means the government will decide when to stop providing medical treatment to senior citizens, according to the latest polling by NBC News released this evening.

Some 45% said they believe the plan is likely to include such a provision that has become known as “death panels” despite bipartisan efforts by President Barack Obama and the provision’s author, Republican Georgia Sen. Johnny Isakson to dispel the idea. (Isakson, in a recent interview with the Washington Post called the confusion “nuts.”)

To be sure, 50% of respondents said they believe the bill was unlikely to include such a provision, but the deep split over the veracity of “death panels” underscores the difficulty Democrats have had in selling their overhaul to the public.

Further, a majority of Americans (55%) believe the bill will extend health insurance coverage to illegal immigrants even though no proposals currently under negotiation would do so. An equally high number (54%) believe the overhaul will lead to a “complete” government takeover of the health care system, although there is also no actual proposal for that, either.

Additionally, 50% believe that the overhaul will use federal tax dollars to pay for abortions. While it is unclear if the final bill would do so, current law bans federal funds from being used to fund abortion except in cases of rape, incest, or to save the mother’s life. The president has said he is not interested in expanding abortion rights in the health care package. “I’m pro-choice, but I think we also have the tradition in this town, historically, of not financing abortions as part of government-funded health care,” Obama said in a July interview with CBS.

Think about some of those findings for a moment. 45% of those surveyed believe that the healtchare reform proposals include "death panels". Several things about that scare me. First, it scares me that people are willing to simply listen to the fearmongers and won't take the time to try to learn the truth (of course, going to a town hall meeting to hear from a member of Congress won't necessarily be of much help; at some town hall meetings, Republican members of Congress fail or refuse to refute the lie and at others there is so much shouting that the elected representative cannot effectively communicate).

 

Second, I worry about why people would believe these sorts of lies. Is it because President Obama is a Democrat? Or is it because he is ... gasp ... black? Do people really, really think that President Obama or Nancy Pelosi want to euthanize grandma? And if they really, really do think that, ask yourself why. Why would President Obama want to euthanize grandma? What have those people -- or any Democrats, for that matter -- done, that would make people really, really believe that they want they government to euthanize people? Is it because Democrats support reproductive choice but opposed forcing Terri Schiavo to be kept alive? What makes people think that Democrats are really that evil?

Third, the media (well, all except FAUX News, I suppose) has been reporting on the fact that there are no "death panels" in the legislation. Yet people -- 45% apparently -- still believe Sarah Palin and Rush Limbaugh and their ilk. Obviously people have heard that there are "death panels" from some source and yet they refuse to believe other sources that tell them that the information is incorrect. Why? Why are people both willing to believe the obvious lie and so unwilling to believe the refutation of that lie?

One more set of numbers that I think further illustrates the issue. Daily Kos/Research 2000 conducted a poll on August 10-13. Look at these two questions and the results. Pay particular attention to the difference in responses between Democrats and Independents on one hand and Republicans on the other:

1. Do you think the health care reform plan being considered by President Obama and Congress creates "death panels" which have the authority to subjectively determine whether or not a gravely ill or injured person should receive health care based on their "level of productivity in society"?

	Yes	No	Not sure
All	11	72	17
Dem	9	74	17
Rep	37	31	32
Ind	17	61	22

 

2. Does the health care reform plan being considered by President Obama and Congress require elderly patients to meet with government officials to discuss "end of life" options including euthanasia?

	Yes	No	Not sure
All	19	58	23
Dem	9	74	17
Rep	37	31	32
Ind	17	61	22

What is causing Republicans to have such a different understanding of proposed legislation?

 

A debate and discussion on the necessity of healthcare reform is essential. A debate and discussion of the form that any healthcare reform takes is necessary. But neither of those debates can occur while we're wasting our time arguing about things that nobody has proposed. And neither of those debates can occur when all we do is yell and scream and not take a moment to be quiet, listen, and most importantly think.

 

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Incidentally, if you're interested in reading the provision, it can be found at the website of the Library of Congress. Unfortunately, direct linking seems to fail (the links time out after a day or so), so I've provided instructions that we accurate as of the date of this post as well as the full text of the relevant section at the bottom of this post. To get to the bill, click the link to the Library of Congress, then click on the link for HR3200: America's Affordable Health Choices Act of 2009, click on the link for Text of the Legislation. Then do a find (Ctrl-F) for 1233, click on that link , and you'll finally be at the bill. Try to find a reference to "death panels" or euthanasia.

And, in order to make things even easier, the full text of Section 1233 is reproduced below (sorry for the lack of formatting):

Section 1233 of House Resolution 3200:

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
(a) Medicare-
(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(A) in subsection (s)(2)--
(i) by striking `and' at the end of subparagraph (DD);
(ii) by adding `and' at the end of subparagraph (EE); and
(iii) by adding at the end the following new subparagraph:
`(FF) advance care planning consultation (as defined in subsection (hhh)(1));'; and
(B) by adding at the end the following new subsection:
`Advance Care Planning Consultation
`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--
`(I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes;
`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--
`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--
`(I) ensures such orders are standardized and uniquely identifiable throughout the State;
`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;
`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
`(2) A practitioner described in this paragraph is--
`(A) a physician (as defined in subsection (r)(1)); and
`(B) a nurse practitioner or physician's assistant who has the authority under State law to sign orders for life sustaining treatments.
`(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).
`(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
`(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
`(5)(A) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--
`(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional's authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
`(ii) effectively communicates the individual's preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
`(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items--
`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
`(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;
`(iii) the use of antibiotics; and
`(iv) the use of artificially administered nutrition and hydration.'.
(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(FF),' after `(2)(EE),'.
(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (N), by striking `and' at the end;
(ii) in subparagraph (O) by striking the semicolon at the end and inserting `, and'; and
(iii) by adding at the end the following new subparagraph:
`(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;'; and
(B) in paragraph (7), by striking `or (K)' and inserting `(K), or (P)'.
(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.
(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-
(1) Physician'S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:
`(3) Physician'S QUALITY REPORTING INITIATIVE-
`(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.
`(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.'.
(c) Inclusion of Information in Medicare & You Handbook-
(1) MEDICARE & YOU HANDBOOK-
(A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:
(i) An explanation of advance care planning and advance directives, including--
(I) living wills;
(II) durable power of attorney;
(III) orders of life-sustaining treatment; and
(IV) health care proxies.
(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--
(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);
(II) website links or addresses for State-specific advance directive forms; and
(III) any additional information, as determined by the Secretary.
(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.