Mitt Romney's Thirteen Health Care Deceptions From the Debate
Section: Spin News
After the Presidential debate, there was a lot of criticism from Democrats that Romney made a large number of false accusations about the President’s policies and misrepresented his own position. Unlike other factcheckers, The Impartial Review News takes a different approach. We first identify the general persuasive style of the politician. After doing that we explain to our readers how that “style” can mislead you.
Therefore, The Impartial Review News doesn’t just look at the facts. The Impartial Review News looks for attempts to create false impressions. This approach makes it much easier to identify false statements because candidates tend to follow easily identifiable patterns if you know the persuasive strategy they are using. This article explains Romney’s persuasion style and as in the past that allowed the The Impartial Review News to discover more factual errors than other fact-checkers.
The Pig in the Poke (Smoke and Mirrors) Tactic
Factcheck.org suggested that in the past Romney has used a Pig in the Poke tactic on health care issues. We’ll elaborate on that idea. A Pig in the Poke is a dishonest political tactic where the politician only presents a partial position or policy on an important issue. Using an incomplete story gives the politician many advantages. First, the politician can adjust the story to make it more appealing to different audiences. This can be accomplished because the politician never gives enough details to let anyone fully understand what he’s proposing. The tactic also hides from your audience what you’re true intentions are.
The Pig in the Poke tactic also gives the politician another advantage. It’s difficult to attack a position or policy that you don’t understand. When analysts or an opponent criticizes the politician’s story, the politician can simply change the story and claim that critics are casting false aspersions. Similarly, when individuals attempt to investigate how you stand on an issue and find a flaw in it, you can shift your position. The politician gains these advantages because the story is so incomplete it’s like an inkblot. It’s essentially meaningless and open to a wide variety of interpretations.
Given that the story is incomplete, a Pig in the Poke story can be designed to be very appealing. That is, it can tell voters that they can have their cake and eat it to. The only problem is the politician can’t explain exactly how the magic is going to work. Therefore, the Pig in the Poke politician must be constantly vigilant that no one exposes the trick. The politician accuses those who challenge the vagueness of the plan by claiming that the person just doesn’t get it or counters with personal attacks that specifically claim the other person is unqualified to judge the plan or is biased. The politician may engage in fear-mongering to misdirect the audience or engage in pre-emptive personal attacks against those who are likely to credibly challenge the story.
The evidence to support an incomplete policy by it’s very nature has to be phony because the plan is incomplete and therefore can’t be supported by any kind of logical analysis unless it’s filled in and this is something the politician can’t do. This presents a problem because people often ask for evidence that a policy works. Therefore, the politician cites complex or appealing false evidence to add to the confusion.
Another quality of appealing but incomplete stories is that the story can be made to seem very appealing. In fact, this is one way to identify this sort of political style. The policies almost seem too good to be true. The story may even seem to rely on magic. However, like most things that are to good to be true, a thoughtful analysis will find the story is promising too much and leaves out important details. However, amidst the confusion caused by the vagueness of the policy, the phony evidence, shifting position, fear-mongering, the complexity of the issue and the back and forth personal attacks, confused supporters take the flimsy evidence on faith without checking and others may become convinced because they hope that all that is promised will come true.
So did Mr. Romney’s present a complete health care plan during the debate? Has he allowed others to subject his plan to rigorous independent analysis? Does his plan have any magical elements in it? Instead of explaining his position, did Romney engage in personal attacks that attempedt to undermine his critics credibility and bolster his own? Has he shifted position on the health care issue or offered phony evidence to support his incomplete plan? Has he engaged in fear-mongering?
Romney’s Medicare and Health Plans or Pigs?
Romney has made it clear that he will attempt to repeal Obamacare. However, since it’s the law he can’t do that. Instead, he proposes a plan that would repeal the regulations that lower insurance company profits and deliver care through insurance exchanges that are no longer government regulated. He argues that the “magic” of the free market will lower costs as a result of free market competition between insurance companies who will be forced to compete with one another for customers. In order to insure that companies don’t try to cut out services or quality, all companies will be regulated in some way similar to the way Medicare is regulated for quality and they will be forced to provide a not entirely specified minimum set of benefits.
The major differences between Romneycare and Obamacare is that Obamacare regulates insurance companies in a number of ways in order to insure that they don’t overcharge for their services and mandates some new preventive care services. Although many aspects of Romneycare remain unspecified his approach is not regulate the companies. Rather, he believes they will regulate themselves because they will all be competing for customers just as they do with Obamacare. That is, Obamacare really isn’t health care reform, it’s insurance company reform. Romneycare could be described as insurance company reform light.
From his website,
- ● Medicare is reformed as a premium support system, meaning that existing spending is repackaged as a fixed-amount benefit to each senior that he or she can use to purchase an insurance plan
- ● All insurance plans must offer coverage at least comparable to what Medicare provides today
- ● If seniors choose more expensive plans, they will have to pay the difference between the support amount and the premium price; if they choose less expensive plans, they can use any leftover support to pay other medical expenses like co-pays and deductibles
- ● “Traditional” fee-for-service Medicare will be offered by the government as an insurance plan, meaning that seniors can purchase that form of coverage if they prefer it; however, if it costs the government more to provide that service than it costs private plans to offer their versions, then the premiums charged by the government will have to be higher and seniors will have to pay the difference to enroll in the traditional Medicare option
- ● Lower income seniors will receive more generous support to ensure that they can afford coverage; wealthier seniors will receive less support
- ● Competition among plans to provide high quality service while charging low premiums will hold costs down while also improving the quality of coverage enjoyed by seniors
From Mitt Romney’s FAQs:
How high will the premium support be? How quickly will it grow?
“Mitt continues to work on refining the details of his plan, and he is exploring different options for ensuring that future seniors receive the premium support they need while also ensuring that competitive pressures encourage providers to improve quality and control cost. His goal is for Medicare to offer every senior affordable options that provide coverage and service at least as good as what today’s seniors receive. Lower income seniors in the future will receive the most generous benefits to ensure that they are able to get care every bit as good as that provided in the current Medicare program.”
How will the plan impact total Medicare spending?
“The total impact on spending will depend on a number of factors, including the rate of premium support increase and the effect of competitive pressure on providers. By replacing the inefficiency of the current system with a competitive, market-oriented system in which every provider – including the government – wants to find the most efficient way to provide high quality care, the plan puts the future of Medicare on a sound footing to meet the needs of future generations.”
How will traditional Medicare remain an option?
“Traditional Medicare will compete against private plans. It will be operated by the government and funded by premiums, co-insurance, and deductibles that are set at the level necessary to cover its costs. The attractiveness of this option to future seniors will depend on how its efficiency and quality compares to that offered by other providers in the marketplace. Future seniors will benefit from the innovation and competition among options.”
How will seniors be affected by the costs of different options?
“Future seniors will be able to enjoy the savings from selecting less expensive plans, or choose to pay more for costlier options. When the insurance premium costs less than the support provided, the balance will be available in an HSA-like account to pay for other out-of-pocket health expenses.”
There are a couple of more details from interviews with Mr. Romney that are known.
What you need to know Instead of the government paying for health care, people would have the choice of receiving a fixed subsidy from the federal government that could go toward a private insurance plan or a plan similar to Medicare.
The amount a beneficiary receives would be based in part on the second least-expensive plan available on the health insurance exchange.
As mentioned in Mitt Romney FAQs, no one knows if the premium subsidy would be able to cover the same set of benefits as traditional Medicare, or how much it would add to out-of-pocket costs to beneficiaries, because Mr. Romney has not provided the nonpartisan Congressional Budget Office(CBO) with sufficient details. However, his VP candidate Paul Ryan did present his very similar plan to the CBO which found it lacking.
Paul Ryan’s ideas are starve the beast strategies that lower revenues which cause a collapse of the system or require a reduction in benefits. The CBO found that Paul Ryan’s health care plan would reduce revenues by 50% within 18 years and therefore it is a classic example of a starve the beast strategy.
Romney’s plan emerged after the CBO report. Some believed this was a shifting position.
During the debate Romney added the following
“I would like to take the Medicaid dollars that go to states and say to a state, you’re going to get what you got last year, plus inflation, plus 1 percent, and then you’re going to manage your care for your poor in the way you think best.
This idea would not cut Medicaid costs as he suggests. Rather, this idea is part of Paul Ryan’s idea that significantly reduced revenues and led the CBO to suggest that the Ryan plan is not feasible.
Romney has suggested limiting the growth of subsidies in the past which contradicts the information on his website. On the 47% tape he argued that people feel they deserve health care and that he doesn’t agree with that assertion which implies that he would cut benefits. To many these three statements appear self-contradictory and represent shifting positions.
Romney add further insight into the way he thinks about health care during the debate.
“And by the way, if the government can be as efficient as the private sector and offer premiums that are as low as the private sector, people will be happy to get traditional Medicare or they’ll be able to get a private plan.
I know my own view is I’d rather have a private plan. I’d just assume not have the government telling me what kind of health care I get. I’d rather be able to have an insurance company. If I don’t like them, I can get rid of them and find a different insurance company. But people make their own choice."
That statement should be a concern to those who want better quality of care. The reason is thinking is wildly inaccurate is because other developed countries deliver better care than the U.S. does at lower costs through government run plans.
How can government run plans work better than the free market? The system before Obamacare and the system Romney proposes are not free market systems. In fact, many of the European public health care systems have more free market incentives than these systems do because they used an American’s idea (John Williamson) to reimburse physicians for providing achieveable benefits to their patients. That is, physicians, hospitals and other health care providers receive money for providing benefits to their patients!
The physician fills out a one-page form that documents the benefits and all the paperwork is done, as compared to the U.S. insurance company run system which grows more and more expensive every year by producing ever larger piles of paperwork. Producing paperwork is not a typical outcome of a free market system! Rather it’s the outcome of a scheme that extracts twice as much money for health care services, as those socialist countries (e.g., New Zealand, Australia, Britain, Germany) that provide public health care. The incentives in these systems is more oritented toward providing higher quality care. In the U.S., the system is oriented toward making larger profits for insurance companies (e.g., larger piles of paperwork) and larger CEO salaries. For that reason, the U.S life-expectancy is not rising as much as it is in other developed countries.
Who is John Williamson? He was the Chair of Hillary Clinton’s health care committee in the 90s.
In sum, Romney’s claim that he has a freemarket plan is misleading because it’s not a freemarket plan. Actually, it’s not a plan at all because it omits crucial details about how much the plan will cost, how much people will have to pay for it and details that could be used to determine whether it’s financially or quality sustainable in the long run. That is, it may only provide the U.S. with larger CEO salaries, bigger piles of insurance company paperwork and profits, lower quality care, ever rising health care costs and move us closer to bankrupting our healthcare system. Until Romney explains his plan, there is really no way of knowing.
Phony Evidence, Fear-Mongering and Personal Attacks?
As noted above, if you have a Pig in the Poke you’re not going to explain what you want to do. Instead, you’re going to use misdirection, personal attacks directed at claiming your attacker is incorrectly evaluating your plan or is incompetent to do so, fear-mongering about alternative policies, flip-flop or changing your position, and provide complex explanations or research that suggests the plan is viable.
So did Romney’s responses during the debate fit the above description?
1. Romney claimed Obamacare
“puts in place an unelected board that’s going to tell people ultimately what kind of treatments they can have. I don’t like that idea.”
Obamacare includes a board that recommends cost-saving measures for Medicare (e.g., purchasing less expensive drugs, not allowing hospitals to overcharge) but the board is not allowed to suggest rationed care or reduced benefits (pdf). This makes Romney’s statement doubly false because it also doesn’t mention that we now have insurance companies that tell people ultimately what kind of treatments they can have. It’s also an example of fear-mongering. The above ad by the Romney campaign also uses fear-mongering by claiming that Medicare is going bankrupt. However, fact-checkers have refuted the claim made in the above Romney ad.
Romney also claimed government run health care would be more expensive. However, as Romney knows virtually every other developed country has lowered health care costs by going with a government run plan. When Mr. Romney and other Republicans complain of a federal takeover, they are referring to more spending and enrollment in government health programs that have proven to be more effective worldwide. Repealing the health care law as Romney suggests would greatly increase health care costs for patients and increase the deficit by over $100 billion 1.
2. Romney accused Obama of doubling the federal deficit. That’s not the case because the annual deficit was already running at $1.2 trillion when Obama took office 2. This is a clearcut example of a personal attack based on false data and it suggests that Obama is incompetent to judge Romney’s health care plan.
3. Romney also claimed that “Right now, the CBO says up to 20 million people will lose their insurance as Obamacare goes into effect next year. And likewise, a study by McKinsey and Company of American businesses said 30 percent of employers are anticipating dropping people from coverage.”
The CBO study in March, not “Right Now”, gave the 20 million estimate but then changed it’s mind. The new estimate suggests that between 3 million and 5 million would be forced to switch from employer-sponsored coverage to an insurance exchange 2 and others factcheckers found a quote from the Director of the CBO that claimed it would be less than 3 million3 but as Romney claims they said it could go to as high as $20 million so some fact-checkers let Romney off the hook. However, they shouldn’t have because what he said is that they would lose their insurance but that’s misleading and fear-mongering because people aren’t actually losing their health insurance they are just being forced to a non-employer health insurance exchange plan because their employer decided to no longer offer health insurance.
Also, the 30 percent estimate wasn’t a prediction about the impact of Obamacare so this appears to be another example of fear-mongering.
4. Romney told the President
“I can’t understand how you can cut Medicare $716 billion for current recipients of Medicare,”
Again, instead of explaining his plan, he launches another personal attack against his opponents that is completely untrue because current recipients of Medicare benefits are only enhanced under Obamacare. The $716 billion figure actually reflects a 10-year target for slowing Medicare spending that doesn’t cut any direct benefits and Mr. Romney should know this because fact-checkers have repeatedly pointed out the $716 billion realignment actually saves money and does cut current recipient benefits as Romney implies!
According to nonpartisan analysts, it is Mr. Romney who would both cut benefits and add costs for beneficiaries if he restored the $716 billion in reductions (CBO estimate)1. This appears to be another example of fear-mongering misdirection and a pre-emptive strike against problems identified in his plan.
6. Romney said
“And, unfortunately, when — when — when you look at Obamacare, the Congressional Budget Office has said it will cost $2,500 a year more than traditional insurance. So it’s adding to cost.”
That’s not the case and represents another example of attacking your opponents plan instead of explaining yours. The CBO said that average premiums on the individual market would be 7 to 10 percent lower in 2016 than they would be without Obamacare. That’s exactly the opposite of what Romney claimed. That is, Romney is implying it add to your cost when the opposite is true!. It wlll cost you $2,500 more when actually the government will pay you up to $2,500 more in subsidies and the law brings down rising cost trajectory and the amount you pay by reducing overpayments to insurance companies that Romney wants to repeal.
That’s not to say that the average premiums on the individual market would not still go up because the law requires greater benefits (that are mostly optional). However, many would end up paying less out of pocket for premiums as a result of federal subsidies for up to $2,500 per year and the law requires individuals to pay a smaller proportion of total costs for health care and requires that costs rise at a slower rate.
This appears to be another pre-emptive strike because as noted in 4 Romneycare would increase the amount people pay each year for their health care.
Some fact-checkers interpreted Romney’s statements as an argument that costs have gone up about that much in the last four years but since he specifically referenced Obamcare which doesn’t go into effect fully until 2014 and the CBO report, we believe the above interpretation is correct.
7. Romney also commented on his own health care plan. He said “I like the way we did it in Massachusetts…What were some differences? We didn’t raise taxes.”
He didn’t raise taxes in Massachusetts because true to form he had the government pay for the largest part of his plan which was Medicare, Medicaid and government grants – 64% of the cost. Also, his new Romney/Ryan plan would make it difficult if not impossible for Massachusetts to continue with his own plan.
Thus, Romney’s statement can best be described as a forward 2 1/2 somersault 3 twist pike whopper. It’s rare that a politician finds a way to self-aggrandize himself by mentioning his own accomplishes and then misrepresents his own proposed policy in order to destroy his own accomplishment that he is bragging about and denigrate his opponent at the same time!
Also, Obamacare only raises taxes on a few individuals who don’t want to have any health care coverage and even for these individuals there is no enforcement mechanism if they refuse to pay the tax. According to FactCheck.org, a minimum assessment is $695 per person (but no more than $2,085 per family) which begins in 2016 when Obamacare is fully phased in. People who want health insurance won’t be taxed.
8. Romney said
“It’s why Republicans said, do not do this, and the Republicans had — had the plan. They put a plan out. They put out a plan, a bipartisan plan. It was swept aside."
Instead of explaining his own plan, Romney again engages in another personal attack against his opponent that is entirely false. This has been a consistent and false personal attack on the President by Republicans since he was inaugurated. They argue he’s unwilling to accept bipartisan ideas. However, Obamacare was a Republican’s idea (Mitt Romney’s) based on a Republican thinktank’s idea.
Why would Republicans not support their own idea? Because while the President was being inaugurated, they’d decided to block every program he suggested as a political maneuver.
It’s not only a bipartisan bill. It’s mostly a Republican bill. The Republican suggestions from their own bill have drawn the most criticism from themselves (e.g., the individual mandate, state-based health care exchanges, high-risk insurance pools, and allowing insurers to sell policies in multiple states).
9. Romney also claimed
“Pre-existing conditions are covered under my plan.”
Romney has admitted this is not true. ThinkProgress estimates that about 72 million or more than 1 in 5 people would end up without any insurance under his plan. Many would be the poor and those without jobs. Only continuous coverage would ensure that you wouldn’t be rejected for pre-existing conditions.
This again appears to be a pre-emptive strike on Obamacare that would provide care for everyone who wanted it.
10. Romney also said
“What I support is no change for current retirees and near-retirees to Medicare.”
What he’s said in the past is that he will repeal Obamacare which will deny current Medicare patients preventive benefits without deductibles or co-pays, increase prescription drug costs and increase costs for premium support 4. Also, Romney’s State Medicaid spending program would increase costs for Medicare recipients on Medicaid 4 and increase costs overall because insurance company profit limits would be repealed.
However, Romney could disagree with this because the details of his plan are sketchy but if he did it would seem like a flip-flop.
11. Romney also said
“Number two is for people coming along that are young, what I do to make sure that we can keep Medicare in place for them is to allow them either to choose the current Medicare program or a private plan. Their choice. They get to choose — and they’ll have at least two plans that will be entirely at no cost to them.”
Another pre-emptive strike that doesn’t explain that families would no longer be able to keep their children on their plan after they reach the age of 18 – a feature of Obamacare. he’s not actually claiming that young people won’t have to pay for health insurance although it’s easier to imagine that many people thought that’s what they heard. He’s actually talking about people who will receive Medicare when they turn 65 ten or more years from now. He’s saying they still won’t have to pay for Medicare but the question everyone is asking will benefits be cut?
His plan is too unclear to make these sort of promises when he hasn’t allowed independent experts to analyze his proposal. Others have argued this his plan is a starve the beast strategy because the size of vouchers will grow at a rate of GDP plus 1.5 percentage points. Historically, health care costs have increased at a higher rate so over time Medicare premiums would be expected to rise or he would have to reduce benefits. The CBO has estimated that Obamacare slows rising health care costs. However, there is no research that suggests Romney’s partial plan will bring down costs and there won’t be until he provide more details.
Also, the free market demands an informed choice. Do you feel you receive enough information about the quality of care and fully understand the coverage when you buy insurance? As noted above, Romney’s idea doesn’t fully adopt true free market principles. With Obamacare, you do get some additional information and the same choice between insurance companies that you get with Romneycare. The major difference is that Obamacare insures that the companies can’t overcharge you and Romney care insures that they can.
12. Romney continued
“And, by the way the idea came not even from Paul Ryan or — or Senator Wyden, who’s the co-author of the bill with — with Paul Ryan in the Senate, but also it came from Bill — Bill Clinton’s chief of staff.”
Also, It seems that Romney is attempting to convince people that his idea is more credible because it has bipartisan support. He adopts this approach instead of giving more details about his plan even though his claim is false because Bill Clinton has endorsed Obamacare. As noted above, the Romney plan is very close to Paul Ryan’s plan and Bill and Hillary Clinton’s plan was the public option. Later, Clinton proposed a plan that didn’t put a cap of 1.5 points on voucher/premium rates which is what concerns most analysts. Clinton also fears the program will run out of money or cost people more and more over time, which is what was estimated would occur with Paul Ryan’s very similar plan which was subjected to a CBO analysis. As noted, Romney refuses to be scrutinized in a similar way which suggests a Pig in the Poke strategy.
13. Romney claimed his Medicare voucher system wouldn’t cut benefits because he’s setting minimum benefits high so that everyone receives quality care. However, as we mentioned previously, the vague assertions on his own website contradict his claim and he hasn’t provided sufficient details for an independent CBO analysis. Romney’s campaign’s policy director, Lanhee Chen, said 1, “all seniors will be guaranteed sufficient support because the support is actually set based on what plans will cost.” That doesn’t answer the question of what happens when the 1.5 points rule is not sufficient to cover rising costs.
Romney has yet to define “wealthier seniors” that he admits will pay more (e.g., could that mean he will raise health care rates for the middle class?). If Romney said no to such a question, he would also have to give his definition of the “Middle Class.”
Also, Romney hasn’t defined “a quality plan” for the poor.
In the debate Romney only provided a couple of new details about a plan he claims to have but to date hasn’t described completely. He spent most of his time using inaccurate or misleading data to scare people away from the President’s plan.
In contrast, the President’s plan is not a Pig in the Poke because it has been subjected to analysis and is fully described in law. However, Mr. Romney is unwilling to have it compared to his plan by independent experts or to accurately his plan or his opponents.
Our conclusion is that Romney is used a Pig in the Poke tactic for the health care portion of the debate and therefore nothing he said can be entirely trusted until he tells us what his plan is. Another obvious question is the Pig in Poke tactic is frequently used by cult leaders and grifters but should it be used in a Presidential debate?
Mr. Romney used a Pig in the Poke style of debating in a Presidential election on a very important issue. That is, it’s possible that the U.S. could elect a person who has never told the public what his health care plan is. Should such a style be allowed to go unchecked by reporters in a Presidential debate?
Should the winner of a Presidential debate be judged on well they describe their own policies or on the quality of their presentation? Can someone win a debate by spending of his time complaining about his opponents policies while failing to describe his own?
News actors tend to rate performances in the way that news actors are rated. News actors are rated by how much they impress people and not on their factual accuracy. If news actors understood the persuasive styles of the candidates, perhaps they would have understood what happened at the debate better than they did.
by Todd Miller
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