The Regular Fake News And The Really Evil Fake News
/The subject of "fake news" seems to have faded from the headlines somewhat now that Hillary's defeat is receding in the rear view mirror. But before the topic disappears completely, I'd just like to pause for a moment to make a distinction between two different kinds of fake news, which for these purposes I'll call the "regular" fake news and the "really evil" fake news.
The kinds of things that Hillary was complaining about I would put firmly in the category of "regular" fake news. Things like "Pope Francis endorses Donald Trump," or "The Clintons are running a child sex ring out of a pizza parlor in Washington, D.C." Did anybody actually believe those things, let alone then change their vote as a result? It's not impossible, but I find it hard to believe that any material number of people could be that naive. Moreover, it's not like there weren't plenty of comparable fake stories relating to Trump. Do you remember "RuPaul claims Trump touched him inappropriately in the 90s"? Just part of the normal political rough-and-tumble.
But here's something I consider to be in a wholly different category: falsely accusing your political opponents of mass killings of tens or hundreds of thousands of people on no basis whatsoever. Here I am talking about what seems to be the norm of acceptable advocacy by progressives as they try to preserve disastrous government programs designed and run by themselves. The prime example of the moment is Obamacare.
The new Congress (with its vow to repeal Obamacare) has only been in session for less than a week, and already it has started. For example, here we have Nicholas Kristof in yesterday's New York Times, under a headline "The G.O.P. Health Hoax":
The paradox of Obamacare is that it is both unpopular and saves lives. Preliminary research suggests that it has already begun saving lives, but it’s too early to have robust data on the improvements to life expectancy among the additional 20 million people who have gained insurance. It is notable that an Urban Institute study found that on the eve of Obamacare’s start, lack of health insurance was killing one American every 24 minutes. . . . The American College of Physicians warned this week that the G.O.P. course could result in seven million Americans losing their health insurance this year alone, by causing parts of the insurance market to implode. Back-of-envelope calculations suggest that the upshot would be an additional 8,400 Americans dying annually.
They're going to kill tens of thousands of people!!!!! But is there any real evidence that lack of health insurance actually leads to materially increased mortality? Of course, the real evidence is firmly against that, and of course Kristof doesn't mention it. In a post back in April, I reported on the results of the big three studies that have attempted to measure in a serious way whether there is any mortality benefit to having health insurance. From that post (with internal quotes from this 2013 article by Megan McArdle summarizing the research):
- There was the big Oregon randomized study that ran for two years from 2008-10. Oregon got some money to expand Medicaid, but only for about half the number of people they wanted; so they held a lottery to determine who got in. And then they ran a randomized study on 6400 people who got in and 5800 who did not. Results: Not only was there no detectable difference in mortality, but "the study failed to find statistically significant improvement on the three targets associated with the most common chronic diseases. This, mind you, is the stuff that we're very good at treating, and which we're pretty sure has a direct and beneficial effect on health."
- Then there was the big observational study, conducted by Richard Kronick of UC San Diego, based on data from 672,000 insured and uninsured people as reported on the National Health Interview Survey from 1986 to 2000. Results: "no mortality benefit from insurance."
- Or, going back a ways, there was the big Rand randomized study of close to 8000 people, divided into five groups ranging from very to much less comprehensive health insurance, that ran from 1971 to 1982. Results: "[T]hey looked to see what differences emerged in health outcomes. Shocker: none did."
So OK, Kristof just fails to mention that the big, real, serious studies completely contradict his contention. We know that that is how they do business at Pravda. But what is the supposed evidence that he relies on instead? For example, what is that Urban Institute "study" that he links to? Go to his link, and you find that this "study" is just an update of a much-criticized Institute of Medicine report from 2002. Here is a 2009 comment on the IOM report (and related advocacy "studies" including the Urban Institute update) from John Goodman of Health Affairs:
Last year [2008], a report by Families USA made the astounding claim that 6 people die every day in Florida because they are uninsured. Seven die every day in Texas, 8 in California, and 25 in New York. How was Families USA able to tally up all that carnage with such pinpoint precision? As Linda Gorman explains, these claims are based on a 15-year cascade of studies — each repeating the errors and misinterpreting or mischaracterizing the findings of the previous one and ultimately relying on data that is 37 years old. It begins with a paper by Peter Franks et al. published in the Journal of the American Medical Association in 1993, estimating that being uninsured increased the probability of death by 25%. Although the subjects were interviewed only once, for the study’s inference to be meaningful, one is forced to make the unverified assumption that the uninsured stayed uninsured for a full 19 years! Continuing the saga, the Institute of Medicine (IOM) uncritically used the Franks result to claim that 18,000 deaths a year in the U.S. are attributable to a lack of health insurance. The Urban Institute updated the IOM report, and Families USA updated the Urban Institute report.
That's how you do it: Instead of studying two populations over a period of years, you just interview some people once. From that you make up a preposterous "estimate" that being uninsured increases mortality by an astounding 25%. Project that "excess mortality" out over the whole population, and voila! you claim "18,000 excess deaths per year" (IOM), or "22,000 excess deaths per year" (Urban Institute). And then you sit back and watch as Pravda uncritically parrots these ridiculous numbers endlessly without ever describing how they were invented or mentioning that the real and serious studies show exactly the opposite. By the way, there's an even more preposterous 2009 advocacy "study" from Harvard University and Physicians for a National Health Program that claimed that the annual number of "excess deaths" for the uninsured was 45,000. The methodology is basically similar -- this time they just assumed 40% excess mortality for the uninsured. This one and the Urban Institute "study" were part of the coordinated 2009 advocacy program for Obamacare, which was enacted shortly afterward in early 2010. Suppose you want to claim 100,000 excess deaths per year? Easy! Just assume 100% excess mortality!
I actually believe that the people who produce these fake "studies," as well as the New York Times, Nicholas Kristof, et al., think that they are on the moral high ground when they do this. Their thinking goes something like this: We're just doing what we need to do, and saying what we need to say, to achieve the moral imperative of bringing the holy grail of universal health insurance to the poor and the vulnerable. Sure it has been difficult to establish empirically that lack of health insurance causes excess mortality. But it's just obvious that that has to be true! So we are completely justified in fudging things and making up tales of thousands of deaths to scare people and thus get to the morally right end point.
The problem is that something like Obamacare is not free. Far from it. It comes with hundreds of billions of dollars of extra government spending to fund Medicaid expansion and private insurance subsidies -- all of which is taken away from things the people would rather do with the money if they were free to spend it themselves. It also comes with forcing millions of the relatively young and healthy to wildly overpay for health insurance that is uneconomic for them and that they would not buy unless forced to do so by government coercion. Loss of freedom and loss of wealth (much of that for relatively low income people) count for nothing in the progressive/New York Times world view.
But, making up tall tales about tens and hundreds of thousands of deaths to scare people into accepting loss of freedom and loss of wealth and increasing government control over their lives? Is that really OK? I'd call it really evil fake news.