One of the most underrated political stories of the next year is the implementation of the Affordable Care Act (also known as the ACA), which continues to unfold at the state and federal level. It’s the sort of complex policy issue that often gets short shrift from reporters, especially in comparison to the ongoing series of dramatic confrontations between the president and congressional Republicans over the “fiscal cliff” and federal debt ceiling.
Unfortunately, one key element of the ACA—the Independent Payment Advisory Board (IPAB)—has become entangled with the “death panel” myth about the legislation, making it an important test case for whether we can have a fact-based debate about whether and how to reduce the explosive growth of healthcare costs.
IPAB is a group of appointed health experts established by the ACA and directed to limit cost growth in Medicare expenditures (see this Health Affairs primer for background). Since the law’s passage, the board has been invoked to justify Sarah Palin’s false claim that a “death panel” in President Obama’s original healthcare plan would deny care to individual patients based on their “level of productivity in society.” (Palin did not actually refer to IPAB in her infamous Facebook post; her comments seemed inspired by a since-removed provision in the law to reimburse doctors for providing voluntary end-of-life counseling to Medicare patients that was misconstrued as forced euthanasia, though Palin later pointed to writings by Obama healthcare adviser Ezekiel Emanuel as her source.)
If healthcare costs are projected to grow too quickly in this or future years, IPAB will be empowered under the ACA to issue special recommendations to cut costs (though it is barred from rationing care, cutting benefits, or raising premiums under the statute). If Congress does not vote down these recommendations or find equivalent savings, they automatically go into effect. This process is likely to be highly controversial. Though the board has not yet even been formed, the GOP-controlled House of Representatives has already passed a special rule that seeks to obstruct IPAB’s fast-track procedures.
The IPAB process is thus on a collision course with the death panel myth, which continues to linger among the American public, in part due to credulous media reporting. When the board makes recommendations—either this year or in future years—these false beliefs are likely to be encouraged by politicians and commentators who oppose the ACA.
The challenge for journalists is thus to limit the spread of misinformation—and factcheck those who spread it—while still providing informative coverage of the initial stages of the looming debate over limiting Medicare spending growth, an issue that is likely to play a key role in our nation’s politics for decades to come.
There is substantial reason for concern. My previous research with Georgia State’s Jason Reifler has shown that unwelcome corrective information in news accounts frequently fails to change people’s minds and sometimes makes misperceptions worse. In a new article with Duke’s Peter Ubel that is forthcoming in Medical Care, we show that a similar response occurred when we provided corrective information about the death panel myth in a mock news report—misperceptions declined among low-knowledge Palin supporters, but increased among her more politically sophisticated backers. (Sarah Kliff wrote about the paper for The Washington Post’s “Wonkblog” last week.)
But while it will be necessary to take caution to minimize potential harms, the media should not be dissuaded from covering the IPAB process, which could have significant consequences for Medicare beneficiaries. One potential option is to feature the Obamacare opponents who reject the death panels claim. Drawing on such experts could be a way to make space in journalistic accounts for ongoing political disagreement over the role of the board—which is appropriate given its new mandate and powers—while sidelining inflammatory and false claims that distort public debate. Reporters have no duty to be neutral toward factually misleading claims like the death panel myth, but they can make such distinctions without appearing to take sides in a dispute that has much larger stakes.