healthcare Rule: Ask The Question

Vote on Ask The Question: Affordable Care Act

With the media’s focus on cancelled plans, higher premiums and the website launch, ATQ Poll turns its attention to other ACA issues:  Medicaid expansion, access to doctors and hospitals, and employer sponsored plans.

What benefits and costs (coverage, financial) do states weigh when deciding whether to opt in vs. out of ACA Medicaid expansion?

The goal of this question is to expose the decision making process that states use in determining whether to opt-in or out of Medicaid expansion, and to do so in clear, monetary/human, cost/benefit terms.

At last update, 27 states have opted-in for MC expansion, 21- out, and 2 (PA, TN) are on the fence.  The decision pivots on 2 considerations: the cost of expanding MC vs. not, and additional people covered with the expansion vs. not.

The terms of cost in ACA are:  the government pays 100% for 3 years, 90% thereafter.
Coverage:  CBO estimates 3 million people will be left uncovered in states that opt-out.

With such favorable terms for opting-in, and the high human cost of not, why are so many states choosing to opt-out?  It seems to come down to a cold assessment of whether the 10% saved in states that opt-out (starting year 4), will more than cover the ER expenses incurred by those left uninsured.

Some states claim that additional 10% will strain their budgets. Others (PA, AR) have requested funds for private insurance, leading one to Ask if that is more cost effective for them than MC, and how.  In this NYT article, the reasons against opting-in in Tennesee are left vague: Republicans are against it (why?), and a previous state system failed.  Groups in favor of opting-in include Democrats, the Chamber of Commerce, poverty & health groups, one of which claims 400,000 will remain uninsured and drive costs up with ER visits.

A refrain heard in the news and echoed by TN’s Governor, is that Medicaid does not control costs.  With at least as many claiming otherwise along with a plethora of other hotly contested issues, the media must start invoking Cite The Basis, Ask The Question, and other Rules if we are ever to resolve these disparities and further our knowledge on what specifically is good, and what is not, about Medicaid.

The News Hour provides an example in this discussion which, comprehensive though it is, still hilights such points of disagreement or lack of specifics where an ATQ or CTB could have illuminated so much more.

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Why are insurers dropping hospitals & doctors from their plans?

There have been numerous stories on doctors and hospitals being ‘dropped from plans’ but nothing explaining why.  The obvious guess is that it has to do with negotiated payment apportionment between doctors and insurance companies, the assumption being- they are less favorable to doctors under ACA.

In this CNN video, Tom Harris explains that he’ll have to find a replacement for his allergy doctor of 20 years, who is being dropped from his plan, and is too expensive without the coverage.

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His doctor, Robert Eitches says he doesn’t know “which, if any, insurance plans he’ll accept”, and “has already stopped taking Medicare” (for which the reimbursement rates to doctors have been lowered).  As for the insurance, his admission that he is considering “not taking any insurance at all” despite regretting the loss of patients he has bonded with, makes no sense whatsoever and is not followed up with additional questions or information from CNN.

Was Dr. Eitches ‘dropped’ from the plan by the insurance company?  Or were the terms changed that caused either Dr. Eitches to drop the insurance, or Mr. Harris to drop the doctor due to higher out-of-pocket expenses for him?  And if Dr. Eitches takes ‘no insurance’, does he not deny other patients his services?

In a CNN debate moderated by Candy Crowley, Sen. (& Dr.) Barrasso, states: “in New Hampshire, Anthem Blue Cross/Blue Shield is excuding 10 of 28 hospitals”.  Howard Dean’s response: “that’s the insurance commissioners fault”, is the only explanation given.  There is no follow up query from Ms. Crowley on what role insurance commissioners have, or what the “fault” of NH’s is.

How many businesses are reducing employee hours to part time levels and how many workers will lose healthcare coverage due to that?

Stories of employers reducing workers hours, or the workforce itself, to avoid having to insure them under ACA have been anecdotal and remain unquantified.  In an economy of high unemployment and where many of the ‘job gains’ have, in fact, been either low wage or part time, this is an important question.

In this CNBC segment, 2 surveys were compared.  One with 400 people participating showed a negative effect, the other with 60,000, showed no effect.

The impact of ACA on small businesses is shown from the business owner’s perspective in this interview of two of them.

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Matt Tyler, of Vickers Engineering, employs 175 people and says his insurance cost in 2014 will increase by 50% (11% taxes & fees, the rest ACA changes), and will be shared with employees.  He is further concerned about the lack of flexibility and growth of healthcare in future years.  Beezer Molton, of Half Moon Outfitters, has 120 employees, 90 of which are part time. He says they will adapt by pushing for still more part time employees to mitigate risk going into 2015.

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So, the initial impact of ACA is just beginning to be discovered.  One expert says it will take 3 years for ACA to ramp up.  Given the many testbeds in it for cost control, it will take that, and years more, for the system to settle out.  The issue of overall health costs is not dealt with in this poll, but it is one of the most important elements that will ultimately determine the success or failure of ACA. As with many complex issues, the consideration of time and long term thinking is critical in evaluating policy solutions, mandating the incorporation of it into any media discussions deemed honest.

economy Rule: Ask The Question Rule: False Argument Rule: Focus Issues Not Politics Rule: Mischaracterization Rule: Out of Context

Budget & Debt Limit Stalemate- The Media As Enabler?

“Insanity is repeating the same mistake over and over, and expecting a different result.” That saying is often used in reference to politics, but maybe in the current political climate, the converse is true.  Maybe Republicans are applying a proven strategy- repeating an untruth over and over- and, via a feckless press, expecting, …and getting, the same result: appearing to be in the right on ‘willingness to negotiate’, thereby prolonging the debate on debt reduction, their goal. In other words, ‘insanity’, as in, ‘crazy like a fox’.

(30 second ad, 2 minute video; if no video below, click here.)

Tuesday, on CNBC’s Closing Bell , Maria Bartiromo, in an interview with Rep. John Yarmuth (D-KY), said: “The idea that the President continues to reiterate ‘I will not negotiate’, isn’t it the responsibility of the President to negotiate? At what point does it look like the obstacle to progress is the President, rather than congress?”

‘The President won’t negotiate’: that is the familiar refrain from the Republicans as channeled through the media these past days. The answer to the question of it being his responsibility to negotiate is, yes, of course it is. The point is, he has done that, as well as be specific and clear on his position, which is also his responsibility, as it is the other side’s.

Ms. Bartiromo’s first Rule break was in quoting the President Out of Context. His true position is: ‘I will not negotiate under threat of government shut down.’ Her second mistake relates to the first. By posing the question of the Presidents responsibility to negotiate as she did, she implies he is shirking that responsibility which he is not. He is simply holding firm on his position as the Republicans are on theirs; thus, she breaks the Mischaracterization Rule. In this, she also forgoes the opportunity to recap and educate the public on the true state of talks, and to keep the focus on the more important issues- the budget agreement and debt limit. Isn’t that the responsibility of the media? This breaks the Focus on Issues, Not Politics Rule.

As for the second Question, Ms. Bartiromo Asked the wrong one. Instead of: “At what point does it look like the obstacle … is the President?”, she should have Asked: “At what point is the obstacle the President, and at what point is it Congress?”

Failure to check this type of routine downfall in the media allows agenda seeking partisans to continually game the system, repeating the cycle over and over, as it has across too many news programs, for too many days.

Using opposing parties in debate format, as in this case, can, despite badly worded questions, still bring clarity if those parties know the facts, and present them honestly. In the case of Rep. Yarmuth, assuming he was factually correct, we got some: “The President’s had about 20 conversations with the Republican leadership in the House about the budget since March. The Republicans in the Senate have consistently blocked the conference there, Speaker Boehner has refused to appoint conferees on budget from the House side. There’s been every opportunity to have negotiations on budget levels for the last 6 months, and Republicans have refused to do that.”

Tuesday night on Charlie Rose, when asked if “there was anything new [in the Presidents speech]?”, Chuck Todd (NBC News) said: “The President will support anything Boehner sends him that is ‘clean’, without any of those extraneous, politically charged amendments on both a spending bill and a debt limit, and he will take it for any length of time, so 6 weeks, 8 weeks… The President essentially agreed that, in that period, they’d be locked in some form of negotiation. … Boehner took that offer and called agreeing to that, ‘unconditional surrender’.”

Also on that show, Al Hunt (Bloomberg News) said the effective positions of the two sides have not changed in two years- Republicans want entitlement change, Democrats say no.

So it would appear that both sides have been equally ‘negotiating’, or– more accurately, equally maintaining their respective positions– and for some time. Such prolonged back and forth highlights the need for recaps. Recapping would cut through the dissembling and make crystal clear the absence of progress and the amount of time that’s been wasted ‘reporting’ on it in an endless loop of recriminations and False Arguments. Recapping clarifies things: it leaves the Emperor with no clothes, neutralizes strategies that ‘play the media’, and forces the Dialog to Advance.

And Advancing the Dialog, advances solutions.

This is a tool people, use it. There is simply too much work to do to waste this kind of time, over, and over, and over, and…..

Rule: Ask The Question Rule: Cite The Basis Rule: False Argument Rule: Generalization Trap voting rights

North Carolina Voting Law Changes: 2 Debates

The PBS News Hour and CNN’s The Situation Room debates on recent changes to NC’s voting law, offer a study in contrast on Rules adherence and debate integrity.  While both were illuminated by facts that supported strong arguments, CNN had more Rule breaks and became mired in False Argument with too much crosstalk because a few basic Questions were not Asked early on.

The change to North Carolina’s law, which takes affect in 2016, has 4 components:
(1) government photo ID is required
(2) early voting period is shortened from 17 days to 10 days
(3) same-day registration no longer allowed
(4) preregistration for those eligible to vote by Election Day no longer allowed

Debate participants included:
News Hour:   Tom Murry (R-NC Rep),  G.K. Butterfield (D-US Rep);
Judy Woodruff, moderator
Situation Room:   SE Cupp (R),  Stephanie Cutter (D);  Wolf Blitzer, moderator

In both debates, the case against the new law was made by contrasting the small number of actual fraud cases found in the 2012 election (PBS NH: <12 out of 4 million voters, gen. election;  CNN SR: 100-112 out of 7 million, combined prim. & gen. elections), with much larger numbers of projected suppressed votes, given the changes (PBS NH: ~300,000; CNN SR: “100’s of thousands”). Since Romney won NC by less than 100k votes, this could be significant.

PBS News Hour (no ads)

On News Hour, impacts of 2 of the provisions- voter ID (1), and shortened early voting (2)- were easier to seperate out, making for a clearer and more concise debate than on CNN. Mr. Murry noted only 3% of voters need an ID and claimed Georgia’s ID implemention resulted in increased minority voting rates. Mr. Butterfield countered that: “300k people [have no ID] and many people won’t [get one]”. On the early voting change, Mr. Murry said more locations will be added resulting in the same number of hours for early voting, overall. Mr. Butterfield clarified the law only “[gave] discretion to add more sites” and argued that an extended, not shortened, period was needed since lines were long, adding that Sunday voting, when many African Americans voted, will be eliminated.

CNN The Situation Room (no ads)

On CNN, Stephanie Cutter supplied stats on early voting: in 2012, 50% of African Americans, 50% of students, and 50+% overall- the majority for Obama- voted early, implying provision (2) would cause the vote suppression. She also emphasized that no voter ID fraud at all was found. This reasonably inferred that the voter fraud happened in areas that provisions (2-4) sought to rectify, calling into question the necessity of provision (1). (Indeed, when Mr. Murry was asked on the News Hour why voter ID was needed, he replied “it’s common sense” and “60-70% of the voters approve it”.)

SE Cupp, to her credit, acknowledged Ms. Cutters “legitimate concerns of voter access” but objected to her refusal to admit “legitimate concerns of voter integrity”. Ms. Cutter responded: “… [they are] trying to create a problem, or solve a problem that doesn’t exist …”, and asked Ms. Cupp if it’s worth trading “100’s of thousands” of suppressed votes for “100 cases of fraud?”, to which Ms. Cupp replied: “… there is so much voter fraud that isn’t reported since [Democrats won’t allow access] … “.

The debate became muddled with each talking over the other, repeating the same points, and falling into the Generalization Trap– Ms. Cupp for not specifying what type of voter fraud those 100+ cases were; Ms. Cutter for not identifying which provisions would result in what portion of those “100’s of thousands” of suppressed votes.

Ms. Cutter was effectively making a False Argument, in essence, arguing the entire law was bad because no voter ID fraud had been found, when, in the absense of attributing some of those future suppressed votes to the voter ID clause (her GenTrap), the fact that no ID fraud was found, does not even prove that that provision, alone, is bad, only that it is unnecessary. And though her early vote statistics imply that provision (2) would result in suppressed votes, by dismissing provisions (2-4) without addressing where the fraud cases occurred, debate was precluded on them.

Of course it fell more naturally to Ms. Cupp to specify what type of fraud those 100+ cases were, since she was the one claiming ‘legitimate voter fraud’. That is her GenTrap break. Had she and Ms. Cutter been more specific early on, we would have been spared the shout-fest and made progress in the debate. (Note: these 2 will soon be co-hosting a new show, Crossfire, on CNN.)

The above notwithstanding, it was really Wolf Blitzers job, as moderator, to Ask The Question (of Ms. Cupp): What kind of voter fraud were those 100+ cases?. With Ms. Cutter, he did Ask why she claimed “100’s of thousands” of suppressed votes, “when people can get an ID from a drugstore for free”. Ms Cutter’s response was: “Let’s see how that gets implemented”. Even assuming a satisfactory implementation of the voter ID requirement, this still left unclear whether, all, some, or no vote suppression would be eliminated.

As well, Mr. Blitzer was remiss in not following up with Ms. Cupps assertion that the amount of voter fraud is unknown due to ‘lack of access’, a serious charge. He should have asked her to Cite The Basis for it.

Am I splitting hairs over argument logic here given the disparity of fraud found vs. claimed impact of changes? Maybe, but it is precisely these cracks in logic that often give enough wiggle room to allow false debates to continue and persist ad nauseum. I’d rather close the discussion out cleanly, and move on.

gun control Rule: Ask The Question Rule: Cite The Basis Rule: Contradiction Rule: False Argument

Gun Control Debate: Same Rules Broken, Multiple Times Each

The amendment for expanded background checks failed to get the 60 votes it needed to proceed in the Senate last week.  Part of a larger bill, it was hotly debated, with criticism and accusations of misinformation coming from both sides.

So how did the media do with its coverage?

Well, there was plenty of it, but with key gaps that were repeated, over and over again.  In a 10 day period, I saw several Rules violated, each multiple times, often with the same person being interviewed on the same subject, on different shows.

Ask The Question & False Argument- it’s all in the wording.

The simplest one to catch related to the wording of recent polls that revealed ~90% public support for universal background checks.  On 3 shows- CNN’s OutFront with Erin Burnett (April 8), Wolf Blitzer’s Situation Room (April 10), and MSNBC’s Hardball with Chris Mathews (April 11, 2:40 minutes in)– the same man, Larry Pratt who is the Exec. Dir. of Gun Owners of America (GOA), questioned the overall accuracy of the polls because of the high support they also showed from gun owners.  Mr. Pratt claimed the GOA and NRA’s own polls resulted in only 4-5% support in their orgs.

Only on OutFront, was Mr. Pratt asked if the wording of the question in the GOA and NRA polls was:  “[Do they] want a gun registry?”, to which Mr. Pratt replied “They know what the deal is”, dodging the question.  Querying the wording difference could expose a False Argument that conflates a different issue- national gun registry- with the one of universal background checks, leading to confusion on both and subverting legitimate discussion on each.  Many, including Mr. Pratt, assert there already is a national gun registry, and that it will expand and lead to gun confiscation.  (More on this below.)

On Hardball, Chris Mathews did, post-interview, read the FOX poll question:  “Do you favor or oppose…requiring criminal background checks on all gun buyers, including those buyng at gun shows and private sales?”.  Supplying the poll results, he added “85% said they were in favor”.

Though Wolf Blitzer had a spirited discussion, citing the 4 polls- CNN, CBS, Quinnapiac, and FOX, he did not zero in on language.

Take your pick- OutFront, Hardball (2:40 min. in), or Situation Room.  They’re all pretty much the same. (If no video below, click here, here, or here.)

So it’s all in the wording, and how many times have we seen that escape hatch left open?  All 3 news anchors should have read the poll question they were citing, then Asked The Question:  “What is the wording of the GOA and NRA polls?”  In OutFronts case, the question should have been re-asked, with any additional non-answers noted.

Clarification made.  Confusion ended.  Move on.

Cite the Basis- existance of a national gun registry.

So, is there a national gun registry or not?

If you believe Larry Pratt, there is.  On CNN’s OutFront he said: “Records are kept in a registry on computers in Clarksburg, West Virginia.”  If you believe Mark Glazer of Mayors Against Illegal Guns, there isn’t.  He claims: ~“It’s illegal to have a gun registry. Gun dealers do background checks.  Government records are destroyed in 24 hours. Gun dealers keep paper records, [they’ve] been doing it for 40 years”.

On CNN’s The Situation Room Mr. Pratt said: “The federal government tells dealers that registration using an internet portal becomes permanent information to the federal government. These background checks are national gun registration”.

How do we know who is right?  We ask them to Cite the Basis, then follow up on it.  That’s how.

False Argument / Contradiction- background checks vs. mental health.

The exact same False Argument and Contradiction Rule breaks occurred 3 separate times recently- 2 on News Hour: April 9 with Judy Woodruf f (5 min. in) & April 17 with Gwen Ifill (4:15 min. in), both while interviewing Lawrence Keene of the National Shooting Sports Foundation; and 1 in the San Jose Mercury News (AP), interviewing Wayne LaPierre of the NRA (March 29).

The current gun background check system is a 2 tier system. The top tier consists of the gun dealers who sell guns and initiate backgound checks on buyers. The second tier is the database known as NICS (National Instant Criminal Background Check System), which has information- criminal, mental health, etc.- on individuals, and is what is used for the background checks.  There are gaps in each.  Only 60% of gun purchases are subject to checks, leaving a gaping 40% hole in the top tier of the gun check system.  The bottom tier, NICS, is reliant on the states supplying information to it, which is voluntary and known to be incomplete.  According to Mr. Keene, 50% of states don’t submit records.

Both Mr. Keene and Mr. LaPierre agree that there should be more “focus on unauthorized access, … mental health [being] most important”, and “getting records into NICS”.  Yet both are against expanding background checks.  In effect, they argue for closing one of the gaps, but not the other, failing to completely solve the problem of access by the mentally impaired.  This is the contradiction underlying their False Argument of why dealing with the mental health issue from the NICS side alone is all that is needed.  Even if states comply and keep NICS up to date, people whose names are in it, including those with mental health issues, can still buy guns at gun shows, part of the 40% top tier gap.

It’s one system and it either works or it doesn’t.

Ask for poll wording.
Find out if there is a gun registry.
Point out an obvious contradiction in logic.

Honestly media, how hard is this?

financial collapse Rule: Ask The Question

Financial Prosecutions: S&P AAA Ratings Lawsuit

Ever since the financial collapse four years ago, the news has sporadically covered the question of why there have been no major prosecutions.  The coverage and the legal system itself have seemed to repeatedly hit a wall over the problem of ‘how provable’ the financial infractions are.

One contributor to the financial meltdown, the AAA ratings that Standard and Poors gave to high risk debt instruments known as CDO’s (collateralized debt obligations), is about to serve as the first big legal test for the ratings agencies and their role in the debacle.

The Justice Department brought a civil suit against S&P, and is considering one against Moodys, for giving the highest rating possible- AAA, to CDO’s that were based on toxic mortgage backed securities (MBS’s).  Investors, including federally insured financial institutions, relied on the ratings and lost billions of dollars when the CDO’s went south, triggering a chain reaction of losses bringing down the financial system and the economy with it.

The lawsuit for fraud includes incriminating emails from S&P managers and analysts that indicate they knew how risky the securities were, yet gave them the top rating anyway, at least in part because they didn’t want to loose income and market share for their agency.

A few choice quotes from those emails: “Let’s hope we are all wealthy and retired by the time this house of card falters.”  “We rate every deal. It could be structured by cows and we would rate it.”

Yet, even with a mountain of emails and testimony, many still think it will be difficult to prove.  Check out this incredible CNBC discussion on the slippery slope of legal intent and proving fraud.   (If no video below, click here.)


Sound familiar? There’s always some glitch, loophole or technicality of the law that allows these transgressions to slip through.  But that’s only part of this quagmire.

It turns out that cases like this rely in part on regulatory agencies, who, if they don’t do their job to begin with (which many think they didn’t), will not have the documentation needed for prosecutions. This NYT piece addresses that and much more in one of the most comprehensive and readable articles I’ve seen.

And then there’s is the conflict of interest issue- the ratings agencies get paid for their ratings!  Sen. Al Franken has renewed his commitment to fixing that after his proposed amendment to the Wall Street Reform bill stalled two years ago.

But back to the S&P fraud suit.  Let’s connect the dots:

The emails show that, internally, the risks were known.
Those risks were communicated up the chain of management.
Top AAA ratings were given anyway.
The securities collapsed.

All this tunnelling in on ‘legal intent’ and the narrow focus on fraud seems to me (not that I have any legal expertise) to be a case of not seeing the forest for the trees.

So to the media I say–

Ask the Question: Why can’t the ratings agencies be sued for financial negligence instead of fraud?

And while we’re at it, tackle these questions too:

Why is so little being done to address the conflict of interest problem in ratings agencies?
Why have no officials in the regulatory agencies been fired?

If you don’t ask, we’ll never advance the dialog beyond this chronic ‘can fraud be proved?’ limbo we’re in.

Finally, check out The Daily Shows take on CNBC’s response to the Franken amendment in this former [intlink id=”110″ type=”page” anchor=”VoW_Asst_DailyShow”]Video of the Week[/intlink].