In August of 2009, Sarah Palin claimed that the health legislation being crafted by Democrats at the time would create a “death panel,” in which government bureaucrats would decide whether disabled and elderly patients are “worthy of healthcare.” Despite being debunked by fact-checkers and mainstream media outlets, this myth has persisted, with almost half of Americans stating recently that they believe the Affordable Care Act (ACA) creates such a panel.
The death panel myth killed neither the ACA nor Obama’s reelection bid. But persistence of this myth could threaten the Obama administration’s efforts to implement the law, because many of its most controversial features are scheduled to be implemented over the next few years. Why is the death panel myth so hard to shake and why is its persistence relevant to the unfolding of Obamacare?
In part, the myth is hard to shake because most people have a very poor understanding of the complex law. The ACA tries to increase access to health insurance through a bewildering combination of Medicaid expansions, private insurance subsidies, health insurance exchanges, and the infamous health insurance mandate. It attempts to improve healthcare quality through things such as reimbursement reforms and promotion of electronic medical records. And it encourages the formation of more efficient healthcare organizations, with inscrutable names like “accountable care organizations” and “medical homes”.
The myth is also likely to persist because the law calls for the establishment of a 15 person committee– the independent payment advisory board (or IPAB)–which is given the job of recommending cost-saving measures to the Secretary of Health and Human Services if Medicare expenses rise too quickly. The IPAB will consist of independent healthcare experts who are forbidden, by law, from proposing changes that will affect Medicare coverage or quality.
In other words, they are a far cry from a death panel, with the ACA specifically noting that this group is not allowed to do anything that would “ration” healthcare. The law also makes sure that the IPAB is not in a position to make policy, but instead to simply make recommendations to the Secretary of Health and Human Services, proposals that Congress is specifically empowered to override if it sees fit.
But the limits to the power of the IPAB won’t prevent the death panel myth from persisting. Indeed, in a recently published study, my colleagues and I show why the death panel myth may even grow with time. (My colleagues, the brains of this study, were the political scientists Brendan Nyhan and Jason Reifler.) In our study, we tested how fact-checking of the death panel myth influences people’s belief in the existence of such panels. We discovered that debunking such myths is effective at convincing some people to give up their belief in death panels. People who had warm feelings toward Sarah Palin, and thus believed her death panel claim, were willing to abandon that belief when faced with non-partisan fact-checking evidence that these death panels did not exist at the time of Palin’s claim. But the fact-checking only reduced belief in death panels among Palin supporters who otherwise had very little knowledge of politics—people who couldn’t say, for example, how many U.S. Senators there are in each state. By contrast, as shown in the picture, Palin supporters who also held basic knowledge of U.S. politics were resistant to fact-checking –debunking of the death panel myth not only failed to dissuade them from believing in death panels, but actually caused them to believe more strongly that such panels exist.
Fact-checking backfires among people who have enough basic knowledge of politics to resist evidence that contradicts their beliefs! It is difficult for people to see the world clearly, when their vision is biased by their pre-existing attitudes. As I have shown in earlier research, we all—liberals and conservatives, Democrats and Republicans–see the world through partisan eyes.
At the time of Palin’s original death panel claim, the IPAB hadn’t been written into legislation. Her claim instead was focused on language being proposed in the bill that would require Medicare to pay for end-of-life counseling. The death panel myth grabbed hold even though the vast majority of Americans are in favor of payment for end-of-life counseling. Given the much greater controversy likely to surround the IPAB when it is formed later this year, and the psychological resistance people have to abandoning deeply held beliefs, expect a recurrence of the death panel controversy as the ACA unfolds.
The ACA has already survived a Supreme Court challenge and a reelection campaign. Only time will tell whether it survives the death panel controversy.
Peter Ubel is a physician, behavioral scientist and author of Pricing Life: Why It’s Time for Health Care Rationing and Free Market Madness and his new book Critical Decisions. He teaches business and public policy at Duke University. You can follow him on his personal blog.