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Gerson And Epistemic Closure

One day, a couple months ago, I set out to define what I called the conservative movement's "misinformation feedback loop," the process by which right-wingers repeat falsehoods back and forth, not paying attention to corrections because those corrections are made by untrusted figures from outside the movement Somehow my deft phrase failed to catch on. A mere two days later, Julian Sanchez called the phenomenon "epistemic closure" -- a phrase no doubt devised by high-priced Madison Avenue firms and tested repeatedly upon focus groups -- and he set the blogging world on fire. Now everybody who uses the phrase has to pay Sanchez a royalty, the proceeds of which he uses to subsidize his leisurely twice-a-week blogging schedule while I grind away.

Anyway, on to my point. The subject of my deeply and unfairly unappreciated post was the persistent belief among conservatives that health care reform relied upon hiding the cost of the "doc fix." It's a pure myth. In 1997, Congress tinkered with the formula for reimbursing doctors under Medicare. Unintentionally, they wrote deep cuts into the law. Almost every year since, Congress has restored the cuts, a ritual called the doc fix. Last year, the House considered including a permanent doc fix in its health care reform bill, which would help attract crucial support from doctors. Eventually, the House decided that finding enough money to pay for covering the uninsured was hard enough without also paying for an unrelated problem, and left it out. Ever since, Republicans have been charging them with hiding the "true cost" of health care reform. People like me keep correcting them  but they keep saying it, over and over.

Michael Gerson does it again in today's Washington Post.

Two months after passing a law that supporters claimed would reduce federal deficits, largely through Medicare cuts, the House is moving toward a temporary "doctor fix" that would add tens of billions in Medicare costs. Even more expensive fixes are likely in the future. Congressional leaders knew this spending would be necessary when they passed health reform in March. Yet they didn't include this liability in the law, in order to hide the overall cost of the entitlement.

Argh. This isn't part of the "overall cost of the entitlement." It's part of the cost of running Medicare. The cost exists irrespective of the Affordable Care Act. The paper savings from lower physician reimbursements were not used to cover insurance subsidies in the bill. If health care reform had died, Congress would still be passing a doc fix. Gerson's charge is utterly, unambiguously false.

Gerson proceeds to lament that health insurance creates an entitlement for people who are not old.

When entitlements began in America, they were mainly focused on the elderly (through Social Security and Medicare) and the poor and disabled (through Aid to Families With Dependent Children and Medicaid). Benefits for the middle class were largely given through tax deductions for mortgage interest and the purchase of health coverage by businesses.
America eventually retreated from some entitlement commitments to the poor because they involved a moral hazard -- discouraging work and responsibility. Entitlements for the elderly have remained a strong, national consensus.
But the idea of a middle-class entitlement to health care, achieved through an individual mandate, subsidies and aggressive insurance regulation, seems to change the nature of American society. Entitlements in the Obama era are no longer a decent provision for the vulnerable; they are intended for citizens at every stage of life.

This is wrong in all kinds of ways. The government already provides health care for low-income people. It's called Medicaid. The government also provides all kinds of entitlements for middle-class people -- unemployment insurance, home mortgage tax deduction, any number of tax credits.

But leave that aside. Focus on Gerson's claim that the Affordable Care Act benefits citizens who are not "vulnerable." By what possible standard is this true? The primary beneficiaries are people who can't afford to buy health insurance! They're vulnerable to getting sick and suffering terrible pain, bankruptcy, or even death either because they or a family member has a preexisting condition, or because their employer doesn't offer health insurance and they're priced out of the dysfunctional individual market. That's not "vulnerable"?

Gerson built his reputation as an advocate of compassionate policies that are compatible with right-wing thought. But his primary work was in the role of putting a compassionate face on the wildly plutocratic agenda of the Bush administration. That is the task that Gerson excels at, and it is on bright display here.