PolitiFact's Medicare-For-All Unexplainer

CORRECTION: This article received a significant correction the same day it was published, affecting three paragraphs. Find specific details here.

In addition to its “Truth-O-Meter” and “Flip-O-Meter” judgments on political speech, PolitiFact delves fairly often into the “explainer” genre.

PolitiFact’s November 2019 “Medicare For All” explainer contained a number of misleading elements while offering its readers a credulous view of Democratic presidential candidate Sen. Elizabeth Warren’s health care proposal.

The Beauty of Vagueness

PolitiFact’s strange editing and unclear language in its section on Medicare For All financing were bound to confuse readers:

The question about how to pay for Medicare for All is ground zero in the Democratic debate. 

The latest estimate comes from analysts at the Urban Institute, a Washington-based policy center. Their computer models predict that the program Sanders has in mind would increase federal spending by $2.8 trillion in 2020, and $34 trillion over 10 years.

Warren, the only candidate with a detailed financial plan, says federal spending would rise $20.5 trillion over that decade.

Her number is so much less for several reasons — partly due to lower costs, and partly due to the way Warren would spread those costs around.

She looks to save $1.8 trillion simply in administrative expenses. Negotiating lower drug costs would save an estimated $1.7 trillion. Hospitals and doctors overall would be paid less, but some, such as rural hospitals and primary care doctors, would get a better deal.

She also taps into projected health care spending by states ($6 trillion) and employers ($9 trillion) and redirects it into Medicare for All.

That leaves about $11 trillion over 10 years to come from other sources. Warren would cover this through stronger enforcement of existing tax law, and raising taxes on billionaires, financial transactions, foreign earnings and similar measures.

First, note that Warren estimated added federal government costs of $20 trillion over 10 years, about $14 trillion below the estimate from the left-leaning Urban Institute.

Second, note that PolitiFact pseudo-explained the lower costs under Warren’s estimate by saying lower costs help account for it (“partly due to lower costs”). Yes, PolitiFact explained Warren’s lower costs by saying it would cost less. Warren also supposedly achieves lower costs by the way she spreads the costs around. We don’t see how spreading costs around results in lower costs. We wish PolitiFact would try to explain how that would work.

After telling its audience that Warren would lower costs by lowering costs, PolitiFact uses its next paragraph to mention Warren’s intent to save more on administration and prescription drugs than the Urban Institute would predict.

Instead, PolitiFact should have told its audience Warren thinks she can save more on administration and prescription drugs than the Urban Institute projects.

Unorthodox Editing

After the smoke and mirrors treatment of Warren’s cost savings, PolitiFact proceeded to conflate Warren’s cost-saving measures with her revenue-raising measures.

Remember, Warren claimed to shave $14 trillion off the Urban Institute estimate of added costs and then somehow claims to pay for the remaining $20.5 trillion.

Warren is not allowed to use the cost savings that cut $14 trillion off the Urban Institute estimate and apply those to the $20.5 trillion remaining after the cost savings. That’s double counting.

What did PolitiFact do?

PolitiFact used one paragraph to tell us Warren would save $1.8 trillion and $1.7 trillion via cost savings. In the next paragraph, PolitiFact said Warren will “tap into” state healthcare spending ($5 trillion) and employer healthcare spending ($9 trillion). After two paragraphs, PolitiFact has Warren paying for $18 trillion of her plan’s added costs.

How did PolitiFact enable Warren to undercut the Urban Institute estimate by $18 trillion instead of $14 trillion?

PolitiFact gave away the game in its next paragraph when it revealed to readers that Warren accounted for all but $11 trillion of her expected added federal costs (“That leaves about $11 trillion over 10 years to come from other sources “).

It’s an instance of bizarre editing. The $9 trillion from business belongs in neither of the first two paragraphs. That $9 trillion does not cut costs. It counts as a potential source of revenue to pay for the added costs of Warren’s plan.

It turns out PolitiFact only identified $9 trillion of the $14 trillion Warren tried to shave off the Urban Institute cost estimate. PolitiFact’s reporting may cause the unwary reader to conclude that PolitiFact’s explanation covered all of it.

Oh, the Credulity!

The PolitiFact narrative, instead of explaining Warren’s proposal, features a $9 trillion question mark. How does Warren propose redirecting what businesses pay for their employees’ health insurance? That money counts as employee income, even though it is held exempt from taxation.

Are employers supposed to give that cash to their employees and also to the government? Or do businesses give that money to the government (via taxation) and not to their employees?

In other words, is Warren pulling a fast one with her claim she will not raise taxes on the middle class? Does her plan execute that tax increase indirectly by targeting employers?

PolitiFact took no apparent notice of the problem

A Lost Opportunity for Opportunity Costs

PolitiFact included a few caveats about Sen. Warren’s proposed means of paying for Medicare For All, notably the observation from the Kaiser Family Foundation’s Drew Altman that eliminating cost-sharing (as with co-pays and deductibles) will lead to a massive increase in health care utilization.

PolitiFact loaded the caveats at the latter half of its section on financing.

Of greater concern for us was the missed opportunity to graphically illustrate for readers the proposed increase in federal government spending.

Fact checkers might take a Congressional Budget Office or Office of Management and Budget projection done in real dollars and add the estimated costs to that graph. A 10-year CBO projection from December 2018 shows nearly $57 trillion in outlays over a 10-year period ending in 2028.

Granted, because this projection is a bit dated the projected spending would be higher for a more recent 10-year projection. But it helps illustrate the point that the Urban Institute’s projected M4A costs increase the federal budget by over 50 percent.

Tax increases used to pay for part or all of the spending for Medicare For All are off the table when it comes to paying down the national debt, which currently stands at over $22 trillion.

Paying for Medicare For All will likewise shrink the new revenue options for Social Security. The Social Security Trust Fund is predicted to run out of reserve funds by about 2035. With the trust fund depleted, Social Security will no longer pay full benefits to recipients.

Review

PolitiFact misled its readers with fuzzy math on Sen. Warren’s Medicare For All plan, presenting $9 trillion in apparently new taxes as $9 trillion in cost savings. The fact checkers suggested Warren could cut costs by cutting costs instead of saying Warren expects greater savings on overhead and prescription drugs than the Urban Institute allows in its cost estimate.

Finally, PolitiFact skipped the obvious fact-checking technique of providing readers a graphic illustration of the spending increase involved with Medicare For All, along with a reminder that paying for the new plan would make paying down existing federal debt that much more difficult.

PolitiFact’s Medicare For All article counts as a poor example of the explanatory journalism aspect of modern fact-checking.