Watching Betsy McCaughey lie about Barack Obama's health care legislation is a little bit like watching Aretha Franklin on stage: It's not as good as you remember, but you have to admit that she's still got it. So too with McCaughey, who I was planning to ignore. I'm too young for nostalgia. But then Limbaugh grabbed her column, and so did Fox news, and of course Drudge, and last night, chatting with an acquaintance who works on the Hill, he got a call from his left-leaning mother who'd heard the stimulus was going to destroy her health care. Indeed, as the Wonk Room shows, the right wing noise machine is almost giddy over her reemergence:
Betsy McCaughey first came to prominence for a New Republic article entitled "No Exit." The conceit of the piece was that unlike everyone else, McCaughey had pored over every page and paragraph of the massive Clinton health bill and come back with a clearer view of the legislation's contours than anyone had previously presented. And what she'd found was worrying. "The law will prevent you from going outside the system to buy basic health coverage you think is better," McCaughey wrote. "The doctor can be paid only by the plan, not by you." Hence, "No Exit." You were trapped in the system.
McCaughey, it turned out, isn't a very good reader. Section three of the Clinton health legislation ("Protection of Consumer Choice") held that, "nothing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services.” But in a policy debate, it's more important that your opinions prove convenient than accurate, and McCaughey's argument was certainly convenient: She got first one cover story in The New Republic and then a second. George Will picked up her views, as did the rest of the right wing media and legislative infrastructure. And this wasn't a "provocative" argument. It was simply wrong. It argued that the legislation said X when the legislation said not-X. It remained an enduring black mark on The New Republic's reputation. When Frank Foer took over as editor, among his first acts was making amends. “We recanted that story in the first issue and apologized for it," he says. It was that bad.
McCaughey, unsurprisingly, is back again, with an editorial in Bloomberg. In it, she warns that provisions of the stimulus bill "are dangerous to your health." In particular, she tells of "one new bureaucracy, the National Coordinator of Health Information Technology, [which] will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective."
Sigh. The National Coordinator of Health Information Technology is not a new bureaucracy created in the stimulus. Bush signed it into office in 2004. it has a web site, a director, and, presumably, a phone line, which could have been used by McCaughey or Bloomberg to check the next fact: That it will "monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective."
You'll be shocked to learn that, no, it doesn't do this, either. McCaughey is darkly conflating two things: One is medical health records. That's what the NCHIT oversees. It's a coordinating authority that helps "guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors, to the extent permitted by law; and provides comments and advice at the request of OMB regarding specific Federal health information technology programs." In other words, it's helping the private sector move your medical records from manila envelopes to computers, and trying to help the private sector settle on a single standard so the records can be shared among different providers. That way, if you have an emergency and are taken by ambulance to the hospital, your primary care doctors can e-mail them your information immediately so you don't die from a drug allergy they didn't know about. This is all about a decade away from happening, incidentally.
Meanwhile, the thing McCaughey is actually talking about, or trying to talk about, or trying to lie about, is comparative effectiveness review. The stimulus bill funds increased research into the value of different treatments. This sort of research goes on every day, all the time. Foundations fund it, as do universities and even pharmaceutical companies. Not only isn't it sinister, it's not even particularly interesting.
As for McCaughey's broader claim, nothing in the bill, nor in the structure of the federal government, gives the Secretary of Health and Human Services the capacity, funding, authority, or mandate to monitor the medical profession's treatment decisions and decide if they're appropriate. There may come a day when that data is used to make coverage decisions, but that day is not today, and nothing in the stimulus brings it any closer. Indeed, doing so would be a question not of data collection but of payment reform (you'd have to change payment rates to reflect the research). There is nothing on that in the bill. McCaughey is simply lying, much as she did in 1990s. And, like in the 1990s, her lies are convenient, and they're being amplified by opportunistic rightwing outlets. But this isn't the 90s. And the thing about nostalgia tours is they never last very long, and they're never as effective as the original.