Fact-checks are one of the latest fads of journalists as they try to recover importance in the age of new media. They’re supposed to show how journalists can cut through the confusion and find the truth about controversial claims. But they can be bogus and misleading. I’m going to show this by fact-checking a fact-check by PolitiFact, a group that won the 2009 Pulitzer Prize. PolitiFact not only got it wrong, whoever wrote the one I’m examining didn’t fully understand the evidence.
PolitiFact is one of the granddaddies of the fact-checking craze. Voice of San Diego cites PolitiFact as the inspiration for its own fact check.
PolitiFact is a project of the St. Petersburg Times, itself owned by the Poynter Institute, a non-profit for journalism. But despite its august pedigree, PolitiFact can get it wrong.
Last year during the health care debates, PolitiFact rated this statement by Rep. Michele Bachmann, R-Minn, false: “Ezekiel Emanuel, one of President Obama’s key health care advisers, “says medical care should be reserved for the nondisabled. So watch out if you’re disabled.”
I think Bachmann was mostly right, after examining the evidence she presented. PolitiFact misrepresented that evidence, following guidance from an Obama Administration spokesperson.
I advise you to read the whole thing on PolitiFact before continuing. I’m going to present a condensed version of PolitiFact’s claim, but want you to have the entire source. This is important, because I contend that PolitiFact selectively presented evidence from the source for Bachmann’s claim, a 1996 article by Ezekiel Emanuel, “Where Civic Republicanism and Deliberative Democracy Meet,” in the Hastings Center Report. It is available from the National Center for Policy Analysis, which I have linked to above. I have also put a copy of the article for download at SD Rostra of the PDF of that article as well. You can judge my interpretation of the quote Bachmann used:
“Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.”
PolitiFact interprets the statement this way:
So the question is, is Emanuel saying that he thinks health services ought not to be guaranteed to patients with dementia?
No, said Kenneth Baer, a spokesman for the White House Office of Budget and Management. “He just unequivocally doesn’t believe that.”
In fact, he said, one need look only as far as the next paragraph:
“Clearly more needs to be done to elucidate what specific health care services are basic; however, the overlap between liberalism and communitarianism points to a way of introducing the good back into medical ethics and devising a principled way of distinguishing basic from discretionary health care services.”
Yeah, we sorta got lost there too.
PolitiFact may have gotten lost there, but I didn’t. It’s not that difficult to understand if you know basic English and are willing to do some serious cogitation. However, the fact-check author isn’t comfortable reading what the piece describes as “highbrow articles for academic journals”.
Continuing on with the PolitiFact quote from White House spokesman Baer. His doctorate is in politics, not medicine, so Baer doesn’t appear to have any special insight denied to the rest of us:
“What it means, Baer said, is that Emanuel was exploring different views of political theory as they apply to health care decisions and following one school of thought through to the point where he notes that it would lead to ‘potentially disturbing types of policy ramifications.’ “
Actually, it says the opposite, as I’ll point out a bit later in this piece.
The PolitiFact piece presents other articles written by Ezekiel Emanuel to support that view. However, most of them were written during or after the 2008 election, and have to be viewed in that context — it would be politically inconvenient to repeat such a controversial idea. Any politically savvy person would know that.
That leaves a 1997 Wall Street Journal article, from which PolitiFact cites an ambiguous quote:
“For the millions of others, legalizing euthanasia or physician-assisted suicide would be of no benefit. To the contrary, it would be a way of avoiding the complex and arduous efforts required of doctors and other health-care providers to ensure that dying patients receive humane, dignified care.”
That quote’s beginning, “For the millions of others . . . ” implies something was left out. And indeed it was. Here’s a link to the whole article.
And here’s the whole paragraph from which PolitiFact took the quote. I am boldfacing the part PolitiFact omitted:
Indeed, of the 2.3 million Americans who die each year, these data indicate that fewer than 25,000 might desire euthanasia for reasons related to pain. For the millions of others, legalizing euthanasia or physician-assisted suicide would be of no benefit. To the contrary, it would be a way of avoiding the complex and arduous efforts required of doctors and other health-care providers to ensure that dying patients receive humane, dignified care.
So Emanuel is knocking down a misbelief that pain is a big reason for patients wanting euthanasia. That says nothing about the morality of euthanasia.
Bear in mind that anything written in the Wall Street Journal is meant for public consumption. It’s the “highbrow articles for academic journals” where professionals talk with each other.
I’m now going to provide the full paragraph that PolitiFact selectively quoted from, with especially pertinent parts highlighted. I didn’t need any spokesman to walk me through it, and neither do you:
“This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to to deliberate about which health services should be basic and should be socially guaranteed. Substantively, it suggests services that promote continuation of the polity, – those that ensure future healthy generations, ensure development of practical reasoning skills, and ensure full and active participation in public deliberations – are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.”
The Communitarian Hive-Mind
While this may be too intellectually demanding for PolitiFact — political reporters aren’t know for their intellectualism — it’s quite understandable if you take the time to read it, as I have.
Emanuel proposes the “communitarian” movement meld with liberal ideology. Both are opposed to the core values of individualism that are the basis of America.
Individualists think of society as being formed to protect the individuals in it. The only rights that matter to them are individual rights, and every individual has equal rights. Any restriction on individual rights, such as not being allowed to falsely shout “Fire!” in a crowded theater, is based on the principle of protecting the equal rights of other individuals.
But communitarians say they want to balance individual rights with that of the community as a whole. Or in more blunt terms, they want to subordinate individual rights to the rights of society as a whole. Communitarians think of society as some mass organism with its own rights that supersede those of individuals.
But how to draw up the rights and powers of this super colony creature over individuals, specifically when it comes to health care? Emanuel thinks that can be achieved with public forums consisting of qualified citizens to make the rules. This, Emanuel wrote, dovetails with a growing liberal movement for “deliberative democracy.”
“Communitarians endorse civic republicanism and a growing number of liberals endorse some version of deliberative democracy,” Emanuel wrote. “Both envision a need for citizens who are independent and responsible and for public forums that present citizens with opportunities to enter into public deliberations on social policies.”
So we’ll have lots of forums where citizens will talk and somehow their advice will be melded into a grand plan for what rights we have — which rights go to the individual, and which go to the communitarian hive-mind.
Getting to health care, Emanuel is saying that this philosophy, “civic republican or deliberative democratic conception of the good,” provides insights for a “just allocation of health care resources.”
That allocation provides as a basic, guaranteed service health care for those “that promote the continuation of the polity,” or future generations. It’s not a right, mind you, but a privilege of guaranteed health care given to those who are judged useful to society. Those who aren’t useful are quite literally second-class citizens. Perhaps they’ll get some kind of health care, but by definition it will be of an inferior kind.
Emanuel gives an example of “patients with dementia,” and it’s an instructive one. Those with dementia are presumably past child-bearing age and in this scenario, have no prospect to recover and make further contributions to society. However, children with learning disabilities might be helped to become productive members of the “polity.”
Two-Class Health System
So in the health care system Emanuel discusses in this article, the continuation of society is a higher value than the welfare of the individual. One might ask how physicians under such a system can reconcile this two-class system with their Hippocratic oath. Well, they can’t. Doctors would have to put the good of society, as the government defines it, over what would be the best care for each patient.
However, Bachmann’s claim that Emanuel is saying that “medical care should be reserved for the nondisabled,” goes too far. It is conceivable that some disabled people could be guaranteed health services under Emanuel’s description. I can imagine that a young and otherwise healthy person with an amputated leg who has children might be judged worth saving. That person might be expected to earn a living and, by caring for children, advance the interests of the “polity.”
Finally, let’s consider this defense from Baer as quoted in PolitiFact:
“What it means, Baer said, is that Emanuel was exploring different views of political theory as they apply to health care decisions and following one school of thought through to the point where he notes that it would lead to ‘potentially disturbing types of policy ramifications.’ “
False. There is no such statement about “potentially disturbing types of policy ramifications” statement in the discussion at issue, which comes toward the end of the paper. The purported quote isn’t there.
To the contrary, Emanuel praises this school of thought as “a way of introducing the good back into medical ethics and devising a principled way of distinguishing basic from discretionary health care services,” as well as “progress in political philosophy.”
A good reporter would have quizzed the White House spokesman on this and pointed out the contradiction. But PolitiFact ignored it.
You can read the paper yourself and see what I mean. Or just look at the screen grabs of the article’s conclusion below. They are two screen grabs because the word “dementia” is hyphenated at the end of a page:
PolitiFact missed these points — reading that highfalutin academic stuff must really be tough for a political reporter! Here is how PolitiFact formulated the statement it supposedly was checking:
So the question is, is Emanuel saying that he thinks health services ought not to be guaranteed to patients with dementia?
Since PolitiFact formulated the question that way, I rate the PolitiFact fact-check as: False. I’ll even use the same icon PolitiFact used for that fact-check:
How To Read A Fact-Check
Personally, I think of fact-checks as a marketing gimmick. They make the reporters feel good, and give the news sources the impression of uncovering truth — complete with cute graphics — but are only as trustworthy as the source.
But when you do read fact-checks, I suggest you do the following in evaluating them:
1: Look for the supporting material. The fact-check should provide them or link to them. Mere citations aren’t enough if they are online. For example, the PolitiFact fact-check I deconstructed didn’t link to the paper in question, although it’s online. It was only by reading the paper that I saw the pertinent material PolitiFact selectively omitted to strengthen its case.
2: Do the materials show the fact-check fairly presents the evidence, or was it selectively presented? It was only by reading the Emanuel paper that I saw the pertinent material PolitiFact selectively omitted to strength its case. That’s dishonesty or just plain incomprehension.
3: Does the fact-check show evidence of using authoritative sources? With this fact-check, PolitiFact should not have been satisfied with a spokesman for the interested party. And since the author of this fact-check was admittedly less than knowledgeable about academic publications, a real expert should have written the piece.
UPDATE: That error-filled PolitiFact item recently misled a blogger on the left-of-center Talking Points Memo. The blogger referred to it in April of this year in a post by one Chuckie Corra that criticized Bachmann. Doubtless there are many other places where PolitiFact’s false piece has spread misinformation, harming the public interest journalism putatively serves.