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Bill Kristol Says Things That Are The Opposite of True

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"One reason the price of health care is going up so fast is because of government programs," says Kristol. "The price of Medicare and Medicaid have gone up faster than private insurance. That's well-documented."

It is true that the growth rates of Medicare, Medicaid, and private insurance are well-documented. But the documentation shows the opposite of what Bill Kristol says it shows. The price of Medicare and Medicaid have gone up much more slowly than private insurance. Take Medicare:

medicarephigrowth.jpg

That doesn't require much explanation. Suffice to say, the growth in per-person spending for Medicare has been significantly slower than private health insurance over the past 20 years, and its advantage has widened in recent years. But wait, you say. Kristol mentioned both Medicare and Medicaid. Maybe he just meant Medicaid? Nope!

medicaidspending.jpg

Bill Kristol, who writes frequently about health care and advises the Republican Party about how to vote on bills, is misinformed on the basic facts of the situation. And even his misinformation isn't terribly coherent: Later in the interview, he says that the Army health-care system -- which is fully socialized -- is the best health-care system we've got, and the reason we can't give it to all Americans is that it's too expensive. Socialized medicine, in other words, works. The rest of us just don't deserve it.

To be fair, I don't believe that Kristol believes that. When he says that the danger with Obama's plan is that it "would put us well on the road to government-run health care," I take him at his word. But it is interesting to watch what happens when his adoration for all things military collides with the distrust of all things federal. Turns out that the conservative in Kristol is no match for the militarist.

By Ezra Klein  |  July 28, 2009; 10:34 AM ET
Categories:  Health Reform  
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Comments

Just like Ezra love for all things liberal will continue to dominate all of his posts.

Posted by: Natstural | July 28, 2009 11:02 AM | Report abuse

Kristol is no President for Media to be tough on him and split analyze coherence of all his utterances. Still, Media will do service if they continuously and consistently hammer these baroque and 'little brain' voices in America's Public Discourse. Ezra has done that here and thank him for the same. Now hope rest of the Media continues this demolishing job of Fred Barnes, Sir Kudlow and the father of all - Rush Limbough.

Posted by: umesh409 | July 28, 2009 11:05 AM | Report abuse

readers deserve factual, accurate information from supposedly respected journalists like george will and bill kristol.
it is important to keep exposing them, and holding them accountable.

they abuse their power, disrespect their readers and do a disservice to other journalists when they spread inaccurate information.

they are entitled to their opinions, but not when they deliberately distort their facts to arrive at them, and pass it on as truth to people who may not be well-versed enough in subjects, to know the difference.

Posted by: jkaren | July 28, 2009 11:09 AM | Report abuse

I grew up in the military, my father was in the Air Force, so I had fine socialist govt run health care throughout my childhood. It was fine for me and my family.

Posted by: bdballard | July 28, 2009 11:16 AM | Report abuse

Never mind Bill Kristol. Why aren't the salient facts and the persuasive graphs of this post prominently displayed in an article in The Washington Post? I bet that they would surprise a lot of readers who are trying to determine the desirability of the public option and the necessity of cost controls.

Posted by: pneogy | July 28, 2009 11:19 AM | Report abuse

It's infinitely more honest than claiming that medicare and medicaid are more efficient than private insurers.

And if you factor in the huge waste and fraud loses of the Government programs, and the expenses of other agencies that support them, then their growth rates are easily greater.

And you should also consider that a portion of every single privately insured premium payment is an indirect subsidy or tax to fund the lower Medicare and Medicaid reimbursement rates.

So if Medicare and Medicaid are destructive disasters to everyone that isn't a mindless hack then why are they being considered as models worthy of expansion? any genuine reform should involve exploring a better way to help the poor and the elderly acquire healthcare services. Stop advocating the expansion of failure!!

Posted by: fallsmeadjc | July 28, 2009 11:21 AM | Report abuse


yeah, i scratched my head when he said that bit about Medicare and Medicaid costs too, thanks for digging it up.

Also, noted there was a bit of conflating VA and Military health in the interview.

Posted by: ThomasEN | July 28, 2009 11:23 AM | Report abuse

Yes, Kristol is absolutely wrong. But let's remember why Medicare and Medicaid spending grows more slowly: Both programs set prices below the cost of care (broadly speaking. It's easier to slow cost growth when prices are dictated. So, it's important to realize that Medicare and Medicaid aren't doing anything to restrain costs that is replicable in the private sector.

Posted by: mbp3 | July 28, 2009 11:24 AM | Report abuse

The irony of a hack criticising a hack is worthy of a Daily Show segment. Your blustering effort and hackish logic are hilarious.

Posted by: fallsmeadjc | July 28, 2009 11:26 AM | Report abuse

Great post.

Posted by: Castorp1 | July 28, 2009 11:29 AM | Report abuse

Out of curiousity, how expensive is the Socialized Medical program of the military? Is there documentation on that?

I assumed that Kristol was BS-ing, as usual, when he said that Military healthcare was more expensive, but I haven't seen any documentation one way or the other (like the documentation you provide on Medicare and Medicaid) that analyzes costs of the military healthcare system. Does such documentation exist?

Posted by: Matt40 | July 28, 2009 11:37 AM | Report abuse

Thanks Ezra - that was frickin hillarious.

Btw, the total cost of the military health system is very weird and difficult to ascertain. The tricare contracts did just get awarded, so we might figure something out there.

On the VA, however, it's considered the most cost efficient health system in the country. It costs substantially less than even the cheapest managed care systems (e.g. Kaiser, Mayo, etc.). Since they negotiate sub-ceiling discounts on drugs and other supplies, they are clearly at at the market rate and not at some price ceiling set by the government. One reason is that docs are employees and they have a very stringent formulary, with a very quick exceptions process, so when they try to set the most cost-effective practices, they are obeyed with minimal hassle.

Posted by: GrandArch | July 28, 2009 12:00 PM | Report abuse

It's an amazing gig that Kristol has, isn't it? His every utterance is completely predictable, almost always proved completely wrong within minutes, and yet he never wants for work. The right-wing perpetually employ him, he swings from one national publication to the next, he is always on tv. He never flinches, even when the egg is dripping off of his face in front of everyone. It's almost like he is just some sort of actor, a character, that the wingnut right needs so they keep paying him and he keeps taking the money.

Posted by: fishermansblues | July 28, 2009 12:05 PM | Report abuse

Ezra, there was a typo in this sentence: "Bill Kristol, who writes frequently about health care and advises the Republican Party about how to vote on bills, is misinformed on the basic facts of the situation."

It should read, "Bill Kristol, who writes frequently about health care and advises the Republican Party about how to vote on bills, is LYING on the basic facts of the situation."

Fixed!

Posted by: steveh46 | July 28, 2009 12:13 PM | Report abuse

"The irony of a hack criticising a hack is worthy of a Daily Show segment. Your blustering effort and hackish logic are hilarious."

It's not irony that this comes from fallsmeadjc; it's just a predictable lack of self-awareness.

Kristol opposes healthcare reform because he believes that it will deliver the reins of power to the Democrats for the rest of his life, an outcome that would leave him to appear on The Daily Show instead of helping the GOP plan illegal wars.

Posted by: pseudonymousinnc | July 28, 2009 12:25 PM | Report abuse

I thought healthcare reform was about helping the uninsured in the most inefficient way that Congress can imagine. Are you telling me its primary purpose is to help the political interests of the Democratic Party? Why are they playing politics with our healthcare? This isn't a game!

Posted by: fallsmeadjc | July 28, 2009 12:36 PM | Report abuse

Keep your government hands off my military!

Posted by: bluegrass1 | July 28, 2009 1:02 PM | Report abuse

"The irony of a hack criticising a hack is worthy of a Daily Show segment. Your blustering effort and hackish logic are hilarious."

When you call someone a hack it is necessary (as Ezra does) to show your work. No points for ad hominem statements. Spelling counts, and no hitting. Inside voice please!

Posted by: jeirvine | July 28, 2009 1:05 PM | Report abuse

I wonder if The Daily Show will run a correction? Stewart would have a ball with it. By the way, judging from that interview, Kristol has a "tell" - watch when he giggles.

Posted by: kcc3 | July 28, 2009 1:05 PM | Report abuse

Good work, Ezra. I wish more people to the time to expose Bill Kristol's consistent untruths and even more consistent talking out of both sides of his mouth. If he spent more time considering the joys of honesty and less time drooling over Sarah Palin, he might actually find himself on the right side of the facts every once in a while.

Posted by: knightstale | July 28, 2009 1:45 PM | Report abuse

Ezra,

I assume that Kristol is referring to this study, which purports to demonstrate his point:

http://www.investors.com/NewsAndAnalysis/Article.aspx?id=480067

The author accuses most studies of failing to include out of pocket expenses of patients in determining the overall system expense. What do you think of its argument?

Posted by: FrBill1 | July 28, 2009 2:19 PM | Report abuse

Bill Kristol is of course an idiot.

That aside, military health is basically a mixed model -- part staff-model HMO and a purchased care network of providers, and part fee-for-service insurance. So costs are little complicated.

Certainly on the Active Duty, military treatment facility side, costs per visit or admission are almost certainly dramatically lower than in civilian care -- due to a healthier population, lower salaries for Active Duty physicians than in the civilian sector, the Feres doctrine that forbids lawsuits between parties within the Armed Forces, and to anti-kickback laws that forbid pharmaceutical detailing and free sample practices common in the civilian sector. Also the govt doesn't charge for physicial infrastructure depreciation, and in general doesn't account for, or cover, all the costs the way that a civilian hospital or clinic would (like detailing out 2nd LTs to paint the lampposts in the parking lot).

So for about $9B or so the military covers 4 million (mostly young, very few with chronic conditions -- those are medically discharged and go out to VA) folks. For another $14b they cover another 3-4 million older retirees and their families mostly through insurance contracts. The rest of the budget is the liabiity for downstream costs in the over 65 population.

Net net, call it about $3000 per capita, which would put it about $4000 less for a family of four than the Milliman index.

But not generalizable that way, and for the reasons above, NOT because it "costs more."

CNA (www.cna.org) has done a number of in depth cost studies, and the Congressional Research Service has the best overview of TRICARE. See the "green book" (DoD Comptroller budget) for more on the Defense Health Program budget details.

Posted by: PandaMan5 | July 28, 2009 2:51 PM | Report abuse

Ezra--

I'm afraid your chart distorts the numbers.

Why cut the chart off at 1983? Becuase it makes Medicare look more efficient than it is.

If you take the numbers back to 1970, you'll find that from 1970 to 2006 (the most recent numbers I have) Medicare spending rose by an average of 8.7% a year while private insuers spending rose by 9.7% a year.

In other words, neither Medicare nor private insurers have been able to rein in costs.

Recently, 1999-2006, Medicare spendign has been rising by an average of 5.6% a year--still completely unaffordable. (Neither GDP nor wages have risen by this amount.)

In other words, having a government insurance plan does not magically contain spending. (Jacob Hacker also picks the beginning point for his chart to suggest that Medicare is significantly more efficient--which just isn't true.)

Private insurers did a much better job of containing costs in the 1990s. The problem is that they said "No" to both effective and ineffective care.

Medicare needs to be reformed, with spending cut sharply (eliminating overpayments for a great many unnecessary and ineffective treatments.)

Then the public option can be modeled on a reformed Medicare.

This is why the House Bill reforms Medicare, and doesn't have a public option kick in until 2013--at that point, it can incorporate some of Medicare's reforms--and keep on incorporating them in the years ahead.

As Orszag tells us on his blog the real savings from structural reforms don't kick in until after ten years.

This is one reason why we need tax increases on the wealthy to seed reforom.

Posted by: mahar1 | July 28, 2009 3:17 PM | Report abuse

But Ezra, he sees it as noble lie, so it's okay.

Posted by: danielburns | July 28, 2009 4:34 PM | Report abuse

Ezra,
You are a fraud. The only reason your Medicare chart works is because you start in 1983. What counts is the trend in recent years and the future.


Overall, the report said, health spending increased 6.7 percent in 2006,

Medicare spending increased 18.7 percent in 2006.

http://www.nytimes.com/2008/01/08/world/americas/08iht-health.4.9083459.html

Posted by: gwlaw99 | July 28, 2009 5:33 PM | Report abuse

gwlaw99 wrote: "Overall, the report said, health spending increased 6.7 percent in 2006, Medicare spending increased 18.7 percent in 2006."

You left out the part about Medicare Part D being added that year. So you're comparing apples and oranges.

Posted by: steveh46 | July 28, 2009 5:45 PM | Report abuse

Why is Kristol still given air time? He's been wrong about so much, so often that giving him time is a real waste.

Posted by: piniella | July 28, 2009 9:58 PM | Report abuse

Very misleading post Ezra. You are playing a game here and hoping people aren't paying attention. The only reason Medicare spending hasn't risen as rapidly as private health insurance is because of the low reimbursements Medicare and Medicaid provide to physicians and hospitals. These reimbursement rates are set by the Federal government. In reality one of the reasons those of us enrolled in private health insurance pay as much as we do is because of this "cost shift" from Medicare. Physicians and hospitals are forced to charge private insurers more for services because they do not receive enough from Medicare. But you already know this.
Give us a real reason for a public insurance option that eventually turns into a government run health care system ...there are plenty of good ones. This is a hack job and a poor one at that.

Posted by: resstrunt | July 29, 2009 2:00 AM | Report abuse

Such dishonesty, Ezra. The fixed payment schedules of those programs amplifies the burden they put on the private sector when true costs go up. Kristol's not wrong about that.

Posted by: whoisjohngaltcom | July 29, 2009 7:31 AM | Report abuse

@steveh has it right, Ezra, although I suspect you were just being polite. Bill Kristol is not misinformed, he's using his time-honored tactic of throwing out the Big Lie in a public forum. What he failed to realize is that Daily Show viewers are among the most politically well-informed.

He's just another liar from the GOP cesspool of crazy wingnuts.

Posted by: BigTunaTim | July 29, 2009 10:06 AM | Report abuse

Figure 4 is the CBO chart of projected future health costs as a percentage of GDP until 2082

Private spending goes from 15% to 50% and increase of 3.33 times its current percentage of GDP.

Medicare goes from 2.5% to 15% an increase of 6 times its current percentaage of GDP.

http://www.cbo.gov/ftpdocs/87xx/doc8758/MainText.3.1.shtml

Posted by: gwlaw99 | July 29, 2009 10:09 AM | Report abuse

Kristol's outfit the Weekly Standard refutes Ezra's attack:

http://www.weeklystandard.com/weblogs/TWSFP/2009/07/costs_of_medicaremedicaid_have_1.asp#more

Money quote: Advocates of ObamaCare like to rely on studies comparing the cost-increases of government-run care with the cost-increases of private insurance. But such studies completely ignore private out-of-pocket costs. They ignore the fact that out-of-pocket costs have gone from being 62 percent of the private market in 1970 to just 26 percent today -- and that private insurance correspondingly covers almost twice as much care today as it did back then (74 percent compared to just 38 percent).

If something similar hasn't happened in Medicare/Medicaid, I think they have a point.

Posted by: blsdaniel | July 29, 2009 5:11 PM | Report abuse

Milton Friedman noted that 56 percent of all hospitals in America were privately owned and for-profit in 1910. After 60 years of subsidies for government-run hospitals, the number had fallen to about 10 percent. It took decades, but by the early 1990s government had taken over almost the entire hospital industry. That small portion of the industry that remains for-profit is regulated in an extraordinarily heavy way by federal, state and local governments so that many (perhaps most) of the decisions made by hospital administrators have to do with regulatory compliance as opposed to patient/customer service in pursuit of profit. It is profit, of course, that is necessary for private-sector hospitals to have the wherewithal to pay for healthcare.

Friedman's key conclusion was that, as with all governmental bureaucratic systems, government-owned or -controlled healthcare created a situation whereby increased "inputs," such as expenditures on equipment, infrastructure, and the salaries of medical professionals, actually led to decreased "outputs" in terms of the quantity of medical care. For example, while medical expenditures rose by 224 percent from 1965–1989, the number of hospital beds per 1,000 population fell by 44 percent and the number of beds occupied declined by 15 percent. Also during this time of almost complete governmental domination of the hospital industry (1944–1989), costs per patient-day rose almost 24-fold after inflation is taken into account.

Posted by: HayeksHeroes | July 30, 2009 1:51 AM | Report abuse

This is ridiculous. For a limited number of people, like those connected to the military, the government can set up a system and run it, and waste a ton of money, and get away with it. But project this over the whole population and you WILL get higher cost and worse care.

Can people not see that, or do they, for some strange reason, like that--maybe because it will be more "fair"?

Posted by: yourstruly1991 | July 30, 2009 10:22 AM | Report abuse

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