Last week, the Washington Post Fact Checker awarded three Pinocchios to Bernie Sanders’ claim that “500,000 people go bankrupt every year because they cannot pay their outrageous medical bills.” Needless to say, Sanders’ campaign wasn’t happy about it. They responded to the fact check with a letter demanding a retraction:
NEWS: The Bernie 2020 campaign has just sent a detailed letter to @washingtonpost editor @PostBaron demanding a retraction of the inaccurate "fact check" article about @BernieSanders & medical bankruptcy. We await Mr. Baron's response. Read the letter: https://t.co/TUwKj3QoT9 pic.twitter.com/1y59QMKa75
— Warren Gunnels (@GunnelsWarren) August 31, 2019
David Himmelstein and Steffie Woolhandler, authors of the study on which Sanders’ claim was based, also called out WaPo for questioning the soundness of their research. Other left-wing journos and media outlets are slamming WaPo for failing to indulge Sanders’ claims:
Getting the facts wrong once is a mistake. Getting them wrong consistently when it concerns one candidate is suggestive of bias.
The Bezos-owned Washington Post is consistently sloppy and negative in its coverage of Bernie Sanders. One might even call it "political." https://t.co/PJyDia2lYM
— Walker Bragman (@WalkerBragman) August 29, 2019
Why is the Washington Post fact checker calling accurate things "mostly false"?https://t.co/8KtBb4EbIL
— Tim Dickinson (@7im) August 29, 2019
The Washington Post's war on Bernie Sanders is dishonest and embarrassing. https://t.co/bbSsVKv4Ow
— Jacobin (@jacobinmag) September 3, 2019
Fact checking is a sacred art, and when it comes to Bernie Sanders, The Washington Post needs to reevaluate its methods. https://t.co/hUCYnVWWgL
— The Nation (@thenation) September 3, 2019
Recommended
Since these outlets don’t seem to be interested in much beyond protecting the precious, WaPo columnist Megan McArdle is graciously doing their work for them and taking a closer look at why Sanders’ claim merited those three Pinocchios.
Megan McArdle (@asymmetricinfo) deconstructs the claim that medical bills cause more than half of all bankruptcies: https://t.co/KJhdmFx4Ol
— Michael F. Cannon (@mfcannon) September 3, 2019
Check it out:
Since everyone is @'ing me on the dispute between the Bernie campaign and our Fact Checker on medical bankruptcy, I will make a few brief notes.
— Megan McArdle (@asymmetricinfo) September 3, 2019
First, the researchers whom Sanders is relying are the cofounders of Physicians for a National Health Program, an organization which long predates (https://t.co/3PxjqPNrTK) their interest in bankruptcy, medical or otherwise.
— Megan McArdle (@asymmetricinfo) September 3, 2019
They're activists. There's nothing wrong with being activists. But they are not disinterested researchers, and you shouldn't treat their work as if they were.
— Megan McArdle (@asymmetricinfo) September 3, 2019
Second, their work appears to be purpose-built to deliver the result that all bankruptcies are caused by medical events.
— Megan McArdle (@asymmetricinfo) September 3, 2019
Third, Woolhandler and Himmelstein have not been as strenuous as they might in correcting the incredibly common misreading of their work, in which careless readers transmogrify "illness related" into "caused by medical bills".
— Megan McArdle (@asymmetricinfo) September 3, 2019
Those are not the same thing. Canada has medical bankruptcy, despite "medicare for all", because if you get sick and can't work, and you have a lot of debt, things go south pretty quick.
— Megan McArdle (@asymmetricinfo) September 3, 2019
Which is how we get to the statistic–falsified *even by the studies that allegedly support it*–that more than half of all bankruptcies are caused by medical bills.
— Megan McArdle (@asymmetricinfo) September 3, 2019
Note that these studies do not say that the bankruptcies are caused by medical bills; their design can't possibly establish causation. But somehow people get that impression! Multiple times! And no one really corrects it! It is a puzzle!
— Megan McArdle (@asymmetricinfo) September 3, 2019
A couple more notes: first, the studies they did showed that having insurance did very little to protect you from a medical bankruptcy (under their definition of a medical bankruptcy).
— Megan McArdle (@asymmetricinfo) September 3, 2019
They say that shows that American health insurance is garbage. I say that shows their data is garbage.
— Megan McArdle (@asymmetricinfo) September 3, 2019
There is a non-trivial difference between having a high deductible and being on the hook for the entire cost of your quadruple bypass. If your study doesn't detect one, you did something wrong. Whatever you're studying, it isn't "medical bankruptcy".
— Megan McArdle (@asymmetricinfo) September 3, 2019
Or at least, you're not studying medical bankruptcy, caused by *medical bills*, which is the only problem that their national health program can solve. No health insurance program in the world fixes the problems of a self-employed plumber with a $500k house and multiple sclerosis
— Megan McArdle (@asymmetricinfo) September 3, 2019
To believe that all of the "medical bankruptcies" they found are caused by medical bills–in the sense of "none of these people would have declared bankruptcy except for having high medical bills"–you have to believe that income loss is irrelevant.
— Megan McArdle (@asymmetricinfo) September 3, 2019
But also you have to believe that in the entire united states, only about 250k people declare bankruptcy for every other reason: job loss, divorce, small business failure, predatory lending, fraud, etc. Does that seem … likely?
— Megan McArdle (@asymmetricinfo) September 3, 2019
Keeping in mind that the majority of the very-high-cost patients are … already on Medicare? Because they're old?
— Megan McArdle (@asymmetricinfo) September 3, 2019
That stat should never have passed the sniff test. It's crazy.
— Megan McArdle (@asymmetricinfo) September 3, 2019
This is not to say that medical bills never cause bankruptcies, or that that isn't a problem worth addressing. But 500k is way too high for that number.
— Megan McArdle (@asymmetricinfo) September 3, 2019
Not least because bankruptcy is almost always multi-factorial. It's people who had a lot of debt and *then* got divorced, or sick, or fired, or sued. If they hadn't piled on the payments, they wouldn't be bankrupt, and also, if they hadn't been unlucky, they wouldn't be bankrupt.
— Megan McArdle (@asymmetricinfo) September 3, 2019
There's this endless debate in bankruptcy that boils down to "unlucky or unwise?" and the answer is "Embrace the healing power of 'and' ".
— Megan McArdle (@asymmetricinfo) September 3, 2019
I’m not sure how any of this is a fact check? Bankruptcy that medical costs contributed to affect over 500,000 people a year. Your paper has published the same thing. You’re not disagreeing with that here either.
— 100% Unbiased (like everyone else) (@SciencePartisan) September 3, 2019
I am, in fact, disagreeing with it. Consider a case I covered in which a woman who has a clear compulsive spending problem BK'd five-figure debts to her cosmetic dermatologist, along with a mountain of housing/school/car debt.
— Megan McArdle (@asymmetricinfo) September 3, 2019
The cosmetic dermatologist did not, in any way, cause the BK; her husband wrote a book on their financial problems, which trace to a) expensive divorces and b) buying too much house.
— Megan McArdle (@asymmetricinfo) September 3, 2019
But it would show up in Himmelstein et al as a medical bankruptcy, even though it wasn't, and used to argue for single-payer, even though no single-payer system in the world covers cosmetic dermatology.
— Megan McArdle (@asymmetricinfo) September 3, 2019
Their method has no way to distinguish those cases.
— Megan McArdle (@asymmetricinfo) September 3, 2019
I'm not disputing that Woolhandler and Himmelstein make these claims. They do! I am saying they have very poor evidence for their claims.
— Megan McArdle (@asymmetricinfo) September 3, 2019
was their research peer-reviewed and published by AJPH? if so, you need to demonstrate that *they* are activists to undercut the findings.
— ?we need a movement? (@youlickboots) September 3, 2019
"peer review" is not some magic incantation that makes arguments correct. At best, it can weed out the most glaring methodological errors. It doesn't even always do that.
— Megan McArdle (@asymmetricinfo) September 3, 2019
Chanting "peer review" will not make these arguments correct.
— Megan McArdle (@asymmetricinfo) September 3, 2019
Look at it this way: if medical bankruptcies are so obviously the majority of the problem, why did Obamacare cause *no* noticeable inflection in the bankruptcy rate? pic.twitter.com/unWyntpWcz
— Megan McArdle (@asymmetricinfo) September 3, 2019
You want to argue that Obamacare is inadequate, fine–but if it really caused zero apparent decline in the rate of bankruptcies, then it should give you pause that we spent a trillion dollars and did *nothing* to make American families more financially secure.
— Megan McArdle (@asymmetricinfo) September 3, 2019
For what it’s worth:
On point, Amy Finkelstein & colleagues use a research design that could plausibly detect a causal effect of medical bills on bankruptcies. They found hospital bills are responsible for maybe 4% of bankruptcies overall and just 6% *among the uninsured*. https://t.co/pApkCVpZva
— Michael F. Cannon (@mfcannon) September 3, 2019
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