Thursday, January 17, 2013

No Death for Death Panels


On Halloween 2009, my costume was a Death Panel. No kidding. And no, I won't show you a picture. As with most political themed costumes, it was funny at the time but was one of those things I thought would melt into the annals of popular culture. I mean, I can't exactly pull that off this year in the way I did then. However, the term "death panel" is one that seems to have perpetuated in the social landscape.

"Death panel" is a political term that originated in an August 2009 debate about federal health care legislation in the U.S. The former Republican Governor of Alaska, Sarah Palin, used it to describe how the new health care law would lead to the rationing of medical care such that decisions about whether the elderly and special needs children would be "worthy of care" would be decided by a death panel of bureaucrats. Palin took a lot of chaff for this remark and later specified that she was referring to Section 1233 of bill HR 3200 which would have paid physicians to provide voluntary counseling to Medicare patients about living wills, advance directives, and end-of-life care options. Take special note of the words "voluntary" and "counseling" in that statement, the fact-checking portion of the media certainly did, reporting Palin's claim as false. The statement was criticized by the mainstream news media, academics, physicians, Democrats, and some Republicans. However, other prominent and outspoken Republicans took it and ran such that it blew up in ways no one could have predicted. It seems that everyone had an opinion, and public opinion often plays an important roll in the success or failure of many policies, like health care.

Public opinion is frequently influenced by misinformation. The media's failure to counter the misinformation about health policy has resulted in a persistence of this misinformation more than two years after the enactment of the Affordable Care Act (ACA), known colloquially as ObamaCare. Unfortunately, it is difficult to overcome "motivated reasoning," people's biases toward their preexisting attitudes and beliefs, which makes them more likely to accept unsupported claims because those claims are consistent with their partisan or ideological views. It certainly doesn't help that the media isn't exactly aggressive about debunking misinformation and even perpetuates it to some degree.

A new study, published online in the journal Medical Care, takes a look at how media corrections might reduce misperceptions about death panels and if these corrections would reduce opposition to health care reform. To do this, the researchers recruited from the SurveySpot opt-in panel, validating their sample by comparing control group responses to poll results. Participants were randomly assigned to versions of a realistic article on the Palin claim modeled on the original Associated Press article but attributed to the fictional "Breakingnews.com." One version included corrective information and the other omitted it. This corrective information was a paragraph at the end of the article explaining why "nonpartisan health care experts have concluded that Palin is wrong." They also collected some additional information about the participants that they thought might influence the effect of the correction on their beliefs and opinions. First, they asked the participants to rate their feelings of Sarah Palin on a 0-100 feeling thermometer (a standard measure in the political science world) where higher values equal warmer feelings. Second, they wanted to assess how knowledgeable or sophisticated their participants were as this can affect how someone resists unwelcome information and hold on to certain misconceptions. So they asked the participants to answer a 5-item political knowledge scale, limiting them to 30 seconds per question to limit their ability to look up the answers online (sneaky, sneaky!).

The researchers found that corrective information can reduce health policy misinformation for some groups. They found that Palin feelings and knowledge moderated the correction's effect, those who felt more warmly about Palin were more likely to believe in death panels. The results also showed "decreased misperceptions about death panels and increased approval of ACA among low-knowledge respondents who viewed Palin favorably." This suggests that fact-checking may improve understanding of policy controversies in these groups. Alternatively, "the correction backfired among high-knowledge respondents who viewed Palin unfavorably, increasing misperceptions about death panels and strong disapproval of ACA." In this case, the motivated reasoning steps in, it is easier for people to believe things they want to be true and disbelieve things they don't want to be true.  So what does all of this mean? Well, it means that public perception about health care is entrenched, and corrective information alone is not enough to overcome motivated reasoning among the more knowledgeable public.

I'm going to end with note to the passionate, the activists (on both sides), and the Internet trolls (who probably won't care regardless): If you've read this far then you also know that I'm not likely to change your opinion of death panels themselves, and I'm not going to try. If you have read this far then you will also have noticed that this post is about a study of public opinion on the matter of death panels rather than death panels themselves (although I describe their origin above and give factual for-your-information links below). As such, if you comment please save us both some time and comment about the study and not about your personal beliefs on whether or not the government wants to kill all of us and our grandmothers. Thanks!

ResearchBlogging.orgNyhan, B., Reifler, J., & Ubel, P. (2013). The Hazards of Correcting Myths About Health Care Reform Medical Care, 51 (2), 127-132 DOI: 10.1097/MLR.0b013e318279486b


More on the Affordable Care Act (ACA) at HealthCare.gov. You can read the full law, look through key features of the law, learn how it affects you, and find a timeline of what's changing and when.

Press release from Duke University's Fuqua School of Business "New Research Shows 'Death Panel' Myth Hard to Correct"

Some articles about death panels:
U.S. News "The Truth Behind Obamacare's 'Death Panels'"
The Daily Beast "The Reality of Death Panels"
FactCheck.org's "Palin vs. Obama: Death Panels"
PolitiFact's "Lie of the Year: 'Death Panels'" 
Snopes "Seniors Beware" and "Euthanasia Counseling"

(image via HowStuffWorks.com)

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