Medical debt is a major driver of personal bankruptcy. This is a fact that Bernie Sanders highlights on the stump in support of his Medicare for All proposal. Sanders, who is more fond of statistics than stories, drives home the point with a big number. “500,000 people go bankrupt every year because they cannot pay their outrageous medical bills,” he said on TV recently, repeating the same point on Twitter:
500,000 Americans will go bankrupt this year from medical bills. They didn’t go to Las Vegas and blow their money at a casino. Their crime was that they got sick. How barbaric is a system that says, “I’m going to destroy your family’s finances because you had cancer”?
The Washington Post has a political fact checking department, and the aim is admirable — to hold candidates accountable and call them out when they’re playing fast-and-loose with the truth. But, as the Post’s recent check of Sanders’ medical bankruptcy stat underscores, the paper’s pursuit of facts can at times go off the rails.
The Post piece gives the Sanders “Three Pinocchios” for the claim on medical debt, which is the paper’s shorthand for “mostly false.” (An aside: What is it with the multiple Pinocchios? The Pinocchio didn’t self propagate when he lied — his nose grew.)
To have earned Three Pinocchios, we must assume Bernie’s claim is a real doozy, one wooden puppet short of a “whopper” per the Post. So what’s the matter with the statistic? As it turns out: Nothing much at all.
Sanders’s team told the Post that the Vermont Senator was relying on an estimate published in a medical journal that found that 66.5% of bankruptcy filers cited either medical bills or missed work due to illness as a reason they went broke. The journal itself said this was “equivalent to about 530,000 medical bankruptcies annually.”
At first glance, it appears Bernie understated the problem by rounding down. The checker did an admirable thing and reached out to the author of the study, Dr. David Himmelstein, a professor of public health in the CUNY system and a lecturer at Harvard Medical School. “When we asked Himmelstein whether Sanders was quoting his study accurately,” the fact checker reports, “he said yes.”
Himmelstein went on to unpack for the fact checker that, even if you were to adopt a more limited measure of bankruptcies that were “very much” linked to medical debt, the number of people going broke is still north of 500,000 a year, because a single bankruptcy typically affects multiple people in a family unit. “Even if you use that restricted definition, then Sanders’s statement is accurate — or an underestimate,” Himmelstein said.
To review: the Post fact checker, going straight to the source, a Harvard lecturer, found that Sanders’ was sticking to close to the facts, and if anything understating the problem.
So why didn’t the Post give Bernie a coveted “Geppetto Checkmark” for truthfulness. (Yes, it’s really called this — you can’t make this shit up.) Who knows?!?
The author spends the rest of the 1,600 word piece splitting hairs and then tying them into knots. He takes it upon himself to not simply fact check Sanders, but the medical journal that Sanders relied on. And it turns out that, if you dig down far enough, you can uncover a minor-league academic beef about bankruptcy statistics, with professors arguing about the extent to which one can say the contributing factor of medical debt is actually what “caused” the bankruptcy.
Despite his pageant of pedantry, the fact checker doesn’t get to the bottom of anything. He doesn’t prove that one side in this ivory tower debate is in fact right, while the other is actually wrong. More important, he doesn’t offer any evidence that Sanders was aware of this teapot tempest or that he in any way set out to deceive voters. Instead author proudly presents the unholy tangle he, himself, created to conclude: “The omissions and twists are significant enough to merit Three Pinocchios for Sanders.”
The process by which the Post fact checker transmogrified a basically true statement into a ruling of “mostly false” is a case study in the uselessness of the political fact-check as it is often practiced.
Subjecting political speechmaking to this kind of nitpick is folly. The entire nature of the political enterprise is looser than that. Politicians speak to broad systemic problems. If they’re sharp and persuasive, they have statistics at hand. And if their staff is any good, those statistics have reputable studies to back them up. By any meaningful measure what Sanders said is accurate for the purposes of the project. If citing a study accurately enough to satisfy its author still gets a “mostly false,” it’s hard to know what could possibly pass muster.
In reality, translating any academic study into mass-market speech necessarily requires getting out of the weeds, making simplifications, and discarding the footnoted caveats. To dole out Pinocchios for a good faith effort to translate public health data into a stump speech is journalistically obtuse — all the moreso in a world where the President daily tells us up is down, left is right, and his Doral golf resort doesn’t have bedbugs.
This pettifogging brand of fact checking is also ironic, precisely because editors and writers commit the same abstractions politicians do. Including the Washington Post. Including on this very piece.
The headline for the fact check — “Sanders’s flawed statistic: 500,000 medical bankruptcies a year” — is an even-handed representation of the (wrongheaded) analysis. But the display copy at the top of the browser sands off the edges, simplifies the story, and becomes far more declarative: “Bernie Sanders’s false claim on 500,000 bankruptcies.”
Is that accurate? By the Post’s own test, it appears to represent: “Some shading of the facts. Selective telling of the truth. Some omissions and exaggerations.” We’d have to give it One Pinocchio.
There now appear to be factual problems with the fact check itself.
The Post author claimed that Himmelstein’s journal article had not been peer reviewed. In a letter by Himmelstein, tweeted out by a senior Sanders adviser, the doctor says that is not true, writing: “Your false claim has besmirched my reputation as a scholar.”
Washington Post: The study Bernie cited on 500,000 medical bankruptcies was not "peer-reviewed"
Study's author: Your Washington Post "Fact Checker" article falsely claimed that my article in the American Journal of Public Health had not undergone peer review. Demands retraction pic.twitter.com/84kMzvpNLR
— Warren Gunnels (@GunnelsWarren) August 29, 2019
Glenn Kessler, the chief of the Post’s Fact Check project, has responded. He maintains the sentence “The AJPH editorial did not undergo the same peer-reviewed editing process as a research article” and a supporting quote in the next paragraph describing a “lack of peer review” did not mean to imply that Himmelstein’s paper was not peer reviewed.
This is false. Article did not say it was not peer-reviewed. We quote an editor saying the "editorial" did not undergo the same peer-reviewed editing process as a research article but note it used a methodology similar to what the researchers used in a 2005 peer-reviewed study. https://t.co/wRiudt0R8L
— Glenn Kessler (@GlennKesslerWP) August 29, 2019