At work, we received a response to a request for proposals that was incredible and fantastic. I don’t mean that the proposal would save money, reduce confusion, reduce false denials and holds on services or even give a senior executive a suite full of nubile young women whose virtue had already been negoatiated. I truly mean it was incredible along the lines of the product shitting cupcakes out a unicorn’s ass incredible. However, on the first read of the response, it looks really good. The second read is when the bullshit started to become obvious. My boss knew it was bullshit but could not quite put her finger on why it was bullshit, so I spent the past two days deconstructing the proposal and thinking bullshit.
There are a couple obvious sign-posts of bullshit in an argument that I think are relevant to general policy analysis. If you start to see the following signs, you are either engaging with a sophomore in college who just learned something really cool in an introductory class but has neither the advanced classes in the field nor the experience to know better or you are seeing bullshit. These two categories are not mutually exclusive.
The units of analysis make no sense
Avik Roy’s “study” of sticker shock in 2014 based on average prices per county had the unit of analysis as the county. A county is a reasonable first unit of analysis as most state regulators regulate plans at a county level. However, it is a shitty final unit of analysis as there are 3,144 counties in the US. 8 counties contain slightly more than 10% of the US population, and the largest county in the US, Los Angeles County, is roughly 120,000 times larger than the least populated, Loving County, Texas. In his “analysis”, these two counties count the same.
The comparisons are wildly bizarre
Again, Avik Roy compares community rated insurance with a fairly rich benefit package to underwritten insurance with significant exclusions of coverage. As I showed last year, this study included plans that excluded mental health coverage, excluded maternity coverage and included plans that rejected outright a quarter of the individuals who applied for coverage. It is real easy for an insurance company to offer low prices when it is statistically unlikely to pay big claims due to a screening of the risk pool. So any comparison between underwritten policies and community rated policies have to be taken with extreme caution. It can be done, but straight up comparisons can’t be made.
The claims are incredible
Timothy Jost looked at Avik Roy’s Obamacare replacement plan and made a note about an incredible set of claims that the free market/Universal Exchange would shit cupcakes out of its ass:
He claims it would increase access to providers by 4 percent (98 percent for Medicaid recipients) and average health outcomes by 21 percent, [my bold] while reducing the federal budget deficit by $29 billion over the first 10 years and $8 trillion over 30 years. It would, he claims, reduce average commercial premiums by 17 percent for individuals and 4 percent for families by 2023.
These claims are based on analysis of the proposal conducted by Stephen Parente, an American Enterprise Institute Scholar. I can find, however, no description of the methodology, or for that matter of the inputs, applied in this analysis. In particular, how Parente and Roy modeled an improvement in health outcomes, something the CBO never attempts, is a complete mystery.
The bolded part, increasing average health outcomes by 21% is an incredible claim that flies in the face of most evidence that suggests access to great medical care is a 10% to 15% determinant of health status. A 21% improvement in health status is an incredible claim. It should have incredible evidence to support it. The evidence should be made public. However it is not disclosed nor has anyone with significant credibility and the charge to conduct that type of analysis ever published anything similar to that model. It could happen, but the support for that number is extraordinarily weak.
The underpants gnomes dominate the theory of change
As we all know, the underpants gnomes have a simple business model/theory of change to get rich:
1) Steal underpants
2) ????
3) Get rich
When the underpants gnomes have to do the heavy lifting in a theory of change, it is either a first draft that needs to be fleshed out, an affinity scam, or bullshit. Congressman Ryan (R-Wis) wants to use dynamic scoring to get around the fact that he is making two incompatible promises — lower tax rates, especially on the wealthy, and revenue neutrality. Dynamic scoring is step two of the theory of change.
Don’t look at past predictions
Be extremely skeptical of people who don’t audit their past predictions. Jonathan Chait ripped Reason magazine’s Peter Suderman apart on his Obamacare predictions:
The latter study comes in for criticism by Peter Suderman, Reason’s indefatigable health-care analyst. Like the entire right-wing media, Suderman’s coverage of Obamacare has furnished an endless supply of mockery of the law’s endless failures and imminent collapse. While some of his points have validity, it’s fair to say that the broader narrative conveyed by his work, which certainly lies on the sophisticated end of the anti-Obamacare industry, has utterly failed to prepare his libertarian readers for the possibility that the hated health-care law will actually work more or less as intended.
And yet, in another way, the conservative media has provided a useful lagging indicator of Obamacare’s progress. The message of every individual story is that the law is failing, the administration is lying, and so on. The substance, when viewed as a whole, tells a different story. Here is how Suderman, to take just one example, has described the continuous advancement of the law’s coverage goals:
People get things wrong all the time. That is fine. It is not fine when their is no evaluation of the process that produces wrongness as that guarantees the continuation of the Garbage In-Garbage Out loop.
There are plenty of other high quality bullshit detection tools that are useful in policy analysis, but the above tools can be safely applied by anyone with some curiousity and interest in a subject.
Baud
Here’s the question I always ask: Is the speaker a Republican and is the topic Obamacare? If the answer to either the first or both questions is yes, then I have a high degree of certainty that bullshit is present.
Richard Mayhew
@Baud: but we can generalise the bullshit detection as you are advancing a special theory of bullshit detection while I’m advancing a general theory of bullshit detection.
Villago Delenda Est
Oh, I don’t know. Rethuglicans lie easier than they breathe. So of course it’s bullshit.
I believe you’ve captured the entire economics curriculum in a nutshell, here.
satby
But Richard is correct in that most of the public seems to have lost (more likely never developed) the critical thinking skills needed to step through an analysis of an article or a policy and detect bullshit. So this is a valuable exercise for those who need that kind of recipe for BS detection.
Baud
Fair enough. But the general theory requires more intelligence and effort to apply.
Villago Delenda Est
The bolded part totally invalidates the word that follows.
AEI is a sewer. Everyone in it should be flushed, with extreme prejudice.
Crusty Dem
Anything by McArdle or her husband should be assumed to be bullshit. And bullshit * 1000 if it in anyway involves numbers. Errors will be numerous. All errors will benefit their argument.
Michael Bersin
I always look for the answer to my first (of many) question in the process of detecting bullshit: “Who really benefits from this?”
Sherparick
Thanks Richard. But Arvik will still be on MSNBC as the responsible “conservative.” The Wingnut welfare counter-state is an amazing thing.
I'mNotSureWhoIWantToBeYet
@Michael Bersin: Yup. Cui bono? is a question that every reader should ask, especially if the proposition seems too good to be true.
Cheers,
Scott.
gene108
These right-wing bullshit artists are dangerous.
I came home for lunch a few weeks back. Flipped on the TV. It was set to CSPAN. A Republican Congressman was talking about something something and as his back-up to defend his position he cited an expert opinion: Bloomberg writer Megan McArdle.
Once these “think tanks” occasionally actually had ideas for real policy, such as cap and trade as an alternative to top-down government regulations, but for the last couple decades it is all bullshit all the time.
These bullshit artists give a very slick cover to the crap the right has been throwing out and many people, unfortunately, figure if it is in Bloomberg, the NYT, WaPo, etc. the crap must have been vetted to weed out the bullshit, which I have learned is not at all true.
The bullshit is everywhere and trying to clean it up is a seemingly impossible task.
One reason, I sometimes feel we are doomed.
MattF
Some of this is reminscent of a famous blog post by Daniel ‘D-Squared’ Davies:
http://blog.danieldavies.com/2004_05_23_d-squareddigest_archive.html
dmsilev
@Crusty Dem:
I’m convinced that their marriage was arranged by some long-lived shadowy conspiracy, with the goal of producing a child who embodies the essence of bullshit. A conservative Kwisatz Haderach, basically.
gene108
@satby:
I disagree regarding the critical thinking part.
No one can be an expert on everything.
We trust the supposed experts to not mislead us. Sometimes we determine some experts may be bullshitting us, so our bullshit detector is up, like an auto mechanic wanting to replace the carburetor in my 2003 model year car. Otherwise we tend to want to trust people, who are supposed to be experts.
For most people economics is a subject they have very sketchy knowledge of and so they do not know what policy implications are. If you sound reasonable, people figure you’ve been vetted by the powers that be, because in other interactions with experts – doctors, pharmacists, engineers, etc. – some entity has vetted these professionals to insure a minimum level of competency.
It is really hard to explain to people the “experts” on editorial boards have not been vetted in any objective sense, but rather exist because they further an ideology that has proven itself to be wrong, but does not want to admit its mistakes.
Richard Mayhew
@MattF: Oh definately, the last bullet point is an explicit rip-off of DD’s 1 minute MBA
gene108
Just want to add, one of the great bullshit point right-wingers use in talking about healthcare and how the free market will solve everything is how they ignore price elasticity of demand.
The whole argument to move to high deductible plans and/or indict us as a nation of hypochondriacs is that once people started seeing what things cost the market would adjust prices because the free market fairy would sprinkle competition dust and magic would happen.
Every time I hear a right-winger talk about the free-market as a solutions to healthcare, I wonder if these fuckers have ever had Econ 101 and if not, did anyone who had Econ 101 ever brief them on price elasticity.
When the alternative is taking the bus or walking, you can manage without a car.
When the alternative is severe illness or death, you cannot manage without your prescription, medical procedure, etc.
Healthcare and pharma have a captive consumer base and they damn well know it, which is why you need some level of government regulation to keep them from charging ridiculous amounts to consumers.
MattF
@gene108: Well, I suppose there’s some monetary equivalent to dying– cost of living, so to speak.
Bob2
Avik Roy is basically another McArdle anyway.
Designed to throw so much shit out there that people with actual knowledge have to keep hosing it down and never actually make any progress on the core issue.
MomSense
The words “Republican Health Care Plan” never fail to set off my bullshit detector.
Alex S.
@dmsilev:
Hehehe…
Chris
@gene108:
I remember reading a few semesters ago an article on how much the meaning of “think tank” had changed since the seventies. It argued that traditionally, think tanks were set up separate from government bodies precisely to avoid politicization, as a place where researchers (in all kinds of different fields) could work professionally, without having to worry about political agendas pressuring them in this or that direction… but that the seventies was when rich right-wingers began to finance a bunch of them explicitly for political purposes in order to manufacture “expertise” which they could then point to to validate what they already wanted to do anyway.
The timing was definitely right in terms of when the right wing started to fund the infrastructure to support its sealed-bubble-universe (similar things would happen in media and in religion, among other things). Don’t know if the article had an excessively idealized view of pre-1970s think tanks, though.
Citizen_X
@Chris:
But oh! There is a place like that. It’s called a “University.”
Of course, those places usually require you back up your work with some evidence. Tends to hamper the bullshitter, that.
Richard Mayhew
@Citizen_X: Back in the 50s and 60s, my sense and from conversations with people who spent time in both the think tank world and universities was that the think tanks were far more policy focused with good intellectual mechanics/engineers and the universities had some policy focus, but more “basic” science/intellectual architects if that distinction makes sense.
rikyrah
ANYONE willing to clown Avik Roy is my kind of people.
keep up the good work.
cmorenc
@Sherparick:
…and taking advantage of the fact that parading bullshit as an authoritative claim far more comfortably fits within the speaker’s allotted time frame (and the program’s overall allotted time slot for that topic) than does the time required for another speaker to adequately parse the claim through bullshit analysis.
The above is but a specific application of the general principle that lies often get a running head start while the truth is still tying its shoes.
Redshift
@Citizen_X: Essentially, right-wing “think” tanks are a response to the (bullshit) idea that academia is rife with left-wing bias and indoctrination. So they created a fake right-wing academia, with “scholars” and “senior fellows” and such, but who are only required to validate their work against right-wing ideology, rather than academic challenge and scrutiny. There may even have been some of them who believed that it was justified because they’re sure that “left wing” academia for the same, but I bet by now they almost all know they’re just in it for the grift and bamboozling the media.
SatanicPanic
@satby: That being said, Democrats still managed to get the ACA passed and it’s not going anywhere. The problem isn’t even critical thinking, it’s that people are more than happy to set aside critical thinking if bullshit makes them feel good, which anti-Obamacare propaganda definitely does.
*edited for clarity
Roger Moore
@gene108:
And what we get instead is patents, which guarantee a monopoly for some goods in the healthcare system.
Chris
@Redshift:
Why “reality has a liberal bias” isn’t just a joke: it really is how they view the world.
Mike in NC
American Enterprise Institute Scholar looks better when written as American Enterprise Institute “scholar”.
Citizen_X
@Redshift: Exactly. And now they’ve developed a parallel set of fake universities: the Regents/Liberty U. ilk.
Mike E
@Citizen_X: Yep, and pretty soon they’ll develop their own currency…oops. Already did that.
JustRuss
@Villago Delenda Est:
Exactly. Honestly, if you’re hunting for BS, an AEI “scholar” who refuses to show her work is one hell of a red flag.
Bubblegum Tate
@Chris:
Just this morning, a wingnut I know posted this bit RE: climate change (and the denialism thereof):
He’s so upset that FactCheck.org is dealing with facts instead of just telling him the lies he wants to hear! And when faced with the choice of accepting facts or sticking with lies, it’s a no-brainer: He sticks with the lie.
StringOnAStick
I was talking with a PhD engineering student from Azerbaijan yesterday. He said that his first impressions of the US brought out two questions: (1) why so many guns? and (2) how come the richest country in the world can’t provide health care for all it’s citizens, like every other rich western country does?
One thing I love about my job is I meet so many students from around the world, and occasionally I get one who wants to talk about serious issues, like this young man. A view point from outside your frame of reference is something every American could benefit from, and something FOX-world ensures never happens.
Epicurus
My take? The Suderman-McMegan household is chock full of ignorance and fabrication. One is more worthless than the other…but we already knew that.
low-tech cyclist
For years, I’ve had something in the back of my mind that I’ve called my “Too-Good-To-Be-True-O-Meter.” It detects when I see something I’d really, really like to be true, but just isn’t very likely.
I think I first noticed it in operation when I was a volunteer for John Anderson’s presidential campaign back in 1980. All spring, the polls had had him at 20% support, then there was a poll that showed him with 30% support. I really, really wanted that poll to be true. But I realized I couldn’t make myself believe it. Too good to be true.
You can especially see it, or its absence, with how people react to improbably slanderous stories about their political adversaries. If you hate Hillary (from whichever end of the spectrum) and find yourself jumping on a story that makes her look bad in a way that you should know right away is just too much of a stretch, then your TGTBTOM has broken down.
Too many conservatives seemingly have nonfunctioning TGTBTOMs. Fox News shovels all sorts of you’ve-got-to-be-kidding-me shit at them, and they swallow it whole.
We all fall for something like this every now and then, but it seems that conservatism as a movement is practically built on people routinely doing so.
mclaren
The crowning irony is that Mayhew has given us a set of excellent tools to debunk the bullshit he spews all the time on this forum.
Let’s run through the list, shall we?
[1] The units of analysis make no sense.
Notice that ACA supporters like Mayhew always talk about ‘the reduction in the rate of increase of costs.” They even talk about “zero cost increase” or “negative rate increases” as though this were the same thing as cost reduction.
But reducing the rate at which an exponentially increasing cost like health care rises is N*O*T even remotely the same thng as reducing absolute dollar medical costs in the current year.
Let’s take a specific example to see exactly how dishonest scammers and liars like Richard Mayhew are when they talk about “cost reductions from the ACA.”
Con artists like Mayhew crow about the alleged ‘reduction in medical costs resulting from the ACA” when we get headlines like
Source: “Obamacare Effect Linked to Lower Medical Cost Estimates,” Bloomberg news, 5 September 2014.
Notice the con job that’s being perpetrated here. Medical costs are now estimated to rise less than formerly calculated, therefore this is being spun as an absolute cost decrease.
But that’s a scam. What’s really going on here is that the ACA has merely reduced the rate of cost increase, and probably reduced it temporarily. Once doctors and hospitals and medical devicemakers and imaging clinics figure out the details of the ACA and gearup to make end runs around the ACA (with scams like drive-by doctoring), U.S. health costs will surge again at the same annual percentage rate they have been increasing at for decades now.
According to the studies, the cost of health care continues to grow at just under 4 percent annually. Reading between the lines, we can calculate from the numbers given in the Bloomberg piece of propaganda how much that rate of growth has dropped because of the ACA. 500 million is 0.000125 of 4 trillion dollars. So all this crowing and celebrating and rejoicing about the alleged ‘cost reductions’ caused by the ACA amounts to a reduction in the rate of growth of 3.95% – 100*(0.000125)% = 3.9375%. That's a .3165% reduction.
Now, as a practical matter, a 4% annual increase in health care costs over the rate of inflation means that we have a doubling time of 18 years (by the rule of 72. In case you're not familiar with it, the rule of 72 says that the number of years times the percentage = 72 for a doubling in cost. A price increase of 24% per year, for example, doubles your total cost within 3 years.)
In reality, the actual doubling time for an actual cost increase rate of 4% per year (over and above inflation) is 17.67 years. That means that in 17.67 years your health insurance premiums will cost twice as much in real terms as they do today, after correcting for inflation. 35.34 years from now your health insurance premiums will cost 4 times as much in real terms as they do today. And so on.
So let's ask ourselves what "help" the ACA has actually provided. The grand "imrovement" of the ACA boils down to lengthening the time it will take for your health insurance premiums to double form 17.67 years to 18.22 years. That means that the supposedly "vast" and "revolutionary" cost savings from the ACA boil down to going froma double time of 212.04 months to 218.64 months.
In other words, the ACA's supposedly "breakthrough cost reductions" will wind up adding a little over 6 months to the time required for your health insurance premiums to double in real terms, after inflation.
6 months.
That's what we get.
That's essentially nothing.
It's a complete joke. Saying "Rejoice! Your health insurance will gobble up twice as much of your income six months later than previously expected!" is such an absurd and such a grotesque con job that even a small child realizes what a complete scam it is.
Yet scammers like Richard Mayhew expect us to not only greet this new with cries of delight, but to applaud and give crooks like him a standing ovation for this alleged "breakthrough" in "cost control."
Meanwhile, health care costs in America continue to skyrocket. Just at a slightly slower rate than before.
[2] The comparisons are wildly bizarre. Mayhew keeps comparing the effect of the ACA on U.S. health care costs with the out-of-control U.S. health care costs before the ACA. But a much better and saner comparison is with post-ACA health care costs in America with the cost of health care in other developed countries like France or Japan or the Netherlands or Germany.
Of course, Mayhew lies to us that this is unrealistic. What’s unrealistic is claims like Mayhew’s that this exponential increase in health care costs can continue. It can’t. American businesses and the U.S. government and American individuals are running out of money. There isn’t enough cash in the universe to pay for health care with the insane prices greedy corrupt American doctors and greedy corrupt U.S. hospitals and greedy corrupt U.S. medical devicemakers are charging. Just take a look at Ezra Klein’s classic article “21 graphs that show America’s health care prices are ludicrous” from The Washington Post in march 2013. That’s well after the passage of the ACA. And things aren’t getitng better. The drive-by doctoring scam Mayhew complains about is only one of the many scams used by doctors to jack up costs and get around the provisions of the ACA. Another classic scam is for a physician to bill a patient for a consultation even though the physician never even sees or examines the patient — technically, the doctors is “in charge” in a facility where a nurse takes the patient’s blood pressure, so according to the byzantine labyrinthine rules of health care, the physician can bill the patient’s insurance company for an exam.
These kinds of scams proliferate like mushrooms in a cow turd, finding increasingly clever ways of bypassing the ACA’s provisions. Net result? Greedy corrupt doctors and hospitals and medical devicemakers are keeping health care costs skyrocketing at an exponential rate, undeterred by the ACA. People are smart and adaptable and flexible. Rules are rigid and fixed and mindless. People can always figure ingenious ways around bureaucratic rules, no matter how complex the rules are and no matter how elaborate the legislation.
The only real way to end the exponential growth of health care costs in America is to take the profit out of medicine. Stop the for-profit practice of medicine. Make American health care a nationalized single-payer system. But this, Mayhew refuses to even consider. He calls it “impossible.” No, what’s impossible is for U.S. health care costs to keep increasing at anything like the current rate — there isn’t enough money in the fucking universe to pay for it.
[3] The claims are incredible. Mayhew’s claims are ludicrous to the point of insanity. he keeps assuring us that health care cost sin America are moderating even as the horror stories in outlets like The New York Times keep getting worse, telling us about ever more egregious extortion by greedy corrupt doctors and greedy corrupt hospitals and greedy corrupt medical devicemakers. Insulan pump manufacturers that change the firmware on their pumps every year, forcing patients to buy entirely new firmware at a cost of tens of thousands of dollars…hepatitis C drugs that now cost $84,000 per year, insanely higher than in any other first-world country…or stories like “The Latest Statin Drug Scam: Half the Doctors on the Recommendation Panel Have Ties to Big Pharma!”
The outrages go on and on and on and on and on and on and on and on and on and on
and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and onn and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on and on…
..Yet Richard Mayhew somehow expects us to believe his rosy claims about how the ACA is going to magically cut costs, even though the reality of the medical horror stories in the news tell us the exact opposite every single day.
[4] The underpants gnomes dominate the theory of change
But that’s exactly what dominates the theory of change in the ACA — the underpants gnomes.
1) Pass the ACA
2) ????
3) Health care reform!
Exactly how that intermediate stage works remains a deep dark mystery, because the ACA contains no explicit cost control provisions. There is nothing in the ACA that sets up a panel which will say to doctors or hospitals or big pharma drug makers or medical devicemakers, “Sorry, you are charging too much more this [operation/drug/exam/medical device], we are going to order you by federal law to reduce the amount of money you charge.”
And for obvious reasons. The ACA is a Republican scheme which forces Americans to buy wildly overpriced for-profit health care from a for-profit greed-based sky’s-the-limit-on-pricing capitalist based health care system.
Whenever you force an entire population to buy a product from a for-profit corporate system, you get predictable sky-high ever-rising cost increases. What else would you expect?
Fuck me, what the hell would you think would happen???!?!?
Just imagine in the federal government passed a law requiring everyone in America to buy lemonade from the kid on the corner no matter what he charged. Would you expect the price of lemonade to go down?
Get a fucking clue. Of course costs will skyrocket at exponential rates, you’ve just used the full power of the federal government to force everyone to dump the contents of their wallets into a for-profit greed-driven private enterprise scheme.
The only way to stop these kinds of insane exponential cost increases is to take the profit out of the system. If you publicly subsidize the cost of lemonade with some distributed tax and strictly control the cost of lemonade with a federal oversight bureau, then lemonade gets dirt cheap. Otherwise, it’s just another mafia scam.
So my Richard Mayhew’s own criteria, everything he has posted since day one is complete and total bullshit.
Seldom has any front-pager in the history of Balloon-Juice provided such a devastating and comprehensively unwitting self-rebuttal.
jame
I just wish that the good people of the Great State of Louisiana had had these BS-detecting tools — and used them — before voting to elect and (dear god) re-elect that fraud Jindal. Of course, it’s no good to have the tools and not use them.
Crusty Dem
@mclaren:
I would like to subscribe to your newsletter. Kthxbai!!
PhoningItIn
For most of the first paragraph I was certain you’d been dealing with one of my former employers.
PhoningItIn
@Richard Mayhew: You’ve read Harry Frankfurt’s ON BULLSHIT, then.
Katy
One of the earliest blogs I ever read had a feature allowing you to just screen out a poster – it was sufficient to deduce their trollish writings, like the movements of Pluto, from the reactions of others. I don’t read Ross Cardinal Douthat, nor Bobo, nor McMegan, nor other mcs – I just wish I weren’t even exposed to them.
Richard Mayhew
@PhoningItIn: Of course, I think it should be required reading in high school.
Cobb
@Villago Delenda Est:
If they use the word ‘Rethuglican’ or ‘vagina’ in normal conversation, they probably have ebola.