END OF 2018 OPEN ENROLLMENT PERIOD (41 states)

Time: D H M S

Biloxi Blues, Vox.com & Myself

There's a lot of great lines in the 1988 semi-autobiographical movie/play "Biloxi Blues" by Neil Simon. Most are funny, some are poignant. To me, one of the most powerful scenes is when Jerome/Simon's (played by Matthew Broderick) diary is found and read by his boot camp bunkmates. Among the private thoughts he has about them being revealed, one of his friends, Arnold Epstein, discovers that Jerome thinks that he (Epstein) is gay. Since the story is set in the World War II-era U.S. Army, this obviously has much bigger implications than it would today.

After the scene plays out, Jerome/Simon/Broderick's voiceover notes that:

"Something magical happens when people read something on paper...they have a tendency to believe it. They figure no one would have bothered to write it down if it wasn't true." (that's a paraphrase...I can't find the video clip or transcript for Biloxi Blues online).

Jerome concludes by noting that this incident taught him to be more careful about what he writes.

I was thinking about this yesterday afternoon when, within the space of a couple of hours, I posted an update on my "underperformers/overperformers" entry which scratched Massachusetts off the "underperform" list, then posted an entry about Colorado in which I lowered my official outlook for the state to 160K (below both my target and theirs) and was then challenged on my California target (1.94 million) by Health Access CA, the state's healthcare consumer advocacy coalition.

In the under/over post, I made sure to include a note that, in this context, "underperforming" mostly means that the enrollment numbers for those states are coming up short of my personal targets (although in a few cases, they're definitely behind even the official goals stated by the exchange itself). Furthermore, I noted that in the big picture, even if some states do come up short in exchange enrollments, that could be a Good Thing if the reason turns out to be a huge hiring surge by companies in that state providing healthcare benefits. Finally, I noted that another 12 states are ahead of where I was expecting them to be at this point.

However, this doesn't change the fact that the "8 states are underperforming" part of the headline is what's likely received the most attention...and the context & caveats tend to get lost in the shuffle in the instant-retweet-repost-share internet age. If I had posted something like that in November 2013, few would have read it, no one would have retweeted it and no one would have cared about it one way or another. A year or so later and my thoughts on the matter are being taken very seriously by a whole bunch of people, rightly or wrongly. In the end, if I say "X state is coming up short", a certain segment of people are taking that at face value, which could have negative PR implications for that state exchange whether it's deserved or not.

The truth is, as I've noted several times before, I haven't done an intensive study of the individual state-level demographics of California, Colorado or any other state. There's a few states with unusual circumstances...and in the case of Massachusetts, I screwed up royally because I misunderstood the specifics of those circumstances. Yet it took me 3 days before I scratched them off the "underperforming" list, when I never should have included them in the first place.

For a long time last year I could get away with pointing out that I'm neither a professional statistician nor a medical or healthcare policy professional...and furthermore, I'm not being paid for maintaining this site (donations and nominal ad revenue aside, of course). All of this is still true, but I can't just rely on that for everything any longer: People trust my judgment in this area, so "hey, that's just one guy's opinion!" doesn't wash anymore, even if it's accurate.

There was another incident yesterday which I was only peripherally involved in, but which runs along the same lines...and has more serious implications than whether Covered California hits one arbitrary enrollment target or another. Yesterday morning, Sarah Kliff of Vox.com, a very capable, experienced and generally accurate healthcare reporter, posted a story about the opinions of then-Presidential Candidates Sen. Obama and Sen. McCain regarding vaccinations and autism.

Regarding Obama, she used a quote of his at a rally which made it sound--out of context--as though he was personally suspicious that there might be a connection between the two. A similar quote by McCain was included as well; the angle was that both men were "pandering" to the antivax crowd while campaigning for President regardless of their stance since that time.

Like many other people, my immediate, kneejerk response to this was, as a supporter of both Obama and vaccination, abject disappointment that he would have given any credence to something which had already been pretty thoroughly debunked. It took only a second or two for me to add a simple "Ugh" to Kliff's post and click "Retweet".

However, it turns out that when you actually watch the clip, it becomes patently obvious that when Obama said "this person included", he was referring to someone in the audience (presumably the one who brought the subject up), not himself. Glenn Kessler (Fact Checker for the Washington Post) and Charles Johnson of Little Green Footballs were (I believe) the first to call Vox on the error; later in the day, Michael Hiltzik of the L.A. Times did a piece blasting it as well.

Since last night, plenty of other people have rightly called Kliff/Vox on the misrepresentation of Obama's statement (McCain's statement, on the other hand, was unmistakably wrong). I deleted my RT of Kliff's original, and also publicly apologized for having reposted it in the first place...but of course the damage was done. In addition, this morning,the error was picked up by none other than the New York Times, which has since corrected their version of the error.

As for Kliff's oriignal Vox story, she's corrected it...mostly. She's added several updates, including the context of his statement, the reference to the audience member and the full video itself...but as of this writing the headline still reads "Obama supports vaccines now — but pandered to anti-vaxxers in 2008".

Kliff explains the lack of headline change as follows:

Obama was, as I note below, gesturing to an audience member when he said "this person included." Even so, his remarks were still off: the science that disproves a link between autism and vaccines (particularly the measles, mumps and rubella vaccine) is not inconclusive. It wasn't back in 2008 when McCain and Obama made these remarks — and it has become even more solid in the seven years since then.

Now, I still disagree with her on this. When you watch the video itself, the rest of his statement is still being taken out of context:

Here's the full transcript:

"We’ve seen just a skyrocketing autism rate. Nobody knows exactly why. There are some people who are suspicious that it’s connected to vaccines and triggers, but (pointing to his right)...this person included. The science right now is inconclusive, but we have to research it. Part of the reason I think it's very important to research it is those vaccines are also preventing huge numbers of deaths among children and preventing debilitating illnesses like Polio. And so we can't afford to junk our vaccine system. We've got to figure out why is it that this is happening so that we are starting to see a more normal, what was a normal, rate of autism. Because if we keep on seeing increases at the rate we're seeing we're never going to have enough money to provide all the special needs, special education funding that's going to be necessary.”

Kliff is saying that when Obama says "the science right now is inconclusive", he's referring to the science about any connection between autism & vaccines. HOWEVER, when you actually watch the clip, Obama's speaking style, with his infamous pauses/pulling back to a prior point, I think it's fairly obvious that when he says "inconclusive" he's referring to "what actually is causing the increase in autism diagnoses", not to the idea that vaccines being involved. More to the point, this is immediately followed by a strong defense of vaccinations.

I'm glad that the clarifications, corrections and actual video have been added to the original story. I just wish that she would change the headline as well (perhaps that's up to her editor or something?). I'm not writing this to beat up on Kliff. She's an excellent journalist, especially when it comes to healthcare, generally supportive of the ACA and this was a unusual error on her part. Of course, I'm biased; she also gave me my first real mainstream media exposure way back in December 2013, and followed up with a much-appreciated profile piece on me in April 2014.

In retrospect, the "this person included" bit should have set off a red flag...for all of his speaking idiosyncrasies, and in spite of FOX News' attempts to paint him as a Tyrannical King, President Obama does not generally refer to himself in the third person.

Anyway, it's a reminder that when you write something down and publish it, it does take on some sort of a mystic quality. It's also an important reminder of the huge difference that voice inflection, body language, facial expression and timing/pauses can have vs. a cold, hard transcript of someone's words.