Abstract
On May 23, a bridge spanning the Skagit River on a well-traveled interstate sixty miles north of Seattle, Washington, collapsed at the town of Mount Vernon, sending numerous vehicles plunging into the river. Miraculously, no one was killed, but the collapse seriously interrupted commerce and dashed Memorial Day weekend festivities. State officials scrambled to come up with a plan to erect a temporary bridge and were optimistic that a permanent structure would be in place by October, at an estimated cost of fifteen million dollars.
Further investigation revealed that the collapse was the result of an overloaded truck hitting an overhead portal and sway braces, thus compromising the bridge’s structural integrity. While state officials had considered the bridge safe for vehicles, it had been classified as “functionally obsolete” due to its fairly narrow lanes. The lane width may have contributed to the accident since the truck driver later claimed that he felt crowded by a passing vehicle. The event brought the issue of our nation’s crumbling infrastructure into sharp relief as observers recalled that the American Society of Civil Engineers had rated the safety of U.S. bridges a C+, that nearly six hundred bridges have failed since 1989, and that one out of nine U.S. bridges are deemed to be structurally deficient. The incident also brought to mind a 2007 tragedy in which a bridge that spanned the Mississippi River and joined Minneapolis and St. Paul similarly collapsed, killing thirteen people and injuring one hundred forty-five. Coincidentally, this bridge also had been classified as “structurally deficient” (PBS Newshour 2013).
I use the Washington state bridge collapse as a micro example of the neglect of our infrastructure, and of public health and safety writ large. From my perspective, we seem to be living in a political environment in which a nontrivial number of elected officials choose to ignore pressing physical and human capital needs, and instead fall into an abyss of ideological intransigence. Resistance to taking action frequently is justified on the basis of fiscal constraint, with policymakers demanding that new revenue sources be found to address infrastructure or other such problems. Invariably, a new revenue source arises through proposed spending cuts, and many legislators are reluctant to support tax increases, even when they take the form of user fees targeted to enhance road and other safety concerns. But perhaps most distressing is the tendency of many elected officials to ignore urgent needs—such as decaying bridges—and instead jump on “gotcha” moments to impugn the integrity of political opponents and exaggerate the perceived shortcomings and harmful effects of proposed or actual policies. As I discuss later in this column, “gotcha” moments also have been widely used to derisively characterize the Affordable Care Act (ACA) with inaccuracies and exaggerated claims, even in the face of some early and widely recognized achievements of the law.
“Gotcha” Moments and the Public Interest
By “gotcha” moments, I refer to efforts by both parties to capture and portray unscripted, frequently awkward, out-of-context sound bites as representative of an individual’s policy stance. To this, I would add unsubstantiated and exaggerated claims of a policy initiative’s harmful effects used to distort its intent and shift public opinion. Examples have become commonplace and were replete during our past election season. Most prominent among such gaffes were Mitt Romney’s comment that he need not worry about the poor because 47 percent of Americans were dependent on the government and paid no income taxes, and his awkward admission that he likes to fire people who work for him. Other examples include President Obama’s statement during a campaign stop in Roanoke, Virginia, that “you did not build this,” which antagonized businessmen by seeming to impugn and underappreciate their entrepreneurial efforts; Texas Governor Rick Perry’s inability during a debate to name the three federal agencies he would eliminate; and Michelle Bachman’s outlandish statement that the HPV vaccination can lead to mental retardation. While Bachman later recanted her statement, one wonders how many parents and young women were discouraged from taking advantage of this public health measure. As a postscript, as of this June writing, the Centers for Disease Control and Prevention have concluded that inoculation of the HPV vaccine has resulted in a decline in the rate of sexually transmitted infections by half since its introduction in 2006, although parental resistance to the vaccination remains high and appears to be growing (Tavernese 2013).
In an era of relentless and instantaneous electronic communications, “gotcha” moments, however trivial, easily can “go viral.” Context and nuance are frequently ignored, and those who are targeted and wish to respond are almost always at a disadvantage. While some gotcha moments can be revealing—as in Mitt Romney’s unfortunate statement about the 47 percent of Americans, former Representative Anthony Weiner’s (D-NY) inappropriate texting to women, or former Representative Todd Akin’s (R-MO) horrendous statement regarding the female body’s supposed defense against pregnancy from a “legitimate rape”—I suspect that, on balance, the costs of such “gotcha” moment revelations generally outweigh the benefits for at least two reasons. First, public officials are likely to be more guarded, less forthright, and more scripted in their statements, following cues from their political operatives and failing to respond spontaneously to hard and legitimate questions asked by journalists and constituents. Next, frivolous “gotcha” moments can be legitimized as “hard news” by networks that engage in mindless “breaking news” alerts. Such moments also can morph into “mediathons” (to borrow a term coined by journalist Frank Rich) with seemingly endless coverage until the next “gotcha” moment emerges. This casts a pall over the veracity of our news reports and the preservation of meaningful standards of journalism.
Over the last year, we have been besieged by “gotcha” moments. Among the most noteworthy was the September 11, 2012, attack on the U.S. embassy in Benghazi, Libya, by Islamic militants that resulted tragically in the death of Ambassador J. Christopher Stevens and three other Americans. The Obama administration drew fire from critics for inaccuracies and mixed messages in its explanation of the circumstances regarding the event. Comments initially made by presidential adviser Susan Rice characterized the attack as a spontaneous protest; it was later revealed that it was a well-orchestrated effort by Islamic militants and that the initial talking points were drafted not by the White House or State Department but by the Central Intelligence Agency (New York Times 2013). Nevertheless, opponents of the president and those of Secretary of State Hillary Clinton (a potential presidential candidate in 2016) continued to accuse the administration and State Department of a cover-up and have held congressional hearings. The “gotcha” moment arising from the Benghazi incident led to a decline in Clinton’s popularity and forced Rice to withdraw her nomination as secretary of state, once again demonstrating how a “gotcha” moment can have far-reaching consequences regardless of its veracity.
Another “gotcha” moment involved the scrutiny by the Internal Revenue Service (IRS) of the tax-exempt status of Tea Party and other conservative groups. At issue was an effort by the IRS to ensure that the 501(c) 4 tax exemption was applied only to groups promoting social welfare rather than engaging in advocacy. Obama critics were quick to seize upon this as an evidence of a pernicious effort by the White House to single out and penalize political groups opposing the president; the incident galvanized Republicans and conservative groups in their efforts to discredit the administration (Weisman and Wald 2013). Senator Pat Toomey (R-PA) declared that the criteria used by the IRS was “akin to an enemies list” such as that used by former President Richard Nixon.
When the facts surrounding this incident emerged, it was disclosed that the close scrutiny given to the conservative groups was not at the behest of the president or his administration. Instead, it was the result of overzealous behavior and poor management of a special Determinations Unit in the IRS’s Cincinnati field office that initially focused its attention on conservative political groups (Weisman and Wald 2013). Nevertheless, as Krumholz and Weinberger (2013) note, this “gotcha” moment had the unfortunate implication of undermining the IRS’s role as a neutral arbiter of tax-exempt status for organizations of all political stripes and in the agency’s efforts to achieve greater transparency in its actions and those of tax-exempt groups. Moreover, since the IRS has the responsibility of examining tax returns to determine tax credits for health insurance under the ACA and penalties for noncompliance with its insurance mandate, opponents of the ACA may use this IRS incident to limit the agency’s role in these important activities, with severe implications for the law’s effectiveness.
Finally, the search for “gotcha” moments can result in a “crowding out” of legitimate and more mundane news stories as the media seek more provocative stories to capture ratings and market share. At a time when attention and serious debate ought to be directed to problems related to our struggling economy, stagnant wages, high and persistent unemployment, falling educational achievement and excessive student debt, threats to intergenerational economic mobility, and growing income inequality, we all suffer when “gotcha” moments dominate the news cycle.
“Gotcha” Moments and the ACA
The ACA offers perhaps the most telling example of the use of “gotcha” moments to discredit, impugn, and chip away at the intent and provisions of a particular policy initiative. Readers may recall the distortions leading up to the ACA’s enactment: the canard of socialized medicine; the specter of “death panels,” voiced by Sarah Palin and given credibility by Senator Chuck Grassley’s (R-Iowa) comment that he would not endorse a policy that would allow some bureaucrat to “pull the plug on grandma”; the claim that the ACA represents a federal takeover of private health insurance; the fear that the federal government would directly withdraw funds from citizens’ bank deposits to pay for care; and the rumors that tax dollars would be used to fund abortions and provide benefits to illegal immigrants. The ACA was characterized as “job killing” legislation long before any of its provisions had been implemented, and early on, critics distorted the facts regarding the costs to states of implementing the ACA’s Medicaid expansion. A more recent claim has focused on the ACA’s health insurance exchanges as ushering in substantial and unaffordable premium increases. As noted earlier, the continuation of such “character” assassination reflects the difficulty elected officials and others face in speaking truth to a “gotcha” moment in order to set the record straight. A long-standing criticism of the Obama administration (not unique to the debate over the ACA) has been the apparent reluctance or unwillingness of the president to rebuke exaggerated claims or to engage in an aggressive and ongoing program of public education regarding the ACA provisions.
Only a week before the Washington bridge collapse, the House of Representatives—for the thirty-seventh time—voted to repeal the ACA. As of this writing, however, supporters of the ACA can take solace in the fact that the law’s early implementation is yielding benefits. The ACA’s dependent coverage provision is widely regarded as a huge success, increasing young adult enrollment in private coverage, reducing uninsured rates, and enhancing access to care. More than one billion dollars in rebates to employers and individuals have been issued under the ACA’s insurer loss ratio provisions; elimination of preexisting condition exclusions for children was one of the earliest implemented provisions of the ACA and a similar provision for adults will be implemented in 2014. Governor Jan Brewer of Arizona and Governor Chris Christie of New Jersey, both conservatives, have temporarily abandoned their previous use of “gotcha” moments and endorsed the ACA’s Medicaid expansion. California’s recent posting of health insurance premiums for its exchange provides a striking example that such premiums are unlikely to skyrocket as predicted by critics, but to rise moderately, reflecting the enhanced quality and value of coverage. Developments in California, Washington, and Oregon suggest that robust competition among insurers participating in their health insurance exchanges is in the offing. Moreover, the premiums for individual exchange-based coverage recently revealed by Washington and Oregon (along with those already noted for California) appear to be lower than those currently available from existing insurers and reflect enhanced coverage. Finally, results from the Oregon Medicaid expansion (Baicker et al. 2013) have arguably favorable implications for the ACA’s Medicaid expansion, with findings indicating a near elimination of catastrophic out-of-pocket spending, increased use of many preventive services, increased rate of diabetes detection, and decreased probability of a positive screening for depression. While the impact of the expansion on other health outcomes was imprecisely measured and underpowered, the findings validate a causal effect of the expansions on these outcomes. Finally, while too early to tell and still only part of the story, the declining rate of growth in national health care spending in recent years that predates the Great Recession may be a promising portent of cost savings to come under the ACA, given the law’s emphasis on payment reforms, evidence-based medicine, and innovations in health care delivery. Ironically, should the ACA achieve or approach its goals, anecdotes by beneficiaries of the legislation may serve as reverse “gotcha” moments, enlisted to tout the legislation’s achievements (Egan 2013).
Conclusion
As I noted at the outset of this editorial, our ability to engage in serious discussions regarding pressing physical and human capital needs—most prominently illustrated by the sorry state of our nation’s bridges and our rancorous debate over health reform—has fallen victim to a reliance on “gotcha” moments to influence policy debates. In the heat of an election campaign or contentious legislative debate, using such a tactic may help to shift the momentum and provide an advantage to individual politicians, their parties, and their political constituents. However, these are likely to be short-lived benefits as the next “gotcha” moment grabs attention for a new issue and a new focus for ridicule and derision. Our increasing tendency to draw upon “gotcha” moments to motivate and justify political criticism rather than apply reasoned and respectful discussion to current issues demeans our legislative process, threatens the credibility of our journalism, and does us all a disservice by diverting attention from important public issues and from the development of essential public policy initiatives. Ultimately, it can only serve to reinforce our poor impressions of our legislators as actors who are mired in innuendo and ideology, seeking a quick way to score political points, unwilling to see the other side of an issue, and unlikely to engage in the kind of compromise necessary to advance the public’s interest.