Health care is messy, complex and, unfortunately, subject to the whims of politics

Snappy soundbites always trump thoughtful analysis.

Sarah Palin in 2008 said the Democrat’s ACA would create “death panels.”

U.S. Sen. Bernie Sanders in 2017 said 36,000 more people will die annually if the Republican’s AHCA passes.

Both earned Four Pinocchios from the Washington Post Fact Checker for leaving out critical context.

Sanders relied on progressive models, generally assuming individuals and legislatures would make the worst possible choices under the AHCA compared to best possible outcomes under the ACA. That’s unlikely.

The models themselves would have earned Three Pinocchios for fuzzy context, but Sen. Sanders unequivocally stated 36,000 more deaths annually as a fact. According to the Washington Post, that “tips this claim into Four Pinocchio territory.”

What about ACA “death panels?” Originally it was a campaign jab at proposals under Medicare to encourage doctors to discuss end of life care with their patients. Fear projected it was a back door to rationing care to the old and sick. Anyone familiar with Dr. Atul Gawande’s book “Being Mortal” understands end-of-life discussions are essential to living well. But public outcry forced the language out of the final version of the ACA in 2009, as well as from a 2011 Medicare regulatory update.

Degree of public noise is a lousy measure of the quality of health care policy. But it’s a great indicator of effective political manipulation.

Palin again used the term in 2012, this time to condemn the Independent Payment Advisory Board, which earned her Four Pinocchios. Not for being wrong about the possibility of future fatal side effects of the board, but for lack of historical context. The board was the result of 20 years of bi-partisan struggles to solve the problem of unsustainable Medicare costs before the money in the reserve fund runs out.

It’s still a controversial and flawed remedy, but the cost problem remains. Cutting through the political phlegm should be of equal interest to those who believe “Medicare for All” is a panacea as it is for those concerned with an appointed federal board meddling in doctor-patient relationships.

Former Sen. Tom Coburn, of Oklahoma, who actively practiced medicine as a family physician and OB-gyn specialist while he served in Congress, spoke at last week’s Solutions Summit hosted by the Washington Policy Center. Coburn focused on the need to start over with price transparency, focusing on disease prevention instead of disease treatment, rewarding excellence and punishing incompetence.

Coburn prescribed reintroducing the free market as an effective treatment with fewer side effects than artificial price controls through the Independent Payment Advisory Board. He cited several national examples of success. Price transparency drives lower prices more efficiently than type of ownership.

Here’s a regional example of the problem. Last month I was quoted prices ranging from $1,225 to $3,280 and additional discounts of 20 percent to 30 percent for cash payment for a simple shoulder MRI. If you have a high deductible, this should matter to you. The lowest prices came from for-profit providers. The most expensive were either publicly owned or nonprofit.

Coburn also charged the federal government with practicing medicine by mandating what can be done and how to do it. Forcing the adoption of electronic medical records to solve one set of problems – duplicate testing and lack of communication among providers – has added to, rather than reducing, doctors’ administrative burden.

Ever been to a medical appointment where the doctor spent more time looking at a screen than looking at you?

The key to quality care is the art of medicine, not only the science. As a four-time cancer survivor, Coburn confidently predicted all cancers will be curable in the next 10 years, “but if we lose the ability to observe you, have a real conversation with you, to listen to you, then we will misdiagnose.”

Now we have noisy claims about how making changes to Obamacare will kill us all. It’s a lousy measure of the quality of any particular health care policy, but a great indicator of political manipulation.

Coburn also cautioned the audience to remember that people still fall through the cracks under the ACA and will fall through the cracks in whatever Congress does in future. Health care is messy, it’s complex, and we need to cut the noise.