A few weeks ago, I wrote a post entitled "The Doc Fix Myth And The Right's Misinformation Feedback Loop." I used the example of a medium-sized claim that's demonstrably false, but has recirculated endlessly among conservatives, most prominently rising star Paul Ryan. The false claim is that the Affordable Care Act uses mythical savings from the "doc fix" in order to offset the cost of expanding coverage. Jeffrey H. Anderson, who has been writing about health care for National Review, the Weekly Standard, the Washington Times, the American Spectator, and Investor's Business Daily, has written a reply. His reply utterly vindicates my thesis. Indeed, it suggests that I understated the case. These people really, really don't know what they're talking about.

Let me first explain the underlying issue. It's not very complicated. In 1997, Congress tinkered with the formula for reimbursing doctors who treat Medicare patients. Congress bungled the formula, accidentally creating a massive cut. Congress takes back the cut on a year-by-year basis, a ritual known as the "doc fix." But technically, the cut remains on the books for future years. In other words, there are hidden costs in the budget.

Numerous conservatives, led by Ryan, have tried to claim that the cost of the doc fix is a hidden cost of the Affordable Care Act. Obama's numbers aren't real, they say, because they don't account for the money needed for future doc fixes. Of course, fixing this problem isn't part of the Affordable Care Act at all. It's a cost that would have occurred whether or not the Affordable Care Act was passed. Indeed, Ryan's own health care plan, as well as the main House Republican plan, did nothing to address the doc fix. The Affordable Care Act simply did not use imaginary physician reimbursement cuts to pay for coverage expansions. I've pointed this out numerous times, most recently in the item mentioned above.

Anderson, in his reply, first objects to my description of Ryan as a "conservative icon":

In truth, Congressman Ryan isn’t an icon, but a uniquely articulate champion of limited government, fiscal responsibility, and liberty, and thus is completely in step with the mounting concerns of the vast majority of American voters — conservatives, libertarians, and independents (and even some liberals) alike.

I thought "conservative icon" summarized the same basic sentiment in a pithier way, but it seems I have inadvertently given offense. Let me rephrase my thesis in Anderson-approved terms: Uniquely Articulate Champion Of Limited Government, Fiscal Responsibility, And Liberty Paul Ryan has been spreading demonstrable untruths about the Affordable Care Act.

Anderson proceeds to cite the Congressional Budget Office as evidence that the cost of the doc fix is being used to help fund the Affordable Care Act. He writes:

The CBO begs to differ: “The provisions that would result in the largest budget savings include these: permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector . . . yielding budgetary savings of $186 billion over 10 years.” That’s the physician pay cut.

Anderson provided no link or citation for this quote. It turns out to come from a December 19 CBO letter (page 10) to Harry Reid, assessing the cost of the Senate health care bill, which is not actually the final version. But never mind that. Anderson, if you noticed, inserts an ellipses into the quote from the CBO. Here is the entire quote. I've bold-faced the part omitted by Anderson:

Permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector (other than physicians’ services), yielding budgetary savings of $186 billion over 10 years.

Did you catch that? Anderson used ellipses to remove the part of the quote that disproves his entire claim. He removed the part that says "other than physicians' services," and then wrote, "That's the physician pay cut." But it's not the physician pay cut. The physician pay cut is simply not part of the financing of this law. By the way, I'm not merely going off my own interpretation on this. I checked this with Paul Van de Water, a budget expert with years of analytical experience at the Congressional Budget Office and other places. He's the one who tracked down the Reid letter for me.

Van de Water was astonished at the brazenness of the tactic used by Anderson, or whoever is feeding misinformation to Anderson. I wasn't. Real budget wonks who circulate among genuine experts often fail to understand the degree to which the public debate is driven by pure hacks. I'm not picking on some marginal figure here. Anderson has been writing about health care for nearly all the major conservative publications. Very few conservatives follow health care reform in any detail. They have a general hostility to government and proposals formulated by Democrats, and since they reject the overwhelming majority of actual health care experts on ideological grounds, they have relied on a tiny handful of self-styled conservative pseudo-wonks to fill in the details for them.

But figures like Anderson are simply not up to the job. And once some factual misapprehension has made its way into the right-wing echo chamber, it's nearly impossible to dislodge. The same basic phenomenon can be seen is debates over climate change, supply-side economics, and other issues. You have a whole ideological movement that, to a substantial degree, relies upon the pseudo-expertise of cranks and hacks.