I have all sorts of misgivings about narrating our present public culture as uniquely afflicted by misinformation and disinformation.
At a really basic level, I think the tropes associated with that storyline are a kind of security blanket for educated elites. They slot in alongside our favorite answer to the ills of this moment and other moments: more education, more information literacy. If only people knew the truth, we reason, they wouldn’t think these things! If only they knew how to sort truth from falsehood the way we can, we’d all be making the right decisions and our democracy would function as it ought to function. The masses would agree with us, policy would be made from facts, trade-offs would be priced-in correctly.
All of this is a way to avoid facing an awful truth: that many people choose bad policies and favor bad politics—the politics of vengeance, of brute force, of domination—in a perfectly agentive and knowing way. They’re not led down the garden path by some lunatic disinformation being spewed around Facebook. A lot of that material might just be a kind of top-level noise, a sort of icing on an always-already baked cake. Or the semantics and hermeneutics of cultures of disinformation are important and interesting but not causal to why people hold the politics they do, why they make the social alliances that they do. The flip side may be equally true: high-information communities, groups and individuals don’t necessarily derive their everyday sociopolitical convictions from information that they know inside out, that they are proficient in. Plenty of exceptionally educated and intelligent people in my social world “trust in the science” but what that really means is that they trust what social peers who are scientists tell them the science says, not that they are deriving that information directly from its source. Moreover, even in my own world, people routinely accuse the other guy of not knowing enough and never on retrospection find themselves wanting—just look at the furious back and forth between educated liberals and progressives about Israel and Gaza and you will only very rarely see two people who have relevant expertise conceding that the other person knows as much as they do and what they’re really disagreeing about is not about knowledge per se but just different readings of ethics and pragmatics.
Yet, ok, there is disinformation—individuals and institutions that are knowingly, deliberately, programmatically spreading lies and distortions in order to protect their own interests and to manipulate people. And there are consequences to disinformation, including people falling down various rabbit holes and becoming trapped in a house of lies. Here too, however, there is a kind of social politesse involved that orients us towards the present, towards seeing disinformation as a newly extreme, newly ubiquitous problem, towards attributing it just to political enemies. That lets us ignore that disinformation is an old and very deliberate practice of our institutions and governments, that there are multiple professional tracks that center on the creation and management of disinformation, and that our public culture has been deliberately clogged by informational pollution for decades.
Exhibit A for the prosecution? A letter to the editor from Rick Pollack, CEO and president of the American Hospital Association protesting a June 18 NYT op-ed by Danielle Ofri.
In the original essay, Dr. Ofri observes that urgent care centers—a line of business that has been growing at 7% a year and are now omnipresent across much of the suburban United States—seem like a good alternative to an emergency room for something like testing for strep or getting an x-ray to determine whether someone has a broken bone considering how difficult it has become to get a same-day appointment with a primary care physician. But Ofri recounts that getting a simple urgent care x-ray for her daughter to rule out a broken bone ended up producing a bill for $1,168 despite the fact that Ofri knows the basic cost of the procedure should be about $100.
It turned out that the urgent care center was affiliated with a hospital and thus was “allowed to charge hospital prices”. So even though Ofri had done the right thing and routed her medical need to what should have been an efficient and low-cost service, she stumbled across a “lucrative corner of the health care market” where a lack of regulation is permitting urgent care businesses to charge much higher prices that someone eventually is going to pay. Ofri spent six months fighting the bill, which led to it being cancelled. (From our experience, I wouldn’t breathe too easy if I were Ofri—some hospital systems will tell you they’re cancelling a charge only for it to resurrect itself via some other billing system or body of records.) Another letter writer points out that Medicare pays facility fees without complaint and often doctors involved in the testing or diagnostic chain have no idea a facility fee was charged; another writer recounts having to fight to get insurance to cover an undisclosed facility fee.
But Pollack, the American Hospital Association CEO, is having none of it. Facility fees, you see, help hospitals “treat sicker, lower-income and more complex patients” and deal with “higher regulatory and safety standards”. Hospitals, you see, lose money treating burn victims and premature babies. Hospitals—sigh—now have to tell Medicare patients if they might be on the hook for a outpatient service, and—sigh—are trying to give “meaningful estimates” on costs.
And Dr. Ofri, you see, is trying to mess up how these facility fees are helping to fix all those frustrating problems. It’s not profit, not at all. These are just a way of making all those books balance! You aren’t against helping sicker and lower-income patients, are you? You don’t just want to see burn victims and premature babies thrown out in the cold, right?
This is infoclog. It’s the long-standing process of dumping reasonable-sounding, pseudofact-laden pollution into every informational creek and river that carries public discourse down to the vast ocean of our democratic society. It’s part of how lobbyists, lawyers, legislative aides, think-tanks, communications offices and executives knowingly create confusion and misdirection. It’s a gigantic shell game, a three-card monte misdirection. By the time Congress or any other governmental body gets around to responding to this particular problem, the institutions that generated the problem will have relabeled, shifted, embedded, hidden or diffused the charge or the practice that was criticized. It’ll be lumped into the charge, mysteriously transformed into the “high cost of health care these days”, which is represented as if it a force of nature, something nobody can understand or do anything about.
What Pollack and people like him never have to explain is, “How was it possible that a kid who might have a broken bone could get an x-ray quickly in 1975 or 1980 without high cost to the parent, whether the parent was an upper middle-class professional or a blue-collar worker in a factory?” How was it possible that we treated even the burn victims and the premature births, the sicker and lower-income, at that point?
There are infoclogging ways to respond to that challenge if somehow the polluter gets trapped in a blind alley and has to talk their way out. Some of them are just plain old disinformation, that is to say, lies—say, to claim that it’s because the American health care system provides such excellent outcomes all around that it’s just plain expensive and back in 1975 it didn’t. A shred of truth might trickle in when we’re told “well, people have coverage that includes more expensive procedures and drug therapies that we didn’t have back in 1975 and we’re all paying our share of that through insurance, and that’s where the need to find more revenue sources is coming from.” But what you’re never going to hear is the truth: that the health care industry is now run at all levels in order to maximize profit, and because health care at some basic level is inelastic, there is almost nothing that can stop the adding on of high charges wherever and however health care is dispensed. Against the risk that you’re making a kid walk around on a broken ankle, with possible life-long consequences, you’ll eat that big bill if there’s no other way. The goal in the end is to make sure there’s no other way.
The goal is also to bottle up public discourse and political action in these little pointless dead ends, to get us all to say, “Oh, perhaps hospital costs really are a part of the issue, we have to study that, we have to appoint a commission” or “Oh, if we limited facility fees, maybe we’d unintentionally kill off incentives to operate urgent care centers and create more health care deserts”.
In the earlier part of the 20th Century, infoclogging was a more innocent affair, often so clumsy and limited to small artisinal bullshit operations that it was almost charming. We are way past that now and have been for a long time. The truth in many situations is not found through the compilation of more information but through the application of the layered common sense most of us have developed about capitalism and government. In a way, knowing that’s the case is what makes some people vulnerable to the latest forms of disinformation. It is not that they are being lied to for the first time, but instead they are hungry for some plain talk, even when it amounts to “We’re going to take you for everything you’ve got and you can’t do a damn thing about it”. Even when the plain talker is just a spectacularly overt liar, the affect of plain talk lures some people in. At least it’s not infoclogging, the kind of lying that polite people in their polite worlds endure with seemingly inexhaustible patience.
Image credit: "Number 9, Surer than Three Card Monte, from the Tricks with Cards series (N138) issued by W. Duke, Sons & Co. to promote Honest Long Cut Tobacco" by W. Duke, Sons & Co. is marked with CC0 1.0.