 Giuliani's repetition of the error even after it had been pointed out to him earned him more criticism and was awarded four "Pinocchios" by the "Washington Post" for recidivism.Health care professionals have tended to avoid the term because of its pejorative nature, but if they use it, they do not include publicly funded private medical schemes such as Medicaid.Opponents of state involvement in health care tend to use the looser definition.