Trump

Healthcare’s Fake News Epidemic

Fake news has replaced responsible journalism. It’s hard to know what to believe. It wasn’t long ago that supermarket tabloids like National Enquirer were considered fake news. Now it seems the Enquirer and TMZ may be more reliable sources of accurate news than the New York Times or Washington Post.

Government agencies aren’t immune from the fake news trend either. The Congressional Budget Office describes itself as, “Strictly nonpartisan; conducts objective, impartial analysis; and hires its employees solely on the basis of professional competence without regard to political affiliation.”

I’ll bet most newspapers and television news networks say the same about their own objectivity.

The CBO analyzed the American Health Care Act of 2017, a lame effort by Republicans to repeal and replace Obamacare.  Passed by the House, it’s now on to “the greatest deliberative body in the world.”

Here the Senate will dither and dawdle, and likely not pass anything. What about the election? What about Trump’s campaign promise to repeal and replace? Campaign promises are for chumps, after all. Congress has had years to repeal and replace Obamacare and has done nothing. Ditto on tax cuts, immigration reform, building a wall, and other campaign promises easily made but not kept.

Even Senate Majority Leader Mitch McConnell has thrown in the towel, saying, “I don’t know how we get to 50 votes at the moment.” He has 52 votes in his caucus, but perhaps it’s Common Core math leading him to conclude that 52 is less than 50. Senator Lindsay Graham joined the chorus of naysayers also saying no Obamacare repeal this year. Does the GOP establishment even want to repeal Obamacare? I wonder.

The CBO threw cold water on the House repeal effort claiming 23 million more would be uninsured by 2026 under AHCA compared to the status quo of Obamacare. This assumes that when the individual mandate disappears, the law requiring everyone to purchase health insurance whether or not they want or need it, no one will purchase insurance of any kind. Really?

If inexpensive catastrophic plans became available as an alternative to Obamacare, no one would buy them? That’s like saying if BMW went out of business, sales of other car brands would remain the same, not increase with BMW customers choosing Fords or Toyotas instead. Inexpensive catastrophic plans are ideal for many young healthy adults but are not available under the rules of Obamacare. They would, however, be purchased if priced reasonably. Just like with expensive cars.

A bit of positive news too from the ACHA which has not been reported. The CBO also predicted a $120 billion savings from the ACHA over the next 10 years, but this wasn’t deemed newsworthy by the media, burying this fact in the 18th paragraph of their stories.

Those wanting to maintain the status quo of Obamacare, such as California Senator Kamala Harris, doubled down on CBO projections saying “129 million people with preexisting conditions could be denied coverage.” How real is that number?

The Kaiser Family Foundation notes that 49 percent of Americans receive employer-based insurance, which covers preexisting conditions. Ditto for 20 percent on Medicaid and 14 percent on Medicare. Leaving only 16 percent on individual plans (Obamacare) or uninsured. The uninsured constitute 9 percent and preexisting conditions are moot as these individuals don’t have insurance anyway. Leaving 7 percent on Obamacare plans.

As an interesting aside, why are 9 percent of Americans still uninsured? I thought Obamacare was supposed to fix this?

Of the 7 percent on Obamacare plans, the good news for them is that the ACHA does require coverage for preexisting conditions. Even CNN concedes that point.

The devil, however, is in the details. Covering a condition doesn’t mean coverage for each and every available treatment option. Those with Obamacare policies already know this. Limited formularies. Many top hospitals and physicians out of network. Unaffordable copays and deductibles.

Your heart problem may be covered but the only hospitals and surgeons able to treat your particular problem are not in your insurance network.  Or the out-of-pocket portion is unaffordable. So you are technically covered for your preexisting condition but may not like or be able to afford the treatment options available to you. In other words, if you like your doctor you may not be able to keep your doctor.

The reality is that only 500,000 individuals are in potential danger of losing their preexisting coverage if Obamacare is repealed, according to a detailed analysis by Betsy McCaughey. All told, a drop in the bucket, but for the media, the sky is falling.

These half million individuals could easily be placed on Medicaid, covering their preexisting conditions with little out-of-pocket expense. Much smarter to attend to this small group rather than make a mess of the system for the remaining 99-plus percent.

Right now we only have a House bill. One of many small steps before grand pronouncements can be made about what replaces Obamacare. It’s not law, simply a bill. The Senate needs to pass their own bill, a long shot at this point. Then back to a House-Senate conference to reconcile the two different bills. Followed by another vote in both the House and Senate before it even gets to President Trump for signature and passage into law.

The media, by throwing out fake or exaggerated news as the legislative process has just gotten underway, undermines any realistic chance of dismantling Obamacare. Despite the fact that it is unaffordable for many and in its own death spiral.

It seems preserving Obama’s legacy is the media’s priority over thoughtful reporting and analysis. Expect the media to double down after Trump threw away one of the other Obama legacies, the Paris Climate Agreement. If the media continues to throw cold water on every repeal and replace effort from Congress, via fake news and fear-mongering, Congress will cower and eventually do nothing. Leading to the irony of Obama’s legacy being the ashes of Obamacare once it finally implodes.

Brian Joondeph is a writer and ophthalmologist based in Denver.

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23 replies »

  1. I should have added another name to the list of those on the rights side of the isle where you utilized pejoratives and name called. Let me quote you “If you have followed health care policy for more than a few years, then you know McCaughey is a crank.”

    It appears you have ignoble name for too many of those that are prominent on the right.

  2. Steve, I guess you forgot about the Independent Payment Advisory board or never really understood its potential threat.

  3. You are right about Krugman, but we have seen a distinct pattern with those that associate themselves with the left. Your accusation that “Sowell is just a hack…” mimics many of those that have more agreement with you than I. It is true that you might have come to this conclusion differently, but you placed yourself in a position, that in order to separate yourself from the others, you now have to prove Sowell to be a hack.

    “ I think, the left thinks, that Palin can read. ” Pardon me for a slight bit of hyperbole, but that is what happens when you make such statements such as “ I would also bet you someone found the Sowell quote(s) for her, or it is a quote from newspaper piece.” and you call the esteemed economist, Sowell, a hack. Your opinion of Palin is your opinion, but it is amazing how your words parallel the vicious words of main street media. You don’t bother to even think about all the things she actually did nor have you bothered to look.

  4. I think Krugman is a hack. Is he black? Have never met him but he must be since I think he is a hack.

    You know making up sh$t doesn’t really help. I think, the left thinks, that Palin can read. I think there are tons of conservatives who are smarter than I am. I work with a bunch of them. I know that statistically they are right about some stuff about which I think I am correct. Sometimes they change my mind on stuff. However, on Palin I didn’t care that much about early news reports. Still don’t. Just listened to her ( a little) and read her words (mostly, as reading is much faster). I would rather judge for myself. Her fund of knowledge on the issues affecting our country was awful. If she had an interest in national politics then she should’ve prepared for that. I have little tolerance for laziness. My best guess is that she had more than enough native intelligence for the job, but she was woefully unprepared.

    Steve

  5. Steve, did you run out of time (understandable) or did you simply not remember the Independent Payment Advisory Board?

  6. “Sowell is just a hack now who carries water for his party”

    Strange, but it seems that whenever an African American receives prominence and is conservative he is called a hack or like Justice Thomas a pervert etc. The left can’t stand anyone straying from the plantation.

    “I would also bet you someone found the Sowell quote(s) for her, or it is a quote from newspaper piece.”

    It’s a quote from her Facebook page. Did you ever bother to read the news reports about her before the election? Take note, the attitude was completely different.

    She is conservative so according to the left she can’t possibly read. To make things worse she is a very conservative female. How can that possibly happen? The current philosophy of the left is she must be a moron to desert the left.

  7. When did you do ICU? Years ago physicians didn’t talk about end of life scenarios as much as they do today. The important time to talk about these situations is when they have a life threatening disease and more frequently than not that occurs in the older population. Some think the young should have living wills as well, and I leave that up to the individual, but the young hear about living wills and have access to them if they want one.

    Many patients don’t even understand the living will that they sign.

    Do you think PCP’s only care about the money?

  8. It has been a while, but I also used to do ICU. The experience there was having the family tell us that the patient had never talked about it with anyone. If you will recall the classic SUPPORT study, this is from memory so hope I have it correct, most patients had never discussed end of life issues. (I guess I should thank you here. I do have a bunch of critical care docs now. This would make a good project for one of them. Have to keep them busy.) Again, it is commendable if you were doing that, but not everyone has been doing that, and I don’t think we should expect PCPs to do it if they aren’t getting paid (adequately) to do it.

  9. I have several of his books in my library. I even enjoyed one of them (Facts and Fallacies). Most of Hayek, some Rothbard. Mankiw too. But really, I hope that you started with Adam Smith’s books, and I do mean the plural. (One of my oldest friends is a true anarcho-capitlaist.) And no, I don’t think anyone not on the left is stupid (Cowen is my favorite economist, rarely miss a day of Kling and I think Hanson is scary bright. Friedman was a genius. Sowell is just a hack now who carries water for his party), just, in this case, Palin. The press did not swoop in to destroy her, she did it herself. I would also bet you someone found the Sowell quote(s) for her, or it is a quote from newspaper piece. Cant see Sarah, like the current POTUS, wading through an entire book of serious ideas. Finally, please list the Democrats that I have claimed are intelligent. You won’t be able to do it as I don’t claim that Democrats are especially bright.

  10. The CBO has consistently proven it cannot accurately predict how healthcare legislation will impact insurance coverage.

    This history of inaccuracy, as demonstrated by its flawed report on coverage, premiums, and predicted deficit arising out of Obanuteare. reminds us that its analysis must not be trusted blindly. In 2013, the CBO estimated that 24 million people would have coverage under Obamacare by 2016. It was off by an astounding 13 million people — more than half—as less than 11 million were actually covered.

  11. Response to Steve. posting #3

    “Her claim was that there was an actual panel of government workers who would decide if you should die. Does not exist.”

    Many people talked about that panel as well and considered that panel to be the “death panel”. I think that panel was named the Independent Payment Advisory Board, fifteen experts with little accountability, I believe under the executive branch, that was supposed to control Medicare expenditures only by cutting reimbursements. They had the power to cut reimbursements on Medicare expenditures even to a point that certain services would not be offered. That could be construed as a “death panel” for that means if they lower Medicare payments enough for a specific expensive disease there might be no one available to treat that disease which would lead to the death of that group of people.

    You might say this can’t possibly be true (because it sounds a bit surreal) and there must be Congressional involvement. There was supposed to be Congressional involvement, but if Congress chose to do nothing to match the decrease in Medicare expenditures then the Panels decision would be the law.

    I won’t bother with the rest of your comments because you don’t manage to defend your position rather you say others are doing the same thing. Not exactly, but to explain the difference would require several paragraphs discussing economics and several more on the fundamentals of our political economic system.

  12. Response to Steve. posting #2

    “No, Palin was not talking about anything Sowell might have said. Doubtful she would know who he is.”

    She did so on her web site. You are so full of misinformation fed by the left wing it is almost impossible to keep up with you. I believe that quote using Thomas Sowell’s name came originally from her Facebook page. It appears that anyone who disagrees with the left in your mind is stupid. That is an irrational view point. I am not going to say Sarah Palin is a genius, but she is not any more stupid than many of the Democrats that you believe to be so intelligent.

    The news media has a tendency to distort all sorts of things including a person’s record. When she became the VP candidate for McCain suddenly the press swooped in and tried to destroy her. I was curious so I went to the newspapers in Alaska that before the election demonstrated a completely different viewpoint.

    You have to start straightening out your data because it appears that you look at only the variables that help your side of the argument. Perhaps you should read a bit of Thomas Sowell. If the price is too high I will personally mail you a whole bunch of his books at my cost if I have your address.

  13. Response to Steve. posting #1

    “You say it was not needed, then note that there was a payment issue. As a result, it was not getting done. ”

    No. There is a payment issue for most cognitive services. I had a large Medicare population and I could have closed my office to all those patients needing care and dealt solely with the end of life issue visit for that payment despite the fact the visit wasn’t necessary. I would have made money on the issue and done very little good while others were forced to wait or go to the emergency room. This isn’t a good use of federal Medicare money or my time. End of life care discussion of the type that would be provided in such a visit to a rational healthy person could have just as easily been given by their neighbor.

    On the other hand I seldom saw a patient who was going to die of their cancer not have that end of life discussion already provided, frequently with papers signed.

    Yet despite all the discussions with patients on the issue when circumstances changed all too many times so did the end of life desires.

    This was typcial phoney political ploy to garner votes.

    “it was not getting done. Those of us who live in the hospital at night and weekends can attest to that.”

    Do you know how many times my patients were provided with copies of living wills? The poorer patients were probably using those copies as toilet paper.

    …And guess what, do you know how many of my patients had advanced directives, but no one could find it? I made sure at least one copy was in my chart and told my elderly patients to post their living will, medication list etc. on the refrigerator door where the paramedics knew to look.

    My guess is that the very vast majority of patient (sick or elderly) that you talk about either didn’t want to sign one or didn’t have it available. Furthermore, in the hospital I had to deal with these patients that were going through something new and one had to make sure they were on the same page as their last advance directive they signed.

  14. I will respond to this posting of yours in three postings at the top of the blog to avoid too much confusion. I wish to seperate the various components of the discussion

  15. You say it was not needed, then note that there was a payment issue. As a result, it was not getting done. Those of us who live in the hospital at night and weekends can attest to that. That said, Medicare does now pay (don’t know how well) for those discussions. That, coupled with it being more of a priority in our network, means that we now have to make fewer decisions about end of life issues on an emergent basis. They should be talked about ahead of time.

    No, Palin was not talking about anything Sowell might have said. Doubtful she would know who he is. Her claim was that there was an actual panel of government workers who would decide if you should die. Does not exist. Or if you want to take the very broad approach, it exists the same as it does for private insurance where the insurers decide what to pay for or to not pay for since private insurers also “will simply refuse to pay the cost”.

    “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide”

    Private insurers already do that. And, just to be clear, is your complaint really that you think government based health insurance won’t spend enough? Really? You think the government needs to spend more? Oops, let us clarify that. State governments clearly underfund medical care sometimes, but the federal government can rarely be accused of not spending enough.

    Rationing? No insurance, meaning only emergency care, is about as strong a rationing program that exists.

    Steve

  16. IPAB (part of Obamacare) is a death panel. When Medicare runs out of money, IPAB can cut Medicare spending. End of life care is low hanging fruit in this arena.

  17. CBO does static analysis. Raise taxes and additional revenue will come in. No consideration that people will respond to the raised tax by changing their behavior. Luxury tax on boats is a good example. The tax cost more in unemployment benefits than it raised since it destroyed the US boatbuilding industry. CBO assumed boat purchasing patterns would not change in the face of the new tax. CBO was wrong about Obamacare too.

  18. “If you have followed health care policy formore than a few years, then you know McCaughey”

    Character assasination doesn’t work with me and a lot of other people. “Death panels” might be a bit of hyperbole, but they accurately described the situation. A bit of hyperbole by using colorful language that at irs essence carries a lot of truth doesn’t make anyone crazy. I have spoken more than once to Betsy McCaughey and she is a bright and articulate woman. Try debating her instead of using character assassination. Furthermore, the term “death panel” came from Sarah Palin, not Betsy.

    Additionally there is a lot of confusion regarding what the term actually related to. I’m not going to try to parse that out now, but what Sarah Palin was saying at the time was ” but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.”

    As a side issue:
    “physicians would be able to get paid to just talk with patients and family about end of life issues.”

    I’m an Internist and I thought this provision was not needed. Internists at the time were being paid for such advice when they billed according to time and documented the visit. It was a duplication of a process which meant it too could be poorly used. Physicians did have these discussions as part of their routine care especially when end of life was appearing. The real problem was the payment issue where cognitive services were undervalued compared to other services.

  19. 1) Extensive comparisons have been with CBO and private forecasters. CBO came out very well in those comparisons. Perfect? Nah, nobody is perfect at predictions.

    2) “If inexpensive catastrophic plans became available as an alternative to Obamacare, no one would buy them? ”

    There is no penalty for not being insured, and there are no “pre-conditions” in the Senate plan. There is no incentive to have insurance on an ongoing basis. People can just wait until they get sick, or need surgery, then buy it. Also, I think you need to decide if you want to keep complaining about Obamacare deductibles. To quote you.

    “Unaffordable copays and deductibles.”

    Then you push for catastrophic plans. You do realize that catastrophic plans are basically very high deductible plans don’t you? So, how does this work? You are going to replace plans with unaffordable deductibles and replace them with even higher deductibles ( higher out of pocket spending)?

    3) Please find a credible health care expert to confirm the 500,000 number. Someone like a Mark Pauly who is very much a conservative, but has real integrity. No one else has come up with a number like that. (This is the blog equivalent of quoting Michael Moore as your expert. I assume you don’t know who she is.)

    4) “As an interesting aside, why are 9 percent of Americans still uninsured? I thought Obamacare was supposed to fix this?”

    Many states decided to not participate in the Medicaid expansion. Many people decided to pay the penalty rather than buy insurance. By law, the ACA does not cover illegal immigrants.

    Steve

  20. If you have followed health care policy formore than a few years, then you know McCaughey is a crank. If you read the ACA, you know that “death panels” was totally made up. Just to refresh everyone’s memory (the wife and i are involved with end of life issues) the ACA was going to have a piece in it where physicians would be able to get paid to just talk with patients and family about end of life issues. That was called “death panels” and ended up being taken out of the bill. Now, every time I end up with yet another older patient who has not talked over end of life issues with anyone, so we just end up doing everything, I remember that it could have been different. Honestly, if you really are doctor, how could you oppose this? (This would largely have PCPs talking this over so there would not have been a lot of bad incentives.) To try to turn this into something partisan is just bizarre.

    Steve

  21. I wouldn’t know where to start with this reply including its analogy so I won’t, but will deal with the contention that politifact called something the lie of the year. I love when people use evidence that comes from other people with the same ideology and the same beliefs. No proof is necessary. Self confirmation is good enough for this type of thinking process.

  22. One of the many ideas the pundits, especially those that believe in force, do not seem to understand is that people buy things when they believe those things are worth the money. They reject those things they believe aren’t worth the money. It is very clear, despite CBO predictions, that Obamacare isn’t worth the money so Obamacare has to resort to penalties that to date don’t change the dynamics. Penalties only change the price and create gaming.

  23. I don’t know where to even start with this but here are three points.

    (1) Why are you claiming that the CBO is producing “fake news”? They’re performing solid, non-partisan analysis. In a stick-and-carrot approach, the individual mandate is the stick which makes being uninsured untenable.

    A more apt analogy is if the government kept drunk driving laws on the books with zero penalties. Yes, the law would exist but you’d also see DWIs increase because the punitive aspect is gone. (https://www.aeaweb.org/articles?id=10.1257/aer.20130189)

    (2) What is the incentive for lower-income consumers to shell out for health insurance if catastrophic plans have deductibles that are too high and coverage that is too limited for day-to-day effectiveness?

    We’re not talking about people stepping down from a BMW to a Ford or Toyota. Metaphorically, we’re talking about people going from having cars to being forced to walk everywhere – while limping.

    (3) You’re going to bring up fake news and then cite Betsy “death panels” McCaughey as a source? The esteemed winner of Politifact’s 2009 Lie of the Year (http://www.politifact.com/truth-o-meter/article/2009/dec/18/politifact-lie-year-death-panels/)? Really?

    Plus, do I need to point out that even your best case scenario has a population larger than the size of Atlanta potentially losing coverage due to pre-existing conditions? In what world is that desirable?

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