Bias and credibility – a cautionary tale

I’ve been somewhat reluctant to write this post, as it takes issue with one of the key presenters at a workers comp conference that I believe is consistently the best I’ve attended. It’s here for one reason: it illustrates how a public podium must be treated with respect and the audience given all the relevant information so each can draw their own conclusion.
Scott Harrington PhD, was on the podium at NCCI last Thursday afternoon discussing the future of Federal healthcare reform, reform legislation, and the implementation of reform. He’s a very knowledgeable and highly intelligent guy, but his presentation was marred by what I consider rather striking bias.
Harrington led off by noting that he is a rare professor in that he is an avowed conservative. No problem with that; many in the insurance community tend to be more on the conservative side, but there’s no shortage of liberal-leaning insurance execs either (although they tend to be relatively quiet about their inclinations).
No, the issue was he allowed his bias to affect what was an important topic, and one of interest to most of the attendees – of health reform and the goings-on in Washington. At the end of Harrington’s talk, I was left wondering what was reality, what was his slanted interpretation of reality, and whether anything he said could be taken at face value.
Here’s what caused my consternation.
The uninsured population
Harrington contended that of the 46 million uninsured, 10 million are eligible for coverage thru their employers but have not signed up, and an additional 11-12 million have incomes above 300 percent of the Federal poverty level, and therefore could buy insurance if they wanted to. Harrington’s point was people are uninsured because they choose to be.
That’s just not true. 300% of the federal poverty level is $66,150 for a family. The average health insurance premium is over $15,000, not including deductibles, copays, coinsurance, and the cost of healthcare for conditions not covered by insurance. Health insurance is unaffordable for many people. Is that a ‘choice’ issue? Perhaps – many ‘choose’ to pay rent and buy food instead of insurance.
Moreover, individuals with pre-existing conditions can’t get any coverage for those conditions in many states and have to pay a big upcharge in others. If you have diabetes and hypertension, what insurance company who doesn’t have to cover you will?
The employer-sponsored issue is less clear, but still problematic. Many smaller employers offer insurance but require workers to pay a big chunk of the premiums; this is especially prevalent among smaller employers. Workers in the lower income brackets would have to pay their part of the premium – typically between 20% and 50% of the total cost, plus the additional deductibles, copays, and coinsurance. For a worker making $20 an hour with a family of three, that’s a little over $40k per year. If their employer requires them to pay a third, that’s $5000 before the deductible, which in many cases is at least a couple thousand bucks.
The Medicaid picture is cloudier still, but Harrington’s inference that many who are eligible haven’t sign up is quite simplistic. Research indicates many of the eligible-but-unenrolled are those with language barriers, live in states that have done little to promote the program or educate potential enrollees, and/or have significant mental issues that inhibit efforts to enroll them or are kids.
Harrington’s attempt to pooh-pooh the uninsurance problem would have been more compelling had he treated it objectively. There is no question some individuals go without health insurance out of choice – Rush Limbaugh comes to mind. But Rush makes just a bit more than $66k a year.
Deficits
Harrington next took on the Medicare deficit, pointing out (accurately) it would rise to $38 trillion by 2008. He then shared a bunch of scary statistics about the size of the debt, amount per person; all in an attempt to point out the unaffordability of the current system.
That wasn’t exactly new news. Where Harrington went off the reservation is his inference that this was somehow the fault of the Democratic Congress and President. In his concluding remarks, Harrington claimed that if the GOP takes over Congress and the White House, the mandate and insurance provisions could be repealed, reductions in Medicare would be legislated, and this would lead to lower costs and deficits.
I’m not sure which Republican party Harrington was talking about; it certainly wasn’t the one we’ve seen in power for most of the last decade.
For example.
Medicare Part D was passed and signed by Republicans, with “no dedicated financing, no offsets and no revenue-raisers; 100% of the cost simply added to the federal budget deficit”. The same Medicare Actuary quoted by Harrington, in the 2009 report to Congress, (pdf) reported that the GOP-passed Part D program has contributed $9.4 trillion to the $38 trillion Federal healthcare deficit. (page 126)
I’d also point out that the same Republican Congress and Administration was responsible for preventing Medicare from considering any cost-benefit criteria in determining whether and what Medicare would pay for procedures, drugs, treatments, devices, etc. Yep, these deficit hawks thought it was just fine for we taxpayers to be forced to pay for procedures with very little efficacy.
(the pertinent language from the 2003 Medicare Modernization Act reads as follows – CMS will pay for items or services “reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the functioning of a malformed body member” (Fed Reg 65-95, p 31124- 31129, 2003 MMA); there is no mention of cost)
Finally, I think it is important to reflect on a simple fact. If private industry had been able to control health care costs, we wouldn’t be having this discussion. The fact is, for whatever reason, the for-profit, and not-for-profit health care insurance and delivery system has been unable to control costs and consistently deliver quality care.
There’s no question the current health reform bill has major flaws; a lack of cost control is perhaps the most glaring. I’ve taken issue with the law, its future cost, the lack of attention to cost, and the failure of both parties to deal with these tough issues. I will continue to do so, and will continue to keep in mind the singular importance of presenting the facts, data, and logic supporting my views, and address opposing opinions that are similarly supported.
And I’m sure you’ll keep me honest.