• Some of the best and worst health policy coverage in America—and in the same newspaper

    The Wall Street Journal news section is an essential information source for anyone seriously interested in health policy. [See, e.g., this story on prescription drug overdoses today.] Meanwhile, the Wall Street Journal op-ed section regularly include disgracefully misleading accounts of health policy which are deeply at odds with the excellent coverage in the rest of the paper.

    Consider yesterday’s op-ed essay by Heather Higgins and Hadley Heath: “Informed Independents Cool to ObamaCare.”

    The guts of the piece are as follows:

    Those who support the president’s health law and those who oppose it have argued past one another…

    Independent Women’s Voice, an educational advocacy organization that runs the Repeal Pledge calling for the elimination of ObamaCare, believes that opinions about health care can be changed. When people’s views are based on faulty or incomplete information, IWV has had great success in changing those views by offering solid information.

    Over one week in mid-September, IWV conducted a message test among independent voters in 24,000 households spread over four states. The goal was to see if simply providing the facts about the true costs of the health law would affect popular support. Would independents, once they were educated about little-known but very real aspects of ObamaCare’s popular elements, change their minds about those elements? Would their support overall for repeal increase?

    After just one week of intensive, multipart, multimedia education message delivery to households in the test group, the results were dramatic.

    Just what was the “solid information” that changed people’s views? A strange laundry list of obviously incomplete, untrue, or misleading claims from a website called healthreformquestions.com.

    Some examples of provided information:

    • The average family’s health-insurance premiums are already up $1,300.

    Readers who track through the references to a Kaiser Foundation report will find no evidence that this $1,300 increase arises from health reform or could have been prevented by a bill whose strongest provisions have yet to kick in. More likely, the $1,300 increase reflects yet another year of general health care inflation and has little to do with ACA.

    • Young workers who buy their own insurance will see a 19%-30% increase in premiums as a result of ObamaCare.

    This analysis cites an Avik Roy column in Forbes which cites an original analysis of health care markets in Wisconsin, Minnesota, and Colorado by MIT economist Jonathan Gruber. I’m not crazy about Avik’s column. (As regular readers may know, Avik is an outside advisor to the Romney campaign. We’ve frequently tangled over his frequent assertions that Medicaid coverage is a form of welfare that hurts people.) At least Roy properly references the pertinent details. Readers of healthreformquestions.com would not know several important facts noted by Gruber himself to Ezra Klein last year.

    First, that 19-30% figure “refers only to those who were already buying nongroup insurance.” It thus ignores the enormous reduction in premiums for people (e.g. people with preexisting conditions) who were shut out of the market because they couldn’t obtain coverage.

    Second, the analysis makes no note that under ACA, individuals would be buying a more generous insurance package. Comparing prices for the same insurance yields notably smaller estimated increases.

    Third–[and probably most important]–this analysis sidesteps state and federal tax subsidies to help individuals obtain health care coverage.

    Then there’s the strange discussion of preexisting condition health plans (PCIP) and high risk pools. (I’ve written about this subject, and have been a persistent PCIP critic.)

    • Remember the 700,000 people whom the Congressional Budget Office predicted would make use of ObamaCare’s federal high-risk program? Just 78,000 people have enrolled. As a result, each person in the program costs taxpayers millions of allocated dollars…

    Pretty much everything is incorrect here. PCIP’s annual budget is about $1.5 billion, totalling $5 billion before the whole thing sunsets in 2014. That 700,000 figure was CBO’s estimate of what PCIP enrollment might reach “if Congress provided $5 billion to $10 billion more than the cap specified in PPACA.”

    Many PCIP enrollees are quite sick. Indeed these individuals proved sicker and thus more costly than CBO had anticipated. For example, 27 percent of PCIP enrollees have cancer. Others require transplants, hemophilia treatments, and treatment for highly acute illnesses and injuries. Average annual program costs reach $29,000 per person. That severe case-mix does not reflect any program failure. Rather, it largely reflects states’ decisions about which mix of patients to target for PCIP outreach and enrollment.

    How does (the unmentioned) $29,000 transmuted to “each person in the program costs taxpayers millions of allocated dollars.”  I tracked through a few links to find the associated passage. It’s again from a Forbes column by Avik Roy. Roy links through to a strange blogpost on South Carolina Senator Jim DeMint’s website, which calculates the following:

     ObamaCare spends $2.6 trillion in its first decade of full implementation, largely to ensure that those with pre-existing conditions have access to coverage. At this rate and based on these metrics — $2.6 trillion in spending, and 56,257 participants – the federal government will spend $4,621,647.08 per year for every person with pre-existing conditions newly enrolled in coverage. That’s not just enough money to buy each person with pre-existing conditions a platinum-plated insurance policy — that’s enough to buy each one a small hospital…

    To get things straight: Senator DeMint’s writers divide a tendentious estimate of the total costs for the entire full-implemented health reform effort which serves many millions of Americans over a full decade. They then divided this total ten-year expenditure by last year’s enrollment in one tiny and temporary program that accounts for maybe 0.25 percent of total spending under health reform.

    • Americans are also generally familiar with Medicaid’s problems, among them the refusal by many doctors to accept Medicaid patients. What most people don’t know is that approximately 10 million of those who gain insurance under ObamaCare will just be dumped into the already cash-strapped Medicaid system.

    I would understand this argument if it were made from (say) single-payer advocates. State Medicaid burdens are a serious concern. Respondents would understand this argument somewhat better if they were told that the federal government will initially cover 100% of the costs of newly-eligible Medicaid enrollees, tapering down to a 90% match over time.

    There’s more. The point is clear. Again, what’s disgraceful here is not that Independent Women’s Voice chooses to peddle crude propaganda under the guise of educating people about health reform. That’s who they are and what they do. The real disgrace is that the Wall Street Journal regularly grants op-ed space for people to make claims that couldn’t pass a ten-minute fact-check in the bottom paragraph of its fashion or sports pages.

    Healthreformquestions.com’s website ends with these words: “We need honest numbers and honest accounting so we can find real solutions to get back on course. This isn’t about politics; it’s simple math.”

    This organization has some chutzpah to say this. I still wish the Journal would take their words to heart.

    @haroldpollack

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    • As a pediatrician I get tired of nonphysicians claiming to know what patients pediatricians wii see. Romney made the same reference to physicians refusing Medicare patients. Physicians I know do not discriminate on the basis of insurance. Physicians incomes have always been more than adequate.

    • Thanks, Harold for this piece.

      It is stunning who gets in the WSJ – Sally Pipes, the Fraser Institute, others completely at odds with reality and often, math.

      Cheers to you!