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From the patient trenches: Lies, Damn Lies, and CBO Scoring

From the patient trenches: Lies, Damn Lies, and CBO Scoring

The dam has to burst.

I was against CBO health care scoring before it was cool to be against CBO healthcare scoring.

In the run-up and aftermath of passage of Obamacare, I devoted numerous posts to the way the way Democrats gamed CBO scoring to present an unrealistic projection of how the law would actually work.

CBO Credibility The First Victim Of Obamacare (March 19, 2010):

Nancy Pelosi announced yesterday how pleased she was with the precision of the CBO report on the cost of Obamacare. It would be easy to laugh out loud if so much were not at stake.

Nancy Pelosi has no credibility to lose, so she did no harm to herself. The tactics Democrats have used as to CBO scoring of bills, however, has destroyed the CBO’s credibility.

The CBO is supposed to be a neutral calculator of legislation. And it is. I have no doubt that the people at the CBO do their best to calculate the cost of a bill, given the assumptions the CBO is required to follow.

And that is the catch. Whereas on less politicized legislation there may be reasonable assumptions built into a bill and requested by those seeking a cost estimate, as to the health care bills proposed by Democrats it has been all games.

Completely unrealistic assumptions have been foisted upon the CBO, and the CBO has been required to score the bill with phony math.

Not surprisingly, CBO projections of cost and coverage were way off. The implosion also is well documented, with insurers leaving the exchanges, and premiums and deductibles make the cost of insurance impossible for many.

Mary will have more details in a later post on the CBO Scoring released today of the Republican repeal and replace bill.

I’m going to give a reality check from the patient trenches of the healthcare system that we have witnessed for the past 18 months dealing with my wife’s illness. (She’s moderately improved lately, but we’ve had these temporary rays of hope in the past, so we’re not celebrating yet .)

Some reality:

  1. It’s getting harder to get appointments with the doctors you really want to see, particularly specialists. It’s like getting tickets to a hot show: Unless you know someone, or at least know someone who knows someone, plan on waiting months for an appointment.
  2. The doctors you really want to see, particularly specialists, frequently (not always) don’t take insurance. Pay out of pocket and seek reimbursement yourself. We’ve been doing a lot of that, even though we have “excellent” insurance through Cornell with a major national carrier.
  3. Ask your doctors how Obamacare has affected their practices. Every single time we have asked that question (and we have asked it many times), the result has been Not Suitable for Work. Whatever Congress and the CBO say, Obamacare is killing practices, demoralizing doctors, and imposing so many policies and procedures that doctors are counting the days until retirement. Practice groups are getting larger and doctors are becoming employees of hospital chains because of the costs of complying with Obamacare. One phrase we have heard more times than we can count is along the lines of: “I tell my children not to go into medicine.” Sad!
  4. Want to spend time with your primary care physician, get phone calls returned, and get help getting appointments with specialists? In other words, get the service those of my and older generations came to expect: Get “concierge” coverage. It’s the hot thing. But be prepared to shell out big bucks (we pay $200 per month for my wife’s primary care physician for that reason).
  5. Having Medicaid doesn’t guarantee good care. Multiple physicians have told us they can’t afford to take Medicaid patients because the reimbursements are so low. Or they take Medicaid patients just one day a week. Almost all of the growth in coverage under Obamacare was through Medicaid.
  6. Things are getting worse.

So the CBO scoring is just politics to me. The reality is as above. The dam has to burst.

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Comments

My personal physician got a threatening letter from CMS some time ago accusing her of Medicare fraud. Eight pages of threats and on the last page, the amount she was accused of mis-billing…. $0.02. Medicare doesn’t pay and if you do offer care to Medicare patients you run the risk of bureaucratic terrorism. It is a shell game of cost shifting, limitation of services and denial of care created by the labyrinth of rules and regs. It is all about control of a populace. People who are very “capitalist” suddenly get very socialist about healthcare and often willing to give up choice and freedom for a promise of coverage by government… Obamacare is Darwinian ….

Professor, that Daily Caller report, and the Weekly Standard report it is based off of, is just factually inaccurate based on its own sources. Did you just not bother to read them?

The 2016 estimates based on the February 2013 Estimates were 246 million insured, 31 million uninsured. The 2016 estimates from the March 2016 baseline were for 244 million insured, 27 million uninsured. Nowhere near “way off”.

I’ve been really disappointed every time I’ve come to this blog since Trump’s election. Last time I was here it was this completely indefensible post: https://legalinsurrection.com/2017/03/media-hypocrisy-jeff-sessions-and-russia-vs-eric-holder-in-contempt-of-congress

where you harp on the media for doing exactly what you did, failing to cover the contempt vote because (as your blogger failed to mention) that was the day NFIB v. Sebelius came out. The level of both intellectual dishonesty, and just straight out dishonesty, at this once venerable blog is extremely disheartening.

    alaskabob in reply to Awing1. | March 13, 2017 at 9:20 pm

    May we rely on your perfection to help us guide ourselves through the Trump-ic storms? I will really feel better.

      Awing1 in reply to alaskabob. | March 13, 2017 at 9:24 pm

      Right, so your claim is what, exactly? That if someone doesn’t have a perfect dictation of the world themselves, they can’t call out gross misrepresentations of the state of things and hypocrisy? I always thought that doing that was the whole point of the blog to begin with.

    Awing1 in reply to Awing1. | March 13, 2017 at 9:21 pm

    Sorry, upon further reading, I made the exact mistake that the Daily Caller wants its readers to make, and assumed that it was talking about “uninsured” throughout the entire post. In reality, it’s only talking about “uninsured” with relation what the most recent CBO estimate says will go up under the new healthcare plan, and then throughout the rest it artfully switches the discussion to “private insurance”, without ever explaining why its appropriate to conflate the two. Other than, of course, because it would be no fun to note that the CBO actually got the reduction in uninsured persons about right in its initial estimate of Obamacare …

    So I’ll just stick with the accusation of intellectual dishonesty, and add some emphasis to it for good measure.

      It’s amazing that there are people out there still pretending that what matters is how many are “insured,” and are unable to understand that being “insured” by a plan that’s utterly disruptive financially due to extraordinarily high cost (a multiple of what I paid just 8 years ago) and effectively unusable due to extraordinarily high deductibles (also a multiple of what I paid just 8 years ago) has resulted in a profound DESTRUCTION of my family’s ability to access actual HEALTHCARE.

      Obamacare’s “health insurance” program is nothing but a wealth transfer scheme from makers to takers, yet another Obama-era handout to the Progressives who support him and his ilk.

      If Obamacare were so popular and effective, how have the Democrats lost over 1,000 political offices during Obama’s two terms, at every level of government, and been reduced to minority status in the states, in the House, in the Senate, lost the Presidency, and soon to be in the minority in the Supreme Court? After all, Obamacare is entirely THEIR play. Not a single Republican voted for it.

      So weird, right?

      All the Progressive lies in the world can’t change that reality.

      What cannot continue, will not continue.

      –Andrew

        Ragspierre in reply to Andrew Branca. | March 14, 2017 at 10:21 am

        Yepo. Concur completely.

        Repeal was what was promised. It is what we MUST demand.

        It’s amazing that there are people out there still pretending that what matters is how many are “insured,” and are unable to understand that being “insured” by a plan that’s utterly disruptive financially due to extraordinarily high cost (a multiple of what I paid just 8 years ago) and effectively unusable due to extraordinarily high deductibles (also a multiple of what I paid just 8 years ago) has resulted in a profound DESTRUCTION of my family’s ability to access actual HEALTHCARE.

        Are you feeling satisfied after beating up on that straw man? I’m not contesting Prof. Jacobson’s arguments that the headline number of reductions in coverage isn’t a useful metric. It’s fine to do that, that’s a perfectly legitimate argument. I’m contesting the claims and tactics of that Daily Caller article that the blog cites to support its assertion that CBO is bad at predicting coverage levels qua coverage levels. When you have a response to that argument, which is the one I actually made, feel free to respond without further contributing to the increasing level of intellectual dishonesty here.

So, are you concern trolling or not?

B+

“Any analysis of the current CBO projections for the Price/Ryan Healthcare proposal should keep in mind the original number of “uninsured” during the 2009/2010 debate over ObamaCare was 30 million.

The entire premise for ObamaCare in 2009 and 2010, as espoused by the people selling the need, was to cover those 30 million uninsured.

With that in mind, the fact that CBO projects uninsured coverage of 28 million in 2026 if no changes are made to ObamaCare – means that seven years of healthcare chaos have resulted in coverage for only 2 million people.”

https://theconservativetreehouse.com/2017/03/13/cbo-releases-analysis-of-secretary-tom-price-and-speaker-ryan-healthcare-proposal-price-responds/

Close The Fed | March 13, 2017 at 9:49 pm

I speak with doctors about their practices occasionally, and no question the 3rd party payer model along with all the other mandated changes in medicine are nothing but headaches. Electronic health records – that’s been ridiculous.

Also, although most here probably are not familiar with it, increasingly “MOC” or maintenance of certification is something physicians are up in arms about also. The certification boards make money off of the requirements they impose. So they keep increasing the requirements to maintain speciality certifications. Some doctors want to ditch the certification, but some insurance companies are requiring it to get paid, and as I understand, some states are considering mandating “certification” in order to keep the physician’s license active. This is completely over the top.

So, a lot is brewing in the medical profession; the problems are in the dozens, and this insurance situation exacerbates it.

    alaskabob in reply to Close The Fed. | March 14, 2017 at 12:03 am

    First all..mis-hit down thumb by mistake…sorry. You are right. I just spent the usual $2500 to take the MOC and my head is still spinning from the esoteric gobbledegook on the test. At least my specialty didn’t renege and covert the test to monthly tests invalidating the passed MOC. Chit chatted with an ER doc from KP about flurry on monthly tests and updates to jump through hoops to stay “current”. True diagnostic acumen is not tested.

    The reimbursement has been driven down that some docs feel lucky to get Medicare rates. Some of my contracts were at 40% of Medicare. Can’t spend much time with patients when “volume” is the only driving force to keep head above water.

    When my policy was cancelled under Obamacare, I had to go to Healthcare.gov as it was the only source of policies. So I was counted as one of those millions saved by ACA . Classic government policy…create the problem then turn around and “solve” the very problem it created in the first place.

    Once government controls your access to health care, they have a powerful tool to coerce one not only to “better health” but better choices in whom to vote for and what social readjustments are needed for healthy thought. Just as they have reached a “consensus” climate change, they can come to ant other consensus they feel is needed.

      Close The Fed in reply to alaskabob. | March 14, 2017 at 8:37 am

      To AlaskaBob:

      Monthly tests?!?! Boy, that one I hadn’t heard about!! Thanks for the heads up. Truly awful.

        alaskabob in reply to Close The Fed. | March 14, 2017 at 12:55 pm

        “The ABNM will be launching a pilot program in 2017 called CertLink™, in partnership with several other ABMS member boards. CertLink™ will deliver questions to diplomates on a regular basis, and provide immediate feedback on answers.”

My experiences mirror professor Jacobson’s. Thankfully we aren’t dealing with any serious illnesses but as a family of five, one of which is a toddler, we have regular medical appointments to make and access has been a problem. Also, I’ve had the same feedback from the majority of doctors I see described in the article. We pay a heavy premium and still deal with a deductible, but he penalty would be worse yet.

So, yay for worse coverage, fewer choices, less access, deductibles and penalties galore! And the cherry on top is the very people we rely on for care are trapped in the middle, suffering right along with us.

This thing has to be stopped before it does any more damage.

I remember in the 60’s and 70’s you could biy health insurance out of a Cracker Jack box it was so cheap. That was before Nixon ok’d for profit with HCA.
For profit has been a disaster, and has caused insurance, and healthcare, to both terrify, and dominate our lives.
I don’t know if we could ever put that genie back in the bottle, but nothing has worked since.

The original broadly-used number was not 30 million nor was it 57 million. It does matter how you define it, notably “uninsured all year” vs “uninsured at any point this year”

http://www.politifact.com/truth-o-meter/statements/2009/aug/18/barack-obama/number-those-without-health-insurance-about-46-mil/

#5…My doctor gave up on Medicaid patients a few years back. He recently told me that doing so, cost him 25% of his patients, which would normally be the end of ones private practice.

After the numbers came in, turns out he didn’t lose a single penny by doing so.

And I can call at 10 AM. have an appt at 4, and barely have time to sit down in the waiting room before I’m called back. And he now has the time to properly discuss my issues and even have time left over for a bit of personal or political chat.

Look, the CBO numbers, the 3 phase plan, the needed super majority in the Senate are all red herrings. They are designed to distract people from the nuts and bolts of the ACHA bill.

The only things currently in the ACHA bill which are of any practical value are the employer mandate cancellation and the defunding of abortions. That is it. The bill continues federal support of the expanded Medicaid program at, at least 80% of the original funding level. It continues the private insurance subsidy, though it calls it a refundable tax credit. It backdoors the personal mandate, by establishing a 30% surcharge for insurance coverage if one has no coverage for more than 62 days. It maintains all of the current regulations associated with the ACA. I short it does little or nothing to mitigate the effects of the ACA and even exacerbates the problems by continuing to fund expanded Medicaid.

All that anyone needs to know about the current AHCA bill is that it is actually worse for Americans than the original and there should be NO rush to pass it.

They lied to get it passed.

They lied about keeping your doctor.

They lied about the $2500 savings per family “on average”

They lied about bending the cost curve down.

They lied about the Medicaid expansion costs.

But now they want us to believe they are telling the truth?

I don’t worry about the CBO score, the headlines or anything else the MSM has to say on this. We as conservatives need to work to get the best repeal bill we can drafted and pass it. Ignore the noises.

The noises are all lies too.

Tackle pre-existing conditions.

Once you do that the rest can be negotiated.

And stop using insurance as pre-paid healthcare.

    murkyv in reply to MSimon. | March 14, 2017 at 11:27 am

    I know many don’t like the idea of keeping some form of assistance to those with pre-existing conditions, but it is a reality we have to deal with.

    Call it whatever it is, a subsidy, entitlement or whatever.

    For example, we now have a crapload of young people with diabetes coming on line now and in the near future. Left unchecked, they will be facing a slew of health issues.

    One of which is the possibility of renal failure. Once one goes Stage 5, they are automatically enrolled in Medicare and Medicaid because dialysis is so outrageously expensive and one can no longer live a normal life working to pay for their own coverage.

    Point being, we will all be paying far more for their treatments than we would if we helped them learn to control their diabetes before the major health issues that result from it show their ugly side.

    Sanddog in reply to MSimon. | March 14, 2017 at 12:59 pm

    End Federal and State coverage mandates. Adults should be allowed to decide for themselves what they want covered.

just think this plan you might just save 2500$, you might just be able to keep your doctor, then again you might be able to get a better doctor.

perspective is everything, how many are really going to lose their health insurance, as opposed to how many are going to give up their health insurance, e.g. Obama replacing attorneys to Trump firing attorneys.

notamemberofanyorganizedpolicital | March 14, 2017 at 5:12 pm

Nice turn on the old phrase:
“There are 3 kinds of lies.
Lies, Damn Lies, and Statistics.”

I went the concierge route once O-care kicked in, mainly because my doctor (whom I really liked) changed his practice. A number of patients had to stop going to him because of the $1600 annual fee.

I ponied up the extra–it was worth it. I was able to get reimbursed via a flexible spending account until–shocker–O’care changes capped our FSAs so low that I was out of money by May.

I had to stop and switched to another doc in the same practice (a colleague of my original doc). So far, so good, but the ability to reach out at short notice is no longer there.

My experience was similar to the professor’s, but before Obamacare. My wife had a terminal neurological disease, diffuse Lewy Body syndrome, kind of a combination of Lou Gehrig and Parkinson, among other complicating and confusing diseases. Found a good neuroendocrinologist in midtown Manhattan, who ran a concierge practice. He gave us referrals that prolonged her life and gave her the best pain management in the country. Mayo and Johns Hopkins gave us only misdiagnoses.

If you want to increase quality of care, increase competition by removing restrictions on hospitals, doctors, nurses. Increase web-based and other automated diagnostics.

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