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

WILLIAM A. JACOBSON MAR 13, 2017 8:30 PM

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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