When a C is a Failing Grade

Economics, Politics

This Week with George Stephanopolous was really good this morning. He had on two senators and two representatives, one from each party, to discuss the Senate and House health care reforms. Senator Tom Coburn (R-OK), a practicing doctor himself, seems to make the most sense to me and he had a lot of great arguments about why this bill is not good for patients. The debate started out as the typical back and forth with Democrats saying their bills are awesome and will save health care and Republicans saying they won’t work and will just cost us a trillion dollars, neither party actually citing statistics or facts.

Then something strange happened — the facts came out. Initially, George did a horrible job as a moderator. Facts were brought up that wiped out a Democrat’s argument, the Democrat chalked it up to simply a difference of opinion, and George just left it at that. Hopefully people are smart enough to see through this kind of dishonest debate.

Here’s a great two-fer example of this. When confronted with the fact that the Congressional Budget Office (CBO) said that both bills of the bills would actually increase health insurance premiums, despite the insistence of Democrats that the whole purpose of health care reform is to decrease costs for households, Rep. Debbie Wasserman-Schultz (D-FL) said this: “Well, there are differences of opinion as to whether or not the Congressional budget analysis is correct on the increase in premiums, but the important thing here is that I hope we can all agree that we have to get rid of the profit-driven, insurance company-drive health insurance system that we have, where it’s insurance company bureaucrats, Senator Coburn, that are getting in between patients and their doctors. To suggest that this bill will put government in between patients and their doctors is really disingenuous.”

Did you catch that? Nevermind the facts. Who cares what the CBO says? It’s just an opinion anyway. Now let’s change the issue to those evil insurance companies.

When the CBO scores a Democrat bill in their favor, they tout the CBO as the “gold standard” which must be respected and believed as the gospel truth. But when the CBO says something the Democrats don’t like, they say “well, there are differences of opinion on that.” I call shenanigans.

In response to her, Sen. Coburn goes on to cite the fact  that the percentage of claims denied by government-run Medicare (6.5%) is almost twice the national insurance company average of 3.5%. In response to the Republican concern that government will ration care, the typical Democrat argument is basically that rationing is going to exist under any health care system (100% true, by the way), but rationing already exists and it’s done by those evil insurance companies. Yet Coburn cites the fact that government rations more than insurance companies. I think that’s a pretty important fact to consider. (Note: see the comments on this post for more on the other side of this issue.)

Another great example happened when Rep. Marsha Blackburn (R-TN) actually read from the bill itself. She started by discussing the controversial announcement this week by the Preventive Services Task Force saying that women should not get mammograms until age 50, replacing the current guidelines which say they should start at age 40; and instead of getting them every year, they should get them every two years. Republicans have been skeptical of this, arguing that this is exactly the kind of government rationing they have been worried about.. They argue that not just a coincidence that as the Democrats are looking to expand the government’s role in health care, the federal government is releasing guidelines telling women to not get as much preventive care. The American Cancer Society rejected these new guidelines.

(Note: The PSTF also said that self-examination does more harm than good, as it gets women thinking they might have cancer when they don’t and then we waste money looking for it. You hear that, women? After decades of saying that you should check yourself for lumps because early detection is the key to beating breast cancer, now the government is saying to stop looking for cancer — because, you know, if you find it, you’ll need to be treated for it. And we wouldn’t want that to happen when the government is going to have to pay for it. Democrats always say we have a horrible health care system, but the one thing that they cannot dispute is that our rate of cancer detection and survival is higher than every other country in the world. If we go down this route towards government-run health care, expect those rates to fall in line with the rest of the world; i.e. more people will die from cancer just at the point where cancer rates in the U.S. are falling because we are so successful at beating it. But the government will save money, so yay for that! As Dr. Bernadine Healy, former Director of the National Institutes of Health, said about the new guidelines: “This will increase the number of women dying of breast cancer. Women in their forties have a very aggressive kind of breast cancer. They tend to progress fast. And to not screen women in that age group is astounding to me and it goes against the bulk of individuals who are actually caring for patients. You may save some money, but you’re not going to save lives.”)

OK, back to the show. Blackburn read verbatim from the bill. Citing titles, sections and pages, she explained how the bill renames the Preventive Services Task Force to the Clinical Preventive Services Task Force. Then she explained how the bill assigns the CPSTF the task of rating all preventive services with a grade of A, B, C, D, or I. At this point, Stephanopolous seemed shocked (shocked!) that the representative had actually read the bill, even perhaps a little annoyed by it. But Blackburn pressed on, explaining that the bill says that only services rated A or B actually must be paid for by health insurance. And the preventive cancer treatments between ages 40 and 50, which the PSTF just announced are unnecessary, were given a rating of C. So the fact is that if women want to continue to get screenings at age 40, they will not be paid for by insurance or the government. You can still argue that we might find more breast cancer in one respect: women over 50 without health insurance will now get free mammograms under their health insurance or government option. But you can’t deny the fact that women 40-50 will either get fewer mammograms or have to pay for them out of pocket. Or can you?

Wasserman-Schultz, who suffered from breast cancer herself just a while back, then accused Republians of playing politics with breast cancer. She flat out denied what Blackburn had just said. Her response to the assertion that the CPSTF’s guidelines would essentially become law: ”No, they would not be.”

At this point I give Stephanopolous some credit. He actually put the language of the bill right up on the screen so we could all see that what Blackburn had said was 100% true. Wasserman-Schultz’s answer: “This task force’s recommendations are simply recommendations. They aren’t controlling, they aren’t going to be binding.” Again, shenanigans. Sure, nobody is saying that a 40-year old woman can’t get a mammogram, but she’s going to have to pay for it herself because no insurance company, especially the government option, will pay for it. I don’t know how this woman can lie to the American public with a straight face, but she did. And to his credit, Stephanopolous called her out on it.

Health care reform (a.k.a. health insurance reform, because it sounds less controversial) is a difficult thing to do, no question about it. There are going to have to be some sacrifices made no matter what we do – if you want to cut costs, you have to improve efficiency or reduce services; it’s that simple. When politicians, of either side of the aisle, exaggerate claims, dismiss facts, or flat-out lie about what is in the bill, they need to be called out. I’m glad that George Stephanopolous finally did that today, and I hope he’ll continue to do it in the future.

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3 Comments

3 Comments

  1. J. Compton  •  Nov 22, 2009 @3:17 pm

    Hi Dave,
    I’ve been trying to follow the U.S. Health Care debate, but I am starting to tune out as does seem to be a lot of rhetoric. I have two points to raise on your post.

    First, you mention the comparison between the percentage of claims denied by Medicare (6.5%) and the average of insurance companies (3.5%). Is this really a fair comparison? If you took the average of insurance company rejections for the population over 65 and adjusted the population by their income distribution, do you think the medicare denial rate would still be higher? My impression is that the elderly, and especially those in lower socio-economic groups, tend to have a higher rate of over-use of the medical system than, say a 28 year old in good health.

    Second, the issue with the breast self-exam is a good one to discuss rationing. I personally don’t think it is unreasonable to suggest that women who are at low-risk of breast cancer (those under 50 without a family history of breast cancer) should not have the same access to scarce quantities of medical diagnostic services as those with higher risks. I don’t think your sentence, “..the government is saying to stop looking for cancer – because, you know, if you find it, you’ll need to be treated for it.” is complete. I think rather that they are saying to stop looking for it if you are low risk because if you find something, it probably isn’t cancer and we are spending a lot of resources on false diagnoses. For the same reason, you wouldn’t want to give a CAT scan to everyone who has a bad headache. It might be brain cancer, but chances are it is not. If there is a family history of cancer, and if you have other symptoms then perhaps the tests are warranted.

    I remember discussing the Canadian-U.S. health systems with one of our fellow WashU students back in the day (which was a Wednesday, in case you’re a Dane Cook fan) and he told a story about getting an MRI when he was 10 and fell off a bike. He meant the story to indicate how great the U.S. system was, that he had access to such great diagnostic tools. I, on the other hand, was appalled at this seemingly horrific misuse of resources.

    Thanks again for the blog – always enjoyable!
    Janice

  2. ProfSwitzer  •  Nov 22, 2009 @3:55 pm

    As always, an insightful comment, Janice. You’re absolutely right about the first one, and I feel like a total idiot for not thinking of it. Medicare is a biased sample (old people), as is Medicaid (poor people). So you’re not comparing apples to apples at all. I tried finding out more about this and came across this analysis and it paints a much different picture: http://intershame.com/on/Patrick_Tuohey_of_BigGovernment_com/

    As for your second comment, about breast cancer, that’s a tricky one. I understand your point — yeah, you have some false positives that will cost money. But when you catch breast cancer in a 40-year old, as Dr. Healy states, it’s usually pretty aggressive. I don’t know the stats on false positives in 40-50 year old women, how much it costs to treat aggressive cancers, and other important things. To be cynical about it, from a pure cost perspective, it’s better to let these women die so we don’t have higher health costs for them in their lives later. That may sound absurd, but it just points out how things can go horribly wrong when all you look at for health care is cost/benefit analysis in health care itself, and don’t look at the number of lives saved and the value of those lives. I don’t know that these guidelines looked at that at all. (They may have, but I don’t think so — Dr. Healy seems to think it’s just looking strictly at health care costs.)

  3. ProfSwitzer  •  Nov 22, 2009 @4:00 pm

    Just watching Meet the Press and Dr. Nancy Snyderman, a doctor on MSNBC, stated that for women ages 39-49, the number of cancer deaths prevented by screening is 1 in every 1,904. The numbers improve as women get older: 49-59 it’s 1 in 1,339; 60+ it’s 1 in 377. She cited a statistic (but didn’t say where she got it from) that said that for these women, for every 1 life saved there are 1,000 false positives that require additional testing and costs.

    One could do some cost/benefit analysis with those numbers, but I don’t know what the costs involved are when a woman gets a positive screening for cancer, to get them to the point where they find out it was a false positive.

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