Re­form the re­form stud­ies

Ev­ery­one with a cal­cu­la­tor has a re­form law cost pro­jec­tion

Modern Healthcare - - Opinions Editorials -

The Pa­tient Pro­tec­tion and Af­ford­able Care Act, aka health re­form, ought to be re­named the Num­ber Crunch­ers and Re­port Writ­ers Full Em­ploy­ment Act of 2010.

Scarcely a day goes by with­out a new study of the leg­is­la­tion, of­ten by a spe­cial in­ter­est group with a stake in pro­mot­ing or scut­tling the mea­sure. Depend­ing on the source, these re­ports show the act will re­turn us to the Gar­den of Eden, do noth­ing, pre­cip­i­tate the end of civ­i­liza­tion as we know it or con­jure up com­bi­na­tions of all three.

In the past week, we have seen one study pre­dict­ing that re­form will squeeze some in­sur­ers to the edge of bank­ruptcy and an­other sug­gest­ing that in­sur­ers will gain enough mar­ket clout to squeeze ev­ery­body else. To read more about the lat­ter, see our “Of In­ter­est” fi­nance blog (“Who saves when in­sur­ers win?”) at modernhealth­­ter­est.

Well, if no one else ben­e­fits from this law, at least it will pro­vide se­ri­ous eco­nomic stim­u­lus for think tanks, econ­o­mists, po­lit­i­cal op­er­a­tives and just about any­body with a cal­cu­la­tor and a will­ing­ness to make a pre­dic­tion.

Mean­while, the re­ports keep rolling in. Two re­cent ones from the Medi­care trust fund trustees and the CMS project that the health re­form law will ex­tend Medi­care’s sol­vency longer than pre­vi­ously pre­dicted (Aug. 9, p. 12). The CMS re­port said re­form would save Medi­care $7.8 bil­lion through 2011 and $418 bil­lion over 10 years. The trustees’ re­port pro­jected that the trust fund would re­main healthy un­til 2029, 12 years longer than pre­vi­ously fore­cast.

Repub­li­cans, of course, im­me­di­ately at­tacked the stud­ies. Crit­ics, po­lit­i­cal or oth­er­wise, con­tended the re­ports made overly op­ti­mistic as­sump­tions and over­es­ti­mated the will­ing­ness of Congress to rein in spend­ing on physi­cian re­im­burse­ment.

News con­sumers should re­gard all these re­ports—whether from govern­ment or the pri­vate sec­tor—with healthy (or health­care) skep­ti­cism. Here’s a good ex­am­ple of why: Ac­cord­ing to mid-1990s re­ports from the Con­gres­sional Bud­get Of­fice and the Medi­care trustees, Medi­care went bank­rupt around 2001. As we can see, things change. The ca­coph­ony of cost pro­jec­tions brings to mind a 2008 New Eng

land Jour­nal of Medicine ar­ti­cle. In it, schol­ars David Blu­men­thal and James Morone re­counted how Pres­i­dent Lyndon B. John­son han­dled ad­verse cost pro­jec­tions for the Medi­care pro­gram he was try­ing to en­act: He ig­nored or sup­pressed them. He feared es­ti­mates of a huge price tag would scare law­mak­ers and cit­i­zens away from some­thing he be­lieved to be good for the coun­try.

The les­son? “The ex­pan­sion of health­care to large pop­u­la­tions is ex­pen­sive, and pres­i­dents may need to quiet their in­ner econ­o­mists,” the au­thors wrote. “John­son de­cided, in ef­fect, to ex­pand cov­er­age now and worry about how to af­ford it later.”

Decades later, the Bush ad­min­is­tra­tion took a sim­i­lar ap­proach when it tried to put a lid on cost pro­jec­tions for the Medi­care Part D drug ben­e­fit pro­gram.

None of this should ex­cuse deceiving Congress and the pub­lic. But you can un­der­stand why pol­i­cy­mak­ers who are ac­tu­ally try­ing to ac­com­plish some­thing (an in­creas­ingly rare breed) of­ten grow in­tol­er­ant of du­el­ing cal­cu­la­tors. Caught in a bliz­zard of con­tra­dic­tory pre­dic­tions, it’s hard to get any­thing done.

We will see what this health re­form law brings. In the mean­time, a close rel­a­tive of the law ex­ists in the real world in­stead of the imag­i­na­tion of wonks. Look to Mas­sachusetts for a glimpse of things to come.

And no mat­ter what, we can be sure that wonks will fol­low a vari­a­tion of the tra­di­tional ad­vice to Chicago cit­i­zens: Vote early and of­ten. In this case, it will be pre­dict early and of­ten.


Man­ag­ing Edi­tor

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