As the campaign against health care reform heats up, I would like to ask for your help.
As I have suggested in earlier posts here and here, those who would defeat reform show little respect for the truth. In their effort to confuse and frighten their audience, they will continue to spread misinformation and disinformation. They will rely on “big lies” –lies so colossal that people will believe that they must be true. (Who would dare make up such a whopper and repeat it on television, online or in print?)
The only way to combat a deliberate campaign of misinformation is to expose the lies —again and again. I plan to use this blog to do just that. But I need your help. If you read or hear someone assert something about health care reform that you know isn’t true –or suspect isn’t true—please send the quote, citing who said it, when and where, to maggiemahar@yahoo.com. If you have evidence that debunks the false claim, send that too. If you don’t, I can probably find the facts needed to set the record straight.
I’m in!
Yes ma’am
amen. let’s start with the canards about how dollars spent on prevention lower medical bills and how folks are jamming emergency rooms because they are uninsured, neither of which is true (tho prevention may be in some isolated cases) yet refuse to die
Maggie-THANKS FOR OFFERRING UP YOU AND YOUR SITE AS A COLLECTION POINT!
(see Paul Krugman column today (Fri May 22) in NY Times)
Trust is something the “disease care” industries should be given very slowly.
Verifiable conditions under regulations with real teeth need to be put in place. Nothing less would be a cruel hoax on the American public.
Dr. Rick Lippin
Southampton,Pa
What about this? http://www.freerepublic.com/focus/f-news/2248676/posts
They argue that our system isn’t broken, that Americans have better access to health care, that low income families in America are less disadvantaged than those under foreign health care systems, and that America does a better job at delivering health care than other nations.
Hmmm….
This is a good idea.
Thank you all!
Jim– you’re right more pventive care doesn’t save money (if it works, people live longer), but it does lead to better outocmes and healthier populations. (we have seen this in Europe, which relies much more heavily on preventive care.
Aaron– thanks much, a good example.
And someone tipped me off to a Congressman who has been going around spreading disinformation at an alarming rate.
I’ll be writing about both soon.
Please keep sending examples, either by commenting here, or sending them to my yahoo e-mail (maggiemahar@yahoo.com)
Thanks much.
This will be fun –and, I hope, useful.
I would urge everybody to look at the Commonwealth Fund/Lewin Group report comparing congressional proposals:
http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Jan/An-Analysis-of-Leading-Congressional-Health-Care-Bills–2007-2008–Part-I–Insurance-Coverage.aspx
And especially Table ES-1
The three to look at are:
Building Blocks: This is meant to represent the Democratic party mainstream, at least before they started further compromising with Republicans for even weaker or no public option. It is essentially what Obama/Baucus started with (similar to Hacker, Edwards, Clinton, etc.)
Wyden of course is based on removal tax credit for employer-based insurance, and increased move to individual market coverage plus safety net.
Stark’s plan is really a strong version of public option but they also consider it to be the stalking horse for single payer (they did not analyze Conyers HR-676).
Table ES-1 compares total costs and who pays what. Note especially that the only plan that actually controls total costs is the single-payer like one. Total costs continue to increase under both Building Blocks (Obama/Baucus) and Wyden. I find Wyden’s plan particularly disengenuous insofar as it is often touted as the fiscally responsible cos-controlling one. It does reduce FEDERAL government costs, so the CBO and OMB like it. But it does not control total costs. Which means of course that individual out-of-pocket costs and State costs go up. That Building Blocks also does not control total costs is why Senator Baucus keeps asking CBO to “fix the numbers.”
Also, we need to get the business community to look at the business side of the issue. Please see http://tinyurl.com/rymbte
There are some ideas which are just so commonplace that no one ever calls those making the statements to account. Those letting things slide are mostly frequently in the press.
A simple example from yesterday. “All things considered” did a bit on the health policy debate and included a sound bite from Orrin Hatch where he expressed his opposition to a public option for health insurance. He said (I’m paraphrasing), without any remark by the reporter:
“Government run programs are never as efficient as private ones.”
Apparently Medicare doesn’t count. Neither does the DoD, the country’s biggest government run program. He supports their spending with nary a note of question.
How is one to counter things like this when they are so pervasive? We hear similar statements about SS going broke, and many younger people now think this is true.
The big lie still works, I guess.
Dr. Steve–
The financial analysis you link to was done by the Lewin Group.
As I am sure you know, Lewin is owned by United– one of the largest–if no the largest– for-profit health care companies in the country.
United is fiercely opposed to Obama’s plan because it includes a public-sector option and because it woudl regulate private insurers.
This makes Lewin’s analysis of the plan suspect.
If we are going to be a truth squad, we should disclose who owns Lewin whenever citing its figures.
And what you say about Obama’s plan not saving money simply isn’t true.
I have written about how it would save money many times
so I won’t repeat myself here.
The CBO January 2009 reports make it clear that comparative effectiveness reserach will reap “significant savings” if given financial teeth. (Google my name, CBO and “financial teeth” to find my post in this with links to the CBO report.)
Jack–
This thread is not about single-payer.
Robert–
That’s a good example from “All Things Considered”
It’s such a blatantly false generalization (as all broad generalizations almost always are) –the interivewer should have, politiely, interrupted: but wait a minute, what about Medicare–which, while wasteful, has done a b etter job of containing costs and satisfying beneficiaries than private insurers have over the past 10 years. What about the many great public (state universities) that in many cases are the equal of (and often better than) private universities– even though they lack the huge endowments of the wealthiest private universities, charge much lower tuitiion, and are kept on strict budgets by state legislators strapped for cash.
I’ll look up the “All Things Considered” transcript.
And yes, many young peole have bought the Big Lie that Social Security is going broke. (It will take minor fixes to keep it going — nothing huge)
The Bush administration was determined to privatize SS, so they worked very hard on that one.
If they had succeeded, our Social Security dollars would have been invested in stocks and bonds–just in time for the big financial melt-down.
(The conservatives wanted to privatize SS in part so that Wall Street could make a fortune in commissions investing the money.)
But we ccan ounteract the Big Lies. We just have to be as persistent as they are.
Debunk. Debunk. Debunk.
Always, with clear evidence.
What’s wonderful about the blogsphere is that one can so easily link to the facts.
>>> “This thread is not about single-payer.”
Maggie, read the comments at the link I provided. Whether single-payer or not they are the lies on health care reform of which you speak. I don’t consider them inappropriate but obviously you do. So be it.
Jack– I did read the link
The op-ed is based on bad numbers– distortions of the truth.
You mean someone somewhere is telling the truth. That’s UnAmerican! And I pledge to wipe it out!
Matthew and everyone-
Everyone– You must understand that Matthew is a “foreigner”. Okay, he speaks English, but he’s from the UK and so doesn’t fully appreciate the total honesty of American newsgathering.
That said, I did get my start as a blogger writing for his blog. . .
Interesting question about “trusting” Lewin Group. All the mainstream folks from center-left to center right have always trusted Lewin. They are considered to be the gold standard in the field. That is why when state and federal plans are proposed they are asked to do the financial/budget scoring over and over again. That is presumably why respetable liberal Commonwealth Fund, which supports Obama/Baucus/Building Blocks used them for this report.
I agree the fact that they owned by United is cause for concern and scrutiny. Yet they have also repeatedly scored single payer and single payer like proposals as good for controlling total costs, which certainly does not suggest a pro-for-profit insurance company bias.
I actually agree with you about the need to contol costs and how controlling services, plus prevention and better chronic disease management ought to help in this. Yet, for some reason, there are many studies that show they do not. alas. And both Lewin and CBO budget socring do not seem to show this. Those are the considered, the gold standard. If we are “truth squading” we have to face up to that.
Again, I urge folks to look at the report,
http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Jan/An-Analysis-of-Leading-Congressional-Health-Care-Bills–2007-2008–Part-I–Insurance-Coverage.aspx
And especially Figure ES-1, shown graphically in figures ES-2, and the comparison between ES-3 and ES-4.
Draw your own conclussion.
According to The Progress Report, right-wing pollster Frank Luntz wrote a memo to conservatives laying out the strategy to block Obama’s health reform. He advised Republicans to fearmonger that “President Obama wants to put the Washington bureaucrats in charge of healthcare.” He also told conservatives to raise the specter of “government rationing care” — ignoring, of course, that insurance companies routinely ration care, even for their policy holders (“mother, may I” medicine).
Immediately, conservatives adopted Luntz’s framing. Within 48 hours of Luntz’s advice to constantly hype the “personalized doctor-patient relationship, conservatives publicly repeated the vapid patient-doctor talking point. Luntz made no secret that his aim is primarily to obstruct Obama’s reform rather than promote a conservative alternative. His suggested wording, he explained, “plays into more favorable Republican territory by protecting individual care while downplays the need for a comprehensive national healthcare plan.”
I’d be delighted to help.
Dr. Steve, Gregory, Joan C.
Dr. Steve– you are right , both liberals and people in the center have trusted Lewin.
But in the past Lewin wasn’t owned by United. This happened in June 2007 when Ingenix — a wholly owned subsidiary of United Health Group Inc., purchaed Lewin.
When I began talking about the connection between Lewin and United a year or so ago, liberals who are knowledgable about healthcare said “Really, are you sure?”
The fact that United puchased Lewin through a subsidiary meant that relatively few people paid attention to the change in ownership.
I agree with you that Commonwealth is an excellent organizaiton and I admire their reports.
But they are using the Lewin nubmers because these are the only comparative numbers available– and Lewin’s analysis is based on very little information.
All of the really important details about the Obama plan are still unknown . For instance, if some people decide to ignore the mandate to buy insurance, what happens?
Will they be fined? How much will the fine be?
Or will they be automatically enrolled in an insurance plan, with premiums deducted form their paycheck (like SS and Medicare) or added to their income tax bill?
How many people will be covered by the administration’s plan? The answer turns on the answers to those questions.
How can Lewin project what percent of the poulation would be covered under the OBama plan without knowing the answers to those quetions? They can’t.
How much will the Obama plan or other plans cost the government? Everything depends on how much the insurance costs.
Does the mandate mean that every one has to buy comprehensive, high quality insurance? Or will people be allowed to buy cheaper, high deudtible plans like the higg-deductible plans available in the Federal employees
menu. (The Federal Emplyees plan is actually a menu of hundreds of private sector plans.)
We know subsidies will be on a sliding scale, with a cut-off of 4 times the federal poverty level (If you are a family of four with $89,000 join income , you don’t qualify for a subsidy.)
But how much of a subsidy will a family earning $70,000 get? Will the govt pay 1/3 of its premium? Or 1/2? Or more?
There are so many unknowns that Lewins analysis comparing plans is based on a great many guesses. . .
Finally, Dr. Steve, trust me, the Obama plan will contain costs. White House budget director Peter Orszag, Obama and the CBO understand this is essential.
More preventive care and chronic disease management is not going to control costs because better prventive care and disease management mean that people live longer, and so over time, we spend more on their medical care.
(The administration favors more preventative care and chronic disease management because it will create a healthier popoulation–Not becuase it will save money.)
To save money we have to cut back on all of the over-treatment–spine surgery that provides no b enefit, the half of all angioplasties that provide no benefit, MRI breast scans for average-risk women, much of the diagnostic testing that we now do, statins for people who don’t benefit (but are exposed to dangouers side-effects) etc. etc.
But the Obama administraiton is not going to try to get Congress to pass legslation saying “we’re going to stop paying for ineffective, unnecessary often unproven and overpriced surgerires, tests, drugs and other procedures.”
Can you imagine the uproar that would create?
AT the same time, Orszag understands that 1/3 of our healthcare dollars are squandered on these treatments. He understands that has to stop. (See his recent WSJ op-ed. And see the recent New Yorker article about Orszag)
Medicare is beginning to crack down. Recently, it said it will not pay for virtual colonoscopies. It will continue to refuse to pay for more expensive treatments that provide little or no medical benefit. (If a virtual colonosopy is “poisitve” the patient then has to undergo a regular colonoscopy, making the whole thing needelessly expensive.)
With as little fanfare are possible, Medicare will continue to say “no” to less effective teratments–or hike co-pays and lower fees for those treatments as a way of steering patients and doctors toward the most effective treatments (which often, though not always, are less expensive.)
Private insurers will follow Medicare’s lead. (They just want Medicare to provide political cover.)
This is how health care spending will be contained.
Gregory–
You are absolutelly right.
The conservatives don’t want a Republic plan They want No health care reform.
They like for-profit money-driven healthcare just the way it is.
And they are going to harp on the notion that the government will be interfering in the partent-doctor relationship.
As if the pharmaceutical industry doesn’t interfere with that relationship with its direct-to-consumer TV ads for often
unproven drugs.
As if hopsitals don’t interfere with that relationship everytime they advertise tests and procedures that may or may not be suitable for a particular patient.
As if insurers don’t interfere with that relationship when they sell high-deductible policies that then make patients reluctant to see their doctors.
Finally, we no longer believe that the individual doctor is God–and that everything ayour doctor tells you must be true.
Even if he or she is a very good doctor, these days no doctor can know everything, even in his own specialty.
This is why very good doctors appreciate guidelines. They want someone to put unbiased information together in one place. They don’t consider this interference–they consider this help.
It is only the relatively small number of doctors who are selling services tha they know are not backed up by medical evidence that worry that “interference” might interfere with their income stream.
Most doctors want to do what is best for their patient–they should speak out about why guidelines are needed.
Joan C–
Thanks much.
Your point about Lewin seems to miss the point: I certainly understand the doubt surrounding Lewin’s impartiality since they were bought out… but why would that result in their “favoring” Starks “public option on steroids” (and per the report, similar to actual single payer) over much weaker middling version of public option Hacker/Obama/Building Blocks and arguably much more pro-insurance company Wyden-Bennett? Your argument here makes no sense since it misses what is actually being said. Also, this report does have Commonwealth Fund’s imprimatur on it, and they are backing Building Blocks too. Hence the results are (I would argue) favorable to Stark/single payer even though both Lewin nor Commonwealth are presumably biased in the opposite direction. Again, your argument makes no sense on this point. There IS a legit argument about the limits of the analytics insofar as they are limited to one-year out, e.g., the scenario postulated is passes/implemented in 2009; what happens in 2010. Hence savings from long-term things like prevention and chronic care management don’t have time to kick in yet. I happen to be enough of a public health and clinical person that I too (want to) believe that those things will save money in the long run. But they will do so better under a less fragmented and more planned system, and one where the organization paying for care when a person is a young adult is still the same organization bearing the costs when that person is over 65. The private for-profits will never have a long-term incentive to do the right thing.
I agree we don’t have enough information to make definitive analytics, but that one from Lewin/Commonwealth is the best we have now. CBO (nor OMB, nor GAO) is not doing anything comparing proposals (at least not for public consumption). And with Baucus putting pressure on them to “fix the numbers” I don’t see any reason to trust them. Far less than Commonwealth/Lewin.
Public Option vs. “public option”: THE REAL QUESTION is what form “public option” will take. As you know the original idea was specifically that the public option would compete against the privates, on cost (global and individual) and quality and satisfaction. Some folks were explicit in hoping that it would be a path to something like single payer.
What we see now of course is a reworking of public option specifically to do away any possibility of it actually competing with the privates. Nichols (New America Foundation)/Schumer/Baucus taking it in the ostensible direction of the state worker plans, but really designed simply to fail. They won’t be allowed to compete. They will have to comply with industry rules and within other limits. programmatically one can seem them getting dumped with the actuarially disadvantageous, the sick and the poor, while the privates skim the healthy and wealthy. Then “public option” will get blamed for having high costs. duh. I see a political parallel to “managed Medicare” and Medicare part D… industry backed “reforms” designed to fail, and to give Medicare/public option a bad name.
It would be a very good thing to dissect the differences and consequences of the very different proposals being called “public option.” The only piece I have seen in the general blogosphere that makes this point was Robert Reich’s: http://robertreich.blogspot.com/2009/05/health-care-cave-in.html . Somewhat older, wonkier, and less directly addressing current events was Uwe’s testimony to the Budget Committee: http://waysandmeans.house.gov/hearings.asp?formmode=view&id=7672
Dr. Steve–
\If United is worried about Obama’s plan, it makes sense to favor Stark’s plan.
Stark’s plan is
much less likely to pass than the President’ plan.
Maybe a Wyden plan could have a chance (or part of it could be incorpoated in Obama’s plan). The Stark plan– from what I know, \ just doesn’t have the support in Congress.
So if you don’t want health reform, what do you do? You say the Stark plan as the only really good plan.
Is this why the Lewin Group appears to favor the Stark plan? I don’t know.
Finally, preventive care and chronic disease management don’t save money. They cost money–because people live longer. But of course we (and the Obama administra tion) want more preventive and disease management to improve the health of the population.
The way to contain costs is to cut way back on the use of advanced medical technologies–
less agggresive care. Less dianostic testing. Less chemo that buys the patient a few more months (and much suffering.) Many fewer surgeries. (Atul Gawande, a surgeon, points out that the number of surgeries done in the U.S. has spiraled in the last 10 years– with no evidence of improved health.
More physical therapy and fewer knee and hip replacements.
Less spine surgery.
Many fewer angioplastites and bypasses . . .
At this point, this thread has wandered far from the topic: misinformation and disinformation by those who oppose all health reform.
Please, let’s get back on topic.
Here’s one for your stupid file:
It’s articles like this will finally drive the final nail into the coffin of the news magazines.
http://www.newsweek.com/id/199167
How Robert J. Samuelson keeps his job remains one of the wonders of the age.
Speaking of truth, Show us where physical therapy has better outcomes for knee and hip replacement for treatment of Osteoarthitis. It doesn’t exist. With the QALY scores that hip and knee replacements have, they more than pay for themselves compared to frivolous treatment of Diabetes and Heart Disease. We should be begging people to have replacement surgery so they stay in the workforce, don’t retire and pay taxes for their healthcare and those that are contributing nothing financially to the system.
Jenga–
Once again, you make assertions without evidence.
On physical therapy versus knee replacement:
Advice from the Mayo Clnic:
“Although surgery can be an effective treatment for osteoarthritis, more conservative treatments — such as medications, self-care, and physical and occupational therapy — also can provide a benefit and Should Be Tried First.”
Then there is this controlled clinical trial published in the Annals of INternal Medicine on physical therapy which concludes: “A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical interv.” http://www.annals.org/cgi/content/abstract/132/3/173
Finally, a very interesting 2005 article from the journal Rheumatology http://rheumatology.oxfordjournals.org/cgi/content/full/44/8/1032
suggests just how hard it is to judge whether the outcome form knee surgery is good because once they have gone through the operation, patients have a strong need to say it was successful. (No one wants to regret an operation.)
But when resereachers interviewed the patients in depth, months after the operation, they found that many were still in great pain
Here’s an excerpt form the article:
“Perception of Total Knee Reaplcement (TKR) Outcome:
On direct questioning, the majority (9/10) stated that their TKR operation was ‘excellent’ (2), ‘very good’ (3) or ‘good’ (4). Questions such as ‘How satisfied are you with your knee replacement outcome?’ often resulted in what appeared to be a socially and personally desired response:
Miss D: I have had a very good outcome, oh yeah … I’m happy with the result, yeah very worthwhile doing. (64, single female, retired, no previous TKR.)
However, despite these positive responses, almost all (8) admitted they still experienced continued pain and immobility. Thus, it was only on further questioning about the outcome that many of the participants qualified their original assertion:
Miss D: I do get a lot of pain sometimes still. I was kneeling on the bed to get myself across to the window and I couldn’t, that was very painful with both knees … and it’s still not very happy about shopping… I think that’s the only thing now and getting up and down stairs but that’s a bit more difficult because there is the problem of falling on stairs so I have got to be a bit more circumspect on that. (64, single female, retired, no previous TKR.)
There were a number of reasons why individuals reported a successful outcome despite the continued experience of pain and immobility. Mrs L, who admitted to being in as much pain after the operation as before it, was grateful for the operation, believing that the ‘bad’ osteoarthritis had been removed. She stated that the knee was ‘bound to be better’ and therefore regarded her outcome as good. Others expressed gratitude for having had the operation and the care given in the hospital, for which they had waited many years:
Mr O: I am still restricted but, you know, don’t get me wrong I am grateful for the attention I got, they looked after us and saw that things were done properly … and this [TKR] was the last resort … so all in all, it was pretty good. (40, married male with family, on disability allowance, previous knee operations.)
In addition, the majority of participants reported that they had coped better than expected with the TKR operation, and this may be a reason for a positively reported outcome. The TKR was indeed beneficial for some aspects of the participants’ life. In most cases, movement, pain or both were improved to varying degrees, and for some this made a significant difference to their life. For these participants, the remaining pain was mild enough for them to be able to live and cope with it, and therefore they perceived the TKR outcome as being a success. Comparisons were also made with their physical state before the operation and the problems they would have experienced had they not had the operation. In addition, comparisons of outcome were made with other people’s TKR outcome. For example, the TKR outcome was viewed as positive when compared with other people worse off than themselves. Overall, most wanted to believe that they had a good outcome and gathered evidence to support this and present it to others, including this interviewer.
Participants struggled to make sense of their continued pain/immobility. More than half believed the recovery process was not complete 6 months after the operation, and therefore they could not give a final verdict on their TKR outcome because they needed more time to improve:
Mrs L: I mean I have got to give it another 2 or 3 months anyway, you know I thought when I had it done I would be running and walking around but I am not, I still can’t do a lot yet so it’s got to take time hasn’t it … 6 months time I will probably tell you different … but really I expected to be running around but it doesn’t work like that. (80, widowed female, retired, previous THR.)
Others acknowledged that because the TKR involved such major surgery, it was only natural to experience pain. Mrs J, who stated she had an ‘excellent’ outcome and had a pain-free joint and improved mobility believed, that her ‘good healing skin’ facilitated her recovery and outcome. Four, who were still experiencing pain and immobility, accepted that they had slower healing times. Other reasons for a less good outcome than anticipated included flu, being overweight, having a weak knee, feeling depressed or worried about the knee and therefore not exercising it, or that the knee had been under too much stress leading up to the operation. Furthermore, the impact of other health problems, such as sciatica, back pain or their other knee, were thought to affect the outcome. Lay beliefs, such as TKRs being less successful than THRs, were also raised by three participants in an attempt to make sense of their outcome:
Mrs E: Well, they say that the hip is a bad one but apparently the knee is the worse because you are putting all your weight on that joint, you know. (64, married female, no previous TKR.)
A major factor that emerged from the struggle to make sense of outcome was the tendency for patients to try and take personal responsibility for the continued pain/immobility. Most of the participants believed that as the knee joint had been replaced by something new, any problems experienced must be their own fault. The participants did not criticise the surgeon or the surgery for their outcome:
Mr P: It’s nothing to do with the joint now, it’s more down to me, like I say it can’t be the actual joint, there shouldn’t be anything there now so … I think I might have done too much too soon. (48, single male, on disability allowance, no previous TKR.)
Six participants blamed themselves for ‘overdoing’ certain activities too soon after the operation:
Mrs B: I was getting pain down the back of my leg and I wondered whether … I mean you hear a lot of people say ‘you won’t get any pain at all afterwards’ and I thought is there something wrong … have I been stupid and done something silly, I didn’t know whether I had done some damage … cos I did go mad when I came home … my husband went out on the Saturday, and I was just pottering around just doing different things and really I should have rested it. (62, married female, retired, no previous TKR.)
Mrs E was so impatient with the slow recovery process that she forced her knee to do activities too soon after the operation:
Mrs E: I have heard so much about different people, like I told you before I have had no one in the family that I can compare with, like I said I have heard different people and they have said ‘oh so and so is like a two year old since they have had their hip or their knee’, course I have been forcing myself to go upstairs since 4 weeks on, and that was when I got told off because they said the stairs is the last thing really I should accomplish and, er, that was when I was told more or less that I am too impatient. (64, married female, no previous TKR.)
Another participant also forced his knee in the recovery process. As a result of reading the information booklet provided by the hospital, Mr T compared his own recovery to the reported recovery times in the booklet. Thus, at 6 weeks, when he did not have the reported range of movement in his knee, he forced it to achieve this range, potentially causing damage to the knee:
Mr T: You sort of get this book and it tells you what exercises to do, and I done all them and it says after 3 weeks you must come off your sticks and you can bear weight and after 6 weeks you should be able to walk up and down the stairs normally … well I can’t walk up and down the stairs normally after 6 months. When I went to see the doctor, you could almost feel the heat there … he said ‘what have you been doing to this knee’ and I said I have been trying to bend it by pulling it back and I force that up … hour after hour I used to do that … I was thinking the more I get it on the way the better, you don’t get any gain without pain and I don’t want any more operations. (66, divorced male, retired, previous operations.)
A key factor in allowing an understanding of the accounts of TKR outcome was the participant’s life context. Individual case studies showed that the participants’ perception of the outcome made sense in the context of the preoperation data and the changes that had occurred since the operation. For example, Mrs L, although in as much pain after as before the operation, stated that she had a ‘good’ outcome because her recovery process coincided with her move from a lonely neighbourhood to a new, more community-spirited residential home, which positively affected her view of her TKR outcome. On the other hand, Mr S made sense of his remaining pain and immobility in the context of his religious belief that ‘you only receive what you deserve from God’. Although he was still experiencing pain and immobility 6 months after the TKR, he thought that the outcome was better than he had anticipated. He believed that this was God’s way of trying to improve him as a person. These environmental and personal factors demonstrate the importance of exploring the life context of the individual when attempting to understand outcomes.
Discussion
This study has shown that patients had a strong desire to state that their TKR outcome was successful despite the continued experience of pain and immobility. Different reasons and rationalizations were made by the participants in an attempt to diminish any disappointment with their remaining pain and disability. As a result of these explanations, and despite the fact that they had considerable pain and disability, they continued to consider the TKR with high regard. Although it would be impossible to state that the small sample in this study was representative of all those who undergo a TKR, their demography corresponded well with the general profile of those operated in the UK [26, 27].”
Robert–
Yes, Samuelson’s column is dumb.
Among other things, it assumes that Medicare costs are rising becuase of the aging population –not true. See http://74.125.47.132/search?q=cache:aMOe2VUWjhUJ:www.openleft.com/showDiary.do%3FdiaryId%3D5121+%22Maggie+Mahar%22+and+%22baby+boomers%22+Reinhardt&cd=4&hl=en&ct=clnk&gl=us
The first study is a very small one with a high dropout rate and most importantly their results dramatically diminish with time. The exact opposite occurs with arthroplasty, patients continue to have improvement going forward. Significant harm is caused by waiting for worsening of preoperative function in osteoarthitis and that has been shown in multiple studies and nearly all with much more power than the study you quoted.
One Example
http://www.ncbi.nlm.nih.gov/pubmed/10446873?ordinalpos=26&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Subjective scores and function continue to improve until 1 year, particularly in TKA, and the second study is basically an Oprah interview at 6 months. There are qualitative aspects of extremity scoring systems particularly the womac. Comparative Effectiveness must be primarly based on quanitative measures to eliminate bias, otherwise it will be doomed from the start and will be a colossal waste of time
Jenga–
The device industry has spent millions trying to convince Americans that they all need hip and knee transplants–and that they will be harmed if they delay.
Every responsbile orthopedist agrees that it very important to try other, less invasive, treatments first: pain relief, physical therapy, etc.
Why? Becuase as with any surgery, there is the real danger of serious complications: blood clots, infections and fatalities.
As for the notion that you can “quantify” outcomes:
P eople have hip and knee transplants in large part in order to find relief from pain.
There is no way to “measure” how much pain a patient is or isn’t still experiencing after the surgery.
This is why in-depth interviews with patients are important as a way of trying to detemine how successful transplants are for which patients.
It’s intersting to note that when patients are given a chance to go through the “shared-decision-making” protocol, given full information about benefits adn risks, more than 20% decide not to go ahead with knee transplants.
Reocvery is not a picnic.
It really depends on how much pain you are experiencing, whether medication and losing 20 pounds will help–and your life-style
If you’re an avid 65-year-old tennis player, the benefit of the surgery is much greater than if you are a relatively sedentary 75-year old writer who spends most of her time reading and writing.
She may do just as well–or better–with a physical therapy coach who teaches her how to walk in a way that won’t hurt her knees, and improves her balance, so that she can go for daily walks without fear of falling.
Finally, we know that knee and hip transplants are 4 times more common in some parts of Florida than others, and that the difference has nothing to do with patient need for the transplants, and everything to do with “Physician enthusiasm” for these procedures.
(The research adjusts for differences in race, income, and sex.)
Unfortunately, some of these “enthusiastic physicians” are taking kick-backs form device-makers who want them to use their most expensive
product. (See the NY Times stories on orthopedists and kickbacks from device manufacturers.)
Talking about truth, Krugman has an opinion article out today (no link yet) that the private insurance side players that were at the healthcare meeting recently with Obama are polishing up their Harry and Louise (2) campaign! Hopefully any truth squad can put together a formidable counter campaign to this upcoming threat to reform.
Maggie,
“As if insurers don’t interfere with that relationship when they sell high-deductible policies that then make patients reluctant to see their doctors.”
How does a HDHP with the deductible 100% funded by the employer make a patient reluctant to see their doctor? How does a HDHP sold to an employer who self funds back down to a $250 or $500 deductible any different then the carrier selling a $250 or $500 deductible, besides being cheaper and more efficient? Unless you secretly support wasting money on premium taxes, broker commission, and insurance company profit there is no reason to oppose HDHP.
“The conservatives don’t want a Republic plan They want No health care reform.”
Conservatives for 10 years have proposed pooling with AHPs. We want to eliminate a number of costly mandates. We want to eliminate the cost shifting from public plans to private plans. For more proof see;
http://www.gop.com/2008Platform/HealthCare.htm
By what measure is Medicare more efficient then private insurance? If you want to compare apples and oranges they pay slightly less for the processing of claims, that slight savings is lost many times over by the ensuing fraud and abuse. They save a quarter then lose a dollar, hardly the model for efficiency. Medicare and Medicaid both have double digit fraud, abuse, error rates.
Maggie and Robert:
Let’s assume that Samuelson is incorrect regarding the primary reason for the Medicare financial situation.
His figures are not incorrect, for they come from the trustees’ numbers.
Can someone please explain to me how our financial situation improves if these “trust fund surpluses” are not used to reduce the public debt?
Don Levit
The problem with the American healthcare travesty is that for-profits (doctors, hospitals, drug makers, device makers, etc.) are all trying to make a profit and do so by overtreating the well-insured, the not so well-insured, and patients on Medicare. Most single-payers never talk about the need to say “no” to the many unncessary tests and treatments. Healthcare is not a commodity and can not be held as a growth industry.
Government comparative effectiveness research needs to establish some kind of guidelines. It needs to reform Medicare by tightening up what it covers, raising co-pays and lowering fees for less effective treatment and giving comparative effectiveness research financial teeth. As goes Medicare, so goes the private insurers. If private insurers can’t stand the heat, get ’em out of the kitchen.
I see nothing practically wrong with Medicare for everyone as an option, but allowing your employer-based insurance if you want it (I have an interest in this in that at sixty two, I would opt into Medicare). I think over a matter of years, a great many other people will decide that they want Medicare because it’s better than the insurance many people have through less generous employers, and even better than the insurance most self-employed people have.
I’ll outsource the takedown of Samuelson to Dean Baker:
“Robert Samuelson Calls for Eliminating Social Security, the Internet and the Wheel”
http://tpmcafe.talkingpointsmemo.com/2009/05/23/robert_samuelson_calls_for_eliminating_social_secu/
If you want to debate, why not do it there, the debate is already ongoing. If you want to delve into the technical issues then this is the place:
http://angrybear.blogspot.com/2009/05/hacktackular-samuelson-on-social.html
Nate and Don–
Nate–The goal of this thread is to expose misinformation. Instead, you are trying to use it to spread mininformation.
For example, on high-deductible plans: most employers do NOT pay the deductible. The employee does. And as a result, Consumer Reports points out “A recent national survey by the Employee Benefit Research Institute, a nonprofit organization, found those currently in Health DAvings Account -type plans with a high deductible were significantly more likely to skip or delay health care because of costs.”
As for Medicare’s efficiency, over the past 10 years Medicare has doen a signficantly better job of holding down health care inflation than private insurers. (I’ve run the chart showing this many times. See figure 1 in this report http://www.tcf.org/Publications/Healthcare/Maggie%20Agenda.pdf
Medicare is making an effort to contain costs–and while it needs to do more–the current effort does not seem to be hurting the qualty of care. In fact, a recent sruvey shows that Medicare beneficaires are happier than those with employer-sponsored insurance because the coverage is more comprehensive. They are less likely to find themselves saddled with expensive bills. http://www.sciencecodex.com/elderly_medicare_beneficiaries_give_their_coverage_higher_ratings_than_do_those_with_esi.
Medicare is providing better care while beginning to rein in spending. That is the definition of efficiency.
It needs to bring health care inflation down by about another 3% to 4% and Medicare spending wll be in line with GDP growth.
Meanwhile, there is no evidence that there is more fraud and abuse under Medicare. To the contrary, a few years ago, the Wall Street Journal reported that private sector insurers were likely to just look the other way when they spotted fraud. (See my book.)
Nate, please do not attempt to use this blog to attempt to spread false facts again. If you do I will have to delete your comment.
Don–
I said Social Security isn’t going broke. Samuleson is distorting the numbers on SS.
Regarding Medicare, yes it would go broke if we don’t begin to squeeze the waste out of the system.
More than 2 decades of reserach shows that in some regions of hte country Medicare is paying for a huge amount of unncessary, ineffective care that provides no benefit to the patient.
(See http://www.dartmouthatlas.gov)
Private insurers are paying for the same treatments–and they are paying hospitals and specialists even more for unncessary treatments, exposiing patients to unnecessary risks.
As White House budget director Peter Orszag has pointed out, if we squeeze even some of that hazardous waste out of the system, Medicare will be on a solid financial footing, and we will simultaneously be lifting the quality of care.
Samuelson ignores that fact.
Robert:
I looked at the links you provided.
There was no technical analysis that I saw.
Just general information that Samuelson is wrong.
Do you have any good third party material, maybe from the Treasury, GAO, or the CBO?
Maggie:
I still didn’t get your reply to my question.
How does our financial situation improve if the “trust fund surpluses” are not used to reduce the public debt?
Don Levit
The gritty details about SS from Bruce Webb who has made it his cause:
http://bruceweb.blogspot.com/2008/08/angry-bear-social-security-series.html
Be prepared for some detailed analysis of GDP growth projections and the like. It’s much harder to wade through than Samuelson’s sound bites.
Robert:
Why don’t you provide some excerpts, so that we all can respond?
Please give the pertinent article, and page number.
Don Levit
Don:
Sorry, SS is a complicated subject and most of what passes for “analysis” has to do with arcane projections about the growth of the GDP, demographic shifts and other factors.
That’s why there is a whole series of articles on the subject on the site I mentioned. You already know the easy answer: there is no SS crisis, any shortfalls can easily be corrected by small changes to withholding tax or retirement start dates or any other of a number of options.
The trustees went from being neutral actuaries to shills for the Bushies and now issue misleading projections designed to scare people into thinking there is a problem. The conservatives have managed to politicize everything, in case you haven’t noticed.
If you want to become even a slight expert you will have to do some reading on your own.
Since the focus is supposed to be on Medicare/Medicaid I’ll say that I don’t believe the projections about this either. There is no way that costs can continue to rise at the same rate they have done in the past, even without reforms.
As economist Herb Stein once said: “If something can’t go on forever it will stop.”
I claim the rise in costs of the past several decades was due to a variety of factors which no longer have the same effect: the rise of high-tech medicine, the rise of patented drugs and the elimination of many of the non-profit insurance companies. The easy money in these sectors has already been made. GE is now looking into cheaper medical technology since the MRI market is saturated, drug company stocks are in disfavor and the insurance companies are way down from their peaks.
Investors see which way the future lies.
Robert–
Thanks very much. You are right. iI people want to
understand what is going on with Social Security, they will have to do some reading.
And the link you originally provided is a good one.
Also, with regard to Medicare, you write: “The rise in costs of the past several decades was due to a variety of factors which no longer have the same effect . . .
II tend to agree with everything you say in the sentences that follow. (And I definitely agree that what can’t continue, won’t)
Those final sentences of your comment seem to me the basis for a very good post.
Would you have any intrerest in writing a guest post?
Gregroy–
The vast majority of more affluent Americans– those earniing over $70,000-have employer based insurance, and their employer pays somewhere between 75% and 100% of the premium. (I’ve writteb about this on the blog and given the sources.)
Single payer would cost them smuch more than they are paying now.. (Couples that earn over about $60,000, joint, would not qualify for a subsidy according to Senate Finance.) Meanwhile, under univeresal coverage, they would have to pay somewhere between $7,000 a year and $9,000 a year according to the Commonwealth Fund. Unless they had an employer paying for 3/4 to 100% of thier coverage.
The problem is that if we moved directly to single-payer, everyone who now has employer-sponsored insurance, we woudl have to give it up and join the natoinal pool.
Otherwise, the single-payer pool would be made up of lower-middle -class working-class and poor famlies- who don’t have good employer-sponsored insurance–and are much sicker than the rest of the poulation. (The major cause of poor health in the U.S. is poverty.)
This would make a single-payer program extraodinarily expensive for tax-payers.
Obama understands that this is why we can’t have a single-payer plan now.
What we can do is give Aermicans a choice beween private sector plans and gov’t sponsored sinruance (Medicare for All). modeled on the Reformed Medicare that is now in the works.
Over time, many people might well choose Medicare for All . It should be able to proivde more comprehensive covearge for less.
Maggie —
I agree with what you say in the comments on single payer, except for one thing.
I think the numbers you are citing for employee costs of employer paid health insurance are for individual coverage, where the employer usually does pay from 75% to 100% of the premium. However, the employee shares of family coverage plans are now usually in the range of 50% of the premium. In my state, the average premium for a family with employer coverage is now supposed to be $6000 a year. In the last two hospitals I worked at the employee premium for family coverage was $7000 at one and $7800 at the other.
A family consisting of two people who both worked at companies that provided good individual coverage packages would pay a very small premium today — probably less than $1500 a year. But the same family with children would need to have one or the other person buy a family plan, raising the costs strikingly, often to as much as $8000 or more.
The insurance crunch is hitting the lower middle class very hard right now. The upper middle class will feel the pinch very soon.
“For example, on high-deductible plans: most employers do NOT pay the deductible.”
United Healthcare is one of if not the larget carriers, they write a ton of high deductible plans with the employer paying part. In addition to working with countless TPAs they also do the administration in house. Here is their website;
https://www.uhcservices.com/home/OurServices/HRA/tabid/59/Default.aspx
Medical Mutual of Ohio bought a TPA in 2007 so they could administer these plans in house. They also work with other TPAs.
http://www.financetech.com/news/insurance/showArticle.jhtml?articleID=203101598
John Alden, also a big player in HDHPs, has a preferred contract with Employee Benefits Corporation (EBC)to process claims for their employers that pay part of the deductible. THey also work with other TPAs.
http://www.johnaldenhra.com/corp/jahra/
2007 Kaiser family study 5% of American healthplans where CDHP with employer funded account.
For more definitive proof;
http://www.meritain.com/files/pdf/TheHotList.pdf
26% of those are HRAs, HRAs are 100% employer money. When you add HSAs and 105 plans there is no mathamatical way the majority of employers don’t fund a portion of the deductible.
Here is the common sitution of how HDHPs are used;
http://www.meritain.com/Home/Resources/Newsroom/InNews/SMBTurnstoConsumer-DrivenPlan
Another real world example of what is going on
http://www.meritain.com/files/File_Posts/CDHP_Superstar.pdf
This survey has 9 million CDHP enrollees with accounts, total CHDP enrollment has not hit 18 million so there is no way most employers don’t pick up part of the deductible
http://www.consumerdrivencare.com/fsenroll.htm
I can post a thousand more links showing most employers do pick up the deductible.
Nate–
As you point out, the employer pays “a portion of the deductible”– not the whole deductible–which is why people cannot afford to use the insurance. Under that plan, there is a $7,000 deductible. The employer contributes $3500. That leaves the family with a $3400 deductible.
As the Health Affairs study cited below shows, only 1/3 of families with a high deductible plan have even $2,000 available to cover a deductible.
And often many services don’t count towad the dedutible– including pre-natal care. So as noted below, a $7,000 deductible becomes a $10,000 deductible.
I high-deductible plan with a health savings account can be a great tax shelter for very wealthy people who can afford the deductible. But we don’t want the wealthy going into a separate plan and a separte pool. Wealthy people are healthier than the rest of us, and so we need them in the general pool of comprehensive insurance to help compensate for people who are poorer and sicker. The whole idea of insurance is having everyone in one pool–sharing the risk.
Read the whole story below as to why “High Deductibles Can Be Bad For Your Health”
Few Can Afford the High Deductible
Research has shown that few policy holders with an HDHP can actually afford the higher deductible. A study published in a 2008 issue of Health Affairs showed that only one-third of those with an HDHP had $2,000 in assets available to cover the deductible if necessary. And affording such deductibles becomes even more problematic when considering lower-income Americans. The April 2005 Commonwealth Fund Biennial Survey of Health Insurance predicted that 33 percent of people with annual incomes below $35,000 and a HDHP deductible of $500 or more would experience cost-related health-care access problems versus only 21 percent of higher-income, insured adults with deductibles below $500.
Total Costs of an HDHP are Unclear
Those considering signing up for an HDHP should make sure to read the fine print. Many policy holders with HDHPs find that these plans often do not cover the same care as a traditional plan might. With the need to reach such a high deductible, it’s important to find out exactly what medical expenses will count toward that deductible. Some drug therapies might not be included. Prenatal maternity care often is not included. And many HDHPs will not cover care for preexisting conditions. It is not rare to find an HDHP policy holder with a $7,500 deductible who ends up spending in excess of $10,000 in health care costs as a result of what is and what is not counted toward the deductible.
HDHP Policy Holders Less Likely to Seek Necessary Medical Care
In reality, most insured individuals do not go to the doctor needlessly. They go to get routine check-ups or when they feel like something is wrong. HDHPs, which are intended to cause people to act more prudently when seeking health care, actually cause people to put off needed care in order to avoiding the costs. The April 2005 Commonwealth Fund survey showed that 38 percent of adults with deductibles of $1,000 or more reported at least one of four cost-related access problems: not filling a prescription, not getting needed specialist care, skipping a recommended test or follow-up, or having a medical problem but not visiting a doctor or clinic. In contrast, only 21 percent of adults with no deductible reported one of these four access problems.
For example, you point ot Meritain as a typical example.
Nate–
Sorry– By “that plan” (at the beginning of my comment) I was referring to the Meritain plan which you point to as a “common example of how HDHPs work.”
Pat S–
Government numbers show that, nationwide the average “better-paid employee” (thouse earning $70,000 or more) pay only 25% of the premium employers pay an average of 75%.
And 15% of “better paid” employees paying nothing toward their family premium; the employer pays the full amount.
So I’m talking about more affluent people who, as a results of being wealthier, tend ot have more political power than the average citizen–another reason why single payer isn’t politically possible today.
But I do agree that the upper-middle class is going to be feeling more of the pinch of rising healthcare costs, probably in the form of higher co-pays . . . And, of course, in this recesssion/depressoin, upper-middle class people are losing jobs, which means they’re losing insurnace.
Maggie —
That may well be right.
A $70000 a year individual salary puts the employee at the lower edge of the top 10% of individuals (not households.)
I do not argue that people who are in that income range — and remember that figure is the lower edge — may well receive excellent health benefits. For one thing the tax laws strongly push people in higher income brackets in the direction of seeking more pre-tax benefits over more taxable income.
However, for people in more typical income brackets — the median income for individual people working full time is about $39,000 — family plan payments by employers are not nearly as generous. As I said earlier, the average employee share of a family insurance plan in my state is now $6000, and costs above $8000 are common. This is simply because employers are unwilling to pay anything from one quarter to one half of payroll expenses for health care, and are demanding that employees contribute at least half of the insurance costs.
There is no argument that people at the top of the income scale will be worse off financially (although perhaps more secure and receiving better care) under any government medical plan, whether it is single payer, the Emmanuel plan, or the potential Obama plan, simply because they will have to pay more to support it and can afford their own insurance now.
However, the lower 75-80% of people will be better off. The cost of the average employer family plan today is $12,000, and as I said the cost paid by the employee now averages $6000, since most people do not get gold plated health programs if they get programs at all. That is at least 10% of the median household income for two earner households. Even the most aggressive plans for financing health care do not exceed that for tax costs for that median family
Count me in. What a great idea for a “Truth Squad” and an even greater thing is that Maggie (the perfect person for this gargantuan task) is willing to head it up. I sent out the link to this post yesterday to the listserve of the Boston-based Alliance to Defend Health Care group; I hope it helps enlist lots of other “Truth Squaders”
A timely piece with links to the many of the current anti-healthcare reform campaigns that are built on lies and other scare-tactics is posted on the Washington Monthly in an article by Steve Benin
May 27, 2009
HEALTH CARE VS. HEALTH SCARE
http://www.washingtonmonthly.com/archives/individual/2009_05/018355.php
P.S. Maggie, thnx for your thoughtful and useful reply to my comment on the “framing” thread; I was out of town until recently and now my 4yo may have H1N1 flu, having just gotten over Strep. Needless to say I’ve not been online much lately… FYI I think I know “Nate” from Ezra Klein’s blog and if it’s the same person he’s full of distortions and misinformation–what a perfect time for him to enter HealthBeat–on the “Truth Squad” post.
Ann–
Thanks for the kind words–and the links.
Hope your child gets better soon!
Jack- As I have explained, this thread is not about Single Payer.
And you have your facts wrong. I’m erasing the comment because I don’t want to spread misinformation on a thread about misinformation!
God’s hands:
I’m with you.
We are all biased, and we need to honor that bias in our interpretations of the “facts.”
My motto is “When someone comes up to you with the truth, run away!”
Don Levit
Pat–
No doubt you are right about what happens in your state, but here are national numbers from the Employee Benefit Reserach Institute:
— on average, employers pay 2/3 of a family plan premium for lower-paid workers– the worker pays only 34%.
Lower-paid workers are those earning less than $60,000. (When I said $70,000, I was quoting from memory. I just double-checked–it’s $60,000)
–employers typically pay 3/4 of the premium for “higer-paid workers.
–but 16% of higher paid workers are lucky enough to have employers who pay 100% of the premium.
-Meanwhile, employers pay 100% of the premium for 8 percent of lower-paid workers.
In other words, if a lower-paid worker has employer-based insurance, he is now probably paying about $4,000 (1/3 of $12,000) if it’s a good, comprehensive plan, less if it’s not.
Another factoid: The statistical middle class (Households liviing on the 3rd rung of a 5-rung income ladder, On the middle rung, earn somewhere between $36,000 and $58,000 (joint.)
Their average age is 47.2 and these households spend 6.7 of income on health care (premiums if they have insurance, co-pays, , out of pocket costs if they don’t. )
A couple earning more than $58,000 –just a hair above that middle rung–will not qualify for a subsidy.
Under universal heath care or single-payer it’s assumed households will spend 10% of their gross income on healthcare. (That’s what they are expected to pay in Massachusetts, before they qualify a subsidy.)
That’s more than the average couple earning $58,000 now spends on healthcare
And the subsidy will be on a sliding scale– a couple earning $45,000, joint, will have to pay part of their premium.
The poor will definitely benefit. The statistical middle class will be suprised by how much they have to pay–as they were in Massachusetts.
Today, many middle-class households have an employer paying 2/3 to 3/4 and the vast majority live in states where there is no community rating and guaranteed issue.
In those states, many of the sick, and many older people under 65 just aren’t covered.
Under universal coverage or single-payer, they will join the pool, making insurance much more expensive for the middle-class–who will be helping to fund insurance for the
sick and older citizens.
In New York State we have the equivalent of community rating and guarantee issue–and insurance here is two to three times more expensive than in other states.
I think this is fair; but middle-class people living in other states–particularly 30-somethings– would be surprised by much insurance will cost them if they had to give up their employer-based insurance.
“In other words, if a lower-paid worker has employer-based insurance, he is now probably paying about $4,000 (1/3 of $12,000) if it’s a good, comprehensive plan, less if it’s not.”
Maggie this math doesn’t work at all. $12,000 is the national average which is driven by MA, NJ, and other states with ridiculously expensive coverage, those states also have a lower percentage of low paid workers. Those low paid workers paying 1/3 the cost are in the midwest and south where family coverage cost substantially less.
“In those states, many of the sick, and many older people under 65 just aren’t covered.”
This would mean they aren’t working, and if they aren;t working they would be eligibile for Medicaid. This brings up the fact that roughly 15 million of the uninsured already qualify for Medicaid or SCHIP but CHOOSE to not sign up. It is assumed they don’t sign up becuase they are healthy and don’t need it.
What prompted the deletion of the last comment? THose where all strait facts correcting commonwealth. Is there a policy we can read so we know how to avoid replies getting sent to the waste basket? Ann can call me decitful but when I try to defend myself it gets deleted? You post studies from the commonwealth fund where are clearly untrue per federal HIPAA law and those links get deleted?
Nate
The Robert Wood Johnson Foundation commissioned the University of Minnesota to do a study fo insurance premiums in every state.
This is what they found “Nationally, the average cost of family coverage increased nearly $2,500—from $8,281 in 2001 to $10,728 in 2005. The percentage of family premiums that employees pay held steady at about 24 percent.
The average premium was $10,728 in 2005.
In 2009 it’s about $12,000.
The math in my comment was correct.
Your comment was deleted because there was so much misinformation in it.
If someone has a fact wrong, that’s no problem. I can comment and set hte record straight. But if someone habitually writes comments filled with unfounded assertions that are, in fact wrong, I begin deleting.
I don’t want this blog used to spread misinformation. There is enough misinformation in the blogosphere as it is.
And I don’t have time to correct one false assertion after another, especially when the writer is simply speculating.
For instance in your most recent comment, you assert that anyone who isn’t working quallifies for Medicaid.
That is not true.
Then you assert that many people who qualify for Medicaid don’t sign up,
presumably because they are so healthy they feel they don’t need it.
That is not true.
Try Goggling and you’ll find plenty of info on what it takes to qualify for Medicaid and
why people who qualify don’t sign up.
Maggie:
While we’re talking here about “truth,” I posed a question which the Treasury Department takes as truth.
That is “How does our financial situation improve if the ‘trust fund surpluses’ are not used to reduce public debt?”
I can provide the link and page number for this Treasury truth.
Why don’t you or anyone else respond to this “truth?”
Or, did we get responses that were deleted?
Or worse, is this ‘truth’ of no interest?
Don Levit
Don–
Your comment is somewhat arcane; it seems people aren’t interested.
Fair enough I’ll keep them short and sweet.
How about my links showing almost every group HSA covers pre-natal?
“The April 2005 Commonwealth Fund Biennial Survey of Health Insurance predicted that 33 percent of people with annual incomes below $35,000 and a HDHP deductible of $500”
HDHP is a legal term defined by the IRS and has never been below $1000. It increases every year when the IRS publishes the new minimum HDHP, $500 has never been HDHP.
Nate —
that was a typo.
It should have been $5,000 not $500.
I’d like to see this thread get back on topic:
lies about health care reform promulgated by those who oppose reform.