This week’s health policy news roundup curated by Jane Orient, M.D.
The Washington Post predicts: “There will be dead bodies one way or another, regardless of which way the Senate swings on its health-care bill.” This apparently refers to political careers, as the attempt to sway votes continues, with behind-the-scenes negotiations reminiscent of the ones that got enough Democrats to vote for ObamaCare. And some assert that passage of the Republican bill would literally mean bodies piling up. Bernie Sanders tweeted that “thousands of people will die if the Republican health care bill becomes law.” Rep. Jackie Speier (D-Calif.) said that the GOP bill “will guarantee that people will die.” Hillary Clinton said people will call Republicans “the death party.” WaPo admits that it is hard to show that having health insurance prolongs life. But the “steep Medicaid spending cuts” helped cause the bill to “suffer a spectacular meltdown.” https://s.washingtonpost.com/camp-rw/?e=amFuZW9yaWVudG1kQGdtYWlsLmNvbQ%3D%3D&s=5953b2c97188502226958a46
In fact, the Senate bill contains no Medicaid cuts—except by the D.C. definition of a slowed rate of growth. “Even under the more restrictive House bill, Medicaid’s budget would still climb 20% over the next decade. So growth will end up higher still under the more generous Senate version,” according to Investor’s Business Daily. http://www.investors.com/politics/editorials/despite-what-youve-heard-the-senate-bill-doesnt-slash-gut-or-even-cut-medicaid/
The Congressional Budget Office (CBO) uses a similar type of definition. The report that 23 million Americans will “lose health care” (i.e. coverage) includes 19 million who do not have coverage now but presumably would have had it by 2026 under ObamaCare. http://thepoliticalinsider.com/obamacare-uninsured-reports-massive-lie/
CBO audaciously claims that the ObamaCare insurance market is “pretty stable” in most places—while insurers head for the exits, but that the Republican bills would be destabilizing. However, if premiums decrease, more young and healthy people might buy coverage. https://townhall.com/tipsheet/guybenson/2017/05/26/ryan-mcconnell-the-obamacare-status-quo-is-an-indefensible-mess-n2331875
The claims that Republican plans would raise death rates ignore evidence that moving in a more market-oriented direction would tend to reduce “amenable mortality” (unnecessary, untimely deaths), according to analysis by Chris Conover of a Lancet article. https://www.forbes.com/sites/theapothecary/2017/05/28/lancet-study-proves-markets-work-in-medicine-when-will-progressives-accept-this-hard-truth/
In evaluating effects on Medicaid, one needs to consider that the expansion put earlier recipients at a disadvantage by requiring the federal government to pay a much greater share of the medical bills for nondisabled, nonpregnant adults than it does for elderly individuals, people with disabilities, children, and pregnant women. https://www.mercatus.org/publications/medicaid-FMAP-ACA
In the real world, expanding Medicaid did not have the anticipated effects. Instead of improving access to primary and preventive care, it greatly increased the strain on emergency rooms. http://www.bakersfield.com/news/it-s-a-big-frustration-local-hospital-emergency-rooms-overwhelmed/article_707246fd-5a86-5ef3-a5a8-7f5beec44a5f.html
Attempts to change Medicaid financing have many obstacles, including the competition among states for federal funding. https://www.forbes.com/sites/realspin/2017/06/16/senators-must-address-a-critical-stumbling-block-to-changing-medicaid-state-envy/#d7db75f531ce Medicaid rewards fiscal irresponsibility as states try to grab a bigger share of funding from their neighbors. https://www.forbes.com/sites/theapothecary/2017/06/16/fixing-the-3-biggest-flaws-in-obamacares-medicaid-expansion-part-2/
Those who object to capping Medicaid spending apparently forget about the cap that ObamaCare placed on Medicare—the equivalent of a global budget that at a stroke reduced Medicare’s unfunded liabilities by more than $50 trillion. Going forward, Medicare spending is scheduled to grow at roughly the rate of growth of real per capita GDP—a rate that is about half the historical rate of growth of health care spending generally. But no Democrat cries about death panels here! https://www.forbes.com/sites/johngoodman/2017/06/15/do-conservatives-really-want-to-repeal-obamacare/
Expanding Medicaid may sound compassionate—until the extra load destroys it, and medical institutions. The dean and CEO of Johns Hopkins Medicine, Dr. Edward Miller, warned that allowing a vast expansion of Medicaid could have “catastrophic effects” at places like Hopkins. Medicaid is now at a “tipping point,” writes Betsy McCaughey. https://townhall.com/columnists/betsymccaughey/2017/06/28/medicaid-at-the-tipping-point-n2347540
If Republicans were to indulge in the same type of rhetoric as Democrats, they would be charging that ObamaCare has already killed 80,000 innocent victims. https://townhall.com/tipsheet/guybenson/2017/06/27/hey-democrats-isnt-obamacare-killing-people-n2347370
Seen on Social Media:
— Healthcareonomics (@HConomics) June 14, 2017
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— Healthcareonomics (@HConomics) June 20, 2017
— Rich Duszak, MD (@RichDuszak) June 20, 2017