To All Readers—Let’s Form a “Truth Squad”

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.

Comments

[Maggie Mahar]

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.

[Nate]

"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]

Fair enough I'll keep them short and sweet.

How about my links showing almost every group HSA covers pre-natal?

[Maggie Mahar]

Don--

Your comment is somewhat arcane; it seems people aren't interested.

[Don Levit]

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

[Maggie Mahar]

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.

[Nate]

"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?

[Maggie Mahar]

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.

[Don Levit]

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

[Maggie Mahar]

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!

[Ann Malone]

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.

[Pat S]

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

[Maggie Mahar]

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 Mahar]

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."

[Maggie Mahar]

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]

"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.

[Pat S]

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.

[Maggie Mahar]

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 Mahar]

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?

[robertdfeinman]

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.

[Don Levit]

Robert:
Why don't you provide some excerpts, so that we all can respond?
Please give the pertinent article, and page number.
Don Levit

[robertdfeinman]

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.

[Don Levit]

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

[Maggie Mahar]

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 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.

[robertdfeinman]

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