Saturday, March 29, 2014

Ten Useful Ways of Looking at ObamaCare Numbers

Calculated over decades to come the number of lives saved is likely to total in the thousands, if not the millions. And that will be the true test of the Affordable Care Act as a historical accomplishment for Barack Obama and his administration.

John Irving, “Numbers We’d Rather Be Talking About, “ The Health Care Blog,  March 29, 2014

John Irving,  executive editor of The Health Care Blog, perhaps the most widely read of the health care blogs, has provided 10 ways of looking at those health care numbers everybody will be commenting on as the  first six months of ObamaCare enrollment comes to a close on March 31. 

Irving concludes that, in the long run,  will be a good thing, resulting in thousands, if not millions, of lives saved.   He comments,

You can forget the nonsense we’ve been hearing about Obamacare costing the lives of thousands of Americans by taking their health coverage away from them.  There is a difference between losing your coverage temporarily because the system is in transition and losing  it and knowing that you’ll never be able to get it back. Ever.”

In other words,  all this talk about the negative effects of ObamaCare is  temporary  and people who lost their coverage will get it back.  

I do not share Irving’s confidence.

Here are Irving’s 10 numbers he says we should be looking at.  The words describing these numbers are Irving’s, not mine.

One, FUDs The number of people who are innocently living their lives thinking they have bought health insurance, but who, for one reason or another,  be it technical glitch, bureaucratic incompetence or technicality – are going to wake up one morning not long from now and discover that they do not have health insurance.

Two, 404s : The number of people  applications lost in the system,  either as a result of the fiasco or because their application is sitting forgotten on somebody’s desk somewhere or in a laptop. 

Three, CANCELS The number of people who had their insurance plans cancelled by insurers on the grounds that they did not meet the standards set by the Affordable Care Act.

Four, UNCANCELS: The number of people who had their plans cancelled by the health insurers only to have them declared “uncancelled” by the Obama administration or their state. 

Five, BUMPS: The number of people who have been “bumped” out of network and are being forced to change doctors.  What’s going on? In gamification terms, bumps make things more exciting. In real life, they suck.  Getting bumped off a flight is annoying, getting bumped in the health care system is potentially life-threatening.

Six, PRE-EXs: The number we should talking about is the number of people who’ve signed up for insurance under Obamacare who would have never been able to buy insurance under the old, evil healthcare system that discriminated against people with previously existing conditions like cancer, high blood pressure and HIV/AIDS.

Seven, NETWORKS and DOCS: Once we figure out how many people have signed up for Obamacare we’re going to have to figure out what they bought. What kind of coverage is Obamacare providing? We won’t understand the new healthcare system we’ve built until we’ve mapped and understood the networks that are organizing under the new rules. How many docs and hospitals are participating in each? 

Eight, YOUNG ADULTS: Based on early reports, there is reason to think this number was looking like it was going to be a lot lower than the administration wanted it to be, a fact which terrified the people at health plan responsible for managing risk. 

Nine, TRUE ENROLLMENT: Yes. Yes. We know. If you’ve heard it once you’ve heard it a hundred times. The number of signups doesn’t mean anything.  The QHPs the White House is talking about aren’t real. They are a proxy. What matters is true enrollment: the number of people who were able to successfully sign up and pay their first premium.  

Ten, LIVES SAVED: As we speak Nate Silver or a smart person who looks and sounds a lot like Nate Silver is sitting at a computer in a darkened room somewhere trying to come up with a reliable quantification of the number of lives the Affordable Care Act has saved and will save by shielding people from the barbaric US healthcare system.  

Thoughtful Discussion

In the course of his thoughtful discussion of the significance of these numbers,  Irving says some of these numbers are difficult to quantify.  Some we will never know.  What counts is whether ObamaCare  will save lives over the long term.  That is a  hard number to know at this point. Perhaps good intentions will prevail.  Perhaps the unforeseen negative consequences will trump good intentions. 

Tweet:   John Irving, executive editor of The Health Care Blog,  has provided 10 useful insights into what ObamaCare enrollment numbers mean.

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