Do Data Have a Place In Discussions of Reform?

I managed to watch Hardball With Chris Matthews today for more than five minutes without changing channels.  Mr. Matthews induced a representative from Gun-Owners of America to declare that he thought it would be acceptable for many thousands of persons carrying loaded guns to enter an auditorium at which a President of the United States was speaking, and even for the persons to sit in the front row.

In other surreal, over-the-top news exhumed by Mr. Matthews, guest Tom DeLay displayed a shoe he will wear on Dancing With The Stars, said he would like President Obama to produce his (Mr. Obama’s) birth certificate, and declared that he would prefer that Medicare were “privatized.”

Considering the last point, I wondered how Medicare measured up to private health-insurance, and I went in search of data. I found some online from “Medicare Versus Private Insurance: Rhetoric and Reality,” published by Health Affairs: The Policy Journal of the Health Sphere. The study was undertaken by Karen Davis, Cathy Schoen, Michelle Doty, and Katie Tenney.

Here are the final three paragraphs of the study:

In the policy debates over the future of Medicare, it is important to listen to the experiences of individuals, whether covered by Medicare or by private insurance. Apart from the lack of a prescription drug benefit, Medicare is reportedly working better for its beneficiaries than is the employer-group coverage available to most persons under age sixty-five. The greater confidence in getting care when needed and lower incidence of access problems reported by Medicare beneficiaries are notable, given that Medicare beneficiaries are disproportionately sicker and poorer than the privately insured are.

The survey also raises questions about how well private coverage is protecting persons at greater risk because of lower incomes or poor health or both. Current trends to increase cost sharing or shift responsibility for health coverage to individuals in the form of defined-contribution plans or personal health accounts may make low-income and chronically ill adults more vulnerable. Increased cost sharing as part of Medicare reform may also be particularly problematic for chronically ill Medicare beneficiaries.

Medicare provides a level of security not typically found in employer or individual coverage. Its beneficiaries are assured that they will not lose their coverage, while coverage for persons under age sixty-five can vary with employment status, employers’ decisions to change plans, or even the onset of a serious illness. Medicare beneficiaries also live in a world with more stable benefits and, for most, fewer complex insurance arrangements than the privately insured have. Thus, attempts to reform Medicare that would pattern coverage on private employer coverage run the risk of undermining the confidence of the people it is designed to serve.

The whole report, including an abstract and data, may be found at , , ,

http://content.healthaffairs.org/cgi/content/full/hlthaff.w2.311v1/DC1

I do not know how valid these conclusions and observations are, but reading a sober report that included data and set out its methodology was a refreshing experience, an antidote (so to speak) to the health-care-reform spectacle that cable-television highlights.  Data gathered in a patient (so to speak), orderly way and conclusions based on them do not seem to have a place in the “rhetoric,” if it ought to be called that, of the spectacle, which now apparently includes Tom DeLay dancing with “birthers.”  Even Chris Matthews seemed flummoxed by the spectacle today.

I might add that some prescription-drug funding was added to Medicare since the report was published, although if President Obama is correct, Congress did not “pay” for the new benefit (by means of new taxes, or by an means). I might also add that I am minimally qualified to assess the methodology of the report.

Tom Delay on Dancing with the Stars: What would Eisenhower think?

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