Blog: Subtlety faces quick demise in political fight

Just as truth is the first casualty of war, policy nuance dies quickly in political combat.

The latest example of that was seen in the healthcare firefight over emergency department use and the Massachusetts healthcare overhaul.

Republican presidential nominee Mitt Romney got things started when he was asked in a Sept. 23 “60 Minutes” interview about any government responsibility to provide healthcare. Romney responded that “different states have different ways of doing that,” including care through clinics, emergency departments and “a solution that worked for my state.”

Romney's comments drew strident criticism for appearing to support the use of costly emergency departments to provide non-emergent care.

But Romney also juxtaposed Massachusetts' approach under his healthcare law to the supposedly emergency department-reliant approach of other states. But it is not clear Massachusetts has turned sharply away from a dependence on such high-priced hospital facilities.

It's true that a January 2012 study by the Blue Cross and Blue Shield of Massachusetts Foundation (PDF) provided some of the first evidence that the state's emergency department use had dropped. Specifically, it found that from 2006 to 2010 both overall use and non-emergent use by non-elderly adults dropped 3.8%.

However, the authors of the study expressed strong reservations and qualifiers that raised questions about even the small improvements they found. Namely, that the reduced reliance on emergency departments may reflect many factors, including increases in cost-sharing requirements by health insurance plans.

The report also noted that among low-income adults—those most likely to benefit from near-universal insurance coverage—there was no statistically significant change in emergency department use.

Another important caveat, according to the authors of the Massachusetts report, was that any reductions could “reflect the effects of a $4.5 million grant from the CMS to support an ED diversion program in Massachusetts.”

Such qualifiers for one state's efforts presage lots of gray areas when the federal healthcare overhaul applies a similar approach to reducing unnecessary emergency department use nationally.

Good thing we won't have to worry about similarly gray political talking points.

You can follow Rich Daly on Twitter @MHRDaly.



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