Dollar signs. Percentages. Margins. Mortality rates. Once you break it down, it seems that healthcare reform is all about numbers and their impact on patients, providers and payers.
Unfortunately, the heavy dose of statistics used to sell reform sometimes clouds an already confusing issue.
Recall that President Clinton and a few of his Cabinet secretaries marched on Capitol Hill recently to rally support for his fading healthcare bill. This pep rally for universal coverage and an employer mandate was built around new Census Bureau statistics showing the percentage of workers receiving coverage from their employers dipped to 61% in 1993 from 66% in 1979. Mr. Clinton also noted that the number of employers sponsoring health plans slipped to 78% in 1993 from 81% in 1988.
Such alarming numbers tell the administration that fewer employers can be trusted to fulfill their social obligation to provide insurance to workers. On further review, however, one discovers that many uninsured workers are young and not heavy users of care.
That plays right into the hands of those who favor less of a role for government. A Lewin-VHI study of the managed-competition bill sponsored by Rep. Jim Cooper (D-Tenn.) shows it would extend coverage to nearly 15 million uninsured Americans. Although that would still leave 9% of the nation without insurance, Lewin contends the Cooper plan would cover 97% of medical services because of the healthy disposition of the remaining uninsured. Say what?
And when it comes to healthcare, the numbers are subject to change...not to mention manipulation and twisting.
Reporter David Burda examined one popular measure of healthcare spending-the Commerce Department's annual Industrial Outlook (May 9, p. 18). Although highly quotable, the government's figures can vary significantly over time. In 1989, for instance, the department forecast healthcare spending would reach $618.4 billion. By last December, the government had revised its 1989 expenditures five different times. The fifth change said spending hit $605.4 billion in 1989, or $13 billion less than originally forecast.
Numbers, percentages and statistics are not sacred. They should be used as tools to help prove a point. In and of themselves, numbers aren't facts. Often, they require further evaluation and deeper analysis.
But that didn't stop politicians and the media from trumpeting the latest Commerce Department estimates that forecast healthcare spending would topple the $1 trillion barrier in 1994. Time will tell if that magic mark is reached this year.
Finally, if you really want to get into the deep numerical doo-doo, consider the Milliman & Robertson study that concluded the recent slowdown in health inflation isn't a reaction to providers' fears of reform. Instead of the "Hillary effect" tempering medical price hikes, it was a decline in national income four years ago that triggered this year's slowdown in health spending. We're sure the Milliman actuaries can prove it.