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On the Third Hand: Games

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I thought I was going to change the topic of my blog today, but it turns out that I’m just using a different path to get to the same point.

The point is that honesty is good. 

It’s hard to be smart, beautiful, rich or effective. It’s easy to make mistakes. And, most of the time, it’s easy to be honest.

In the tangle of lies, secrets and half truths that make up the U.S. health finance system, honesty may be both a powerful tool for fixing things and a nice end, in and of itself.

If, it turns out, there’s no way to fix our system, maybe at least we could be honest with ourselves about why we’re doomed. Maybe knowing why we’re doomed, and how doomed, would be better than the situation we’ve had for the past 20 years.

This week, some policymakers have the knives out for states that tried to create state-based exchanges, took lots of federal money, and failed.

And, of course, some of the managers of the failed exchange efforts may have been arrogant jerks, or even corrupt. If any of them were crooks, throw the book at them. If they were irritating blowhards, get Jon Stewart to make fun of them. 

But, on the other hand: If they just bit off more than they could chew, made reasonable attempts to create exchanges, messed up, and were pretty open about what went on — well, who here is without error? If you proofread carefully, you may find five typos here before the close of this paragraph. Messing up is a core human activity.

If I were going to throw a book at an exchange, I’d throw a book not at an exchange that “failed,” but at an exchange — example: the New York state exchange — that hid behind vague press releases and hardly put any documentation of its activities on the Web. Supposedly, some of those exchanges enrolled a lot of people in coverage, but, really, how do we know that those closed-window exchanges did anything?

And what educational value is there in having public health insurance exchanges that make Nasdaq look like the star of a 24/7 reality TV show?

Meanwhile: Another topic came along.

The editors of The Money Anxiety Index pointed out that gross domestic product (GDP) would have fallen in the first quarter if health care spending hadn’t increased a huge amount.


I actually tried to write up the original Commerce Department first-quarter health spending increase data because I thought the figures were really interesting.

Here was the first concrete data showing that the 2014 Patient Protection and Affordable Care Act (PPACA) coverage expansion provisions had had a measurable effect on the economy.

Then I read the report footnotes and saw that the government economists had no first-quarter health care spending data. The economists were estimating what the numbers might be, given how many people had signed up for Medicaid or private coverage through the PPACA exchange system.

I tried to tell my editors, and people on Twitter, that reports that claimed PPACA had led to a huge increase in health care spending were based on speculation, not sales numbers. Most people ignored me. 

I figured: Poor government economists. They went to all that trouble to write that footnote, and no one read the footnote. Sad.

Then, on the other hand, The Money Anxiety Index article forced me to remember that some people are not all that nice and open.

“Oh,” I thought, with the piercing insight of Sherlock Holmes’ 3-year-old niece. “The government knew no one would read that footnote. Officials projected a big increase in health care spending just so that they could jiggle the GDP number hard and make it go cheerfully up, rather than dismally down.”

Of course, it could turn out that the projection is correct.

But the government did absolutely nothing whatsoever to keep reporters or investors from reading the health spending number in a naive way.

The obvious interpretation is that the government fixed the health spending number to make GDP look good.

On the third hand, maybe I’m wrong and honesty is not such a great thing. Maybe we’re better off playing with phone apps in a pleasant world where GDP always goes up and everything is nice. (Until the catastrophic day when the power we need to play the phone games runs out… But then we’ll just get a government economist to write a report stating that the power exists, and everything will be fine. Won’t it?)

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