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On the Third Hand: Ninja content

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Organizations seem to be making more use of commentaries masquerading as neutral reports as public policy weapons. This is a menace to my own peace of mind, because I want to try to make the Health Channel suitable for readers who look at health insurance policy from a wide range of perspectives.

See also: On the Third Hand: Playing field

Sometimes, other organizations pick up the “neutral reports” (that aren’t), and cover them as if they were straight news. I get asked why I haven’t covered those “important new reports.”

Because: The reports were just fancy letters to the editor, not presentations of interesting new information or insightful new analyses of previously published data.

America’s Health Insurance Plans (AHIP) has come out today with a respectable, positive example of the genre: A “report” by actuaries at Milliman about why narrow health plan provider networks can be fine. The actuaries note that narrow networks can have problems, but they say narrow networks have helped some health plans hold down costs. They argue that well-designed narrow networks may actually increase patient satisfaction and improve the quality of care.

The Milliman actuaries’ paper is nice. It might be helpful to people who’ve never thought about the network issue at all, or need a few statistics about the issue to put in a briefing report for a higher-up. But the paper isn’t really news in the way, say, a summary of new AHIP insurer survey results is news.

The White House Council of Economic Advisers (CEA) has what I think of as a nasty example of the genre: “Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid.” The people who wrote the “report” talk about all of the horrible things that will happen in the states that fail to take Patient Protection and Affordable Care Act (PPACA) Medicaid expansion money.

The CEA analysts who wrote that report seem to be adopting the strategy that many Democrats were taking back before PPACA was PPACA: Whenever the Republicans break from complaining that Obama is a gun-seizing Pakistani intelligence agent who is not actually his own mother’s son long enough to point out possible problems with PPACA, haul out someone with cancer, or the mother of someone who died of cancer, or someone who eventually will have cancer, and get everyone crying.

See also: On the Third Hand: Sales

The basic White House response to any concerns about PPACA is that the critics are waging war against photogenic orphans with dread diseases.

On the one hand, personally: I like the idea of expanding Medicaid. It looks as if some hospitals in Medicaid expansion states are reporting immediate, dramatic reductions in the number of uninsured patients.

It seems reasonable to speculate that reducing the uninsurance rate could improve the newly insured people’s health. It seems completely reasonable for the White House to get CEA analysts to estimate what the effects might be if more states took PPACA Medicaid expansion money.

It’s possible that a successful Medicaid expansion effort could pay for itself by reducing all of the many costs related to high uninsurance rates.

But, on the other hand, instead of gently encouraging the non-expansion states to take the PPACA expansion money, the CEA analysts bray about the horrors non-expansion state will face without doing much to acknowledge how uncertain the predictions about expansion-related improvements in health are, or anything to acknowledge the non-expansion states’ concerns about federal finances.

See also: On the Third Hand: Fudge

If expanding Medicaid in Texas reduces the number of people with serious problems with paying medical bills by 200,000 per year in 2015: Great. But what if Medicaid expansion does not pay for itself, and Congress starts to cut back on Medicaid expansion money, what happens to all of the health indicators if states come up with the cash to keep Medicaid big or let it shrink?

Different people have different thoughts about what the federal budget deficit means. I think thoughtful people can make a reasonable case that, if federal Medicaid expansion money goes away, states should swallow hard and find money to replace the federal money.

But I think other, reasonable people could argue that states also need money for schools and parks, and that ordinary workers need to be able to keep more of the money they earned because, hey, they earned that money. Why should the government be so quick to tax away money that workers managed to earn in today’s difficult labor market?

On the third hand: Maybe the secret is that, for whatever reason, the White House actually wants to hold down the number of states that take Medicaid expansion money, and posting irritating, one-sided “reports” about how the non-expansion states are ogres is a way to make sure they never come around asking for expansion money.


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