All health care plans are not created equal

But that’s what some reporters want you to think.

An article that ran in Freedom Communications newspapers in Eastern North Carolina about how gubernatorial candidates Bev Perdue and Pat McCrory would expand health insurance to more children did not include any context or fact checking. Instead, the writer simply quoted the campaign claims of each candidate and just left it to the reader to sort out the truth from the chaff.

You can read the original story here.

Perdue has a straightforward and comprehensive plan to cover children, which you can read about here. It builds on many of the suggestions of North Carolina Institute of Medicine’s task force on covering the uninsured.

She advocates expanding the State Children’s Health Insurance Program and reaching out to the families of kids who are eligible for Medicaid but not currently enrolled. The news article did not point out these steps and merely quotes Perdue’s campaign as saying:

She said that she supports efforts to get the families of poor people insured as a means to getting parents to enroll their children in health insurance programs.

Getting insurance to more parents, by the way, is an effective way to get more children insured.

McCrory, the article points out, supports “child health-care tax credits.” His campaign does not say how much of a credit he will offer, and the reporter apparently did not push them on the issue. The story also fails to mention that North Carolina used to have a child health care tax credit, but a bi-partisan commission recommended its elimination because it didn’t work. What would McCrory do to ensure the success of a program that failed last time it was tried? No word on that in the story.

Perhaps more frightening is the reporter’s recitation of McCrory’s facts and figures without any questions asked. An example:

McCrory’s campaign says that the state’s 47 private insurance mandates are estimated to cost increases in insurance premiums of about 41 percent.

Where, a reader might wonder, did McCrory get this surprising statistic. He bases the number on estimates provided by the industry group Council for Affordable Health Insurance, or CAHI. Where, then, did CAHI get this surprising statistic?

For that you will have to look at the CAHI report and flip to the methodology section to see how the calculations were done. Except there is no methodology section. CAHI doesn’t say how it got its estimates. And that’s the problem.

McCrory also fails to provide any evidence that limiting malpractice lawsuits lower health insurance premiums. And the reporter again fails to push him for evidence.

A question to the Perdue campaign about whether or not reducing obesity will really lower health care costs is also in order. Reducing obesity rates would certainly add to quality of life. It’s also medically sound. But it’s unlikely to produce huge savings in the health care system.

When voters are trying to assess the candidates we don’t need a recitation of competing stump speeches. We can get all of that on the campaign websites. What we need are reporters who put the candidates on the hot seat.

All health plans are not created equal, and newspapers should not shy away from pointing that out.


  1. All health care plans are not created equal

    October 27, 2008 at 5:55 pm

    […] Go to the author’s original blog: All health care plans are not created equal […]

  2. Council for Affordable Health Insurance

    October 28, 2008 at 2:37 pm

    Since 1992, the Council for Affordable Health Insurance staff has been tracking health insurance laws in all 50 states, but only made the information public since 2004, the result of many requests from policy experts asking us to share our information with the public. This document is a snapshot – a glance at the mandates and their costs. If Adam Linker had bothered to actually read the report’s introduction, he would have found his answer under the section “How is the Research Compiled.”
    We explain that we have compiled this information since 1992, and to corroborate our own findings, we survey every state department of insurance and talk with other industry experts. At the top of page two, we detail how we arrived at our mandated benefit costs under the section, “Assessing the Cost of Mandates.” In this section, we detail that our Actuarial Working Group on State Mandated Benefits analyzed proprietary insurance company data and their real product experiences and provided us with cost-range estimates.
    Further on page two, we advise under the section “A Caution about Comparisons and Cost Estimates” that some mandates have a much greater impact on the cost of health insurance than others. It may be tempting to think that since a particular mandate does or does not add much to the cost of a health insurance policy therefore there is no reason to oppose it. However, over 16 years of looking at this issue, we have concluded that it is actually the accumulated impact of dozens of mandates, not just one, that makes health insurance unaffordable for some people.

  3. AdamL

    October 28, 2008 at 4:31 pm

    You “detailed” that CAHI “analyzed company data and their experience and provided cost-range estimates” … Wow, that’s really specific.

    Instead of a single paragraph that provides no real information, a recent legislative analysis in Massachusetts included nearly 30 pages explaining the methodology. Reporters should ask tough questions when an organization refuses to say exactly how it came up with its calculations. Those numbers certainly should not be uncritically recited in the newspaper.

  4. Adam Searing

    October 29, 2008 at 10:04 am

    It’s a simple question. How exactly did CAHI come up with its numbers and do its calculations? As Adam says, the above paragraph is simply another non-answer answer. “Trust us” isn’t enough.

  5. JP Wieske

    October 30, 2008 at 8:16 pm

    Guys, thanks for looking at our report. I appreciate our resonse wasn’t on the mark by any means and I have more specific info posted at our blog.


    My co-workers response is more about the collection of the mandate data and not the costs you guys are focusing on.

    Additionally, if you have looked at our whole report, you’ll find we caution against adding up the numbers. In fact, you’ll find the vast majority of mandates are actually listed at less than 1% — a position that is often used by mandate advocates. We also don’t reccomend adding them up because we use ranges.

    I also want to emphasize the impact on premiums can vary quite a bit — from state to state and plan to plan. In truth, estimating mandates across the whole market — large group, small group, individual, PPO, HMO, high deductible, managed care, etc. creates many variables.

    Our data is based on what our member actuaries see in their job, and how they price real products.

    I know I won’t be answering all of your questions and you’ll disagree with us, but thought you deserved a better response.

  6. Adam Linker

    October 31, 2008 at 1:39 pm

    Thank you for the thoughtful response.

    Our problem is that many organizations and politicians regularly add up your numbers to say that 47 state mandates add 41 percent to the cost of insurance premiums.



    And while you might aggressively respond to our criticism, CAHI does not aggressively and publicly correct people who misuse its numbers.

    Also, I was making the simple point that reporters should probably not use data when there is not a clear and transparent explanation on how the numbers were derived.

  7. JP Wieske

    October 31, 2008 at 4:10 pm

    We’ve seen some comments before and not responded. One of our staff happen to see the hit in the media, and it struck a cord — normally we haven’t really responded because we just don’t have the time. We have a small staff — 6 plus two consultants.

    Last word. We thought our description of the cost increases was clear in the chart, that comes from people reading it that know what we are talking about, not an unaffiliated outside observer. Your comment that it wasn’t clear is fine and within bounds, and points to the fact that we need to edit that language to make it clearer.

    When you read your own stuff, you often know what you are talking about — even if no one else does.

  8. AdamL

    November 2, 2008 at 9:07 pm

    Fair enough.

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