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Blue Cross criss crosses myths and facts

The Blue Cross and Blue Shield of North Carolina misleading health reform website [1] has a nifty little link that promises to sort out “health care reform myths vs. facts.”

This is actually a great section of the website if you read “fact” every time you see “myth” and “myth” every time you see “fact.” Let’s take a look.

First “myth”:

Prevention and wellness efforts do not impact health care costs.

Again, if you read that as fact then Blue Cross is absolutely correct, wellness efforts do not impact health care costs. But don’t take it from me (or Blue Cross). Instead, here’s what the nation’s leading health care economists say (in a recent Fortune magazine article [2]):

The main reason is something Victor Fuchs, a health economist at Stanford, pointed out long ago. The bulk of most people’s lifetime health spending comes in the last five years of life, when one body part after another begins to crumble, often in tandem. That’s when we roll out the heroic medicine, as endlessly inventive technology is applied to stave off the day of death. Nothing on the prevention agenda alters this end-of-life dynamic.

“Prevention gives you a better quality of life,” says Uwe Reinhardt, a health economist at Princeton, “but I have never seen any analysis that shows that in the long-run a society that uses a lot of prevention will have lower health care costs.”

Second “myth”:

Private health care insurers hold an unfair monopoly on health care insurance.

I think this is an attempt to say one of two things (it’s not clear): either Blue Cross does not have a monopoly on the health insurance market in the state or that the monopoly is not “unfair.” The numbers, which Blue Cross does not include on its website, speak for themselves. Blue has 96.8 percent of the individual market. That’s a hair away from total control.

Now, is the monopoly unfair? Blue Cross received big tax breaks for much of its history, which allowed it to gain an advantage over other health plans. It also built enormous political power so that — for example — it can obtain no-bid contracts from the state.

Most of us would say that a little competition is in order.

Third “myth”:

Employer-based health coverage is unpopular and on the decline.

I don’t think anyone has ever claimed that employer sponsored insurance is unpopular. And most policy makers want to build on the employer-based system. But Blue Cross only uses the offer rate to claim that employer-based insurance is not on the decline.

Here’s what the North Carolina Institute of Medicine says:

Even though ESI [employer sponsored insurance] is the largest source of health insurance coverage, the proportion of individuals covered by ESI has steadily declined over the past few years. In 2000, the ESI coverage rate for all North Carolinians was nearly 68%; today it is six percentage points lower. There was a similar drop among full-time workers, from 79% in 2000 to 74% in 2004.

The above quote is taken from the NC IOM report of the North Carolina Task Force on Covering the Uninsured. Barbara Morales Burke, who now works for Blue Cross, served on this task force; Bob Greczyn, CEO of Blue Cross served on the task force; and Andrea Bazan, corporate board member of Blue Cross served on the task force. If Blue Cross honestly thinks that ESI is not on the decline in North Carolina all of these people should have objected to the NC IOM printing such blatant misinformation.

Fourth “myth”:

Most workers aren’t happy with the quality of the health coverage they receive from employers.

I’ve never heard someone make this claim. But Blue Cross does have a point here, most people like the coverage they have at work. That’s why there would not be an exodus to a public plan even if it were open to everyone.

Fifth “myth”:

Government programs don’t impact the cost of private care.

The claim here is that Medicare and Medicaid underpay doctors and hospitals for services and that private insurers are forced to overpay so that those doctors and hospitals can still make ends meet. Blue Cross likes to claim that there is $88 billion in cost shifting from public programs to private insurance.

So where does the $88 billion figure come from? Here’s the first sentence in the study [3]:

At the request of America’s Health Insurance Plans, the American Hospital Association, the Blue Cross Blue Shield Association, and Premera Blue Cross, Milliman has prepared this comparison of hospital and physician payment levels among Medicare, Medicaid and commercial payers.

That’s right, it’s a Blue Cross study. Milliman tries to capture the national dynamic but it’s difficult since payment rates vary drastically by region. North Carolina, for example, has pretty good Medicaid reimbursement rates, which allows programs like Community Care of North Carolina to thrive. Also, because Blue Cross contracts with providers are strictly confidential we don’t know how much Blue Cross pays to hospitals and doctors in our state.

Plus, commercial insurers should reimburse more because they cause bigger headaches for providers.

Sixth “myth”:

Most employees would rather have a higher salary than employer-provided health coverage.

Never heard this claim either. Although some people (especially young, healthy people) would probably prefer a higher salary if their employer is only able to offer some sieve-like insurance plan.

Now, I probably don’t have to tell you that Blue Cross executive know a great deal about health care in our state. They are not accidentally posting false and misleading information on their website. They just call myths facts and facts myths because they know they can get away with it.

That’s why we’ll call out every lie — for whatever it’s worth.