Good News -- Bad News

By Kim Bellard, December 19, 2011

Reading several recent news stories, I’m reminded of an old joke.  A man gets a call from his doctor, who informs him he’s got the results of some tests.  The doctor tells the man there is some good news and some bad news, and asks the man which he’d like to hear first.  The man is taken aback, but – optimist that he is – asks for the good news first.  The doctor dutifully informs the man he only has 24 hours to live.  The man is stunned.  “That’s the good news?” he asks incredulously.  “What the hell is the bad news?”   Rather sheepishly, the doctor informs him, “I was supposed to call you yesterday.” 

(Slight pause here for polite laughter).   

Let’s see how this good news/bad news works in the real world.  Take, for example, a recently released a report by Float – a mobile learning consulting company – on the increasing use of mobile technology in health care.  According to their research, 80% of U.S. physicians already use smartphones and mobile apps, and over half report either already having an iPad or planning to get one in the next six months.  They cite a number of uses for mobile technology in health care, which they expect to increase rapidly. 

That’s the good news.  I’m a huge supporter of more use of technology in health care, especially mobile.  It’s great that it is becoming more mainstream.  However, it is not an unalloyed boon.  The corresponding bad news was discussed in recent reporting by The New York Times on “distracted doctoring.”  They quote Dr. Peter Papadakos, who has published an article on “electronic distraction” in Anesthesiology News, as saying, “You walk around the hospital, and what you see is not funny…My gut feeling is that lives are in danger.”  Dr. Papadokos sees medical personnel on phones, surfing the Internet, and especially on Facebook.  The Times cites another study that indicates over half of technicians who monitor bypass machines were texting or even talking during surgery, even though most acknowledged it was unsafe behavior.  The Times even found situations where surgeons were reportedly making personal phone calls during surgery, using wireless headsets.  Scary stuff. 

It’s much like texting while driving.  We know it’s not safe, we criticize other drivers we see doing it, but we’re so used to the connectivity that the technology allows that we have a hard time drawing appropriate boundaries for ourselves.  Perhaps health care needs a NTSB to warn us when we really shouldn’t be using mobile devices.   

Another good news/bad news example is a recent study by GfK Custom Research North America about the projected impact of ACA on employer health coverage.  The news reports focused on the “good” news – that the majority (56%) of employers said they are likely to continue offering coverage.  "This survey suggests that firms aren’t considering a wholesale flight from employee health care coverage as health care reform is implemented,” said Tim Nanneman, Vice President and Director of Health Insurance Research for GfK, who also added, “However, many employers are skeptical about the potential effects of health care reform.”   

Indeed, the bad news from the study was that 12% of employers already expected to drop coverage, with another third not sure what they will do.  To make things worse, slightly more than half of employers expected their costs to rise because of ACA, with only 11% under their impression their costs would go up more slowly. 

When McKinsey estimated 30% of employers would drop their coverage once the exchanges were operational, they were excoriated by the Administration and other ACA supporters.  There were some flaws in the McKinsey methodology that left it somewhat open for the criticism, yet I’m surprised that a study showing barely half of employers expect to continue coverage hardly rates a mention, or is reported as good news.   I find GfK’s results deeply troubling – although not surprising. 

Speaking of costs increasing under ACA, the final piece of good news/bad news was the recent announcement by HHS that more young adults got coverage due to ACA provisions than expected – some 2.5 million in total.  Earlier estimates had shown one million newly covered, so the Administration took some pride in this even higher estimate.   

Everything being equal, of course, getting 2.5 million more people covered is good news.   The reality, though, is that everything else isn’t equal.  The bad news is that there is a cost to this good effect.  I read the HHS press release carefully, as well as the news accounts of it, and I didn’t see mention of the cost of those additional 2.5 covered young adults.  I previously blogged on the cost of ACA’s already implemented provisions, but the thing to remember is that this expansion is a tax on employment-based insurance.   By which, of course, I mean it is compensation taken from workers’ paychecks.  That’s the bad news.  For workers with single coverage, or who have families which do not include young adults, I might be wondering why I am paying for these young adults’ coverage.   

It never made much sense to me for this provision to be Rube Goldberg-ed onto our already jury-rigged employer-based system, making employers cover not only people who are not only not employees but who also are not even dependents of workers.  But it was politically expedient to do so and hid the costs.  The Administration is kind of in a bind: either this population doesn’t cost very much, in which case the 2.5 million perhaps isn’t worth crowing about, or the costs are substantial, in which case it should be more honest about them and who is bearing those costs.  I do think we’re talking billions of dollars annually.   When HHS starts reviewing health insurance price increases, it should remember its own complicity in at least some part of those increases.  It won’t, of course. 

There are lots of calls for transparency in health care, but we need to remember this shouldn’t just be about reporting the numbers.  The truth is rarely one-sided – something hard to remember in this hyper-partisan era – and we all should look at both sides of issues.  While I’ve been writing this blog, Reps. Wyden and Ryan have come out with their Medicare proposal, and Secretary Sebelius announced the flexibility that states will get in developing essential benefits packages…now I need to go take a look at the good and bad of each of those!