2018 MIDTERM ELECTION

Time: D H M S

In which Dan Diamond dismantles the "60 Minutes" attack on Obamacare in 1,500 words

Last night, "60 Minutes" had a segment about Steven Brill's new book, "Bitter Pill", which is an attempt to tell the comprehensive story of how the Affordable Care Act (aka Obamacare) was created.

I don't know much about Brill other than that he did write a compelling account of the technical problems at HealthCare.gov (along with the successful "Apollo 13-style" effort to repair the site) for Time Magazine last fall. Obviously he's a talented writer and he's done a bunch of research. This post isn't about his book itself, which may or may not be brilliant & dead-on target...I haven't read it, so I'm in no position to judge.

However, the 60 Minutes segement itself was a bit, shall we say, lacking. You may or may not be able to actually watch the segment at the link--it isn't available as I type this--but the full transcript is included. Those in the know should pay attention to not just what is said and how it's presented, but also what isn't discussed. Yes, it's a 13-minute TV segment, not an in-depth analysis, but there are still some gaping holes and questions which are never answered or even brought up.

Fortunately, Dan Diamond has already written an excellent list of a half-dozen points on which the 60 Minutes segment falls on it's face:

60 Minutes on Sunday ran an eye-raising exposé of the health law’s many shortcomings — or as correspondent Lesley Stahl called the segment, “What Obamacare Doesn’t Do.”

Unfortunately, when it came to telling a complete story about the Affordable Care Act, there was a lot that 60 Minutes itself didn’t do.

That’s too bad, because the incredibly popular and venerable newsmagazine is a force for steering national conversation. And 60 Minutes acknowledged that the ACA has accomplished some good, like help 10 million uninsured Americans get access to care.

Here were six of my biggest sticking points with 60 Minutes — and an argument for how they could’ve presented them instead.

I strongly recommend reading Diamond's whole piece.

In addition to the points he raises, here's a couple of additional ones which were raised by others in a quick Twitter discussion last night:

From Adrianna McIntyre of Vox.com:

Here's the clip of Brill on 60 Minutes: http://t.co/tz24FnASdx Parts of the discussion feel limited to the point of being unhelpful.

— Adrianna McIntyre (@onceuponA) January 12, 2015

e.g., what's happening with the slowdown, what the differences are between for- and not-for-profit hospitals—important, nuanced issues!

— Adrianna McIntyre (@onceuponA) January 12, 2015

Dan Goldberg of Capital New York:

@onceuponA and did that guy HAVE to go to ms Anderson or just want to ? Would cheaper in network option have produced same outcome?

— Dan Goldberg (@DanGoldbergCNY) January 12, 2015

And, if I may be so bold, from...myself:

@DanGoldbergCNY @afrakt @ddiamond will do. Also noted zero mention of the 80/20 med loss ratio, which seems worth at least a nod...

— Charles Gaba (@charles_gaba) January 12, 2015

Goldberg's point is the one which bothers me the most. In TV segments like this, the "Human Face" factor--interviewing "case study", "normal, everyday folks" can be far more compelling than throwing a bunch of numbers and statistics around. That's why when the Koch Bros attacked the ACA in a series of TV commercials last spring, they used "normal people" with "real life" horror stories about how Obamacare was "destroying their lives" bla bla bla.

Of course, pretty much all of those ads turned out to be a big ol' tub of malarkey, as Joe Biden might put it. In some cases the ads used actors. In other cases, the medical situations of the people featured may have been absolutely accurate...but they flat-out lie about how much their new policy is costing them (in the infamous Boonstra case, she's actually saving $1,200/year under her new plan).

This wasn't limited to "official" Koch Bros ads, of course; in the GOP's response to the State of the Union address last year, Republican Representative Cathy McMorris Rodgers used the case of "Bette in Spokane" Washington, who supposedly is paying $700 more per month because of the ACA. In that case, it turned out that the woman in question didn't even have true health insurance coverage to begin with and never even bothered visiting the website to see what options--and tax credits--were available.

It's important to stress that I am not attacking the Recchis' story on 60 Minutes, and it's entirely possible that the MD Anderson cancer center was the only reasonable option for his cancer situation. However, as Goldberg notes, the 60 Minutes segment never even asks the obvious question: Did they bother to check with other cancer centers to see what their options were? Maybe they did, maybe they didn't, but 60 Minutes never even asked. Here's the relevant section from the transcript (remember, this was before the ACA):

Sean Recchi: I just want to get healthy and that's what I told 'em.

Their story begins in 2012 when Sean Recchi - then 42, father of two - was diagnosed with cancer, stage 4 non-Hodgkin's lymphoma.

Sean Recchi: I have two young children. You know, I wanna see 'em get married. I wanna see my grandchildren. You know. Too early.

Stephanie was determined to get him to MD Anderson in Houston, one of the premier non-profit cancer centers in the country. But because their health insurance policy was so limited, they had to pay upfront: first $48,900 for the evaluation...then more for the actual treatment.

Stephanie Recchi: And they told me that we would have to give them another $35,000 to get him, to get chemo.

Lesley Stahl: Did you have the money?

Stephanie Recchi: I didn't. My mother did.

Lesley Stahl: Your mother had to give you the money?

Stephanie Recchi: Yes. I just kept thinking in the back of my mind, there's a mistake and we'll work it out. I just have to get him there and I have to get him better. That was my main concern.

When Sean was sick, they felt vulnerable and scared. Like most people in that kind of crisis, they never once asked what any specific item or test cost. When they got the bill, they gave it to Steven Brill, who found charges he couldn't believe.

Again, as Goldberg notes, why did it have to be MD Anderson? Was there a particular doctor there who they trusted? Was the particular chemo treatment he needed only available there? The family is from Ohio, but the center is in Houston, so I assume it wasn't a case of geographic limitations.

And yes, it's true that most people in a medical crisis tend not to think too rationally about financial decisions. On the other hand, as Goldberg noted later on:

@charles_gaba hard to know w/o medical chart. Also 60 min/brill said in times of crisis and panic we don't make good choices. 1/2

— Dan Goldberg (@DanGoldbergCNY) January 12, 2015

@charles_gaba but this man wasn't having a heart attack or stroke. They chose best hospital and were told in advance the costs. 2/2

— Dan Goldberg (@DanGoldbergCNY) January 12, 2015

Once again: I am not ripping on the Recchis here. They may have had perfectly good reasons to insist on this particular medical center vs. a different one.

My beef is with 60 Minutes for never even asking the basic questions I asked above (or, if they did ask, never bothering to address the questions or answers in the segment).

Anyway, read Diamond's piece.

UPDATE: OK, until now I wasn't sure whether it was fair to characterize the 60 Minutes piece as an "attack" on the ACA or not; it could just be sloppy work or poor editing or something.

However, thanks to Michael Hitzik for pointing out this piece by Steve Benen of MSNBC from last January...regarding the exact same couple:

.@DanGoldbergCNY @onceuponA isn't this the same family that called the ACA a "godsend"? Was that in 60 minutes? http://t.co/ARxIifOiP0

— Michael Hiltzik (@hiltzikm) January 12, 2015

Sure enough, check this out:

Sean Recchi, a small-business owner in Lancaster, Ohio, was diagnosed with cancer in 2012. The business he and his wife ran wasn’t making a lot money; the family was forced to borrow heavily; and officials at the cancer center where he sought treatment said his insurance was effectively worthless.
 
Despite these horrific circumstances, Sean’s wife, Stephanie Recchi, told Time’s Steven Brill last fall, “I don’t think Obamacare will help us. I don’t want anything to do with it.” She added, “I hear a lot of bad things about it – that it doesn’t cover pre-existing conditions and it’s too expensive.” Why did she believe this? Recchi said she’d seen “television ads and some politicians talking on the news.”
 
Here’s a family facing a terrible ordeal, through no fault of their own, and clearly in need a hand. But they’d been misled by charlatans and cranks, feeding on public confusion, and leaving the Recchi family with a mistaken impression of reality.
 
That was a few months ago. Brill published a follow-up report this week, noting that “what has happened to the Recchis and their health care options more recently might be emblematic of the law’s potential” (via Joan McCarter).

“When they came to my office, Stephanie told me right up front, ‘I don’t want any part of Obamacare,’ ” recalls health-insurance agent Barry Cohen. “These were clearly people who don’t like the President. So I kind of let that slide and just asked them for basic information and told them we would go on the Ohio exchange” – which is actually the Ohio section of the federal Obamacare exchange – “and show them what’s available.”
 
What Stephanie soon discovered, she told me in mid-November, “was a godsend.” The business that she and her husband had launched … had recently received investor interest after being featured on an episode of the television series CSI. So she estimated to Cohen that their income would be about $90,000 in 2014. But even at that level, her family of four would qualify for a subsidy under Obamacare.

Yeah. I'd say "attack" or "hit piece" is about right.

True, the point of the 60 Minutes piece was that the actual cost of treatment continues to skyrocket, even if the patients themselves are no longer going bankrupt from having to pay that cost. And yes, they do note that Mr. Recchi is now cured, has good insurance and will never again face the prospect of bankruptcy due to medical bills:

Sean Recchi: I am 100 percent cancer clean, and feel great.

Even though he's $84,000 in the hole. Today - despite Sean's preexisting condition, the Recchis have good health insurance, because in 2013 they signed up for Obamacare. So now they have total coverage, 100 percent subsidized by taxpayers.

However, even there the angle is presented as if the Recchis are somehow "scamming" taxpayers--not to mention making it sound as though they aren't "taxpayers" themselves.

As a side note, there's this rather confusing exchange:

Lesley Stahl: So Obamacare has passed. MD Anderson goes to give someone Rituxan, are they still charging $13,700?

Steven Brill: They probably are if you don't have insurance.

If you do have insurance - through Obamacare or otherwise, prices would in most cases, be negotiated down. What about the Recchis' $84,000 bill at MD Anderson in Houston? It would most likely not be negotiated down because they signed up for Medicaid under Obamacare in Ohio, which is not recognized in Texas.

Wait a minute: According to Benen's piece:

What Stephanie soon discovered, she told me in mid-November, “was a godsend.” The business that she and her husband had launched … had recently received investor interest after being featured on an episode of the television series CSI. So she estimated to Cohen that their income would be about $90,000 in 2014. But even at that level, her family of four would qualify for a subsidy under Obamacare.

The Recchi family zeroed in on a plan with a $793 monthly premium, which would ultimately cost $566 a month thanks to the ACA subsidy. That was based on $90,000 income – if the family made $40,000, as it had last year, the premium would have cost them $17 a month.

So wait a minute...are they on Medicaid or were they on a private QHP?? It says they "signed up for Medicaid "under Obamacare" in Ohio" which wasn't possible until 2014, well after the actual treatment. So now I'm just confused.