Editorial Opinion: Fact Check Please!

Fact checkers, always a busy group during election seasons, have been working overtime recently to try to keep politicians honest and the public informed. For example, The Tampa Bay Times publishes Politifact.com, a score-card about politician statements related to health care.¹ As of this writing, it is discouraging, albeit not surprising, that less than half (46%) of all statements made by politicians about health care are factually correct, which includes statements that are mostly true (15%) and those that are half true (19%). 

Persons like us in particular (ie, educated in the sciences) find it helpful to have our facts straight. So, let’s go through a few common phrases you and your patients may hear repeatedly during this election cycle. 

1. Medicare spending is out of control. Not really. According to a recent Kaiser Family Foundation² report, the growth of Medicare spending has decreased notably. Between 1989 and 2014, Medicare spending per enrollee increased an average of 5.5% per year. This increase lessened to 1.4% per year between 2010 and 2015. Thus, despite increased enrollment since 2011, average annual growth declined from 9% between 2000 and 2010 to 4.4% between 2010 and 2015. However, the spending per enrollee and overall growth is expected to increase again, with spending increases on prescription drug costs (Medicare part D) averaging 5.8% per year. 

2. In America, we pay the highest prices in the world for prescription drugs. Mostly true. According to the International Federation of Health Plans³ and following a review of more than 370 million medical and 170 million pharmacy claims, American consumers pay some of the highest prices in the world. For example, a 30-day supply of rivaroxaban (Xarelto, Janssen Pharmaceuticals, Inc, Titusville, NJ) costs $102 in Switzerland and an average of $292 in the United States. If you live in the United Kingdom, a 28-day supply of adalimumab (Humira, Abbvie, Inc, North Chicago, IL) sets you back $1362, half of the $2669 cost in the US. 

3. Market competition will keep prescription drug costs down. Considering the increases in Medicare part D spending and the report cited earlier, this clearly has not happened. In 2003, when Medicare part D was signed into law, Congress added specific language stipulating that the secretary of Health and Human Services could not interfere with negotiations involving drug prices. It was believed a market-oriented approach would keep prices in check. Calls to allow Medicare to negotiate lower prices are heard loudly again this year. However, the Central Budget Office⁴ has said that simply removing the non-interference clause for negotiating drug prices will have a negligible effect on federal spending without instituting other measures such as establishing a formulary. 

4. Health care costs have skyrocketed because of Obamacare. This is false, but commonly heard. As Drew Altman⁵ wrote in The Wall Street Journal, “The slowdown in health-care cost growth has been all but invisible to the average consumer.” Average increases in health care spending and premiums have increased a very moderate 5% per year during the past 10 years (see Figure 1), but consumers are now spending a great deal more than they did in the past. Overall premiums increased moderately, but worker contributions for employer-sponsored coverage jumped from an average of $779 in 2009 to $899 per year in 2010. Between 2005 and 2014, cumulative consumer-per-year spending on deductibles increased from 18% to 256% while cumulative spending by insurance companies increased from 7% to 58% (see Figure 2). In other words, health care costs have not increased substantially; consumer costs have.

5. Health insurance rates will increase in 2017. No doubt about it. In several but not all states, insurance companies have requested double-digit rate increases. Reasons cited include increases in the price of prescription drugs, projected medical costs, and other premium components.⁶ All 3 include administrative costs. A quick fact check on some administrative costs: in 2014, the median compensation of CEOs in health care (including hospitals, pharmacy chains, pharmaceutical companies, and insurance companies) was $5.4 million, with a median increase of 9.6% over the prior year.⁷ 

A sound byte from the movie The American President that rings particularly true: Politics is perception. Sometimes despite the clearest of facts, it is difficult to convince people otherwise when they believe what they think is true. At the very least, health care providers should operate (pun intended) from a position of knowledge and truth and do their best to proliferate accuracy in this time of huge decisions. 

References

1. Politifact. Statements about Health Care. 2016. Available at: www.politifact.com/subjects/health-care. Accessed July 24, 2016. 

2. The Henry J. Kaiser Family Foundation. The Facts on Medicare Spending and Financing. July 20, 2106. Available at https://kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/. Accessed July 29, 2016.

3. International Federation of Health Plans. 2015 Comparative Pricing Report. Available at: https://static1.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/578d34649de4bb15e7a9f2e2/1468871781348/2015+Comparative+Price+Report_Final+071516.pdf. 

Accessed July 30, 2016.

4. The Henry J. Kaiser Family Foundation. Searching for Savings in Medicare Drug Price Negotiations. February 9, 2016. Available at: https://kff.org/report-section/searching-for-savings-in-medicare-drug-price-negotiations-issue-brief-8834/#endnote_link_176347-11. Accessed July 30, 2016.

5. Altman D. Why consumer issues are rising on the health agenda. The Wall Street Journal. Available at: https://blogs.wsj.com/washwire/2015/09/22/why-consumer-issues-are-rising-on-the-health-agenda/. Accessed July 24, 2016.

6. American Academy of Actuaries. Issue Brief. Available at: https://www.actuary.org/content/drivers-2017-health-insurance-premium-changes-0. Accessed July 30, 2016.

7. Evans M. Top-paid Healthcare CEOs See Pay Grow Faster Than Profits. Available at: www.modernhealthcare.com/article/20150425/MAGAZINE/304259980. Accessed July 30, 2016.