What Steven Brill and 60 Minutes got wrong about Obamacare

by Rob Cullen on February 24, 2015 - 1:52 AM

steven brill and lesley stahl

If you asked us to name the best article on health care we’ve read, near the top of the list would be Steven Brill’s 2013 Time Magazine cover story, “Bitter Pill: Why Medical Bills are Killing Us.” It’s a fascinating (and at 36 pages, thorough) look at a topic that affects all of us: America’s ridiculously high medical costs.

Brill’s follow-up articles were also excellent. His “Hate Obama, Love Obamacare,” published in January of 2014, was one of the best assessments of Obamacare’s successes and shortcomings in providing access to care that we’ve seen; and “Obama’s Trauma Team” was an interesting look at how the healthcare.gov website was fixed so quickly after its disastrous launch.

We expected his new book, America’s Bitter Pill, would be equally great since it combines that previous work with new behind-the-scenes reporting on the passage and launch of the Affordable Care Act. The result, however, is less than the sum of its parts, and one of the book’s main assertions– that there’s almost nothing in Obamacare to control healthcare costs– is wrong.

Unfortunately that was the part of the book that 60 Minutes focused on in a recent segment featuring Brill. The result is a trainwreck of misinformation.   [click to continue reading…]


wolf and corbett

There was big health care news in Pennsylvania this week: as promised, newly elected Democratic governor Tom Wolf has announced the first steps in transitioning the state away from his predecessor’s Healthy PA plan to full Medicaid expansion under Obamacare.   [click to continue reading…]


child getting vaccinated

As a website devoted to explaining complicated topics in healthcare, we haven’t really tackled the vaccination debate before, because, well… it’s not all that complicated. The science is clear: there’s no evidence that vaccines cause autism. End of story.

Or at least it should be. With so many people choosing to opt out of vaccinations, an outbreak of measles– a disease that the Centers for Disease control considers eliminated in the U.S.– recently infected at least 40 people at Disneyland who spread it to at least six states. In the midst of this, some prominent political leaders (most notably Rand Paul) have implied that vaccines actually do cause “profound mental disorders” despite zero credible evidence, while others, like New Jersey Governor Chris Christie, have said that the decision whether or not to get a vaccine is simply a matter of personal choice.

But while vaccines have gotten much more attention in recent weeks, there’s still not that much to say about the issue. According to Aaron Carroll, a professor of pediatrics at the University of Indiana who blogs at The Incidental Economist, all that really needs to be said on the subject are these points:

  1. Measles is a terribly infectious illness that is a public health issue.
  2. There’s a vaccine that is amazingly effective.
  3. The vaccine is very, very safe, and it doesn’t cause autism.
  4. Policies in the United States should try and encourage all children to get immunized, as we need almost everyone to be immune to achieve herd immunity.
  5. We should allow some people to forego vaccination if they absolutely must, but we should try to make sure it’s not for reasons that are scientifically wrong – ie violate (1), (2), or (3).
  6. Unvaccinated people can be restricted from certain public activities (ie school) during emergency situations like outbreaks.

We agree; however, we thought it might be helpful to explain the reasoning and scientific evidence behind each of them.   [click to continue reading…]


CBO director Doug Elmendorf testifies before the House Budget Committee

Current CBO director Doug Elmendorf testifies before the House Budget Committee

The thing that stood out most for us in the Republican response to the State of the Union last week was what was missing. Aside from a call for President Obama to approve the Keystone XL pipeline, Iowa Senator Joni Ernst didn’t mention a single specific policy. She criticized the Washington mindset that “gave us political talking points rather than serious solutions,” shortly before launching into… a list of political talking points:

  • “We’ll propose ideas that aim to cut wasteful spending and balance the budget.”
  • “We’ll advance solutions to prevent the kind of cyberattacks we’ve seen recently.”
  • “We’ll work to confront Iran’s nuclear ambitions.
  • “Let’s simplify America’s outdated and loophole-ridden tax code.”
  • “We must also honor America’s veterans.”

There was however, one substantive part of the speech– a quick mention of something the GOP had already done: “The new Republican majority you elected started by reforming Congress to make it function again.” It’s a vague claim, but since it supposedly already happened, it’s also something we could look into.

We found one helpful reform in the House: scholars from think tanks testifying before the House will now have to disclose whether their organizations have received money from foreign governments. And in the Senate, new majority leader Mitch McConnell has promised to allow members of both parties to offer more amendments to bills than they could under Harry Reid (although it’s not an official rule change– he could easily change his mind and clamp down on amendments when it suits him).

However, as the New York Times reports, rather than “making Congress function again,” many of its new rules are an attempt to game the system for Republicans:

One new rule allows the House to overturn recommendations of an independent panel created by the Affordable Care Act to trim Medicare costs. Another makes it more difficult to shift Social Security money between the program’s different trust funds, increasing the likelihood that deep cuts to disabled workers and their families will be made as the Disability Insurance Trust Fund nears depletion in 2016. That quickly drew condemnation from AARP, the powerful lobby for retired people.

But the most troubling examples of Republican “reforms” are those targeting the Congressional Budget Office: replacing its respected director and changing the way it estimates the costs of bills. If politics were a football game, this would be the equivalent or replacing the ref and rigging the rules to favor your team.   [click to continue reading…]

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The Health of the Union 2015

by Rob Cullen on January 21, 2015 - 9:56 PM

obama sotu 2015

Compared to past President Obama’s past State of the Union addresses, this year’s was an unusual one for health care. The words “Affordable Care Act” weren’t spoken at all, and the only reference to the president’s signature law was a brief sentence mentioning the uninsured who gained coverage and the recent slowdown in the growth of healthcare costs. The omission of the ACA is especially odd considering that (1) so far the law has not just met, but exceeded its goals for expanding coverage and controlling costs; and (2) there’s another month left of open enrollment to buy coverage for 2015– something it seems like the president would want to mention.

On the other hand, a bunch of other health care issues did come up in the speech, including a couple that we haven’t really talked about before on this site. Here’s our annual look at health care in the State of the Union.   [click to continue reading…]


An Obamacare guide for filing your taxes

by Rob Cullen on January 13, 2015 - 6:17 PM

looking at tax form

One of the hardest parts about covering America’s healthcare system is that if someone comes to us with a question– even if it sounds relatively simple– there’s almost never an easy answer.

For example, wondering what the penalty for not having health insurance is in 2015? The short answer is it’s $325 per person or 2% of your household income, whichever is higher. But, if we wanted to be more accurate, the real answer is “it depends”– based on your income, family size, how many months you went without coverage, and whether you qualify for any exemptions. Or want to know whether your income is low enough to qualify for Medicaid? Well it depends on your family size and what state you live in. If your state didn’t expand Medicaid under Obamacare, it also may depend on whether you’re pregnant, disabled, a parent, etc.

You might notice that we answer questions with “it depends” a lot.

So we were somewhat shocked that we recently got a question from a reader that seemed like it would require a complicated answer (it’s about Obamacare and filing taxes), but actually did not require an “it depends”:

When you’re filing your taxes, how do you provide proof that you had insurance in 2014?

Answer: You don’t have to provide proof. If you had coverage all year, you simply check the box that says you had full year coverage (line 61 on the 1040). That’s it. Here’s what it looks like:

1040 health coverage reporting

Unfortunately that turned into a slippery slope of other questions with “it depends” answers. What do owe if you didn’t have coverage, or only had coverage part of the year? If you bought coverage on the exchange, how do you determine whether you got the correct subsidy? If you ended up making more money than you estimated when you applied for Obamacare, how much do you have to pay back?

To help answer these questions (and others) we’ve put together a quick guide to how Obamacare works when you’re filing your taxes.   [click to continue reading…]



There was a piece in The New Yorker recently that looked at how psychological research shows that a headline not only determines how many people will read an article, it also “changes the way people read an article and remember it.” Headlines influence your mindset as you read, and if a headline is slightly misleading, reading the actual article may not be enough to correct that initial misconception. People tend to remember information that aligns with the headline and forget information that contradicts it.

The reaction to a recent New York Times article titled “Harvard Ideas on Healthcare, Hit Home Hard” is a perfect example. At first glance, the premise– professors are in an uproar over new deductibles and copays that are the result of policies championed by, well, Harvard professors– sounds almost satirical (we were reminded of The Onion headline, “Urban Planner Stuck in Traffic of Own Design”). Conservatives say it shows how the liberal elite will reject the new law the minute it applies to them. “Obamacare for thee and not for me,” wrote one conservative website.

However, if you read past the headline and first two paragraphs, you see that the article is really about something quite different:

The anger on campus remains focused on questions that are agitating many workplaces: How should the burden of health costs be shared by employers and employees? If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both?

And what’s interesting about Harvard in this respect is buried in the second-to-last paragraph. The university structured its plan in an unusual way, with the hope that it can do both: reduce costs by encouraging employees to use fewer unnecessary services, while still ensuring they don’t have to skip care they actually need. [click to continue reading…]

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What the single-payer movement can learn from Vermont

by Rob Cullen on December 31, 2014 - 10:28 AM

peter shumlin

There was some bad news for supporters of single-payer healthcare this week: in what he’s calling “one of the most difficult decisions of my public life,” Vermont’s governor Peter Shumlin announced on Wednesday that he was abandoning– at least for now– his plan to enact a single-payer system in the state. Supporters had hoped that Vermont would be a model for the rest of the country, so it’s worth examining what lessons the single-payer movement might take from this setback.   [click to continue reading…]


Our guide to getting covered under Obamacare (updated for 2015!)

by Rob Cullen on December 12, 2014 - 6:44 PM

The first deadline for Obamacare’s second year is coming up fast– for coverage that starts on January 1, you have to sign up by this Monday, December 15– and the February 15th end of open enrollment for 2015 will be here before you know it. Buying insurance can be ridiculously confusing, especially if you’ve never done it before, and on top of that, the deadlines, income guidelines, and penalties have all changed since last year. But don’t worry: to help make the process a little easier, we have a new guide to getting covered under Obamacare for 2015!   [click to continue reading…]


UK - Candle Light Vigil for Michael Brown at US Embassy in London

A few weeks back, when a grand jury failed to indict the police officer who shot and killed an unarmed teen in Ferguson, Missouri, sparking waves of protest, former NYC mayor Rudy Giuliani had this to say on Meet the Press:

The fact is that I find it very disappointing that you’re not discussing the fact that 93 percent of blacks in America are killed by other blacks. We are talking about the significant exception here [in the Brown case]. I’d like to see the attention paid to that that you are paying to this.

Plenty of people have already pointed out that Giuliani’s statements are both (1) offensively misleading (he neglects to mention that 84% of whites are killed by other whites); and (2) willfully ignorant of the point of the protests. Atlantic Magazine’s Ta-Nehisi Coates puts it succinctly in “The Gospel of Rudy Giuliani”:

Yes. It’s almost as if killers tend to murder people who live near them. Moreover, it seems that people actually hold officers operating under the color of law to a different standard.

But as a healthcare blog, we were interested in his dismissal of police violence as a “significant exception.” Of course other homicides happen much more frequently, but since we’re hearing a lot about police killings lately, we were curious– what are the exact figures? Are these shootings becoming more common? Are they more likely to occur in certain areas? How many people who are killed were unarmed? How much more likely are police to shoot people of color?

Turns out Giuliani wasn’t able to offer an exact figure because no one is keeping track. [click to continue reading…]