Two day ago, the Washington Post wrote up an article documenting the often unstated connections between the Lewin Group -- whose health care talking points have been widely cited by those trying to derail reform -- and the health care industry. Did you read it? If not, don't feel too bad, the staff of professional journobarista extravaganza Morning Joe haven't either.
Earlier today, Morning Joe hosted a discussion of the health care reform bill with Republican Representatives Tom Price (Ga.) and Dave Camp (Mich.). It didn't take long for the Lewin Group to come up:
MIKE BARNICLE: I have heard the President of the United States say to me through the television, that if I like my health care plan, under this proposal going forward, I keep my health care plan. If I like my doctor, I keep my doctor. I think I just heard you say that this plan means government intervention and government bureaucrats dictating to me what doctor to go to and what kind of health plan I'm going to have. Are you telling me that the President is kidding me?
PRICE: What I'm telling you is the President says the right things oftentimes, but sometimes...my sense is that he hasn't read the bill before the committees and on the floor of the House of Representatives. Because the bill that's on the floor of the House, or will be on the floor of the House next week has a stipulation that within five years every single health plan, every single health insurance policy in this nation must look exactly the same. What that means to me and folks across this land who may have health insurance policies that don't look just like that, you won't be able to keep it. In fact, The Lewin Group did a study that demonstrated clearly that more than a hundred million Americans -- a hundred million Americans! -- will be moved --
BARNICLE: What's the Lewin Group?
PRICE: It's a study group. it's a nonpartisan private study group that looks at public policy issues.
BARNICLE: Who funds them?
PRICE: Who funds them? I think they are a foundation. what they have shown is over 100 million Americans will be forced from private personal insurance to the government-run program. That ought to give pause to everybody. And that's why we believe we ought to sit down in a bipartisan way and come up with the positive solutions available to us.
CARLOS WATSON: Congressman Camp, Carlos Watson here. I really appreciated you pointing outlining those three points.
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How annoying! It's like being teased. For a second there, I really thought that Barnicle was going to actually secrete some journalism-like substance. What is the Lewin Group? Let's go to the Post article:
Generally left unsaid amid all the citations is that the Lewin Group is wholly owned by UnitedHealth Group, one of the nation's largest insurers.
More specifically, the Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association, a physician's group, of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied its parent company and other insurers with data that allegedly understated the "usual and customary" doctor fees that insurers use to determine how much they will reimburse consumers for out-of-network care.
In January, UnitedHealth agreed to a $50 million settlement with the New York attorney general and a $350 million settlement with the AMA, covering conduct going back as far as 1994.
Ingenix chief executive Andrew Slavitt said the Ingenix data was never biased, but Ingenix nonetheless agreed to exit that particular line of business. "The data didn't have the appearance of independence that's necessary for it to be useful," Slavitt said.
Lewin Group Vice President John Sheils said his firm had nothing to do with the allegedly flawed Ingenix reimbursement data. Lewin has gone through "a terribly difficult adjustment" since it was bought by UnitedHealth in 2007, because the corporate ownership "does create the appearance of a conflict of interest."
But outside of the fact that the Lewin Group is owned by the insurance companies (and it should be noted that supporters of health care reform have also cited Lewin's findings for their purposes), this particular statistic, which Price discusses, applies to no health care plan that's currently being proposed. Jacob S. Hacker addressed this recently, in The New Republic:
According to the group's new analysis, if all employers and individuals in the country could buy into a national public plan that paid Medicare's rates to doctors and hospitals, over 131 million Americans would enroll in the public plan. That number is half the population not covered by Medicare today, and a much higher enrollment in the new public plan than any previous analysis of proposals of this sort have come up with--including the Lewin Group's own analysis of my 2007 proposal for health care reform, a proposal that includes public plan choice and which looks a lot like, but not identical to, the proposal that President Obama embraced during the campaign. (The Commonwealth Fund has also advanced a proposal along these lines, which the Lewin Group has also examined.)
Conservatives have predictably seized on the Lewin Group's findings to argue that the proposal to have a public plan compete with private plans is a "Trojan horse" for a universal Medicare-for-all program of national health insurance. A case in point is a new editorial from the Wall Street Journal, titled "The End of Private Health Insurance."
But the Lewin Group's new report suggests nothing of the sort. While it does indicate that the savings from having a public plan compete with private plans could be huge (as has every previous analysis of public plan choice), it has virtually no bearing on the question of how large enrollment in the public plan would be under a reform proposal like mine, or like President Obama's campaign proposal, or like Senator Baucus's 2008 "White Paper". That's because the illustrative proposal that the Lewin Group analyzed is fundamentally and strangely different from these proposals -- in ways that assure that enrollment in the public plan will be much, much larger.
I have posted a long (fairly technical) discussion of the Lewin Group analysis and where it goes awry on the website of the Institute for America's Future. Readers interested in the gory details should go there. But in a nutshell, the Lewin Group looked at a hypothetical proposal in which employers could buy into a national public plan by paying the plan's premium. What's more, in the hypothetical proposal that the Lewin Group examined, new rules would be imposed on employment-based health insurance that would vastly increase the cost for some firms of providing coverage. No wonder the public plan was projected to be big!
By contrast, all the proposals that are actually on the agenda today have employers buy into an "exchange" that has both a public plan and private plans as a choice within it. Moreover, all these proposals have at least large employers enroll their workers in the exchange by paying a payroll-based contribution, not the public plan's premium. Finally, none of these proposals includes substantial new regulations on employment-based health insurance.
All these may seem like small distinctions, but they're not. They are the difference between the huge public plan that Lewin's analysis foresees, and the likely effects of the proposals that are actually being debated today--which, according to prior estimates by the Lewin Group itself, result in more Americans having private insurance after reform than they do today.
It's also worth pointing out that Price was allowed to state that government intervention in health care is "not what the American people want." In fact, the public option has been and remains astoundingly popular with the American people.
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