A conservative friend of mine whom I deeply respect as both an intellectual and moral thinker has written a response to
. He raises some more-than-fair objections to a number of my assumptions and interpretations. I plan to respond to his post in full at a later date, but for now I just wanted to get it up and out there for the world to see, lest I be accused of being unwilling to face criticism and, in some cases, outright embarrassing corrective. Much to my friend's chagrin, I haven't changed my overall conclusion about the ad AFP made, but I do believe that his points are solid and that I did indeed make some mistakes which you can read all about below.
Let me be clear that my posting his response is not an endorsement of his opinion or anything he says within. I'm just sharing it because I think it is only fair to let readers see what turn out to be some valid objections to some of my previous statements.
Let me start off by agreeing with the main thrust of your
first five paragraphs. Let me continue by agreeing with you that it is
detestable that many liberals, after reading Kessler's post, attacked Boonstra,
accusing her of being a liar and/or mocking her. A critic of her ads basically
has to treat Boonstra one of two ways: as a liar or as a
poor, addlebrained cancer patient with no moral agency whatsoever duped and
taken advantage of by the Koch brothers-backed AFP. You’ve settled mostly on
the latter, but I’m not really sure one is a whole lot better than the other.
Boonstra would probably find your explanations of how you could have navigated
her health needs better than she can patronizing and probably wouldn’t much
appreciate your sympathy in light of your using her situation throughout your
post as a cudgel with which to bludgeon those who gave voice to her grievances,
and even her to some extent. Though I suppose we’ve already established it
doesn’t really matter what she thinks…
Paragraph six is where you lose me, for reasons that will be
clear once you’ve finished reading this comment. For the sake of clarity, I’m
going to follow your lead and break up your list of grievances, trying to stick
to your numbering and pointing out the errors you made along the way:
0) Calabrese is a hypocrite for criticizing Kessler for not
speaking directly with Boonstra, and his claims don’t pass the smell test.
If Calabrese’s complaint were solely that Kessler didn't
talk *directly* to Boonstra, I agree with you that would be silly. But his
complaint is primarily not that Kessler's failing isn't that he was unable to
get in touch with Boonstra or anyone at AFP but that Kessler a) took the
insurance company's word (not even a written contract) as gospel, b) did
nothing more than look at a bunch of price lists, c) more importantly, ignored
the fact that Boonstra already had to forgo treatment in the meantime as she
attempted to figure out what her plan will cover (quick note on this in the
next paragraph*), and d) also more importantly, upon becoming aware of
additional facts, failed to give these facts a fair hearing. Kessler at no
point, as far as I can tell, updates his post to account for Calabrese’s
column; his only response to these facts is a credulous endorsement of “a very
detailed look at Boonstra’s situation by Uri Manor, a postgraduate fellow at
the National Institutes of Health,” which he appears not to have read with any
care despite implying the contrary with his endorsement (the Kessler standard is
apparently that false implications get you Two Pinnochios) and which this post
will poke significant holes in. A self-proclaimed “fact checker” like Kessler
ought to account for all the facts, not just the ones that can be spun a
certain way. To the extent Calabrese’s claims "didn’t pass your smell
test," I fear it may be because your sinuses are infected by Kessler’s
original proclamation that Boonstra is a liar, and perhaps by other political
or ideological biases as well.
*Quick note as promised: You comment early
on in your post that you “don’t know of any doctor or hospital that would
refuse to let a cancer patient make multiple smaller payments on a bill,” so
her concerns about upfront affordability can be dismissed. (You wrote “by her,
not us” but I’m assuming you meant “by us, not her.”) But if her previous plan
covered a particular procedure, such as a regular schedule of bone marrow
biopsies (which we’ll get into in further detail below), but it’s unclear
whether her new plan will cover the same frequency of biopsies, she must either
take the chance on a procedure that can cost in the high thousands or forgo it.
Working out an installment plan with the provider, and the hospital, and the
lab, assuming for the sake of argument that’s even as simple as you say it is,
still leaves her deep in the hole. Which means this argument lacks merit with
regard to demonstrating that AFP’s ad was misleading. I strongly question the
assertion that we should ignore the perspective of the person paying the bills
in a conversation about the affordability of those bills anyway. If she can't
ignore her concerns about upfront affordability, neither can
we.
While your attempt to actually address (rather than ignore,
as Kessler chose to) the facts raised by Calabrese is to be commended, your
blogpost is based on a series of assumptions—flawed, as I’ll demonstrate in a
moment—that I think could only have been made were you taking for granted that
Boonstra—er, sorry—that AFP was lying, and that therefore any additional facts
from Herman Cain employee and AFP mouthpiece Dan Calabrese must also be lies.
Frankly, if this reasoning were any more circular, it would come with coupons.
Flawed Assumptions about Boonstra’s Prior
Coverage
You write that you assume, on the basis of Julie Boonstra’s
marriage to Mark Boonstra, who is now a Michigan judge, that Boonstra’s old
plan was the 2013 Blue Care Network plan for Michigan judiciary employees, or
that that plan is at least a “useful upper limit estimate” for her previous
plan. (Unclear why you note that he is the former chair of the Washtenaw County
Republican Party, since it’s not actually relevant to her plan. Most lefty
bloggers cited that fact for the purpose of undermining Boonstra’s credibility, and there isn't really any other reason to mention it. Doesn't
quite sync up with your decision to treat Boonstra as a moron rather than a
liar.) There isn’t a particularly strong basis for declaring the Michigan
judiciary plan the upper limit of coverage she simply must have had; in fact, I don’t think you really have any well-founded basis for
assuming what she was getting for her $1100/month at all; in all likelihood she
would have chosen a plan that best served her own particular needs rather than
those of the Michigan judiciary. Making assumptions about her plan that confirm
your allegations is circular reasoning that reeks of foregone conclusions
and/or bias. I think it severely undermines your fact check from the start.
Particularly since Boonstra’s previous plan could not possibly
have been the Michigan judiciary plan you identified, for
several reasons:
a) Mark Boonstra was appointed to the Michigan Court of
Appeals in March 2012, just over two years ago. Boonstra says she purchased her
canceled plan shortly after being diagnosed with leukemia five years ago.
b) Even if Mark had been appointed five years ago, Julie
Boonstra is actually Mark Boonstra's ex-wife, not his wife, as a number of
articles about her mention. Once they were divorced, she could no longer be on
his plan, which is the one you assume she was on. (At least not through him.
The only way for her to have remained on that plan is through COBRA, but that
doesn’t make sense either, since COBRA runs out after 36 months for former
spouses. I don’t know when the divorce was, but her account suggests she’s been
on her plan longer than 36 months, so it presumably would have run out by now
on its own. COBRA is also not typically the best idea for people who can obtain
a private plan.)
c) Even without getting into that, in the second ad you can
see the letter from BCBS canceling her plan due to the so-called ACA’s new
coverage requirements. These new coverage requirements don’t even apply to employer-provided
plans yet, so it’s surprising you would assume her old plan was an
employer-provided plan and that Kessler wouldn’t have noticed the
glaring error. The many who have lost employer-provided
plans up until now have lost them because of their employers' responses to
Obamacare's incentives, not its coverage requirements.
d) Along similar lines, Boonstra’s 13 March 2014 letter to
the Detroit News says the first thing she did when she was diagnosed with
leukemia five years ago was find a “Cadillac” plan that covered 100 percent of
her expensive treatments. Expensive, but it gave her peace of mind so she could
focus on her health and see the specialists and doctors she needed. A person
can’t just walk out and purchase an employer-provided plan—she is obviously
referring to a plan on the individual insurance market. I think this error is
equally glaring.
e) Her plan had no deductible and basically no co-pays for
brand name drugs, she told the Detroit News. (Per Politifact: "While the
cost of the plan was expensive at $1,100 per month, there were no co-pays or
deductibles. Basically, her out-of-pocket expenses were nonexistent, she
said." The original article appears to be behind a Detroit News paywall.)
This is not true of the plan you identified, and obliterates your assumption
that that plan represents a useful upper limit on her coverage. Amazing the
poisonous deceptions you can see through with even a basic Internet connection,
amiright?
In sum: We can’t be certain what her previous plan was, but
we can be certain it was not the one you identified, demolishing an assumption central to your post that a
slightly more detailed look would have prevented and undermining your fact
check before it gets off the ground.
Continuing on to Calabrese’s contested facts:
1) “Given that [Boonstra’s] new plan does offer home health
care and acute long-term care, it is very misleading to imply that she would
now be shit out of luck if she had to go back to bed for 2.5 years again,” as
Calabrese did by observing that long-term care and nursing care are not covered
by her new plan.
Simply googling acute long-term care ought to sufficiently
demonstrate why we should not "fully expect [her new plan] to be able to
cover whatever she needed if she went through the same 2.5 year ordeal again
(God forbid)" just because her new plan covers acute long-term care. Acute
long-term care means in an acute long-term care facility, not at home, which is
obviously preferable, and which is what her previous predicament called for.
Acute long-term care also tends to be somewhere in the neighborhood of 2.5 to 5
weeks, not 2.5 years, depending on the severity of the
medical condition. It's basically one step below the ICU.
Which leaves us with home health care, which you similarly
misunderstand. Home health care is basically part-time skilled nursing care in
the home. If you need more than 8 hours per day or 35 hours per week, you're
“shit out of luck,” as you put it. And we (and she) have no idea what exactly
her new BCBSM plan would actually cover or how long it would cover home health
care for. All we know is that her previous plan covered her 2.5 years of
bedrest. But since you've already decided she has no credibility and that AFP
is a bunch of liars, you assume she has no idea what she's talking about and no
cause for concern.
Take a closer look at the
statement of benefits you linked to and you can see that for home health care,
she's still paying 20% coinsurance, and if she has to go out of network that's
entirely on her. For skilled nursing care, she's a) limited to 45 days per year
(i.e., there’s no long-term nursing care and she’s "got a big
problem" if she's on bed rest for 2.5 years again), b) the care doesn't
take place at her home, but at a BCBSM-approved facility, c) BCBSM will cover
her only after she reaches her deductible, plus a $500 copay, and d) she still
has to shoulder 20% of the cost herself (coinsurance).
Thus, your assertion that it is very misleading for Boonstra
to imply she'd be in a pickle if she were, God forbid, ever to have to return
to bed rest for another 2.5 years, since her new plan covers home health care
and acute long-term care, is itself misleading. Scratch that: not misleading,
just plain wrong. Her new plan only partially covers home health care, unlike
her old plan if we are to take her at her word. And acute long-term care—which
1) is overkill if a doctor is prescribing bed rest, 2) takes place in an acute
long-term care facility rather than the comfort of home, 3) in which a patient
typically stays for 2.5 weeks(!) not 2.5 years, and 4) which no insurance
company would cover if the appropriate treatment is merely bed rest with some
form of nursing care—is more or less irrelevant. The fact is, her new plan will
not cover circumstances she has faced before as satisfactorily as those
circumstances were covered by her previous plan—the one she was kicked off of
by Obamacare. This is true even under the upper limit you (baselessly) assume
for her previous coverage.
2) “Since glaucoma exclusion is not mentioned anywhere in
the statement of benefits, I'm calling this one a lie. Again - not Boonstra's
lie, but rather AFP (I'm going to assume Calabrese took AFP's word for it).”
I don’t see any explicit mention of glaucoma in the
statement of benefits either, but I assume Calabrese is referring to the fact
that Boonstra’s new plan does not cover vision. This was less than clear on his
part. You can have this one, since he’s almost certainly wrong about glaucoma
treatment not being covered.
However, your reasoning that “it is hard to believe that
they would incentivize getting glaucoma screening for HMO customers, but
entirely fail to treat PPO customers for glaucoma,” is flawed. You fail to
realize or mention that that specific HMO is BCN Advantage, which is Blue Care
Network’s
Medicare Advantage plan. Just because
BCBS incentivizes Medicare patients (with a coupon booklet, yippee…), who are
at higher risk of glaucoma, to get a glaucoma screening covered by Medicare at
no cost to Blue Cross, it doesn't logically follow as you claim that Blue Cross
would pay for glaucoma treatment for non-Medicare customers out of its own
pocket. If something was lost in translation and AFP/Calabrese meant glaucoma
screening rather than treatment, other Blue Cross plans don’t cover glaucoma
screening (see this woman’s
experience,
for example), notwithstanding their incentivizing Medicare patients to get one.
If that's what they meant, they might have been correct, since it’s hard to
tell whether BCBSM considers it covered preventive care – it certainly
doesn’t count as a free preventive screening as far as Obamacare is
concerned, though. If Boonstra's plan is like the aforementioned woman’s plan,
it covers what is essentially a routine eye exam, i.e., the chart with the big
E on top, not a comprehensive eye exam that would detect glaucoma.
3) Boonstra's prescription drugs are covered, and even if
they weren’t, she can get a year’s supply of generic Loratadine for $17, “so
this appears to be yet another example of AFP being incredibly misleading,
coupling an anecdote about a very typical pharmacy/prescription mishap with a
cancer patient's worries about losing life-saving cancer drugs. This is all
obviously intended to create the impression that Boonstra's new health
insurance is going to stick her with paying the full amount for incredibly
expensive cancer-treatment drugs, or else she will die. Obviously, this is not
the case (you can see in her statement of benefits that chemotherapy is
covered), and it is shameful that AFP is willing to use a cancer victim, who is
probably scared out of her mind, to spread this kind of deception. This will
ultimately end up making her look like she doesn’t know how to navigate the
modern world, and all for the sake of AFP and Calabrese's political agenda.”
It is important to note here that due to the disruption of
her plan and her inability to purchase insurance via the dysfunctional website
or any of the dysfunctional workarounds established by the administration,
despite being proactive and trying for months to line up a replacement, she was
still scrambling to line up new insurance days before her prior plan lapsed. Boonstra
was put in an untenable (read: unaffordable) situation by Obamacare, which
kicked her off her insurance plan, an insurance plan which worked for her,
without a viable, functional exchange, essentially leaving her stranded. You
can listen to her
interview with Sean Hannity if you care to hear the specifics of her predicament in her
own words. Or you can read her 13 March 2014 letter to the Detroit News,
“Dexter cancer victim: I'm not lying about Obamacare.” She has quite literally
been faced with the possibility that her medication and tests would not be
covered and she would have to pay for it herself upfront, with or without any
guarantee of reimbursement. All in line with both her ads.
You claim it’s no problem, she can just work out a plan with
the hospital or the drug provider to pay any upfront out-of-pocket costs.
Number one, you don’t know that. Number two, if she can’t, and has to pay a
great deal of her out of pocket costs early, in the first few months of the
year, she may have to pass on a test one month because she doesn't have the
money up front. Under her old plan, she had the security of budgeting $1100 a
month, no more, no less. Having to pay $6350 in the first month, for example,
means having to come up with ~$4700 more than she had to before ($6350 minus
the $1100 she would have budgeted under her old plan minus the $571 to account
for her lower monthly premiums). Second month, ~$3550 more. Third, ~$2550 more.
Fourth, ~$1350 more. I think you'd agree these aren't exactly pittances. I
imagine for most single moms like Boonstra having to come up with that, even
potentially, is accurately described as “unaffordable,” zero Pinnochios.
Potentially having to pass on a test or prescription one month because she will
be paying much of the out of pocket costs in the first few months of the year
and won’t have the money for that test or prescription is not fair, and calling
her or her defenders liars for referring to that situation as unaffordable for
her is low.
Boonstra said that, costs aside, she was still concerned
about the delay while transitioning from plans during the ACA going into
effect. In the Dexter Leader, Boonstra stated that she faced a period of not
being covered and going without the medications that are necessary to her
survival due to technical issues with the ACA website and delays in reaching an
ACA representative over the phone. Your comment above that “this is all
obviously intended to create the impression that Boonstra's new health
insurance is going to stick her with paying the full amount for incredibly
expensive cancer-treatment drugs, or else she will die” is actually accurate.
She was faced with this exact situation, due to Obamacare, because of the upfront
out-of-pocket costs. You meant to imply this was a false impression, so in that
respect you’re inaccurate, but the impression itself is accurate. By this point
in the year, she may be alright. For the first several months of next year, and
I suppose every year, she faces the same issue once again regarding upfront
costs (though she will at least have a better sense of what's covered after
she's paid those costs) and be deprived the peace of mind and ability to budget
she had under her old plan.
Kessler has perhaps never had to worry about such mundane concerns as these, and
certainly hasn't had to
recently,
possibly explaining his inability to understand why this predicament is
unaffordable.
Counter to Glenn Kessler’s claims that you can’t claim a
plan is “unaffordable” when over the course of the year it will provide you
with substantial savings, her plan will not necessarily provide her with the
substantial claims he envisions, forces her to have to forgo care, and of
course a plan can be unaffordable if in the short-term you face costs that are
unaffordable even if in the long-term it may provide you with savings. This is
not a mere “annoyance,” as Kessler puts it, or pain in the ass, as you put it.
No doubt her chemotherapy is covered, but your reiterated
argument that the absolute maximum she can possibly pay for her chemotherapy
drugs ($350), when added to her monthly premium ($571), comes to (~$900), still
less than her previous monthly premium ($1100) is, first of all, silly, as if
her chemo drugs are the only costs she has to worry about, and we know they
aren’t. Secondly, it is based on flawed assumptions about her previous plan and
its deductible: you say the deductible was $400; in fact, she had
no deductible. Thirdly, her plan also says the
maximum copay is actually $300, depending on whether she’s using preferred or
non-preferred, which bumps you up to $450, which puts her at just about where
her old premium was. But we'll generously go along with you, assume she’s using
a preferred provider and therefore has a maximum copay of $200. But this copay
applies to
each drug each month—copayments being
payments made typically at the time the patient receives the service (click the
Prescriptions tab
here).
If she has to fill four drugs, assuming the fifth drug is Loratadine (since I'm
tired and don't feel like checking whether it was five chemo drugs + Loratadine
or four chemo drugs + Loratadine) with a $200 copay, that puts her at $150,
plus $800 for that month. Plus her premium, which puts her several hundred
dollars over her previous monthly premium, contrary to your calculation. (I
believe
this is a significant error on your part.)
Given the cost of chemo drugs (and the supply crisis of generic chemo drugs),
this can't be dismissed as an overestimate. And again, that’s not even the
maximum hit for all medical expenses she may incur, just drugs. Under her old
plan, she didn’t have to worry about that. Under her new plan, she appears to
remain significantly exposed.
4) “Given that we now know her previous, super-awesome plan
cost her a maximum of ~$18,900/year after premiums ($1100/month, according to
Boonstra), out-of-pocket maximums ($1500 in-network, $3000 out-of-network, both
not including deductibles), and deductibles ($400 in-network, $800
out-of-network) are all added up, it does appear that she could end up spending
quite a bit more on her current plan, which adds up to a maximum of $21,468.
But that’s only assuming the worst, and only because she had an insanely
awesome plan before (and only assuming I’m looking at the correct plan).”
Recall: We “know” nothing about her
previous, super-awesome plan that you’ve written here aside from that her
premiums were ~$18,900 a year. Everything else you’ve
assumed, and demonstrably
incorrectly. You have to subtract at least $1200 (since
you're wrong about the deductibles), and probably another $4500 (since you're
probably wrong about the OOP maximums) given her comment that her previous
Cadillac plan essentially covered all expenses. That puts you at about $13,200,
compared to $21,468. (Willing to take your word on the latter number.) But
herein, even by your own original numbers, you demolish your post all by
yourself, without any help from me even. And with my help, correcting your
calculations, even moreso. This pretty much moots your and Kessler’s entire
effort! (Though both were already mooted by the unaffordability of the
immediate potential upfront costs.) At best, by your math, Kessler should have
awarded Boonstra’s original ad one Pinnochio if you agree with him that she
implied she lost her doctor, which is debatable; a reasonable viewer (i.e., one
not specifically looking to discredit her ad) would likely conclude she lost
her insurance plan but kept her doctor, in light of her twice mentioning she lost her insurance plan without also
mentioning she lost her doctor. For the record, by the way, she kept her
specialist only because she intentionally chose a plan that covered that
specialist to replace the plan Obamacare kicked her off of.
You go on here to score AFP for not educating Boonstra about
Obamacare's "huge money/life-savers," namely narrow networks and free
bone marrow biopsies, which is particularly amusing in light of your own need
for education in that regard, given several serious errors you make. I suppose
shame on the AFP for not educating you about them either. So allow me:
“But there is no reason to assume the worst,” you write,
because the ACA
requires insurance companies to provide
free preventive care (including free bone marrow biopsies). Wrong wrong wrong
wrong wrong wrong wrong.
Here is the list of preventive services insurance companies must cover. (That link
goes to healthcare.gov, so no guarantees it will remain functional by the time
you get to it.) Surprisingly easy to track down if you have an Internet
connection. You’re basically saying she’ll do just fine, because the ACA covers
flu shots and some other screening services. Anything not on this list—cholesterol,
diabetes, obesity, STD, HIV, and the other screenings listed there, which are
probably relatively low on the list of most cancer patients' concerns—is not
free. This is another
significant error on your
part.
“This is similar for emergency care,” you write, i.e., no
reason to expect the worst. The
NewYork Times begs to differ:
Some states limit the amount that
out-of-network hospitals and doctors can charge above what insurance has
covered, experts said, but there are no federal curbs on balance billing. The
new health care law, does, however, offer some protections for people who need
emergency care: insurers cannot charge more for co-payments and co-insurance
for emergency services than they would charge when you use in-network
providers. Insurers must also pay out-of-network emergency providers according
to a standard schedule, in hopes of lessening the likelihood that patients will
be left with enormous bills. Still, there’s nothing in the law
that stops health care providers from billing consumers for the balance, which
is what often happens — and exactly what the D’Andrea family
experienced. “This is not an issue that the Affordable Care Act
fixes,” said Timothy S. Jost, a professor at the Washington and Lee University
School of Law and expert on health care laws. “It is conceivable that the problem
gets worse for some people if the Affordable Care Act encourages narrower
networks, which some people think it might
do.”
But perhaps the most serious and glaring errors you make
here are with regard to the bone marrow biopsies: First off, the free bone
marrow biopsies are for people
over 50, as you
even note later. Boonstra is
49,
as any
number of articles have mentioned. Second, it’s actually a free
biops
y -- you only
get one per year, not the regular schedule of them that Boonstra had set up.
Third, the free biopsies are for preventive care related to
COLORECTAL CANCER, as a more careful (less
careless?) reading of
your own link shows (right there at the top of page 7 of the PDF), as mandated
by law; in arguing that if BCBS covers a preventive bone marrow biopsy for
colorectal cancer screening as mandated by law, it surely also covers them at
least partially for cancer patients, you are succumbing to the same logical
flaw as above with regard to glaucoma screening. Fourth, the regular schedule
of biopsies that Boonstra had made with her doctor to monitor for a relapse of
her leukemia would not, by any stretch of the imagination, be free under this
provision of Obamacare, nor is there any reason to assume, even if one could
assume that they are partially covered for cancer patients, that all the
biopsies she used to get will be covered under her new plan. The government’s
forcing Boonstra to bend over and receive what it considers good for her is not
what's meant here by preventive colorectal care.
You also fail to understand the nature of the out-of-pocket
“maximums.” See, for example, this story from the
LATimes:
As a Blue Cross Blue Shield representative
patiently explained to me, however, the out-of-network limit isn't really a
limit. When a customer reaches that amount, the insurer will still pay only the
standard out-of-network share. That's why my plan covered only 50% of the
$54,755 charged by Tristate Care Flight to ferry me (by helicopter) from a car
wreck in Quartzsite, Ariz., to a hospital in Phoenix. If Tristate wanted to
bill me for the other half, the representative explained, it was free to do so.
The healthcare law's out-of-pocket limit suffers from the
same shortcoming. Once you reach it, your insurer will cover 100% of the cost
only of the essential health benefits covered by the plan, and out-of-network
services are exempt (except for emergency treatments). That's a troubling
thought, considering how many insurers are reducing the number of doctors and
hospitals in their plans. These ‘narrow networks’ increase the chances that a
doctor, therapist or clinic you'd like to use won't be subject to the annual
cap.
More ominously, being treated at an in-network hospital is
no guarantee that the specialists who see you there will be in your plan's
network as well. If there's no emergency involved, you could be stuck paying
the difference between the contracted amount and the specialist's charges, even
if you've hit the out-of-pocket limit. And the difference can be staggering: In
one extreme example cited by the insurance industry, an out-of-network
California pathologist charged $8,100 for a tissue exam for which Medicare
reimburses $128.
His story had a happy ending, but it illustrates how a
person could be stuck with ridiculous bills for out-of-network services for
life-saving treatments she may need for her cancer, your assurances to the
contrary notwithstanding, since the “caps” on out-of-network services are not
really caps. I’ve pointed this out to you before in other contexts, if memory
serves, which raises the question of why I’m bothering to point it and other
errors out to you in this response, the answer to which is that I’m clearly a
masochist. Also that maybe other people are reading this.
I am also not sure that a 39-59 percent, or essentially
50-50, chance of reversal on appeal (that rate comes once again from your own
link)
constitutes "very, very high" odds for success. 80% or 90%
constitutes very, very high; 50-50 is a coin toss. I know a certain fact
checker at the Washington Post who might have awarded you a Pinnochio for that
had he bothered to give your “very detailed look” an even slightly detailed
look. But it’s AFP’s spin that’s misleading… On top of that,
this link you posted notes that "the number of payment disputes for
these emergency services is likely to rise" due to the shrinking networks
you attributed to Obamacare.
5) Boonstra having to go through the painstaking process of
getting her chemo drugs approved again is a major pain in the ass but not
actually necessary, and her response to the Loratadine incident is overblown.
Given the timeline—with all the problems with healthcare.gov
and its various workarounds (as a result of which the implementation of the
entire act should have been delayed until ready but
wasn't, with callous disregard for those who were hurt by it), Boonstra was
only finally able to purchase replacement insurance coverage days before her plan
was set to expire—her "overblown" response to the Loratadine incident
was nothing of the sort. If you were on meds that you had to take, that had
been working for you, and that you might now have to pay an exorbitant amount
out of pocket for since you're not yet sure whether your insurance will cover
the specific drugs you've been on and need, in the particular amounts you need,
went to the pharmacy and were told you had to pay counter to what you thought
about your plan, and didn't have time to find out since you need your meds
immediately and who knows how long the approval process takes, you would likely
do the same. (We’ll note here also that you don’t know what meds she’s on, in
what dosages, or what tier they fall into under her new plan, so you’re making
presumptions here that you lack basis for making. Under her old plan she didn't
have to worry about that, as her plan covered brand-name drugs without
co-pays.) You would also likely take issue with anyone who told you you were
acting irrationally by doing so. It’s not just a major pain in the ass. It’s
having to budget for those expenses yourself in the meantime, out of your own
pocket. There’s a word for that in the English language as pertains to people
who are not as liquid as you or I may be and who "do not have $5,000 or
$6,000 dollars in the bank," as she has claimed. That word:
"unaffordable."
6) “Bone marrow biopsies are not only covered – they’re
FREE” thanks to Obamacare, and “the fact is she did not have to cut back on her biopsies.” Boonstra has cut back on them out of
ignorance, but at least you are graciously willing to concede the
possibility AFP/Calabrese may not have known this either
and are not intentionally screwing her over on this particular aspect of her care.
I covered the particulars of this above. Not only are
unlimited bone marrow biopsies not free for anyone (you get one a
year (not a regular schedule of them) if you’re
over 50 (which Boonstra is not) for colorectal
cancer prevention (Boonstra is already fighting,
not preventing, leukemia, not colorectal cancer), there is no reason to assume, as you do here, that just
because Obamacare mandates a free preventive colorectal cancer screening, it
follows logically that out of the goodness of their hearts, BCBS will cover the
same regular schedule of bone marrow biopsies Boonstra had worked out
previously with her specialist under her old plan. You claim “the fact is she
did not have to cut back on her biopsies,” but the actual
fact is that you have no idea what bone marrow biopsies
her new plan will cover. Until she finds out, she’s potentially on the hook for
those costs, which for each biopsy are in the thousands (physician fees, lab
fees, etc). How gracious of you to point out that if this is an issue for her,
she can no doubt work out a plan with her provider to pay in installments over
time. Going forth with a previous course of action simply because one
"cannot imagine" one's previous medical regimen will not be covered
is rightly described as assuming significant financial risk upon oneself. Just
because you've been making foolish assumptions doesn't mean Boonstra should…
______________________________________________________
As an aside, you claim that every plan, Democrat or
Republican, would result in similar losers to Boonstra. Under GOP plans, a lot
of people would likely be dropped from their current plans. But I don't know of
any Republican proposals that would forcibly kick people off their current
insurance without adequate time to identify and evaluate alternative coverage
as happened with Obamacare. They would be able to purchase replacement plans
they like more cheaply, not that bureaucrats like more expensively. Many
proposals are also being reexamined in light of Obama's lies to minimize the
disruption. Oh yeah—the GOP has also not attempted to hoodwink the public about
their proposals, and one can read their proposals end to end and come to an
informed decision. There is only one plan that passed (if you can call it that)
only because the American people were lied to about it (and continue to be lied
to about it) over and over and that forcibly kicked people off their insurance
plans despite those false assurances to the contrary, because that plan
introduced new mandates for coverage, and because the administration executing
that plan (frequently less than faithfully and less than legally, in which
respect its execution follows in the spirit of its passage) chose to take a
particularly narrow definition of the “grandfather” clause, kicking multitudes
off plans they were happy with, and failed to delay this disruption until a
functional marketplace had been established. With more on the way. There was no
need to break a few million Boonstras in order to make this particular
Obamelet. (Particularly one that many people are finding doesn’t actually get
them access to care, i.e., a product that doesn’t work and/or that raises their
expenses, significantly.) And it was reckless and inexcusable to break those
few million Boonstras without a functional system in place for them to purchase
replacement insurance, putting those few million Boonstras in a position in
which they were literally scrambling (no pun intended) to obtain some form of
insurance to meet their needs, even if that meant having to cut back on their
own health care in the meantime. That alone is an untenable, unaffordable
position, and that alone would render your entire blogpost moot and Kessler’s
multiple fact checks incorrect on their face, even if it weren’t possible to
pull his and your reasoning apart on their own terms, as I’ve done above.
______________________________________________________
The accusations you level against AFP throughout this post
are so scathing and sanctimonious it seemed fitting to go back and read your
conclusion in light of the errors in your own post. I recommend you go back and
see if those accusations—intentional misinformation campaign, using Boonstra as
a pawn (which you do here repeatedly, using her as a cudgel with which to beat
those who gave voice to her grievances and contributing to the effort to shut
her up and scare away others), causing her grief while tarnishing their own
credibility, diminishing her sincere complaints and making them seem less
significant—can’t legitimately be turned around on you now that your errors,
egregiously flawed assumptions, and knowledge gaps have been pointed out and
the supposedly malicious, deceptive AFP and Calabrese and the confused,
feebleminded Boonstra have been shown to be correct throughout, with one or two
exceptions that are at best sidepoints. You have been shown to be incorrect
regarding the one claim that matters, namely that Boonstra’s new plan is not,
as Kessler claims, more affordable than her old plan: because of the upfront
costs she cannot afford (both due to the deductible and due to the uncertainty
of coverage) and the tests or medications she must forgo or change, because she
does not necessarily come out ahead even in the long-term, because she is not
similarly covered for circumstances she has already experienced (2.5 years of
bed rest), and because of her increased exposure to financial risk.
In light of this, who has major soul searching to do? Who
has “taken a legitimately bad story and stained it with poisonous deception so
transparent that anyone with an internet connection can see through it”? The
answer is not AFP. (This last criticism is especially rich in light of my
frequent use of your own links and the errors you make that a quick googling
would have avoided.) I wouldn’t refer to your post as a “poisonous deception,”
since I think these are mostly errors rather than the intentional deception you
accuse your political/ideological opponents of perpetrating, but they were
arrived at due to bias toward a particular outcome. And while I don't think
your errors deceitful, some of your accusations are, particularly this fantasy
that AFP is deliberately withholding information from Boonstra that is preventing
her from seeking treatment to which she is entitled. As above, I think she
would probably take umbrage at your concern for her already fragile health in
light of your accusing those who highlighted her story of subjecting her to the
negativity that in actuality you, Kessler, and the lot have subjected her to
unjustifiably. AFP will no doubt continue to spend energy and money trying to
help those like Boonstra, and the Democrats will no doubt spend a significant
amount of energy and money trying to tear her down and scare people like her
from coming forward and convince the base that the Koch brothers rather than
Obamacare are getting in the way of her well-being.
I think you owe Boonstra and AFP a retraction. I think you
also owe Glenn Kessler an apology for exposing him as a credulous fraud. (Also
Mark Robison of the Reno Gazette-Journal, who cited you by name and affiliation
with the NIH but didn’t link to your blog so you may have missed it.)
I rate your blogpost Three Pinocchios.
