Prediction Angst

March 18, 2016 was a wild day… mad, even. 

On that date, there were more upsets in the NCAA basketball tournament than any single day in history.  Little unknown schools knocked off college basketball royalty left and right.  It was a hoot to watch. 

Also fun was watching people who couldn’t make a 12-foot jump shot if their life depended on it act as if their life was ruined because they picked Michigan State to win it all and never saw the first round upset coming.

Relax.  The experts – NCAA selection committee, endless talking heads on ESPN, Vegas wise-guys –didn’t either.  And they supposedly know this stuff.

So it is kind of funny to hear how the Congressional Budget Office’s scoring of the American Health Care Act, released earlier this week, is being reported.  You think your bracket has a lot of things moving parts?  Imagine the inputs to this model.

Yet, the headline claims from the CBO’s report (14 million people will lose insurance coverage next year and that will rise to 24 million by 2026; the law will reduce the deficit by $337 billion over a ten-year period) are being discussed as if we have that money locked in special savings account somewhere and those 24 million people are in a single file line down at the homeless shelter.

Can we take a deep breath for a minute – both fiscal hawks who like that one line about the deficit reduction and ACA defenders who are running around quoting Dr. Peter Venkman from ‘Ghostbusters,’ shouting ‘disaster of biblical proportions, human sacrifice, dogs and cats living together, mass hysteria’ – and remind ourselves this is just a prediction?

Not only is it a mere prediction, but it comes from a group that does not have a very good track record of late, at least in this arena.

In 2010, the CBO predicted ObamaCare enrollment would reach 25 million by 2016.  Every year, they ratcheted that down a little bit and by the middle of 2015, just a mere six months out, their enrollment prediction for 2016 was 20 million.  The actual number came in at 12.7 million and a couple million of those were phony because they enrolled, but never paid their premiums.

That is a huge miss.  And we are citing this group like they are the Encyclopedia Britannica?

Look, I don’t think the administration or the Republicans get to just wave this off because they don’t like the answer, but the CBO score is only one input into the discussion.  Here is another economic analysis, but it, too, is susceptible to forecasting errors.  And this type of scoring is only one lens through which we should evaluate legislation of this magnitude. 

Bring on the scorecards, not as final evidence, but to prompt a better discussion about how we want to tackle healthcare.

However, that discussion will have wait until next week because I will be a bit distracted Thursday through Sunday.  Go team!


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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

Yes, I'd like to get Tim's blog.