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Chief actuary for CMS exposes impact of political agendas on healthcare


Rick Foster, the chief actuary for the Centers for Medicaid & Medicare Services (CMS), detailed the impact of an ever-deepening political divide in his keynote address at the Society of Actuaries' 2011 Health Meeting on June 13.

Rick Foster, the chief actuary for the Centers for Medicaid & Medicare Services (CMS), detailed the impact of an ever-deepening political divide in his keynote address at the Society of Actuaries' 2011 Health Meeting on June 13.

Foster, who made headlines for opposing his superior’s filtering of actuarial information to Congress during the Medicare Modernization Act in 2003, shared his concerns on the current state of politics.

“The former administrator didn’t try to change our analysis, but the results being released to Congress were ones that were able to be used to support the Medicare Modernization Act,” Foster said during his keynote. “The law - as I understood it - gave the administrator the right to do this. Still, I thought it was inappropriate and unethical.”

After inquiries and investigations found former CMS Administrator Thomas A. Scully had broken federal law by withholding information from Congress, Foster said he thought it would be smoother sailing.

“Now we know we are no longer caught between what’s legal and what’s right,” Foster said. “I thought the end result would be a reliable stream of information to Congress, which made it all worthwhile.”

However, he noted that a new problem became apparent during the Patient Protection and Affordable Care Act debate - one in which technical information from CMS actuaries was either simply ignored or purposefully misused by policymakers. Foster, who has been an actuary for 38 years, said that today, more so than in the past, policymakers’ goals seem to be political victory regardless of the impact on sound policy.

“For years and years in my career, we were valued for technical input to do something that makes sense,” he said. “But more and more we get requests for one-sided information that they can use to support their opinion.”

In addition to examples of policymakers ignoring information that proved certain proposals were not workable and requesting one-sided reports, Foster cited a White House blog entry that misrepresented information from his office.

“Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama,” reads a Sept. 9, 2009 White House blog post. “The Act will make healthcare more affordable for Americans. In fact, the actuary’s report indicates that total healthcare spending per insured American will be more than $1,000 lower thanks to the provisions of the new law than it would have been if Congress and the president had not acted.”

However, Foster said his office’s estimate was that the average per capita cost of total health spending in U.S. would increase by about $300 per person once the law is fully in place.

“What the White House did was take total national health expenditures - including people with and without insurance - and divided it by the number of people with insurance. So the concept is just not meaningful. It produces a misleading result for public consumption.”

Foster cited examples of misrepresentation from both sides of the political aisles, but he is hopeful that bipartisanship can prevail.

“It doesn’t have to be this way,” he said. “It can’t continue to be this way. We can do better than having Republicans accusing anyone interested in comparative effectiveness research of wanting to ration care or creating a death panel. We can do better than Democrats charging anyone trying to address the long-range financial adequacy of Medicare of trying to change Medicare as we know it.”

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