Monday, September 18, 2017

Bernie-Care (Medicaid for All) and the Magical Moment of Cost Effectiveness.

“Robert Frank made the familiar cost-effectiveness case in the New York Times earlier this summer, and, as usual, it left me with more questions than answers. Frank made three points. First, administrative costs are lower in single-payer systems. Second, single-payer systems save money by not having to advertise. Third, the government can use its monopoly on demand to negotiate lower fees paid to providers.

Even if all three points are true, it is unclear why they are unique to health care. Someone arguing for single-payer plumbing or single-payer automotive maintenance would probably make the same points. To what extent is the case for single-payer health care different from the case for government financing of all goods and services? Frank doesn’t say.

As for whether costs are indeed lower, “you get what you pay for” would seem to apply regardless of whether the payer is the government or a private insurance plan. Want better fraud detection? Administrative costs have to go up. Want more program utilization? Increase advertising costs. Want better doctors? Compensate them more. How a single-payer system is supposed to change this basic relationship between cost and quality is not clear.

Compare health care with education. Public schools are essentially single-payer education systems within the areas they cover. When was the last time we heard anyone argue that public schools are a great tool for containing education costs? When has Bernie Sanders or any Democrat called for the government to push down teacher salaries in order to save money? Any suggestion that teachers should be paid less is met with the obvious counter-argument that teaching quality would suffer. And yet single-payer health care, which comes with the explicit promise to pay doctors less, is supposed to reduce costs without reducing quality. By what magic?” - The Single-Payer ‘Cost-Effectiveness’ Mystery, national, 09/14/2017

Link to the entire essay appears below:

Thursday, July 27, 2017

What is the “Skinny Repeal” of ACA/Obamacare?

“There is an alternative, if not a very satisfying one. Republicans seem to be able to achieve near-unity on ending the individual mandate, allowing insurers to offer discounts for younger people, protecting taxpayers from having to subsidize abortion coverage, and giving states some freedom to relax regulations. They should work for legislation that achieves these goals and includes as much Medicaid reform as 50 senators are prepared to tolerate.

 Republicans should not claim that such legislation would repeal and replace Obamacare, since it would not, and should make it clear that additional legislation will be needed in the future. The conservative holdouts should be prepared to judge this limited legislation based on whether it gives people more freedom to choose the health insurance they want, not on whether it does everything for which Republicans have been campaigning over the last seven years.” - Don’t Settle for Nothing, National Review, 07/18/2017

Link to the entire article appears below:

Thursday, May 25, 2017

ACA/Obamacare: When Saving $2,500 Per Year Really Means Spending $2,928 Per Year

“The Congressional Budget Office score of the American Health Care Act shows that the bill will reduce deficits by $119 billion over the next decade and result in 23 million more people being uninsured by 2026. This leaves the impression that people would be better off if Obamacare were unchanged. But a new report from the Department of Health and Human Services dispels this myth.

The DHHS report shows that premiums in the individual market exchanges increased by 105 percent in the 39 states using from 2013 to 2017. This is equivalent to $244 per month in additional premium payments for people buying insurance through the exchanges, or $2,928 over the course of a year. People not eligible for exchange subsidies are fully exposed to these increases, while taxpayers will bear the brunt in the form of higher outlays for subsidies for enrollees who are eligible.

Despite the promises that Obamacare would “cut the cost of a typical family's premium by up to $2,500 a year,” average premiums on the exchanges more than doubled over this period. In some states, such as Alabama and Alaska, the average premium more than tripled.

The high average increase is not driven by a few outliers, as 23 out of the 39 states included in the analysis experienced premium increases in excess of 105 percent. Only three states, North Dakota, New Hampshire, and New Jersey, had cumulative premium increases below 50 percent.” - Memo to CBO: Obamacare Is Unsustainable,, 05/24/2017

Link to the entire article appears below:

Friday, May 12, 2017

ACA/Obamacare: Say Goodbye to Aetna

“Health insurance company Aetna (AET) announced Wednesday it will completely withdraw from the ObamaCare marketplace in 2018, a decision Health and Human Services Secretary Tom Price perceived as a sign of continued instability in the health care sector under the Affordable Care Act.”

‘“At this time [we] have completely exited the exchanges,” Aetna said in a statement to FOX Business.

In April Aetna said it would not participate on the state exchanges in Virginia next year and last week committed to pulling out of Iowa. In 2016 the insurer sold plans across fifteen states. It trimmed that position to just four states at the outset of 2017, citing financial losses.

“Our individual Commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership. Those losses are the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration,” the company said Wednesday.’ - Aetna to Completely Pull Out of ObamaCare Exchanges by 2018, fox, 05/10/2017

Link to the entire article appears below:

The Highly Misused Terms of "Health care", "Medical care" and "Medical insurance".

"Media reports say that 20 million Americans will lose their “health care” under the Republican plan to replace ObamaCare, as if health care is like a cellphone, wallet, or item of clothing unintentionally left somewhere or stolen by someone.

Such confusion about “health care” stems from the misuse of the term itself. In common usage, the term “health care” is used as a synonym for “medical care” and “medical insurance,” although these terms have widely different meanings. This is more than an issue of semantics. There are serious policy implications of using the wrong words, and the misuse reflects an entitled attitude among the populace and lazy thinking by the media, academia, and politicians.

Health care means taking care of one’s health. It’s what one does to stay healthy—namely, to have a heathy diet, exercise, not abuse alcohol or drugs, and avoid risky behaviors.

Medical care or treatment is what you seek from medical professionals when you have a medical problem and aren’t in good health.

Medical insurance is what you obtain to protect yourself financially from a catastrophic illness or injury requiring expensive medical treatment. In insurance terms, you pool the risk with others."

Stop Misusing the Term "Health Care", FEE, 03/16/2017

Link to the entire article appears below: