OT: Senator Kennedy is dead/Insurance reform

I understood this although wasn't clear. However, in your earlier post, clearly you were wildly inaccurate in saying this only effects 4k people a year.

http://www.nytimes.com/2009/08/30/opinion/30kristof.html?_r=1

Can't agree. From the linked column, 62% of bankruptcies in the country are for medical problems and 78% of those people had insurance. Rescission is a significant piece of this. I agree with you that the numbers that have been made public are less than ideal for exacting analysis.

 

Really? How about lies about the specific bill on the table?

http://factcheck.org/2009/08/twenty-six-lies-about-hr-3200/


"Twenty-six Lies About H.R. 3200
A notorious analysis of the House health care bill contains 48 claims. Twenty-six of them are false and the rest mostly misleading. Only four are true. "

This particular email has been forwarded by a Republican politician but this type of crap is being echoed by Grassley, Palin, Hannity, Beck and Limbaugh.

 

Yep, because no one believes the specific bill on the table is the end result. Not the people opposing the bill, not the people supporting the bill.

Regarding the 4k people, I didn't mean to imply that it only affects 4k per year. I thought I was saying 4k per year of the people covered by those companies. What would be useful to know is how many people those companies cover and whether it's roughly 1% or 25% of the population. Or more.

 

The specific analysis that was reviewed (scorecard: 48 claims with 4 claims being true) was done on the bill, not the concept. We are going to have to agree to disagree on this point.

I do blame the media for much of the mess we are in in terms of having a rational debate. Here is the Post's omnibudsman talking about some of the coverage problems. The coverage is about the political horserace and not a deep analysis of the ideas presented. http://www.washingtonpost.com/wp-dyn/content/article/2009/08/28/AR2009082802613.html

 

Any bill that gets through the house has to be matched up with whatever gets through the Senate, which is where a lot of slippery shit takes place. I give the democrats credit for asking the right question, but their answer is only 33% correct, and 50% wrong.

There's an interesting article in the Economist about how the health insurance companies are going to end up coming out winners through all of this "reform" based on how it will enable them to additionally restrict coverage. Seems like if that's the case, then this bill is fucked however it ends up. I'll be damned if I'm going to have my health care restricted in various ways so that an additional 10-15% of the people get covered.

 

That would be news to me. Got a link? Or an author's name? Or anything?

 

Well, I don't have a link, but given that insurance companies have figured out how to weasel around pretty much every law that's ever been passed with the (ostensible) intent of making them do something, I think it's a safe bet they will.

When companies are attached at the hip to government, the usual result is less competition and more market power, which ends poorly for consumers. It ends well for companies. Companies are omnivorous. They can profit (or not) through competition, or they can profit or not through negotiation and lobbying. It makes no difference to them, though it does for us.

McArdle's latest.

Bonus points, a generic anti-trust post from Brian Caplan (full disclosure, he was my prof in grad school) that has a good lesson for health care:

 

You might be onto something. I'm all for a single-payer approach and taking insurance companies out of the picture for the majority of all citizens. Seems to work fine for Medicare. And for other countries.

 

Obama not backing the public option. Insurance companies are winning. http://www.politico.com/news/stories/0909/26672.html

 

That sorta depends on what you mean by "fine". In a nutshell
* Medicare and Medicaid "work" because doctors are not locked into their fee schedules. If you move everything to that style, the result is going to be a lot fewer doctors without a doubt.
* Beyond that, they "work" - in the sense of not angering too many people- because the people with Medicare basically can get anything they want, at any cost. Nobody believes, however, this is sustainable in the current environment, and moving the entire health care industry to this model will only hasten it the problem.

* Many of the countries people seem to point to as government run success stories in health care are pretty evidently not fine. I'd much prefer to get sick in the American system than in the British or Canadian systems. Belgium and France seem to do a bit better for reasons I don't completely understand, but the idea is there's still a pretty wide variation amongst plans. Given our government and people's historic ability to run and work within a bureaucracy, I wouldn't expect we necessarily get a "good version" of single payer care rather than a "bad version".

* The biggest kicker with international comparisons is that these other countries look relatively successful under these systems because the US does not have such a system. If the US health industry is (further) taken over by the government, one of the truly unfortunate things is that the rest of the world will no longer be able to (largely) free ride off our innovations. Not only will it greatly reduce the rate of improvements inour health and quality of life, but it will inflict the same punishment on much of the rest of the world as well.

 

Get ready to be pissed.

Unfortunately, however, it isn't, since the facts pretty strongly suggest that the features allowing Medicare and VA benefits to be popular cannot be maintained if you simply tried to roll it out for the whole country. Bread and circuses for some will certainly make those guys happy. Bread and circuses for all will quite certainly not work.

And incidentally, it's quite evident, after a moment of thought (and backup research), that health care is not the exception to the rule that government tends to have higher administrative costs that private sector equivalents (which, as a further aside, are significantly burdened by government administrative regulations that give us the privilege, for example, of spending a couple minutes signing a HIPPA form every time we set foot in a DR's office).

By yeah, there are several obvious accounting and economic reasons that the 1% vs. 15% comparison is seriously off-base. Government accounting practices aren't the same as private ones. To make a truly equal comparison, you'd need to add in the various costs that are actually Medicare related but fall under other government agency budgets (IRS for revenue collection, OMB for buildings, Congressional negotiations, etc), the deadweight loss of taxes, and the general need to compare across a like set of customers. In terms of true costs, the government version is almost certainly as much, and probably higher.

 

And there are going to be fewer doctors because we can always be lawyers or money managers instead? A lot of professions on the ropes. I'm thinking there will be plenty of good candidates that still want to go into medicine. I do think we might see some smarter use of nurse-practitioners.

This is an over-exaggeration but ultimately there will need to be some needed changes. Clearly, the current system has it's only unseemly rationing going on.

You are entitled to your opinion, but the age expectancies and the outcomes are not better here.

Really, you might want to read this whole article from Ezra Klein from the Washington post who takes on Megan McArdle on this issue and others.

http://voices.washingtonpost.com/ezra-klein/2009/07/on_megan_mcardles_case_againt.html

And Klein makes the case that an expansion in national health care is as likely to help innovation as not. Much more at the link.

 

How can you over-exaggerate something? And for that matter, do you really think the legal profession is on the ropes? To summarize my thoughts

1. It's pretty evidence we already don't have enough doctors. I don't think it's controversial to say that reducing their compensation while still it's extraordinarily costly to be a doctor will reduce the number of people who want to be doctors relative to other things.

2. I don't think the seriousness of our governmental finance issues can be exaggerated. Nobody projects that we have a reasonable way to pay for the current system. We will have to cut benefits we're projected to give people and/or raise taxes. Probably both, and not in some moderate "tax only a couple zillionaires' sort of way. So as a first proposition, I'm inclined to figure that out before I add more obligations to the mix. Consider it proof of concept. If one thinks the government can come in and (successfully) take over the entire health insurance industry, demonstrate how it can be successful in the parts it already offers.

3. I agree 100% on NPs. Unfortunately, the fact they are not in as widespread use as they should be is largely a result of regulations imposed that prevent them from legally doing many of the things doctors do. I'd like to see the government be able to resolve problems its created like this before I cede more control and decision-making power to them.

Oh no, those are not opinions, those are verifiable facts. The US health care system provides better treatment to people who, on average, are in worse shape. In treating heart attacks and cancers, the results are across the board better. Taken from that last paper, here are 5 year survival rates for folks treated for various cancers in the US and various European countries:

Code:

Cancer	US	Europe
Prostate	99	76
Skin	92	86
Breast	90	79
Uterus	82	78
Colon	66	56
Lymphoma	62	55
Stomach	25	25
Lung	16	11

That article also shows death among the elderly from more common things like pneumonia and flu are lower than average in the US when adjusted to consider differences in population characteristics.

Overall mortality rates in the US are lower for basically behavioral reasons, not the quality of the health care we receive. Another study I recently read indicated, for example, that the average American who reaches age 65 can expect to live nearly half a year longer than the average Dutchman who reaches 65. Which is probably more amazing because the state of your average 65 year old American's body is typically worse than the Dutchman's

This fact sort of leads into the behavioral concerns McArdle rants about and Klein tries to dismiss, but it's pretty evident from looking at the data that the biggest issue causing Americans to appear to have worse health care than Europeans is the fact that we lead less healthy and more dangerous lives.

I don't expect, by the way, that Klein had a straight face when he was making that argument. Among other things that quote from him is patently absurd. He surely knows, for example, that Medicare only started including prescription drug coverage about 3 years ago (that was the Medicare part D bill). So when he argues that Medicare is somehow funding the development of new and better drugs, he's not even in the right ballpark (and missing out on the 37 years where people were paying for it themselves).

Beyond that, Medicare is relatively famous for insisting that folks use outdated but proven means of doing things, because doing anything else, literally, takes an act of congress. For example, my grandmother had Alzheimer's for the last several years of her life, and because of the various drugs she was given, had to have her blood sugar checked a couple times a day. Now, if you know about this stuff, you might know that there now exist means of testing this without the old-fashioned finger prick tests. You just use a little machine that instantly and painlessly measures it. However, for several years, these were not approved for use by Medicare, and thus the Nursing home wouldn't get one and use it. Even worse, they would not be reimbursed for the time the testing took if they didn't use the Medicare approved method of poking my grandmother's finger every day. And oh yeah, it would expose them to a lawsuit (which is something the current health care "reform" proposals do nothing about. Hence, even when my granddad offered to buy the machine and give it to the nursing home at no cost, they refused on both of those grounds.

And, of course, there's the elephant in the room that we mentioned before: Medicare is uber-expensive despite the sort of insane decision-making it leads to, and is thus not employable to the entire population in the same way it has been (unsustainably) employed to those 65 and over.

 

My bad, it was businessweek. "Why health insurers are winning." 8/17/9

 

People just out of med school are getting jobs....can't say that about lawyers these days....I see your point but think keeping the incentives right to have enough doctors is one of the more manageble issues.

That's interesting. Speaks to my earlier point at how Republicans and the media have done a terrible job covering this. Comparing these types of stats vs. mortality and age expectancies should be mainstream.

Of course, if we were really grown-up the healthcare discussion could talk about real tradeoffs --- for instance...Canada's slighly lower survival rate (79%) to US (81%) vs. their healthcare costs which are ~54% lower per capital or 10% of their GDP vs. 15% for us.

How are you defining uber-expensive?
from http://krugman.blogs.nytimes.com/2009/07/29/medicare-versus-insurers/
"Since 1970 Medicare costs per beneficiary have risen at an annual rate of 8.8% — but insurance premiums have risen at an annual rate of 9.9%."

 

Another reason to fear this version of healthcare reform. More unionization. http://online.wsj.com/article/SB10001424052970203440104574400571702189240.html

 

Yes, it gets to the heart of the whole issue. It's why I don't trust any of these assclowns further than I can throw them, and I don't want them having any sort of decision-making power over my health. If we really cut to the chase, here, we're talking about when it's fiscally prudent to pull the plug on someone.

But that's the essence of the kind of questions we shouldn't be answering as a society, but all have to answer as individuals. It's a matter of conscience for an individual, and any way you get the government involved in it, you're going to end up getting a serious question wrong for a lot of people. We're all going to die on the end, but fundamentally, it ought to be a matter of personal choice whether we want to go gently into that good night, at the lowest cost, or, if we want to say, a la George Carlin, "Don't pull the plug on me"!

When we start making those decisions via government - whether explicitly or implicitly through creating a system in which the government is the only payer, and decides when to cut folks off - we're on that path, and it's, IMO, a pretty bad path to be on. Even if we're talking about a few months of life, it's still life. Beyond the economics of it, I think it's very hard to make a moral argument that society should be able to impose a value on it. Especially, when the alternative - to let people deal with their own affairs based on their own values, beliefs and abilities, seems to produce about the same result. It's more expensive, but it's mostly more expensive because people choose to spend their money on living longer and better. I don't begrudge anyone that, even if it's not what I'd do. I think, if anything, we ought to have a constitutional right to keep that decision to ourselves as individuals, just like we have constitutional protections on our rights to religious beliefs (or non-beliefs), speech, association, etc.