A study published online today [Thursday] estimates nearly 45,000 annual deaths are associated with lack of health insurance. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.
The new study, "Health Insurance and Mortality in U.S. Adults," appears in today's [Thursday's] online edition of the American Journal of Public Health.
The Harvard-based researchers found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.
Lead author Dr. Andrew Wilper, who worked at Harvard Medical School when the study was done and who now teaches at the University of Washington Medical School, said, "The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health. We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease -- but only if patients can get into our offices and afford their medications."
The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking education, income and many other factors including smoking, drinking and obesity into account. It estimated that lack of health insurance causes 44,789 excess deaths annually.
Bin Laden killed 3,000 people on 9/11. Lack of health insurance kills fifteen times that number every year.
It's easy to forget what we're fighting for with all the ranting and raving and lying going on. This isn't about soaking the rich or getting votes or growing government or turning the country into a socialist utopia; it's about saving a lot of lives and improving the quality of life for a lot more people.
Let's try to remember that.
(HT: Andrew Sullivan.)
43 comments:
I'd like to point out that there is disagreement among experts whether lack of health insurance in the United States really does kill thousands of people.
So long as we can always rationalize that it's not us, or our children, or our family, it doesn't matter how many people die.
Darwin might have closed down all health care.
http://jewishphilosopher.blogspot.com/2009/09/darwin-and-death-panels.html
45,000 Excess Deaths Annually Linked To Lack Of Health Charity?
The issue is not that anyone wants to see people sick and dying, but how they want to see them helped.
Ortho:
The opponents of universal health care coverage have had decades to come up with a working alternative. Republicans had all three branches of government for 6 years straight, and they didn't even bother trying.
I think the issue very much is that people don't care enough about the tens of thousands of people who will die without this (or a viable alternative) to do something about it.
This plan, whatever you think of its drawbacks, would cover (most of?) those people. No alternative that I've heard of that Republicans would agree to would do the same.
JA,
I don't give two hoots about whether its Democrats vs Republicans or whatever. My view is that it was a mistake for government to get involved in healthcare since Medicare came around and getting more involved is to walk more in the wrong direction.
Not only are such public healthplans financially unsustainable, they also hide the costs to patients leading to inflationary spending and frivolous use of healthcare. In addition, such public plans limits medical practice regarding what is or is not covered and tend to pay barely at-cost to what the profession lays out.
They are unfair to the taxpayer and they are unfair to the medical provider.
In my view, if the government is to cover anything, it should just cover catastrophic care - say an annual indemnity care for >$5,000 out of pocket. People should be responsible for paying for their own annual physicals and oil changes. If real market forces were in effect, how fast do you think the costs of blood pressure drugs and diabetes drugs would drop?
And if people cannot afford even that then people on a community level should have well organized medical charities - the way it was before Medicare, and medical providers should offer charity care and be able to deduct it come tax season.
Can you guess which patients are the biggest jerks? Those who get their care as an entitlement and then look down their noses at the doctors who *serve* them. I don't want that attitude universalized.
Of course I know that the ship has long sailed for this kind of arrangement and it's only for that reason that I'm not as vigorously against whetever plan congress will eventually push through as I would be otherwise. Whatever plan they have will be a terrible mistake, but it will likely be better than it is today.
I don't give two hoots about whether its Democrats vs Republicans or whatever. My view is that it was a mistake for government to get involved in healthcare since Medicare came around and getting more involved is to walk more in the wrong direction.
What's your take on the recent poll that shows a majority of doctors favor the public option?
Not only are such public healthplans financially unsustainable,
Untrue.
they also hide the costs to patients leading to inflationary spending and frivolous use of healthcare.
That's something to watch out for, just as it is with private insurance, but there are ways to fight it: deductibles, guidelines, etc.
In addition, such public plans limits medical practice regarding what is or is not covered
So do private plans!
and tend to pay barely at-cost to what the profession lays out.
And yet the profession supports it! And they're not skimming 30% off the top like private insurers.
In my view, if the government is to cover anything, it should just cover catastrophic care - say an annual indemnity care for >$5,000 out of pocket. People should be responsible for paying for their own annual physicals and oil changes.
That's a terrible idea! Imagine if car insurance paid to fix your engine after you didn't change your oil for 2 years but didn't pay for oil changes. If we're going to pay for the big stuff, the small preventative stuff pays for itself.
If real market forces were in effect, how fast do you think the costs of blood pressure drugs and diabetes drugs would drop?
Define "real." Are we getting rid of patents and regulations? Regardless, this is orthogonal to health care coverage.
And if people cannot afford even that then people on a community level should have well organized medical charities - the way it was before Medicare, and medical providers should offer charity care and be able to deduct it come tax season.
Easy to say what people should do, but what if they don't? How many people have to die while we wait to see if private charities step up to fill in the gaps? When do we get to declare that little experiment a failure and step in with the government?
Can you guess which patients are the biggest jerks? Those who get their care as an entitlement and then look down their noses at the doctors who *serve* them. I don't want that attitude universalized.
Eh, old people are going to be jerks regardless. :-)
Of course I know that the ship has long sailed for this kind of arrangement and it's only for that reason that I'm not as vigorously against whetever plan congress will eventually push through as I would be otherwise. Whatever plan they have will be a terrible mistake, but it will likely be better than it is today.
Well, ok then.
JA,
"What's your take on the recent poll that shows a majority of doctors favor the public option?"
I strongly question their methods since that isn't remotely my experience among people I've worked with. And I work in the Bronx where you can't throw a rock in the street without hitting someone on a public plan.
"Untrue."
Oh, ok. Did you fail to recognize the huge and unsustainable growing costs of our current medical entitlements? How does adding to this burden make it more fiscally sound?
"That's something to watch out for, just as it is with private insurance, but there are ways to fight it: deductibles, guidelines, etc."
Great. I hate HMOs. Something to look forward to, eh?
"So do private plans!"
I agree - they also suck. Any time you have a third-party paying the bills, things get screwed up.
"And yet the profession supports it!"
Only because they're choosing between bad and worse options.
"And they're not skimming 30% off the top like private insurers."
Sure, because they saddle administrative costs on the providers! That's why doctor's offices now have to hire a special "medical biller" just to take care of paperwork to insurance programs. The mere existence of such a job plainly shows how screwed up the system is.
"That's a terrible idea! Imagine if car insurance paid to fix your engine after you didn't change your oil for 2 years but didn't pay for oil changes. If we're going to pay for the big stuff, the small preventative stuff pays for itself."
I don't think you realize it, but virtually everyone gets that atempted "engine fix" sooner or later. Staying healthier delays it, but does not prevent it. We're not saving anything by paying for oil changes AND the fix. Besides, as a matter of principle, people should take some responsibility for their own health. They have a simple incentive for doing so!
"Easy to say what people should do, but what if they don't? How many people have to die while we wait to see if private charities step up to fill in the gaps? When do we get to declare that little experiment a failure and step in with the government?"
It's not an experiment, it worked! LBJ didn't say that Medicare was needed because old people were dying in the streets, but because relying on charity is an indignity! The accidental consequence of such public health plans decimated health-based charities.
And, again, as a matter of principle, taking from taxpayers what they could give in charity is not much different from simple robin hood robbery.
"Eh, old people are going to be jerks regardless. :-)"
Heh, I was actually referring to youngish Medicaid types. Old people are cranky but they tend to be respectful.
No one is saying that an uninsured population isn't a problem or that health care can't or shouldn't be reformed.
The controversy is how this should be dealt with. Health care and insurance is expensive. Making it public doesn't make it any less expensive. Money is not saved by preventative care. Have you ever seen a study that says that it is? They all say that prevention in a populations is more expensive. It is done because it benefits individual patients, and helps prevent lawsuits against gp's, not because it saves money.
So we have a plan that is expensive, but the democrats won't admit that it is expensive, they just say obvious lies about 'preventative care' trying to cover it up so they don't really get down to talking about how to pay for it.
If people can't afford health care now, how will making paying this cost they can't afford or a fee help anyone? For many healthy families with low incomes but good saving habits, catastrophic coverage with a high deductible may be the best option. But this option may be taken away.
If the democrats worked with Republicans and could get even 1 or 2 republicans on their side, they wouldn't need to be doing things like getting Massachusetts to change their laws to appoint a representative. Instead they vilify half the country.
If their motivation is universal health care for necessary medical expenses, they shouldn't have substidies go to plans that pay for elective abortions. That would get a lot more people on board.
It isn't just the Republicans who are bringing this change down. The Democrats need to work with the Republicans instead of trying to 'sell' a plan that most people don't want and paint the Republicans as not caring about the poor and sick.
If Darwinism is science why doesn't anyone recommend eugenics as way to solve the health care crisis? Stuff like compulsory sterilization of poor people would probably go a long way.
Let's not forget the ideas of the founder of Planned Parenthood.
http://en.wikipedia.org/wiki/Margaret_Sanger#Eugenics_and_euthanasia
Orthoprax,
"Not only are such public healthplans financially unsustainable"
Government provided health insurance is no more unsustainable than private health insurance. In fact, Medicare has controlled costs better than private health insurance between 1970 and 2000.
"they also hide the costs to patients leading to inflationary spending and frivolous use of healthcare."
And private health insurance is different how?
"In addition, such public plans limits medical practice regarding what is or is not covered ... "
And private health insurance is different how?
"and tend to pay barely at-cost to what the profession lays out."
This happens in Medicare because Medicare has more bargaining power. But as long as the reimbursement rates are carefully reviewed and adjusted, I do not regard this as a bad thing. It is only bad if Medicare is paying below cost and health providers cannot cut costs without reducing quality to compensate for it. However, we have competent people in MedPAC carefully reviewing reimbursement rates and making recommendations to Congress to prevent and fix these problems.
"In my view, if the government is to cover anything, it should just cover catastrophic care - say an annual indemnity care for >$5,000 out of pocket. People should be responsible for paying for their own annual physicals and oil changes."
The main problem with this proposal is that it has the effect of rationing health care by income class. High income people will have no problem spending $5,000 in a year if needed, but low income people will have much more difficulty and will likely forego treatment in many cases. We are already rationing health care by income class so this may not be any worse than the status quo, but it does not do much to solve this problem either.
"If real market forces were in effect, how fast do you think the costs of blood pressure drugs and diabetes drugs would drop?"
But Medicare did not even include prescription drug coverage until Republicans passed Medicare Part D in 2003! If you have evidence that this increased the costs of prescription drugs, please do provide it. (I would not expect it to reduce costs much either though since the prices are negotiated by relatively small private insurers with less bargaining power than the government.)
"And if people cannot afford even that then people on a community level should have well organized medical charities - the way it was before Medicare, and medical providers should offer charity care and be able to deduct it come tax season."
This is totally unrealistic. Firstly, health care spending in the United States as percent of GDP has tripled between 1960 and 2007. Even if this was an workable solution before 1965 (and I highly doubt that), it is not reasonable to conclude from this that it would work today.
Secondly, Medicare paid $431 billion in 2007. But total charity in the United States was in 2006 was only $295 billion! It is totally unrealistic to abolish Medicare and then expect charity to cover the shortfall.
"Can you guess which patients are the biggest jerks? Those who get their care as an entitlement and then look down their noses at the doctors who *serve* them. I don't want that attitude universalized."
So basically your argument is that old people and poor people are rude to doctors, and so it is correct for our country to deny old people and poor people health care if they cannot afford it?
Theresa,
"The controversy is how this should be dealt with. Health care and insurance is expensive. Making it public doesn't make it any less expensive."
There are numerous pieces of evidence that show that government health insurance is more cost efficient than private health insurance. I'd be happy to support this claim upon request. But anyway, this is not as relevant as most people think because the uninsured are largely going to be covered through private health insurance in any legislation Democrats are likely to pass.
I do agree though that without drastic changes to the health care system (i.e. moving to a single payer system), it will cost a substantial amount of money to cover these additional people.
"So we have a plan that is expensive, but the democrats won't admit that it is expensive, they just say obvious lies about 'preventative care' trying to cover it up so they don't really get down to talking about how to pay for it."
That is not completely fair. I agree that Democrats are often not fully honest when they talk to the public about how expanding coverage will be paid for, but the legislation they write does include provisions to pay for most of it. The CBO says that the draft of the American Health Choices Act it scored in July mostly pays for itself with tax increases and elimination of overpayments to private insurers who participate in Medicare Advantage. The CBO says $239 billion over a 10 year period (out of a total of $1,042 billion) is still unpaid for, but it is not the final bill.
Let's compare this to the Medicare Modernization Act passed by Republicans in 2003, which increased spending by hundreds of billions of dollars over 10 years but had no provisions to pay for it.
"If people can't afford health care now, how will making paying this cost they can't afford or a fee help anyone? For many healthy families with low incomes but good saving habits, catastrophic coverage with a high deductible may be the best option. But this option may be taken away."
It's unlikely these families will be paying more. Low income families will receive subsidies to help them pay for their health insurance.
"If the democrats worked with Republicans and could get even 1 or 2 republicans on their side, they wouldn't need to be doing things like getting Massachusetts to change their laws to appoint a representative."
Why should Democrats make concessions to Republicans if Republicans will not agree on what concessions will be sufficient for them to vote on the bill?
"Instead they vilify half the country."
I believe that is not a fair representation of reality. It is mainstream Republicans (i.e. Sarah Palin) who accuse Democrats of trying to create death panels to kill old people and down syndrome babies. It is Republicans who grossly mischaracterize legislation to say it is a government takeover of the health care system.
"If their motivation is universal health care for necessary medical expenses, they shouldn't have substidies go to plans that pay for elective abortions. That would get a lot more people on board."
Has any Republican senator said he or she would vote for the bill if it required that abortion coverage be removed from any subsidized plans? And if not, why should Democrats make this change just because Republicans complain about it?
"It isn't just the Republicans who are bringing this change down. The Democrats need to work with the Republicans instead of trying to 'sell' a plan that most people don't want and paint the Republicans as not caring about the poor and sick."
Most people don't want the plan because Republican propaganda has been very effective. You are an exception to this, but I think you are unusual in that regard.
>So basically your argument is that old people and poor people are rude to doctors, and so it is correct for our country to deny old people and poor people health care if they cannot afford it?
No, he is simply adding a little piece of human psychology as to what happens when people have a feeling of entitlement.
Avian,
"Government provided health insurance is no more unsustainable than private health insurance."
Yes, but private insurance is at least in theory responsive to market forces and poor business models will simply bankrupt individual companies. Whereas public programs are entitlements, almost politically impossible to take away from the people and will bankrupt the government itself.
"And private health insurance is different how?"
They're not. As I said above, private companies are in many ways equally as bad. But in theory, doctors can work together and collectively work for their own interests against private companies. This becomes far more difficult when the government is your adversary and they can simply order you to work and accept their price model (as what happened in Illinois a few years ago).
"This happens in Medicare because Medicare has more bargaining power. But as long as the reimbursement rates are carefully reviewed and adjusted, I do not regard this as a bad thing."
Yes, Medicare has lots of coercive power and I think it's a terrible thing for the government to dictate to doctors what their time and expertise is worth. That's one sure way to kill the profession in America!
"If you have evidence that this increased the costs of prescription drugs, please do provide it."
Link: http://tinyurl.com/yalbkzf
"This is totally unrealistic. Firstly, health care spending in the United States as percent of GDP has tripled between 1960 and 2007. Even if this was an workable solution before 1965 (and I highly doubt that), it is not reasonable to conclude from this that it would work today."
It's tripled, in part, *as a consequence* of moving away from the classic charity model.
"Secondly, Medicare paid $431 billion in 2007. But total charity in the United States was in 2006 was only $295 billion! It is totally unrealistic to abolish Medicare and then expect charity to cover the shortfall."
Which is why I suggest a cap of ~$5000 per year for which people have to pay OOP (or from charity) before some federal program kicks in for what is likely catastrophic care.
"The main problem with this proposal is that it has the effect of rationing health care by income class. High income people will have no problem spending $5,000 in a year if needed, but low income people will have much more difficulty and will likely forego treatment in many cases."
And so here is where charity organizations come into play. Community hospitals, free clinics, etc. $5000 is not bankbreaking for any but a small minority of people in America. It is for them that charity is designed - not entitlements.
"So basically your argument is that old people and poor people are rude to doctors, and so it is correct for our country to deny old people and poor people health care if they cannot afford it?"
No, the point is that nobody is *entitled* to my time and work. They should get the very best care - and know that they got it only because people were kind enough to give it to them.
Orthoprax,
"Yes, but private insurance is at least in theory responsive to market forces and poor business models will simply bankrupt individual companies. Whereas public programs are entitlements, almost politically impossible to take away from the people and will bankrupt the government itself."
There are many reasons in theory -- and confirmed by evidence -- that private health insurance should tend to harm society and be less able to control costs when compared to public health insurance:
* Private insurance has more administrative costs than public insurance. We can confirm this with comparisons between countries. We can also confirm this within our country by comparing Medicare (run by the government) with Medicare Advantage (run by private insurers). Medicare Advantage costs the taxpayer 14% more than Medicare per enrollee.
* On the private individual market, it is very profitable for private insurance companies to deny coverage and treatment to the people who need it most. And the money private health insurance companies spend on looking for ways to deny coverage and treatment to the people who need it most increases administrative costs even further.
* On the employer market, the government subsidizes health insurance by making health insurance benefits provided by employers tax exempt. As such, we have taxpayer money being spent on health insurance for the people who need it the least.
* Private health insurance companies tend to have weak bargaining power compared to larger public health insurance programs, and tend to overpay substantially. On average, private insurance companies paid around 32% above cost to hospitals in 2007 (see figure 2A-6 on page 18 of this MedPAC report). Since private health insurance companies are profitable on average, these costs are clearly being passed down to enrollees.
Orthoprax,
"They're not. As I said above, private companies are in many ways equally as bad. But in theory, doctors can work together and collectively work for their own interests against private companies."
That happens both theory and in practice. But it enables hospitals and medical groups to bargain prices far above cost and drive up health spending (see figure 2A-6 on page 18 of this MedPAC report).
"This becomes far more difficult when the government is your adversary and they can simply order you to work and accept their price model (as what happened in Illinois a few years ago)."
Yes. That is the point. :)
I am not familiar with the situation you refer to in Illinois, but I do agree that it is certainly possible for public programs to underpay hospitals and medical groups. This happens with Medicaid in many states (i.e. in New Jersey) and is definitely a problem. This is one reason I do not particularly like Medicaid. Medicaid is run by states and that makes it too hard to fix these problems on a national level.
"Yes, Medicare has lots of coercive power and I think it's a terrible thing for the government to dictate to doctors what their time and expertise is worth."
Medicare does not dictate prices. Medicare says what prices they are willing to pay, and private hospitals and doctors are free to reject those prices (and lose a substantial percent of their customers and revenue).
"That's one sure way to kill the profession in America!"
As I noted earlier, we have competent people in MedPAC carefully reviewing reimbursement rates to ensure we do not have reductions in supply or quality. See this recent MedPAC report for example.
Orthoprax,
"Link: http://tinyurl.com/yalbkzf"
But health spending -- including prescription drug spending -- has been increasing faster than inflation + GDP growth for decades! We cannot derive anything meaningful from an observation that it is still increasing after Medicare Part D was introducted.
Further, that graph only shows price increases for brand name prescription drugs. The fact is that prices for generic prescription drugs have been reducing substantially since Medicare Part D went into effect. You can find this on page 37 of this AARP report (the same report the graph you provided came from).
"[Health care spending] tripled, in part, *as a consequence* of moving away from the classic charity model."
Do you have any evidence that health care funded by charity can control health costs better than Medicare without rationing care or reducing quality?
"Which is why I suggest a cap of ~$5000 per year for which people have to pay OOP (or from charity) before some federal program kicks in for what is likely catastrophic care."
OK, but the government would still be spending an enormous amount of money. In 2002, 80% of health care spending in the United States went to treat 20% of the population. This 20% consisted of people with health care costs that were more than $3,219, but this was in 2002. I estimate (from the data on exhibit 1 of this report) that health care spending per capita rose about 60% between 2002 and 2009. This would bring that number to $5,150, which would mean that this deductible would cover less than 20% of health care expenses.
"And so here is where charity organizations come into play. Community hospitals, free clinics, etc. $5000 is not bankbreaking for any but a small minority of people in America. It is for them that charity is designed - not entitlements."
OK, but how do you expect such charity to come into existence without any government funding? Do you expect them to come into existence spontaneously through the goodwill of wealthy people? And if so, why is health care being rationed by income class today? Why aren't charities filling the gap?
Sorry, I failed to provide a source for this claim:
"In 2002, 80% of health care spending in the United States went to treat 20% of the population. This 20% consisted of people with health care costs that were more than $3,219, but this was in 2002."
This is the source.
Avian,
"Private insurance has more administrative costs than public insurance."
Only because they can manipulate the system and push paperwork onto the providers of healthcare. They require doctors to hire people to fill out the endless forms for them - or add 10-20 hours of work per week to the doctor's schedule. How nice.
"On the private individual market, it is very profitable for private insurance companies to deny coverage and treatment to the people who need it most."
There is no reason to believe this is something that will not effect public programs too. Money needs to come from somewhere.
"On the employer market, the government subsidizes health insurance by making health insurance benefits provided by employers tax exempt."
Sure - and I think it's dumb to link healthcare to people's work.
"Private health insurance companies tend to have weak bargaining power compared to larger public health insurance programs, and tend to overpay substantially."
It's a business model. I support more competition and bargain seekers will find less expensive insurance programs.
"That happens both theory and in practice. But it enables hospitals and medical groups to bargain prices far above cost and drive up health spending (see figure 2A-6 on page 18 of this MedPAC report)."
Working at a profit base of 20-30% more than cost is not a lot as far as I'm concerned. How do you expect hospitals to keep up new machines and equipment, hire quality staff and so on if they're only working at cost?
"Yes. That is the point. :)"
Yes - and not only do I consider that bad policy, it's also downright evil.
"I am not familiar with the situation you refer to in Illinois"
http://www.ama-assn.org/amednews/2007/07/23/gvsb0723.htm
Avian,
"Medicare does not dictate prices. Medicare says what prices they are willing to pay, and private hospitals and doctors are free to reject those prices (and lose a substantial percent of their customers and revenue)."
Sure, that's the way it works now. But when those compensation rates start dropping and doctors continue to balk at accepting, then the government could very well use coercive means to force doctors to treat seniors.
"As I noted earlier, we have competent people in MedPAC carefully reviewing reimbursement rates to ensure we do not have reductions in supply or quality."
Yes, because Central Planning of markets has a proven track record on the world stage, eh?
"We cannot derive anything meaningful from an observation that it is still increasing after Medicare Part D was introducted."
I believe the graph demonstrates higher rates of increase after 2003.
"The fact is that prices for generic prescription drugs have been reducing substantially since Medicare Part D went into effect."
And so what can this be attributed to? Perhaps the donut hole that creates a competitive market at the level of the actual consumer?
"Do you have any evidence that health care funded by charity can control health costs better than Medicare without rationing care or reducing quality?"
I think charity care kept costs low before Medicare came on the scene, but I know of no system out there that is similar to the one I've described.
"OK, but the government would still be spending an enormous amount of money."
Probably - but it would be a stable amount.
"This would bring that number to $5,150, which would mean that this deductible would cover less than 20% of health care expenses."
Sure - but it would be the FIRST 20%, which would create the consumer-based competition and price control that would keep costs reasonable for the large majority of Americans.
"OK, but how do you expect such charity to come into existence without any government funding? Do you expect them to come into existence spontaneously through the goodwill of wealthy people?"
It's a matter of culture. Back in the day, charity was a matter of course and responsibility to one's parents health was paramount. When the government took healthcare as a charity away from the people and turned it into an entitlement and convenience then the charity for this cause dried up.
"And if so, why is health care being rationed by income class today? Why aren't charities filling the gap?"
Entitlements kill charity.
Orthoprax,
"No, the point is that nobody is *entitled* to my time and work. They should get the very best care - and know that they got it only because people were kind enough to give it to them."
If you are being paid to treat me, why shouldn't I feel that it is your responsibility to provide me that treatment? Why should it matter whether you are being paid from my pocket, from my health insurance company, or from a government program?
Even though I feel it is your responsibility to provide me that treatment, I would not be rude to you because that is not proper. But again: this is the same regardless of how you are being paid.
I don't see why we should believe -- a priori -- that getting health insurance through a government entitlement program would cause them to be more rude to medical professionals.
If you have any evidence to support the claim that government provided health insurance does make people more rude to medical professionals, please do provide it. But even then, you would need to somehow control for rudeness caused by other factors.
Orthoprax,
"Sure, that's the way it works now. But when those compensation rates start dropping and doctors continue to balk at accepting, then the government could very well use coercive means to force doctors to treat seniors."
Medicare has been functioning for more than 40 years and this has not happened yet.
"Yes, because Central Planning of markets has a proven track record on the world stage, eh?"
Yes, Central Planning of markets for health insurance has a very good track record on the world stage. Some evidence to support this:
* Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care
* It’s The Prices, Stupid: Why The United States Is So Different From Other Countries
"I believe the graph demonstrates higher rates of increase after 2003."
Medicare Part D went into effect in 2005. But anyway, it is not possible to derive anything meaningful from small differences annual change over 3 year periods. There is always fluctuation. And changes in spending may be caused by a wide variety of factors.
"And so what can this be attributed to? Perhaps the donut hole that creates a competitive market at the level of the actual consumer?"
But before Medicare Part D there was no donut! All the outpatient prescription drug spending was by the patient or the private Medigap policies they purchased.
"I think charity care kept costs low before Medicare came on the scene, but I know of no system out there that is similar to the one I've described."
Do you have any evidence that charity care did in fact control costs without rationing care or reducing quality before Medicare was established?
What mechanisms do you believe would cause charity care to control costs in this way?
"Probably - but [the money the government would be spending on health care] would be a stable amount."
No, it would not a stable amount. Health care spending would still increase faster than inflation + GDP growth. And government spending on health care would increase faster than inflation + GDP growth too.
"Sure - but it would be the FIRST 20%, which would create the consumer-based competition and price control that would keep costs reasonable for the large majority of Americans."
It is debatable whether it would actually do this. But more importantly: The large majority of Americans aren't the reason why health care spending consumes 16% of GDP.
"It's a matter of culture. Back in the day, charity was a matter of course and responsibility to one's parents health was paramount. When the government took healthcare as a charity away from the people and turned it into an entitlement and convenience then the charity for this cause dried up ... Entitlements kill charity."
But in the case of people who cannot afford health insurance and are not eligible for Medicare, Medicaid, or SCHIP, we have a situation where people are not the recipient of any government entitlement programs and yet charity has not been sufficient to close the gap.
If we abolish all government entitlement programs, do you believe charity is going to begin covering people who weren't even covered by those entitlement programs? And if so, please do provide some evidence for this claim.
Orthoprax,
"Only because [public health insurance] can manipulate the system and push paperwork onto the providers of healthcare. They require doctors to hire people to fill out the endless forms for them - or add 10-20 hours of work per week to the doctor's schedule. How nice."
Are you saying that Medicare pushes more paper work onto providers of health care than private insurance? Do you have any evidence for this claim?
I have not found data comparing the administrative costs to hospitals processing Medicare vs. private insurance claims, but consider this study from NEJM comparing costs between Canada (mostly public health insurance) and the United States (a mix of public and private). On page 4 you can see that hospitals and doctors in the United States pay 3 times as much in administrative costs!
"There is no reason to believe this is something that will not effect public programs too. Money needs to come from somewhere."
Of course there is a reason: The public programs have a responsibility to the public. In contrast, private insurance has a responsibility toward shareholders. Medicare, Medicaid, and SCHIP do not discriminate enrollees on pre-existing conditions. And they do not deny care to people later on the basis that the enrollee did not disclose a preexisting condition.
And of course money has to come from somewhere: The money comes from tax increases, efficiency increases, and/or spending cuts.
"Sure - and I think it's dumb to link healthcare to people's work."
It is dumb, but it has the beneficial effect of creating large risk pools. With all its problems, it would be far worse to push people into the private individual market in its current state which is as dysfunctional, wasteful, and socially destructive as it gets. But with the necessary reforms, the private individual market has the potential to work well and I'd be happy to abolish employer-based health insurance. The health care reform proposals proposed by Democrats in Congress include most of these much needed reforms. (I'd be happy to substantiate these claims upon request.)
"It's a business model. I support more competition and bargain seekers will find less expensive insurance programs."
I don't understand what you mean. Are you talking about consumers shopping for insurance? Or private health insurance companies negotiating prices with health providers?
"Working at a profit base of 20-30% more than cost is not a lot as far as I'm concerned. How do you expect hospitals to keep up new machines and equipment, hire quality staff and so on if they're only working at cost?"
MedPAC considers these factors when determing payment rates. Read the report.
"http://www.ama-assn.org/amednews/2007/07/23/gvsb0723.htm"
Interesting case. I haven't looked at all the details, but my initial reaction is to side with the health care providers in this case. But this is one case in one state, and is probably a product of that state's unusual antitrust laws.
At the end of that last comment, I should have said: But this is one case in one state, and might just be a product of that state's unusual antitrust laws. (I do not have any knowledge of state antitrust law so I do not know.)
This is a great example of what I term "no cost analysis." We bring up a problem, argue that we must have a solution to this problem, and avoid determining what the costs will be in implementing a solution.
tommy,
That's not true. In July the CBO estimated the cost and insurance coverage effects of a health care bill introduced in a House committee in July. The final bill will certainly be different, but this it probably wont be that much different.
But also: The Tax Policy Center and the Lewin Group estimated the cost and insurance coverage effects of Obama's and McCain's health care proposals before the election.
Avian,
I wrote a long response to your first two posts, but I goofed and it got deleted as I was posting it. I guess I'll rewrite it later on.
Here's the last third or so of it:
"Are you saying that Medicare pushes more paper work onto providers of health care than private insurance? Do you have any evidence for this claim?"
More than private? Sometimes, not always though. But they are still excessive, slow in payment and penalize those who fill out paperwork incorrectly. As an aside, how much fraud do you think Medicare lets slip through the cracks by its barely-there oversight?
"And of course money has to come from somewhere: The money comes from tax increases, efficiency increases, and/or spending cuts."
Or simple rationing of care, which is likely.
"I don't understand what you mean. Are you talking about consumers shopping for insurance? Or private health insurance companies negotiating prices with health providers?"
Consumers.
"MedPAC considers these factors when determing payment rates. Read the report."
Sure, so they considered them. I don't disagree with their conclusions but I don't think they're a bad thing either.
"Interesting case. I haven't looked at all the details, but my initial reaction is to side with the health care providers in this case. But this is one case in one state, and is probably a product of that state's unusual antitrust laws."
Antitrust laws come in federal form too, y'know. There is no reason to not expect such things to happen on the national stage.
Avian,
"If you are being paid to treat me, why shouldn't I feel that it is your responsibility to provide me that treatment? Why should it matter whether you are being paid from my pocket, from my health insurance company, or from a government program?"
Because if you're getting a free service then you do not recognize the value of what you are receiving. The doctor's time and effort appears cheap in every sense of the word.
"I don't see why we should believe -- a priori -- that getting health insurance through a government entitlement program would cause them to be more rude to medical professionals."
This isn't a priori. I work in healthcare and have personal experience with this. I can always tell who the Medicaid patients are on the floor without looking at their charts.
"Medicare has been functioning for more than 40 years and this has not happened yet."
Sure, because it's politically easier to just allow costs to run out of control. But soon enough the the inevitable "crisis" will come to the fore and the government will be "forced" to act and begin coercing methods. This will all be much easier to accomplish when the government controls most of healthcare.
"Yes, Central Planning of markets for health insurance has a very good track record on the world stage."
I'd say it's more of a mixed picture with some countries having significant problems in their systems. Plus, the US being the forefront of medical research and provider of drugs underwrites much of foreign nations. And lastly, I would contribute much of our contry's healthcare problems to central mismanagement over the last few decades - from pushing work-based insurance, to new federal programs to limiting insurance competition.
"Medicare Part D went into effect in 2005. But anyway, it is not possible to derive anything meaningful from small differences annual change over 3 year periods...But before Medicare Part D there was no donut! All the outpatient prescription drug spending was by the patient or the private Medigap policies they purchased."
So how does Medicare D explain reduced price of generic drugs - even though that trend didn't start in 2005, while we see the opposite for brand name drugs over the same time period? I can't find any meaningful conclusions from the data.
Avian,
"Do you have any evidence that charity care did in fact control costs without rationing care or reducing quality before Medicare was established?"
Do you have any data from the 50s? I just know there weren't the financial problems in medicine remotely like we have today.
"What mechanisms do you believe would cause charity care to control costs in this way?"
It's not the charity that controls costs - it's the returning the market to the consumers and having simple bargain-seeking behavior determine prices. The charity is just what'll make up the difference for the few who cannot pay the difference.
"No, it would not a stable amount. Health care spending would still increase faster than inflation + GDP growth. And government spending on health care would increase faster than inflation + GDP growth too."
What do you have to base this assertion on?
"It is debatable whether it would actually do this. But more importantly: The large majority of Americans aren't the reason why health care spending consumes 16% of GDP."
Oh, then who?
"But in the case of people who cannot afford health insurance and are not eligible for Medicare, Medicaid, or SCHIP, we have a situation where people are not the recipient of any government entitlement programs and yet charity has not been sufficient to close the gap."
Sure, because these people are relatively well off and could often have bought insurance had they chosen to. They're a tough case to sell to charity - particularly to a population who are not used to giving for medical needs.
"If we abolish all government entitlement programs, do you believe charity is going to begin covering people who weren't even covered by those entitlement programs?"
No I don't! But such people should be able to afford the ~$5000 before the government kicks in anyway.
Orthoprax,
"As an aside, how much fraud do you think Medicare lets slip through the cracks by its barely-there oversight?"
No idea. But if fraud were indeed a huge problem in Medicare, and if private insurers could control fraud better, then we would expect to see Medicare Advantage plans run by private insurers costing less than traditional Medicare. Instead, we find that Medicare Advantage plans cost the taxpayer 14% more per enrollee.
If your argument is that both Medicare and private insurance have considerable fraud but medical charity has less, then please provide some evidence for that.
"Or simple rationing of care, which is likely."
Yes, this can happen. But we already ration health care by income class. If we were to abolish Medicare and Medicaid, or set $5,000 deductibles, then surely such rationing would increase rather than decrease. You say that charity will fill the gap for people who cannot afford the $5,000 deductibles, but you have not provided any evidence that this would actually happen.
"I'd say it's more of a mixed picture with some countries having significant problems in their systems."
Yes, other developed countries have problems too. But we are quite unique in the respect that we have such a large fraction of people without no health insurance and limited access to health care. We are also unique in the respect that we spend much more of our GDP on health care than any other country.
"Plus, the US being the forefront of medical research and provider of drugs underwrites much of foreign nations."
I agree. The United States throws a huge amount of money on health care so it is not surprising some good things come out of it. But our system tends to encourage a large amount of medical research that benefits private shareholders but not society as a whole. For instance, drug companies that spend large amounts of money creating new drugs that are no better than existing drugs on the market. It would be more economically efficient and better for society if we had the government use taxpayer money to fund more of this research (either by doing it themselves or contracting it out to private companies) and put the intellectual property gained from such research in the public domain.
Orthoprax,
"And lastly, I would contribute much of our contry's healthcare problems to central mismanagement over the last few decades - from pushing work-based insurance"
Nobody likes work based insurance, but it makes sense to push it because the alternative -- insurance on the private individual market -- is so much worse.
"to new federal programs to limiting insurance competition."
Such as?
"So how does Medicare D explain reduced price of generic drugs - even though that trend didn't start in 2005, while we see the opposite for brand name drugs over the same time period? I can't find any meaningful conclusions from the data."
I can take some educated guesses, but I'd prefer not to. I only pointed out that prescription drug coverage was only added to Medicare in 2005 in response to the following statement you made: "If real market forces were in effect, how fast do you think the costs of blood pressure drugs and diabetes drugs would drop?"
"What do you have to base this assertion on [that health care spending will keep rising]?"
The CBO (see figure 4 on page 13 of this report) for one. The default position is that it will keep growing faster than GDP, just like it has for decades. I doubt there is a single economist with expertise on health care who disagrees. (If you can find one, I'd be interested to know.) The idea that $5,000 annual deductibles are going to halt this growth is completely implausible because most health care spending is spent on a minority of people who spend far more than $5,000 per year. (I've substantiated this already in a previous comment.)
"Sure, because these people are relatively well off and could often have bought insurance had they chosen to."
This represents some of the uninsured, but not most of them. The fact is that most uninsured people are below 200% of the federal poverty line (see page 6 of this KFF report). The cost of the average employee-sponsored health care plan was $13,375, and I'd assume that is a better price than the average family would get on the private market due to lower administrative costs. It is totally unreasonable to say most of the uninsured could buy health insurance if they wanted to.
Orthoprax,
"Do you have any data from the 50s? I just know there weren't the financial problems in medicine remotely like we have today."
You are correct but you are assuming causation in the wrong direction. If health care spending is are low, we can expect charity to be able to cover relatively more of it. If health care spending is high, we can expect charity to be able to cover relatively less of it.
"It's not the charity that controls costs - it's the returning the market to the consumers and having simple bargain-seeking behavior determine prices. The charity is just what'll make up the difference for the few who cannot pay the difference."
But we can expect a lack of bargain-seeking behavior with with people with all kinds of health insurance: public or private, free or not free. And it is totally unrealistic to abolish health insurance and expect most middle class people to be able to pay $100,000 hospital bills (as if the medical problem was not terrible enough). And it is also totally unrealistic to expect charities to be responsible for every unpaid $100,000 hospital bill either.
And if your argument is that we should keep health insurance but have $5,000 deductibles: $5,000 deductibles aren't likely to control health care spending much because it would only cover a minority of health care spending. (I provided evidence for this in a previous comment.)
And among lower class people, there are further problems: We can hope the people will get charity to help cover the $5,000, but if charity is paying for a service then I'm not sure why we would expect the person to exercise "bargain-seeking behavior." And if charity does not pay, or does not pay a sufficient amount, then we are effectively rationing health care by income class. We can certainly reduce health care spending by rationing care by income class, but let's be honest about what we are doing.
Sorry, I wrote: "The cost of the average employee-sponsored health care plan was $13,375, and I'd assume that is a better price than the average family would get on the private market due to lower administrative costs." But I meant to say: "The cost of the average employer-sponsored health care plan for a family in 2009 was $13,375, and I'd assume that is a better price than the average family would get on the private market due to lower administrative costs."
Avian,
"No idea. But if fraud were indeed a huge problem in Medicare, and if
private insurers could control fraud better, then we would expect to see Medicare Advantage plans run by private insurers costing less than traditional Medicare. Instead, we find that Medicare Advantage plans cost
the taxpayer 14% more per enrollee."
Why would you expect that? The government is still paying the bills with Medicare Advantage and therefore the private companies have little incentive to stem the tide of fraud - indeed they may have interest in increasing it.
It may interest you to know that Medicare fraud is estimated by law
enforcement experts at over $60 billion dollars annually - enough to wipe out any savings from lack of overhead.
"Yes, this can happen. But we already ration health care by income class. If we were to abolish Medicare and Medicaid, or set $5,000 deductibles, then surely such rationing would increase rather than decrease."
Hardly. With globally rationed care you'd end up with generally poorer care for most and good care for those who could afford to buy extra. This at the cost of pulling down the entire system.
"You say that charity will fill the gap for people who cannot afford the $5,000 deductibles, but you have not provided any evidence that this would actually happen."
The point is that if Americans truly care about the health of their fellow citizens then they shouldn't rely on the government to solve that problem. It should be solved by grassroots and non-coercive methods.
"It would be more economically efficient and better for society if we had the government use taxpayer money to fund more of this research (either by doing it themselves or contracting it out to private companies) and put
the intellectual property gained from such research in the public domain."
Sure, more economically efficient, but deadening to the market-based
system of innovation. Take away the profit motive and you retard progress.
"Nobody likes work based insurance, but it makes sense to push it because the alternative -- insurance on the private individual market -- is so
much worse."
Not if there was real competition between insurance companies.
"Such as?"
Medicare, Medicaid, SCHIP, etc. And insurance companies are protected from competitioon by local rules and regulations.
"I only pointed out that prescription drug coverage was only added to Medicare in 2005 in response to the following statement you made: "If real
market forces were in effect, how fast do you think the costs of blood pressure drugs and diabetes drugs would drop?""
Oh, so that whole discussion was a red herring. It's not just Medicare
that contributes to drug costs but the whole insurance mechanism in the first place where consumers do not see the cost of what they buy and therefore choose their drugs based on the newest and most expensive rather than the equally effective.
"This represents some of the uninsured, but not most of them."
I agree, that's why I didn't say 'most.' But most likely could afford some basic indeminity care even if not a big employer-based plan.
"If health care spending is high, we can expect charity to be able to
cover relatively less of it."
Not if we're just talking about that $5000k per person.
"And if your argument is that we should keep health insurance but have $5,000 deductibles: $5,000 deductibles aren't likely to control health care spending much because it would only cover a minority of health care spending. (I provided evidence for this in a previous comment.)"
How is it unlikely? The point I made before was that $5000 represents the first 20% of health spending and would therefore slow down spending generally except for those truly in dire straights.
"And among lower class people, there are further problems: We can hope the people will get charity to help cover the $5,000, but if charity is paying for a service then I'm not sure why we would expect the person to exercise
"bargain-seeking behavior.""
Obviously that's a matter of how easy it is for them to get such charity care. If it's *too* easy then they'll take it for granted and abuse the charity system.
"And if charity does not pay, or does not pay a sufficient amount, then we are effectively rationing health care by income class. We can certainly reduce health care spending by rationing care by income class, but let's be honest about what we are doing."
What percent of people in America cannot cobble together $5000 for medical care? I think very few people would be put out and rationed out of health in my system. To note too, you're ignoring my additional type of charity which is doctor-care that can be credited on tax day.
Orthoprax,
"Why would you expect that? The government is still paying the bills with Medicare Advantage and therefore the private companies have little incentive to stem the tide of fraud - indeed they may have interest in increasing it."
No, that does not make sense. The government pays private insurers per beneficiary, not per service. This means that if private insurers can control fraud better, they can increase their profit margin.
"It may interest you to know that Medicare fraud is estimated by law
enforcement experts at over $60 billion dollars annually - enough to wipe out any savings from lack of overhead."
Which experts? What is their methodology? What is the evidence that private insurers do any better?
"Hardly. With globally rationed care you'd end up with generally poorer care for most and good care for those who could afford to buy extra. This at the cost of pulling down the entire system."
I am confused about what we are talking about now, so I don't know how to respond. Are we talking about whether we should keep or abolish Medicare and Medicaid? Are we talking about the Democratic proposals being debated in Congress? Are we talking about some hypothetical single-payer system in the United States?
"The point is that if Americans truly care about the health of their fellow citizens then they shouldn't rely on the government to solve that problem. It should be solved by grassroots and non-coercive methods."
If there is no evidence that charity will be sufficient to pay the $5,000 deductibles for poor people, then it makes sense for Americans such as me to expect the government to pay for these people.
"Not if there was real competition between insurance companies."
You completely ignored the two articles I cited, both of which demonstrate why this argument makes no sense. Here is one more.
Orthoprax,
"I agree, that's why I didn't say 'most.'"
You said that people who cannot afford health insurance and are not eligible for Medicare, Medicaid, or SCHIP "are relatively well off and could often have bought insurance had they chosen to." I gave you the benefit of the doubt by assuming you meant "most" and not "all."
"But most likely could afford some basic indeminity care even if not a big employer-based plan."
This is highly implausible. Firstly, these people will be buying health care on the private individual market which has enormous administrative costs. And secondly, a less generous plan means more out of pocket expenses, which many of these people will also be unable to afford. There is no free lunch.
"How is it unlikely? The point I made before was that $5000 represents the first 20% of health spending and would therefore slow down spending generally except for those truly in dire straights."
The point is that burden almost all of those "truly in dire straights" is shouldered by most of the population in one form or another. This is passed down to people mostly in the form of high health insurance premiums (i.e. healthy people in employer plans subsidizing unhealthy people) and in taxes (Medicare, Medicaid, reimbursement for uncompensated hospital care, etc.).
"Obviously that's a matter of how easy it is for them to get such charity care. If it's *too* easy then they'll take it for granted and abuse the charity system."
And if it is too hard, then people may end up being denied care that they need. The point is that these are problems faced by both government and charity. But at least the government can guarantee (with laws and taxes) that people who meet certain requirements (low income, disabled, with children, 65 or older, etc.) can get a certain level of care. With charity, it is quite unpredictable whether or not these people will get the care they need.
"What percent of people in America cannot cobble together $5000 for medical care? I think very few people would be put out and rationed out of health in my system."
A lot. The US Census Bureau says that people 53.8 million people (17.9% of the population) were below 125% of the poverty line in 2008. You can on see on this page how difficult it would be for these families and individuals to afford $5,000 deductibles (or whatever charity doesn't cover). And people in bad health would likely need to spend that amount (or whatever charity doesn't cover) every year.
Avian,
"No, that does not make sense. The government pays private insurers per beneficiary, not per service. This means that if private insurers can control fraud better, they can increase their profit margin."
Ah, I see. Looking further into the matter it seems that Medicare Advantage's higher costs are simply due to the government granting them huge subsidies for the same service and little to do with fraud. Citing MA as evidence of poor fraud control in the private market is a red herring when you don't take into account the subsidies that increase government payments from the get go.
"Which experts? What is their methodology? What is the evidence that private insurers do any better?"
http://www.msnbc.msn.com/id/22184921/
Obviously you cannot get good data on unknowns like this, but fraud in the private insurance programs are estimated by experienced private counter-fraud agents at ~3% while Medicare is estimated at the range of 10-20%.
http://www.politifact.com/truth-o-meter/statements/2009/aug/27/tom-coburn/coburn-says-20-percent-every-medicare-dollar-goes-/
"I am confused about what we are talking about now, so I don't know how to respond."
Any socialized system that would overprice itself to induce rationing.
"If there is no evidence that charity will be sufficient to pay the $5,000 deductibles for poor people, then it makes sense for Americans such as me to expect the government to pay for these people."
Except that the "government" doesn't really pay for anything - it all comes from taxes. What you're really saying is that if your fellow free citizens aren't willing to charitably provide for care then you agree with coercively taking it from them.
"You completely ignored the two articles I cited, both of which demonstrate why this argument makes no sense. Here is one more."
Sure, if you handicap the companies by mandating that they cover abc through xyz and a dozen other regulations that tie their hands then they need to be more selective with who they accept onto the plan and a hundred other things that'll increase costs on the individual market basis. A free market is a free market and you cannot pretend to demonstrate freedom when the companies cannot freely compete on their own terms.
"You said that people who cannot afford health insurance and are not eligible for Medicare, Medicaid, or SCHIP "are relatively well off and could often have bought insurance had they chosen to." I gave you the benefit of the doubt by assuming you meant "most" and not "all.""
The operative term in my statement is with the word "often." Often doesn't means *always* nor does it mean *most of the time.*
"This is highly implausible. Firstly, these people will be buying health care on the private individual market which has enormous administrative costs."
Not for indemnity care plans.
"And secondly, a less generous plan means more out of pocket expenses, which many of these people will also be unable to afford. There is no free lunch."
Which is not relevant to the point that most of such people could afford indemnity-type insurance plans that would protect them financially in the case of catastrophic illness.
"The point is that burden almost all of those "truly in dire straights" is shouldered by most of the population in one form or another."
And? How does that demonstrate necessarily increasing medical costs?
"But at least the government can guarantee (with laws and taxes) that people who meet certain requirements (low income, disabled, with children, 65 or older, etc.) can get a certain level of care."
Perhaps. Perhaps not. I have a post on my blog detailing how public medical programs in many cases do not pay enough to keep doctors in business - and therefore there is a growing number of physicians who reject programs like Medicare and Medicaid. I would expect any "public option" would face similar problems.
The point is that in theory the government can cover everyone - but at what lowest common denominator of care and at what cost to the system at large?
"A lot. The US Census Bureau says that people 53.8 million people (17.9% of the population) were below 125% of the poverty line in 2008."
Alright. But how many of these people would require spending $5000 in medical costs? Not so many. That's where charity comes in play.
Orthoprax,
"Ah, I see. Looking further into the matter it seems that Medicare Advantage's higher costs are simply due to the government granting them huge subsidies for the same service and little to do with fraud. Citing MA as evidence of poor fraud control in the private market is a red herring when you don't take into account the subsidies that increase government payments from the get go."
The Medicare Advantage payment process that permitted overpayments was established by Republicans in 2003. The reason for this was that Medicare+Choice, the predecessor to Medicare Advantage, had only 12% of the market share in 2002, and the CBO projected it would go downhill from there. Private insurance was given a chance to compete fairly with the government. The fact is that private insurance -- which both you and Republicans insist is more efficient than the government -- could not compete very well with the government when they were given an equal opportunity. And so Republicans rigged the system to give private insurance an advantage.
So either (a) private insurance companies cannot control fraud better than Medicare, or (b) private insurance companies can control fraud better but it still could not compete very well with Medicare in spite of that.
"Obviously you cannot get good data on unknowns like this, but fraud in the private insurance programs are estimated by experienced private counter-fraud agents at ~3% while Medicare is estimated at the range of 10-20%."
The MSNBC article makes the claim "Law enforcement officials said it's just one of the many widespread, organized and lucrative schemes to bilk Medicare out of an estimated $60 billion dollars a year — a staggering cost borne by American taxpayers" and provides absolutely no evidence or source for this whatsoever.
PolitiFact does not support the claim either. The only support PolitiFact provides to substantiate the claim is Malcolm Sparrow, who said in an interview that the $80 billion estimate is "perfectly plausible," but also makes it clear he has no good data to support this. And further, if you read Sparrow's paper (available on EBSCOhost) you can see that he complains about fraud in the entire US health care system, not just in Medicare. It is not clear that he believes Medicare is any worse than private insurance.
Orthoprax,
"Except that the 'government' doesn't really pay for anything - it all comes from taxes."
I have very clearly acknowledged this.
"What you're really saying is that if your fellow free citizens aren't willing to charitably provide for care then you agree with coercively taking it from them."
Yes. Just like the government coercively takes money from my fellow free citizens for:
* Public parks: "I have my own backyard. Why should the government coercively take my money to build parks for people who don't?" says the fellow free citizen.
* Public libraries: "I can buy my own books. Why should the government coercively take my money to make books available for other people?" says the fellow free citizen.
* The police: "I can buy my own private security. Why should the government coercively take my money to hire security for other people?" says the fellow free citizen.
* The military: "I am anti-war. Why should the government coercively take my money to kill people?" says the fellow free citizen.
"Sure, if you handicap the companies by mandating that they cover abc through xyz and a dozen other regulations that tie their hands then they need to be more selective with who they accept onto the plan and a hundred other things that'll increase costs on the individual market basis. A free market is a free market and you cannot pretend to demonstrate freedom when the companies cannot freely compete on their own terms."
Discrimination based on pre-existing conditions and high administrative costs are inherent problems in free market solutions for health insurance. Clearly, you either did not read any of the articles I provided or willfully misunderstood them. You have failed to address anything in any of the articles.
"Not for indemnity care plans."
In contrast to HMO plans? Do you have any evidence for this claim?
Anyway, indemnity plans tend to be more expensive than HMO's. So even if administrative costs for indemnity plans on the private individual market are less than HMO plans, the savings are being lost anyway.
Orthoprax,
"Perhaps. Perhaps not. I have a post on my blog detailing how public medical programs in many cases do not pay enough to keep doctors in business - and therefore there is a growing number of physicians who reject programs like Medicare and Medicaid."
I already said most of what I want to say about this issue, but I responded on your blog to the specific statements you wrote there.
Post a Comment