The MinnPost article linked below pointed to the AHRQ Brief linked below. Then I threw in some additional links.
"In 2010, the top 1 percent ranked by their health care expenses accounted for 21.4 percent of total health care expenditures with an annual mean expenditure of $87,570. Overall, the top 50 percent of the population ranked by their expenditures accounted for 97.2 percent of overall health care expenditures while the lower 50 percent accounted for only 2.8 percent of the total." From the AHRQ Brief
Maybe that 80/20 rule applies to this also... Thoughts?
AHRQ Expenditure Brief
MinnPost Costliest1% of Patients Spend 21%
EOI US Healthcare Costs
Common Wealth Explaining High American Costs
G2A American Healthcare Drivers
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24 comments:
Insurance is like roulette. When the wheel is done spinning, it's the one who picked the right number who gets the payoff. If money bet was returned to the gamblers, the game would have little appeal. One difference with insurance, is that the folks who didn't get a payoff are the winners, not the folks who did have to claim the proceeds,
--Hiram
So what we expected to be true is now proven, and the 80/20 rule is again shown to be valid. I see only two other questions:
1) Does current government interference in the health care/health insurance system exacerbate this situation?
2) Isn't it highly likely the one-size-fits-all nature of Obamacare makes the problem worse, not better?
It's interesting to me that people argue against a different Obamacare than the one we have. A basic feature of Obamacare is choice. That's what the exchanges give us. It isn't a one size fits all system all though it could have been. There may well be advantages to a choice based system, but it will also be less efficient, often more expensive, and as we have seen very glitch prone.
--Hiram
1.) No.
2.) No.
Why? Because one never knows whether one is going to be in the 80 or the 20. If one had perfect knowledge of where one would lie, it would be possible to build a perfect system that would handle things perfectly.
Sean, I think you are missing something. There is no "choice" in the exchanges, except as to who will provide the exact coverage required by the Obamacare law. The reason private insurers are cancelling endless policies is because the O'care requirements make current policies, which people LIKE and want to Keep, non-compliant. In other words, O'care will not permit you to buy what you want. In the exchanges, the policies are all fully compliant AND higher priced (because of it). It's like having a choice between death by hanging and death by lethal injections.
So I guess the easy way to reduce our healthcare expenditures is to cap benefits like they do in other socialized medicine countries.
I mean it will affect a minority of the systems users and make the metrics look much better. Practical?
FYI. I copied these over to the Healthcare post.
Jerry, in 2008 the dems won at all levels- house, senate, and pres, after campaigning about improving access to health insurance. The reason no republicans voted for Obamacare is they opposed the goal of universal access. The dems worked for many months in the senate trying to get at least a few senators to support the bill and would have made compromises in exchange for votes.
Extremism is putting politics ahead of compromise in creating policy that helps millions of citizens. Our constitution does not require a super majority to pass legislation." Laurie
"The reason no republicans voted for Obamacare is they opposed the goal of universal access."
That's an exceedingly biased statement. You are saying that every single Republican hates people and wants them to die. Or at least that's what Democrats have said about Republicans who oppose Obamacare, and they cannot possibly be right. The typical liberal problem raises its Hydra heads again here; while the goal may be admirable in general terms, the means for it to be achieved at all is doubtful, the means for it to be achieved by government even less so, and the notion that it can be "comprehensively" solved by Congress and the federal bureaucracy would be laughable if it were not currently being visited on us in exactly the terrible fashion anyone who understood the problem and the legislation predicted.
"Universal access" is not something that government can grant. The FREEDOM to seek or to provide health care is the only thing that government SHOULD simply leave unhindered. In all other goods and services, the free market has provided the greatest good for the greatest number.
You also overlook that Republicans have offered many, many "solutions," though none so arrogantly "comprehensive." The problem Democrats have with these common sense solutions is that they do not place the government in total control of your life. It is very hard to build your Utopian dreamworld when people have free will." Jerry
Jerry,
What have the Republicans offered that would slow the rampant healthcare cost growth and ensure that low income folks can afford to be covered?
It seems the Liberals are correct here. The GOP has offered exactly zero... Thoughts?
The problem the Republicans have is that the mainstream media are "in the tank" for Democrats and perfectly good Republican ideas are never heard except by the few paying attention. I know, this sounds like the typical conservative wailing about a biased media, but there is ample evidence to support that contention. For example, a recent survey found that a majority of Americans agreed with Republican ideas in something like 13 of 16 issues, but when told they were "Republican" ideas, support dropped to about 35%! That happens because the Republican brand has been consistently slandered by Democrats and their media allies-- roughly 90% of whom vote for and contribute to Democrats.
As for the ideas, how about: allowing insurance to be sold across state lines, reducing the cost of frivolous malpractice claims, permitting anyone to have an HSA (and maybe subsidizing those who cannot afford it), converting Medicare to a premium support model rather than government-run price-fixing fee-for-service, turning Medicaid over to the States with subsidies but minimal strings (MNCARE was more efficient), transferring the employer tax exemption for health care to the employee making health care portable and solving a lot of the PEC problem, reducing the insurance regulations that result in a one-size-fits-none non-choice. Republicans have even introduced these ideas in a "comprehensive" bill, did you know that?
"So I guess the easy way to reduce our healthcare expenditures is to cap benefits like they do in other socialized medicine countries"
Sorry, it's too late. Medicare (and Medicaid) GREATLY restrict the amount paid to providers, generally to about 33% of what providers would charge otherwise. That is why so many doctors are now refusing new Medicare patients who have no supplemental insurance, and why Congress every year has to pass the "doc fix" bill to keep payments from falling even further behind actual costs. The crazy thing is that if Medicare and Medicaid just "went away," costs would drop to about what those programs now reimburse.
The Republican health care "reform" ideas sound wonderful, but they don't do anything to fix the problem. When the CBO scored it, the % of uninsured didn't change and it was worse for the budget than the ACA.
Sean, excuse me for doubting your assertions about the Republican health care alternatives. First of all, it used to be that the CBO was the "gold standard" for evaluating legislation, but that is no longer the case. They are mired in the notion of "static scoring," go only out ten years, and rely on Congress to tell them what other assumptions to use. Sometimes Congress lies, of course, or plays games. For example, the original Obamacare scoring included 10 years of taxes and only 6 years of benefits.
But even if we are talking about the same GOP alternative, the fact that they "sound good" (i.e. sensible and realistically applicable to the problem) ought to be highly favorable to their adoption. I mean, given a choice between something you are pretty sure will work and something you are pretty sure can't possibly work, like Obamacare, one ought to be able to find a rational decision. Hard to do, though, when you've got irrational Democrats calling you "terrorists" for asking not to make people pay for something that doesn't work.
Sean,
Please provide source for the "Republican" proposal and its scoring.
Most of the times the Liberals say that the GOP has offered no solutions. So your awareness of their alternative has me somewhat surprised.
Here's the link:
http://cbo.gov/sites/default/files/cbofiles/ftpdocs/107xx/doc10705/hr3962amendmentboehner.pdf
Of course the original scoring of the bill included 10 years of taxes and 6 years of benefits, because the taxes started before the benefits. It doesn't change the fact that over the long-term the ACA is still favorable from a deficit perspective.
Actually, I'm rather confident the ACA can work, because it's working in Massachusetts. That's the difference between going on things that sound good and finding out what actually works.
CBO GOP Proposal Review
We will need a little more review regarding the Massachusetts program / success.
I am curious what factors are used in that evaluation and how they are weighted?
From what I have read, the MA program doesn't cover nearly as many people as was promised, has considerably increased premiums and reduced competition. Not a blinding success because it is built entirely on the false assumption that people aren't capable of making their own decisions.
Actually, RomneyCare has been largely successful. Not perfect, but better than before.
Here's a link.
http://www.factcheck.org/2011/03/romneycare-facts-and-falsehoods/
Fact Check RomneyCare
I'll read it later.
Very impressive summary, and believable. My takeaways: 1) MA did not have far to go-- 93% already were insured, 2) 80% of the newly insured were subsidized, 1/2 of those totally so, 3) their "exchange" actually worked in producing competition, unlike what I had heard, and 4) unlike the federal plan, there is no cost-controlling "death panel."
There's no "death panel" in the ACA, Jerry.
Not by that name, no. The IPAB will eventually function in exactly that fashion, regardless of what was intended. Even before that, bureaucrats will be making decisions about who lives and who dies. I know from personal experience.
Two views.
Cancer World European Rationing
Scientific American Book Review
And remember my friend's Land Lady in Italy. Oh you have cancer... Well here is $50,000... Enjoy your last 6 months of life...
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