From G2A Who Demands Compliance Jerry said
"Healthcare requires money. Well said, but it makes the glaringly erroneous assumption that the only way to deliver health care is exactly the way it is done today. As I've said before, four changes would reduce our total costs by about 50% without affecting quality. So should we NOT do those things, just because we might be able to lower taxes for somebody? I'm not understanding the reasoning, here. It looks like an attempt to keep a political argument alive, regardless of what the "right thing to do" might be. " JerryI asked him to provide them and here are the answers.
"Actually, they aren't mine; they come from a Mayo study many years ago. They are:
- Eliminate first dollar coverage. Every use of the system costs /something/ (a copay, IOW).
- Eliminate fee-for-service. This is the big one. Rather than doing what is the quickest and best treatment, doctors are led to do what pays the best or, more likely, to add on something unnecessary just to cover their costs.
- Eliminate third-party payers. Forget single-payer. Everybody pays their own fees or buys insurance on their own. If they get a stipend or a tax credit to do so, that's their own affair.
- Eliminate defensive medicine. The malpractice system is out of control and drives up costs, not directly, but indirectly.
To that we should add, now, deregulation of the health insurance industry. If I want, I should be able to buy a "catastrophic only" policy, or open an HSA or "prepaid care account," without government telling me I can't."We just have a whole lot of well paid people in the system." G2A"And yet that marketplace is badly distorted by government regulation. Medicare tells doctors they can only get, say, $250 for an appendectomy (I have no idea, but) the doctor doesn't make a penny unless he charges at least $500. So he makes it up somewhere else or refuses to do it. If the doctor could charge, say $550, he might get "rich," but do we really want to hire the low-cost bidder for something like that?
And by law, all insurance companies in Minnesota are "non-profit." Why would anybody get into that business?In fact, the whole idea seems illogical to me. If we had a free (or mostly free) market in health care, prices would be set by the millions of individual choices and implicit contracts made between providers and patients-- sellers and buyers. The best and/or scarcest goods and services would make those providers "rich" and everybody else would enter the market at the point where they saw a beneficial exchange, or exit the business for lack of business. Absolutely nothing wrong with that. " Jerry
76 comments:
And by law, all insurance companies in Minnesota are "non-profit." Why would anybody get into that business?
Health insurance companies do make money. Nobody is in the business for their health. The reason there are so few companies in the health care business, is that it isn't a good business. The risks are just too risky, and the profit margins are too low. This is why small market states have such difficulty in attracting insurers.
Now there are lots of ways to reduce the cost of health care. American health care expenses are very high. But the problem is that the people with the political power are the people who benefit from high costs. They are also in the power position in terms of how care is provided. I personally would like to use the market power of government to force down prices but I can tell you now what the arguments would be. Socialized medicine, death panels, taking away freedom of choice. YOu won't be able to keep your doctor. These are all arguments against measures aimed at reducing health care costs, and believe me, there are many more and they are effective. Without Republican support, that just isn't a road down which I have much interest in going. I have been burned way too many times on that.
--Hiram
"people with the political power are the people who benefit from high costs"
You still preaching that sermon. Look at all the Stakeholders in our System. And that is only the direct jobs / industries.
A good chunk of the Twin Cities' economic success and vitality is because of Medtronic and the hundreds of other device companies that they attracted here. Along with the MAYO and the U of MN Medical School. My point is that a whole lot of American citizens benefit from our high cost of healthcare.
It is one of the areas where it is hard for cheap American consumers to get the product or service from low cost countries overseas. Though it sounds like a lot of people area doing that. Anything to avoid paying American workers...
Throwing up one's hands isn't a solution. The reality is that the market (such that it is) for healthcare didn't just develop organically. It's the result of decisions that policymakers have made over the course of decades.
For instance, Americans spend over $400B annually on prescription drugs annually. Studies indicate that if all drugs were available as generics, that total would be less than $100B a year. That's because we've built a system that protects the intellectual property of pharmaceutical companies -- and we've made those protections stronger and longer lasting over recent decades.
That's a policy decision that costs Americans over $300B a year. And it often puts the newest and most effective drugs out of reach of some patients. We could choose to soften (or eliminate) those protections and save gobs of money (and probably a few lives, too) if we wanted to.
We'd have more than enough money, by the way, to replace the $70B in R&D that drug companies do every year. It's an option that we never seem to discuss because the big moneyed interests would never allow it to happen.
Maybe we should discuss it, though. (Yes, there are some serious counter-arguments to doing such a thing, and I'm not necessarily endorsing such a move. But I daresay it's much more serious and compelling than the sort of nonsense that the GOP Congress is working on right now.)
A good chunk of the Twin Cities' economic success and vitality is because of Medtronic and the hundreds of other device companies that they attracted here.
Sure, but that contradicts the notion of patient centered health care that Republicans advocate but don't support. Instead of focusing on care, they focus on the economic interests of companies involved in health care. Now let's bear in mind, I am not someone who likes to view things in moralistic terms. I don't think it's necessarily wrong to favor policies that aren't all that patient centered. If asked, I can certainly make some pretty good arguments for the providers. But favoring the providers is going to result in higher costs. The question you have to ask is are the higher costs worth it?
--Hiram
When you think about markets, the basic question you have to know the answer to is, "Who makes the decision to buy and sell?" Where in the process is there the bid, and the ask, and who has the power to decide what the bid should be, and what the ask should be? Wherever that happens, that's where the market is.
Where is the market in health care? Who has the discretionary power to decide what prices should be?
--Hiram
Well Jerry wants it to be the patient...
"Eliminate third-party payers. Forget single-payer. Everybody pays their own fees or buys insurance on their own. If they get a stipend or a tax credit to do so, that's their own affair."
Unfortunately we have agreed that our society's morality will not allow cheap skates to die when they refused to pay premiums they deemed to high. So even though it would reduce costs greatly, I don't think it will work.
As for markets... I think they work fine in the USA as long as everyone has money to pay for insurance... Let's use the Blue Cross vs Childrens Negotiations as an example.
Employees choose to work at my employer in part because they have acceptable benefits. We know what will be covered, what the cost is, etc.(negotiation 1)
My company is self insured but negotiates with multiple insurance companies to determine who can offer the best management services value for the money. (negotiation 2)
Blue Cross works across all the clinics and hospitals in MN (and the USA) to ensure the costs, quality and availability are competitive. (negotiation 3)
The system doesn't really get screwed up until...
- Those who are receiving the care
- Are not the ones paying the bill
In my case I know that my premiums will increase if my co-workers live unhealthy lives, so I am okay with the healthy living program, higher premiums for non-participants and when certain experimental procedures are turned down.
My company, BCBS and I have a vested interest in keeping costs down.
Where as I don't think that works as well with Medicare, Medicaid, etc.
I mean their is such a huge disconnect between the patient and the payer (ie tax payer)...
"Where as I don't think that works as well with Medicare, Medicaid, etc."
Over the last 25 years, per capita spending in Medicare has grown more slowly than private insurance -- despite Medicare's older and sicker population.
NHE Fact Sheet
Medicaid Challenges
Of course, governmental price controls work... To reduce cost...
Unfortunately lowering that leg affects the other 2 negatively... (ie availability / timeliness and possibly quality)
Sean,
Can you think of any substantial policy rules in Medicare / Medicaid that pressure the participants to live healthier lives?
Remember that my wife are highly motivated by that ~$3,000 / year credit we get for staying healthy and/or under a Doctor's care.
And actually this year it increased to a $5,000 incentive. I can pass on a lot French fries, chips and sweets for that kind of cash... Now if I can just get motivated to exercise...
Sean,
"despite Medicare's older and sicker population"
It occurred to me...
Do you think old people are older and sicker today than they were 25 years ago?
My guess is that the older folks may be the same or healthier than they were 25 years ago. Most of my older friends had their open heart surgeries and stints installed in their mid-50's under their employee health insurance... And that gave them motivation to live cleaner.
An interesting link.
Understanding Life Expectancy
"Life Expectancy at 65: As people age, their life expectancy actually increases. Each year you live means that you have survived all sorts of potential causes of death. If you were born in 1942, your life expectancy at birth was about 68 years. But the good news is that you didn't die of infectious diseases when young, car accidents, or anything else."
My point is which 70 year old is likely more healthy?
The one who was born in 1922 and was 70 in 1992?
The one who was born in 1947 and was 70 in 2017?
Personally I am betting on the one born in 1947 given being post Depression and having the benefit of modern medicine. Though I suppose our becoming couch potatoes and getting fat isn't helping the boomers any...
Well Jerry wants it to be the patient...
Does he? Should the patient determine what he pays for health care? How long would heart surgeons stay in business if they got paid, say 20 dollars for a procedure? How long would medical device companies stay in business if they had to give away their product for free?
Not even I am in favor of those things.
--Hiram
Well remember the 3 legs...
- Cost
- Quality
- Availability / Timeliness
Markets balance these pretty well...
Governments... Not so much so...
And do you think patients value a healthy and functioning heart at $20?
"My point is which 70 year old is likely more healthy?
The one who was born in 1922 and was 70 in 1992?
The one who was born in 1947 and was 70 in 2017?"
Certainly, the probabilities are in favor of the one born in 1947. But, that in part is also due to the expensive medications and technology that we have now compared to previously, so there are forces working in opposite directions.
"- Cost
- Quality
- Availability / Timeliness
Markets balance these pretty well."
What is the evidence that this is the case as it relates to health care? Can you provide me an example of a country where the market functions in such a manner?
Yes there are a lot of causes out there... I am just pointing out that this statement is questionable at best.
"Over the last 25 years, per capita spending in Medicare has grown more slowly than private insurance -- despite Medicare's older and sicker population."
I am not sure I can find one since so many governments have waded into the market to protect those with little wealth/income.
Why do you think that healthcare is different than most open markets that balance these 3 factors every day?
I wonder what would happen if the government provided free electricity and natural gas to every low income citizen / family?
Would those users make life changes to keep costs down?
Or would they just use it with little concern to waste and cost?
if the government provided free electricity and natural gas to every low income citizen / family?
An interesting question. The government does provide a lot of stuff for which they don't charge at point of service. What does the way that low income people use roads or schools tell us about the way they would use free electricity? How would the burden of the cost of electricity be allocated? Would it fall on low income people indirectly, through a higher cost in goods and services?
--Hiram
"Why do you think that healthcare is different than most open markets that balance these 3 factors every day?"
There are dozens of reasons, but here are a few:
* Everyone requires some level of health care.
* Many critical health-care decisions are made under duress without the ability to price-shop.
* Making a bad decision in a health care market can result in your death. As such, it makes the asymmetry in information between doctors and patients more acute and harder to deal with.
* Traditional market forces are not always effective at producing desired results in health care. The proper market response for an insurance company dealing with a person with cancer is to jack up their rates or to refuse to cover them (just as they would when evaluating car insurance for someone with a horrible driving record). But that's not the result we want as a society, is it? Increasing the share of out-of-pocket payments for people does tend to the amount of health care that people consume -- but that also means that some people bypass needed care.
should be "tend to reduce the amount of health care that people consume"
Hiram,
Considering how many poor folks fail to use our free schools and socials services to improve their lives should concern us greatly. (ie drive up costs with low positive results) Free electricity, gas and healthcare is likely very similar.
Roads are a bit different because it does cost people to drive and the gas taxis pretty tightly linked. (ie no free road usage)
No the free services if like social services, public schools, healthcare, etc would be paid for by other citizens. The greatest burden being transferred to the successful citizens.
Sean,
I think the phrase "desired results in healthcare" is likely a BIG STICKING point. And I am often astounded at how people think the Doctor's and insurance companies are out to screw their clients / patients?
How will they keep customers and attract new customers if they do so?
As for... "Increasing the share of out-of-pocket payments for people does tend to reduce the amount of health care that people consume" -- but that also means that some people bypass needed care."
Again you want someone to baby sit the consumer... When will you agree that humans have the right to make bad choices and live with the negative consequences?
Again you want someone to baby sit the consumer.
the issue is always disparity in economic power. There is a view that a choice you don't have the power to make isn't a real choice. It is a disputable issue, I suppose.
--Hiram
"I think the phrase "desired results in healthcare" is likely a BIG STICKING point."
OK, how would you define it?
"Again you want someone to baby sit the consumer... When will you agree that humans have the right to make bad choices and live with the negative consequences?"
We try to protect people from bad choices all the time. You like to focus on "welfare" for the "unvirtuous", but you and I benefit from things like food inspections and product safety regulations and environmental laws. My argument would be that our society ought to be able to afford being able to prevent folks from having to choose between refilling their prescription and having enough food to eat. Or, the choice a friend of mine once faced of whether or not her family could afford to finance her battle against cancer.
There are a couple of differences between healthcare and other "goods and services." As Sean says, the need to buy can arise suddenly and require an "urgent buy" situation. So if a person is self-insured, or has insurance, no problem. For those that don't we have the law requiring emergency room treatment without immediate charge. No problem here.
Then there is the notion that government "provides" health care to people. They don't. They can use taxpayer money to pay for what private "providers" provide. It's a lot like road work, in that we pay private contractors to do public work. The difference here is that government decides what roads get built, where, at what "quality," etc. We certainly do not want that in health care, and we don't want to tell these private contractors what to bid to do the job or the job won't get done.
And finally, we have a problem with the notion of "entitlement." So long as people are given stuff for "free" they will take all they can get. If they are required to give up something, like a copay or a health insurance premium (even a subsidized one), they will choose more wisely AND the providers are more likely to provide the service because they will be paid enough to do so.
So, insist on copays, no third-party payers, and no fee-for-service, and all of this banter about what is "good" or "who benefits" gets swept away as everybody chooses for themselves. If that means a choice between food or medicine, we can look at ways to alleviate that sad situation AFTER the individual has made all reasonable efforts to resolve their situation. Government should be the answer of LAST resort; our system makes it the first.
Then there is the notion that government "provides" health care to people. They don't.
Well, of course they often do. But that said, government pays for health care. And the determined resistance of Republicans to understand how our decisions about what we do are inevitably linked to how we pay for what we do is at the heart of why Republicans fail at government.
--Hiram
we have a problem with the notion of "entitlement."
When we work for things and are promised things in exchange for our work, we are "entitled" to those things. I don't see the problem.
--Hiram
Sean,
"desired results in healthcare"
Maybe:
I as a citizen can work, save and/or pay insurance premiums so that my family and I can obtain capable effective healthcare when needed.
As long as I maintain coverage I will not see any large changes to my premiums if I get sick.
Sean,
Food inspections are generic government services that stabilize our economy by reducing risk and protect a large number of people. And I am not sure if they are necessary either given the strength of our litigious society.
Free healthcare is much more like free electricity, because the individual's choices impact how much is spent on the individual.
Jerry,
I wonder how this topic relates to your desire to provide educational vouchers?
Maybe if healthcare is a human right. Maybe every citizen should get a "health insurance voucher" to be spent with an insurer of their choosing?
The concept of "insist on copays, no third-party payers, and no fee-for-service, and all of this banter about what is "good" or "who benefits" gets swept away as everybody chooses for themselves" seems flawed when 30% of households are earning <$30,000 per year.
Ultimately are you willing to let people die if they make poor choices?
If not we need to find funding to pay for the irresponsible, stupid and unlucky of the world. And historically charity has not been able to fill the void.
Hiram,
"promised things in exchange for our work, we are "entitled" to those things"
Their are few or no "work" requirements to obtain Medicaid and ACA subsidies.
They are pure hand outs from the tax payers to specific individuals who have been... "irresponsible, stupid and/or unlucky".
"Their are few or no "work" requirements to obtain Medicaid and ACA subsidies."
Correct. However, let's review who gets these. The majority of folks on Medicaid are children, elderly, or disabled. The majority of the remaining are employed. The others are likely eligible for some other program that has work requirements so they would be covered there. If you're not on Medicaid but receiving an ACA subsidy, that indicates you're earning money.
The other point to make here -- again -- is that unhealthy people are going to have a hard time being a productive worker. Let's allow them to get the care they need to be healthy and put the requirements on other forms of aid.
Sean, I like that formulation, that we subsidize health care because it allows citizens to (return to) being a productive worker. So what if the person we subsidize has neither the ability to find productive work or the desire to do so? And why is the taxpayer assumed to be the person responsible? If you are going to argue that health care is an "investment," than should we not see some return on that investment, in terms of productive labor output, at some point?
John, I'm just not seeing any linkage between education vouchers and "premium support" (or refundable tax credits) for health care. I suppose one might argue that either introduces competition and choice into a government-dominated delivery system, thus reducing costs and increasing quality. But neither will ever be a "right."
"...seems flawed when 30% of households are earning <$30,000 per year." And yet if these measures reduce costs by 50%, a lot more people will be able to afford health insurance AND the resulting care than is currently the case. Literally millions are dropping health insurance because Obamacare has priced them out.
"If not we need to find funding to pay for the irresponsible, stupid and unlucky of the world." People die from bad choices all the time-- drug overdose, criminal involvement, scaling El Capitan without a safety rope, etc. We cannot and should not try to prevent this stuff. What we CAN do is make it possible to make good choices, by allowing them a choice of having a sensible health insurance policy and giving those poor by bad luck some public support. We must assume and insist they NOT be "irresponsible and stupid." If they still choose poorly, guess what happens.
Sean,
I don't think the Conservative Medicaid cuts will impact the children, old and disabled if we made the choice to purge the others off the system. As Jerry says... Let them die in the streets?
Jerry,
I have seen NO sources from you that in anyway prove that your proposals would decrease costs by 50% without severely impacting quality or availability for many citizens. Only your opinion.
I think public education and healthcare are very similar if we as a society agree that having both educated and healthy citizens are important to the success of our country. Just like having good roads is important to our success.
The point being that you are adamant that society should handout money to Parents for education... Then I suppose we should hand out money for health insurance?
Finally, "If they still choose poorly, guess what happens." Come on say it... They get to die in the streets... Which of course is not acceptable in our kind helpful society.
Therefore what actually happens is that someone pays for their care and the costs are hidden from measurement. They are just an invisible drain on US productivity rather than a visible one.
Given the pressure that BCBS puts on the healthcare system and the customers to justify MRIs and other high cost tests, I really wonder if there is an excess amount of defensive medical waste out there.
My family has been turned down for pre-approval for a couple of things. In fact we are looking into buying a "bone growth stimulating device" to help some vertebrae and bone segments fuse more effectively this time around. Apparently it is a bit hit and miss, but to us it is worth the expense to do everything we can.
"I don't think the Conservative Medicaid cuts will impact the children, old and disabled if we made the choice to purge the others off the system."
That math doesn't work unless states make up the difference. As we've seen with Medicaid under the ACA, different states are going to do different things.
Interesting we keep talking about "dying in the streets." People die in the streets all the time, from natural or manmade causes, and as a result of their or somebody else's "bad choices." We cannot stop it. And wasn't Obamacare supposed to prevent that by insuring all 48 million uninsured people? How are the 30+ million STILL uninsured faring? Are they dead yet? Aren't we still overlooking the fact that Medicaid participants have "health outcomes" no better than the uninsured?
I've tried and tried, but I simply cannot find the original Mayo study; it was many years ago. Since then (especially after Obamacare) the problems have only gotten worse. And I have told you from personal experience that my medical insurance cost was halved, back when I was offered a different type of insurance, and that my quality of care improved.
And you miss the essential difference between education vouchers and "premium support" for health insurance. Taxpayers already pay for all students, many of who receive very poor results, and parents wanting something better pay for it in addition. If the same amount of money were sent to parents, those who wanted something better but could not get it because of cost would get it, quality for all would likely improve to compete, and total cost to the taxpayers would be the same or less. Hmmm. I guess you are right; it IS just like the current health care marketplace. The only difference is that only SOME people get the government freebie and the rest of us pay extra.
Sean,
It looks like 19% of Medicaid spend goes to "adults". That is lots of millions...
Jerry,
So many opinions... So few facts...
"Medicaid participants have "health outcomes" no better than the uninsured"
As for vouchers... You often say it is a civil rights issue... I guess you want to ensure poor minority children can go to a good school, but don't care if they can go to a Doctor... Very confusing.
"It looks like 19% of Medicaid spend goes to "adults". That is lots of millions..."
The proposed cuts are bigger than 19%. And some of those adults are working folks.
Sigh...
WSJ
USAtoday
National Review
Forbes
Factcheck
Why do you doubt me so often?
"As for vouchers... You often say it is a civil rights issue... I guess you want to ensure poor minority children can go to a good school, but don't care if they can go to a Doctor... Very confusing."
Ah, I now see the source of your confusion. Education is a civil rights issue because taxpayers pay for it, everyone is REQUIRED to use it, and government delivers it. The poor are given "less" than what others get, and those folks tend to be black. It is a rights issue because the right to get a good education for your child is taken away. Health care is not because taxpayers pick up the tab for only some, nobody is required to use it, and government does not deliver it. Since health care is not a right, it cannot be a civil rights issue.
Jerry,
I think you had best read your own Factcheck in more detail. I didn't have time to get to the others yet, but it is obvious that your opinion is incorrect.
Whether or not Black people could be forcefully segregated in Private businesses was a civil rights issue, no government services required. I am sure lack of access to good healthcare will become a civil rights issue also.
As I said above...
" I guess you want to ensure poor minority children can go to a good school, but don't care if they can go to a Doctor... Very confusing."
After looking at the Forbes and FactCheck articles, I don't think much can be learned from the Oregon study. And the others seem to be from Conservative columnists just spinning things.
Some more clarification of the studies from the people who ran them.
Politifact VA Study
So does that mean Medicaid is the culprit for the higher odds of patient deaths? Not at all, University of Virginia School of Medicine professor and cardiovascular surgeon Dr. Irving Kron (rhymes with "phone") told us. Kron was one of the researchers for the study.
While it does adjust for socioeconomic factors, the study notes that if you’re on Medicaid, you’re probably suffering from a whole host of risk factors other categories of patients don’t have, he said. Medicaid recipients are the poorest, least educated and sickest of all patients, and often don’t seek medical help until conditions are at their worst.
Those patients have the highest incidence of AIDS, depression, liver disease, neurologic disorders, psychoses and metastatic cancer, the study said.
"The reality is it’s apples and oranges," Kron said. "The problem with Medicaid is there’s more emergencies, because they’re sicker than most people. … They wait for care and unfortunately, emergent patients don’t do as well as elective patients."
Kron said the study focused on whether socioeconomic status was a factor in medical treatment, which it clearly was, and not on the quality of the systems paying for health care. Corcoran insisted the study proved him right.
"My point was that Medicaid is a subpar health care delivery system," Corcoran said via email. "The University of Virginia study supports that conclusion."
The study does include a caveat that there is a possible "system bias" that gives privately insured people access to better hospitals and doctors. "For many surgical patients, private insurance status often allows for referral to expert surgeons for their disease. Alternatively, Medicaid and uninsured patients may have been referred to less skilled and less specialized surgeons," the study said.
But Kron and health policy experts disagree with Corcoran’s takeaway.
Leighton Ku, director of the Center for Health Policy Research for the Milken Institute School of Public Health at George Washington University, said Medicaid patients are a very broad category that is tough to compare to others, even the uninsured.
Echoing Kron’s concerns, he added that uninsured patients may elect to go without coverage and end up on Medicaid when they become sick, or that insured patients in the study may have reached lifetime policy limits and had to resort to Medicaid.
"As the researchers in the paper acknowledge, part of the reason that Medicaid is associated with higher mortality is that many people fall into Medicaid when they are very sick and impoverished," Ku said.
Politifact More Likely to Die
"Dr. Michael Gaglia, associate professor of medicine at the University of New Mexico and an author of the 2011 study in the American Journal of Cardiology, said that Gottlieb ignores the full findings of his study and the broader picture about Medicaid.
For those younger than 65, the Medicaid patients fared a little better than those who were uninsured, he said.
He said that such arguments that having Medicaid is worse than not having insurance is "absurd."
"This implication that somehow you get worse care with an insurance plan -- Medicaid -- than you would by not having an insurance plan at all -- no coverage, just going to the ER for emergencies -- for most reasonable people that doesn’t make any sense," he said.
PolitiFact has previously found at least seven academic papers that detected a link between securing health insurance and a decline in mortality. In general, these papers present a stronger consensus that having insurance saves lives.
Harvard researchers recently wrote a piece summarizing the evidence on the effect of Medicaid or other insurance on mortality. Their review of the evidence concludes that insurance like Medicaid significantly reduces mortality relative to being uninsured, said Katherine Baicker, one of the authors. The researchers found that "coverage expansions significantly increase patients’ access to care and use of preventive care, primary care, chronic illness treatment, medications, and surgery. These increases appear to produce significant, multifaceted, and nuanced benefits to health."
Jerry,
Do you understand how silly the Conservative talking point is now?
Or are you still adamant that having Medicaid is bad for people?
Personally I think we are back to our endless argument of why do schools fail more often in communities where many people are poor and uneducated...
We could change the question to why does Medicaid fail more often when their patients are poor, uneducated, unhealthy, dependent, disabled, old and other things that prevent them from being successful in the work force?
Maybe this makes sense to you...
95 year olds who drink orange juice every morning are 100 times more likely to die that day than 25 year olds who drink beer in the morning. Therefore we should not start our day with OJ but with beer.
Where do Conservatives get this ability to take studies out of context?
You are making quite a number of assumptions here in favor of your bias, so why not apply it all the way around? Yes, it makes sense that people with insurance will make better lifestyle choices, seek more preventive care and earlier treatment. But according to you, the people on Medicaid are those who are irresponsible and make bad choices. So how does "giving" them insurance suddenly make them capable of making good choices like preventive care and early treatment and lifestyle choices? It's that "it's a rental car" situation all over again. People who BUY insurance bought it for a reason and will use it responsibly, giving them better outcomes.
And the notion is not off the wall. It IS backed by reasonably scientific studies. Just because the results do not match what liberals expect to happen (they rarely do) does not mean they are not correct in general.
studies
So you trust the summary of Hotair... More than this guy...
"So does that mean Medicaid is the culprit for the higher odds of patient deaths? Not at all, University of Virginia School of Medicine professor and cardiovascular surgeon Dr. Irving Kron (rhymes with "phone") told us. Kron was one of the researchers for the study."
Or this guy...
"Leighton Ku, director of the Center for Health Policy Research for the Milken Institute School of Public Health at George Washington University, said Medicaid patients are a very broad category that is tough to compare to others, even the uninsured.
Echoing Kron’s concerns, he added that uninsured patients may elect to go without coverage and end up on Medicaid when they become sick, or that insured patients in the study may have reached lifetime policy limits and had to resort to Medicaid.
"As the researchers in the paper acknowledge, part of the reason that Medicaid is associated with higher mortality is that many people fall into Medicaid when they are very sick and impoverished," Ku said."
Or this guy...
"Dr. Michael Gaglia, associate professor of medicine at the University of New Mexico and an author of the 2011 study in the American Journal of Cardiology, said that Gottlieb ignores the full findings of his study and the broader picture about Medicaid.
For those younger than 65, the Medicaid patients fared a little better than those who were uninsured, he said.
He said that such arguments that having Medicaid is worse than not having insurance is "absurd."
"This implication that somehow you get worse care with an insurance plan -- Medicaid -- than you would by not having an insurance plan at all -- no coverage, just going to the ER for emergencies -- for most reasonable people that doesn’t make any sense," he said."
"how does "giving" them insurance suddenly make them capable of making good choices like preventive care and early treatment and lifestyle choices?"
It doesn't, just like giving them free education doesn't.
If we are unwilling to force to make people change and improve, then all we can do is provide:
- raise the cost of doing the wrong thing
- lower the cost of doing the correct thing
For example, raising the cost of smoking, drinking and gambling with taxes to help pay for the cost incurred on society.
Or to reduce the financial and travel costs of visiting a clinic. (ie Medicaid, Free Clinics, etc)
Here is an interesting story how to lower hurdles.
Republicans want to put unhealthy people into insurance pools and have taxpayers pay for them. It's one way to do it, but the rationale, even in partisan terms is unclear.
--Hiram
And yet your story says "... where few doctors accept Medicaid patients." The "implication" here is that Medicaid is EXACTLY the same as having no insurance at all. Having insurance does not mean much if you are unable to get health CARE, and that is the fundamental conceit of Obamacare. If it worked as envisioned, it would have greatly increased demand while doing nothing for supply, while holding down prices. Fundamentally flawed.
Remember Obamacare was supposed to greatly reduce or eliminate trips to the ER for routine care (since the law requiring "free" treatment at the ER was and is still on the books)? Well, ER visits have gone UP. Over one million people in Texas alone have paid the penalty rather than buy something they don't need, can't use and can't afford. Let's go back to the simple solution for our health care "mess," which is to get government OUT of the health care marketplace as much as possible, get prices down, and then create some way for lower income folks to buy basic insurance or to receive true emergency care at a low cost.
Hiram, the rationale is perfectly clear. Government commands that insurance not be actual insurance, based on the financial risk to the insurance company. The insurance company stays in business only insofar as it is able to charge a premium commensurate with the likelihood of you paying in more than they pay out. Now since it is unlikely that everybody in the pool is going to get sick, especially at the same time, the collective premiums pay the occasional very large bill. Government has knocked this very sensible arrangement on its head, as in Obamacare's "must issue" rule, where somebody can go break both legs and THEN pay their first premium.
The simple solution, as it was BEFORE Obamacare, were state-run "high risk pools" where those with pre-existing serious conditions and who were not already covered under a policy could find a new one at a reasonable price. The prices were artificially held down by public subsidies or as a state requirement for insurance companies to do business in the state (basically raising everybody's premiums to subsidize the few). Now if we simply transferred the tax deduction for health insurance from the employer to the employee, making health insurance portable between jobs, most of the pre-existing condition problem goes away. Why don't we do that? Because health insurance became an employee benefit in response to government wage controls long ago, and government still hasn't let go of the power.
The simple solution, as it was BEFORE Obamacare, were state-run "high risk pools" where those with pre-existing serious conditions and who were not already covered under a policy could find a new one at a reasonable price.
When dealing with legislatures in these decadent times, it is simply irresponsible to assume that they will do the right thing. And what is even more unfortunate, some policy makers assume, and depend on their doing the wrong thing.
We are an aging society, and what that means is that we will either spend more on health care, or we will let more people die without care we could have, but chose not to pay for. Republican policy makers have chosen the latter alternative. But they have a political problem. Letting grandma and grandpa die early isn't a popular policy, particularly with grandma and grandpa. No one wants to be seen taking responsibility for it. No one wants to serve on death panels. So what's the solution? It's simple, death without the panels. Let's create high risk pools which seem to solve the problem, and then let's leave it to our successors to adequately fund them which they won't. Two bird are thus killed if you will pardon the expression, with one stone. The policy objective of death panels is achieved without anyone anyone taking responsibility for it. That's your Republican Party at work.
--Hiram
Wow, that is a dismal view of roughly half the voting population. Let's do it on a more objective basis. Most importantly, "we" are not choosing to let people die, nor are "we" refusing (or agreeing) to pay for it. Your medical care should be under YOUR control and "we" ought have no particular say in it, nor obligation to pay for it. Now because we have been mislead by a liberal elite into thinking that enough public money thrown at a given problem can make everything perfect for everybody, we spend vast sums to achieve pretty much nothing at all.
I agree we cannot assume legislators (and more particularly, regulators) will "do the right thing." I doubt, from their public statements, that they have any idea of what the "right thing" is. That doesn't mean the right thing doesn't exist.
Jerry,
This was said by the reporter... "where few doctors accept Medicaid patients"
Here is a more in depth view.
USN Medicaid and Finding a Doctor
"A 2011 nationwide survey of doctors found 31 percent were “unwilling” to accept new Medicaid patients, with acceptance rates across states varying widely. Across the nation, the study estimated 69 percent of doctors were accepting Medicaid, but state acceptance rates ranged from a low of 40 percent in New Jersey to 99 percent in Wyoming, according to the study published in Health Affairs. This was pre-ACA expansion and prior to any reimbursement fee changes."
Now a medicaid recipient may not get the best Doctor / Hospital but they sure can find Licensed and qualified care. And those Medicaid funds help cities like Hayward to open up those local clinics that can operate at a much lower cost.
It looks like there are many reasons for continued ER use.
"Why isn’t emergency room use going down?
Experts cite a mix of reasons.
Medicaid reimbursement rates are lower than those for private insurance, so appointments at doctors’ offices may be hard to obtain for those who received Medicaid coverage under the Affordable Care Act. In addition, "two-thirds of emergency visits occur on weekends and when doctors’ offices are closed," said Laura Gore, a spokeswoman for the American College of Emergency Physicians.
Demographics may play a role, too. Senior citizens are growing as a percentage of the population, and older Americans are likelier to have chronic health problems that require an emergency room visit, Gore said.
In fact, the trend of growing emergency room use predates the enactment of the Affordable Care Act.
"Emergency department use has been rising since they were popularized after World War II," said Scott M. Dresden, a physician and assistant professor at Northwestern University who co-wrote the Illinois study. "Research on health services use since the 1970s has shown that providing patients with assistance for health care costs, such as insurance, leads to increased health services use. So it's not particularly surprising that providing patients with insurance didn't decrease emergency department use."
But the biggest factor may be force of habit.
"Old habits are hard to break," said Gail Wilensky, who headed Medicare and Medicaid under President George H.W. Bush. "People who were used to seeking care in ERs may continue to go there for a while. When Kaiser first started taking Medicaid patients, many continued their use of the ER for routine care like they had always done. It took a while to wean them away."
Katherine Baicker, a professor of health economics at Harvard University’s T.H. Chan School of Public Health and co-author of the Oregon study, agreed.
"Expanding health insurance coverage leads to greater use of care across many settings, including the doctor's office, the pharmacy, the hospital, and the emergency room," she said. "This is what one might expect from the basic economics: Medicaid took health care that was expensive and made it free, so people used more of it.""
Oh, so a federal program that insures an additional 5% of people, or so, results in 31% of them not being able to find someone to accept that insurance? Again, supply and demand are going to balance out, regardless of government fiat.
Now if you want to throw in charity hospitals or free clinics or a tax credit for doctors who treat "poor" patients, that's a whole different kettle of fish. You might as well start by reducing the cost of health care to something people can afford on their own, and then find non-government-intrusive ways for those too poor to do that to get care.
What is it you are arguing FOR?
ACA Expensive for Middle Class
I think that is why Sean wanted to change the subsidies.
"I would extend the subsidies beyond their current cutoff point to limit some of the impact on those who are being impacted by the rising individual market premiums. The current cutoff point is around $90,000 income for a family of 4, I would extend that up to $250,000 with the subsidies having less value the further you move up the scale." Sean
I agree this terrible... "somebody can go break both legs and THEN pay their first premium. "
We should mandate that every citizen pay for insurance during their whole life. Then this can't happen. :-)
"results in 31% of them not being able to find someone to accept that insurance? "
That has got be the funniest math you have ever written here.
Let's say that there are 1000 health systems and that 310 do not take new medicaid patients and that 690 health systems are taking new medicaid patients.
How in the world does that translate to medicaid patients not being able to find a provider?
There are 690 organizations happy to have them as customers...
And given the number of new hospitals and care centers in rural America, they are happy to invest, expand and grow to get them and those medicaid dollars.
In summary, the high cost systems don't want these customers..
The low cost systems are fine with these customers.
It seems as a tax payer I am happy that the people getting free medical care are getting it at the lower cost facilities who still have licensed professionals.
So, your complaint is that, since government regulation and price controls force up the cost of medical care (unnecessarily), the solution is for government to force more people into lower-cost, lower-quality (at least by government definition) care? Why not just lower the cost of care for everybody, and allow supply and demand to actually work? Why does "you as a taxpayer" enter into it at all?
So, your complaint is that, since government regulation and price controls force up the cost of medical care (unnecessarily),
I think there is a distinction worth noting. Pushing up the cost of health care isn't the same thing as pushing up what we pay for health care.
--Hiram
Absolutely right, Hiram. And therein lies the problem. If it costs me more to grow corn than what people are willing to pay for corn, I quit planting corn. If it costs me more to provide medical care than what government will pay me to provide medical care, I quit providing medical care to those with government "insurance." That is why we should eliminate third-party payers (like government), first-dollar coverage (like government), and fee-for-service (like government). Bring costs down for the providers until in line with a price people can afford, and the system balances out.
If it costs me more to provide medical care than what government will pay me to provide medical care, I quit providing medical care to those with government "insurance."
Not if you are medical care provider. They routinely provide care at a loss. Indeed the law often requires them to. And the fact is, profit and loss in this complicated area are virtually meaningless concepts. It all depends on what is allocated to what.
I am currently reading a book called "The Deal of the Century" about the ATT breakup. Without going in to detail, a big problem they had was with pricing and the cream skimming that was done by their competitors particularly MCI. It's always a huge problem in finance of any business.
--Hiram
"If it costs me more to grow corn than what people are willing to pay for corn,"
That is so funny since you say on the other that if...
"The Government gives out educational vouchers... Someone will find a way to provide the service for that price."
Apparently healthcare providers are not able to be lower cost like educational providers. Very strange.
Oh I forgot... The people of Hayward did find a way to do just that, and leverage their fire station locations. Ironically the only people that gave them a hard time was the Cal Nurses Union... They insisted that it had to staffed with Union members... Surprise...
Bring costs down for the providers until in line with a price people can afford, and the system balances out.
In your analogy, what happens if the price of corn people can afford are below your price of production. Do you continue to produce?
This is, in fact, the problem business has all the time, but it's a quiet kind of a problem since it is the economics of things that do not happen. And things that do not happen, don't get much attention. Products that aren't made don't appear on shelves. Companies that don't exist don't hire lobbyists. Workers who never had jobs don't ever ask for pay raises, and they never, never receive employer provided health insurance.
In fact there are tons of things that don't exist because business can't find a way of making them profitable. It's why ATT didn't go into the microwave phone business. And it's why MCI, the M stands for Microwave, did.
--Hiram
"Do you continue to produce?" No. And that is exactly what government price controls, in the form of Obamacare regulations, Medicare and Medicaid reimbursement rates, etc., create-- a shortage of supply.
John said: "The Government gives out educational vouchers... Someone will find a way to provide the service for that price." Yes, that is correct. And it works because "someone" is not part of the government monopoly, setting price and quality with impunity, unable to innovate. We have come too far in giving government a monopoly on our health care, and the same miserable outcome will result.
Perhaps you can explain why doctors are starting to practice in "cash-only" clinics?
CNN MONEY
Interesting, if you compare the rates quoted in the item, it comes to $1440/year for a family of four ($2640/year if the adults are over 44), while the average health insurance policy cost is estimated at $20,000 (multiple sources). Of course, you have to add costs for a catastrophic policy to the former, but still, that seems to be well over a 50% savings.
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