Under the federal law, the state-run exchange aims to fundamentally reshape the health insurance market by negotiating with insurers for the best rates and assisting consumers in choosing a plan. The exchange must also help millions of Californians figure out whether they qualify for an expansion of Medicaid, the government insurance for the poor, or federally subsidized private coverage....Recreational soccer leagues? Bloggers popular with Latino mothers? Health insurance plotlines on "Modern Family"? Does that sound like the way an insanely huge, complex, and comprehensive program will successfully penetrate a vast population quickly and pervasively? Oh, but the billions in federal dollars is such an incentive! Except that if you don't succeed, you won't get that money....
[If California doesn't get enough people enrolled, it] could lose billions in federal dollars and insurance premiums could soar. The task is daunting, given the size and diversity of California's population, said Paul Fearer, an exchange board member. "It's critical to get it right," he said....
[In] focus groups of consumers recently in San Diego and Sacramento[, o]nly about 20%... had even heard of the exchange....
About half of California's 7 million uninsured are Latinos, according to the exchange. To reach those who are eligible for coverage, the state may sponsor professional and recreational soccer leagues and court bloggers popular with Latino mothers. Officials also may hit up Hollywood to get TV shows such as "Modern Family" or "Grey's Anatomy" to weave the health insurance expansion into their scripts.
November 19, 2012
About those states that are opting to set up the Obamacare health insurance exchanges.
It won't be easy! Consider California:
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138 comments:
If California were run by the sane, they just could opt out of Medicaid and let the Federal government administer the program.
For the 500th time:
Health care reform without outcome-based rationing will fail.
Do you need any more proof that this is a boondoggle of monumental proportions.
It was never about healthcare.
It was always about control.
For the states that seriously want to make the mandate and the exchanges work, won't they have to pile on a hefty state penalty on top of the dinky mandate/tax from Obamacare? Otherwise, if pre-existing conditions are covered no matter what, why would the citizenry bother?
Also, California needs money. Badly.
Recreational soccer leagues to inform people about government benefits? That's... awkward.
You voted for him.
Sounds like a good opportunity for highly paid consultants with phony degrees.
Will the Medicaid complications be the elephant in the room that breaks the camel's back and turns the Golden State into a pile of fiscal shit?
California has one third of the nation's welfare consumers.
This will be interesting to watch.
But we're all screwed.
Health care reform without outcome-based rationing will fail.
We know that. But the reality-based community denies it.
Re: Peter:
Health care reform without outcome-based rationing will fail.
Yes, we call those "death panels." It's not exactly clear to me how the Independent Payment Advisory Board's backers think it is supposed to achieve this outcome, but obviously in order to achieve their goal, they're going to have to slash reimbursement rates. They won't "ration" health care, just cut the reimbursement rates for treatments they deem ineffective so low that they effectively won't be covered. When reimbursements to providers drop, this may naturally produce a contraction in supply, leading to de facto rationing, but it won't be direct rationing.
In the Obamacare ruling the Supreme Court left a poison pill for the democrats. The Federal government can't coerce the states in to funding federal programs. It's just a question of time before one or more states decides to opt out of Medicaid. Then the Democrats in Congress and Obama will have that to deal with. And by inference of that ruling all federal mandates on the states become a potential bomb on the Democrats.
Officials also may hit up Hollywood to get TV shows such as "Modern Family" or "Grey's Anatomy" to weave the health insurance expansion into their scripts.
The dumbing down of a nation continues. Full speed ahead.
Obama voters, who comprise a majority of California voters, own this looming debacle.
It won't work.
To "save it," they'll throw more tax dollars at it (only one of few dozen good reasons this was never going to bend the cost curve).
It still won't work.
Idiots, all.
...the state may sponsor... court bloggers...
I've heard of court jesters, but court bloggers?
"For the states that seriously want to make the mandate and the exchanges work, won't they have to pile on a hefty state penalty on top of the dinky mandate/tax from Obamacare? Otherwise, if pre-existing conditions are covered no matter what, why would the citizenry bother?"
1) I think the ACA precludes states from imposing their own penalties, er, taxes (Thanks, Chief Justice Roberts!!) on the mandate (and other aspects of the ACA);
2) States will just bill the feds for cash;
3) Yes, California needs money, badly. Gotta pay all those public employee pensions, employ all those "world-class teachers" (lol!), and build that high-speed rail from nowhere to nowhere.
New State Motto: YOLO!
It won't be just Modern Family, Barry wants a lot of TV shows to propagandize Obamacare.
On the upside, it may finally make the Mexicans go home.
Hillarycare touted Canada's single payer system as a model.
The court blew that up, they now have private insurance.
Canada couldn't make single payer work with at the time 20++++ million people.
We have 310 million, but we're special, we're the ones the world has been waiting for.
Pain, misery & death will follow and it will never be the ideology's fault.
Save your money to travel out of the country for medical care.
Re: Tim:
1) I think the ACA precludes states from imposing their own penalties, er, taxes (Thanks, Chief Justice Roberts!!) on the mandate (and other aspects of the ACA);
States have broader powers than the federal government. They can institute true penalties, not just taxes. Anyhow, where in the ACA does it prohibit states from imposing their own taxes on top? Not saying you're wrong, just hadn't seen that before.
Officials also may hit up Hollywood to get TV shows such as "Modern Family" or "Grey's Anatomy" to weave the health insurance expansion into their scripts.
I like Modern Family, but every charactor on there is absurdly well off. Are we going to have to feel sorry for them and their failure to get health insurance while they live in huge, beautifully decorated homes?
Even tho it's Wiki:
"Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed", according to a report in the New England Journal of Medicine.[38][39] In June 2005, the Supreme Court of Canada ruled in Chaoulli v. Quebec (Attorney General) that Quebec's prohibition against private health insurance for medically necessary services laws violated the Quebec Charter of Human Rights and Freedoms, potentially opening the door to much more private sector participation in the health system. Justices Beverley McLachlin, Jack Major, Michel Bastarache and Marie Deschamps found for the majority. "Access to a waiting list is not access to health care", wrote Chief Justice Beverly McLachlin.
The Quebec and federal governments asked the high court to suspend its ruling for 18 months. Less than two months after its initial ruling, the court agreed to suspend its decision for 12 months, retroactive to June 9, 2005
"It's critical to get it right,"
They should just count on being able to use the same level of thought that went into crafting the ACA in 2010.
"About half of California's 7 million uninsured are Latinos, according to the exchange. To reach those who are eligible for coverage, the state may sponsor professional and recreational soccer leagues and court bloggers popular with Latino mothers."
Hmmmm... Suddenly, I'm thinking to myself.... What can I blog about that will be popular with Latino mothers so I can get some of this cash!
ObamaCare - They had good intentions, but what a steaming pile of law this is!!!!
"[In] focus groups of consumers recently in San Diego and Sacramento[, o]nly about 20%... had even heard of the exchange...."
And yet California voted for the plan's sponsor, 59%-38%, with 80% of consumers not knowing what they were voting for.
Ai Yi Freaking Yi.
Living in rural calif where many people would either qualify for the "free" option or the subsidized expansion .... we have heard nothing at all. I would imagine that less than 20% of the population has even heard about what is coming down the pike at them from the State of California or from the Federal Government.
Maybe Sandra Fluke would be available to educate 10 people at a time in supermarket parking lots around the state.
Recreational soccer leagues? Bloggers popular with Latino mothers? Health insurance plotlines on "Modern Family"? Does that sound like the way an insanely huge, complex, and comprehensive program will successfully penetrate a vast population quickly and pervasively? Oh, but the billions in federal dollars is such an incentive! Except that if you don't succeed, you won't get that money....
It sounds to me like quite a lot of money going towards liberal activist groups with few tangible deliverables.
And if you do "succeed" you'll find the money from the feds disappears anyway.
But, hey, spending hundreds of billions of dollars will ultimately save tens of billions of dollars, so it's totally worth it.
Health insurance plotlines on "Modern Family"?
They think that because of Sofia Vergara that "Modern Family" draws in every Hispanic viewer in the country. Realistically they'd be better off if they worked it into a skit on "Sabado Gigante". Not only is that one of the most popular Spanish language shows ever, it would also be a lot cheaper.
They are just as cocooned as they claim the Republicans are!
One fourth of California's population is living in poverty. Will there be enough money to subsidize their health insurance?
To say nothing of the illegal aliens, who don't qualify for these subsidies. The ERs will continue to be required to treat these residents.
Plus, what Peter said.
"States have broader powers than the federal government. They can institute true penalties, not just taxes. Anyhow, where in the ACA does it prohibit states from imposing their own taxes on top? Not saying you're wrong, just hadn't seen that before."
Yes, states do have broader powers than the feds; regardless, I think this provision of the ACA could be interpreted to exclude taxing powers if the feds determine they conflict with the ACA:
Sec. 1311 (k): Conflict.--An Exchange may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary under this subtitle.
----------------------------------
Anyway, it should be apparent to all the ACA is a huge expansion of federal power (freedom loving liberals? Uh, not so much.) through which it is entirely possible states will have their rights curtailed.
Obama and his supporters claim that his greatest achievement was the healthcare act. However, this law was written in such a way that he would not have to run for re-election on its effects. Such becoming modesty....Also, the left is always seeing enroaching fascism in such sinister government measures as monitoring the emails of radical Muslims. Isn't there at least a baby step towards totalitarianism when the entertainment industry is asked to support an unpopular government program? A good portion of the American public looks upon Hollywood as a bunch of Democrat aparatchiks. This will increase these numbers.
Another huge bureaucracy to grow the bankrupt state govt., another billions to grow the trillions federal deficits. The goal is to guarantee a populace of dependency to guarantee jobs for bureaucrats and politicians.
Ann, Annn, Ann. The issue of raising taxes on the "rich" isn't really about raising taxes, it's about having an issue to use at election time. And since we are
campagning 24/7 expect to see and hear a lot more stool about "Fair share"
Not to worry. United Healthcare owns the company that designed the software that will determine how these exchanges are set up and gather up all the data. The choices on the exchange will United Healthcare, United Healthcare, and United Healthcare.
This whole thing is going to be one big clusterfuck. If it wasn't going to someone affect me I would be sitting back with a nice big bowl of popcorn and having some good laughs.
Blogger Tim said...
To "save it," they'll throw more tax dollars at it...
Don't worry, Californians love to pay taxes. When they had a chance, they voted to raise their own taxes to fund their "education" system in which some professors make $600,000 a year, presidents millions. All for the children.
Guess all those selfish people who don't want to finance govt workers' life style have moved to Texas. I think the poor, the unemployable, the infirm, and the old should move in to take advantage of their gorgeous weather and spectacular freebies.
Re: Tim:
Yes, states do have broader powers than the feds; regardless, I think this provision of the ACA could be interpreted to exclude taxing powers if the feds determine they conflict with the ACA:
Sec. 1311 (k): Conflict.--An Exchange may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary under this subtitle.
It could be read that way, though I'm not sure that is the most natural reading. In any event, though, why are you talking about "taxing powers"? That's totally irrelevant to the states -- they can make it a crime not to have proper insurance if they want to. Unlike the federal government, there's absolutely no reason they need to implement mandates through a taxation power.
And politically, it would evidently be easier to get the public to swallow a mandate as an exercise of the general police power than for them to swallow the mandate as a tax -- that's why the President engaged in his idiotic rigmarole about how the mandate totally was not a tax. I can't imagine why any state would want to implement the mandate as a tax, at this point, given that they have other means available.
"In any event, though, why are you talking about "taxing powers"? That's totally irrelevant to the states -- they can make it a crime not to have proper insurance if they want to."
The Left hates the individual mandate.
In California, there's no chance a bill making it a crime to not have health care coverage - they'll make it a crime instead for practitioners to turn away anyone needing care outside of the ER - before they make lack of coverage a crime.
Other states, as you note, may do so.
But not California (or any state with notoriously powerful unions).
Mad Mad's suggestion has been the way to go for some time now. Have the employer add money to your paycheck for fringe benefits so the employee goes out and uses that money for health insurance or whatever his heart desires. It gets the employer and the govt out of the insurance business.
Republican governors are the firewall against Obamahorrorcare. Hang tough against Obama's thugs as they go into their demonizing act.
ObamaCare is, at its core, such a weirdly outdated bureaucratic idea that California is the perfect place for it to meet reality. It can't succeed -- you wonder what "getting it right" would even look like -- but will be pronounced a success by the bureaucrats nonetheless. Like Gov Brown's train to nowhere.
The states that are likely to sign on to ObamaCare exchanges and expanded Medicaid are already essentially bankrupt -- here's looking at you, CA, NY, IL. As for the rest, and particularly those that have been doing the difficult work of getting their finances in order, the whole thing will be a non-starter. Just waiting for Ezra Klein and Peter Beinart to tell me that it's all a feature, not a bug, planned by the geniuses who brought us ObamaCare in the first place.
Sounds like a good opportunity for highly paid consultants with phony degrees.
Will probably be the same ones that made a good living off of the ADA (Americans with Disabilities Act) & HIPAA (Health Insurance Portability & Accountability Act) implementations.
I remember purchasing lots of big binders full of "policies" that those consultants generated. Probably the first profitable use of word processing software too - composed the stuff for their first client, after that just swapped in your company name, but charged everyone the same.
Here is a PSA for California:
Illegal immigrants are not covered by Obamacare. If you are here illegally, you cannot, I repeat cannot qualify for Medicaid and cannot receive any public subsidies in the exchanges.
Now, back to your regularly scheduled program.
Re: Tim:
The Left hates the individual mandate.
In California, there's no chance a bill making it a crime to not have health care coverage - they'll make it a crime instead for practitioners to turn away anyone needing care outside of the ER - before they make lack of coverage a crime.
Well, making it a crime as such they would not do, but you can still load on a financial penalty through a power other than taxation. That said, while I'm not sure I understand the role of unions (didn't the unions already get the law written to exempt them from the excise taxes on over-generous health insurance plans?) I can imagine California's gutter populists torpedoing such a measure.
That won't solve the state's problem with getting people into the exchanges, though. For that, mere carrots will not suffice. They will need a stick. One that hurts.
Recreational soccer leagues? Bloggers popular with Latino mothers? Health insurance plotlines on "Modern Family"? Does that sound like the way an insanely huge, complex, and comprehensive program will successfully penetrate a vast population quickly and pervasively?
No, but it does sound like the way for the Democratic Federal Republic to penetrate into every aspect of what was formerly considered the private sphere.
"Except that if you don't succeed, you won't get that money...."
Wrong. If they can't meet the standards, new standards will be devised. Or waivers. Or just an outright gift.
You really think the feds will let California go without this income? How charmingly innocent.
I don't think anyone knows all that is in the AHCA, but I suspect it is like a logjam, and if you can just find the right log to pull on, the whole tangle will collapse and get swept downstream and out to sea.
About half of CA's uninsured are Latinos, but 40% of CA's population is Hispanic. Overrepresented among the uninsured, yes, but hardly to the extent that the writer seemed to be trying to imply.
So why do they deserve special outreach, and where are the governmental programs to reach the other half of the uninsured?
So why do they deserve special outreach, and where are the governmental programs to reach the other half of the uninsured?
Because they're treated as a monolithic cohort which votes Democratic?
Balfegor said...
They will need a stick. One that hurts.
Chip S. said...
...it does sound like the way for the Democratic Federal Republic to penetrate into every aspect of what was formerly considered the private sphere.
So we're gonna have our private spheres penetrated by a stick that hurts. I think that pretty well sums up the ACA.
Those who designed Obamacare might well also have been under the impression that turkeys can fly!
"That won't solve the state's problem with getting people into the exchanges, though. For that, mere carrots will not suffice. They will need a stick. One that hurts."
As a practical matter, I agree.
Given governing ideology, and the fact the exchange disproportionately advantages the middle and lower income groups earning above 133% of the federal poverty level, I don't see a bill coming out of the legislature to the Governor that exacts any pain whatsoever on those lower income folks.
More likely, given the Democrats breathtaking irresponsibility, they'll more likely enact or increase "sin" taxes on things like sugared sodas, alcohol and tobacco, and use those funds to aggressively enroll people in the exchange.
Or, easier still, just make them all automatically enroll at all any and all points of contact with government services: driver licenses, food stamps, section 8 housing, voter registration, public school enrollments, proof of vaccinations for their children, property taxes, jury duty, arrest, traffic tickets, park permits, etc., etc, etc. This could be done with web-based programs, easily.
Think "seamless public services" for the masses.
It's easy, if you try, lol.
"Or, easier still, just make them all automatically enroll at all any and all points of contact with government services..."
Meant to say, "...just make them all automatically enroll at any and all points of contact..."
And the most obvious points of contact of all?
The ER, and community flu shot programs.
Re: Tim:
Or, easier still, just make them all automatically enroll at all any and all points of contact with government services: driver licenses, food stamps, section 8 housing, voter registration, public school enrollments, proof of vaccinations for their children, property taxes, jury duty, arrest, traffic tickets, park permits, etc., etc, etc. This could be done with web-based programs, easily.
Linking participation in the exchanges to drivers licenses is probably the way to go. Require them to fill out whatever info is needed for the exchanges at the same time as they fill out or renew their license, and automatically enroll them that way. Problem is then whether people will pay the premiums. But if they send a bill, people will probably pay it (if unhappily).
"Officials also may hit up Hollywood to get TV shows such as 'Modern Family' or 'Grey's Anatomy' to weave the health insurance expansion into their scripts."
SRSLY? Would this be the same "Modern Family" that, in a recently-aired episode, had Luke in the hospital, and when Lilly asks how much it cost, his answer is "I don't know, but thanks to Obama, you're paying for it?"
Oh, wait, that's right. Because the show features an older man with a much younger second wife, a stressed-out professional mom with a goofball professional husband, and an adorable gay couple, it must be a "liberal" show!
This idea should serve as Exhibit A in what some call the "epistemic closure" of the left.
For Cali, there will be a deal.
mccullough said...
"Here is a PSA for California:
Illegal immigrants are not covered by Obamacare. If you are here illegally, you cannot, I repeat cannot qualify for Medicaid and cannot receive any public subsidies in the exchanges."
So you think this will continue to be so? Ha. This will be resolved either by "immigration reform" or changing the eligibility rules.
"The state expects to enroll about 2 million additional residents in Medi-Cal, the state's version of Medicaid, and sign up another 2 million for subsidized private insurance."
Four million more takers, and who's going to pay for all of this?
" federal insurance subsidies will be available to privately insured families earning up to about $93,000."
Oh. Every family earning more than $93,000. will pay for it? That's gonna be a whopper of a tax bill!
Plus the cost of advertising its availability, and the cost of facilitators to help people navigate the system so they can collect from it (of course).
"An election is an auction of goods which have not yet been stolen." So, let the theft begin!
"One of those who may be eligible for the help is Denise Robinson, 62, a former teacher and breast cancer survivor who has diabetes and severe back pain. Robinson, of Panorama City, lost her Kaiser Permanente coverage two years ago when she left teaching after 17 years because of an injury. Now, she can't afford to buy a policy on her own, she said."
Denise is nearly perfect, isn't she. I'm a little disappointed that she's not a lesbian with two adopted Cambodian children with AHDD and autism, but you can't have everything.
Anyway, if she's 62, single and drawing 80% of her former California teacher's salary in disability pay, she may be in for an unpleasant suprise.
Hagar said...
Those who designed Obamacare might well also have been under the impression that turkeys can fly!
As God is my witness, I'd swear turkeys could fly.
I'm sure all states want to emulate California's roaring mid-2000s success story.
2013 will be the year of the student loan + public employee union pension bailouts.
Health care reform without outcome-based rationing will fail.
The Europeans seem to be doing just fine. They laugh at our backwards health care system.
Shakespeare for everyone!
--The Europeans seem to be doing just fine. They laugh at our backwards health care system-
If you don't experience it, how do you know it's backwards?
They think we're still the Wild West, too.
Doctors told to try and talk women giving birth out of having epidurals to save NHS money (as they cost £200 a pop)Caesareans cost around £1,200 a time while epidurals – anaesthetic injections into the spine – are around £200
Via Drudge:
Ask not what you can do for your country, but what your new country can do for you.
“Welcome to USA.gov,” a website maintained by the Department of Homeland Security’s U.S. Citizenship and Immigration Services (USCIS), bills itself as the “primary gateway for new immigrants to find basic information on how to settle in the United States” — featuring a prominent section for new immigrants about how to access government benefits.
“Depending on your immigration status, length of time in the United States, and income, you may be eligible for some federal benefit programs,” the Web page reads....
Europe is falling off the cliff, they can't afford their advanced health care.
Soon 'Obamarupt' will become the new word for bankrupt.
And California will lead as the brightest example.
No hope for change.
Re: Paul:
No hope for change.
On the contrary, there is every hope for change. Reality will assert itself eventually. We had, and rejected, the opportunity to soften the blow (if only a little), but the blow will come eventually whether we like it or not. The question is only how painful it will be when it comes. And when it comes, we will change. We won't continue as we have continued because that will simply be impossible. Not to say the way we change will necessarily be the way I would like. It probably won't be. Only that the cold equations are looming in the middle distance, and when they come into play, things will change.
Re: Seeing Red:
Europe is falling off the cliff, they can't afford their advanced health care.
And we are seeing that play out right now. Pharmacists were striking in Spain because the governments weren't paying the bills that had come due under the public health system:
He said the regional government owed pharmacies 450 million euros ($575 million) for prescription medicine issued under the public health system between May and September.
"If the banks do not renew their credit for the pharmacies, 500 pharmacies could go bust this very month," said the president of the College of Pharmacists, Maria Teresa Guardiola, in a statement.
Banks renewing credit is all well and good, but the pharmacies will need a revenue stream to pay the banks back. And that's going to have to come from the government. Which doesn't have the money now, and isn't going to have it in the future unless their puppy-dog eyes persuade Germany to give them a little more cash.
The same situation obtains in Greece:
ATHENS, Greece — A sign taped to a wall in an Athens hospital appealed for civility from patients. "The doctors on duty have been unpaid since May," it read, "Please respect their work."
"Oh, but the billions in federal dollars is such an incentive!"
You think they would have learned from the high speed rail fiasco. Stuck on stupid.
"As God is my witness, I'd swear turkeys could fly." - edutcher
They fly amazingly well for such a huge bird. The weirdest thing is seeing them roost in trees at night for safety; I'm sure they didn't shimmy up the trunk to get there. Since their introduction here in Wisconsin (we traded some ruffed grouse with another state for some) they're reproducing like rabbits, having 10-12 offspring per batch. Not long ago, a 35# bird went through the windshield of an suv; they said it would have been a new state record had it been shot (why that matters I don't know). It caused so much damage the vehicle was totaled.
Those who designed Obamacare might well also have been under the impression that turkeys can fly!
Ummmm,,,, Turkeys CAN fly! Up to 50 miles per hour if they need to.
That the whole Rube Goldberg contraption will fail in spectacular fashion is a feature, not a bug. Then, they can say "Well, we tried, but healthcare just does not work if private actors are in the mix". It'll be the excuse they need to nationalize the whole industry.
It'll be the excuse they need to nationalize the whole industry.
As many here pointed out a long time ago.
The only real way to achieve all the assorted health-care goals has always been a two-tiered system. The big problem is how the relative sizes of the two tiers will be determined.
Sensible policy keeps the lower tier small. Unfortunately, we're on track for something much worse.
Thanks, Democrats!
Greece has the population of the state of IL.
This isn't going to end well for we proles.
Yeah, we are fucked.
Recreational soccer leagues? Bloggers popular with Latino mothers? Health insurance plotlines on "Modern Family"? Does that sound like the way an insanely huge, complex, and comprehensive program will successfully penetrate a vast population quickly and pervasively?
Seeing as how the guys behind that stuff massively crushed you when it came to winning the votes of both Latinos and women, I'd say, yeah, they probably do have better ideas when it comes to reaching the market for informing these populations on how to make use of them.
But then, I'm preaching to the crowd here who had absolute faith in Rasmussen and sympathized with those who derided the work of Nate Silver as consensus-driven climate science-like.
Seeing as how the guys behind that stuff massively crushed you when it came to winning the votes of both Latinos and women, I'd say, yeah, they probably do have better ideas when it comes to reaching the market for informing these populations on how to make use of them."
The Obama campaign is running the healthcare promo in Cali? Cool.
The only real way to achieve all the assorted health-care goals has always been a two-tiered system. The big problem is how the relative sizes of the two tiers will be determined.
Actually, this wouldn't have been all that much of a problem. The answer was to have a public option, in which case the entire health insurance market would have decided which program worked better: The one that didn't inefficiently have to allocate 15 - 30% administrative costs, i.e. the GOVERNMENT.
But the REPUBLICAN slave-owners whined and complained and screamed that they just couldn't compete with that.
A government allegedly too inefficient to do anything, and the Republicans complained that they couldn't compete with it. Pretty remarkable.
The one that didn't inefficiently have to allocate 15 - 30% administrative costs, i.e. the GOVERNMENT.
You mean, "the one that could be subsidized by the Treasury."
This nonsense about lower administrative costs was debunked a long time ago when people took the trouble to make apples-to-apples comparisons.
The simple solution was indeed a public option, tho. Hell, I could've drawn one up on the back of an envelope that would've taken care of people w/ pre-existing conditions.
The trouble is, a rational public option would've been demagogued by the Dems, b/c it would've had to have charged a premium to protect the system from adverse selection.
Ah, so you take the lawyerly route and use "could be" as a way of implying "is" or "proven to be".
Thanks for the stab at honesty, Chip.
Administrative costs are at least eight times higher among the monopolies that run/ran the regional, private health insurance game. The rate of growth in their spending rose 50% more from 1997 to 2009. Don't know where you got your stats. Try Kaiser. If you're hell-bent on some alterna-narrative, though, I can't help you.
Oh ok. Ezra Klein agrees with you and even uses the catchphrase "apples to apples." Still, he calculates a more accurate estimate at 5 - 6%. Still less than half what private insurance "requires".
RE: Ritmo:
But the REPUBLICAN slave-owners
What the hell is wrong with you? Do you honestly expect anyone to take you seriously when you take that tone? It's like, on the other side, writing "Dhimmicrat" -- it's a neon signal flashing that you're arguing in bad faith.
Ritmo,
I'm hell-bent on a correct analysis.
Here's a nice overview of what I'm talking about.
It really comes down to comparing Medicare to private insurers on a per-beneficiary basis instead of per-dollar basis.
Well, that plus a proper accounting of the opportunity cost of government revenue.
And also the fact that Medicare sets its reimbursement rates by decree, while private plans negotiate them. In the end, this may be the most important difference. Only a federal-government plan can alter prices in such a way as to significantly affect the long-run supply of doctors.
That's a bug, not a feature.
Sorry Balfegor. I really should have done my best to get that one out of my system before the election, but came up with it more recently than that. Romney's horrendous post-election remarks don't necessarily help that case, but I guess he's just driving the nails ever further into the coffin of his line of political thinking at this point, anyway.
Good Ezra Klein piece, Ritmo. He highlighted the most important issue:
Rick Kronick, a political scientist at the University of California at San Diego, has done some of the best work on administrative costs, and he summed the situation up quite well. "The main question," he said, "is why are health care costs going up at 2.4 percent a year faster than GDP? And most of the answers to that question have nothing to do with administrative costs. The answers are that we do more stuff and have more technology.
This cannot be emphasized enough. Whatever affects the level of health expenditures, the rate of change is driven largely by R&D costs.
I'm glad that our system is so innovative. It's a fallacy to think that new medical devices that are more effective in diagnosis and treatment mean "costs" of health care are higher. The cost of quality-adjusted health care is what "cost" really means.
You know what would be a really inexpensive HMO? One that used 20-year-old technology and only prescribed drugs that were off-patent.
I'd be happy to let that be established as a low-cost alternative.
It really comes down to comparing Medicare to private insurers on a per-beneficiary basis instead of per-dollar basis.
Why? Which is more efficient?
Well, that plus a proper accounting of the opportunity cost of government revenue.
And still, Ezra Klein - while sympathetically defending your point of view, still shows that the government comes out way ahead.
And also the fact that Medicare sets its reimbursement rates by decree, while private plans negotiate them.
So what? In this regard, as well as others, government acts as the driver for quality in the health insurance market. Insurers decide what to cover based on what Medicare covers. You are opposed to the government setting the same benchmark trends for pricing? Why?
In the end, this may be the most important difference. Only a federal-government plan can alter prices in such a way as to significantly affect the long-run supply of doctors.
The government will do no such thing. Medical schools decide to limit the supply of doctors in order to drive up the cost of demand for their services/monopoly/cartel. That's their prerogative, and there's a decent public safety and incentive argument behind it.
But the idea, once again, that it's unfair for a cheaper, more efficiently run government program to compete on a cost-basis with the private insurance market is the only cry of defeat that those who would defend the private insurance market in terms of efficiency need to sound.
My motto for 2013 will be: "Don't blame me, elections have consequences."
My people who have had fantastic health insurance for around $3K/yr for many years, will likely lose it. Regardless, we will all have to share the coming shortage of doctors, although the wealthy will find a way to get what they want regardless. The working and responsible who paid for their healthcare for years will now lose what they had so that they can support those who were irresponsible, plus all those who now decide that being responsible is a suckers choice.
On top of that, the bonus we pay out quarterly to all employees to distribute profits is going to need to be slashed now. Tax increases just voted in here in CA are retroactive, and will be compounded by the federal changes that are being pushed by the Dems. At our year end party when they find out, I do intend to inform them of exactly why it is reduced from what it would have been. I'll tell them the truth: that people voted to take this money from you and give it to the government. I'm sure that will warm their hearts.
This cannot be emphasized enough.
Yes it can be. Keep reading.
Whatever affects the level of health expenditures, the rate of change is driven largely by R&D costs.
Bull. It's driven by the perception of quality care as a reflection of the quantity of care. It's also driven by many other things - administrative costs being one that you seem particularly wedded to refuting. But increased care and tests are the bigger part of it. Medicare is not slower to cover whatever newer treatments private insurance covers. If you think this, you don't know the market.
What's happening, if you're curious, is that evidence is becoming the standard. Evidence of superiority to existing treatments. Newness and shininess as defined by an R & D company that merely passed the safety and efficacy benchmarks required by FDA is not the same thing. Private insurers get this no less than Medicare, let me tell you. Same with the physicians who give a fig about the administrative networks that can afford to pay them.
I'm glad that our system is so innovative.
Good for you. So am I. But innovative =/= superior. You confuse marketing and newness with quality. Those things are not the same, Dear Lad.
It's a fallacy to think that new medical devices that are more effective in diagnosis and treatment mean "costs" of health care are higher.
No it's not. It's exactly the point. And once again, you are committing the fallacy of equating "newness" with "better". For someone making the conservative's argument, you sure sound like quite the progressive. But the point is comparisons that are unlike in kind. In a very basic way. Why is that so hard to get? It seems to be a rather common political problem.
The cost of quality-adjusted health care is what "cost" really means.
Not sure what this means, but it could probably be taken either way. Run it through the correctives above and get back to me on it.
Bag O - Go back to Google, cherry-pick some even more "interesting" and untested factoids and argumentoids, and get back to us with something new. Or just throw out the line about drinking someone else's milkshake. Yes, that one will be sure to convince everyone of your beneficence as a humble, job creating, Joe Schmoe who is in this debate for the sake of the employed.
Why? Which is more efficient?
It's not a question of which way to measure is more "efficient", it's a question of which way best measures actual administrative efficiency. To figure that out, you've got to ask what constitutes a unit of "administration".
Medicare patients on average have much higher medical bills per billing than non-Medicare patients. So if Medicare and a private insurer both processed each claim at the same cost, Medicare would appear to be more efficient on a "per dollar" basis.
If you think that the cost of administration is proportional to the dollar amounts processed, then that's the way you'd measure it. But I think that's not true. It isn't 10 times more costly to run the paperwork on a $10,000 physician's fee as on a $1,000 one.
The government will do no such thing [affect the supply of doctors thru pricing].
You should check w/ Pogo on that. There's already talk of a shortage of primary-care physicians b/c of the structure of Medicare reimbursement. It must be true, cuz I head it on NPR.
the idea...that it's unfair for a cheaper, more efficiently run government program to compete on a cost-basis with the private insurance market is the only cry of defeat...
This would be fine if the "public option" were entirely self-financing. But why should anybody expect that to happen?
I'm late for dinner. Gotta go. Good discussion.
Adios.
You should check w/ Pogo on that. There's already talk of a shortage of primary-care physicians b/c of the structure of Medicare reimbursement. It must be true, cuz I head it on NPR.
I don't trust Pogo on much of anything, but even if NPR sez that it affects the choice of specialty, that is nowhere near the same argument as affecting the quantity of physicians. Specialists started driving up care ever since the rock-star physician specialties started taking off in the 1980s or so. Watch your TV medical dramas. It's not hard to see who gets and got the glory and why. The specialists drove up costs (not that they shouldn't have) long before everyone else figured out that primary care availability was massively suffering. There's a significant differential in reimbursement and given the costs of training (which the gov't can impact) it makes sense to field any stakeholders in that discussion of how to best incentivize toward specialties in need.
Glad you enjoy the discussion. It's good for me to hear out the opposing arguments, too. But you should really read my last reply on innovation/R & D. Enjoy your dinner.
RE: Ritmo:
But the idea, once again, that it's unfair for a cheaper, more efficiently run government program to compete on a cost-basis with the private insurance market is the only cry of defeat that those who would defend the private insurance market in terms of efficiency need to sound.
Look, if private insurers are competing with Medicare or a government plan, they don't really care about "cost basis" or whatever -- what they care about is whether they're competitive on the balance of services and price to the consumer.
The biggest advantage of Medicare isn't that it's "more efficient" or "cheaper." It's that Medicare doesn't have to balance its budget -- deficits will just be made up by the "trust fund" of government securities or (when the trust fund runs out) government directly. Also that Medicare is funded through mandatory tax payments (including from private insurance customers), not voluntary premium purchases.
Look at 2011. Revenue was $229 billion, of which $195 billion came from payroll taxes (as opposed to premiums). Meanwhile total expenditures were $256 billion, more than $27 billion in excess of receipts. A private insurer losing $27 billion/year would be out of business. That's a lot of losses to float, especially when projections indicate those losses are going to continue forever.
If you step back and think about it, there's no apples to apples comparison really possible here. There's no way private plans can compete with a plan that can afford to lose infinity dollars. If you're arguing about private plans competing with government plans, and using Medicare as your example of a government plan, discussions about efficiency or administrative costs are just a blind.
Wait, let me amend that slightly. Private insurers generally aren't selling to the consumer (which is part of the problem). They're selling to a bunch of businesses that are buying health insurance for their employees. So there's distortions there too -- the existing private market is not an ideal market, to be sure, and it's not really clear to me that health plans are competing in the normal way on the balance of price and service.
That said, general point obtains. It's hard to compete against someone who doesn't have to break even, let alone turn a profit.
Side point, how is the ratio of administrative costs even an appropriate means of comparison? Using that metric is tantamount to an assumption that our objective is to spend as much money as possible. You can goose the number as much as you like by allowing overbilling and fraud. Of course, with a private plan, you have to cover that with increased premiums, whereas in Medicare, you can cover it with more government debt (or taxes).
Ritmo,
I don't have the luxury of playing your childish academic games. I actually know people, real people with jobs, and lives and dreams which people like you assume to be toys to be played with and argued about with your schoolboy links and pretense of knowledge. Lift your head from the keyboard and talk to someone real. Take on an actual challenge helping someone in life rather than spending your time trying to out bullshit some anonymous foe.
---The government will do no such thing [affect the supply of doctors thru pricing].----
LOLOLOL
Hillarycare did. There was a Med School cap.
And then there's Oklahoma and that wonderful little proviso in Obamacare.
There's a book on amazon, Ritmo - a doctor read all 2700 pages and let's us know what's in store.
Real people don't go to school, eh Bag O? Sounds like you've got that American dream thing down pat. Just ask those "real people" that you know so well, and spend so much time with, what they think of the idea that education is a waste of their kids' time.
In any event, I will never out bullshit you, my friend. You've got me completely beat there.
It's not going to work. It never has, it never will.
The question is why is it a crisis for the cost of health care in the private market to go up? People would gladly pay more for better care. The problem is the cost of healthcare for e government which is driven solely by its promising more health care than it can afford. So, the government screws up the private health care market because it can't pay for the promises it made. Crazy, huh?
Ritmo said:
"Good for you. So am I. But innovative =/= superior. You confuse marketing and newness with quality."
Unfortunately, this is true. Most people don't realize this, but when a new drug is unleashed on the world, although they do test for safety, they don't do a comparison against the older medications to see if the new more expensive drug is MORE EFFECTIVE than the old, less expensive one. We the consumer end up paying a much higher price for the new shiny pain killer, yet it's often not any more effective than regular aspirin or ibuprofen.
than regular aspirin or ibuprofen.
Please stop. You're comparing OTC minor to less moderate pain remedies with actual prescription medication for a variety of specialities.
Please, illuminate us all about the depth by which drugs coming to market need to be tested for everything from advanced chemotherapies to drugs for treatment of Crohn's disease or Multiple Sclerosis, like this:
"The study measured patients for two years and also included patients treated with Teva Pharmaceutical Industries Ltd.'s injectable MS drug Copaxone."
We the consumer end up paying a much higher price for the new shiny pain killer...
I suggest you tell your physician that you want him or her to prescribe only old drugs for you.
But thanks for the sweeping assertion of facts. I always find that incredibly persuasive.
What's coming next? A telling anecdote?
I suggest you tell your physician that you want him or her to prescribe only old drugs for you.
Alternatively, you could tell him that aspirin, morphine and nitrates are too old to do anything for your heart attack.
What are you trying to prove, Chip? There is not a problem with insufficient appreciation for shiny, new molecular doctor toys. The problem is with the public's understanding that newer is not usually, let alone often better. Sonic brings up analgesics. Do you know how many dozens were developed in that same class? You probably don't. The new ones, touted for their selectivity in sparing GI effects, turned out to be even worse at bringing on heart attacks. Not a good track record but that's the kind of data that you need the numbers only available in post-marketing to determine.
Or we could play it this way. Tell me which one of the more recent blockbusters you find most appealing and astonishing. I have extensive training in pharmacology. I will let you know what the drawbacks are, whether they were discovered pre or post-release, and how the shiny new thing does or does not measure up to any proposed advantage over existing therapy. In the long run, most of the purported gains end up being marginal at best. Doesn't mean the research wasn't beneficial, but not in the way you exaggerate.
Ready when you are.
In the long run, most of the purported gains end up being marginal at best.
I won't dispute this, I've seen it first hand.
The problem is also whether or not the system in place compounds cost problems by making drugs more difficult to get to market. It's amazing to see how many drugs are approved in Europe well before they see the light of day here.
We recently pitched a drug that had a half percent market share.
Ha! A half percent. The thing is, the market for this class of drugs was HUGE. So, going from half-percent to 0.75 of a percent meant big sales.
The drug was like, seventh to market in the class.
Ridiculous. How can this be? It's a waste of money!
Well, I suppose. But ask yourself how many beers are currently on the market.
I bow to your extensive training in pharmacology, Ritmo. But this is a question of economics.
To address that question, I won't claim any personal expertise at all. Instead, I'll cite the well-known work of MacArthur "genius grant" winner Kevin Murphy and his co-author Robert Topel:
...we estimate that increased longevity after 1970 yielded a “gross” social value of $95 trillion and the capitalized value of medical expenditures grew by $34 trillion, for a net gain of $61 trillion. Two-thirds of this “occurred” in the 1970s, when both gross benefits were highest and additional costs were lowest. Overall, rising medical expenditures absorb only 36 percent of the value of increased longevity.
It's amazing to see how many drugs are approved in Europe well before they see the light of day here.
Thalidomide being a great example.
In general we tend to approve the same things. There might be a few months of a lag getting them to the states, but that's not the longest wait in the grand scheme of things. The ICH sees to it that our regulatory hurdles and theirs are increasingly similar. But don't forget, too, that a lot of countries in Europe had (and still have?) cost-effectiveness hurdles for the NDA to clear. The monopsonies (single buyer) also probably contribute to companies wanting to get their drugs approved there faster, in order to make up for decreased profits.
It would be interesting to see the percentage of drugs being used off-label in the U.S. market.
A lot of models, summation/integral signs and, and phi, Chip! Those geniuses included the best known Phish song.
Anyway, GIGO. I can't figure out what the damn inputs are. Are you aware that the majority of increases in lifespan result from decreased infant mortality? Even for whichever contribution you suppose from drugs/treatments that were recently discovered, a lot of effectiveness research relates to how they (and older drugs) are used, not just the mere fact that they exist. Antibiotics were a huge exception, and I'd expect that the recent strides we'd made in cardiac care didn't hurt. But we've still got a ways to go with cancer. There is where we can and should expect advances in drug discovery to help quite a bit.
But medicine is complex, Chip. The most important buzzwords in cardiology nowadays are primary and secondary prophylaxis, meaning preventing a first or second heart attack. And other than diet, exercise and the like, you know what the best way to do that is? Aspirin.
Well, statins too, but those have pretty much all gone generic anyway. Totally unnecessary if your patient bothers to eat right, but of course they never do.
Are you aware that the majority of increases in lifespan result from decreased infant mortality?
I'm well aware of it. In fact, I've cited it in several discussions of Social Security right here.
Murphy and Topel are also aware of that. In fact, they discuss it in their paper. I'm sorry about all the math shit, but that's unavoidable in those kinds of papers.
There's a very simple point here, which has nothing to do with the fact that the pharmaceutical industry has hits and misses just like any other exploratory field. That point is that the advocates of Obamacare or single-payer start w/ the premise that we spend "too much" on health care in the US. Murphy and Topel's estimates show that that isn't even within shouting distance of the truth.
Then they're completely full of it. We spend more than anyone else and our outcomes (lifespan isn't the only metric) rank us around 30th or 40th place.
Let the industry have their hits or misses. Private insurance is already doing the rationing on that, anyway. But to argue that our outcomes are the best is a pretty fringe position. I've never heard anyone serious make it.
But anyway, SHINY BRAND = x(y) x f(x) dy/dx = AWESOME!
Sorry, couldn't resist.
BTW, wiki ranks the U.S. at #37 for life expectancy -- behind even the U.S. possession of Puerto Rico.
But we're ahead of Guam - (at 58)! That's something to celebrate, right?
You sound like a goddam creationist disputing the fossil record. Oooh, math!
I can't believe you're falling back on life expectancy. I gave you credit for being brighter than that. Try to put aside your math phobia for just a sec while I go over some basic stuff.
The contribution of a health-care system to outcomes is what it does for people conditional on their being sick. Life expectancy is a function of health care, genetics, and lifestyle.
Before Canada started its single-payer system, Canadians had a longer life expectancy than Americans. They still do.
But do know where people have the higher 5-year survival rates for all forms of cancer that I can find statistics for? I'll give you a hint: not Canada.
Anyway, here's another, less mathematically abstruse, very empirical and concept-oriented take on things. 'Night.
That's just more life-expectancy eyewash.
Check out Table 5 of this study to see what I'm talking about.
The contribution of a health-care system to outcomes is what it does for people conditional on their being sick.
Not anymore. Medical homes? Accountable care organizations? The payment paradigm is trending pretty solidly toward prevention.
Life expectancy is a function of health care, genetics, and lifestyle.
Yes. The impact of the last of which cannot be underestimated. Neither can it be easily separated from something that self-proclaimed rugged individualists claim to hate: Social factors!
Before Canada started its single-payer system, Canadians had a longer life expectancy than Americans. They still do.
As well as better access to care.
But do know where people have the higher 5-year survival rates for all forms of cancer that I can find statistics for? I'll give you a hint: not Canada.
Chip, what are you trying to pull here? You go on about the supposed necessity of differentials, and don't mention Kaplan-Meyer curves when bothering to bring up cancer? By how much were these rates different? Comparing which stages, and by whom? Did you know how long survival periods of deadly cancers are measured? Months. Even the newest "blockbuster" drugs make it a point to show improved survival periods of weeks at best.
You're going to need to get specific when you bring up something as intense and nitty-gritty as cancer, 'cause you can sure bet your ass that the oncologists do. Consistent, statistically significant survival advantages? By how many percentage points?
Chip, thanks for bringing the ACS to bear, but Table 5 compares U.S. rates during a timeframe of 1999 - 2006 to all other countries' timeframes of 1995 - 1999. Not fair. Advances and all that.
Come on, man. How could you not catch that? It took me all of a few seconds. But then, I need to be good at this sort of thing for a living...
Canada's not even listed in that table.
And where's France? They have like the best outcomes. Britain's sucks, IMO. Germany probably offers something close to what we'd want or would get. They're not all the same. Canada at least has the advantage of offering whomever you'd want to see for the same rate.
There are various advantages and disadvantages of how one chooses to approach this. I like a lot of what I'd found out about Switzerland's system based on an article linked to your Forbes article. But we couldn't emulate it here. Not enough highly trained labor with as much disposable income.
Advances and all that.
Wait a sec. Previously you pooh-pooh'ed medical R&D, saying "new" =/= "superior". Now all of a sudden half a decade of advance is enough to generate the huge disparities in survival rates in that table? Wow!!
You want some more data? Fine. Here's something w/ a little Canadian spin. But the US is still on
top by a substantial margin.
Ritmo, you're flailing. You don't seriously think they omitted France b/c its outcomes were so great, do you?
You must know that everybody's fave health-care system is Switzerland's. Just compare its survival rates w/ the US's. There's no need to look at anyone else's, b/c they're way behind.
To try to wrap this up for the night, I'll just say that I believe the burden of proof is on those who want to overhaul the US health-care system. And I don't think there's anything remotely close to meeting that standard in any of the evidence I'm aware of.
I think that a few tweaks to the ways we deal w/ pre-existing conditions and lifetime benefit caps would achieve almost every goal worth attaining, at minimal cost and disruption.
Ciao.
Wait a sec. Previously you pooh-pooh'ed medical R&D, saying "new" =/= "superior". Now all of a sudden half a decade of advance is enough to generate the huge disparities in survival rates in that table? Wow!!
Chip - you didn't read what I said. I spoke of the usefulness of effectiveness research. Most of the cytotoxic chemo drugs that still comprise the mainstay of therapy are still used, just in different combinations, in different doses, at different times, etc. Chemotherapy is a lil bit more complex than just giving whichever drug, without a specified dose, regardless of the combination and timing. You are committing a humongous error by believing that all medical advances = new products/technologies. Not true, Sir.
Swiss health care cannot be emulated in the U.S. if the payment/social models are not comparable. If they were, then great. And the French system produces the best results overall; I didn't say w/r/t cancer. But there's no way Republicans would allow the U.S. government to design and administer something as intricate and complex and effective as the French model. It would go against their entire philosophy of the need for government to be incompetent.
I'll just say that I believe the burden of proof is on those who want to overhaul the US health-care system.
Really? You wouldn't place the burden of proof on those saying that America should be happy with 37th place (and if not in longevity, its place in overall outcomes is close)? Or with tens of millions of uninsured? Guess again, the public now seems to.
I think that a few tweaks to the ways we deal w/ pre-existing conditions and lifetime benefit caps would achieve almost every goal worth attaining, at minimal cost and disruption.
Even universality? Why did the Republicans take so long and not even come up with at least that much, then?
Chip S. said...
To try to wrap this up for the night, I'll just say that I believe the burden of proof is on those who want to overhaul the US health-care system. And I don't think there's anything remotely close to meeting that standard in any of the evidence I'm aware of.
I think that a few tweaks to the ways we deal w/ pre-existing conditions and lifetime benefit caps would achieve almost every goal worth attaining, at minimal cost and disruption.
But, chip,that wouldn't let our political betters control us the way they want to. You can't let people decide for themselves.
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