News As Obamacare goes into effect, new criticisms leveled

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The discussion revolves around criticisms of the Affordable Care Act (ACA), particularly focusing on issues related to its implementation and the potential for fraud. Participants express concerns about the complexities of the legislation, including the repayment of subsidies when income changes, which could create high effective marginal tax rates for low-income families. There is a significant debate about the legality of certain mandates within the ACA and the expansion of the IRS to enforce these rules. Critics argue that the legislation was rushed through Congress without adequate understanding or scrutiny, leading to potential negative consequences for both healthcare providers and patients. The conversation also touches on the broader implications of government involvement in healthcare, with some participants questioning the effectiveness and fairness of the system. Overall, the discussion highlights a mix of skepticism regarding the ACA's implementation and the challenges of navigating its complexities.
  • #151
Market based healthcare solutions are based on a myth- there is no market for healthcare. The demand for life-saving care is completely inelastic. Information is completely asymmetric between doctor and patient, and in an emergency, patients can't chose which state, hospital, provider, etc, they end up with.

Without state support (medicare), the insurance model would be completely broken. Over a long enough time scale, everyone becomes incredibly risky. Hence, Daniels' arguments are broken. More privatization = more inefficiency in this case. Insurers have a huge layer to evaluate risk, which the government does not need.

Further, he ignores the best part of Obama's bill- the focus on evidence based medicine. A planned push for empirically successful treatments is the only way to bring down costs AND improve outcomes.
 
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  • #152
ParticleGrl said:
Market based healthcare solutions are based on a myth- there is no market for healthcare. The demand for life-saving care is completely inelastic. Information is completely asymmetric between doctor and patient, and in an emergency, patients can't chose which state, hospital, provider, etc, they end up with.

Without state support (medicare), the insurance model would be completely broken. Over a long enough time scale, everyone becomes incredibly risky. Hence, Daniels' arguments are broken. More privatization = more inefficiency in this case. Insurers have a huge layer to evaluate risk, which the government does not need.

Further, he ignores the best part of Obama's bill- the focus on evidence based medicine. A planned push for empirically successful treatments is the only way to bring down costs AND improve outcomes.

Care to support any of your comments - or is it all opinion?

I'm especially interested in your statement "Without state support (medicare), the insurance model would be completely broken." Do you care to elaborate?
 
  • #153
WhoWee said:
Care to support any of your comments - or is it all opinion?

Most of what I listed are basic facts of the system. i.e. no consumer choice in an emergency- for obvious reasons you go to the nearest treatment center. Completely inelastic demand for life saving care- people want to live, the price is not an object. Changing the price in no way changes demand. Asymmetrical information- Doctors are highly trained professionals with much specific knowledge. Any discussion of treatment will always be asymmetrical between Doctor and patient (unless the patient themselves is a Doctor). This is all basic, obvious stuff. The healthcare sector has none of the requirements needed for an actual,efficent market.

I'm especially interested in your statement "Without state support (medicare), the insurance model would be completely broken." Do you care to elaborate?

On a long enough time scale, everyone's risk of catastrophic health failure goes to 1. How do you manage your risk in such a situation? Insurance companies will be forced to extract more from a person over their lifetime than they put out in costs, so what's the point of insurance?
 
  • #154
ParticleGrl said:
Further, he ignores the best part of Obama's bill- the focus on evidence based medicine. A planned push for empirically successful treatments is the only way to bring down costs AND improve outcomes.

don't we already have empirically based medicine? don't injury lawsuits lead to development of protocols?
 
  • #155
I'm not trying to challenge everything you've posted.

But, when you posted
"Without state support (medicare), the insurance model would be completely broken."

It was not obvious what you were trying to say. Now to clarify, you've stated:
ParticleGrl said:
On a long enough time scale, everyone's risk of catastrophic health failure goes to 1. How do you manage your risk in such a situation? Insurance companies will be forced to extract more from a person over their lifetime than they put out in costs, so what's the point of insurance?

I'm still not connecting how Medicare - a Federal Government program - prevents the insurance model from being broken? As for the insurance model itself - I'm not certain insurance was ever intended to pay all of the costs of health care. Insurance doesn't work that way in any other industry - does it?

Does your car insurance pay for tune-ups, oil changes, brake jobs, and tire rotation? Does your homeowners insurance pay for light bulbs, paint, and lawn care?

Why should anyone expect their health insurance to pay for doctor visits, blood work, and prescriptions?

Insurance is typically purchased to guard against catastrophic loss - that is the insurance model.

As for consumer choice, you (or your employer) typically choose an insurance plan based upon network - each with doctor and hospital choices.
 
  • #156
I'm still not connecting how Medicare - a Federal Government program - prevents the insurance model from being broken? As for the insurance model itself - I'm not certain insurance was ever intended to pay all of the costs of health care. Insurance doesn't work that way in any other industry - does it?

You are missing the point, this isn't an issue of a deductible. Insurance works by spreading the risk of catastrophic payment over many people. However, as we get older, our risk of catastrophic failure heads to 1. IF every single person insured will have a catastrophic failure at some point, than the insurance company cannot hedge that risk. The only way to turn a profit is to extract from every person enough money to pay for that catastrophic health failure (at which point, why be insured?). The alternative is to simply not insure the elderly. However, the elderly are the biggest consumers of actual medical services, if they weren't insured and couldn't afford treatment, the healthcare industry would collapse.

What does medicare do? It removes the elderly from the risk pool. Since the majority of people will have their catastrophic health care costs late in life, the risk of catastrophic failure amongst the remaining pool is much lower.

As for consumer choice, you (or your employer) typically choose an insurance plan based upon network - each with doctor and hospital choices.

Yes, but this small amount of choice, far removed from the actual product (health care procedures) does not make for an efficient market. Before people advocate market remedies, they need to ask themselves "is there actually a market?"

don't we already have empirically based medicine? don't injury lawsuits lead to development of protocols?

Most of the US medical data is disjoint and hard to put together. By creating a national medical database, the health care bill will create a massive amount of data. A large database of treatments and outcomes will give us a chance to do empirical medicine on an incredible scale, which will drive down costs.

As an example, there is currently no statistical evidence that spinal fusions alleviate back pain, but we've been doing them for decades. That is a lot of waste.
 
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  • #157
ParticleGrl said:
You are missing the point, this isn't an issue of a deductible. Insurance works by spreading the risk of catastrophic payment over many people. However, as we get older, our risk of catastrophic failure heads to 1. IF every single person insured will have a catastrophic failure at some point, than the insurance company cannot hedge that risk. The only way to turn a profit is to extract from every person enough money to pay for that catastrophic health failure (at which point, why be insured?). The alternative is to simply not insure the elderly. However, the elderly are the biggest consumers of actual medical services, if they weren't insured and couldn't afford treatment, the healthcare industry would collapse.

What does medicare do? It removes the elderly from the risk pool. Since the majority of people will have their catastrophic health care costs late in life, the risk of catastrophic failure amongst the remaining pool is much lower.

Every single person does not have a catastrophic failure and subsequent health care insurance claim - do they? Some people die in accidents, others have strokes or heart attacks and die instantly, some people never get sick and die of old age - don't they?
With Medicare, it's not that simple. First, Part A is funded through payroll deductions over a worker's life. Part B has a premium - for 2010 enrollees it's $110.50 per month unless income exceeds $85,000. Part D is the prescription benefit and Part C is Medicare Advantage (MA). The MA combines A & B, and can include Part D (MAPD). Medigap is the insurance that (basically) is designed to pay the 20% cost share that Medicare leaves behind (no prescriptions - need a Part D). Worth mentioning, Medicare covers only the first 100 days in a Skilled Nursing Facility.

If a beneficiary needs to be placed in a nursing home - they are on their own. Once their assets are depleted (house and savings/investments) most are dependent on Medicaid - a funded by Federal and State contributions. The insurance designed to cover is named Long Term Care Insurance. LTC protects assets.

Then, we need to consider the reality of death, some people purchase life insurance - as everyone dies (either natural or un-natural causes) - that is certain.
 
  • #158
WhoWee said:
Every single person does not have a catastrophic failure and subsequent health care insurance claim - do they?

No, but the risk heads to 1, because nearly everyone does. For this argument, the details of medicare aren't important- what is important is that medicare reduces the risk to insurance companies to manageable levels.

Then, we need to consider the reality of death, some people purchase life insurance - as everyone dies (either natural or un-natural causes) - that is certain.

Thats why many life insurance policies are term- they don't last for life. Similarly, many whole life policies are accidental death and won't cover natural causes. This reduces the risk, and creates a pool of premiums that can help pay the cost of whole policies. Even still, the premium on a whole policy escalates rapidly in the later years.
 
  • #159
ParticleGrl said:
This is all basic, obvious stuff.
No, it's just stuff. Are you really so convinced that health care is so singular? Consider that other fields have asymmetric information and critical needs challenges, yet have been long served by markets and been studied ad nauseum in the economics literature. Your posts in this line suggest none of this is true without reference, though you've been asked for backup.
 
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  • #160
ParticleGrl said:
No, but the risk heads to 1, because nearly everyone does. For this argument, the details of medicare aren't important- what is important is that medicare reduces the risk to insurance companies to manageable levels.

Thats why many life insurance policies are term- they don't last for life. Similarly, many whole life policies are accidental death and won't cover natural causes. This reduces the risk, and creates a pool of premiums that can help pay the cost of whole policies. Even still, the premium on a whole policy escalates rapidly in the later years.

Before we go any further, I'm going to disclose (again) that I'm very active in the insurance industry. I have substantial industry experience and familiar with all forms of life, variable annuity, accident, and health policies. I have extensive Medicare/Medicaid experience.

Medicare really doesn't reduce the risk to the insurance company. A Medigap plan covers the 20% that Medicare doesn't pay - the risk exposure to the insurance company remains 20% regardless of the claim amout. If a beneficiary pays $100 per month for a Plan F and incurrs $5 million in bills - the Medigap insurance company will pay $1,000,000 - Medicare doesn't cover a penny of this 20%.

A Medicare Advantage plan pays INSTEAD of Medicare. Medicare pays a fixed amount (last figure I saw was $849.95) per month - about $10,000 per year - to the insurance company. The insurance company is responsible for all of the costs as per their Summary of Benefits that describes the beneficiaries co-pay and cost sharing requirements. The beneficiary (has typically already paid for Part A through payroll deductions) pays a Part B premium (new enrollees $110.50 per month) to Medicare.

Basically, Medicare has collected Part A payments over time and continues to collect Part B premiums - then re-insures under Part C.

As for life insurance - I'm not sure what your point is -term coverage typically has a lower premium.
 
  • #161
mheslep said:
No, it's just stuff.

What does that mean?
 
  • #162
WhoWee said:
A Medicare Advantage plan pays INSTEAD of Medicare[/B]. Medicare pays a fixed amount (last figure I saw was $849.95) per month - about $10,000 per year - to the insurance company.

Interestingly, that's almost identical to what my brother pays for his family medical insurance (him, his wife, his son). Is that Medicare Advantage plan for one person, or a family?
 
  • #163
mugaliens said:
Interestingly, that's almost identical to what my brother pays for his family medical insurance (him, his wife, his son). Is that Medicare Advantage plan for one person, or a family?

All Medicare plans are individual. The premium could exceed that amount - it's an average. To clarify a bit, if the amount of the insurance contract with Medicare exceeds the amount Medicare agrees to pay - the beneficiary would pay the difference. For instance, if the monthly contract premium is $870 and Medicare agrees to pay $850 - the premium requirement for the beneficiary would be $20 - the amount can be deducted from the Social Security check or billed via coupon book (typically). These Medicare Advantage (MA) plans can offer hospital A and medical B or they can include Part D and be labeled "MAPD". The premiums on MAPD's typically range from $0 to $100 per month - varies by county. Some plans will actually reduce the Part B premium up to the full amount. This means the beneficiary would receive more money in their Social Security check. Other plans might cost more than $200 per month - again, it varies by location.

If $10,000 sounds expensive - it actually tracks from the groups approaching retirement age with comparable coverage.
 
  • #164
mheslep said:
Consider that other fields have asymmetric information and critical needs challenges, yet have been long served by markets and been studied ad nauseum in the economics literature.

Please, give references to well functioning markets with little consumer choice,large asymmetric information, etc. All of the economics papers I've read (largely theory papers) suggest these are impediments to market efficiency. In the extreme case, the market ends up a market for lemons, and the bad drives out the good (see Akerlof's famous paper).

Before we go any further, I'm going to disclose (again) that I'm very active in the insurance industry. I have substantial industry experience and familiar with all forms of life, variable annuity, accident, and health policies. I have extensive Medicare/Medicaid experience.

Thats fine, but let's not bog this down by too many details, and make it simple. Surely you agree that elderly are extremely risky to insure? Surely, you agree that the state's agreement (via medicare) to cover 80% mitigates this risk?

With your insurance experience, if you had to underwrite a (non-state subsidized) plan for an average 65 year old (say an 80/20 plan, to be concrete), what premium would you have to charge? How quickly would the premium have to grow, year by year, to eat the risk?
 
  • #165
I'm enjoying this very much, but if I might ask for the sake of clarification: WhoWee has a background in Health care/Insurance.

@Particlegrl: You sound like you're coming from the macroeconomic theory angle? I'm curious, not because I'm questioning credentials or anything like that, but it's rare to see two people with serious knowledge of this kind of subject... one practice, one theory. I just want to be sure that's the case, and I'm not missing even more than I know I already am.
 
  • #166
ParticleGrl said:
Surely you agree that elderly are extremely risky to insure? Surely, you agree that the state's agreement (via medicare) to cover 80% mitigates this risk?

With your insurance experience, if you had to underwrite a (non-state subsidized) plan for an average 65 year old (say an 80/20 plan, to be concrete), what premium would you have to charge? How quickly would the premium have to grow, year by year, to eat the risk?

It does cost more to cover an elderly person. I should have been more descriptive when I posted that premiums track to this level as people reach retirement age.

What I meant was a relatively health non-smoking male, age 64, taking no meds and with comparable deductibles and co-pays would expect to pay between $600 and $800 per month. Worth mentioning, many of the MAPD plans include prescription coverage.

I think the details are important and I did a quick comparison to post.

Accordingly, I just went onto a (competitive) major carrier site and entered these same details. To stay out of trouble on marketing rules and disclosures, I won't name the carrier or the location AND I must stipulate this is NOT to be considered an offer to sell insurance.
The 80/20 (In-network - 60/40 out of network) plans offered consistent $35 primary/$50 specialist co-pays and a range of deductibles: from $0 to $1,000 on prescriptions and from $1,000 to $6,000 on medical.

The $0 deductible prescription plan with $1,000 medical deductible priced at $967.68/mos and the $0 deductible prescription plan with $2,500 med deductible was priced at $637.28

By comparison, the $500 deductible prescription plan with a $3,500 medical deductible is priced at $495.47 per month.
The "most affordable" plan was the $1,000 prescription deductible (6 office visits per year max) and a $6,000 medical deductible is priced at $349.99 per month.


Next, I checked the same carrier for a Medicare plan in the same zip code.
Premiums ranged from $61 to $291 per month and included prescription coverage. The medical deductibles are $0, but the hospital deductible on both the $61 plan and the $291 plan mirror original Medicare at $1,132 for days 1-60, then $283 per day from days 61-91, and $566 per day from day 91-150 (under original Medicare beneficiary pays 100% days 151 and beyond). Both of these plans also have a $310 prescription deductible. Doctors are 20% same as orig Medicare.

The $71 premium plan featured a hospital co-pay of $220 per day for days 1-8, a $15 primary doctor co-pay and $35 for a specialist.


Last, I pulled a Medigap Plan F (different carrier with a competitive rate) in the same zip code and no prescription coverage - only the 20% that Medicare doesn't pay - along with the hospital coverage. Plan F is the most comprehensive of the supplement plans. The premium would be $144.55 per month.

--------------
To answer you question - these are real costs - concrete.

Now, we also have to remember that Medicare sets the reimbursement rates and has to approve every aspect of these plans before they can be offered. These plans are also subject to state regulation.

Does Medicare mitigate the risk?
To the insurance carrier - NO
To the beneficiary - YES

As for premium increases - it varies. My best guess is about $25/month average across the board from 2010 to 2011 plans.

The next level of details to consider would delve deeper into the particulars of coverage. Many MAPD's include health club memberships, some dental, and some vision. Then, quite a few dual eligible plans (people with both Medicare and Medicaid) include transportation and very low drug costs ($1.10 to $6.50) with no "donut hole".
 
  • #167
ParticleGrl said:
Please, give references to well functioning markets with little consumer choice, large asymmetric information, etc.
As to examples of markets with asymmetric information, where to begin? Car maintenance and repair - the asymmetry between the consumer and the mechanic. Financial investments: buying and selling of securities and the like - the asymmetric between you and the pros. Yes the asymmetries in these situations present challenges to the market, but consumers have found multitudes of solutions to deal with them - financial advisors, warranties, word of mouth in the community. I don't accept the notion that the public has little choice with respect to doctors and hospitals. Emergency needs are a small portion of national health expenditures.

ParticleGrl said:
All of the economics papers I've read (largely theory papers) suggest these are impediments to market efficiency. In the extreme case, the market ends up a market for lemons, and the bad drives out the good (see Akerlof's famous paper).
Yes conditions as described by Arrow and Akerlof no doubt create challenges for the market, though Akerlof is http://resources.metapress.com/pdf-preview.axd?code=h3h8530156276515&size=largest":
Hoffer said:
It is shown that the economic literature is divided on whether a lemons market actually exists in used vehicles.
In any case it certainly does not follow from Arrow/Akerlof that working markets under such conditions simply can not exist as asserted above as a matter of fact:
ParticleGrl said:
Market based healthcare solutions are based on a myth- there is no market for healthcare. The demand for life-saving care is completely inelastic. Information is completely asymmetric between doctor and patient, and in an emergency, patients can't chose which state, hospital, provider, etc, they end up with.
...
Most of what I listed are basic facts of the system.
...
Changing the price in no way changes demand

Also: I grant insurance doesn't make sense in all situations especially for chronic illnesses, and the market based reforms on the table recently all prefer risk pools over insurance for those cases. But I can't fathom how one can be aware of and cite the case of life insurance on the one hand where the eventual end is certain, and then imagine that somehow insurance can't deal with high risk illnesses in the case of health care.
 
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  • #168
mheslep said:
Car maintenance and repair - the asymmetry between the consumer and the mechanic.

A market that historically has been ripe with fraud and inefficiency. Everyone knows the anecdotes of shady mechanics. What empirical studies demonstrate this market is actually efficient? Also, its different in a key way- health care is the only thing I know of where the demand is so inelastic. This breaks important market principles.

Financial investments: buying and selling of securities and the like - the asymmetric between you and the pros.

There is a huge difference here. The biggest participants in the market are professionals. Hence, the symmetry of information between the largest players sets the price for everyone.

Even still, some have argued that asymmetrical information (between major players like Goldman and AIG) and fraud in the derivatives market has been largely responsible for the present financial crisis. See anything recent by Galbraith. I'm not sure I buy it, but at the same time, it seems crazy that AIG took the market position it did with swaps.

Yes the asymmetries in these situations present challenges to the market, but consumers have found multitudes of solutions to deal with them - financial advisors, warranties, word of mouth in the community. I don't accept the notion that the public has little choice with respect to doctors and hospitals.

Lets agree to disagree for now on the financial market (which I consider to be the purest market economist can study), and focus on car maintenance and repair- why should we believe this market is fair or efficient?
 
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  • #169
ParticleGrl said:
...A market that historically has been ripe with fraud and inefficiency. Everyone knows the anecdotes of shady mechanics.
Yes it is in the nature of people that some of them are shady. Some economic approaches accept this as a given, others, not so wise in my view, attempt to anoint some of the same fallible people and put them in charge of the daily lives of the rest, because, well, they might be shady.
What empirical studies demonstrate this market is actually efficient?
The tactic of asking for references to disprove claims, while providing none, won't move the discussion along.

... and focus on car maintenance and repair- why should we believe this market is fair or efficient?
The useful question is compared to what? Government run car repair? Look at what the repair market, such as it is, currently does: repairs nearly any imaginable car problem, on over a thousand different make-model combinations, generally within a couple days, across the entirety of the US, from typically several hundred to a couple thousand dollars. Among the tens of thousands of mechanics, we'll have some combination of crooks and innocent incompetents ( I can say from being in the business as a teen that the problems are overwhelmingly due to incompetence). On top of that we have tens of thousands of auto parts stores for the do-it-yourselfer, fierce competition among vehicle manufacturers for the best warranties, and now in addition we have the internet, Craigs list, etc, etc.
 
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  • #170
mheslep said:
As to examples of markets with asymmetric information, where to begin? Car maintenance and repair - the asymmetry between the consumer and the mechanic. Financial investments: buying and selling of securities and the like - the asymmetric between you and the pros. Yes the asymmetries in these situations present challenges to the market, but consumers have found multitudes of solutions to deal with them - financial advisors, warranties, word of mouth in the community. I don't accept the notion that the public has little choice with respect to doctors and hospitals. Emergency needs are a small portion of national health expenditures. <Snip>


re bold especially: I have to agree with this, although I think consumers are generally still playing catch-up. I think airlines and hotels are an example we're not disgustingly familiar with thanks to William Shatner and a dozen other sites like the one he hocks. Those are a fine example of a way that consumers literally bypass the asymmetry and use it to utterly turn the tables. Some don't use this service, but it's not for lack of it being on offer.

Health-Care though... you're in a fairly unique situation with your health, don't you think? It may be that those inequalities can't be allowed to fester until consumers are allowed or figure how to "catch up". In addition, at this point, it doesn't seem as though the consumer can do much to effect the market... it is HAPPY to dump your sick tush. You're also very vulnerable when seriously ill, and this isn't a hotel or a sport... you take care of yourself or die early/live badly.

To be blunt, Health Care is unlike most markets in terms of impact on the individual and family, and life in general. Let's be blunt... it can be the difference between living or dying, and the quality of life. I'd like to see a comparison of the Q-TWIST say, of a given cancer patient on various types of health insurance, and none. Compare that to other consumer "choices", and I'm not sure it's something that's so easily grouped.

Health, Food, Shelter, Comfort, Company, etc... some measure of ALL this is needed if you want a decent life. When my car breaks down, it may ruin a lot of things, but it doesn't make me suffer and die.
 
  • #171
mheslep said:
The tactic of asking for references to disprove claims, while providing none, won't move the discussion along.

We both agree asymmetry of information is a difficulty for a market.

You suggested that in the specific case of car maintenance and repair, this problem is solved, I'd like some positive proof of this. I'd argue its not solved- some proportion of crooked dealerships stay in business.

The useful question is compared to what? Government run car repair?

Its not about comparing to the government. If we look at the main topic we are discussing (health care), the government is obviously more efficient because it does not have to evaluate risk (a large part of insurance). http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf.

Its about the efficiency of the specific market- over time do crooked dealers go out of business and honest dealers prosper? In an efficient market, this is what happens. In a market-for-lemons situation, the crooked dealers will thrive and drive out the honest dealers. You are making a positive claim- the market has solved the asymmetrical information problem inherent in car repair.

When I have time to type up some mathematics, I'll lay out the broader case for health insurance risk being dramatically reduced by medicare.
 
  • #172
ParticleGrl said:
Its not about comparing to the government. If we look at the main topic we are discussing (health care), the government is obviously more efficient because it does not have to evaluate risk (a large part of insurance). http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf.

(my bold)
The Government uses the Medicare Advantage plan to offset some of their risk. They have evaluated risk. The Federal Government has expanded Medicaid recently - this forces a share of the cost onto the states - are the states evaluating that risk?

Original Medicare is paid through Payroll deductions for Part A and a premium payment for Part B. The Part B premium was increased from $96.50 to $110.50 in 2010 - because the risk was evaluated - wasn't it?

There are at least a dozen possible healthcare outcomes when a person reaches age 65.
1.) Original Medicare only
2.) Original Medicare plus Part D
3.) Either 1 or 2 above plus a Medigap Supplement
4.) Original Medicare plus Medicaid (multiple levels)
5.) Original Medicare plus Part D with LIS (multiple levels)
6.) Part C Medicare Advantage (MA)
7.) Part C Medicare Advantage with Prescription (MAPD)
8.) no Medicare coverage (Group/Private or nothing at all)
9.) no Medicare coverage - Medicaid only
10.) VA only
11.) VA in combination with something from above
12.) TRICARE (multiple)

There are other cost sharing and specialized (ESRD) plans (for instance).

Other than people with Group/Private insurance, the only insurance scenario that eliminates risk to the Federal Government is the Medicare Advantage program. The Government pays a fixed amount to a 3rd party insurance carrier that pays instead of Medicare. Every other scenario puts the Government at risk. The Government does not have unlimited resources (believe it or not). I've posted several links previously that estimate long term deficits from Social Security, Medicare, and Medicaid spending approaching $86 Trillion. The Federal deficit is currently $14 Trillion - up almost $5 Trillion in the past 5 years - there are limits to the risk Government can cover. Government does have to evaluate risk.

I've posted multiple times in the various healthcare debate threads on this topic. This is a condensed version of my OPINION. The Government needs to fund facilities (including large ticket equipment), including local clinics - perhaps convert some of the Post Offices that are closing. Provide tax incentives to doctors to volunteer in the clinics. The goals would be to address routine and preventative issues and to eliminate non-emergency Medicaid visits to emergency rooms. Next, the Government can create high risk insurance pools to cover catastrophic claims/pre-existing above a certain limit - $5 million (IMO). This will give the insurance industry a $5 million maximum risk to address. The next level of concern is leveling the playing field for carriers. We need to standardize insurance regulations (to some of the higher standards) across the 50 states, D.C., Guam, Puerto Rico, etc. to allow more companies to participate and reduce the administrative (nightmare and) cost. There are other concerns including an evaluation of the cost of litigation (including Doctors ordering unnecessary tests to protect themselves). Medicare already sets the reimbursement rates - need evaluation. The Government also needs to address the costs of bringing a drug to market. Insurance is the "demon", not the problem. Again - IMO.
 
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  • #173
ParticleGrl said:
We both agree asymmetry of information is a difficulty for a market.
Yes agreed, a difficulty. It doesn't make markets untenable, at least not in many cases.

Its not about comparing to the government. If we look at the main topic we are discussing (health care), the government is obviously more efficient because it does not have to evaluate risk (a large part of insurance). http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf.
Where in that 167 page document is the government shown to be obviously more efficient?

Its about the efficiency of the specific market- over time do crooked dealers go out of business and honest dealers prosper? In an efficient market, this is what happens. In a market-for-lemons situation, the crooked dealers will thrive and drive out the honest dealers. You are making a positive claim- the market has solved the asymmetrical information problem inherent in car repair.
Let's not turn this around. I entered the discussion to suggest there were obvious exceptions to your positive claims:

particlegirl said:
Market based healthcare solutions are based on a myth- there is no market for healthcare. The demand for life-saving care is completely inelastic. Information is completely asymmetric between doctor and patient, and in an emergency, patients can't chose which state, hospital, provider, etc, they end up with.

Without state support (medicare), the insurance model would be completely broken. Over a long enough time scale, everyone becomes incredibly risky. Hence, Daniels' arguments are broken. More privatization = more inefficiency in this case.
I take exception with every sentence of the above.
 
  • #174
Where in that 167 page document is the government shown to be obviously more efficient?

Medicare loses about 4% in overhead, to insurance's 11%. Further, look at:

http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf

Medicare's cost per beneficiary has been rising about 9% per year since 1970. Private insurers have seen premium rise 10% per year. Also, these rapid growths underscore that we don't simply have out of control medicare growth. We have out of control health care expense.

mheslep said:
I take exception with every sentence of the above.

The lack of market is made up of each of the supporting points:

On price elasticity see the famous RAND health insurance experiment. It is the largest study I know of, and concludes a price elasticity of about -0.2. Its not quite 0, but its pretty close : http://www.rand.org/health/projects/hie.html

On asymmetry of information, we seem to agree- correct me if I'm wrong?

Also, do we need to argue about whether patients in an emergency have choice?

The question then, is can a market operate efficiently in these situations.
 
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  • #175
Medicare loses about 4% in overhead, to insurance's 11%.

This is complete nonsense. Forget for a moment that relative administrative overhead costs tell us nothing of practical value about efficiency of healthcare delivery; let's pretend for a moment that having an advantage in administrative services is necessary or sufficient to lend a given firm a comparative advantage.

What exactly are we talking about when we say Medicare spends (the money is spent, by the way, not "lost")? This means that 4% of the premiums collected by Medicare are spent on administration, with the remaining 96% spent elsewhere - specifically, mostly on covering medical bills. It is also true, then, that private insurance likewise spends its remaining 89% elsewhere - specifically, mostly on covering medical bills.

Does this corollary (Medicare spends 96% of its revenues paying medical bills, and private insurance spends only 89%) prove that private insurance has an efficiency advantage in paying medical bills relative to Medicare? I gather you'd reject that claim. And you'd be right to do so on the basis of this statistical sleight of hand - in fact, I've proven no such thing.

Medicare, by design, covers the elderly, and they are a much riskier portion of the population. Even if Medicare and private insurance companies spent an identical real dollar amount per patient on administrative costs, the relatively higher medical expenditures in Medicare would make administrative costs a smaller percentage of overall costs. When we actually look at the per patient administrative costs for Medicare versus private insurance, we find that they are not equal. In fact, Medicare spends far more per patient than the private sector, despite the fact that private firms must pay taxes, fees, marketing and regulatory costs that Medicare simply does not have.

On price elasticity see the famous RAND health insurance experiment. It is the largest study I know of, and concludes a price elasticity of about -0.2. Its not quite 0, but its pretty close : http://www.rand.org/health/projects/hie.html

A PPD of -0.2 is not at all close to the perfectly inelastic case of 0, which does not exist in real markets. In fact, there are an infinite number of real values between 0 and 0.2 on the number line.

In real terms, this figure tells us that the price elasticity of demand for healthcare is relative inelastic, but still elastic - a 1% rise in prices, ceters perebus, results in 0.2% less consumption. This is more than sufficient to create viable markets. For comparison, the market for eggs is relatively more inelastic than the market for healthcare, by a factor of 2. Consumers are twice as responsive to changes in the cost of healthcare than to changes in the cost of eggs!

This is a far cry from your original claims - that dieing people will spend anything on life saving treatments, and that therefore healthcare is not a marketable good. Shall we nationalize the egg market next?

On asymmetry of information, we seem to agree- correct me if I'm wrong?

I don't! I haven't seen any argument that the market for healthcare is more prone to moral hazard or adverse selection than any other technical or specialized marketplace. The existence of asymmetries in healthcare makes the sector neither special nor unworkable. Consumers and suppliers deal with information scarcity constantly; this fact alone is not sufficient to establish market failure. Rational market participants are understood to invest the resources necessary to inform their decisions before they make them. Where they cannot, they price in risk premiums. If they cannot, the transactions don't occur.

This is confirmed by most studies which attempt to measure the adverse impact of information asymmetries on real world markets; in practice it's virtually impossible to find and measure statistically. Do so on a systematic basis, and you'd probably win a Nobel prize. Good luck, though; I think you'll find market mechanisms are remarkably self-preserving.

Also, do we need to argue about whether patients in an emergency have choice?

Of course patients in emergency have choice. That patient may prefer immediacy of care, all things being equal, but this is not determinant. If the nearest hospital is closed, the consumer certainly won't choose it on the basis of distance. Likewise if the nearest hospital only accepts Visa and he carries Mastercard, or if it only treats cancer patients and he is having a heart attack. These points might seem absurd, but they serve to make the point. Indeed, critical patients are routinely routed to medical centers other than the closest for myriad reasons.

You seem to imagine that the healthcare market is some extreme, fantastic place full of zeros and infinites. In the real world, you simply don't find that, and if your theory suggests you ought to, there's probably something wrong with the theory.
 
  • #176
talk2glenn said:
This is complete nonsense. Forget for a moment that relative administrative overhead costs tell us nothing of practical value about efficiency of healthcare delivery;

How do you define efficiency of healthcare delivery? I would argue that in the context we are discussing, the administrative costs are a good measure.

What exactly are we talking about when we say Medicare spends (the money is spent, by the way, not "lost")? This means that 4% of the premiums collected by Medicare are spent on administration, with the remaining 96% spent elsewhere - specifically, mostly on covering medical bills. It is also true, then, that private insurance likewise spends its remaining 89% elsewhere - specifically, mostly on covering medical bills.

For the case of medicare, the remaining money is spent mostly on medical bills, obviously. For private insurance, the rest of the money won't be spent on medical bills, some of it is profit. It is obviously unfair to count profit as inefficiency.

Medicare, by design, covers the elderly, and they are a much riskier portion of the population. Even if Medicare and private insurance companies spent an identical real dollar amount per patient on administrative costs, the relatively higher medical expenditures in Medicare would make administrative costs a smaller percentage of overall costs. When we actually look at the per patient administrative costs for Medicare versus private insurance, we find that they are not equal. In fact, Medicare spends far more per patient than the private sector, despite the fact that private firms must pay taxes, fees, marketing and regulatory costs that Medicare simply does not have.

Per patient administrative costs is obviously not a good metric. If I insure a pool of 22 year olds who makes no claims in an average year, my administrative cost can approach 0. The per CLAIM administrative cost would be a better number, but we can't get it from the CBO data above.

BUT, what we can do is directly compare medicare advantage plans (through private companies) to the similar pool of medicare. Now we have the same demographics, I hope you would agree? What do we find- between 3 and 4% administrative costs for medicare, and about 11% for the private medicare advantage plans. Comparing these similar demographics, we find private companies spend more in administration per patient of the same demographic.

A PPD of -0.2 is not at all close to the perfectly inelastic case of 0, which does not exist in real markets. In fact, there are an infinite number of real values between 0 and 0.2 on the number line.

Of course the perfectly inelastic case doesn't exist. Generally, anything between 0 and -1 is considered inelastic. I would say -0.2 is extremely inelastic.

Consumers are twice as responsive to changes in the cost of healthcare than to changes in the cost of eggs!

Yes, eggs are famously inelastic. Largely because they are among the cheapest proteins, so there are no close substitutes, to follow the econ 101 logic (although I don't know an actual study of their inelasticity, could you provide one?) . Of course, if the price of eggs jumped above the price of chicken or beef, elasticity would set in. With health care, what do you think can explain the inelasticity? Is there a price where health care becomes more elastic? Given that it is obviously a necessity, with no substitutes, might the relative elasticity be due to people who are priced out of the market all together?

This is a far cry from your original claims - that dieing people will spend anything on life saving treatments, and that therefore healthcare is not a marketable good. Shall we nationalize the egg market next?

First, the PPD I quoted is across all health care, not simply life saving care. I still contend that the demand for life saving care is very nearly perfectly inelastic. For life saving care, if you arrive at the hospital the hospital is obligated, both morally and legally, to treat you, regardless of price.

Rational market participants are understood to invest the resources necessary to inform their decisions before they make them. Where they cannot, they price in risk premiums. If they cannot, the transactions don't occur.

Yes, all rational participants in the health care market invest the resources to get the MD required to understand the best course of action, and successfully negotiate with their provider and insurance company.

Of course patients in emergency have choice. That patient may prefer immediacy of care, all things being equal, but this is not determinant. If the nearest hospital is closed, the consumer certainly won't choose it on the basis of distance. Likewise if the nearest hospital only accepts Visa and he carries Mastercard, or if it only treats cancer patients and he is having a heart attack. These points might seem absurd, but they serve to make the point. Indeed, critical patients are routinely routed to medical centers other than the closest for myriad reasons.

Right, but the routing is done by the ambulance, not the patient, on the basis of medical reasoning, not patient choice. If you call 911, you are going to where the ambulance takes you, whether or not they are in your provider network, or take whatever payment you have on you, etc. The choice is whether or not to call 911.
 
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  • #177
I would add... by definition some emergencies don't leave you in a position to make choices, or make them known. The economics... I am steering clear of, but the point about emergent care is also accurate. You can refuse treatment doctor to patient, but your going to have a hell of a lot of explaining to do if ALL of your doctors do it. There might be whispers of it being "policy", and that would be *sounds of axe falling*.
 
  • #178
ParticleGrl said:
Medicare loses about 4% in overhead, to insurance's 11%. Further, look at:

http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf

Medicare's cost per beneficiary has been rising about 9% per year since 1970. Private insurers have seen premium rise 10% per year. Also, these rapid growths underscore that we don't simply have out of control medicare growth. We have out of control health care expense.

It's not clear how much of "insurance's" overhead is due to Medicare/CMS and state regulations compliance - any idea?

Just in the context of Medicare (not group or individual or group Medicare or Medigap), in order for a company to offer a Medicare Advantage (usually 1 basic MA plan per state), a Part D prescription plan (most file 2 or 3 -plans per state), a Medicare Advantage plan with prescription coverage (typically HMO's, PPO's, PFFS's, and possible SNP's - typically 3 to 4 per state) - the insurance company must file a specific plan for each county in the state - some vary by zip code. As an example, Ohio has 88 counties. This process has to be repeated for each and every state in which the company intends to offer plans. The CMS must approve the plans each year - plans are then subject to state oversight. The insurance companies must also re-train and certify their entire sales force in every state - every year - for each product line. Again, this must be done in every state.

Next are the marketing restrictions - must be approved by CMS and each state. There are also records management and disclosure requirements. In order to talk to a Medicare beneficiary, an insurance agent needs to file a "scope of appointment" form. Basically, it's a document that states the beneficiary requested the meeting and has agreed to discuss specific plans - nothing else can be discussed. This document must be kept on file for 10 years. Next are telephonic records management - calls are recorded and kept on file for 10 years. The greatest challenge to complete documents in a timely manner - some 24 hour and 48 hour restrictions. There are MANY other regulations - many subject to FBI inspection under HIPPA and MIPPA. (Almost forgot the annual agency meetings with HIPPA/MIPPA attorneys - more certifications.)
 
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  • #179
WhoWee... have you considered making something for the PF library, or a sticky based on this? You have a hell of a lot of facts on hand, and when we've taken all ideology out of the mix as you seem to naturally do with your business... it's very sound. I can't help but think you could write a guide to some of these entities that would inform future discussion.
 
  • #180
nismaratwork said:
WhoWee... have you considered making something for the PF library, or a sticky based on this? You have a hell of a lot of facts on hand, and when we've taken all ideology out of the mix as you seem to naturally do with your business... it's very sound. I can't help but think you could write a guide to some of these entities that would inform future discussion.

There is a lot of information to consider - a quick CMS link - a few downloads:

https://www.cms.gov/ManagedCareMarketing/03_FinalPartCMarketingGuidelines.asp

"Downloads
2012 Revised Draft Medicare Marketing Guidelines Memo, 1/06/2011 [pdf, 62Kb]

2012 Draft Medicare Marketing Guidelines [zip, 1Mb]

2011 Medicare Marketing Guidelines Memo, 6/04/2010 [pdf, 223 Kb]

2011 Medicare Marketing Guidelines [pdf, 1.5Mb]

Allowable Use of Medicare Beneficiary Information Obtained from CMS & Prohibition on Using Federal Funds for Non-Plan Related Activities [zip, 73Kb]

Clarification of MMG and Appeals Related Error in Annual Notice of Change/Evidence of Coverage Templates [pdf, 76Kb]

Clarification of Medicare Marketing Guidelines Requirements and Outbound Enrollment Verification Policy [pdf, 81kb] "
 
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