2009/10/29
Maggie Mahar (Health Beat): (a) there is waste in the system, therefore (c) we need reform. Exercise for the reader: Identify the minor premise (b) that would turn this non sequitur into a real syllogism.
Urban Institute: Study estimates how bad things will get without health reform. Missing: How much worse it will be with reform.
Bruce Douglas (at KevinMD.com) “Money should not be mentioned, directly or indirectly, because health care, at any level, cannot be equated in dollars and cents.” CBO budget problem solved: just don’t mention the cash.
Jason Shafrin (Healthcare Economist) encourages Dr. Douglas to return to reality.
James C. Capretta and Thomas P. Miller (National Review): less intrusive solutions for pre-existing conditions.
On the Capretta/Miller idea, isn’t this more government interference with thte price system? Most of what I have been reading lately at this blog suggests that when premiums are not actuarially fair, people face perverse incentives. When they act on those incentives, all hell breaks loose.
What am I missing?
I agree with Ken. The solutions may be less intrusive, but they are still intrusive. Why do we need government to set insurance premiums?
If John Cochrane’s solution to the problem of insurance pricing (discussed at length at this blog) is the correct solution, the Capretta and Miller approch seems to be taking us in the wrong direction.
Mahar is an airhead.
Note to Dr. Douglas: when the local orthopod practice tries to rip me off by “prescribing” an ankle brace that I can buy at Walgreens and which I know doesn’t work because I already have one, and then has the temerity to say “don’t worry, your insurance will pay for it,” you’d better believe that we are going to have a discussion about health care dollars and cents.
I wonder if Matt Holt is as joyful seeing the protestors trying to disrupt Pelosi’s rally.
Jason Shafrin is right to suggest the fallacy of ignoring costs. If left unreformed, medical spending will literally erode our standard of living over time as we are forced to dedicate (through tax subsidies and wage reductions) increasing proportions of our income to pay for health for ourselves (or other people). For the sake of argument, what happens a century from now when, say, 80% of each individual’s lifetime earning are going towards health care? Will Bruce Douglas agree that might be an appropriate time to discuss costs?
Somebody should point out to Dr. Douglas that in health care areas where money is more of an issue (where insurance and government isn’t involved) prices haven’t been increasing and quality has been.
This is just the opposite in the areas that government is involved (making money less of an issue).
Dr. Douglas may have just found the cure for cancer!
Just don’t mention cancer. The problem will go away.
How about the fact that when premiums ARE actuarially fair, there are also perverse incentives?
That’s the problem with this whole debate. Everybody seems to approach it like a trial lawyer, only acknowledging points that bolster his or her own position.
I don’t buy all of the Capretta and Miller
suggestions, but I like their analysis.
I must have ate some bad fruit for breakfast this morning, because I find myself partially disagreeing with Capretta & Miller, which has never happened before (and I hope will never happen again). C&M want to tighten up HIPAA & COBRA, such that the continuous creditable coverage provision that precludes underwriting for pre-existing conditions when a former employee leaves his job should be extended directly to the individual market without exhausting the group coverage that COBRA offers. But the real problem with COBRA is that it gives the former employee two months to elect COBRA (perhaps longer if the employer, broker, and carrier execute their responsibilities to notify at the end of their mandated periods). This creates adverse selection which C&M’s proposal does not solve. Maybe if the law demanded that the former employee elected continuation coverage on the same day he left work (and handed over a check), you could get away with outlawing underwriting pre-existing conditions but that is simply not realistic in the case of a lay-off.
Why wouldn’t it be much better to have personal and portable insurance long the lines suggested in the NCPA’s book on state health care reform?
I agree with Tom. The Capretta/Miller proposal may not be Obama lite, but it is definitely liberal lite.
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