tag:blogger.com,1999:blog-582368152716771238.post2140686178032605879..comments2024-03-28T09:32:23.535-05:00Comments on The Grumpy Economist: Healthcare repair on "The Hill"John H. Cochranehttp://www.blogger.com/profile/04842601651429471525noreply@blogger.comBlogger35125tag:blogger.com,1999:blog-582368152716771238.post-42077300234338486072019-01-13T13:14:08.285-06:002019-01-13T13:14:08.285-06:00www.uritpitstop.com
Under a system where "P...<a href="https://www.uritpitstop.com" rel="nofollow">www.uritpitstop.com</a><br /><br />Under a system where "People pay for most regular care the same way they pay for cars, homes, and TVs" many people may choose to forgo care unless they feel they need it urgently at that moment. On the face of it this sounds good for controlling costs by nudging people to avoid unnecessary care. However, I'm curious what your view is on the role of routine, non-essential medical care in catching conditions early and possibly avoiding bigger costs down the road. Is it possible that forcing people to pay more out of pocket for routine care could actually drive up total costs by leading to more chronic conditions over time?Anonymoushttps://www.blogger.com/profile/03214628793093916037noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-11623695502161595842017-04-01T16:39:47.304-05:002017-04-01T16:39:47.304-05:00Perhaps instead of a snarky answer about free glid...Perhaps instead of a snarky answer about free gliders, John Cochrane could have actually responded to the questions raised. The entire developed and most of the developing world has shown that indeed you can get good quality government supplied healthcare. There is a reason some of my professional coworkers returned to Europe when they were ready to have children to get better healthcare. <br /><br />As a non-ideologue, the differences between shopping for a good option for Lasik or a car and for a hospital while sick from cancer or impaired by mental illness or senility are pretty self-apparent. How is a "health consumer" supposed to choose among treatment options and hospitals? Nor do I see any ideas from you, a supposed expert, on how a health plan following your ideals would be constructed. All "plans" are perfect in concept and powerpoint but unlike you, my beliefs about the market are not faith-based.<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-39802509529583722482017-03-09T07:59:23.346-06:002017-03-09T07:59:23.346-06:00""Young healthy people might choose bare...""Young healthy people might choose bare-bones catastrophic coverage, but the right to step up to a more generous plan later. Nobody’s premiums subsidize others, so such insurance is cheap""<br /><br />Who subsidizes the right to step up ? The insurer surely has to pin a price tag on that right.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-77595419571227716642017-02-23T09:45:28.228-06:002017-02-23T09:45:28.228-06:00I do not at all get the attraction to this system....I do not at all get the attraction to this system. It sounds bizarrely overcomplicated. I would rather have crappier but simpler health care. Cochran's plan sounds like something out of a bad scifi novel, not a real plan for the real world.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-34520077523536821932017-02-17T10:07:30.159-06:002017-02-17T10:07:30.159-06:00I think the answer (to Abiel at 8:52pm) is Yes.
Lo...I think the answer (to Abiel at 8:52pm) is Yes.<br />Look at Kaiser Permanente. This is a business, albeit a not-for-profit, but operating under business rules all the same. They don't have to reward owner capital but they do have to pay for borrowed capital, offer a competitive price, and all the other business constraints. So they have to minimise cost so that they can prosper in a price competitive market. Kaiser (presumably as a cost optimisation) encourages people to come in for routine checkups, immunisations, fixing stuff on a weekend that could wait till Monday but is better fixed now, and so on. This is all stuff that people would defer, or ignore, until more expensive in a pay-for-everything system. Especially so in a system (one comparable to auto insurance) where the patient pays up front the first $n of every visit.<br />Arguably the outcomes are also substantially worse in a system were people are encouraged to defer medical attention. Unless, of course, you are amongst those who consider untimely death an economic good on account of reduced retirement payouts.<br />And few people, hypochondriacs aside, bother to get medical attention unless it hurts more than aspirin can deal with. So unnecessary care is limited to expensive interventions in conditions where the medical provider benefits financially from the transaction.<br />--E5Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-62970142301221619702017-02-16T20:52:41.182-06:002017-02-16T20:52:41.182-06:00Under a system where "People pay for most reg...Under a system where "People pay for most regular care the same way they pay for cars, homes, and TVs" many people may choose to forgo care unless they feel they need it urgently at that moment. On the face of it this sounds good for controlling costs by nudging people to avoid unnecessary care. However, I'm curious what your view is on the role of routine, non-essential medical care in catching conditions early and possibly avoiding bigger costs down the road. Is it possible that forcing people to pay more out of pocket for routine care could actually drive up total costs by leading to more chronic conditions over time? Abielhttps://www.blogger.com/profile/16275921931834929356noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-43271930471279804612017-02-15T13:56:25.209-06:002017-02-15T13:56:25.209-06:00What's your opinion about Maryland's "...What's your opinion about Maryland's "All Payer" pricing to avoid the fake prices you mentioned in your anecdote about going to the doctor recently?Kevinhttps://www.blogger.com/profile/00130907653267184039noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-13390188755299231362017-02-15T13:45:41.850-06:002017-02-15T13:45:41.850-06:00I'm pretty liberal and very against repealing ...I'm pretty liberal and very against repealing the ACA without a better plan, but I agree with a lot of this. Especially "Health insurance then follows people from job to job, state to state, in and out of marriage, just like car, home and life insurance, and 401(k) savings."<br /><br />One often overlooked problem is that your company makes a decision on how much insurance to buy for all employees. This is often framed from the perspective of how expensive it is, but I personally have always wanted better healthcare than my employer provides. I would pay more for it. When I have a choice I pick the most expensive plan. We have a situation now where I'm basically beholden to the whims of my company's decision on benefits.Kevinhttps://www.blogger.com/profile/00130907653267184039noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-61481737194509918632017-02-14T21:36:19.892-06:002017-02-14T21:36:19.892-06:00Disclaimer: I am a retired physician. I have no “s...Disclaimer: I am a retired physician. I have no “skin in the game” except as a consumer. I do offer some observations about medicine.<br /><br />First, there is no amount of medical care offered to a group of individuals that will satiate the desire for more of it (as far as I can tell this occurs in no other aspect of life except amassing money).<br /><br />The second observation follows from my first. Namely, there are only four ways to control cost in the medical care:<br /> <br />1) Make the patient responsible for rationing their own medical care based on cost.<br /><br />2) Make the “government” responsible for rationing medical care based on arbitrary criteria.<br /><br />3) Make the system so slow and onerous to obtain care (long waiting times) that patients ration their own care based on frustration.<br /><br />4) A combination of the previous three previous rationing methods.<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-16328454530097882252017-02-14T12:56:17.989-06:002017-02-14T12:56:17.989-06:00"As a conservative, if they fail to pass anyt..."As a conservative, if they fail to pass anything, I will be pleased."<br /><br />The ACA does not repeal itself so if they do nothing the ACA continues.<br /><br />As someone who believes the public has a right to make informed choices I think that it is important that politicians tell the truth. I think it is important to the proper functioning of the American democracy that the Republicans put forward this alternative plan they have been promising or give a candid explanation for why, after making promises for six years, they can't.Absalonhttps://www.blogger.com/profile/09131268683451462949noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-46474124883501597452017-02-14T01:10:11.007-06:002017-02-14T01:10:11.007-06:00Don't trust your reaction to such rhetoric. I...Don't trust your reaction to such rhetoric. It is designed to invoke such reactions that are, probably, counter to your well being.<br />A well designed system has basic no-fee service that can be supplemented by extra money either out of pocket or from insurance.<br />So the government has monopoly only on the no-fee part of it.<br />--E5Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-23959781441037349112017-02-14T00:36:39.646-06:002017-02-14T00:36:39.646-06:00"Be careful"
Yes, with a little care we ..."Be careful"<br />Yes, with a little care we could have the kind of system that exists in most of the "developed" world. "Single payer", "national health", whatever the name for basic medical services provided to whoever needs them. Plus insurance, or self-pay, for extra services.<br />--E5Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-21642247254467431932017-02-13T16:04:38.630-06:002017-02-13T16:04:38.630-06:00Be careful, I think you quite logically walked yo...Be careful, I think you quite logically walked your way into single payer. Anonymoushttps://www.blogger.com/profile/04223579458055662262noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-20948875038031086572017-02-13T11:53:07.168-06:002017-02-13T11:53:07.168-06:00I'm not sure I understand the argument. It is ...I'm not sure I understand the argument. It is true that there is no empirical evidence offered in the post. This is obvious.<br /><br />Are you saying we should not consider alternative solutions without evidence? There are economic foundations that suggest his ideas could work. Conversely, can somebody please provide evidence that the current system will lead to more affordable healthcare? I am appalled by the system's track record, and there must existing evidence that things will get better? Right?<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-83959600838934074382017-02-13T11:21:21.971-06:002017-02-13T11:21:21.971-06:00Ultimately the question is should health care be s...Ultimately the question is should health care be seen as a community service like police, fire brigade etc or something that belongs in the market domain. My view is that this is mostly just a matter of taste. There are good arguments that can be made either way. A good amount of health care really can be said to be just something to be purchased - e.g. a dental clean-up. But a good amount wouldn't fall into that category e.g. stuff that impairs a person's physical or psychological functioning. When the latter happens, we, as human beings, do not feel comfortable leaving our fellow human in distress. In other words, we gain some "feel-good" utility in paying some money to help that person if he/she cannot do it by themselves. I think the question in the end is, how much money we want to pay i.e. how much is it worth to society - in terms of the pleasure of helping out. It seems then the solution should be a a two-level system. (1) Health -care services that you just have to pay for out of pocket and (2) Services that are entirely paid for through taxes. Now which services fall into (1) and which in (2) should just be a matter of the legislative process that will account for changing tastes over time. There is really no need for "health insurance" at all! Rahul Malhotrahttp://www.allianzgi.comnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-88167167924264440112017-02-13T10:10:29.522-06:002017-02-13T10:10:29.522-06:00I usually agree with you, but you are skating by a...I usually agree with you, but you are skating by a very difficult problem with respect to pre-existing conditions. You say Price's plan is tied to "continuous coverage." Well, that's not much protection, is it? What happens to the person who loses their job and must choose between feeding and housing their family, and paying their now-higher health insurance premium (since they lose the employer contribution), and who chooses the former? It sounds like they are out of luck -- permanently. What happens to the person who is chronically ill and cannot work, and has difficulty making their payments? Unknownhttps://www.blogger.com/profile/03694117881871527518noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-15077830515594175462017-02-13T09:42:04.388-06:002017-02-13T09:42:04.388-06:00But what about Moral Hazard? You promote a health ...But what about Moral Hazard? You promote a health insurance that doesn't rely on subsidies, with an individual choice for how much coverage to get. But you also say nobody dies in the streets, i.e. people with bad luck will be helped out somehow. This means people will get too little insurance, knowing that if something bad happens to them, the government will help!Lukas Altermatthttps://www.blogger.com/profile/05617632612189094442noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-56359888783733608122017-02-13T07:09:11.129-06:002017-02-13T07:09:11.129-06:00https://www.aei.org/publication/american-medical-a...https://www.aei.org/publication/american-medical-association-the-strongest-trade-union-in-the-u-s-a/Robhttps://www.blogger.com/profile/06139931386286494460noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-21910543047238224752017-02-13T07:06:54.061-06:002017-02-13T07:06:54.061-06:00If we are to fix costs won't supply-side compe...If we are to fix costs won't supply-side competition have to be restored? To do this, the power that the AMA has to restrict competition would have to be reformed. It is not a question of having enough people who are able and talented enough to increase the percentages of physicians it is a question of letting an association control those percentages to protect the economic interest of their members. Should it take months to see a specialists because there are so few within a certain area? If had prospect lined up for months to see me how customer-friendly would I really have to be? If someone has an appointment at 1 PM and I don't see them until 2 PM do I have to worry about my business being hurt? No not until someone across town is scheduling patients in a week, seeing them on time for less money will my behavior change but that won't happen when an association is controlling how many physicians per X are available. Robhttps://www.blogger.com/profile/06139931386286494460noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-76724003353139087652017-02-12T19:25:51.104-06:002017-02-12T19:25:51.104-06:00Isn't part of the problem that the ACA (withou...Isn't part of the problem that the ACA (without Medicaid and the taxes) is in fact, always was and will be the orthodox republican plan?Anonymoushttps://www.blogger.com/profile/04223579458055662262noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-84259514060527511782017-02-12T15:25:42.827-06:002017-02-12T15:25:42.827-06:00As a conservative, if they fail to pass anything, ...As a conservative, if they fail to pass anything, I will be pleased.<br /><br />Same could be said for tax policy, banking regulation, etc.FRestlyhttps://www.blogger.com/profile/09440916887619001941noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-71899316532726814212017-02-12T14:56:21.053-06:002017-02-12T14:56:21.053-06:00Cochrane bemoans the patchwork nature of healthcar...Cochrane bemoans the patchwork nature of healthcare. "Patch, patch", he laments. <br /><br />But is a centrally planned reboot of healthcare really the solution to patchwork? Say goodbye to the benefit of decentralized decision-making. (The irony!)<br /><br />Patchwork systems readily develop in the private sector, as well. You can blame decentralized decision-making for this. (More irony!) <br /><br />Instead of rebooting their complex products, companies patch them, and then work very hard to produce for their customers the illusion of an unpatched simplicity. (You wouldn't know this unless you've worked in the private sector.)<br /><br />The point: complexity is a fact of life in all sectors. Bashing the government for generating excessive complexity is misguided.<br /><br />JZhttps://www.blogger.com/profile/12994372644670111315noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-31484583668133464472017-02-12T13:51:10.993-06:002017-02-12T13:51:10.993-06:00Thomas Sowell suggested when I see "single pa...Thomas Sowell suggested when I see "single payer" I should think "government monopoly." I think some "people" would not welcome single payer under that prospect.Kurthttps://www.blogger.com/profile/03603066844040463486noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-35892649193473732712017-02-12T10:35:41.701-06:002017-02-12T10:35:41.701-06:00and, besides, we all benefit when somebody else is...and, besides, we all benefit when somebody else is healthy, suffer when they are sick, especially if the sick propagates to us.<br />--E5Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-72920818063150664882017-02-12T10:33:16.931-06:002017-02-12T10:33:16.931-06:00The Republican Party has been promising a better, ...The Republican Party has been promising a better, cheaper alternative to the Affordable Care Act for six to eight years.<br /><br />It really is long past time for them to roll out their detailed proposal. We should not be having such first principles discussions. Absalonhttps://www.blogger.com/profile/09131268683451462949noreply@blogger.com