tag:blogger.com,1999:blog-582368152716771238.post1819262747129000505..comments2024-03-28T11:50:52.581-05:00Comments on The Grumpy Economist: Single payer sympathy?John H. Cochranehttp://www.blogger.com/profile/04842601651429471525noreply@blogger.comBlogger47125tag:blogger.com,1999:blog-582368152716771238.post-10859859923938255172021-02-15T23:44:42.001-06:002021-02-15T23:44:42.001-06:00Hi Professor Cochrane,
I have a question to you o...Hi Professor Cochrane,<br /><br />I have a question to you or others, but I doubt anyone will read this since it is so late. Still a last ditch effort: how would you come up with the price for the full voucher or partial voucher? This is currently the issue. If you come up short with a partial voucher eventually enough hospitals aren't paid and they go back to cross subsidies using those with means to pay the premium. If not partial voucher then how will you determine the "full voucher"? Some CMS style committee to decide what "full cost" would be? If so that's open to either abuse (e.g., I charge anyone with govt voucher higher than others purely because I see no limit) or to capping which again leads to eventual cross subsidies. So, if anyone can elaborate on what I'm missing to explain this to me that would be great.Armchair Polymathhttps://www.blogger.com/profile/08823537855417208595noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-35687263974953746552018-08-08T18:44:01.141-05:002018-08-08T18:44:01.141-05:00Most people don't realise it, but Australia...Most people don't realise it, but Australia's constitution contains a clause barring the civil conscription of docotors, which means no price setting of doctors fees. Even though I lean left, I have to thank the right-wingers for causing that clause to be inserted, because I think that it saved us a lot of grief.<br /><br />As price setting was off the table, Australia decided to set up a system of public hospitals completely paid for by tax payer money. I believe that needing to compete against pubic hospitals that essentially charged no fee at point of delivery forced private hospitals to be more conscious of their prices than their US counterparts. Deliberately inflating the price or refusing to tell potential customers the cost is a terrible strategy when they can go elsewhere!<br /><br />As for our universal public health insurance program Medicare, that operates like a voucher system. The government will pay the first $X and it is up to patients and their insurers to cover the rest. Private health insurance generally operates in the same way, acting as a voucher rather than a price setter. Thus, doctors and hospitals CAN charge whatever they want (avoiding the problem of price setting), but they very much risk losing customers if they take it too far. It also means that the government can lowball medical payments, knowing that providers can simply increase their fees should it be necessary.<br /><br />Interestingly enough, Australia's constitution does not ban price setting of medical devices (they are not doctors) and when we tried using that policy to protect patients, it backfired horribly. Insurers were forced by law to pay out FIVE times the cost of devices as public hospitals, as the price they set did not account for the fall in device costs! (I do wonder, has the US seen that type of fall as well?)<br /><br />I sometimes wonder whether Australia is actually more free market than the US. Sure we have a lot of government involvement in healthcare, but that intervention serves to give us power over the industry because it gives us the ability to say 'no.' Ultimately, isn't that what the free market is about - sellers are forced to act in the best interests of consumers or risk losing business?Anonymoushttps://www.blogger.com/profile/00743751597232663488noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-67899611281179956552018-08-08T08:19:00.994-05:002018-08-08T08:19:00.994-05:00Do you all consider it a problem that healthcare i...Do you all consider it a problem that healthcare is mostly regulated at the state level even while half of it is paid for at the federal level? So if a state politician is looking at a regulation that looks like it would slightly increase safety but at a fairly high cost he is more prone to go for it than if half the cost was not covered by the Federal Government.JWOhttps://www.blogger.com/profile/00004178958481335795noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-20527281088357581742018-08-08T06:39:19.562-05:002018-08-08T06:39:19.562-05:00I have been promoting a 'Medicare for Anyone&#...I have been promoting a 'Medicare for Anyone' program for several years, much in line with what Prof Cochrane is describing.<br /><br />In this program, which absolutely must be federal to avoid red state sabotage, Medicare is opened up to anyone. The premium is set at an amount which is widely affordable, like $250 a month, and the government covers the rest of the cost.<br /><br />Medicare for seniors currently costs about $12,000 per person per year. ($1,000 per month)<br />Medicare for anyone under 65 will of course cost less. How much less is an <br />actuarial challenge but solvable.<br /><br /><br />The political challenge is to collect the new taxes. If 20 million people sign up for new Medicare, and the real cost is $600 per month, then the subsidy is $350 a month ($4200 a year.) The total federal cost for 20 million persons is then $84 billion a year.<br /><br />That is about 1% of payroll if we chose to tax it that way. I could accept that.<br /><br />However, we have a Congress that goes to the mat over $8 billion in CSR payments or SCHIP programs. I don't know what mat they would go to over $84 billion.<br /><br /><br />bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-91408228886291962442018-08-06T10:23:23.348-05:002018-08-06T10:23:23.348-05:00Dear Absalon, I am afraid to bring bad news for yo...Dear Absalon, I am afraid to bring bad news for you: There is absolutely no better medical service than the one provided in the US. Look at cancer survivorship rates, prevention, etc. This type of claim is just terrible leftist propaganda that, as always, do not stand a chance with the facts.<br /><br />What you are saying is that people die later in other countries. This has very little to do with the quality of medical services and a lot more with violent deaths, bad eating habits, and etc.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-84114954870355107452018-08-05T22:59:33.705-05:002018-08-05T22:59:33.705-05:00Professor: You continue to exhibit a misunderstan...Professor: You continue to exhibit a misunderstanding regarding the lack of limitations that a sovereign has in issuing currency. Money of course does grow on trees, or at least can be key-stroked into existence. The limitation is the productive capacity of the economy (full employment as we discussed). When we run out of sharpie kids who can be trained to become doctors, nurses, PAs, and bed/equipment assemblers or drug manufacturers, that's when we can worry about say too much money growing on trees and say potential inflation. <br /><br />Until then, finding the money to provide additional care is not an issue. Moreover, all we are talking about is incremental medical care since whatever care the govrmnt provides may well represent a reduction of care already provided by private sector. DoDealshttps://www.blogger.com/profile/03771077157351067426noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-2696592844614681882018-08-05T13:15:31.266-05:002018-08-05T13:15:31.266-05:00but you and I are forbidden to escape it, to have ...but you and I are forbidden to escape it, to have private doctors, private hospitals, or private insurance outside the scheme. <br /><br />The above statement certainly supports your libertarian world view, except that it is not true. The single-payer design in, e.g., California's many proposals (two of which were vetoed by Schwarzeneggar) allowed any provider to opt out of the system (they had to opt out completely), and only disallowed private insurance for what was covered under the plan (private insurance to upgrade your hospital accommodations, e.g., was fine). That said, yes, everyone has to pay into the kitty, you could not opt out of that, for obvious reasons. But you have hit on the heart of the matter, the larger the risk pool, the lower the costs. The ideal, of course, is a single risk pool that includes everyone, as any actuarial scientist will tell you.Bartohttps://www.blogger.com/profile/04247173667969535809noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-71848050195427411032018-08-04T06:56:06.140-05:002018-08-04T06:56:06.140-05:00I recently heard that some docs prefer Medicare to...I recently heard that some docs prefer Medicare to avoid the insurance maze of questions and wasted time and expense.<br />HR676 savings would allow higher reimbursements without deductibles and copays.orgdevprohttps://www.blogger.com/profile/10803711163418506700noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-1303404344506221622018-08-04T03:55:55.899-05:002018-08-04T03:55:55.899-05:00Under a single payer that everyone must use you ar...Under a single payer that everyone must use you are forbidden to have private doctors and private hospitals? But look at the traditional Medicare program. Patients have free choice of their physicians and hospitals. They also can elect to enroll in the private Medicare Advantage (MA) plans, but then they lose their their health care choices by being restricted to provider networks. Not only that, but "MA insurer revenues are 30 percent higher than their healthcare spending," demonstrating the surplus that the private insurers are receiving from the taxpayers (NBER No. 23090) - a cross subsidy of sorts, but benefiting the insurer rather than the patients.<br /><br />Of course, single payer advocates also support tax and spend, but we want our tax funds to be used wisely. Providing excess public funding to private insurers while they take away health care choices from patients is not a wise use of our tax dollars. It would be far better to improve the traditional Medicare program and cover everyone with it, and then let the health care delivery system compete on the basis of service, access, and quality.Don McCannenoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-70271978382208289962018-08-03T18:33:13.859-05:002018-08-03T18:33:13.859-05:00I thought Medicaid reimbursement were low which is...I thought Medicaid reimbursement were low which is why so many doctors refuse it<br />MICHAEL CHOEhttp://twitter.com/MBCHOEnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-19994580817444626862018-08-03T18:30:51.817-05:002018-08-03T18:30:51.817-05:00What if the optional single payer option was simpl...What if the optional single payer option was simple catastrophic coverage (high deductible, low premium)? And would it be administered by the federal or state or county governments?<br />MICHAEL CHOEhttp://twitter.com/MBCHOEnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-1209234502126024512018-08-02T12:39:41.379-05:002018-08-02T12:39:41.379-05:00Well, duh, federal budget commitments are going to...Well, duh, federal budget commitments are going to go up if M4A is implemented. The savings (supposed or real, I dunno) come from not having to spend money on other forms of health insurance. Adam Bowershttps://www.blogger.com/profile/01606529305410286742noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-70571550613032822812018-08-01T13:42:54.052-05:002018-08-01T13:42:54.052-05:00Follow-up comment:
What type of medical services a...Follow-up comment:<br />What type of medical services are patients paying for cash? <br /><br />Typically:<br />-Short general practitioner visits, such as annual checkups, getting a few prescriptions, and specialist referrals. Usually a hundred dollars a visit or so.<br />-Medical imaging. A few hundred dollars; depends on the type of imagine (MRI, CT, ...).<br />-Minor surgeries. Usually a few thousand dollars.<br />-Eye surgery--mostly cataracts--used to be a popular in the private sector. Not as much anymore as the public sector experience has improved.<br />-Orthopedic surgery. ACL, shoulder, knee replacements, hip replacements, etc. $5k-$20k, typically.<br /><br />As for the more expensive stuff--such as (n)ICU, heart/chest surgery, cancer--it's basically all done in the public sector. LK Bélandhttps://www.blogger.com/profile/10345099680900371024noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-92025775818013733602018-08-01T09:23:49.079-05:002018-08-01T09:23:49.079-05:00"Not only is there some sort of single easy t..."Not only is there some sort of single easy to access health care and insurance scheme for poor or unfortunate people, but you and I are forbidden to escape it, to have private doctors, private hospitals, or private insurance outside the scheme. Doctors are forbidden to have private cash paying customers. That truly is a nightmare."<br /><br />Without going into the merits and issues of the Canadian system, it does permit a private option. Essentially, the physician has to choose to accept Medicare or not:<br /> -If so, the physician cannot accept private payments.<br /> -If not, the physician can accept cash payments.<br />About 2-3% of physicians in Québec choose cash payments.LK Bélandhttps://www.blogger.com/profile/10345099680900371024noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-59103167327397166372018-07-31T17:20:07.897-05:002018-07-31T17:20:07.897-05:00Manfred - for the record: the CAT scan technique w...Manfred - for the record: the CAT scan technique was invented by a South African physicist who started his work in South Africa and continued it at an American University. His theoretical work was then used by an electrical engineer at EMI in England to build the first working CT machine. <br /><br />For the rest of your post we will have to agree to disagree. Absalonhttps://www.blogger.com/profile/09131268683451462949noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-70507554795458786872018-07-31T13:38:28.064-05:002018-07-31T13:38:28.064-05:00This is the paper that Bernie loved, from the Merc...This is the paper that Bernie loved, from the Mercatus Center at George Mason University:<br /><br />https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf<br /><br />Abstract:<br />"The leading current bill to establish single-payer health insurance, the Medicare for All Act (M4A),would, under conservative estimates, increase federal budget commitments by approximately $32.6 trillion during its first 10 years of full implementation (2022–2031), assuming enactment in 2018. This projected increase in federal healthcare commitments would equal approximately 10.7 percent of GDP in 2022, rising to nearly 12.7 percent of GDP in 2031 and further thereafter. Doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan. It is likely that the actual cost of M4A would be substantially greater than these estimates, which assume significant administrative and drug cost savings under the plan, and also assume that healthcare providers operating under M4A will be reimbursed at rates more than 40 percent lower than those currently paid by private health insurance."<br /><br />Not sure this is a ringing endorsement of "Medicare for All".Manfred the mamoothhttps://www.blogger.com/profile/07516724901598949627noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-29503960218887659522018-07-31T12:07:44.822-05:002018-07-31T12:07:44.822-05:00Absalon,
Yes, the CAT Scan maker got paid, by the ...Absalon,<br />Yes, the CAT Scan maker got paid, by the Canadians, and yes, they did accept that price. Sometimes companies sell to have a market presence, but not because they make money. Medical device and pharma make their money in the US, what they sell to Canadians and Europeans and Australians is icing on the cake. The R&D that led to the CAT Scan they used on you was funded by American money, not Canadian money. If the world goes by what the Canadian health care system (and the British, and the French, and the Australian, etc) paid, there would not NO medical or pharma research (or at the most, very little)<br />And this is what many people don't get. <br />They think that developing all those devices and drugs is free, like the Canadian Health System or the British NHS. <br />R&D would be killed off, and thus, the socialization of health care would be paid by future generations, with less R&D available to them.<br />But... who cares about future generations anyway?<br />No, R&D is not free, it costs a *huge* boatload of money, but for Canadians and the British and the French it is easier to free ride on the Americans.<br /><br />As for health outcomes, it may certainly be true that outcomes are worse. That can be because of many factors - socioeconomic factors play a big role.<br />But there is a reason why there are many Canadians coming to the US for treatment (and British and others). If the Canadian system is so great and such a paradise, why are they coming to the US? Answer: because in the US they get timely, fast, high tech treatment, something the Canadian system cannot provide to many Canadians.Manfred the mamoothhttps://www.blogger.com/profile/07516724901598949627noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-36742374780849154692018-07-31T11:06:53.906-05:002018-07-31T11:06:53.906-05:00Manfred
The United States is paying more than any...Manfred<br /><br />The United States is paying more than anyone else for healthcare for worse outcomes:<br /><br />https://seekingalpha.com/news/3376018-u-s-healthcare-spending-nearing-20-percent-gdp<br /><br />quoting a Wall Street Journal article.Absalonhttps://www.blogger.com/profile/09131268683451462949noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-61868813365719902702018-07-31T10:44:22.846-05:002018-07-31T10:44:22.846-05:00Manfred, I am well aware that I pay taxes.
The Am...Manfred, I am well aware that I pay taxes.<br /><br />The American companies that provided the CAT scan machine was paid. All the other medical device makers were paid. If they did not like the prices they should not have sold the machine. <br /><br />On pharmaceuticals, patents are respected in accordance with Canadian laws. Canadian government agencies do bargain for bulk pricing and can use legislative powers to pressure pharmaceutical companies so we get lower prices for drugs. For example, the price of an Epi-Pen in the United States has gone up by a factor of three over the last ten years but not in Canada where they are 1/3 the price of the United States. Absalonhttps://www.blogger.com/profile/09131268683451462949noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-77789597100580805002018-07-31T08:35:08.042-05:002018-07-31T08:35:08.042-05:00Wrong Absalon.
It did not cost you $0.0.
Your out ...Wrong Absalon.<br />It did not cost you $0.0.<br />Your out of pocket may have been zero, but it cost you and many other Canadians taxes.<br />And one thing about the Canadian system: it is a big free rider on the inventions of others, mainly the American medical and pharma industry. Canada does not invent anything, does not produce any significant output in medical devices and pharmaceutical drugs (and neither do many other countries). Canada free rides on America to do all this (and on Americans to pay for all this).<br />All that equipment for those surgeries you had? They were probably invented and/or produced in the US.<br />So no Abasalon. Stuff is not free. Somebody somewhere pays of free stuff.Manfred the mamoothhttps://www.blogger.com/profile/07516724901598949627noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-88327061993841011402018-07-31T08:07:18.754-05:002018-07-31T08:07:18.754-05:00No cross subsidies means no community rating, righ...No cross subsidies means no community rating, right? In that case, the public option is going to pick up everyone with a significant pre-existing condition, on top of the healthy poor who can't afford anything. Your ideal free-market health care system will exclusively serve people who don't need much health care. I have to admit, for providing health care to people who don't need it, there's no better system than the free market!Anonymoushttps://www.blogger.com/profile/09950034871913315404noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-6518524309745439462018-07-31T07:57:48.615-05:002018-07-31T07:57:48.615-05:00In the clearest sign of an about-face at the liber...In the clearest sign of an about-face at the libertarian-leaning Koch network, the billionaires funded a study that found that a Medicare-for-all plan by Sen. Bernie Sanders of Vermont would save the US $2 trillion over a decade . Sanders thanked the Koch network by name .<br /><br />---30---<br /><br />Wel, I guess anything can happen. Benjamin Colehttps://www.blogger.com/profile/14001038338873263877noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-39584470326665753802018-07-31T05:36:52.535-05:002018-07-31T05:36:52.535-05:00"A single bureaucracy that ... pays partially..."A single bureaucracy that ... pays partially but allows doctors to charge whatever they want on top of that" is pretty much exactly the NZ system. You also have the option of not signing up for it if, for some reason, you don't want the partial payment. Best of all, there are no forms to fill out. You can also take out private insurance that'll cover the costs of what's not covered by the government. That does require some form-filling (for minor expenses), but only once every 6-12 months. <br /><br />There are still some fish hooks though, e.g., GPs act as gatekeepers to most (private) specialists. And there doesn't, as far as I can tell, seem to be a huge amount of price competition (might be different in a bigger economy though). Cokerhttps://www.blogger.com/profile/02631288439451432057noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-530649422256623012018-07-30T23:38:28.578-05:002018-07-30T23:38:28.578-05:00Exactly, what people dont understand is that healt...Exactly, what people dont understand is that health care in some european countries is more efficient than in the us not because of the public system, but because of a quite competitive market that goes along with it. In fact, people use the public system for very expensive treatment or dangerous diseases, but given long waiting time for less expensive and less dangerous treatment they opt for the private sector in this case. This amounts to public insurance only for mortal or expensive diseases, and market for the rest. LMhttps://www.blogger.com/profile/04209992315578358377noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-33517287106125279192018-07-30T22:14:46.133-05:002018-07-30T22:14:46.133-05:00Here is how you implement a single payer health ca...Here is how you implement a single payer health care system: Extend Medicare to everyone. Medicare eligibility age? Zero! Get rid of Medicare taxes altogether. Instead fund Medicare from general revenue, i.e. taxes. This way the Republicans will not be able to challenge Medicare expansion in the courts. Lower deductibles to zero so people would not be discouraged to seek medical help (waiting too long will increase the cost of care). So when you get sick, all you will need is your Social Security #. Of course, taxes will go up, but you won't have to worry about medical insurance premiums. If you like private insurance, great! If you don't use Medicare, more money will go to others. Since Medicare is a successful program and works well for people 65 or older, it is guaranteed to work for younger than 65, because they are less likely to get sick. rafalhttps://www.blogger.com/profile/03627684458558457142noreply@blogger.com