[kenberg]

 Winstonm, on 2013-May-09, 07:01, said:

Physicians are not required to accept Medicare. With the recent decrease in allowable charges for physicians, the number of choices for physicians who accept Medicare has again decreased.

Sure, I am aware of this. So far this has been a potential problem, not an actual problem. I have successfully exercised considerable choice, and I would very much not want to lose the option to make such choices. The fact that some doctors might refuse to take me as a patient for any of a variety of reasons, the most frequent being they already have all the patients they can handle, has not prevented me from exercising choice.

I believe that anyone who wishes to reform the system needs to take this preference for choice into account since I am pretty sure a large number of people share it. If potential reformers discount such issues as unimportant, they are apt to have very limited support for their plans.

[Vampyr]

 mike777, on 2013-May-09, 00:14, said:

the debate seems to be replace one insane method...today...over a even more insane method.


again this seems to be where everyone hates to agree on a method of failure. Where failure in the short run leads to something better in the long run.


given trial and error..in the short run ...people die...but in other run people die but people hide or accept it.

I mean see vamps comments where people think they are lucky, very lucky\ compared to the confusion in the usa, today.

This is slightly more coherent than usual; are you saying that NHS clients are not as lucky as they think they are?

Well, private insurance here is much cheaper than in the US, because it has to compete with the single payer. And very few take it up.

[neilkaz]

 Phil, on 2013-May-08, 08:30, said:

I go to my car mechanic because my water pump needs replacing. He's required to give me a written estimate before we agree he will repair my vehicle. If he needs to exceed that price (maybe when he got underneath he discovered a leaky gasket w/e), he has to call me for approval.

I go to a clinic because my foot gets lacerated on some broken glass. The physician or PA stitches it up. I give the front desk a co-payment. The clinic submits a bill to the insurance company. They agree to pay 'x'. I get a bill for the balance. I have no idea what this difference is when I enter the clinic, and its likely that different physicians would bill differently, and the insurance company would probably have different payment levels, depending on how the laceration is classified.

I hope 2014 is different.

It will be... you'll probably have to pay more says the cynic in me.

[billw55]

 Vampyr, on 2013-May-09, 17:59, said:

Well, private insurance here is much cheaper than in the US, because it has to compete with the single payer. And very few take it up.

This interests me. Does the government provide a rebate/tax reduction for people who obtain private insurance? Is there a noticeable difference in service quality between public and private coverage?

[PassedOut]

Every business person knows just by looking at the US healthcare numbers -- very high costs yielding comparatively poor results -- that a tremendous amount of waste exists in the system. One of the reasons that business people (excluding those who pig out on that waste) favor the ACA over the alternative of maintaining the old status quo is that the ACA starts to cut away at the disgusting waste.

Quote

The law includes virtually every big idea put forward to promote efficiency, such as rewarding doctors and hospitals for their quality — not quantity — of care. These policies are making a difference: Over the past three years, health-care costs have grown at their lowest level in 52 years.

Of course this is just a start, and even with the ACA the US healthcare system won't be as good as that in European countries. But we have taken the step from intolerable to merely bad. And, speaking personally, our businesses are already seeing the benefits in much smaller increases in insurance premiums.

[Vampyr]

 billw55, on 2013-May-10, 10:20, said:

This interests me. Does the government provide a rebate/tax reduction for people who obtain private insurance?

I can't imagine their doing that, but I don't know. I do know that some large companies provide it for their current and retired employees.

Quote

Is there a noticeable difference in service quality between public and private coverage?

I don't know this either; private insurance companies generally claim that you don't have to wait for elective surgery. In any case, the majority of private medical care is, I believe, performed by NHS doctors as a sideline, with leased NHS hospital rooms.

There are, of course, doctors in Harley Street and the like, who practise only privately. They are OK I am sure. And of course they are cheaper than their counterparts in the US because they have to compete.

EDIT: corrected gibberish when I was in a hurry and switched between two thoughts.

[barmar]

It's not clear that the reduction in the rate of increase of healthcare costs is totally, or even mainly, because of the ACA. The report I heard said that it could also be due to the recession: people are spending less on health care because they can't afford it.

[ArtK78]

 barmar, on 2013-May-10, 10:58, said:

It's not clear that the reduction in the rate of increase of healthcare costs is totally, or even mainly, because of the ACA. The report I heard said that it could also be due to the recession: people are spending less on health care because they can't afford it.

They can say what they want, but health care costs didn't go down in any prior recessions over the last 40 years.

[barmar]

 ArtK78, on 2013-May-10, 11:06, said:

They can say what they want, but health care costs didn't go down in any prior recessions over the last 40 years.

It's almost certainly a combination of the two, and more detailed analysis will be needed to unravel how much impact each had. Also, this has been the most severe downturn since the Great Depression, hasn't it? So its impact on health care spending is presumably greater.

Some industries are often referred to as "recession-proof" -- they're not discretionary spending. But nothing is really recession-proof. If you break your leg, you need to go to the hospital, but if you have a cold you can choose whether to the doctor or not, and you can certainly skip annual physicals.

Although it's probably the case that most of the big costs in health care are for procedures that are not discretionary. If you have a stay in the hospital that ends up costing tens or hundreds of thousands of dollars, it's probably not for something you could have chosen to live with.

[Winstonm]

From New York Times

Quote

Major new studies from researchers at Harvard University, the Henry J. Kaiser Family Foundation and elsewhere have concurred that at least some of the slowdown is unrelated to the recession, and might persist as the economy recovers

The Levin/Paul Ryan narrative appears to have been fiction.

[kenberg]

.Apparently it's tough to get a handle on it. From the Times article:

Quote

That led economists to surmise that other factors were at play. In new research, the Kaiser Family Foundation estimated that the recession accounted for about three-quarters of the lower spending trajectory, with the rest attributed to other factors not directly related to the economy. Professor Cutler of Harvard calculates that the recession accounted for about 37 percent.

75% and 33% are two very different numbers.


The following paragraph:

Quote

Among other factors, the studies found that rising out-of-pocket payments had played a major role in the decline. The proportion of workers with employer-sponsored health insurance enrolled in a plan that required a deductible climbed to about three-quarters in 2012 from about half in 2006, the Kaiser Family Foundation has found. Moreover, those deductibles — the amount a person needs to pay before insurance steps in to cover claims — have risen sharply. That exposes workers to a larger share of their own health costs, and generally forces them to spend less.

This shouts questions, at least to me. These workers are spending less on their health. Good if the deleted spending would have been for whimsey, bad if the deleted spending was for important care. Bad for the patient of course, but also quite possibly bad for the bottom line over a span of time. I hope they have some idea of which sort of spending is being deferred or cancelled.

A later paragraph:

Quote

In a new study in Health Affairs, Michael E. Chernew of the Harvard Medical School and his co-authors estimate that rising out-of-pocket payments, like deductibles and copays, account for about 20 percent of the decline in health spending.

If we take the Kaiseer estimate that the slowdown accounts for 75% and the Chernew estimate that rising co-pays account for about 20%, we are close to 100%. Close enough for government work, as the expression goes.

I often find news stories amusing. Here we have the Kaiser group estimating 75% and Professor Cutler saying 37%. Might the reporter have asked each of these sources how they explain the huge discrepancy in results? Do they each feel that the other estimate was based on shoddy work? Quite often, it turns out that people with radically different numerical results are using words in substantially different ways. "the recession accounted for" is not exactly free from ambiguity, intended or not.

I have mentioned before that I was listening to some radio discussion (on NPR, not Fox) where two guests were presumably referring to the same data, one describing it as having a 3% effect, the other as a 50% effect, and the host just calmly let them blabber on, never once raising the issue that seemed obvious to me: "Precisely what do you mean by 3% effect and 50% effect?". Either one of them was lying, or they were using words very differently (not alwasy quite the same as lying).

[barmar]

 kenberg, on 2013-May-11, 10:32, said:

75% and 33% are two very different numbers.

As Barbie once said: "Math is hard"

Or as Nate Silver has said more recently, economics is complicated.

[Winstonm]

 kenberg, on 2013-May-11, 10:32, said:

.Apparently it's tough to get a handle on it. From the Times article:




75% and 33% are two very different numbers.


The following paragraph:




This shouts questions, at least to me. These workers are spending less on their health. Good if the deleted spending would have been for whimsey, bad if the deleted spending was for important care. Bad for the patient of course, but also quite possibly bad for the bottom line over a span of time. I hope they have some idea of which sort of spending is being deferred or cancelled.

A later paragraph:





If we take the Kaiseer estimate that the slowdown accounts for 75% and the Chernew estimate that rising co-pays account for about 20%, we are close to 100%. Close enough for government work, as the expression goes.

I often find news stories amusing. Here we have the Kaiser group estimating 75% and Professor Cutler saying 37%. Might the reporter have asked each of these sources how they explain the huge discrepancy in results? Do they each feel that the other estimate was based on shoddy work? Quite often, it turns out that people with radically different numerical results are using words in substantially different ways. "the recession accounted for" is not exactly free from ambiguity, intended or not.

I have mentioned before that I was listening to some radio discussion (on NPR, not Fox) where two guests were presumably referring to the same data, one describing it as having a 3% effect, the other as a 50% effect, and the host just calmly let them blabber on, never once raising the issue that seemed obvious to me: "Precisely what do you mean by 3% effect and 50% effect?". Either one of them was lying, or they were using words very differently (not alwasy quite the same as lying).

The Rand/Levin position:

Quote

"The trillion-dollar deficits were shocking, dangerous; Obamacare didn’t do anything to limit the continuous rise of health-care costs. "

Both positions have been shown to be wrong. Debt-to-GDP is more important than actual debt, and the ACA is helping to lower health costs.

Of course, hardliners will hold onto the explanation that "it was the recession" in order to retain narrative anti-Obama belief systems. I understand that the recession was partly the cause - but only partly. The ACA helps.

[kenberg]

You are including the material I quoted from the NYT link you supplied but I am not following how it connects with what you say in response, if it is intended as a response.

[Winstonm]

 kenberg, on 2013-May-12, 14:13, said:

You are including the material I quoted from the NYT link you supplied but I am not following how it connects with what you say in response, if it is intended as a response.

Sorry, Ken, maybe I misunderstood. I took your dissection of the NYT article as a response so I wanted to point out the position I took was simply that the Ryan/Levin narrative has been shown to be wrong. Nothing more.

[kenberg]

 Winstonm, on 2013-May-12, 14:49, said:

Sorry, Ken, maybe I misunderstood. I took your dissection of the NYT article as a response so I wanted to point out the position I took was simply that the Ryan/Levin narrative has been shown to be wrong. Nothing more.

I was taking the article as a whole. What I got out of it was that the situation is unclear. If one guy says 75% and another says 37%, at least one of them is off by a bit. This is not necessarily either incompetence or misdirection, but I thought that the writer might have pointed out the wide discrepancy (I don't think that would be editorializing) and even asked some qualified person how this could happen.

As far as Ryan/Levin is concerned, they weren't mentioned were they? At least not prominently so that I saw it.

Anyway, to the extent that I got something out of the article it was not that Ryan was right about something or wrong about something but rather that the change in the pace of increase in healthcare cost is not well understood. There are competing claims and competing studies. I wish them well in this important topic but I did not see it at all as a conclusive study showing that this person or that person has been right or wrong. When economists disagree about what is behind an event I have no problem at all with an article presenting different ideas from different sources. That's the way I saw this article.

[Winstonm]

 kenberg, on 2013-May-12, 16:53, said:

I was taking the article as a whole. What I got out of it was that the situation is unclear. If one guy says 75% and another says 37%, at least one of them is off by a bit. This is not necessarily either incompetence or misdirection, but I thought that the writer might have pointed out the wide discrepancy (I don't think that would be editorializing) and even asked some qualified person how this could happen.

As far as Ryan/Levin is concerned, they weren't mentioned were they? At least not prominently so that I saw it.

Anyway, to the extent that I got something out of the article it was not that Ryan was right about something or wrong about something but rather that the change in the pace of increase in healthcare cost is not well understood. There are competing claims and competing studies. I wish them well in this important topic but I did not see it at all as a conclusive study showing that this person or that person has been right or wrong. When economists disagree about what is behind an event I have no problem at all with an article presenting different ideas from different sources. That's the way I saw this article.

The Ryan/Levin narrative is important because it can be traced directly to the gridlock that has ground Congress to a virtual halt, so quickly showing those beliefs to be wrongheaded is critical to moving past the stalemate into genuine compromise, instead of 49 ridiculous failed attempts to repeal the ACA.

[barmar]

 Winstonm, on 2013-May-13, 10:04, said:

The Ryan/Levin narrative is important because it can be traced directly to the gridlock that has ground Congress to a virtual halt, so quickly showing those beliefs to be wrongheaded is critical to moving past the stalemate into genuine compromise, instead of 49 ridiculous failed attempts to repeal the ACA.

Unfortunately, the gridlock is mostly based on partisan ideology, the facts are practically irrelevant.

The nice thing (for politicians) about economics is that it's so complicated that you can probably find a legitimate study that supports practically any policy.

[blackshoe]

It's not that economics is complicated, it's that economics is not well understood, even by economists.

[Winstonm]

 barmar, on 2013-May-13, 10:29, said:

Unfortunately, the gridlock is mostly based on partisan ideology, the facts are practically irrelevant.

The nice thing (for politicians) about economics is that it's so complicated that you can probably find a legitimate study that supports practically any policy.

Gridlock is based on a difference between reality-based conclusions contrasted with narrative-based conclusions, i.e., those who formulate their beliefs about reality based on interpreting data and those who think their beliefs equate to reality. The first type person has the ability to change his mind; the latter never sees a reason to alter his position.