dagblog - Comments for "(Any) Health Act Repeal Could Threaten U.S. Job Engine"

Cross-link to related: Aetna

artappraiser — Fri, 12 May 2017 18:53:57 +0000

In reply to (Any) Health Act Repeal Could Threaten U.S. Job Engine

Cross-link to related: Aetna CEO Says America Should Have a ‘Debate’ About Single Payer

Generic observation. But I

Obey — Sun, 07 May 2017 12:26:23 +0000

In reply to Obey:question. When you write

Generic observation. But I was spitballing based on the now 108 co-sponsors behind the single-payer bill

https://www.congress.gov/bill/115th-congress/house-bill/676/cosponsors?q=%7B%22search%22%3A%5B%22676%22%5D%7D&r=2

I also remember that back in '09, Medicare buy-in for over 55's had broad support and almost made it into the final ACA bill until Lieberman killed it.

But obviously a lot of movement since, and a lot can change in support for the current single-payer bill - both in the positive or negative direction.

Obey:question. When you write

Flavius — Sun, 07 May 2017 11:18:53 +0000

In reply to A slower transition is

Obey:question. When you write

¨150 instead of 100 votes¨

is this a generic observation or are you referring to a specific occasion when Sanders when proposed that ?

It's this kind of argument.

Obey — Sun, 07 May 2017 10:06:54 +0000

In reply to There's an argument against

It's this kind of argument.

https://www.forbes.com/sites/theapothecary/2011/06/30/the-myth-of-medicares-low-administrative-costs/#4a4fe2a9140d

I'm not sure what point you

ocean-kat — Sun, 07 May 2017 06:49:20 +0000

In reply to There's an argument against

I'm not sure what point you're referring to as the link has several points. While there are competing claims all that I've seen claim the administrative costs are in the single digits. I'm not enough of a policy wonk to decide between the competing claims. I just happen to have a job that gives me lots of free time to read several hours a day. Actually one of the few choices I have while at work is to read and I happen to like reading the news so a chunk of my reading time is spent on the news sites.

There's an argument against

Peter Schwartz — Sun, 07 May 2017 02:18:40 +0000

In reply to The administrative costs of

There's an argument against this point, which, unfortunately, I can't lay out. The opposing side calls the comparison misleading. Maybe you know what I'm talking about.

A slower transition is

Obey — Sat, 06 May 2017 23:14:50 +0000

In reply to I should add: dreamers about

A slower transition is probably the best - eg. in the first instance, allowing a Medicare buy-in for those over 55 to solve the problem of the young having to subsidize the older, and expanding Medicaid to 150% of the poverty rate. And then expanding either or both programs later. Or open up the market with a Medicare buy-in in states with concentrated markets (like less than three competing insurers)

I don't see single-payer passing as a stand-alone one-shot bill. The transition is just too radical. Here in Switzerland which has a decently functional version of Obamacare, doctors and patient organizations keep setting up referenda for a single-payer system - for the same reasons that AA cites of reducing overhead costs - and it keeps getting shot down, because people are worried about the transition and because they don't like the unknown world without a private option. Unlike the US, there isn't a huge public program that can just be gradually expanded in accordance with popular demand.

Sanders would have a lot more success with his Single-payer crusade if he did some more modest and limited version of it that could get 150 instead of 100 democratic votes, and it might even put some heat on GOP reps.

The administrative costs of

ocean-kat — Sat, 06 May 2017 22:48:13 +0000

In reply to I should add: dreamers about

The administrative costs of Medicare are estimated to be about 1.4%. There's some argument about that estimate but even the highest estimate of 6% is substantially lower than the 20% limit mandated by the ACA.

I should add: dreamers about

artappraiser — Sat, 06 May 2017 21:22:10 +0000

In reply to (Any) Health Act Repeal Could Threaten U.S. Job Engine

I should add: dreamers about single payer need to worry about the loss of jobs in a transition, too.

These jobs (except from an Oct. 14 Forbes piece "Why Health Insurance is Doomed"),

as little as most of us care about these people, a lot of them, now being paid by all of us one way or another, would end up unemployed with single payer:

A bureaucracy that would make Kafka blush

It’s June 2014, and unfortunately I need back surgery. My back surgeon, having carefully reviewed my MRI, turns me over to his “scheduler,” a full-time employee who spends all day every day on the phone talking to insurance company functionaries (or waiting on hold to speak to them) to get authorization to deliver medical care. This staffing is typical of most medical offices, particularly for specialists, who confront endless forms, prior authorizations, and other manifestations of bureaucracy. And then there are the other people doctors and hospitals have to hire to hound the insurance companies for payment once the care is delivered.

The time spent dealing with insurance intermediaries costs money and aggravates physicians and their patients. As one doctor lamented in a column in The Wall Street Journal, “U.S. doctors spend almost an hour on average each day, and $83,000 a year … with the paperwork of insurance companies.” And for every call coming from a doctor’s office or hospital to an insurance company, there is someone at that insurance company on the other end of the line to process the call.

In 2012, more than 460,000 people were working in the health insurance industry, and employment growth in health insurance is much higher than for the providers of actual health care. Of course, managing all these people is expensive—very expensive. In 2011, the CEO of Blue Shield of California made $4.6 million and the organization’s top 10 executives earned $14 million in total, although of course none of them did any medical research or delivered any care to real patients. The Affordable Care Act mandated that health insurers had to spend at least 80% of their collected premiums on medical care. The very inclusion of that provision implies that at least some health insurers had overhead rates in excess of 20%. All of this seems expensive and wasteful, and it is.

There are other models. Kaiser Permanente, a health care provider that combines both a health insurance plan and care delivery in a single organization, serves more than 9 million members and employs more than 17,000 physicians. Without a separate insurance company intermediary, Kaiser saves money, which it then uses to offer lower health insurance rates. For instance, for 2015, the total cost (Stanford’s portion plus my contributions) of purchasing the Blue Shield-administered plan in which my wife and I participate is 39.7% higher than the cost of getting health insurance through Kaiser Permanente. Although many factors might explain this huge difference in price, the simplification of access and the reduction of administrative overhead is a big part of the story. Kaiser, by being both health plan administrator and care provider, has eliminated the insurance company intermediaries that raise administrative costs.

To be clear, that’s precisely what insurance companies are—intermediaries.

It is not true that many of them could get government jobs with single payer. Or at least, hopefully not! Another huge bureaucracy should not be the result, not much of a future goes that way! Perhaps they could be transitioned to jobs more related to caregiving at the same time the huge boomer generation needs more of it.