The Onion gets into the health care debate (thanks to GGW for the tip):
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As a concerned citizen, I must voice my adamant disapproval of the “universal health care” proposals we’ve been hearing so much about. I don’t have any gripes with expanding and improving health coverage, per se. It’s the “universal” part that irks me. Providing health care for all would completely undermine the whole idea of health care. If every last one of the 40 million uninsured bozos in this country is going to get access to the vast, virtually unnavigable system of medical care we chosen few now enjoy, then I no longer even want it.
A tangent: Maybe one of the reasons that health care costs so damn much is because it costs so damn much, i.e. people want to justify the amount of money that gets taken out of their paycheck, so they go see doctors when they don’t absolutely need to. It’s a “sunk cost” argument, and kind of a variant of the “moral hazard” argument. Uwe Reinhardt might disagree.
And I also wonder about the “Harvard Effect”, comparable to the skyrocketing cost of higher education: The outrageous sticker price is actually part of the appeal. Do we have a fetish for overpriced procedures and drugs because we imagine them to be more effective — in spite of contrary evidence?
Some “rational” free market, huh?
(Update: Linked to Google’s cache of the New Yorker article, above.)
I understand what a moral hazard is, and I don’t think it applies to health care very frequently.* Two reasons: * Co-pays offer a financial disincentive to hazard morally. * Time. Who has just “ran in” to a doctors office, got the attention they wanted, and scooted out, like picking up a gallon of milk. It rarely (never?!) happens. Going to the doctor is a pain in the neck. Limited hours, difficult to schedule, and they don’t call it a waiting room for nothing.
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p> * Frequency is rate of incidents, not cost per incident. I think that when it does happen, it might indeed be rather costly, but I have no numbers available to help decide.
And as I said, it’s more of a sunk cost argument, that folks feel the need to justify their expenditure. “I’m paying for it, so I’m damn well gonna use it.”
…we reside both in the Boston area and in Munich (Germany, not North Dakota). When we’re in Boston, we mainly use Lahey. When we’re in Munich, we use a clinic.
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The irony is that, as expensive as health care is in the USofA and as good as it’s touted to be, it actually takes longer–a lot longer–to get an appointment with a doctor at Lahey (non-emergency, of course) than it is to get in to see the doctor in Munich (regardless of whether it’s an emergency). And, the cost in Munich is a lot less (comparing Lahey’s bills to the insurance company to our bills in Munich).
From an excellent and recent post by Dr SteveB over on Daily Kos “What Are Mandatory Health Care Plans?”(you can look at all of Steve’s “Health Care Thursdays” diaries here; they’re incredibley through and informative)
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p> Please consider signing up to help put the positive momentum of MA HC Reform onto a sensible and successful course with MassCare.org; view the slideshow about the New Health Care Law. As Martin Luther King, Jr. said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” It’s very sad to say, but the current MA law is woefully inadequate to address these inequities.
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p.s. Charley, the Uwe Reinhardt link didn’t work for me; I immediately thought of Malcolm Gladwell’s piece in the New Yorker and think that’s what link was intended to go to–was is a section of the Gladwell piece quoting Uwe?
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p.p.s. Co-pays don’t function as health insureres would have you think, reams of data prove they don’t discourage “frivolous care” but DO serve to discourage timely needed care (hint: the kind that’s less expensive overall)
As Abraham Lincoln, 16th president of US (1809 – 1865), once said: “You may deceive all the people part of the time, and part of the people all the time, but not all the people all the time.” This quote from a very wise man is quite applicable to the MA health care reform initiative especially the publication of their monthly premium rates. I love politicians, they always only give you half a loaf.
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The MA premiums identify two issues: 1) for a $122 monthly premium what health care benefits are covered and what are the deductibles, coinsurance and copayments associated with the policy? and 2) what will be the typical out-of-pocket expenses for an average state resident based on normal health care utilization patterns? Without that information a MA resident, or for that matter anyone else, cannot really determine what the $122 or $800 monthly premium is buying and if it has any value at all, aside from simply saying that someone has health insurance.
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Let’s try to deal with the premium costs and additional costs strictly from a financial perspective:
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Single Monthly premium – $122 X 12 = $1,464 annual + deductibles + coinsurance + copayments + benefit exclusions = Total Cost (TC) of ???
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Middle Monthly Premium (whatever that means) – $175 X 12 = $2,100 annual + deductibles + coinsurance + copayments + benefit exclusions = TC of ??
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Older (over 55) Monthly Premium – $800 X 12 = $9,600 annual + deductibles + coinsurance + copayments + benefit exclusions = Total Cost of ??
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Wow!! Talk about buying a Pig in a Poke!! Good luck to the residents of the great State of Massachusetts.
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Thomas J. Garvey, MHA
Chairman, Board of Directors
TheCenter for Health Care
Policy, Research and Analysis
15 Argyle Road
Merrick, NY 11566
(516) 379-6812
Cell (516) 317-4063
http://www.thepolicy…
What is the moral hazard argument? You got my interest.
When you have to make a $10 co-payment for a doctor visit, or your plan has $1000 deductible, the purpose is to a) make a few bucks and b) make your use of the health-care system more efficient by making you share the cost of your health decisions. This, the argument goes, reduces moral hazard.
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You won’t take the free thing because you don’t really need it.
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That’s the moral hazard argument. It’s easier to believe in with respect to other examples like, say, the S&L crisis of the 1980s. The Federal government increased insurance of depositors funds, and the S&Ls invested in more risky investments as a result because they knew they didn’t bear the risk of loss. The S&Ls created a moral hazard.
Second sentence makes no sense.
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Should read, if the thing is free you’ll take it. If the same thing costs even a bit, then you won’t unless you need it.
…b) make your use of the health-care system more efficient by making you share the cost of your health decisions.
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By paying the premiums, you are sharing in the cost of your health (care) decisions. And, your health decisions, as well. Medical care isn’t fun, you know–as anyone who takes prescribed pharmaceuticals or goes under a surgeon’s knife could tell you.
Or go here.
A couple points…
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First, there’s a problem with “universal” in its current MA form. The market is supposed to help with price controls, but let’s look at what happened with the Connector’s plans. First off, insurance companies did not compete with one another to become part of the plan. If one company knew they were going to win the whole pie, perhaps they would have bid more competitively. Instead, they are “frenemies” — no one stands too far out from the pack, and the pack is distributed widely enough so that each will get a piece.
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I mean give me a break — it’s going to be illegal for a resident to not buy insurance. I’m sure that had the insurers shaking in their boots!
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Then of course theirs the question of fairness. Suppose I’m a law-abiding 57-year old who makes just above the threshold to qualify for subsidized insurance. Congratulations, I now have a $5,000 tax to pay from the $30K I’m making. If I’m healthy, I’m going to pay the penalty (~$250 the first year and $2,500 thereafter). Or, I’ll move out of state but still use the ER facilities in downtown Boston. Or, I’ll not pay into the system, but I won’t pay a penalty either because I work under the table. Or… you get the picture.
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Second, there are concerns about what the health care system will look like. Yes, it’s expensive but this law does nothing to address that. But more importantly, health care in this state is pretty darn good — for insured and uninsured alike. What we don’t want is waiting 5 months to have a lump in our breast examined. We don’t want an 8-week wait following diagnosis to begin cancer treatment. You hear about this type of stuff all the time during Prime Minister’s Questions.
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I for one worry when I read things like this:
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In an ideal world, people would start treatment within a month of being diagnosed. The Government agree and have set this as a target for all cancer patients, to be achieved by 2008 . . . Unfortunately, this maximum one month wait will not happen overnight. It is likely to be several years before all NHS hospitals throughout the UK can offer people with cancer shorter waiting times between diagnosis and treatment.
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and
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In the UK, waiting times can vary depending on the type of cancer you have and the type of treatment you are going to have. For example, if you are going to have radiotherapy, you may have to wait several weeks before you begin your treatment. This is because in the UK there is a shortage of the machines used to give radiotherapy and the staff to operate them. Even though the Government are trying hard to equip radiotherapy units with enough staff and machines, it still takes time to install the equipment and 3 to 4 years to train staff to run them.
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I worry because even though there are some good wait time metrics also cited in that article, I have no confidence the advances in the UK will port to our government (no President’s questions to keep the pressure on) or to a country our size or to a populice that does enjoy its quality of health care. Heck, we couldn’t even handle converting to the metric system and that movement had the whole force of the public education system behind it!
The problem was with the doctor, not the system — implying that it’s not unique to public/single payer health care.
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Doctor error, not public health care error.
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Furthermore, there is this assumption that there’s no wait times on medical tests/access to equipment in tUSA. I’m sure that there are wait times for some equipment or tests. Which ones, how long, and what the distributions look like in tUSA as compared to UK, Germany, France, Canada, et al I don’t know. This kneejerk “times are longer in socialized medicine countries” seems silly without heaps of data.