Tag Archives: health care

Obamacare Premiums

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Stephanie Armour noted that Obamacare premiums are expected to be lower in 2020 than they are this year, and she wondered whether that means Obamacare is working, or if there remain problems to be fixed.

The drop doesn’t address the core problem with Obamacare: it’s a government welfare program that mandates coverages at prices independent of the risk being transferred.

Falling premiums? They’re still much too high, as are deductibles (which Armour completely omitted from her article), especially when compared to what would be the case in a free market, and they’re for coverages that aren’t, generally, needed, to boot.

To the extent subsidies are legitimate and truly needed to help offset [excessively high] premium costs, those just as easily can be paid in conjunction with policies bought through employers or privately in a free market.

Racism in School Admissions

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Federal District Judge Allison Burroughs, of the Massachusetts District, has ruled in a Harvard admissions case that racism in its admissions process is entirely jake.

Race conscious admissions will always penalize to some extent the groups that are not being advantaged by the process, but this is justified by the compelling interest in diversity and all the benefits that flow from a diverse college population.

With that, Burroughs has exposed her own racist bent.  Her “justification” is just her cynical rationalization of her racism. It stinks.

The WSJ editors in that piece also noted Supreme Court Justice Anthony Kennedy’s own tortured effort to correct racism in school admissions in his Fisher v University of Texas opinion:

…he wrote that different treatment of an individual because of race is “inherently suspect” and requires “strict scrutiny.”

No, different treatment of an individual because of race wants no strict scrutiny; it wants no scrutiny at all. Such treatment needs to be proscribed altogether from our schools.  To start with.

These folks, Harvard management personnel and bench-sitters alike, more than merely being racist, insult minorities, and actively hold them down, by insisting they just can’t cut it in an evenly done endeavor; they must have that artificial handicap applied. It’s redolent of Woodrow Wilson on segregation: “segregation is not a humiliation but a benefit, and ought to be so regarded by you gentlemen.”

And they punish the successful by telling them they’re too good for their own good.

Only Part of the Story

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New Hampshire publishes on a State Web site the prices charged by hospitals in the State, and President Donald Trump is working up an Executive Order that would, with some differences in breadth (including information on the prices negotiated with insurers), make the practice a nationwide one.

Price transparency is a Critical Item in controlling—bringing down—the cost of health care, but it’s only part of the story.  A measure of cost transparency would be useful, too, not only for the consumer, but for governments as they look for (non-subsidy, non-tax) ways to further price competition.

Most costs are legitimately proprietary, especially in the competitive market environment that’s optimal for constraining prices.  One cost, though, would be useful: how much of the price charged through insurance to a consumer goes to covering the cost to the hospital of treating an uninsured consumer—both the voluntarily cash-paying consumer and the consumer who can’t otherwise afford the prices charged.  Within that cost, too, are useful data on how it is split between the hospital and the insurer(s) with which it has contracted.

Surprise Medical Billing

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The Wall Street Journal recounted one such example and a (partial, I say) solution in Benedic Ippolito’s (of the American Enterprise Institute) Tuesday op-ed.

The example was a man with a broken jaw who was transported, unconscious, to a hospital ER for treatment.  The hospital turned out to be in his medical insurance network, but the treating surgeon turned out not to be.  The latter’s bill was for $8,000, which the insurer refused to pay.  The man was unaware of that fee until after the treatment had been effected.

The solution described by Ippolito (one of three and the one favored by him; the other two were just price fixing in one form or another) is this:

[an] “in-network guarantee,” is a better solution. Hospitals would ensure that all providers treating insured patients are also considered in-network. Some already do this. Doctors at these facilities would have two options: come to an agreement with the insurer (as most already do) or receive payment directly from the hospital. This would eliminate the inflated surprise bills, reduce premiums and federal spending, and leave it to doctors, hospitals, and insurers to work out market prices.

While a good start, this option is incomplete.  All of those prices and fees need to be known to the patient and to the public at large beforehand.  Further, this needs to be the case for all the medical facilities in a region—hospitals, urgent care facilities, clinics.  Such prices and fees easily could be posted on each facility’s Web site, or on the facility’s entrance if it hasn’t joined the 20th century.

The patients and potential patients in the general public need to be in on the working out of market prices.

Medicare for All

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Senator and Progressive-Democratic Party Presidential candidate Bernie Sanders (I [sic], VT) has the canonical version of Medicare for All; the other Progressive-Democrat candidates have only slightly varied versions of it.  Here’s Sanders on his Next Big Idea for health care provision and health care coverage:

You will have a card which has Medicare on it, you’ll go to any doctor that you want, you’ll go to any hospital that you want.

Right.  Been there, done that.  Both claims were straight up lies then, too.  There is a major difference, though, between Sanders’ two lies and ex-President Barack Obama’s (D) two lies: Sanders would make private insurance illegal—both the selling and the possessing.  That, though, only potentiates the power of Sanders’ lies.

As The Wall Street Journal mentioned on the other side of the link,

The point of Medicare for All is to cut reimbursement rates to Medicare levels, which government can now set so low only because private commercial reimbursement rates are so much higher. Cutting reimbursement rates would “probably reduce the amount of care supplied and could also reduce the quality of care,” CBO says.

Not could—would.  Reducing availability cannot help but reduce quality, if only from denying it altogether to many who need it or would merely benefit from it.  But that’s not the only pathway: that reduction in availability will flow, at least in large part, from that reduction in reimbursement rates.  As a result of that, those doctors and hospitals whose talents and skills warrant higher pay will limit their practices to the bare minimum.

That’s not out of personal greed, either: costs of care delivery go up markedly as the number of patients go up.  Absent meeting costs with fees charged, these providers would have no choice but to limit their costs by limiting their services and the numbers of potential patients served.

There’s another cost path, too: the more complex or difficult, or even merely rare, a medical problem, the more expensive it is to provide services for dealing with it.  Capped reimbursements will limit the availability of that care. And—lower reimbursement rates again—lower the quality of those providers willing to provide the care.