Megan McArdle On Universal Health Care & Medicare
Megan has a very good post on the subject.
Perhaps predictibly, someone showed up in the comments to my post on Medicare and Social Security to argue that liberal analysts have very serious plans to cut Medicare’s costs, which is why we need universal coverage, so that we can implement those very serious plans.
I hear this argument quite often, and it’s gibberish in a prom dress. Any cost savings you want to wring out of Medicare can be wrung out of Medicare right now: the program is large and powerful enough, and costly enough, that they are worth doing without adding a single new person to the mix. Conversely, if there is some political or institutional barrier which is preventing you from controlling Medicare cost inflation, than that barrier probably is not going away merely because the program covers more people. Indeed, to the extent that seniors themselves are the people blocking change (as they often are), adding more users makes it harder, not easier, to get things done.
This is absolutely right. The idea that universal care is a necessary condition for reducing Medicare costs is pretty much baloney. Or if it isn’t I’d like to see the argument laid out in very simply language with some evidence to back it up.
Correct. Indeed, I’ll go father and wonder if anyone can actually produce facts that show if ‘universal’ coverage isn’t in fact the fastest way to raise costs, even absent the choice issue.
Steve –
At DS’s GEye a poster noted that Medicare (single payer proxy) overhead was 2%, and private insurane was 30%. She provided a link.
However, I did not even take the time to inspect the link because it didn’t pass the Drew life experience, and snicker, test.
That said, are you familiar with overhead structures in other countries and health care delivery systems?
As an example of raising costs under universal (Government!) care:
When healthcare is the province of government, it’s a one step process to unionize. Government is one of the few places where unions are growing. Can anyone here think of a faster way to raise costs, than to allow unions to take hold?
This is a variant of “we’ll lose money on every transaction but we’ll make it up on volume!”
Yes, and that 2% number is dubious at best. I think (going by memory) the actual numbers are 15% to 30%. The government counts things differently as they are governed by a different set of rules.
IIRC, some doctors will not accept Medicare or Medicaid patients because they will not accept the mandated payment schedules. How long will these physicians be able to do this once “universal” coverage is enacted?
Noting Drew’s sniff test, can anyone name a single government program that only has 2% overhead?
C’mon Charles. Obama has only been in office a couple months. Give him a few more weeks and 2% will be the norm.
After all, he said so in a speech.
According to the JAMA study that seems to be the gold standard for this info (there’s a link over at my place somewhere but I’m too lazy to dredge it up again), the overhead in the U. S. is 30% and in Canada it’s 15%. IMO estimating that we could save 10%-15% isn’t unreasonable. Estimating that we can save significantly more is a reach.
Here is one study I’ve found. Its main findings are that for the private sector administrative costs are 8.9% to 16.7% depending on how you count it, and for Medicare 5.2%. Thus, the discrepency isn’t as large and total amount for the private sector is considerably lower than is typically reported.
Further, there is the issue of are these costs really wasteful. From the article linked above,
If this is true, the many of the programs and proposals of those who favor universal coverage will likely increase Medicare’s administrative costs, not lower them. In other words, we could end up with the private sector’s administative costs as abuse if ferreted out and “ounce of prevenetion” policies are implemented.
Frankly, one of the test should be to look at total costs for providing similar services to treat patients under private sector plans and Medicare. Looking only at the costs in piece-meal fashion can lead to the wrong conclusion.
Yeah, sure, let the Bernie Madoffs of the world take hold. (oh, wait a minute, they already HAVE)
For the record Bit, my union has done a pretty good job of keeping these costs under control. I just got done with 6 days in ICU (with ancillary costs). My price tag: $370. (ttl bill? $25-30,000)(so far)
Mind you, the premiums take a larger and larger chunk of my paycheck every year, but I need to point out one thing here: I had been laid off for 6 months when I went into the hosp. My Insurance was still in force.
So Bit, f-u and all your “anti-union” crap. Been working out for me for years. I figure the only reason you are so anti-union is because the COSWDKHAFAItG Brotherhood has not yet been formed.
ps: don’t any one ever ask me what that means, I will never remember.
tom p, hope everything is better or will be soon.
Hopefully we can agree that some unions do some very good things for their members and for the people who use unionized labor (thinking primarily about construction here from my personal experience), while noting that at times some unions are having some pernicious effects in the aggregate. Unionization per se isn’t a problem, but the corruption and rents obtained from Congress and the current administration through funding the Democrat Party is another issue entirely.
Steve and Dave-You are talking aples and oranges, kinda. The 5% and 9-17% figures cited by Steve are just for Medicare vs Private insurance. The 15% vs 30% number if for the administrative costs incurred by Canadian hospitals vs American hospitals, Canadians being lower.
Steve’s quote about private insurers implementing policies to improve quality of care is total BS IMHO, at least in Pennsylvania. The improvements I can think of have been pushed by Medicare. Central line placement, antibiotics before surgery are just two examples. On costs, I will again note that private insurance almost always pays more than Medicare or Medicaid for equivalent procedures. Why do you think lots of docs do not want to care for Medicaid patients? (I am OR based, so know less about primary care reimbursement.)
Steve
Good grief Steve (May 14, 2009 | 05:15 pm), before you quote a study on Medicare vs Private Insurance you should check out the source, to wit:
You are taking a “study†by the Insurance Industry front group which advocates “market oriented solutionsâ€.
I refer you to page 8 of the quoted study where Data is presented with and without “commissions, premium taxes, and profitsâ€. Executive salary, compared to Medicare managers is no where mentioned, monies utilized for excluding individuals with prior existing conditions or to deny payments are not presented. The lack of data in this “study†just boggles the mind , the lack of scholarly references speaks volumes (check out pages 15 to 19).
It is beyond my comprehension why you are unable to understand what most sentient individuals accept: Insurance companies are in the business of Health Care to make money, not to improve the health of their policy holders, and certainly not to improve the quality of health care. They will screw policy holders if it is to their economic gain, and successfully match their computers against those of the government. Your private doc will tell you how they bugger him, if you ask, and are willing to listen…
PSSST: The usual quoted administrative cost for Medicare is in the range of 5%, while those for Insurance Companies range all over the lot, depending on how they are calculated. Most observers place Administrative costs in the range of 23 to 30% for private Insurance Companies if the accounting includes management cost, profits, and actuary departments devoted to maximizing profits…
The post is overall not bad, but McArdle makes a typical mistake and says that Canada “outlaws private care”. No, it doesn’t – essentially all care is provided by private doctors and hospitals. What Canada does outlaw (or at least usually outlaws, pending that one Quebec Court case) is private insurance covering the same thing that the universal health insurance program covers.
@Drew
Yo…way, way, way ot, but I replied to your response to my post over at Dave’s place, but some “spam filter” horseshit prevented its posting (sorry, bro, you deserved an answer)…in fact all my comments over there are gone (I mean, I know they’re not that good, but this seems a bit excessive)…in fact, the last commenter in the Rule of Law thread said:
Well, I won’t go there….but what’s up with this, Dave?
I have an aggressive spam filter because I get an enormous amount of spam. Make sure you put a valid email address and a valid URL into your comment. Unfortunately, your old comments have already been purged or I’d recover them for you.
Here’s the link to the study I cited above. And here’s one to a compilation of my earlier posts on health care reform. It also includes an executive summary of my position on the subject.
OK Dave, thanks (sorry ’bout the ‘horseshit’ thing…)
The vaugeness of your memory regarding the total bill shows clearly how detached you are from actual costs. (Not just you, of course, I mean to say, the editorial you) Universal care, of course would detach us from that reality even farther.
That point back to the side, let me ask you; What would the costs have been absent the unions? Can you say with any assurity? I suspect the test cannot be made.
Typical Megan, she makes up some position that she imagines is the liberal position and then attacks the straw man she just created.
The Obama position is that universal coverage is a highly desirable outcome, but we can not afford it unless cost are reduced and future price increases or brought under control. Therefore we are making cost control a major objective. At no point does the Obama administration take the position that Megan describes as her straw man.
Perhaps this is a bit too nuanced, but does President Obama want to reduce the price of healthcare or the cost of healthcare? They aren’t the same thing, unless you assume a utopian all government solution. No one who actually runs a business confuses or conflates these two terms.
As an aside, an underlying premise of free markets is that nothing is free.
Our Paul,
First off precluding people prior conditions also lowers premiums. Including them would drive up premiums. That is precisely the point of how administrative costs, even higher ones, can keep premiums lower and thus create value for customers of a private insurance company.
I’ve never made this argument you attribute to me.
If this is the best you can do Paul, you get an F.
Steve, I concur that you never said this but you let him off the hook too easily with an F. He used a false dichotomy to create his strawman. You called him on the strawman but not the false dichotomy. Many healthcare providers enter their fields (including business professionals, accountants, etc.) to help people, not just to make money or a living, or however he may chose to denigrate their efforts and impugn their motives. Making a profit is what allows them to continue to do it day after day and year after year.
There is actually a very competitive market for healthcare insurance. I know as I pick one for my company ever year. They expend a lot of effort trying to keep their customers healthy because it will allow them to incur lower healthcare costs which will in turn allow them to charge a lower price for their insurance which allows them to take customers away from other healthcare insurers that aren’t doing as well at controlling costs.
I’m sick to death (pun intended) of this idea that healthcare insurance, or anything else, that generates a profit is somehow less moral or necessarily less effective and less fair than what the federal government and it’s non-profit purity will provide.
Oh, and, um, how do you think he felt about Michele Obama’s $300K salary at the University of Chicago Hospital to do community outreach? Damned insurance companies. And if insurance companies are so bad, why does he advocate having a single monolothic, dare I say monopolistic, insurance company to take care of everyone — i.e., the federal government? Will the federal government’s non-profit status somehow make the purity of their inevitable rationing decisions more palatable?
Charles,
I also would like to note that I have at least pointed to study whereas our anonymous friend Our Paul points to nothing when it comes to supporting the 20% to 30% claim.
Also, he does seem to agree with the industry provided study in regards to Medicare administrative costs of 5% (approximately).
This PricewaterhouseCoopers study indicates that $0.87 in premiums goes to paying for medical services. The implication is a 13% cost for administrative expenditures.
Charles, things are going… more or less OK.
Bit, you are an idiot, totally ignorant of how the system works. My inability to come up with a ttl cost is due only to the fact that I have yet to recieve more than one bill. I am going off ONLY what my insurance has sent me so far.
Let me quote you from my latest statement:
Blood work: $29.00, Not Covered:$8.82 Paid: $20.18
Molec Signal Amp Nucleic Acid: $920.00 Not Covered: $920.00 Paid: $0.00
Moleccular Diag Nucleic Acid P: $550.00 Not Covered: $167.20 Paid: $382.80
Assay, Homoccystine: $232 not covered: $70.53 Paid: $161.47
Molecule Mutation Scan by Phys: $230.00 Not covered: $230.00 Paid 0.00
Molecular Diagnostics, Nucleic: $110.00 NC: $33.44 Paid: 76.56
Molecular Diagnostics, Digesti: $110.00 NC: $33.44 Paid: $76.56
Genetic Examination and Report: $110.00 NC:$110.00 Paid: $0.00
Cardiolipin Antibody, EALGCL $1,047.00 NC: $318.29 Paid: $728.71
TTL Charges: $3,338.00, NC: $1,891.72 Allowable Amount: $1,446.28
TTL Paid: $1,446.28 CoPay: $0.00
Does ANY of that make sense to anybody else????Bit, I am happy you are healthy, and have not dealt with any of this stuff in so long that you are totally ignorant of how it works, but if you take a moment and look at the preceding, it becomes obvious, THAT THEY HAVEN’T GOT A CLUE WHAT IT COSTS EITHER!!!
The next time you decide to quote your conveniently agreeable talking points I have a suggestion: StFU. You don’t know what you are talking about and neither does anybody else.
Most especially Megan McArdle.
PS: thank god I have a union behind me who understands that we all get sick from time to time and takes a little more now, to cover that which is yet to come. And let me remind all: I WAS LAID OFF FOR 6 MONTHS when I got ill.
FU Bit, and all your anti-union bull*hit. If it wasn’t for my union, I would be bankrupt now (times 2… let me tell you about the time they wanted to amputate my son’s leg)
Charles, I have to ask, then why are they so afraid of competing with the gov’t?
(I am sorry, I am back to work now, so cannot read your answer)(and no, making a profit is not a constitutional right)
Sigh, an F for Failure by Steve Verdon, and after my best effort, he is asking me to do better? What a demanding, cruel and wicked taskmaster is our host on this thread.
The thread began with a quote from Megan McArdle (Center Right commentator at the Atlantic Channel). A glance at Megan’s post shows shining scholarship, and insightful thinking, presented into four brief paragraphs. No need to even mention that Megan wraps her gibberish in a prom dress, and proceeds to scare the bejesus out of us by with the usual Center Right piggy story that we are headed towards (gasp) a Canadian style system that outlaws private care. (Pssst: as others have pointed out, private medical practice in Canada has not been “outlawedâ€).
There are ways to control Medical costs, the most obvious is to control the Medicare Advantage boondoggle (see my link above), and to introduce price controls on medications. Neither sister Megan, nor brother Steve wishes to bring these points to your attention. Nor will they point to any studies with meat on them — by meat I mean that they have data that can be examined, and references that can pursued.
One thing is certain, we cannot get a grasp the problems within our Health Care system, unless we are willing the compare it to others. Correspondents in this, and other threads have pointed out that we pay more, have worse out come results, and that the rate of increase in health care costs is greater than other industrialized countries. In the past I have referenced the most recent OECD study detailing these facts and potential areas for reform.
A logical approach to the data in the OECD studies can be found in the Jan’07 study by the McKinsy Global institute study titled Accounting for the cost of health care in the United States. It is a groaner as to length, but can be scanned read because of its logical and easily understood graphics.
Even now, after more than six hours of thinking on the matter, I still do not understand why I deserve an F for my previous humble offering. I did not disagree with his thesis that insurance companies would be able to decrease premium costs to their customers if they limited coverage to catastrophic illness and excluded folks with prior existing medical conditions. All I stated is that Insurance companies are in the business of Health Care to make money, not to improve the health of their policyholders, and certainly not to improve the quality of health care.
Pssst: The original metaphor to wrapping gibberish in a prom dress can be found In Megan’s post quoted by Steve Verdon. How could I resist?
man sorry you got sick bro but it happens to us all, and I’m glad you guys in the unions that are destroying this county still have free health care,free for you that is, and hell you never know, you wait a few more days and maybe 0bama will take over your company and give it to you.
That should make you feel even more better.
and remember its not the little they take that they save for your health care, it’s the massive donations that they give to the baby murdering liberals democrats that really matters in the long run, what would you do with out your masters to tell you how to live , think, vote?
Oh, and can we please git a post on how treasonous undermining of the the war effort for political gain is now coming back to bite liberals like the Lich Queen right in the donkey?
If I had a nickel for every thread where G.A.Phillips mentions abortion (usually having nothing to do with the topic being discussed), I would have more than enough money to pay for the healthcare of every commenter here…
Time for bed… way tired… but I could not help but notice that nobody has an answer to either of my questions.
Hmmmm… Maybe it is because there are no easy answers? Or maybe because the answers do not fit our preconcieved arguments?
Hmmmmmm……. Food for thought.
As usual GA, You don’t have a clue. You want to know what my health care costs me? (actually “Health and Welfare”, we have other things under that phrase, like disability ins., and more)
$212.00 per 40 hr week… I been doing this stuff for almost 30 years, and have only needed my health insurance in a serious way 2 times (once for me, once for my son)
FU GA, I been paying for this a long time (do the math, allow for inflation) and just in case you haven’t yet figured it out…
That is what health insurance is for.
One more thing GA… WTF???????????????? Personally, I think you just have penis envy.
Let me cap my participation in this dieing thread. To clear up the issue of anonymity: I am a retired physician with specialty training in Endocrinology and Metabolism. Part of my career was in the Academics, part in the field of Geriatrics and Long Term Care, as a physician, and as Medical Director.
I do not comment in OTB without first reading the links that our host may present, and I certainly read any links that participants in a thread may present. Having spent time in the Academics doing research and teaching, data is important, and criticism of thought is always neutral, offered to advance the exploration of the topic on hand.
That said, we can proceed to this gem:
This time I will not go to primary sources, but will quote Dave Schuler from the link he kindly provided above, to wit:
Finally, a careful read of the paper you linked to by the CHAI will show that it is a re-worked technical paper by Mark Litow (page 4) and the criteria used to analyze Litow’s data can be found on page 15, to wit, under Methods they say:
You got it baby, self proclaimed experience and judgment will always carry the day…
lol, you know, F me?
FU and all your little union thug buddies, punks with big mouths in communist organizations don’t scare me dude.
lol why would a sniveling little liberal give me penis envy, I thought I explained to you man lovers how I am happy with my own own penis more then once.
but I guess I’m happy to know you still love and think fondly of at lest part of me and my tax money.
Do you realize that we just said FU to each other on a blog, lol, what a couple losers.
some time I think I should vote for liberals, cause I’m so childish.
get well bro, and stay honest.
Our Paul, I have always found your insights thoughtful and enlightening. I do not always agree, but keep up the education.
thanx.
Yeah, I know you GA. You are like all the rest of your union bashing buddies, you tried, you couldn’t hack it, you couldn’t keep up (either that or you didn’t have the balls to try)
Hahahaha… That is why you hide behind your keyboard, right? C’mon to a jobsite, and try your chickensh*t crap. We will see how all my “little union thug buddies, punks with big mouths in communist organizations don’t scare” you…
Funny… You were the one that was sniveling about the “free health care” I have been paying for, for years….
As to the penis envy, you had that long before I came along… I just pointed it out.
For the record, I do not think fondly of you at all (and I know how to spell l-e-a-s-t), and when it comes to your “tax money”, I do not know how much you pay, but it would not surprise me in the least if I pay more.
I do have a question tho: Why do you have a problem with 20,000 people making $50,000 or less, pulling together to fight for their rights against one guy who makes a billion dollars?
Here is a hint GA… it is, at best, equal on the dollar amounts… and money is power.
On that note, I can finally agree with you.
I’ll try to answer the question that makes my point and spell it right like that matters.
because I do not covet.
lol, don’t need a keyboard to talk crap to liberals, come down to the job site blah blah blah……..
1345 Deane blvd Racine WI. were I live. I’m to poor to fly out to you.
\
Since I can only work on what you tell me, how am I to blame for making a judgement based on incomplete info?
I note, however, you can’t tell me where the prices would ahve been absent the Unions. You know full well they’d be substantially lower, and therefore can’t answer my questions.
Because that money isn’t yours to steal, by whatever means?
Exactly how is fighting for one’s rights characterized as “stealing”?