Rush Limbaugh: Shut Up

Birth control is a lifestyle drug. Except when it’s used for other purposes, which are irrelevant to the subject here.

No, I’d say the other uses are quite relevant, despite you trying to upset the chessboard because you’re badly losing.

anjin-san

March 5, 2012 at 2:10 pm

As such, it really shouldn’t be provided by insurance which, ideally, should be reserved for things that are both rare and expensive.

Yea, I know all these conservative freeholders are financially prepared to pay 100% of their non-catastrophic medical costs out of pocket at the drop of a hat. Because each and every one of them lives within their means and keeps a prudent cash reserve at all times. And if they come up a little short, they will just give up sleep and work six jobs to avoid becoming “moochers.”

michael reynolds

March 5, 2012 at 2:15 pm

@Gold Star for Robot Boy:
I am somehow unable to remember wine and beer labels, so here’s my routine every time I’m buying Chimay. “Is it the blue label or the red label I like best? Hmm. Better buy both.”

PD Shaw

March 5, 2012 at 2:18 pm

@Matt Parker: (1) Contraceptions for non-birth control reasons has always been covered in policies with a prescription drug benefit if medically indicated, so your first point is irrelevant.

(2) I think Prof. Taylor’s other point is rather that contraception is a planned expense; therefore it is not an insurable risk. Ms. Fluke could complain that she had to sell her car because she couldn’t afford to pay the cost of gasoline. Would Democrats then require gasoline to be covered by auto insurance policies? What would happen to the cost of auto insurance? What would happen to the cost of gasoline?

Oral contraceptives (both brand and generic) are around $30/month if you’re paying cash, or between $15-$25 if you’re paying a copay through your insurance.

The myth of the free lunch. If you make the insurance company buy contraception, they’ll pay $30 per month to the pharmacist and assess $5 in administration costs, and then charge $35 for the coverage, either through higher premiums or co-pays.

sam

March 5, 2012 at 2:18 pm

“First off, taking “the pill” is not dependent on how many sexual partners you have. Limbaugh made it sound like the more promiscuous a woman is the more it will cost in terms of birth control. Somebody should clue Rush in: whether a woman has 1 or 100 partners in a month all she needs is one pill. What an idiot.”

Yeah. The only way a lot of what he said makes any sense is if you consider that he thinks a woman taking birth control pills is like him taking that V-stuff — you know, on demand. As you say, what an idiot.

Jenos Idanian

March 5, 2012 at 2:21 pm

@Gold Star for Robot Boy: I’m saying the other uses are irrelevant to this discussion. The issue is those who morally oppose contraception being forced to pay for it anyway; the use of “birth control pills” for other uses was never brought up. And even the Catholic Church has supported such use of those medicines for years. Their only objection has been to their use for birth control, and even now all they’re saying is “don’t make us pay for it.”

For example, V-agra was developed initially as a heart medicine, and is sometimes used to treat pulmonary hypertension and altitude sickness. It’s even been given to prepubescent children for certain conditions because of its effect on blood vessels. And no one has a problem with that, except for the occasional snickers. Likewise, no one — not even the Catholic Church — has issues with women who use “The Pill” for menstrual irregularities or difficulties. So yeah, it’s a non-issue.

Gold Star for Robot Boy

March 5, 2012 at 2:28 pm

@Jenos Idanian: Sure, you can say this issue is about contraception and religious institutions’ beliefs… but right now America is talking about how that gasbag Limbaugh called all women who use contraception prostitutes.

IOW, your side has lost control of the narrative. That’s your own fault, thanks to “allies” like Rush, so don’t take your frustration out on us.

grumpy realist

March 5, 2012 at 2:30 pm

@Jenos Idanian: Except that isn’t this exactly what happened at the very beginning of all of this–a woman not obtaining the appropriate medication for a polycystic ovary because the health insurance offered to Georgetown students DID NOT cover anything that could be used as birth control?!!

Can you please explain how getting a free condom will protect a woman from losing an ovary?

Doug, I’m afraid that the Republicans posting on this topic are idiots….

March 5, 2012 at 2:33 pm

@michael reynolds:

I don’t know, wasn’t trying to…just lucky I guess.

To everyone else…

As for health care and insurance, yeah the idea of insurance is costly and rare. That we don’t do that is one of the reasons why health care costs are out of control. I know it isn’t a popular position, but the idea that we can “have everyone else pay for everyone else’s frequent and low cost health care” is not a sustainable position.

With the current growth rate in health insurance/care costs things can not continue forever. Removing from health insurance things that are low cost and frequent would help to some degree.

michael reynolds

March 5, 2012 at 2:33 pm

How about the morality of health insurance plans that pay for drug rehab? Say for an Oxycontin addict?

How about plans that pay for surgery on ears and hearing aids for drug addicts whose hearing is destroyed by their addiction?

Care to weigh in on those?

grumpy realist

March 5, 2012 at 2:34 pm

Oh, and when all the men squawking about how “birth control shouldn’t be covered by insurance” are as equally horrified about insurance covering those little blue pills (that we can’t name otherwise the spam filter catches it) and make as much of a stink about it…then I’ll maybe start listening to your arguments. Until then, goose==gander.

anjin-san

March 5, 2012 at 2:35 pm

The issue is those who morally oppose contraception being forced to pay for it anyway;

I morally opposed the Iraq war and was forced to pay for it. When I pointed that out, conservatives called me a traitor.

Do try harder.

Gromitt Gunn

March 5, 2012 at 2:37 pm

@PD Shaw: Health coverage – and in particular group health coverage, the type at issue – is chock full of planned expenses. Annual physicals, well-woman exams, preexisting condition coverage, maintenance medications for asthma, diabetes, high blood pressure, cholesterol, and mental health, among others, screenings for various cancers and conditions, durable medical equipment for chronic conditions, etc.

Jenos Idanian

March 5, 2012 at 2:37 pm

@anjin-san: Some day I’m going to bring up five random topics, and challenge you to link them to the Iraq war. To you, it’s the Kevin Bacon of politics.

Gold Star for Robot Boy

March 5, 2012 at 2:38 pm

Speaking of losing the narrative, Laurens County, S.C. GOP, you’re not helping.

michael reynolds

March 5, 2012 at 2:38 pm

I basically agree with that, in principle — given the current situation. And you can accomplish this with a high deductible. For me insurance is for sh-t hitting fan.

The problem is that for meds the plans negotiate better rates than I’d get as self-pay, so you have to go to Blue Shield or whoever just to avoid getting completely raped by drug and device folks, not to mention doctors.

The obvious solution is a more European system. There was an article just recently pointing out that an MRI costs us 1080, and in France costs 280. The 800 dollar difference is the premium we pay to satisfy ideological objections to single payer.

Tsar Nicholas

March 5, 2012 at 2:39 pm

Limbaugh is not exactly the brightest bulb in the display case. Let’s be blunt: When you flunk out of a school like Southeast Missouri State University, during the spaced-out late-1960’s and early-1970’s no less, it’s not a sign of a superior intellect. QED.

Regarding the whole contraceptives kerfuffle, if a private insurance company wants to underwrite the costs of the pill, condoms and like items, in exchange for a higher premium, hey, more power to them. If the government wants to mandate that a private insurance company cover those costs, however, or that a health care provider must provide contraceptives-related services, or that a pharmacy must sell those items, well, those are horses of completely different colors.

First, governments shouldn’t be mandating particular health care services nor coverage therefor. Bad idea. Slippery slope. No bueno. Second, the 1st Amendment to the U.S. Constitution contains a free exercise clause, in addition to its oft-recited establishment clause, and given that contraceptives coverage can and often does tread upon religious liberty it’s best for Uncle Sam for that reason alone to keep his toes out of these waters.

sam

March 5, 2012 at 2:42 pm

The issue is those who morally oppose contraception being forced to pay for it anyway; the use of “birth control pills” for other uses was never brought up

Well, and quelle surprise, that just uninformed bullshit. Here, read Ms. Fluke’s testimony, on page 2 where she talks about her friend with polycystic ovarian syndrome.

anjin-san

March 5, 2012 at 2:46 pm

@ Jenos

In other words, you can’t refute my argument. That’s a shock.

Gromitt Gunn

March 5, 2012 at 2:47 pm

@Steve Verdon: Under a capitation model, as opposed to a fee for service model, it is the encouragement of those little things – screenings, substitution of generics for brand names, wellness exams, etc. – that reduce overall costs. At least in theory – you really do need a large enough pool in order to handle the annual fluctuations in expenses related to high-cost patients – but that risk exists regardless of whether or not you encourage preventative as opposed to reactive medicine.

anjin-san

March 5, 2012 at 2:49 pm

With the current growth rate in health insurance/care costs things can not continue forever.

Then let’s take the 60 million a year that the CEO of Wellpoint is pulling down off the table. Let’s take a hard look at why the topline on my colonoscopy bill was 14k – for a routine procedure that takes 45 minutes.

Hey Norm

March 5, 2012 at 2:50 pm

What about the liberty of those denied basic health care services? Contraception benefits society as a whole…reduces the spread of STD’s, reduces the number of abortions, helps in family planning. And it can have medicinal benefits beyound birth control. What about those liberties? Why isn’t the church interested in limiting abortions? Why isn’t the church interested in limiting the transmission of STD’s?
Just because some child-molesters in velvet robes and pointy gold hats say birth control is a sin doesn’t make it so. Not long ago the church said divorce was a sin. Now…not so much. The sum total of what the church has been wrong about over it’s history is incalculable. They f’ing put Galileo under house arrest because he though the earth revolved around the sun. And we’re going to listen them on this…why?

PD Shaw

March 5, 2012 at 2:51 pm

Oops, I thought this was Prof. Taylor’s piece for some reason. I’ve always wondered who those morons are that can’t figure out who is writing a particular OTB piece. I see that they must be highly enlightened souls who can’t be chained to details.

PD Shaw

March 5, 2012 at 2:57 pm

@sam: “Here, read Ms. Fluke’s testimony, on page 2 where she talks about her friend with polycystic ovarian syndrome. ”

Ms. Fluke says that medical use of contraception is “covered by Georgetown insurance because it’s not intended to prevent pregnancy.”

She has an identified friend, who had such coverage also, but the claim was denied because of the evidence.

I don’t know who this mystery friend is, I don’t know if the evidence supported medical use of contraception, but this anecdote supports the conclusion that contraception is covered under insurance policies for medical reasons.

john personna

March 5, 2012 at 2:58 pm

Steve made a wrong-turn early on, and I’m not sure he was caught on it.

We all want “health care,” but have in many cases just “health insurance.”

Some of us do have “health maintenance organizations” which split the difference a bit more explicitly.

What I hear from women is that they want “health care,” and answering with technical definitions of “insurance” won’t buy you a lot, with them.

john personna

March 5, 2012 at 2:58 pm

(And I’d say yes, women see birth control as part of health care.)

Jenos Idanian

March 5, 2012 at 2:59 pm

@sam: Without insurance coverage, contraception can cost a woman over $3,000 during law school.

Or, at Wal-Mart, it would run $144. At Target, $324.

There’s a Wal-Mart within 10 miles of the Georgetown campus. A Target, even closer.

Oh, and look! Here’s the actual quote you cited!

A friend of mine, for example, has polycystic ovarian syndrome and has to take prescription birth control to stop cysts from growing on her ovaries. Her prescription is technically covered by Georgetown insurance because it’s not intended to prevent pregnancy.

The “uninformed bullshit” here is what you said, as she said the precise same thing I did.

The other stories she recounts aren’t a matter of moralizing, but economizing and small people power-tripping. And if you think insurance bureaucrats are stubborn and capricious, wait’ll government bureaucrats are doing it.

john personna

March 5, 2012 at 3:00 pm

(Really the “talking past each other,” and health care versus health insurance is an ancient form of health care debate in the US. When a conservative dives into nuance of insurance, that’s because care isn’t a priority.)

Brummagem Joe

March 5, 2012 at 3:07 pm

but the idea that we can “have everyone else pay for everyone else’s frequent and low cost health care” is not a sustainable position.

This statement proves you’re not to be taken too seriously Mr Verdon. Every developed society in the world operates universal healthcare systems for their citizens. We just happen to pay more less twice as much as anyone else for the same product.

David M

March 5, 2012 at 3:07 pm

@Jenos Idanian: It’s not about religious beliefs at all. Remember, the official GOP position is that any employer can refuse to cover any health service they don’t approve of for any reason.

The cheapest contraceptive isn’t always the best option for all women, so the existence of cheap generic birth control pills doesn’t matter.

Jenos Idanian

March 5, 2012 at 3:16 pm

@David M: Remember, the official GOP position is that any employer can refuse to cover any health service they don’t approve of for any reason.

Really? The arguments I’ve heard and read specified the religious exception, based on the 1st Amendment.

The cheapest contraceptive isn’t always the best option for all women, so the existence of cheap generic birth control pills doesn’t matter.

It matters to the majority. We can carve out exceptions for the minority. And I presume you know exactly how much pharmacies cost for each type? And what percentages of women need which types?

David M

March 5, 2012 at 3:27 pm

@Jenos Idanian: A good place to start would be the actual language of the Blunt Amendment. (That would seem to be some pretty basic information.)

In my view, this is an extreme position only worthy of ridicule, although it does suit the current GOP: any employer can refuse to cover any health service they don’t approve of for any reason.

rodney dill

March 5, 2012 at 3:35 pm

@Gold Star for Robot Boy:

pay more less twice as much

Did you mean “Pay more or less twice as much”?

Brummagem Joe

March 5, 2012 at 3:40 pm

@rodney dill:

Did you mean “Pay more or less twice as much”?

You should move into 221b Baker Street.

CB

March 5, 2012 at 3:48 pm

though chimay isnt my favorite, i had the same exact thought. is it happy hour yet?

PD Shaw

March 5, 2012 at 3:50 pm

@David M: The contraception provisions don’t seem radical; they appear to be the same as Illinois, which allows any employer the freedom of conscious to not offer birth control coverage.

I don’t think the part about opting out of Obamacare is radical, its cheap political theatre.

Gold Star for Robot Boy

March 5, 2012 at 3:55 pm

@CB: It’s happy hour somewhere…

Matt Parker

March 5, 2012 at 4:12 pm

@PD Shaw:

1. Oral contraceptives will either be on or off-formulary, regardless of cause, so it does, in fact, matter.

2. That’s just not how the industry works. Cash prices at pharmacies are almost ALWAYS higher than the rates negotiated with insurance companies, even including dispensing fees. This is part of the reason why high-deductible health plans are a good deal — it’s better to pay 100% of the negotiated rate that an insurance company and pharmacy chain have worked out than to pay the full retail price.

Jenos Idanian

March 5, 2012 at 4:14 pm

@David M: You’re right; the “moral exemption” did not specify strictly religious organizations. And, in retrospect, that’s a good thing; it would be problematic to carve that out.

But it’d be interesting to see what employers would invoke such an exception, and how it would be perceived by the courts. That employer better have their ducks seriously lined up to meet the standard. Unless they had a history of taking strong moral positions in the past, they’d be hard-pressed to prove their case.

March 5, 2012 at 4:14 pm

@michael reynolds:

You mean something like a pre-existing condition kind of thing?

@grumpy realist:

I’m fine with that too.

@michael reynolds:

I’ve been in favor of moving towards a more European model, the posts are here on this site for those who doubt me.

My overall objection to health care expenditures is we act like we have unlimited amounts of money and resources. We don’t. We are on an unsustainable trajectory and something will have to change. Either we make that change or it will be forced upon us.

Yeah, I don’t buy it.

When you are talking tens of trillions in the coming years $60 million is nothing. By all means go confiscate that money if it makes you feel better, but getting upset about it is like worrying about dropping a penny on the ground when making change.

@Hey Norm:

The pill does not reduce the spread of STDs. Condoms would, but that isn’t what this is about, at least not solely.

Show me a sustainable health care system aside from Singapore and the Netherlands (maybe). So far we have one example from a country that is not at all like the U.S. All other systems share a trait with ours…none of them are sustainable. Or to put it differently, we are all rushing towards a problem with health care…the U.S. happens to be leading the way, and that is not a good thing.

March 5, 2012 at 4:17 pm

By the way, your observation does nothing to refute my claim regarding sustainability. You do know that, right?

Brummagem Joe

March 5, 2012 at 4:23 pm

When you cut through all the bs, Limbaugh’s grotesque insults and all, this issue is very simply put. Should employers for religious reasons (or under the Blount amendment any reason they choose) have the right to exclude contraceptives or ANY other controversial services from the healthcare insurance coverage that their female employees receive. After this became an issue wih the Catholic Bishops the DHHS came up with a neat way out which satisfied many Catholic organisations but not the Bishops and of course not the Republican party who decided to double down with the egregious Blount amendment which was defeated. Meanwhile the Catholic Bishops seem to have gone very quiet on the topic (I wonder why?) and I suspect the events of the last week or so are making many Republicans wish the whole issue goes quiet as soon as possible.

anjin-san

March 5, 2012 at 4:29 pm

When you are talking tens of trillions in the coming years $60 million is nothing.

What is the total annual profit of the health care insurance industry? Are you really saying that taking that money and spending it on, you know, health care would not do anything to address the imbalances in our current system?

Brummagem Joe

March 5, 2012 at 4:33 pm

By the way, your observation does nothing to refute my claim regarding sustainability. You do know that, right?

Well except that the claim is worthless because it’s untestable. One could make such sustainability claims about about all kinds of things. The simple fact is the entire developed world regards universal healthcare as a given and is able to fund it within their national budgets. A task that is made easier in their cases by the fact that their models are so much more efficient than ours. But rather than address these realities it much easier to make specious claims. You do know that, right?

Gromitt Gunn

March 5, 2012 at 4:34 pm

@Steve Verdon: Don’t buy what? That’s how managed care models currently work in practice.

Brummagem Joe

March 5, 2012 at 4:37 pm

Show me a sustainable health care system aside from Singapore and the Netherlands (maybe). So far we have one example from a country that is not at all like the U.S. All other systems share a trait with ours…none of them are sustainable. Or to put it differently, we are all rushing towards a problem with health care…the U.S. happens to be leading the way, and that is not a good thing.

See my comment on the sustainablility argument. And far from leading the way we’re behind the curve because of our gross incompetence in this area.

March 5, 2012 at 4:38 pm

Yes, I’m saying precisely that. It isn’t simply a question of spending money. In fact, we want to spend less money…or more precisely we don’t want the increases in spending to be so large.

Right now health care spending grows at something like 2-3x what our economy is growing at. Here is a thought experiment:

Take two dollar amounts: $1 and $100. Let the dollar increase each “year” by 7% and the $100 by 3%. What happens if that goes on long enough? Eventually the $1 will grow to be larger than the $100 of starting money.

That is our problem. Taking profits and spending the money on health care does not address the fundamental problem.

Now, if contraceptives work at reducing the growth rate of health care expenditures…then yeah, they probably should be part of health care coverage. I have no moral problems with it. I’m willing to be persuaded by the evidence on this particular issue. However, in general high frequency low costs health care expenditures should probably be covered out of pocket. And yeah, that could include viagra for all I care.

Jenos Idanian

March 5, 2012 at 4:41 pm

@Brummagem Joe: I disagree with your basic question..

Should employers for religious reasons (or under the Blount amendment any reason they choose) have the right to exclude contraceptives or ANY other controversial services from the healthcare insurance coverage that their female employees receive.

Rather, should the government have the power to compel organizations to pay directly for things they have a long-standing moral objection to?

After this became an issue wih the Catholic Bishops the DHHS came up with a neat way out which satisfied many Catholic organisations but not the Bishops and of course not the Republican party who decided to double down with the egregious Blount amendment which was defeated.

The positions of these Catholic organizations are irrelevant. The Catholic Church has a very strict hierarchy, and the word of the Bishops is literally (canon) law. These groups can say they can live with the “compromise” all they want; if the Bishops say “no deal,” then they can accept the deal and give up their Catholic affiliation. (The “compromise” was completely BS; it called for the insurance companies to provide it “for free,” but nothing in this world is free; they would have passed the cost back to the Church after obscuring it in some fashion.

Meanwhile the Catholic Bishops seem to have gone very quiet on the topic (I wonder why?) and I suspect the events of the last week or so are making many Republicans wish the whole issue goes quiet as soon as possible.

I suspect the Bishops are seeing how things play out before they decide whether or not to start playing serious hardball. They have a LOT of cards left in their hands. They can start talking about excommunication, shutting down Catholic institutions like hospitals, calling upon the Faithful to fight the move…

Plus, the US just got a new Cardinal, a very well-respected and charismatic fellow. He’s still getting used to his new little hat. Should he make this his cause, look out.

March 5, 2012 at 4:45 pm

We have managed care here in the U.S., such as HMOs and they aren’t working at keeping cost growth down.

I did, twice now. The fact that other countries are paying half as much is not the point. It is the growth rates. Like I said, we are out front (i.e. paying more) but everybody is hurtling towards the same cliff (i.e. no medium to large country is sustainable).

Now, that being said moving to a more European model would likely be a reasonable first step in moving closer to sustainability. I’ve noted that here on this website a number of times. However, it will not make our system sustainable, the ultimate goal. That goal might very well entail that people pay more out of pocket for the high frequency-low cost aspects of health care.

March 5, 2012 at 4:47 pm

A sustainable health care system would be one where expenditures grow at a rate equal to or below the rate of growth in the economy.

Pretty simple, and pretty easy to test.

Really, you are out of your depth here.

Meg

March 5, 2012 at 4:49 pm

A lot of folks like to trot out the low-cost options available at Walmart and Target. I would like to point out that, in the realm of birth control pills, it is not one-size fits all. Different formulations will affect different women in any number of ways, some of them very negative (migraines, gastrointestinal problems, severe mood disorders, blood clots, and so on). These “cheap” prescriptions are limited in range, and if a woman cannot tolerate that particular formulation, what would you recommend she do? Suck it up and not use the pill at all, even if there are brands out there that will work for her? Use condoms only? The latter option is also problematic in that it requires compliance from the partner. Birth control pills allow women full control over contraception. In an ideal world, all men would gladly put on the condom when asked, and all women would demand it without reservation, but in the real world, it doesn’t always work out that way. Some men will resist it, and some women won’t force the issue if their partner declines. It ain’t my business to tell those people they shouldn’t be having sex, because all the nagging in the world won’t stop them from having sex.

All of this adds up to the point that the choice to use the pill is a deeply personal decision based on any number of factors, and I’m of the mind that employers have no business telling their employee what they can or cannot do with their private health insurance benefits. I understand the discomfort that some may feel about paying into a plan that provides birth control, but people do not retain control over the money they pay to receive a service (which is what health insurance is) once that money has left their hands. This is part of living in a society. At any given moment, every single one of us has spent money that has ultimately ended up going toward something we wouldn’t have spent it on ourselves. So if you, or an employer, or whoever has a personal moral objection to the pill, then they shouldn’t use it. Doesn’t mean they get to tell someone else they can’t, or that they should have to pay full price and jump through hoops to get it (which amounts to punishing someone for not sharing your beliefs).

Gromitt Gunn

March 5, 2012 at 4:54 pm

@Steve Verdon: Okay, then, serious questions:

How do you define health care, economically. Do you see it as a public good, a private good, a social good, something else entirely?

Should Emergency Rooms be allowed an absolute right to deny care to anyone they see fit?

Brummagem Joe

March 5, 2012 at 4:57 pm

A sustainable health care system would be one where expenditures grow at a rate equal to or below the rate of growth in the economy.

I’ll ignore the gratuitous ad hom whiich is a sure sign you can’t defend your ridiculous premise. Even this definition is faulty in that ignores national priorities. Most of the Europeans are spending about 7-10% of GDP on healthcare and while containing cost is a problem it’s a very long way from being unsustainable. I would agree however that our model is probably unsustainable and that the ACA is just one step on the road coming to grips with reality.

March 5, 2012 at 5:01 pm

Health care fits the definition of a private good, by and large. Some aspects of it have external effects–e.g. immunizations. Some aspects of health policy can be seen as having possible public good dimensions as well (sewers, water treatment, etc.). But by and large health care is a private good. When a woman takes a pill so she wont get pregnant she is the only one taking that pill. It is rivalrous in its consumption and it excludable.

Should Emergency Rooms be allowed an absolute right to deny care to anyone they see fit?

Economically speaking, that sure would help with some aspects of our current problem. From a moral perspective, no. That part of the problem is very difficult to say the least and I don’t have an easy answer. In fact, on that one I don’t have an answer at all. I like the access, but the cost problems need to be addressed.

March 5, 2012 at 5:06 pm

Dude, you were the one that started out by saying I shouldn’t be taken seriously. HTFU if you are going to throw insults.

No European country has a sustainable system. Last I looked (about a year or so ago) the Netherlands might. Some are closer to sustainability than others, but all are going to have to come to grips with the issue of cost growth sooner or later.

The only country that I have found that does have a sustainable system is Singapore. Their system is very different from ours and entails things like forced savings and tiered plans (i.e. if you are rich you can opt for a more expensive plan where you’ll get nicer care–e.g. private rooms).

I would agree however that our model is probably unsustainable and that the ACA is just one step on the road coming to grips with reality.

Not really. The big fly in the ointment is Medicare and it remains to be seen if Congress will stick with it or keep doing what they have done for the last decade or so. I’m betting that they do what they’ve always done.

Brummagem Joe

March 5, 2012 at 5:08 pm

The fact that other countries are paying half as much is not the point. It is the growth rates. Like I said, we are out front (i.e. paying more) but everybody is hurtling towards the same cliff (i.e. no medium to large country is sustainable).

Now, that being said moving to a more European model would likely be a reasonable first step in moving closer to sustainability.

You do realise you just contradicted yourself here. The fact other countries are paying half as much isn’t the point but apparently moving to their model would be a reasonble first step in moving closer to sustainability. It’s the entire point. If you’re going to have any hope of containing costs and keeping them in line with society’s ability to pay (however paying is organised) you need the most efficient model for health care delivery and we have the most inefficient.

March 5, 2012 at 5:14 pm

Here is why the ACA isn’t likely to help much on health care cost growth. And it isn’t just me, it is guys like Dave Schuler, so maybe you shouldn’t take him seriously either.

You do realise you just contradicted yourself here. The fact other countries are paying half as much isn’t the point but apparently moving to their model would be a reasonble first step in moving closer to sustainability.

sigh

Okay, for exposition purposes:

U.S.: Health care costs are growing at 3x the rate of GDP growth on average.
European country: Health care costs are growing at 1.75x the rate of GDP growth.

So, if we move to the European model and see a deceleration in health care cost growth that is a good thing and no contradiction.

Now, if we could also reduce current costs as well that would be great, especially if the quality and quantity of health care is not adversely impacted. However, I don’t think that is at all possible.

Brummagem Joe

March 5, 2012 at 5:15 pm

The big fly in the ointment is Medicare

The fly in the ointment isn’t Medicare. It’s the cost of delivering healthcare. We’re paying 2-10 times what other societies are paying for medical care, routine procedures, drugs, et al. That’s the fly in the ointment. Medicare is just a single payer mechanism for meeting the bills of retirees and it’s notably more efficient in dollar terms than it’s private sector counterparts who handle employee insurance.

March 5, 2012 at 5:21 pm

President Obama: Soaring health care costs are unsustainable for families, they are unsustainable for businesses, and they are unsustainable for governments, both at the federal, state and local levels.

Maybe he shouldn’t be taken seriously either….

March 5, 2012 at 5:24 pm

Okay Joe, I’m done. You just don’t know what you are talking about. Medicare is where a huge portion of our health care dollars are spent. To say that this is not part of the problem is to indicate one is completely out of touch with reality.

And no, I’m not saying get rid of Medicare, in case you decide to go down that route. I’m merely saying that any cost containment is going to have to address Medicare. Failure to do so means you wont have cost containment.

Brummagem Joe

March 5, 2012 at 5:24 pm

sigh

Again I’ll ignore the ad hom. I can do the math. I understand the connection between a society’s growth in GDP and it’s ability to pay it’s bills for everything from grandma’s hip replacements to fighter jets.

So, if we move to the European model and see a deceleration in health care cost growth that is a good thing and no contradiction.

Except for the fact you said the the European’s lower cost model was not the point It’s the entire point. Viz.

If you’re going to have any hope of containing costs and keeping them in line with society’s ability to pay (however paying is organised) you need the most efficient model for health care delivery and we have the most inefficient.

Gromitt Gunn

March 5, 2012 at 5:29 pm

@Steve Verdon: The reason that I ask is that I think that there are two possible starting points for discussions of health care and health insurance.

If it is a pure private good – each person is individually responsible for their own healthcare – then treating health care as an insurable risk makes some sense. However, this view of insurance is what leads to things like people with a BMI above a certain point being excluded from individual policies, strict policies regarding pre-existing conditions, etc. – because in order for health insurance to be truly insurance, coverage has to be based soley on fortuitous events. Otherwise, it is has cost-sharing features that aren’t really insurable risks. Something like a catastrophic policy is a good example.

If it is a pure public good, then we pretty much should be doing single-payer.

I think that is a social good. Or at least more a social good than anything else. Since there is a floor to the level of care that we as social creatures are willing to provide to each other, healthcare has aspects of a public good, in that there are going to be free riders in the absence of an individual incentive to contribute. And government is the necessary mechanism for picking up that tab.

I have many more thoughts on this topic – it is part of my career to think about these things – but I have to run.

David M

March 5, 2012 at 5:29 pm

Medicare’s costs are not a problem. They are a symptom of the overall cost problem in our health care system. There really is no reason to worry about Medicare at all, if the solution doesn’t address the entire health care system, it isn’t a solution to our actual problem. Any solution to our actual problem will most likely fix Medicare too…

Brummagem Joe

March 5, 2012 at 5:32 pm

Okay Joe, I’m done. You just don’t know what you are talking about. Medicare is where a huge portion of our health care dollars are spent. To say that this is not part of the problem is to indicate one is completely out of touch with reality.

Back to the ad homs so I’ll say do you have a comprehension problem or something? I did not say it was not part of the problem. But it is not the major problem. Viz.

The fly in the ointment isn’t Medicare. It’s the cost of delivering healthcare. We’re paying 2-10 times what other societies are paying for medical care, routine procedures, drugs, et al. That’s the fly in the ointment. Medicare is just a single payer mechanism for meeting the bills of retirees and it’s notably more efficient in dollar terms than it’s private sector counterparts who handle employee insurance.

Instead of addressing the substance of my comment you misrepresent what I said. There’s a name for that.

Barb Hartwell

March 5, 2012 at 5:40 pm

@Dean: They have in all the plans I had starting in the 1970s I am just shocked this is an issue now.You could also get other birth control devices at that time. Go in any welfare office and get free condoms so people do not spread disease, does anyone have problems with this too. We as a society need to do what is good for the masses.

Nobody complains when we spray unwanted weeds on taxpayer money as if we let things get out of hand we would have more problems. Now I do not equate weeds with children, but the truth is many kids that are born to parents that clearly cannot take care of them. Some of these children are born with defects do to drugs and poor nutrition. Then they end up in a welfare system, sometimes in foster care and many will end up in prisons. Of -course there are exceptions but very few.

March 5, 2012 at 5:40 pm

Final link to something I wrote hear awhile ago. I know I haven’t written much here lately and many might be wondering about my overall views on health care. That link covers some of the key points.

Brummagem Joe

March 5, 2012 at 5:51 pm

Btw Steve since you have obviously chosen not to respond to my critique Medicare that big fly in the ointment covers about 20% of total US healthcare expenditures as best I recall. It’s a mechanism for paying that probably comes closest to some of those European models you applaud (and sure it’s going to increase in the years ahead as the boomers come on board) but the real problem lies in the cost of providing care not how we organise paying for it. You do know that, right?

Brummagem Joe

March 5, 2012 at 5:57 pm

@David M:

Medicare at all, if the solution doesn’t address the entire health care system, it isn’t a solution to our actual problem. Any solution to our actual problem will most likely fix Medicare too…

Exactly so. People like Verdon want to focus on the symptoms not the disease. Hence they bloviate about the outrageousness of adding contraceptives to the schedules of insurance coverage or Medicare which is obviously facing future funding problems with the advent of boomers but the vast bulk of the 2.5 trillion we’re spending is going to providers who are basically ripping us off.

Jenos Idanian

March 5, 2012 at 6:08 pm

@Meg: These “cheap” prescriptions are limited in range, and if a woman cannot tolerate that particular formulation, what would you recommend she do? Suck it up and not use the pill at all, even if there are brands out there that will work for her? Use condoms only?

Here’s an ugly word: “Prioritize.”

I have a cheap cell phone that is just a phone — the camera doesn’t even work for me, ‘cuz without an internet connection (and no removable card) I can’t get the images off the camera. I have a seven-year-old laptop with a busted hinge. But I have a new tablet and a 2-year-old desktop that I built myself, as well as a reliable car. I’d like a smart phone and a new laptop, but I have higher priorities for my money — including my medical needs.

There seems to be some notion that health care shouldn’t cost people. Well, it ain’t free. It’s just like any other good or service; it has to be paid for by someone. And as the ultimate consumer of those goods and services, I prioritize my expenses.

That means I do without some things I’d really like. Which sucks. But that’s life.

Besides, I thought the mantra was “get the government out of our sex lives.” How do we jibe that with “I want the government to pay for my sex life?”

anjin-san

March 5, 2012 at 6:15 pm

@ Steve Verdon

I’ve heard the annual profit of the health care industry estimated @ 200 billion. Call me crazy, but I think if we took that money off the table, it would help with the issue of delivery costs.

WR

March 5, 2012 at 6:20 pm

@Jenos Idanian: ” I’m saying the other uses are irrelevant to this discussion. The issue is those who morally oppose contraception being forced to pay for it anyway”

We are all forced to pay for things we’re morally opposed to. I’m morally opposed to aggressive wars like Iraq and the death penalty. I’m morally opposed to shovelling my tax money to freeloader states in the south. Why don’t you spend some time fighting for me, instead of for the couple hundred Catholic bishops who are the only ones who give a damn about this?

WR

March 5, 2012 at 6:24 pm

@Tsar Nicholas: Oh, my goodness, Tsar N has finally found someone he’s actually heard of.

Can’t say I’m surprised that one person is Limbaugh.

David M

March 5, 2012 at 6:27 pm

@WR: Don’t forget in this case the Georgetown students are the ones paying for the insurance, not Georgetown. His objection doesn’t even apply. Also, he obviously is not familiar with Fluke’s testimony, as a significant portion of it was about non-contraceptive use.

Brummagem Joe

March 5, 2012 at 6:52 pm

I’ve heard the annual profit of the health care industry estimated @ 200 billion.

Total health expenditures are around 2.5 trillion and the private insurance share of that is about 35% or maybe 900 billion. The industry stop loss ratio is claimed to be in the 80-82% range so that’s around 180 billion gross income so it’s in the ballpark. Of course out of that they have to take their O/H replete with fat management bonuses. I think the industry nets 4-5% which is pretty good for a low risk business.

March 5, 2012 at 7:01 pm

I think it is a private good. I think most people want to treat it like a pure public good. I acknowledge that my position is weak in the sense that people love to get something they perceive as not having to pay for. As such, I think policy should be crafted to limit the damage of treating a private good like a public good.

So I would say I’ve reluctantly ended up at your social good definition. But to be clear, I think this is a bogus category of good. Any private good can end up in this category if enough people think they should get some sort of help in consuming it.

March 5, 2012 at 7:12 pm

You’ll get a one time decrease in the total cost, the rate of growth on the other hand may hardly be impacted at all. It is the growth rate of costs.

I know everybody loves to point to private insurance, but that is not really the cause of our problems (e.g. some European countries have private insurance companies as well).

For example, Medicare reduces the incentive to save while one is working. Savings is where investment tends to come from. Less savings means that you will end up with less investment, unless the investment is done by foreigners (looks over at our current account deficit). That can have implications for long term growth rates. Note that Singapore, IIRC, doesn’t have something like Medicare (or if they do it is pretty small). They do have mandatory health savings accounts though. Would that work or help here in the U.S.? I don’t really know for sure, but it might.

Also, we’ve created a significant tax incentive for health benefits and quite possibly over insuring. Changing that could also help–e.g. taxing health care benefits as if they were income.

Brummagem Joe

March 5, 2012 at 7:13 pm

I think it is a private good. I think most people want to treat it like a pure public good.

Yes much easier to talk about this ephemeral philosophical stuff than substantive issues being raised by people who are out of their depth isn’t it Mr Verdon?

I was answering a question that was asked of me.–SV

Meg

March 5, 2012 at 7:17 pm

Government isn’t paying for my sex life. Contraception, even under the mandate, is not free. I am paying for it by buying into a private insurance plan. What the government mandate does is tells insurance companies I don’t have to pay more than I already do for it. It tells employers that they can’t preclude me from paying for it at a reasonable rate. It tells employers that my sex life is none of their business to regulate based on their moral convictions.

I mean, if we want to be honest, I don’t think contraception should be prescription-only. I wish it were available over the counter at more affordable prices so that this wouldn’t be an issue at all. However, so long as it is a prescription-only, medical expense at the price that it currently is (for what it’s worth, without insurance, I would pay $800/year for my birth control, which is a generic), insurance coverage is necessary. I also find it incredibly presumptuous of you to assume that a woman trying to afford her birth control doesn’t already tightly control her expenses. How do you know that she hasn’t already foregone cable, or a fancy cell phone plan, or any number of other luxury expenses? No matter which way you cut it, without the benefit of insurance, birth control can be prohibitively expensive.

I actually generally agree with Alex’s basic argument that insurance is a bastardized way to deal with skyrocketing health care costs. But it’s the best system we’ve got right now. And I’m quite resentful of this overall debate because birth control (and Plan B, if we’re being comprehensive) is the ONLY prescription drug that carries this undue moral baggage. This whole discussion invades women’s privacy and, as I said, punishes them by forcing them to pay extra for basic preventive care.

March 5, 2012 at 7:18 pm

That is a lie Joe and you know it. I haven’t been bloviating about adding contraceptives, from the OP I indicated I’d be willing to consider including them in insurance if they reduce costs.

This is why I’m trying to ignore you. You are intellectually dishonest.

Brummagem Joe

March 5, 2012 at 7:21 pm

I know everybody loves to point to private insurance, but that is not really the cause of our problems (e.g. some European countries have private insurance companies as well).

It’s part of the problem because a private for profit industry has less incentive to hold prices down in a market where demand is inelastic. And sure several European countries run their programs via insurance companies but they are very tightly regulated not at all like here.

For example, Medicare reduces the incentive to save while one is working.

Oh boy now Medicare is responsible for low savings rates.

March 5, 2012 at 7:28 pm

I never said that Medicare is responsible for the low savings rate, I indicated it is a factor in that it reduces the incentives to save. There are other factors as well, such as taxes on interest income just off the top of my head.

I know it is fun to try and score points here, but really all it does is lower the signal to noise ratio.

Brummagem Joe

March 5, 2012 at 7:31 pm

This is why I’m trying to ignore you. You are intellectually dishonest.

I’m not in the least intellectually dishonest. And I haven’t lied about something you said as you did about a comment of mine. The reason you’re ignoring me is because I’m reasonably well informed on this topic (not a expert by any means) and am able to point out the flaws in your arguments

I haven’t been bloviating about adding contraceptives,

Oh really what was this then?

As for health care and insurance, yeah the idea of insurance is costly and rare. That we don’t do that is one of the reasons why health care costs are out of control. I know it isn’t a popular position, but the idea that we can “have everyone else pay for everyone else’s frequent and low cost health care” is not a sustainable position.

Brummagem Joe

March 5, 2012 at 7:35 pm

I never said that Medicare is responsible for the low savings rate

You could have fooled me Viz

For example, Medicare reduces the incentive to save while one is working.

anjin-san

March 5, 2012 at 7:44 pm

There seems to be some notion that health care shouldn’t cost people.

Yes, and it exists in the minds of peanut heads such as yourself. The right wing noise machine has told you that this is what “liberals” think, and you bought it, hook, line, and sinker.

Jenos Idanian

March 5, 2012 at 7:50 pm

Something bugged me about the “well, my taxes pay for things I don’t like” argument, and it finally clicked: in taxes, it’s all going to a general fund to be spent by the government. Here, we’re talking about money going from one private entity to another for a very specific purpose. NOT a good comparison.

March 5, 2012 at 7:51 pm

Whatever Joe. If it makes you feel better, you are super smart, 100% correct in everything you write and we should all bow down to your greatness.

Happy?

March 5, 2012 at 7:53 pm

FFS….

Joe, it is one factor that is lowering our savings rate.

Jesus f*cking Christ on a pogo stick….that I have to explain every little thing…

David M

March 5, 2012 at 8:02 pm

@Jenos Idanian: LOL, if “it’s all going to a general fund to be spent by the …” doesn’t describe an insurance company, I don’t know what does. Besides, the money is going from the Georgetown students to the insurance company. I see no reason that transaction shouldn’t be regulated by the government or why it should be subject to Georgetown’s whims

March 5, 2012 at 10:02 pm

March 5, 2012 at 8:08 pm

Health care benefits are paid for by the employee, not the employer. Sure the employer writes the check, but so what, it is part of the employee’s wage and benefits package. That is, absent the benefits in a competitive labor market the wage would increase so that it would include the benefits costs as well.

So the idea that an employer has to “pay for something they find morally objectionable” is a complete load of baloney.

Or to put it more simply: If Meg wants to use your health care benefits to get birth control they are her benefits and she should be allowed too. All the moralizing busybodies….STFD, STFU. Unless you are living a sin free life maybe you shouldn’t be so preoccupied with what others do with their lives.

Meg

March 5, 2012 at 8:27 pm

@David M:

I think this is an important detail that has been lost in the conversation. Under Georgetown’s student insurance program (which, once upon a time, I paid into as a grad student), students pay the entire premium up front, in addition to a deductible. So it’s particularly out of line for the school to deny the coverage of contraception since they’re not paying any portion of the student’s premium. This is where the religious freedom argument oversteps its boundaries.

Nikki

March 5, 2012 at 9:12 pm

@Dean: Good question. Might I posit that it is because men head insurance companies? After all, throughout this entire birth control fight, it has been mostly men who have argued so vociferously against providing cost-free coverage.

WR

March 5, 2012 at 9:31 pm

@Steve Verdon: “Jesus f*cking Christ on a pogo stick….that I have to explain every little thing”

Well, only because your claim that Medicare lowers the national savings rate is so insane and so ludicrous no one could believe you were actually making it.

Hazel

@Dean: That’s why insurance companies supported the Obama mandate.

March 6, 2012 at 11:33 pm

March 6, 2012 at 2:09 pm

@WR:

Why? It seems quite reasonable. Without it people would increase their savings to better cover health care expenses later in life. Now much of those expenses are covered by someone else. Basic economic theory suggests that taking that savings and using it for current consumption is what most people would do.

See for example, this paper, and this one.

matt

@Steve Verdon: HhAhaha

Pre-medicare reality doesn’t jive with your ideology…