Patterico's Pontifications

7/8/2009

Obamacare’s “public plan” is built on a Medicare myth

Filed under: General — Karl @ 1:22 pm

[Posted by Karl]

When Pres. Obama did his hour-long pitch for a government takeover of the US healthcare system on ABCNews, he offered a standard defense of a government-run insurance plan:

The concern, [Charlie] Gibson articulated, is that such a plan wouldn’t be offered on a level playing field.

The president rebuffed that, arguing that “we can set up a public option where they’re collecting premiums just like any private insurer and doctors can collect rates,” but because the public plan will have lower administrative costs “we can keep them [private insurance companies] honest.”

However, the same day Pres. Obama said that, the Heritage Foundation issued a report by Robert A. Book, Ph.D., showing that:

[O]n a per-person basis Medicare’s administrative costs are actually higher than those of private insurance–this despite the fact that private insurance companies do incur several categories of costs that do not apply to Medicare.

Pointing this out is sufficiently dangerous to the Left that New York Times columnist Paul Krugman attacked Book’s study — or, more accurately, attacked the Heritage Foundation, as ad hominem is twice as good coming from someone who used to advise Enron. Unfortunately for Krugman, the NYT allows comments, thus allowing Book to embarrass Krugman on his own site.

Moreover, Krugman’s attempted attack did not even address the point Book made in passing, but which Merrill Matthews notes with a bit more detail:

Public figures for Medicare’s administrative costs count only what it takes to print reimbursement checks. Normal operating costs — rent, management, health insurance, taxes, capital to start a business and new equipment — which private insurers must include in their administrative costs, are counted elsewhere in the federal budget.

Official Medicare administrative costs simply exclude what most companies must include. No administrative cost savings exist in the public plan, and the true costs will never be counted because they’ll be hidden in the federal budget.

For that matter, as Shikha Dalmia recently pointed out:

[L]ower administrative costs do not necessarily mean greater efficiency. Indeed, the Congressional Budget Office analysis last year chastised Medicare’s lax attitude on this front. “The traditional fee-for-service Medicare program does relatively little to manage benefits, which tends to reduce its administrative costs but may raise its overall spending relative to a more tightly managed approach,” it noted on page 93.

In short, Medicare — our already-existing government-run health insurer — does not have lower adminsitrative costs. That myth is based on fuzzy math, the program’s own laxity, and the fact that it gets to hide its costs elsewhere in the federal budget. Indeed, that last factor is the sort of unfair competition that is essential to the government-run plan envisioned by the Left. Pres. Obama claims he wants to keep private insurers honest, but he’s not being honest himself.

(Thanks to Craig Newmark via Mary Katharine Ham.)

–Karl

104 Responses to “Obamacare’s “public plan” is built on a Medicare myth”

  1. I have been screaming this for years.

    ‘Bout time.

    HeavenSent (641cde)

  2. If this were such a great idea, they would not need to lie about what they want to do, and how they plan on doing it.

    JD (47b659)

  3. And Krugman beclowns himself yet again.

    SPQR (72771e)

  4. Indeed, the Congressional Budget Office analysis last year chastised Medicare’s lax attitude on this front

    Has there ever been a POTUS so at odds with his own CBO estimates and projections? Obama’s fantasy math truly begs credulity, and yet the reality is that most of the staffers at the CBO happen to be Democrats as well (if memory serves). When you’re at opposite ends with institutions from your own supposed loyal constituency, you’re going down a rabbit hole of immense proportions.

    BTW Karl, is that the Craig Newmark of Craig’s List mentioned here? If it’s the same guy, then holy frijole, Obama’s already in the crapper.

    Dmac (e6d1c2)

  5. JD, Karl, furthermore, if they were being honest about the whole deal, they’d be able to tell us why Medicare is going broke, and why the feds had to step in to help with medicaid which just about broke the backs of the various states. You don’t suppose dishonesty is their stock in trade do you?

    GM Roper (85dcd7)

  6. The irony of it for me is that I suspect that more people would be more willing to support these ideas if they were just f*cking honest about them. When it is obvious that they are lying to your face, it makes you wonder what else they are lying about.

    JD (0d62a3)

  7. If a National Public Healthcare scheme were the answer, the Native-Americans would have the finest healthcare system in the world, instead of the 150+-year history of neglect and abuse they suffer with.

    AD - RtR/OS! (685f75)

  8. Official Medicare administrative costs simply exclude what most companies must include. No administrative cost savings exist in the public plan, and the true costs will never be counted because they’ll be hidden in the federal budget.

    This is the perfect kind of accounting for people who think a government option provides free health care.

    MayBee (5ff8b1)

  9. It is an interesting analysis, but comparing the two is a bit apple and orange. The medicare patients are probably older with higher care and administrative cost per patient. A narrower comparative study using similar populations and demographics would provide us a clearer picture.

    Still, if anything it shows us costs are comparable and there will likely be no savings with a government program. That is unless they plan on savings by keeping users from getting their full medical treatments.

    Ray (50c3a0)

  10. I read all the comments and saw no one mention the difference between non-profit and for-profit entities, especially in healthcare. That was quoted as the advantage of single payer by a number of the comments. It would be instructive for someone to work in a for-profit hospital that becomes non-profit. I have. What is the big difference ? There are no shareholders so the administrators add many, many more employees and the incentives switch from making money for shareholders to empire building and increasing salaries. The eventually cost to the customer in both cases becomes what the market will bear but the for-profit, although often ridiculed for its profit-making nature, is far more efficient and agile.

    I deal with both for-profit and non-profit (State Comp) companies every day. It shows.

    Mike K (2cf494)

  11. That’s what they plan, Ray, Obama has even hinted at it in his faux “townhalls”.

    SPQR (72771e)

  12. The irony of it for me is that I suspect that more people would be more willing to support these ideas if they were just f*cking honest about them. When it is obvious that they are lying to your face, it makes you wonder what else they are lying about

    Exactly.
    Would it be so bad to say, the government can provide you some minimum level of care. You might not be able to choose your doctor and you may get your vaccinations at a clinic rather than in a posh doctor’s office, but nobody will go without standard treatment. ?

    Also, they can surely do an analysis of how much money people currently spend on overpaying for their own care to make up for those who do not pay for care.
    Come up with that figure, then let us know if they can save more than that by offering a public plan.

    MayBee (5ff8b1)

  13. Come up with that figure, then let us know if they can save more than that by offering a public plan.
    Comment by MayBee — 7/8/2009 @ 2:35 pm

    MayBee,

    It’s not about saving money or even providing healthcare. It’s about power.

    Stashiu3 (3fc50f)

  14. #12 — “You might not be able to choose your doctor and you may get your vaccinations at a clinic rather than in a posh doctor’s office, but nobody will go without standard treatment. ?”

    IT ALREADY EXISTS!!!!!!!!! It is called the County Health Clinic people want to avoid because they are slow, over staffed and provide crappy service..

    HeavenSent (641cde)

  15. The other big lie is people go without health care because they lack insurance and there are no reasonable cost options.

    The health system is littered with “free care” if only folks bothered.

    But people are lazy lumps who want everything easy.

    HeavenSent (641cde)

  16. Check out this excellent article by Dan Walters on the role of unions in wrecking California’s budget. (Sorry for being off-topic; there are almost no California conservative blogs.)
    http://www.sacbee.com/capitolandcalifornia/story/2008291.html

    Wesson (03286d)

  17. Health care is expensive. While you might be able to squeeze a small amount from administration costs, insurance and liability, the driving cost for health care is cost of services. The more you want the more it costs. In the 1930s, health care was far less expensive, because there was very little health care. The services available now are amazing, but amazing has a price tag.

    The only way to build efficiency into the system is to make health care competitive. Is it any wonder that plastic surgery costs are rising at a far lesser rate than other services privided under medicare and insurance, the reason is the market is pushed to stay competitive.

    Joe (a32cff)

  18. Electing God, in this case Rahm Emanuel’s brother (the doctor not the foul mouthed agent).

    Joe (a32cff)

  19. Or rather Electing God and then delegating to Rahm’s unelected brother.

    Joe (a32cff)

  20. And the real cost of health care, the real blood in the turnip, is research.

    The federal government really is lousy at choosing what to research. Only recently did they stop pouring money into Spam style home remedies that some congressmen liked.

    I got flack earlier because I don’t have health insurance and don’t want to pay for it in any shape. But my sister does have some, for a very tricky condition that is easily in hand, but required a lot of research and is not a one size fits all illness. I seriously wonder a) if Obama would tell her to use a more popular medicine and b) if newer treatments will be discovered if the drug companies aren’t making as much money.

    Juan (bd4b30)

  21. I’m almost 63 years old and a lung cancer survivor for 3.5 years. But, if it comes back under obamacare, I’ll be turned away from state of the art treatments because I’m to old. I still got a lot of work in my future and I don’t mind dying, but damn, if I get the short end of the stick because of rationing? That sucks. :)

    GM Roper (85dcd7)

  22. IT ALREADY EXISTS!!!!!!!!! It is called the County Health Clinic people want to avoid because they are slow, over staffed and provide crappy service..

    And who says the disadvantaged aren’t already given a big helping hand here in America, by the public sector of the US? Certainly as things are in California, where thousands of people on any given day glom onto the services and staff of various hospitals, get treated, don’t pay a nickel — don’t pay a cent — and then walk out the door. (I imagine Obamacare will make it that much nicer and easier for the mooches not just in Calif but throughout the US — citizens or not — to hitch a ride on the system.)

    Then there’s the example of the extremely politicized, extremely do-gooders-R-Us King-Drew Medical Center in Los Angeles, the very essence of the party and ideology of Obama. Never mind that it’s gone out of business. Just sing a round of kum-bah-wah and all will be forgiven.

    Mark (411533)

  23. I hope that doesn’t happen, GM, to you or anyone else.

    DRJ (6f3f43)

  24. If people just ate their cheerios most of these problems wouldn’t be near so bad, what I heard.

    happyfeet (e8d590)

  25. Ray (#9),

    If you read Book’s response to Krugman, he gets into a comparison of Medicare vs Medicare Advantage patients, and the point generally holds, despite the fact that Medicare Advantage enrollees tend to be a much healthier population than Medicare generally.

    Karl (ade276)

  26. happyfeet, I got a lot of grief when I posted a book review on what sounds like one of those quack remedy books that sell so many copies. The book was The great American Heart Hoax and purported to show that heart surgery was unnecessary and a plot by greedy doctors. In my review, I suggested that if everyone just kept their weight in the ideal range, exercised and didn’t smoke, they wouldn’t need the book OR heart surgery.

    Lots of outrage, as you’ll see if you look at the link.

    Mike K (2cf494)

  27. Lots of outrage, as you’ll see if you look at the link.
    Comment by Mike K — 7/8/2009 @ 5:43 pm

    Well, of course, Dr.Mike.
    How dare you be critical of their life-style choices.
    You are sooooooo insensitive, and judgemental, too!

    AD - RtR/OS! (685f75)

  28. Mike K – Do you have any idea where to look for a realistic height/weight chart would be? Some of them are so utterly unrealistic so as to make them meaningless.

    JD (17b802)

  29. that is very wise Mike. What’s cruel though is how keeping your weight in an ideal range is at such odds with quitting smoking. Definitely proof we’re living in a fallen world I think, if more were needed.

    happyfeet (e8d590)

  30. Mike K,

    I agree with you, but I’d add that people also need to choose their parents carefully.

    DRJ (6f3f43)

  31. I love this from your amazon thread…

    This is just someone using the viral marketing of web 2.0 to spread his own agenda.

    precious monkey founded himself some buzzy buzzy words

    happyfeet (e8d590)

  32. I wrote about this in May: in 2006, Medicare reimbursed hospitals a grand total of $205.7 billion, but Medicare patients incurred $225.1 billion in costs to hospitals, a $19.4 billion loss and net operating margin of -9.4%. And Medicare was considerably better than Medicaid, whose patients left hospitals with a 14.7% operating loss. It is only by overcharging responsible people who actually buy health care insurance that hospitals make a profit, a whopping 6.4% operating margin in 2006.

    The numbers were pretty clear: if the federal government took over all health care, and reimbursed hospitals the same way it does so now for Medicare, our hospitals would all go broke! We’d have “free” health care, but no place to get health care.

    An important study by the actuarial firm, Milliman finds that Medicare underpays hospitals by $34.8 billion and physicians by $14.1 billion, while Medicaid underpays hospitals by $16.2 billion and physicians by $23.7 billion. These amounts are made up for by commercial payers, resulting in 18% greater costs for private carriers for hospital services and 12% for physician services.

    This is why physicians don’t like taking Medicare and Medicaid patients: payments are low and slow.

    The mathematical genius Dana (474dfc)

  33. The services available now are amazing, but amazing has a price tag.

    There’s the argument that the most popular procedures are the ones that cost the most money, even when no therapy has been shown superior to another. And that no one seems eager to delve too deeply into wasteful care.

    The country is paying at least several billion more dollars for prostate treatment than is medically justified — and the bill is rising rapidly.

    You may never see this bill, but you’re paying it. It has raised your health insurance premiums and left your employer with less money to give you a decent raise. The cost of prostate cancer care is one small reason that some companies have stopped offering health insurance. It is also one reason that medical costs are on a pace to make the federal government insolvent.

    steve (bdaad1)

  34. Juan may be the smart one:

    I got flack earlier because I don’t have health insurance and don’t want to pay for it in any shape.

    In a capitalist system, discipline is imposed by the fact that you get what you pay for; if you don’t pay for something, then you don’t get it.

    Juan may be quite healthy, but if he gets run over by a 1969 Volkswagen microbus filled with aging hippies, and requires serious, major, expensive hospital care, the fact that he is uninsured does not mean he won’t be treated: we simply will not let him just die in the street because he doesn’t have insurance.

    This is the breaking of capitalist discipline: Juan knows that, in extremis, he actually does have health care coverage, even though he chooses not to pay for it. I don’t know Juan; perhaps he is wealthy and can pay for such a personal catastrophe out of his own pocket. But whether he, personally, has the resources to be responsible for his own expenses, millions of others do not, and drag down the system.

    This is our greatest problem in health care coverage: we are trying to run a capitalist system over a socialist benefits program. In the end, that cannot work.

    The serious Dana (474dfc)

  35. steve,

    How much more wasteful will health care be if people think it’s “free”? They will head to the doctor for every sniffle, cough and ache.

    DRJ (6f3f43)

  36. The daughter got herself a “skateboard cut” on her chin (with no skateboard involved). Her pediatrician, for whatever our insurance pays plus $20.00, said, “She’s a girl. Take her to a plastic surgeon”. The plastic surgeon said, “I do not take insurance. $7,000.00.” I minded the general anesthesia a lot more than the money.

    nk (b5d4a6)

  37. The serious Dana,

    I think that’s a good point — health care is already socialized when it comes to most emergent and life-threatening care — but in that case we should only be talking about government-sponsored catastrophic coverage.

    DRJ (6f3f43)

  38. Dana, I agree that I know I have something like coverage in an emergency.

    I assure you, however, that I do pay for it, since I’m not destitute. If I have an ambulance ride and the emergency room helped me, I would pay my bill. I also pay taxes. I also don’t have catastrophes and manage my risk very well.

    but, at the end of the day, I also think it’s perfectly decent of society to provide ‘free’ ambulances and treatment for real emergencies. Not free treatment for anyone who shows up at the emergency room, or free ambulance taxi service, but something like a catastrophic service, like police and fire, wouldn’t be such a bad thing for my tax dollars to fund.

    The creep from that to socialist heath care, which as you note competes with private insurance and… my health care, which is to go to the doctor when I’m sick and pay him with my Visa card.

    Juan (bd4b30)

  39. Steve linked an article which notes that there are “side effects” to the more invasive treatments for prostate cancer, but doesn’t tell you what they are. A lot of men don’t choose them because they often mean wet pants and an end to sex. The more expensive procedures are designed to avoid those side effects.

    When we wind up with single payer, it will be simple: the high-dollar tests are too expensive, so you can choose to have a dead dick and wet pants, or you can hope that die faster from something else.
    ___________________
    ¹ – PSA: Prostate Specific Antigen

    The Dana who has had a PSA¹ test and is safe (474dfc)

  40. They will head to the doctor for every sniffle, cough and ache.

    As Mike related earlier (and I’ve witnessed myself while in Canada), the hospitals are crammed to the gills with the “worried well.” It puts the lie to the axiom of preventative care in many respects, unfortunately.

    Dmac (e6d1c2)

  41. They will head to the doctor for every sniffle, cough and ache.

    Comment by DRJ — 7/8/2009 @ 7:13 pm

    That was the experience of GP’s after the start of Medicare/Medicaid, and caused the first big explosion in healthcare costs as demand ramped up but the supply of caregivers was relatively static.

    AD - RtR/OS! (685f75)

  42. … is bad.

    Sorry for the fragment.

    Juan (bd4b30)

  43. And really, is there something wrong with emergency care that becomes a debt that is dischargable only through bankruptcy?

    If emergency rooms simply didn’t do anything but emergency work, and had a county clinic next door, I really wouldn’t have a problem with this.

    This idea that I’m some kind of freeloader because I don’t have insurance is very amusing to me. I simply don’t use services I don’t want. I look up basic things on google and use OTC medications. I dieted really well in much the same way. I do get checkups when I get sick enough to want antibiotics, and when I’m older I intend to get really good insurance (perhaps paid for largely with the money I have saved by not having insurance when I am a healthy young man).

    What I’m getting at is that universal health care is a transfer of wealth from me to the people who don’t take good care of these issues.

    Juan (bd4b30)

  44. Comment by The Dana who has had a PSA¹ test and is safe — 7/8/2009 @ 7:22 pm

    I can afford to go to Europe for the procedure I want. Anyway, my urologist is not going to let the Watusi Weenie tell him how to do his job. He will go to Europe, on vacation, with the money I pay him, for the operation I need.

    nk who needs to have his PSA retested and found out the hard way what DRE stands for.

    nk (b5d4a6)

  45. DRJ wrote:

    I think that’s a good point — health care is already socialized when it comes to most emergent and life-threatening care — but in that case we should only be talking about government-sponsored catastrophic coverage.

    At this point, I’d note the case of Diamonte Driver. Young Master Driver (he was twelve) died due to an untreated abscessed tooth; the infection spread to his brain. His mother had let the family’s Medicaid coverage lapse through the failure to complete government paperwork, and felt frustrated when Master Driver’s mother could not find a dentist who would accept Medicaid patients for his older brother. Master Driver’s case wasn’t an emergency case until very late in the game, when the abscess spread.

    The Drivers were eligible for Medicaid, and had been in the system. The coverage lapsed because of the typical government paperwork that is imposed to keep cheaters from abusing the system, and Mrs Driver’s inability to keep up with it.

    Our health care system is socialized not just when it comes to emergency and life-threatening care, but routine things as well; it’s just not socialized well or efficiently.

    The anti-socialist Dana (474dfc)

  46. nk, someone I care about is dealing with prostate cancer. You’re in my prayers for that.

    I know that in the near future, we’ll still have all of our basic treatments. Rich people aren’t going to lose too much. The democrats writing these laws will be fine.

    But Sasha and Malia will be harmed. So will I. The baby boomers have taken so much from my generation, and now they are actually trying to take away innovation and research.

    Juan (bd4b30)

  47. Dana, that’s sickening. Partly because of the paperwork mess, but also because, at the end of the day, she probably could have gotten this young man to non life threatening situation for an easily attainable sum of money.

    Perhaps I’m wrong, and I’m sure this isn’t the case for every single illness. But part of the problem with ‘free’ health care is that people think they are suckers if they pay for health care.

    Juan (bd4b30)

  48. NK: I had some routine tests done about two months ago, which was my first visit to a physician in seven years! I do go to the dentist routinely, though I’m not sure whether it’s because I want to keep my teeth clean or because of the absolutely gorgeous redheaded dental technician who works there.

    The Dana married to a nurse but who still avoids doctors (474dfc)

  49. Juan wrote:

    she probably could have gotten this young man to non life threatening situation for an easily attainable sum of money.

    You could and I could, but Mrs Driver was in and out of assistance shelters.

    The Dana who isn't poor (474dfc)

  50. Thank you, Juan, but I have not been diagnosed with cancer, yet. I am (still) in the watching part, a finger up the ___ and a needle stick in the arm every three months.

    nk (b5d4a6)

  51. All we really need to know is that Barcky and the congresscritters will not be required to be a part of this system. Teh One told us as much.

    JD (28a22e)

  52. Don’t forget the example of Hetty Green, who was almost certainly the richest woman in America when she died in 1916, but refused to pay for treatment for her son’s broken leg. She tried to get treatment for him at a hospital charity ward, and was indignant when she was recognized and aked to pay for services. He survived, despite gangrene and amputation of the leg.

    She inherited $7.5 million in 1864, four years before her son’s birth, and was worth over $100 million at her death.

    GaryC (c1edfb)

  53. The reality is that the White House keeps touting fake “deals” with segments of the health care industry to pretend that they are leading something.

    I can’t figure out who is fooled by the White House’s vacuous press releases – other than MSM lapdogs like Krugman.

    SPQR (26be8b)

  54. When we wind up with single payer, it will be simple: the high-dollar tests are too expensive, so you can choose to have a dead dick and wet pants, or you can hope that die faster from something else.

    Doctors should provide treatment when the true probability of effectiveness is high. A significant part of our current system favors high-dollar procedures over cost-benefit imperatives. Profit care over patient care.

    I’m so glad I never got a vasectomy.

    They make you wear a cast, and then everybody wants to sign it.

    steve (bdaad1)

  55. People in the media still rarely question Teh One about how he plans to make the first government run healthcare program actually more efficient and more cost effective than the private sector. This is one of those lies that is never actually addressed, and is simply one of those dishonest platitudes that they let slide on by. Also, they never seem to ask him how he plans on paying for this.

    JD (126241)

  56. steve, so you support Obama’s suggestion to quit treating the terminally ill.

    That’s the kind of rationing that your proposal results in in practice.

    SPQR (26be8b)

  57. SPQR – You should know by now that they will not admit to that. That will be the part of the bill that is not actually yet written when voted on. Just ask Steny Douchenozzle Hoyer.

    JD (af8fa5)

  58. JD, Obama let it slip in his townhall meeting and has been scrambling to lie about it since.

    SPQR (26be8b)

  59. I made no proposal.

    The “Be afraid, be very afraid” gambit, as we know, cuts in both directions.

    steve (bdaad1)

  60. Ah, steve, you are a true Obamaphile. For that’s Obama’s tactic too, to not actually make any concrete proposals.

    The Democrats intend to push through a stealth bill specifically to avoid allowing opposition to coalesce.

    It is really going to be a disasterous political move by Democrats. Obama will be a one term president and Democrats will lose their control of Congress quickly as the American public realize how they are being screwed.

    SPQR (26be8b)

  61. Karl, “despite the fact that Medicare Advantage enrollees tend to be a much healthier population than Medicare generally.

    Just the opposite.

    With that said the alleged “inefficiency” of Advantage Plans has nothing to do with Medicare being more efficient — it has to do with when Medicare outsources its role to Advantage Players it has to pay the Advantage Players for those admin cost Medicare conveniently forgets to include in its cost calculations.

    Secondly, Advantage plan while profitable (20% net margins) have become so competitive they are offering benefits never envisioned in basic Medicare like DENTAL COVERAGE, FREE TRANSPORT, GYM AND WELLNESS BENEFITS.

    So in essence not only are Advantage Plans as costly as Medicare (when Medicare assumes admin costs i pawns off on the Feds) it also works so efficiently that it creates more value for it’s beneficiaries than regular Medicare.

    And that is what capitalism has shown us in its brief 250 years of history. It simply squeezes more from a lemon.

    Advantage hands down delivers more dollar for dollar than Medicare does.

    HeavenSent (641cde)

  62. I kind of like this whole “health-care” debate because it makes liberals such as Steve — and Obama and all their ilk — argue that certain people shouldn’t receive the care that doctors believe is necessary because that would result in everyone receiving care that their doctors recommend.

    So, let’s kill ‘em in the womb and kill ‘em when they’re old and everyone receives free health care except when it may actually help them live.

    It’s an interesting conundrum that they can’t seem to logically talk themselves out of.

    Ag80 (3acbfd)

  63. Don’t let ‘em be born, or let them die early, and it will be unicorn farts and fairy dust for everyone!

    JD (fd1993)

  64. steve is all in favor of Barcky’s plan, but if you ask him, he will not be able to tell you what that plan is, what it will entail, what it will cost, or how it will be paid for. He just knows that he wants what Teh One told him he deserves.

    I like capital-S Steve far better.

    JD (cdb4e1)

  65. The Democrats intend to push through a stealth bill specifically to avoid allowing opposition to coalesce.

    I’m certain the opposition will coalesce.

    Reliance on science over belief when it comes to unneeded procedures should be requisite.

    Six Common Medical Procedures That Do No Patient Any Good – Norton Hadler, MD.

    steve (bdaad1)

  66. steve – That is a very stupid sounding article. The reactions in the comments were pretty much uniformly negative, including those from some medical professionals. Did you even understand it?

    daleyrocks (718861)

  67. Feel free to rebut the conclusions.

    Or those from the earlier piece.

    There’s nobody whose job it is to say no to surgeries being done without scientific evidence. I believe that at Kaiser, doctors tend to be paid a set salary regardless of which procedures they do.

    It’s one facet of the debate, no more.

    steve (bdaad1)

  68. Steve:

    Good article from a single doctor with references. I do have a couple of quibbles.

    Can’t argue with the oral prescriptions for Type II diabetes. I guess we should just dig the holes and bury the folks with this disease. What’s the point in trying? As the doctor said:

    “We decided that we needed to reanalyze the complex data set ourselves to make a better informed decision about what the meaning of those data might be.”

    Do stents and by-passes work? Probably not in the long-run, but they definitely do clear blocked arteries long enough for people to resume healthy lifestyles and receive therapeutic treatments to extend lives.

    Don’t take those screening tests, they’re useless, unless, you know, you actually have the disease they screen for. Don’t worry about that cracked hip, Granny, your useful life is done.

    Arthroscopic surgery also is no good. Thousands of athletes can’t be wrong.

    Look, I agree that many tests and procedures may not work out for the best for everyone. I also know that these types of procedures result in increased expenses and raise the overall expense of medical care.

    However, just because these procedures are expensive, we should re-engineer the whole health-care system of the United States? I’m not buying that.

    Ag80 (3acbfd)

  69. no one seems eager to delve too deeply into wasteful care.

    Are you interested in the fact that survival of prostate cancer in the US is far higher than anywhere else in the world ?

    The greatest problem for people like Juan is the fact that retail prices for care are grossly distorted by Medicare and insurance contracts. If real prices reflected real costs, we would have a far better chance for a market solution.

    Note the other two countries with high prostate ca survival, France and Japan.

    Blacks have a much worse prognosis for breast and prostate cancer, probably for biological reasons. Black men have a ten year lower age expectancy and it’s not just the violent underclass. Of course, no one studies this because it would be admitting a racial difference.

    Mike K (2cf494)

  70. [...] Pontifications delivers one very well rounded smack down of the whole lower cost idea (Obamacare’s “public plan” is built on a Medicare myth).  He’s got a great roundup of quotes and studies to really point out just how useless this [...]

    Beating on Krugman « Brian Simpson (565823)

  71. Kinda too bad that lady was recognized

    hf (9bda9c)

  72. “Feel free to rebut the conclusions.”

    steve – They were rebutted just fine in the comments to the piece and Ag80 added a nice comment above. No more needs to be said from my perspective.

    daleyrocks (718861)

  73. Dana who isn’t poor, if that woman seriously could not afford the basic dental care, she should not have possession of her child. State care is awful, but it’s light years better than a parent who is that extremely awful at parenting.

    But she probably could afford it and made a choice. Same applies to the rest of her situation. I know a few mentally ill people who really, seriously, can’t make it on their own. But I know so many mooches. either way, my heart goes out to her. Even though I’m sure it doesn’t sound that way.

    Juan (bd4b30)

  74. The best comment to steve’s article was ‘I just discovered Malpractice III!’

    LOL

    It was self refuting. Fact is, I want the power to tell my doc what I want and what I don’t want. Health care should be a personal thing. I should have full control.

    Juan (bd4b30)

  75. HeavenSent (#61)

    Book:

    The Medicare Payment Advisory Commission (MedPAC) reports (page 62) that Medicare beneficiaries who report their health status as “excellent” or “very good” are twice as likely to enroll in Medicare Advantage as those who report their health status as “poor.” Any Medicare beneficiary can enroll in Medicare Advantage, but those who choose to do so are, on average, healthier than those who remain in the “traditional” Medicare program. In short, Medicare Advantage plans are not “treating the same population.” They are not “operating under similar rules” either; the Medicare Advantage plans have an entire set of regulations of their own, quite different from the rules of the traditional Medicare fee-for-service system.

    Putting aside the factual errors and the fact that expressing administrative costs as a percentage of total costs is misleading, the GAO report doesn’t say what Hacker says it says. The administrative costs shown in the GAO report include major administrative functions not included in the figures are not comparable to those for reported by Hacker for the traditional Medicare. Since the bulk of Medicare Advantage plans are HMO plans, the 16.7% figure includes both functions of operating a health plan and functions that occur in doctors’ offices and health plans. In traditional Medicare, the fees paid to physicians and hospitals include an amount attributable to their internal administrative costs. For physicians, that amount averages 17.3% of their fees — this is administrative costs in addition to costs incurred at the Medicare program level, which Hacker says is 2% but is actually 3% or 6%, depending on whether you include just the cost of the Medicare bureaucracy, or that plus other the cost other government agencies incur in support of Medicare.

    So even if we believe Hacker’s comparisons between Medicare Advantage and traditional Medicare, a true “apples-to-apples” comparison shows that traditional Medicare’s administrative cost are higher — even using a “percentage-of-costs” approach weighted in its favor.

    But yes, we agree on the larger point.

    Karl (ade276)

  76. Medicaid is thoroughly corrupt with all sorts of fraudulent practises that various states have uncovered, as well as the Social Security Administration. Worse is the government’s long hidden policy of deliberate failure to recover overpayments caused by fraud.

    Its laughable that anyone would even attempt to claim the government can do the same services at a more efficient level than private industry. To prove this look at the number of private contractors the government employees because it cannot get its employees to do an effective job.

    Thomas Jackson (8ffd46)

  77. Doctors should provide treatment when the true probability of effectiveness is high

    So according to Steve, I’d have died over 4 years ago, and the clinical trial I was participating in (of whose prospects for success were unknown at the time) would never have happened, which would have negated the FDA ever approving the drug in the first place, leading to perhaps thousands of cancer patients dying of the same disease well before their time. Don’t take this personally, but F-ck off and die, Steve.

    Dmac (e6d1c2)

  78. Juan wrote:

    if that woman seriously could not afford the basic dental care, she should not have possession of her child. State care is awful, but it’s light years better than a parent who is that extremely awful at parenting.

    You have just conflated being very poor with being “extremely awful at parenting,” sufficiently so that the state should terminate parental rights and seize the children. I’m not poor now, but I grew up poor, and I take great exception to such a notion. Money is no substitute for a loving parent.

    Look at the Columbine parents; they had plenty of money, but their kids turned out like crap. The Menendez brothers grew up wealthy, but didn’t seem to turn out so well.

    Poverty can be a temporary situation; you never know when someone who is dirt poor will start to make a better life for himself and his family. The notion we would seize children because someone is poor certainly fails to consider that. Nor do I see the government as a better parent.

    The formerly poor Dana (3e4784)

  79. Juan wrote:

    Fact is, I want the power to tell my doc what I want and what I don’t want. Health care should be a personal thing. I should have full control.

    Oh, well, you’ll have to go outside the United States. If you want your physician to prescribe a prohibited or contraindicated medicine, you’re out f luck.

    The Dana who used to work in a hospital (3e4784)

  80. Oh for fuck’s sake, what a non sequiter.

    Juan (bd4b30)

  81. Hear, Hear to the formerly poor dana.

    MayBee (5ff8b1)

  82. Not really, Juan. Dana’s point is that medicine is already regulated to a great extent. What we are arguing about is how much more it will be regulated.

    SPQR (72771e)

  83. if that woman seriously could not afford the basic dental care, she should not have possession of her child.

    Juan, are you actually advocating a standard(s) of good parenting which would allow a parent to keep their child is whether they can afford basic dental insurance?

    Please clarify.

    Dana (8d88ef)

  84. Our pediatrician threatened to fire us as patients if we did not have the baby weaned from the bottle by age sixteen months. Showed us some horrific pictures of milk tooth decay, too.

    nk (57f631)

  85. The even larger Medicare myth:

    Medicare is not a comprehensive health care plan. Never has been. Part A, is hospital care. Beneficiaries have to pay a monthly premium for physician services, Part B. In 1998, congress added “5″ preventive benefits to the plan – a slight improvement. President Bush led in providing substantial Rx benefits, via Medicare Part D (delivered via private insurers). Prior to that there were no outpatient drug benefits (one of the largest costs to private health insurers.)

    Are we there yet? No. Tens of millions of Medicare beneficiaries go out on day one of signing up for Medicare to not only buy a private Medicare Part D plan; they also select, and will pay for a private Medicare supplement plan. Why? Medicare is a partial health plan.

    I’d bet that it would cost an easy $1-2 Trillion/ ten years just to make the benefits under Medicare comparable to private insurance.

    Secondly, in addition to the fact that Medicare (as is) actually costs more than private health care, per member, it’s cost has been rising faster, per member, since 1970 – according to a recent study, by JEFFREY H. ANDERSON and published by the Pacific Research Institute, takes all health-care spending in the United States and subtracts the costs of the two flagship government-run programs, Medicare and Medicaid. It then takes that remaining spending and compares its cost increases over time with Medicare’s cost increases over time.

    The results are clear: Since 1970 — even without the prescription drug benefit — Medicare’s costs have risen 34% more, per patient, than the combined costs of all health care in America apart from Medicare and Medicaid, the vast majority of which is purchased through the private sector.

    There is so much critical information which our national leaders in the Democratic party and the national mainstream media is keeping out of the required national discussion on this most critical issue.

    Gary H (47b0ad)

  86. SCHIP covers all children and includes Dental Care.

    If an idiot mother does not know then …..

    HeavenSent (641cde)

  87. Comment by Gary H — 7/9/2009 @ 10:16 am

    Comparing Medicaid/Medicare cost increases directly to those of the private sector is comparing apples and oranges. Medicaid/Medicare cover the poor and the elderly, two demographic groups that have a far disproportionate share of the health problems of our country’s citizens.

    Why are average Medicare costs per patient more in eastern Massachusetts than western Massachusetts? And more in Dallas than nearby Waco?

    steve (869d88)

  88. So according to Steve, I’d have died over 4 years ago, and the clinical trial I was participating in (of whose prospects for success were unknown at the time) would never have happened, which would have negated the FDA ever approving the drug in the first place.

    A much different discussion. Clinical drug trials establish effectiveness.

    Heart drugs, the newer ones, are more cost-effective than angioplasty for roughly half the patients getting the surgery.

    “Artery-opening angioplasty adds $10,125 to a patient’s medical bill without significantly extending life or improving health for someone with chest pain, researchers said.”

    steve (869d88)

  89. steve, it goes without saying that many medical procedures are not necessary. Sometimes they are preventative and sometimes they are mistakes, and perhaps sometimes there is even a little profiteering.

    But going to single payer… to let the government pretend it knows what I need/want and what I don’t, is counterproductive in the extreme. How many babies are in that bathwater?

    Juan (bd4b30)

  90. steve, your selective quotation misrepresents the contents of that article rather brazenly.

    SPQR (72771e)

  91. “Artery-opening angioplasty adds $10,125 to a patient’s medical bill without significantly extending life or improving health for someone with chest pain, researchers said.”

    Comment by steve — 7/9/2009 @ 2:16 pm

    I saw that movie with Harrison Ford and Tommy Lee Jones. I guess that all those invasive cardioligists that kepr my father alive all those years were just committing a fraud.

    nk (57f631)

  92. steve, your selective quotation misrepresents the contents of that article rather brazenly.

    No, it doesn’t. It’s the lead sentence.

    Why are average Medicare costs per patient more in eastern Massachusetts than western Massachusetts? And much more in Dallas than nearby Waco?

    steve (869d88)

  93. SPQR – It is easier to simply assume that with lower-case s steve.

    JD (a5b324)

  94. Yes, but I thought others should know that when you read the article, it is far from as definitive as steve makes it out.

    I am getting the impression that steve does not actually have any understanding of the medical issues he’s opining upon.

    SPQR (72771e)

  95. nk, how to you know they were keeping your father alive? Because he didn’t die? That’s poor logic.

    In fact, the movie you’re quoting was about some medicine… which I think is the alternative to angioplasty for the patients in this news story.

    I don’t think this is evidence of fraud so much as medicine constantly learning and improving, a process that Obama’s one size fits all approach will likely slow down.

    Juan (bd4b30)

  96. #92, you question is nonsense and can be easily answered.

    1) Eastern MA has about as many Hospital and Research institutions as anywhere in the world. Typically the “costs” at these facilities are significantly higher because significantly sicker people go there.

    2) Medicare adjusts reimbursement for local factor costs ….. lots of unions in Eastern MA with nice salaries that Medicare needs to feed

    3) Medicare cover lots of under-65 sick people like AIDs victims and those folks ten to live in large Urban Centers

    …. I could go on …..

    But more importantly, anyone who believes Gov.t will do a better job than the market in allocating health care is (A) delusional and (B) ignoring mounds and mounds and mounds of historical data.

    Health Facists is really what they are….. simply by saying no to health care is not a health care policy.

    HeavenSent (641cde)

  97. A much different discussion. Clinical drug trials establish effectiveness.

    You’re fond of moving the goalposts, Steve – but it ain’t gonna fly. That is not what you originally said, but thanks for attempting to backtrack furiously on your inanity.

    Dmac (e6d1c2)

  98. Medicare cover lots of under-65 sick people like AIDs victims and those folks ten to live in large Urban Centers

    But then why would Atlanta have per-patient expenses LOWER than smaller Macon? Chattanooga?

    A metro with 5.5 million people – and the premier academic medical facilities in the South – should command more of those “nice salaries that Medicare needs to feed.” The Dallas and Waco per patient expense differential is more in line with your theory. ‘Cept for the “lots of unions” angle.

    An elderly person spent an average 10.6 days in the hospital during the last two years of life in Bend, Ore., but 34.9 days in Manhattan. Is it all a factor of more poor people w/no safety net?

    steve (869d88)

  99. steve – what are the specifics of your party’s plan? How much will it cost? How do you plan on paying for it? Until you can answer those 3 simple questions, all you are doing is distracting from the big picture. While you are at it, how about showing us where government run healthcare here has been able to deliver care comparable to the private sector in a more cost effective manner. Also, you can tell us what a unicorn fart smells like.

    JD (a4e58a)

  100. How about you recite all the virtues of the current system.

    Chances are slim any meaningful change will happen, especially given that the suggested tax increase on +200K earners would kill small business owners.

    But doing nothing is not a placebo. It’s a Diprivan IV.

    steve (869d88)

  101. I am not the one claiming to be able to do things better, quicker, and more efficiently. I am not the one trying to dismantle the current system, which I happen to be a big fan of, warts and all. As I suspected, you either cannot or will not answer those simple questions. Quite revealing.

    JD (a4e58a)

  102. You should never admit there are warts in our health care system.

    Specifics and financing of a health care fix are not finalized. You demanded that I supply numbers three weeks ago, too.

    It’s unlikely this will turn out to be anyhing approaching comprehensive, seismic reform. Unemployment and record debt are bigger pariahs.

    steve (869d88)

  103. [...] unfairly compete with private insurers — bypassing the laws that apply to private insurers, sticking taxpayers with hidden administrative costs, pay below-market Medicare rates, and so on, until they have crowded competition out of the [...]

    The Greenroom » Forum Archive » Obamacare: The mask is off (e2f069)

  104. [...] refutes that argument. The Heritage Foundation’s Robert Book showed back in late June (HT Patterico) that Medicare’s administrative costs per beneficiary is actually higher, despite myriad obvious [...]

    BizzyBlog (cb6326)


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