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Will Donald Trump Privatize Medicare?

Will Donald Trump Privatize Medicare?


  • Total voters
    31
The door to privatization of Medicare is already open with Medicare Part C.
 
Yes, and we vote.
Those whippersnappers who still haven't even seen their 60th. birthday don't vote in anything like the percentages that seasoned citizens do.

I hope he does privatize medicare, because then baby boomers will stop voting against their own interests. Now that there are no safeguards or checks in place against their choices, they will finally see that the Conservative right just likes to scare them into voting their way and have little or no interest in making their lives better. Neither do the liberals, they just don't pretend to be to overly concerned like the right wing does about the elderly. "Oh veterans need this, Seniors need this, ISIS is coming to main street because they hate your freedom. Only us Warhawks that's been around a war or two can bring back the quiet terror of the Cold War your parents shielded you from as a child." Now that you've won, will you fix what you said? "Of course not, how am I supposed to win the next election if I fix it this term? They'll forget what I said in a couple years, then I'll blame the coloreds, recipe for success that is..."

So yeah, I really hope they privatize medicare. And I hope Trump starts a company through his blind trust to run the thing. And I hope they gut social security, and any other entitlement program (yes, they are entitlements because more benefits are drawn out than is paid in premium by a lot) the entitled generation has while calling mine the entitlement generation because we don't want crippling debt when we try to navigate the world they flipping created.

Aside from the hippies, who all agree with me, the Baby Boomer Generation needs an awakening in the form of a swift kick. If you can't use a computer, you should accept your usefulness to society is over and just mind your own business. If I have to explain to you five times how to login into your email, chances are I'm not going to trust your opinion on whats wrong with my generation. So let's take their social security, and their medicare. Both things instituted by seriously racist right wing democrats trying to switch the paradigm of the two party system and pick up voters from the liberal republicans.

And don't worry boomers, if you worked hard your whole life, like you claim. You should have enough money to not have to depend on the governments hand outs. If not, you can pick yourselves up by your bootstraps, which you claim to be good at, and try the job market you left us with and see how far you get. And no I don't care if you're to old or two sick, because while your drawing benefits and judging others, you don't care about the less fortunate in the slightest. In fact you blame them for most of your problems. While applauding the people who are actually sticking it to you.

It's not like my generation will ever get to enjoy medicare or Social Security. Although we are paying in, at a higher rate than you ever did, for you current care. We won't have the same luxury with how things are shaping up. So I for one hope their chickens have come home to roost. I hope their entitlements get gutted. And they go back to dying in poverty like before WW2. This liberal republican is tired of Baby Boomers strutting in like the **** of the Walk, and ****ting all over everything and expecting to be thanked for it. Except for the Hippies, you guys are cool.

Tl: DR version. Old people voted for these ****s, so they have it coming when they send them back to dying in poverty. And when they do, all I am going to ever say to Baby Boomers "Best pull yourselves up by your bootstraps! Show me how it's done..."
 
not like my generation will ever get to enjoy medicare or Social Security. Although we are paying in, at a higher rate than you ever did, for you current care. We won't have the same luxury with how things are shaping up. So I for one hope their chickens have come home to roost. I hope their entitlements get gutted. And they go back to dying in poverty like before WW2. This liberal republican is tired of Baby Boomers strutting in like the **** of the Walk, and ****ting all over everything and expecting to be thanked for it. Except for the Hippies, you guys are cool.

Tl: DR version. Old people voted for these ****s, so they have it coming when they send them back to dying in poverty. And when they do, all I am going to ever say to Baby Boomers "Best pull yourselves up by your bootstraps! Show me how it's done..."

Given that the oldest demographics were instrumental in giving the GOP total control of government, there is a certain logic to the sentiment that when the GOP starts to gut Medicare those reforms should apply to current beneficiaries.
 
Given that the oldest demographics were instrumental in giving the GOP total control of government, there is a certain logic to the sentiment that when the GOP starts to gut Medicare those reforms should apply to current beneficiaries.

But only in the red states of course. I'm from Mass., where we were the only state not to vote for tricky dicky either. Don't lay this crap on us. Don't blame me, I'm from Massachusetts.
 
So is offering an ever declining payout to potential care providers. A big difference between SNAP and Medicare is that SNAP covers 100% of the retail market price while Medicare falls well short of doing that. If SNAP offered 60% (or less) of the retail price then it would be accepted by many fewer food outlets.

No insurer pays full price for medical services. Look at any EOB, they always have negotiated a lower rate. Moreover, if food had an inflation rate over over 10% a year, I would imagine that SNAP would work different than it does now.
 
He might try. He has, after all, championed a lot of bad ideas. He does seem to be backing off on the worst of them, so maybe he won't try to "privatize" i.e. put a cap on Medicare.

Giving seniors a fixed dollar amount with which to purchase insurance in a market where the price keeps going up and up and no one really wants to insure the most expensive demographic is the king of bad ideas.
Oh. The King. So what position in Chess is the current idea, where we ignore the problem that outlays will outstrip our ability to pay until the system collapses, and we are forced to start tossing seniors off nilly willy?

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No insurer pays full price for medical services. Look at any EOB, they always have negotiated a lower rate. Moreover, if food had an inflation rate over over 10% a year, I would imagine that SNAP would work different than it does now.
Moreover, inelasticity of demand due to the predominance of third-party-payment systems (like current Medicare) is the main reason why we have that inflation in the first place.

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I hope he does privatize medicare, because then baby boomers will stop voting against their own interests. Now that there are no safeguards or checks in place against their choices, they will finally see that the Conservative right just likes to scare them into voting their way and have little or no interest in making their lives better. Neither do the liberals, they just don't pretend to be to overly concerned like the right wing does about the elderly. "Oh veterans need this, Seniors need this, ISIS is coming to main street because they hate your freedom. Only us Warhawks that's been around a war or two can bring back the quiet terror of the Cold War your parents shielded you from as a child." Now that you've won, will you fix what you said? "Of course not, how am I supposed to win the next election if I fix it this term? They'll forget what I said in a couple years, then I'll blame the coloreds, recipe for success that is..."

So yeah, I really hope they privatize medicare. And I hope Trump starts a company through his blind trust to run the thing. And I hope they gut social security, and any other entitlement program (yes, they are entitlements because more benefits are drawn out than is paid in premium by a lot) the entitled generation has while calling mine the entitlement generation because we don't want crippling debt when we try to navigate the world they flipping created.

Aside from the hippies, who all agree with me, the Baby Boomer Generation needs an awakening in the form of a swift kick. If you can't use a computer, you should accept your usefulness to society is over and just mind your own business. If I have to explain to you five times how to login into your email, chances are I'm not going to trust your opinion on whats wrong with my generation. So let's take their social security, and their medicare. Both things instituted by seriously racist right wing democrats trying to switch the paradigm of the two party system and pick up voters from the liberal republicans.

And don't worry boomers, if you worked hard your whole life, like you claim. You should have enough money to not have to depend on the governments hand outs. If not, you can pick yourselves up by your bootstraps, which you claim to be good at, and try the job market you left us with and see how far you get. And no I don't care if you're to old or two sick, because while your drawing benefits and judging others, you don't care about the less fortunate in the slightest. In fact you blame them for most of your problems. While applauding the people who are actually sticking it to you.

It's not like my generation will ever get to enjoy medicare or Social Security. Although we are paying in, at a higher rate than you ever did, for you current care. We won't have the same luxury with how things are shaping up. So I for one hope their chickens have come home to roost. I hope their entitlements get gutted. And they go back to dying in poverty like before WW2. This liberal republican is tired of Baby Boomers strutting in like the **** of the Walk, and ****ting all over everything and expecting to be thanked for it. Except for the Hippies, you guys are cool.

Tl: DR version. Old people voted for these ****s, so they have it coming when they send them back to dying in poverty. And when they do, all I am going to ever say to Baby Boomers "Best pull yourselves up by your bootstraps! Show me how it's done..."
From the opposite end of the political spectrum: agreed. Boomers made this bed, ordered this bed, insisted on this bed, and angrily refused any suggestion the bed be adjusted. Let them lay in it.

Boomers had more wealth floor through their hands than any generation in human history, and they blew it. Let them serve as a warning to others.

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Moreover, inelasticity of demand due to the predominance of third-party-payment systems (like current Medicare) is the main reason why we have that inflation in the first place.

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The vast majority of healthcare costs are for critical care and chronic conditions. Do you honestly think we would have less of a need for critical care and chronic conditions if we did not have Medicare and private insurers?
 
This poll has gotten a number of "No" responses but it's worth noting that Trump is installing a major proponent of Medicare privatization to lead HHS.

According to multiple reports Monday evening, President-Elect Donald Trump has settled on Rep. Tom Price (R-GA) as his nominee to become Secretary of the Department of Health and Human Services. Price, an orthopedic surgeon and Budget Committee Chair in the outgoing Congress, is an arch-critic of 'Obamacare' and a top supporter of Speaker Paul Ryan's plan to phase out Medicare and replace it with private insurance and vouchers.

On November 17th, when TPM asked Price about his timeline for moving Medicare phaseout legislation in the next Congress, Price said he did not believe it would be in the first legislation Trump and the Republican Congress would tackle in the Spring. He said he expected it would come mid-year in the second phase of the budget reconciliation process. "I think that is probably in the second phase of reconciliation, which would have to be in the FY 18 budget resolution in the first 6-8 months," Price told TPM.

Democrats have promised to oppose any effort to phase out or privatize Medicare in the next Congress.
 
The vast majority of healthcare costs are for critical care and chronic conditions. Do you honestly think we would have less of a need for critical care and chronic conditions if we did not have Medicare and private insurers?
The vast majority of medical services are not for emergency or inherently high-cost items, yet we insist that insurance cover them. That's like insisting that car insurance cover oil changes and gas refills. If your insurance bought gas for you, would you ever car pool or buy anything other than Premium? Neither would anyone else. Ask any waiter how they feel about businessmen traveling on expense accounts (they love them). Within the field of chronic care, many procedures are done defensively, rather than out of a realistic sense of need for the patient. While the latter has a critical tort reform piece to it, both of these issues are primarily solvable by returning price pressure a market far too long without it.

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Oh. The King. So what position in Chess is the current idea, where we ignore the problem that outlays will outstrip our ability to pay until the system collapses, and we are forced to start tossing seniors off nilly willy?

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That's the queen of bad ideas, but the one most likely to be followed.
 
The vast majority of medical services are not for emergency or inherently high-cost items, yet we insist that insurance cover them. That's like insisting that car insurance cover oil changes and gas refills. If your insurance bought gas for you, would you ever car pool or buy anything other than Premium? Neither would anyone else. Ask any waiter how they feel about businessmen traveling on expense accounts (they love them). Within the field of chronic care, many procedures are done defensively, rather than out of a realistic sense of need for the patient. While the latter has a critical tort reform piece to it, both of these issues are primarily solvable by returning price pressure a market far too long without it.

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You are confusing visits with overall costs though. Yes, the majority of healthcare services are delivered via routine visits. This is because more people are apt to see their doctor each year for routine care than to visit the hospital. However, that is not where the majority of costs are.

http://www.nihcm.org/pdf/DataBrief3 Final.pdf

For example, one will spend more in one month of cancer treatments than they would in a lifetime of routine care. I am not against HSA's coupled with a high deductible plan as I think that younger healthier people can save a good deal of money with them, and if you build up your HSA you could have a lot of money in it when you are older and will need it.

However, routine care is not where our health costs are at. HSAs are going to do nothing to curb overall health spending because a lifetime of consumer driven healthcare does not change the fact that one heart attack, cancer diagnosis, elderly dementia, severe trama, or type 2 diabetes diagnosis will lead to much much more spending on healthcare than the individual would ever spend through routine care.

For example, I am 40 years old. I have been an avid runner my entire adult life. I have ate a strict whole foods diet my entire adult life. I have strength trained regularly my entire adult life. My routine healthcare for my entire life thus far has been just a few hundred dollars a year on average, and that is before insurance so my out of pocket has been much less. Back in August, while out riding my road bike over my lunch hour a woman that was looking at her cell phone rather than at the road plowed into me from behind at 40 mph while I was stopped at a stoplight. It resulted in a broken back, broken ribs, broken scapula, bleeding on the brain, a tear in my face extending to the skull and other injuries. As a result I spent 2 days in ICU and 4 days in the hospital. Had I not been in such good shape and health I would have been in the hospital much longer and it quite possibly would have killed me. Nonetheless, just 4 days in the hospital resulted in $50,000 in medical bills. So here I was a guy that was doing everything right in terms of my health and yet just one accident resulted in much more health spending than a lifetime of routine care had. That is the problem with thinking that consumer driven plans will drive down overall health spending / inflation in this country. Its the big stuff that's the problem and you can't address those costs with a HSA plan.
 
You are confusing visits with overall costs though.

No, I wasn't, but I wasn't drawing the point out clearly, for which I apologize. The healthcare market is dominated by services that are neither emergency nor inherently high cost. Hence, measures that return price-pressure to the healthcare market by allowing insurance to function as insurance will have broad effect.

The same would continue to be true of car insurance, for example, if we switched from the hypothetical in which everyone gets gas, but a few people get into car wrecks with $500,000 liabilities due to deaths, to the system we have today where car insurance covers only those catastrophic costs.

Yes, the majority of healthcare services are delivered via routine visits. This is because more people are apt to see their doctor each year for routine care than to visit the hospital. However, that is not where the majority of costs are.

http://www.nihcm.org/pdf/DataBrief3 Final.pdf

Correct. As your source does an excellent job of highlighting, the majority of costs are concentrated among our Medicare-using elderly, particularly at the end of life. Generically speaking, we aren't paying $300,000 to give a 40 year old mother of three a chance an even shot at another 40 years, but rather $500,000 to give a 85 year old less of a chance at another 9-18 months.


Now, at some point, we lose the ability to fund ever-more-expensive care for ever-reducing odds of diminishing returns. The decisions about that point can either be made by a government body deciding that your life is no longer worth spending money on (as occurs in single-payer healthcare systems), or it can be a decision made by patients and their doctors.


But so long as price is no object, we will continue to pay every skyrocketing costs for an ever more sclerotic system that focuses ever more resources where they do the least good, while raising prices for those who can least afford it.



HSAs are going to do nothing to curb overall health spending

Interesting. How do you then account for the fact that they have already done so?


For example, I am 40 years old. I have been an avid runner my entire adult life. I have ate a strict whole foods diet my entire adult life. I have strength trained regularly my entire adult life. My routine healthcare for my entire life thus far has been just a few hundred dollars a year on average, and that is before insurance so my out of pocket has been much less. Back in August, while out riding my road bike over my lunch hour a woman that was looking at her cell phone rather than at the road plowed into me from behind at 40 mph while I was stopped at a stoplight. It resulted in a broken back, broken ribs, broken scapula, bleeding on the brain, a tear in my face extending to the skull and other injuries. As a result I spent 2 days in ICU and 4 days in the hospital. Had I not been in such good shape and health I would have been in the hospital much longer and it quite possibly would have killed me. Nonetheless, just 4 days in the hospital resulted in $50,000 in medical bills. So here I was a guy that was doing everything right in terms of my health and yet just one accident resulted in much more health spending than a lifetime of routine care had. That is the problem with thinking that consumer driven plans will drive down overall health spending / inflation in this country. Its the big stuff that's the problem and you can't address those costs with a HSA plan.

No... HSA's come married to Catastrophic Health Insurance Plans, which are designed to A) give you lower premiums while B) covering precisely that kind of incident.
 
No, I wasn't, but I wasn't drawing the point out clearly, for which I apologize. The healthcare market is dominated by services that are neither emergency nor inherently high cost. Hence, measures that return price-pressure to the healthcare market by allowing insurance to function as insurance will have broad effect.

Right but that doesn't change the fact that the majority of health spending are not for those services, thus curbing the costs of those services or utilizing them less would have little effect towards reducing overall health spending.

The same would continue to be true of car insurance, for example, if we switched from the hypothetical in which everyone gets gas, but a few people get into car wrecks with $500,000 liabilities due to deaths, to the system we have today where car insurance covers only those catastrophic costs.

Car insurance is not comparable to how health insurance must work at all. For example, when you buy a new car, your car is insured for the fair market value of the car. That value year by year and thus the amount the car is insured for reduces year by year. Moreover, the insurer caps overall costs to the value of the car. Thus is your car is worth 20k, then the insurer will not spend anymore than that value to repair or replace it. Furthermore, even your liability insurance is capped to a certain amount for injury and property and the insurer is not obligated to pay out more than that policy limit.

If health insurance worked the way car insurance works, then your insurer would determine a fair market value for your life and not insure you for a cent more. The older you got, the less your life's value would be, thus the lower your policy limit.

Correct. As your source does an excellent job of highlighting, the majority of costs are concentrated among our Medicare-using elderly, particularly at the end of life. Generically speaking, we aren't paying $300,000 to give a 40 year old mother of three a chance an even shot at another 40 years, but rather $500,000 to give a 85 year old less of a chance at another 9-18 months.


Now, at some point, we lose the ability to fund ever-more-expensive care for ever-reducing odds of diminishing returns. The decisions about that point can either be made by a government body deciding that your life is no longer worth spending money on (as occurs in single-payer healthcare systems), or it can be a decision made by patients and their doctors.

But so long as price is no object, we will continue to pay every skyrocketing costs for an ever more sclerotic system that focuses ever more resources where they do the least good, while raising prices for those who can least afford it.

1. Originally in the ACA there was a provision for doctor's to be reimbursed for time they spent with patients for end of life planning. That was derided as "death panels" by Palin and many other opponents of the ACA.

2. If you leave those decisions between the patients and their doctors, then that is exactly the system we have now. Even if we switched to HSA's and High Deductible Plans, once you exceeded the amount of the deductible then there would be no financial incentive at all for a patient to spend less at the end of their life as the insurer is the one that is on the hook for the bills. The only way to mitigate those costs would be to have some kind of independent panel (whether its government or insurance) that makes those coverage decisions in terms of cost / benefit.


Interesting. How do you then account for the fact that they have already done so?

I don't have a WSJ subscription, so I cannot read it. However, I would point out that it is an Op/Ed.

The Commonwealth Fund looked at HSA's and found the following:

Patients' Use of Information Alone Is Not Likely to Dramatically Reduce Health Care Costs or Improve Quality

It is unrealistic to expect that patient financial incentives, even if better information is available, will lead to dramatic improvements in quality and efficiency.

Most health care costs are incurred by people who are very ill, often in emergencies. Ten percent of the sickest patients account for about 70 percent of all health care spending.

Payers, federal and state governments, accrediting organizations, and professional societies are much better positioned to insist on high quality and efficiency.

Health Savings Accounts and High-Deductible Health Plans: Why They Won't Cure What Ails U.S. Health Care - The Commonwealth Fund

This makes perfect sense as even high deductible plans are obligated to cover chronic and catastrophic care and that is what accounts for the majority of our health spending.

continued...
 
No... HSA's come married to Catastrophic Health Insurance Plans, which are designed to A) give you lower premiums while B) covering precisely that kind of incident.


I agree that a Catastrophic Health Insurance Plan covers you for exactly that kind of incident. However, as those kind of incidents and chronic care account for the majority of health spending, a Catastrophic Health Insurance Plan is doing nothing in terms of curbing those costs that traditional insurance or Medicare doesn't do. Once again, routine care is not where the majority of health care costs are. As I pointed out earlier, the costs of my being hospitalized for 4 days exceeded a lifetime of routine healthcare for me.


So while you could say that HSA's and Catastrophic Plans can be a better deal for the insurance consumer, particularly if you are young and healthy, if they are not curbing the costs of catastrophic and chronic care (and they aren't), then they are doing little to curb the overall costs of healthcare in this country.


My wife works at a Corporate / Insurance Defense firm. She looks at medical records and bills all the time. The problem we have in this country is a neurologist can charge 5000 grand for 10 minutes of their time to glance at a CT scan. A Hepatologist might charge 3k for a couple minutes of their time to glance at a metabolic panel. The only curb we have at all on these costs are prenegotiated rates that insurers and Medicare have. You don't have any choice in the matter. In fact, often you are not even conscious when those services are rendered. The problem with controlling healthcare costs is that necessary healthcare simply doesn't adhere to the laws of supply and demand because demand for those services doesn't change regardless of their costs.


I don't know what the answer is. I don't think anyone really does. I think the "answers" various groups have are more ideologically driven than driven by pragmatism. Personally I think our best bet would be to block grant all federal health spending out to the states with the strict conditions that providing coverage and health care services is all they can do with it, and let each of the states build their own systems. Maybe in a couple of decades we could see which states had systems that curbed costs while providing good coverage and which states didn't.
 
No, I wasn't, but I wasn't drawing the point out clearly, for which I apologize. The healthcare market is dominated by services that are neither emergency nor inherently high cost. Hence, measures that return price-pressure to the healthcare market by allowing insurance to function as insurance will have broad effect.

To SouthernDemocrat's point, those services dominate by volume but not by revenue. Consumer price exposure can lower spending in two ways: 1) Exposing price variation between providers on shoppable services and encouraging consumers to use lower-priced providers, and 2) discouraging service use altogether.

The former is more interesting, particularly because our anomalously higher health care spending is driven more by prices than greater service use here than in other countries. And there is potential there to attack unwarranted price variation and encourage competition in the provider market. But it's important not to overstate the case. The potential there is limited by 1) the disconnect between individual service line prices and total revenue in the current system, and 2) the proportion of actual revenue derived from shoppable services.

In reality, health spending is extraordinarily concentrated on a narrow segment of the population, driven significantly by non-shopppable services or the costs of chronic conditions (meaning any reasonable out-of-pocket maximum for such a person would ultimately insulate them from cost and prices anyway).

The problem with the car/gas analogy is that in a given year, everyone with a car buys gas. Lots of it. All the time. In health care, half of the population will account for virtually zero of the spending in a given year. So it doesn't follow that because removing price exposure to gas would raise consumption and spending that increasing price exposure in health care naturally leads to enormous savings for everyone. I can't save you more than the zero dollars you already spend on me. Nor can the other 150 million people like me.

There may be some value in having folks question whether a procedure or visit is necessary in the first place, but I wouldn't hold up discouraging service use on the consumer end as a great goal in and of itself (addressing waste and unnecessary service delivery is better addressed on the provider side by examining volume-based reimbursement incentives).
 
Car insurance is not comparable to how health insurance must work at all

At current, that is correct, because we let car insurance function as insurance, while treating health "insurance" as a kind of super-awkward, poorly-designed, socialized pre-payment system.

For example, when you buy a new car, your car is insured for the fair market value of the car.

Yes. This would be comparable to the degree to which your insurance costs would (in a market in which price pressure occurred) differ based on what kind of health you are in - insuring against the expense.

That value year by year and thus the amount the car is insured for reduces year by year. Moreover, the insurer caps overall costs to the value of the car.

You don't carry liability insurance?

If health insurance worked the way car insurance works, then your insurer would determine a fair market value for your life and not insure you for a cent more. The older you got, the less your life's value would be, thus the lower your policy limit.

Not quite. If health insurance worked the way insurance is supposed to work (for example, more like it does in the car insurance world), then premiums would be lower because you would be expected to pick up routine costs yourself, creating a market in which price-pressures exist and transactions are generally transparent, instead of entering a weird world where you paid either $8 or $1 a gallon for premium gas depending on whether or not you had AllState or Geico, and whether or not the gas station was on your approved list of gas stations.

1. Originally in the ACA there was a provision for doctor's to be reimbursed for time they spent with patients for end of life planning. That was derided as "death panels" by Palin and many other opponents of the ACA.

That is incorrect. The item derided as "death panels" was the Independent Payment Advisory Board, whose job it was to keep costs down by determining what procedures would be reimbursed at what price. This created a structure where the Government determined at what point they would cease to reimburse providers for care at a rate that they could afford to provide it at, effectively cutting off care. The IPAB was deliberately made to be almost impossible - even for Congress - to overrule (it required a supermajority vote, the same level required to amend the Constitution).

2. If you leave those decisions between the patients and their doctors, then that is exactly the system we have now.

Not really. At current, the system simply continues to pay, creating an incentive structure that rewards ever-higher spending on ever-less-likely-to-succeed procedures to produce ever-reducing results. So we have distorted the incentives, and - as your source points out - the result is spiraling costs concentrated in a few key consumers.

Interesting. How do you then account for the fact that they have already done so?

I don't have a WSJ subscription, so I cannot read it. However, I would point out that it is an Op/Ed.

That's interesting. If you go straight from the link it expects you to sign in, but if you go there from Google, it gives you the full article.

It's an Op Ed - by Mitch Daniels, former OMB head who was governor of Indiana. The key section to whether or not the introduction of HSA/HDLP plans help reduce costs:

...In a time of severe budgetary stress, Indiana will save at least $20 million in 2010 because of our high HSA enrollment. Mercer calculates the state's total costs are being reduced by 11% solely due to the HSA option. Most important, we are seeing significant changes in behavior, and consequently lower total costs. In 2009, for example, state workers with the HSA visited emergency rooms and physicians 67% less frequently than co-workers with traditional health care. They were much more likely to use generic drugs than those enrolled in the conventional plan, resulting in an average lower cost per prescription of $18. They were admitted to hospitals less than half as frequently as their colleagues…. Overall, participants in our new plan ran up only $65 in cost for every $100 incurred by their associates under the old coverage.

Are HSA participants denying themselves needed care in order to save money? The answer, as far as the state of Indiana and Mercer Consulting can find, is no. There is no evidence HSA members are more likely to defer needed care or common-sense preventive measures such as routine physicals or mammograms….

 

The head of the Commonwealth Fund is David Blumenthal

During the U.S. presidential campaign in 1987-1988, Blumenthal was chief health advisor to the Dukakis campaign. Twenty years later, in 2008, he was senior health adviser to the Obama campaign​

And they have a history of unfortunately stating data so as to give the wrong impression in order to make political arguments. So yeah. When you define "success" as "getting us to a single-payer healthcare system", then HSA's and structures that decentralize decision making aren't considered a "win".


I mean - look at the lead argument they present. "Some say that increasing price pressure will cause people to become more price conscious. But we discovered that, when people felt price pressure, they became more price conscious!!! BAD!".

I mean, really?


Even if we switched to HSA's and High Deductible Plans, once you exceeded the amount of the deductible then there would be no financial incentive at all for a patient to spend less at the end of their life as the insurer is the one that is on the hook for the bills.

That is a good critique. I had a bit above (I had to cut it for length considerations) addressing the similar claim you started with, but I wanted to make sure I dealt with it:

1. No – reintroducing and increasing price-pressure in the market has salutary effects across the market, not only in the “deductible” space, because it forces providers to become more efficient. So even the Chronic/high-cost items will indirectly benefit from the creative destruction in the market.

2. Many services will occur in both the “deductible” and “post-deductible” space, meaning that improvements to provision at cost will also directly carry over.

3. Premium Support models replacing the Fee-For-Service model (which, as I understand, is broadly what we are discussing here in terms of Medicare, which – as your source points out – is behind the majority of healthcare costs and increases), putting demand elasticity back into the system and reintroducing competition. The CBO:

Heightened price competition would probably restrain the growth of Medicare spending over the long term by curtailing demand for costly new technologies and treatments and by boosting demand for technologies that reduced costs

My wife works at a Corporate / Insurance Defense firm. She looks at medical records and bills all the time. The problem we have in this country is a neurologist can charge 5000 grand for 10 minutes of their time to glance at a CT scan. A Hepatologist might charge 3k for a couple minutes of their time to glance at a metabolic panel.

Goodness. That sounds to me like consumers of these specialists’ services aren’t being very price-sensitive, and they are completely free from any competition whatsoever.


Personally I think our best bet would be to block grant all federal health spending out to the states with the strict conditions that providing coverage and health care services is all they can do with it, and let each of the states build their own systems.

As I understand it, that is the House GOP plan for Medicaid.
 
Goodness. That sounds to me like consumers of these specialists’ services aren’t being very price-sensitive, and they are completely free from any competition whatsoever.




As I understand it, that is the House GOP plan for Medicaid.

I don't have time now to address all of your post, but I will address this real quick. If you are in a hospital, there can be a ton of different providers that are providing your care. Some of them you won't even meet or know what they did until you get your bills or EOBs. For example, I had a neurologist evaluate my CT scan before I was even conscious. So he could bill me whatever he wanted to bill me and its not like I could have shopped the service around as I was not even conscious for it.

That all said, I think the real answer is to somehow figure out a way to effectively incentivize individuals to make better life choices in regards to their personal health. The best way to save yourself (or Medicare) potentially hundreds of thousands of dollars in healthcare expenses as you grow old is to do everything keep yourself in good health throughout your life. I wish I could find the source, but I remember reading once where some economist figured out that if you bought and used 2 pairs of running shoes a year starting at age 20, you would on average save yourself 100,000 in retirement due to the much, much lower incidence of heart disease, cancer, obesity, and type 2 diabetes. Just the simple act of going for a run a days a week could mean you will never have knee problems (which are usually due to obesity), diabetes, or ever need heart surgery. The problem is getting more people to do that. However, in the end, the best way to reduce health care spending is to reduce the need for it.
 
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You have no idea. That's Trump.
 
You have no idea. That's Trump.

None of us has any idea what he might try to do or what he will succeed in doing, only that his supporters will claim that he did everything that need to be done to make America great again despite the "left" and their opposition to all of the wonderful things he does.
 
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