The high price of scrapping Obamacare

[Prospero]

This is a good short and powerful indictment of the GOP position on healthcare in the US.

Of course Obama's plan is Communistic! Good old Vladimir Illich Osama bin Obama.

BEWARE OF ROMNEYCARE
BY JAMES SUROWIECKI
OCTOBER 29, 2012

Mitt Romney can be a hard man to pin down. But there is one thing that he’s been clear about: if he becomes President, he will repeal Obamacare. That simple promise, more than any other that Romney has made, illuminates what is most at stake in this year’s election. The campaigns may spend most of their time talking about taxes and jobs. But health care is where the election’s outcome will have the most immediate and powerful impact on how Americans live.
Abolishing Obamacare would eliminate subsidies for people buying insurance and rescind regulations requiring insurance companies to guarantee coverage and benefits (for instance, to people with preëxisting conditions). Romney’s proposed alternative is to give individuals a tax break when they buy insurance and to push them toward high-deductible insurance plans, which he believes will make them more rigorous and price-conscious in choosing doctors and treatments. Romney also wants to reform Medicare by encouraging more competition among private insurers. The details are skimpy, but the core principle is that unleashing the power of the free market will bring down costs and raise quality.
This is an appealing vision. In most areas of the economy, free-market principles insure that products and services keep improving, and that consumers get better and better deals. But the free market, though it may be the best way of allocating new TVs and cars, falters when it comes to paying for bypass surgery or chemotherapy. The reasons for this were established nearly fifty years ago, by the economist Kenneth Arrow, in a classic article entitled “Uncertainty and the Welfare Economics of Medical Care.” Arrow showed that health care is distinctive in ways that limit the power of the market. Because people don’t have the expertise to evaluate doctors, hospitals, or treatments, it’s hard for them to comparison-shop. Because they can’t pay for major care out of pocket, they must rely on insurance, thereby often losing the final say in what to buy or how much to spend. More fundamentally, markets work only when consumers have the power to say no if the price isn’t right. Yet it’s very hard for people to say no in the case of things like end-of-life care or brain surgery.
The evidence for Arrow’s thesis is all around us. Take the idea that high deductibles will transform the health-care system. It’s certainly true that giving consumers more skin in the game can make them better shoppers. But Americans’ out-of-pocket health-care spending is already higher than it is in most developed countries, and our over-all costs still aren’t any lower. And while a well-known study called the Rand Health Insurance Experiment showed that higher co-pays can encourage people to forgo unnecessary care, the same study showed that higher co-pays also encourage sick people to forgo necessary care, which raises costs in the long run. Increasing co-pays sometimes makes sense, but it’s no magic bullet.

As for Medicare, it’s not clear why Romney believes that competition among insurers will bring down costs. In the wider market, after all, that competition already exists, and yet it has done little to reduce health-care costs. Indeed, over the past forty years, government-controlled Medicare has been better at holding down health-care inflation than the general market has. This shouldn’t come as a surprise. Every other developed country in the world has far more government involvement in health care than the U.S. does, and in every one of those countries health-care costs are much lower than ours and have risen more slowly over the past three decades—with medical outcomes that are as good as or better than ours. The economist Austin Frakt has demonstrated the close relationship between public-sector involvement and lower health-care costs, and calls the evidence “overwhelming.”
But the truth is that, despite the rhetoric, Romney’s main concern isn’t to bring down over-all health-care costs. In fact, he has regularly attacked one of the Affordable Care Act’s most aggressive cost-cutting measures—the independent board that can make binding recommendations on how to cut Medicare spending. What he wants is just to have the government less involved in health care. Insofar as his plans would lower federal health-care spending, it’s not because of the power of the free market; it’s because a Romney Administration would simply have the government do less. Romney would eliminate the Obamacare subsidies for health insurance. He would turn Medicaid into a block grant to the states and trim its annual budget, with the result that its funding would lag behind the rise in health-care costs. And, if he adopts his running mate Paul Ryan’s premium-support plan for Medicare, he would make Medicare recipients pay higher premiums. With these changes, the government would spend less, but only because it would provide less, and Americans would get less. It’s like saving on defense by protecting only two-thirds of the country.
Of course, plenty of people don’t think that guaranteeing affordable health insurance is a core responsibility of government. These days, Mitt Romney seems to be one of them (though things were very different back when he was the governor of Massachusetts). But plenty of people take the opposite view, and the premise of Obamacare is that health care is a collective good, like national defense—something that government has to help provide. The real issue, come November 6th, isn’t about who has the best ideas for controlling health-care costs. It’s about who has the right idea of what government should do. ♦


Read more http://www.newyorker.com/talk/financ...#ixzz2ACiM3YY4

[Ben]

Why Are People with Health Insurance Going Bankrupt?

Dr. Margaret Flowers and Kevin Zeese: Obama care will not put an end to medical bankruptcies - 80% of people going bankrupt due to healthcare costs had insurance.

http://www.youtube.com/watch?feature...&v=2ZSWLY7GwEE

[Ben]

Did RomneyCare Really Have No Effect on Medical Bankruptcy in Massachusetts?

http://www.theatlantic.com/business/...husetts/72179/

[Ben]

[paulclifford]

>>>Obama care will not put an end to medical bankruptcies - 80% of people going bankrupt due to healthcare costs had insurance.

Additionally, the study on bankruptcy from medical bills that appeared in the American Journal of Medicine — authored by 4 leading supporters of a single-payer system — had the following statement:

http://www.amjmed.com/article/S0002-...404-5/abstract

"Using a conservative definition, 62.1 percent of all bankruptcies in 2007 were medical; 92 percent of these medical debtors had medical debts over $5,000, or 10 percent of pretax family income,"

The study never asks whether those who declared bankruptcy apparently "due to medical reasons" might also have been deeply in debt for other reasons: school loans, home equity loans, car payments, credit cards, etc. The study points out that the debtors were well-educated, owned homes, and had "middle-class occupations," so it's doubtful that a debt of $5,000 by itself would put them into bankruptcy.

As an example of the kind of spin the authors engage in, see:

http://content.healthaffairs.org/con...lstein_Ex2.gif

Notice that the author (Himmelstein) conflates data on bankruptcies from medical bills with data on missing work due to illness . . . . . . even if there were no medical bills during the time spent away from work. So the problem here was not necessarily that they had high medical bills; the problem was they had no income.

That's certainly a problem, but it's not a particularly exciting one ideologically. It's much more exciting to try to mobilize people for a "make government pay for it" campaign in healthcare if you can spin and conflate the data in such a way as to make it seem that "high medical bills", in and of themselves, "cause 60% of all bankruptcies."

Now that's the kind of news that can launch email campaigns to your senator!

[trish]

As an example of the kind of spin the authors engage in, see:

?..because they proved they were already stupid enough to vote for Hussein Obama...

_paulclifford, the author of the above post. http://www.hungangels.com/vboard/sho...&postcount=165

Spin? Racism? Or both?

[broncofan]

"The study never asks whether those who declared bankruptcy apparently "due to medical reasons" might also have been deeply in debt for other reasons: school loans, home equity loans, car payments, credit cards, etc. The study points out that the debtors were well-educated, owned homes, and had "middle-class occupations," so it's doubtful that a debt of $5,000 by itself would put them into bankruptcy."

http://www.amjmed.com/article/S0002-...404-5/fulltext

This is why you have to delve into the article and not just read the abstract. The average income of the participants was about 30,000 dollars a year. So 5,000 dollars out of pocket would indeed be a strain. The article stated that they were trying to determine the cases where medical bills strongly contributed to bankruptcy. They never stated in the article that medical bills were the sole cause of bankruptcy and they did regression analysis on the subset of medical bankruptcies and found a statistically significant group had gaps in their coverage that led to large bills.

"Teasing causation from cross-sectional data is challenging. Multiple factors push families into bankruptcy. Yet, our data clearly establish that illness and medical bills play an important role in a large and growing proportion of bankruptcies."

This is in the body of the article, not the abstract.

There was also another section that used the exact same criteria for bankruptcy over time which was a time trend analysis. Therefore, if you did not like their criteria, as long as it was consistent there would be an accurate time trend analysis. They found that the percentage of bankruptcies based on these criteria had a 48% (relative) increase from 2001 to 2007.

[broncofan]

"Out-of-pocket medical costs averaged $17,943 for all medically bankrupt families: $26,971 for uninsured patients, $17,749 for those with private insurance at the outset, $14,633 for those with Medicaid, $12,021 for those with Medicare, and $6545 for those with Veterans Affairs/military coverage. For patients who initially had private coverage but lost it, the family's out-of-pocket expenses averaged $22,568."

This is also from the American Journal of Medicine Article. Debts of $5,000 does not mean their expenses were not much higher. If someone who makes about 30,000 dollars a year has to pay 20,000 dollars out of pocket, they might come very close before having to declare bankruptcy.

[paulclifford]

>>>Racism?

Of course I'm racist against Obama . . .

. . . but it's the white part of him I detest — the Marxist part — not the black part.

No, the black part be cool.

(Sigh. Obamabots always forget that the President's mother was white.)

[Prospero]

_paulclifford, the author of the above post. http://www.hungangels.com/vboard/sho...&postcount=165

Spin? Racism? Or both?

Racist in my view - and mr Clifford will face censure if he posts more racist remarks.