CBO: Obamacare costs revised downward, again. Finds lower than expected premiums.

[jimbob]

Coercion absolutely counts as denial of volition or agency, and hence, being a necessary element of exploitation, can be exploitation. My point was that offering somebody an additional choice, which they wouldn't have had, while not removing or undermining any other choices, is not coercion and therefore cannot be exploitation.

You're the one who is attacking strawmen. Consider a scenario where a man with a wallet full of cash finds himself dying of thirst in the desert just a day's walk from safety. I happen by, and I have a gallon of water. I offer to share my water with the man, but only if he gives me the contents of his wallet. Is that "nice?" No, probably not. Is it exploitation? No.

The problem is that you twist that scenario into one where a man with a wallet full of cash finds himself walking in the desert with just enough water to make it to safety. I happen by, take his water, and then offer to give it back to him if he gives me the contents of his wallet. That is a different situation, do you agree? The key is that the man would have been better off, or at least as well off, if I hadn't shown up.

Why are you bothering with hypotheticals when we have real examples in medicine like Martin Shkreli?

 

[jimbob]

Try this search.

Commoditization of health care is a real thing, and it has been going on for decades. Maybe you can find examples where it's difficult to find substitutes for, say, a particularly skilled surgeon (I actually gave an example regarding a treatment for pancreatic cancer), but those would still represent a tiny percentage of health care spending. My guess is that north of 95% of spending is on completely commoditizable medical services.

Your smartphone example is poor because the upgrade cycle is about 2 years. What I knew about smartphones even four years ago is completely obsolete today. This is true for most purchase decisions consumers face these days, although not in health care.

As for the claim that there are almost no standards of practice in medicine, that's very silly. The vast majority of doctors are just following rulebooks and protocols that they've learned in medical school or as a resident. Expert systems, i.e. computer programs, are increasingly being used for diagnosis. Once again, you can find certain examples at the outer edge of human medical knowledge where standards of practice haven't been solidified, and where doctors are forced to use their judgment, but that represents a tiny fraction of health care spending.

That's an odd view when more than 30% of US healthcare spending is on administration (some of which is necessary)

http://www.ncbi.nlm.nih.gov/pubmed/15088673


This article suggests that the administrative waste in 2011 was about 24% of the costs:

http://www.pnhp.org/news/2011/november/us-health-care-spending-where-is-the-waste (the difference can be accounted for because some admin is needed)

It also attributes about 20% of the cost* to inappropriate treatment. Some is the fallout from dealing with the consequences of under-treatment (example, you break your neck, but can't afford treatment, so get stabilised with a neck brace but no more treatment until it all goes wrong). Some is due to over-treatment.

*in fact it is somewhat more damming than that:

Unnecessary and inappropriate care is due to inadequate access to necessary care (under-treatment), or to various forms of over-treatment. There is actually far more under-treatment than over-treatment in the U.S.,6 but much of it is in the form of unnecessary suffering and death due to lack of access to care that does not show up in cost figures.

 

[sunmaster14]

We tried unregulated healthcare - it was a disaster. The FDA prevented a Thalidomide tragedy in the US.

Bit of a strawman there. I haven't argued for complete deregulation. There is virtually no market in the US which is has no regulation. I am arguing to remove regulations regarding what kind of insurance people must have, remove the tax subsidy for health care insurance, and allow a market to develop where people are directly responsible for a larger fraction of their health care expenditures. If you want to give poor people money or vouchers to spend on health care, that's fine. A free market doesn't have to mean that poor people lose out. In fact, if I had my druthers, they would gain, as would everybody else.

The two examples you have given (the car industry and the semiconductor industry) are industries that do have significant barriers to entry.

And yet, they are free markets with healthy competition, where consumers have been seeing quality-adjusted price drop dramatically over the years.

Your argument is silly.

An unscrupulous doctor could easily state that unnecessary treatment is needed just to get the money. They could recommend more expensive treatments rather than what they'd consider the best choice.

Easily? No, I don't think so. How would an unscrupulous doctor do that? It's far easier for an auto mechanic to rip you off on the repair of your car. For all you know, he purposely breaks something during the inspection. Is your unscrupulous doctor going to give you syphilis while he's examining you?

A dentist in my town was recently struck off for stating that patients needed fillings when they didn't - it was a nice little earner for him. The patients had little idea about that.

Well, it sounds like he was found out. Hopefully, in a free market, such dishonest providers can be ferreted out quickly. They're certainly more likely to be found out in a free market where people exchange information freely and prices are lower (easier to get a second opinion).

If I buy a house from someone and they have mislead me I can sue, depending on contract law. If a doctor gives me bad advice and I die, I can't sue.

You can't sue? Are you kidding me? Well, maybe not you if you're dead, but your loved ones and dependents can sue. Medical malpractice lawsuits are very common in the US. Too common actually.

Read the real-life example that Emily's Cat gave

You and Emily see that as a rebuttal to my claim. I see it as supporting evidence. Four weeks is plenty of time to make good decisions. It is just that the primary decision she had to make, which consumed all of her emotional energy, dominated all the rest. This isn't usually the case, nor is it the case that you're all alone (as she was perhaps) in making all these decisions. In a free market, you would probably see a health care concierge service industry pop up. If that existed, Emily could have offloaded some of her decision making to a 3rd party who was acting as her advocate.

A smartphone, however, will meet minimal standards of functionality, and you can change it after your contract has expired, or upgrade beforehand or simply buy another and they all probably cost less than a single trip in an ambulance in the US.

There are plenty of situations where they are. And the most important ones are the ones where bad decisions aren't reversible.

You're still trying to conflate very specific dire situations, which at best represent a tiny percentage of health care spending, with health care in general. And in a free market, professional services will arise which meets the demand for quality, 3rd party advice.

I am struggling to be polite here - but that isn't how most humans behave when they or their loved ones are under mortal threat.

You're now the 3rd person in the last day in this thread to use this passive-aggressive language. Here's a hint. It is impolite to say that you're struggling to be polite. So, you may as well cut the crap and be impolite. I'm not giving you credit for being polite anyway when you speak that way.

Early treatment tends to have a better prognosis and cost less. Preventative treatment often is even better.

Studies have shown that preventative health care usually costs more in the long run. Yes, there are special situations where it saves money, and in those situations (where there are positive externalities), it makes sense for the government to subsidies its provision (e.g. vaccinations). For the vast, vast majority of health care spending, there are no positive externalities.

Someone could work with a bad back but be less productive.

Coulda woulda shoulda. If you start subsidizing bad back treatments, you could also end up with double or triple the number of people claiming to have a bad back.

Someone could have TB and be unable to afford the treatment. Whilst they are slowly dying, they are infectious and they could infect many other people. Some of these then use the unregulated free market and buy a long course of antibiotics to treat the disease, but because of the lack of oversight, the bacteria has developed immunity to that antibiotic (and indeed most other antibiotics). Again, we have a model for this - India and the rest of the Indian Subcontinent. It has a sufficiently large middle class (>200-million) for there to be a market in healthcare but little effective regulation.

Under your proposed system, it would make sense for insurance companies to employ people to specifically find (spurious) reasons why treatments shouldn't be paid for. This is one thing that the ACA addressed.

The claim that insurance companies are finding spurious reasons to avoid paying for treatments is largely a myth. My personal experience is that insurance companies are big bureaucracies which follow protocols diligently, and as long as you dot the "i"s and cross the "t"s you get what you're entitled to. Unfortunately, there is a lot of fraud and selection bias in the system, so insurance companies have to be vigiliant to keep premiums for honest people affordable.

People with preexisting conditions, or family histories, presumably should just find the most comfortable way to die in your preferred system.

More disingenuous, emotional rhetoric is not a good substitute for argument. Regardless, doing something for people with preexisting conditions is a separate issue from the best way to set up a health care market. If people have conditions which make their health care expenses unaffordable, then perhaps charities or the government should step in and subsidize their health care. Forcing insurance companies or hospitals to lose money on them is just a way of sweeping their costs under the rug and making other health care consumers pay those costs implicitly. Politicians of course like doing this because they don't have to raise taxes or cut spending elsewhere to provide subsidies for those constituents. There's nothing a politician likes better than replacing a tax hike with a little extra regulation, even though the effect on the taxpayer/consumer is the same.

 

[sunmaster14]

Why are you bothering with hypotheticals when we have real examples in medicine like Martin Shkreli?

Hmmm. Not sure your use of the plural here is appropriate. Shkreli is kind of an outlier. Regardless, his little gambit was only made possible by the fact that his drug has a small market and that he bought the rights to manufacture that drug from the only generic maker with FDA approval to make it. So in this case, his monopoly was facilitated by the fact that it is very expensive and time-consuming to get FDA approval to manufacture a generic version of the drug. In time it would happen. It would happen even faster if the FDA sped up its approval process or waived some of its onerous requirements.

I'll note also that Shkreli suffered a public relations backlash for his strategy to corner a teensy bit of the pharmaceutical market. Personally, I think most people or companies would not consider the tradeoff to be worth it. I'm not sure it has worked out well for him, given that he is now under federal indictment for securities fraud.

 

[sunmaster14]

That's an odd view when more than 30% of US healthcare spending is on administration (some of which is necessary)

http://www.ncbi.nlm.nih.gov/pubmed/15088673

That's irrelevant. I'm talking about spending by the consumer. It matters little what percentage of the cost of the commodity service is in administrative costs. A large part of the cost of the gasoline I buy at the pump is probably administrative costs too. It's still a commodity.

 

[jimbob]

The claim that insurance companies are finding spurious reasons to avoid paying for treatments is largely a myth. My personal experience is that insurance companies are big bureaucracies which follow protocols diligently, and as long as you dot the "i"s and cross the "t"s you get what you're entitled to. Unfortunately, there is a lot of fraud and selection bias in the system, so insurance companies have to be vigiliant to keep premiums for honest people affordable.

http://www.ct.gov/oha/lib/oha/docum...on_recission_of_health_insurance_policies.pdf

They certainly used to until legislation forced them to stop:
From the congress report:

Insurance companies rescind coverage even when discrepancies are unintentional or caused by others. In one case reviewed by the Committee, a WellPoint subsidiary rescinded coverage for a patient in Virginia whose insurance agent entered his weight incorrectly on his application and failed to return it to him for review. The company's Associate General Counsel warned that the agent's actions were "not acceptable" and recommended against rescission, but she was overruled.

• Insurance companies rescind coverage for conditions that are unknown to
policyholders. In 2004, Fortis Health, now known as Assurant, rescinded coverage for a policyholder with lymphoma, denying him chemotherapy and a life-saving stem cell transplant. The company located a CT scan taken five years earlier that identified silent gall stones and an asymptomatic abdominal aortic aneurysm, but the policyholder's doctor never informed him of these conditions. After direct intervention from the Illinois Attorney General's Office, the individual's policy was reinstated.

• Insurance companies rescind coverage for discrepancies unrelated to the medical conditions for which patients seek medical care. In November 2006, a Texas resident with a policy from WellPoint was diagnosed with a lump in her breast. The company initiated an investigation into the patient's medical history and concluded that she failed to disclose that she had been diagnosed previously with osteoporosis and bone density loss. The company rescinded her policy and refused to pay for medical care for the lump in her breast.

• Insurance companies rescind coverage for family members who were not involved in misrepresentations. When a UnitedHealth subsidiary determined in 2007 that a policyholder in Michigan failed to disclose his abnormal blood count and other conditions, the company also rescinded coverage for his spouse and two children. When his spouse called to find out "[w]hy we dropped whole family instead of husband," the company official "[c]alled her back told her coverage was voided to medical history not on app."

• Insurance companies automatically investigate medical histories for all
policyholders with certain conditions. WellPoint and Assurant informed the
Committee that they automatically investigate the medical records of every policyholder with certain conditions, including leukemia, ovarian cancer, brain cancer, and even becoming pregnant with twins. UnitedHealth was unable to explain specifically how its investigations are triggered, claiming that it utilized a computer program so complex that no single individual in the company could explain it.

• Insurance companies have evaluated employee performance based on the amount of money their employees saved the company through rescissions. The Committee obtained an annual performance evaluation of the Director of Group Underwriting at WellPoint. Under "results achieved" for meeting financial "targets" and improving financial "stability," the review stated that this official obtained "Retro savings of $9,835,564" through rescissions. The official was awarded a perfect "5" for "exceptional performance."

 

[sunmaster14]

http://www.ct.gov/oha/lib/oha/docum...on_recission_of_health_insurance_policies.pdf

They certainly used to until legislation forced them to stop:
From the congress report:

This was from a report analyzing the individual market in the US pre-Obamacare. That market was completely broken. Because of the tax subsidies for employer provided health care, which encourage everybody to get employer sponsored insurance, the individual market was tiny and subject to huge selection bias pressures and fraud. The only way for insurance companies to make it work, even marginally, was to do post-claims underwriting, rather than underwriting before pricing and issuance. This, of course, leads to sob stories of people being denied insurance they thought they had, but even those sob stories are exaggerated, nor are they as "sob-orific" as claimed. These are people who probably would have been denied affordable insurance in the first place.

Regardless, I think the individual market was dysfunctional and something should have been done. The solution, of course, was easy. Get rid of the tax subsidy for employer sponsored insurance and allow the individual market to become a real market. Or at least provide the same tax benefits to individual insurance as are provided to employer provided insurance. Obamacare is not going to work until the playing field is equalized (which was actually what the Cadillac tax was going to do, although now it has been gutted unfortunately). Obamacare is only "working" to the extent it is (although not very well) because of the explicit subsidies provided by the government to people who make less than 4 times the poverty line. Pretty soon, however, even those subsidies won't be enough because people making over 4 times the poverty line won't be able to afford the typical premiums in the Obamacare market. This is due to the fact that premiums will continue to rise faster than the poverty line.

 

[jimbob]

We tried unregulated healthcare - it was a disaster. The FDA prevented a Thalidomide tragedy in the US.

Bit of a strawman there. I haven't argued for complete deregulation. There is virtually no market in the US which is has no regulation. I am arguing to remove regulations regarding what kind of insurance people must have, remove the tax subsidy for health care insurance, and allow a market to develop where people are directly responsible for a larger fraction of their health care expenditures. If you want to give poor people money or vouchers to spend on health care, that's fine. A free market doesn't have to mean that poor people lose out. In fact, if I had my druthers, they would gain, as would everybody else.

Apologies - I read your posts as being in favour of a true free market without any regulation except to enforce tort law.

However, I don't see how you square your acceptance of the need for regulation with your views about the benefit of the free market.

The two examples you have given (the car industry and the semiconductor industry) are industries that do have significant barriers to entry.

And yet, they are free markets with healthy competition, where consumers have been seeing quality-adjusted price drop dramatically over the years.

There are alternatives which do not exist in the case of medical treatment. I can defer buying a new car, I can buy a secondhand car, I can choose to have a feature phone rather than a smartphone, it's possible to hire cars... Shopping around is easy. It isn't so easy to shop around when you are ill. It's also hard to shop around for possible treatments for potential illnesses that I might develop in the future.

Your argument is silly.

An unscrupulous doctor could easily state that unnecessary treatment is needed just to get the money. They could recommend more expensive treatments rather than what they'd consider the best choice.

Easily? No, I don't think so. How would an unscrupulous doctor do that? It's far easier for an auto mechanic to rip you off on the repair of your car. For all you know, he purposely breaks something during the inspection. Is your unscrupulous doctor going to give you syphilis while he's examining you?

Three are plenty of conditions with different treatment regimes, maybe I am slightly overweight and the doctor recommends bariatric surgery.

A dentist in my town was recently struck off for stating that patients needed fillings when they didn't - it was a nice little earner for him. The patients had little idea about that.

Well, it sounds like he was found out. Hopefully, in a free market, such dishonest providers can be ferreted out quickly. They're certainly more likely to be found out in a free market where people exchange information freely and prices are lower (easier to get a second opinion).

Why should it be any easier in a free market than one with oversight?

If I buy a house from someone and they have mislead me I can sue, depending on contract law. If a doctor gives me bad advice and I die, I can't sue.

You can't sue? Are you kidding me? Well, maybe not you if you're dead, but your loved ones and dependents can sue. Medical malpractice lawsuits are very common in the US. Too common actually.

Yes, I can't sue being dead, my dependents might be able to, but they have more difficulty in knowing the case than me.

Read the real-life example that Emily's Cat gave

You and Emily see that as a rebuttal to my claim. I see it as supporting evidence. Four weeks is plenty of time to make good decisions. It is just that the primary decision she had to make, which consumed all of her emotional energy, dominated all the rest. This isn't usually the case, nor is it the case that you're all alone (as she was perhaps) in making all these decisions. In a free market, you would probably see a health care concierge service industry pop up. If that existed, Emily could have offloaded some of her decision making to a 3rd party who was acting as her advocate.

Why is an additional middleman better than setting up the system so that the doctor can be trusted as they aren't making money out of the procedure, just from providing good care?


One link I posted earlier suggested that about 20% of the cost of the US system was in inappropriate care.

A smartphone, however, will meet minimal standards of functionality, and you can change it after your contract has expired, or upgrade beforehand or simply buy another and they all probably cost less than a single trip in an ambulance in the US.

There are plenty of situations where they are. And the most important ones are the ones where bad decisions aren't reversible.

You're still trying to conflate very specific dire situations, which at best represent a tiny percentage of health care spending, with health care in general. And in a free market, professional services will arise which meets the demand for quality, 3rd party advice.

At any one time it might be a small number of people, however the vast majority will end up infirm towards the end of life.

I am struggling to be polite here - but that isn't how most humans behave when they or their loved ones are under mortal threat.

You're now the 3rd person in the last day in this thread to use this passive-aggressive language. Here's a hint. It is impolite to say that you're struggling to be polite. So, you may as well cut the crap and be impolite. I'm not giving you credit for being polite anyway when you speak that way.

Possibly because we are reading your posts as having no empathy or understanding of the circumstances of people in such a situation.

Early treatment tends to have a better prognosis and cost less. Preventative treatment often is even better.

Studies have shown that preventative health care usually costs more in the long run. Yes, there are special situations where it saves money, and in those situations (where there are positive externalities), it makes sense for the government to subsidies its provision (e.g. vaccinations). For the vast, vast majority of health care spending, there are no positive externalities.

Someone could work with a bad back but be less productive.

Coulda woulda shoulda. If you start subsidizing bad back treatments, you could also end up with double or triple the number of people claiming to have a bad back.

Really? What reason would I have to claim treatment for a non-existent back problem?

It would be of no benefit, and take time and effort on my part, possibly with added discomfort.

Someone could have TB and be unable to afford the treatment. Whilst they are slowly dying, they are infectious and they could infect many other people. Some of these then use the unregulated free market and buy a long course of antibiotics to treat the disease, but because of the lack of oversight, the bacteria has developed immunity to that antibiotic (and indeed most other antibiotics). Again, we have a model for this - India and the rest of the Indian Subcontinent. It has a sufficiently large middle class (>200-million) for there to be a market in healthcare but little effective regulation.

Under your proposed system, it would make sense for insurance companies to employ people to specifically find (spurious) reasons why treatments shouldn't be paid for. This is one thing that the ACA addressed.

The claim that insurance companies are finding spurious reasons to avoid paying for treatments is largely a myth. My personal experience is that insurance companies are big bureaucracies which follow protocols diligently, and as long as you dot the "i"s and cross the "t"s you get what you're entitled to. Unfortunately, there is a lot of fraud and selection bias in the system, so insurance companies have to be vigiliant to keep premiums for honest people affordable.

People with preexisting conditions, or family histories, presumably should just find the most comfortable way to die in your preferred system.

More disingenuous, emotional rhetoric is not a good substitute for argument. Regardless, doing something for people with preexisting conditions is a separate issue from the best way to set up a health care market. If people have conditions which make their health care expenses unaffordable, then perhaps charities or the government should step in and subsidize their health care. Forcing insurance companies or hospitals to lose money on them is just a way of sweeping their costs under the rug and making other health care consumers pay those costs implicitly. Politicians of course like doing this because they don't have to raise taxes or cut spending elsewhere to provide subsidies for those constituents. There's nothing a politician likes better than replacing a tax hike with a little extra regulation, even though the effect on the taxpayer/consumer is the same.

I see from later posts that you do advocate subsidising healthcare for poorer people, I am unsure why you think that your preferred model is superior to Canada's. I am also unsure as to what your preferred model entails, except not too much interference in the market.

 

[Hercules56]

Let us know when premiums under the ACA are finally lower than where they would be had the ACA never been created.

 

[quixotecoyote]

This was from a report analyzing the individual market in the US pre-Obamacare.

Goalpost move.

You said the insurance companies using spurious rescission was a myth.

Evidence showed it happened frequently.

You handwave.

Don't expect you to acknowledge it, just putting it out clearly in the thread.

 

[Ziggurat]

Let us know when premiums under the ACA are finally lower than where they would be had the ACA never been created.

And not just a little lower, but $2,500 lower. That's what we were promised.

 

[sunmaster14]

Goalpost move.

You said the insurance companies using spurious rescission was a myth.

Evidence showed it happened frequently.

You handwave.

Don't expect you to acknowledge it, just putting it out clearly in the thread.

First of all, I said "largely a myth." A few anecdotes about the individual market, which represented 5% of the insurance market in the US before Obamacare, does not disprove that claim, and I stand by it.

Second, I used the term "spurious." Even if you accept those anecdotes at face value (and I don't), they're not spurious.

Your move ...

 

[Puppycow]

Let us know when premiums under the ACA are finally lower than where they would be had the ACA never been created.

And not just a little lower, but $2,500 lower. That's what we were promised.

So, do we know where average insurance premiums would be in 2016 had the ACA never been created?

Pre-Obamacare (from 2000-2010) insurance premiums rose by an average of 7.9%/year. Since then, the rises have been about 5%/year.

Here's an argument that the promise has actually been met:

http://nymag.com/daily/intelligencer/2015/09/obamacare-haters-freaking-out-over-new-report.html#

Ultimately, we can only compare with projections of what the costs might have been in a parallel universe without the ACA, but we can't really be certain.

A sensible interpretation of Obama’s promise would be a $2,500 savings against the baseline of existing projections — Obama’s reforms would save the average family $2,500 compared to what would happen if his reforms were not enacted. That promise, again, has come true.

Merline and Gillespie instead assume that Obama was using a baseline of existing nominal prices. The only way Obama’s reforms could succeed is not only if the decades of medical inflation slowed their rate, but if prices actually dropped in nominal terms. Of course, Obama never actually said anything like this.

 

[sunmaster14]

So, do we know where average insurance premiums would be in 2016 had the ACA never been created?

Pre-Obamacare (from 2000-2010) insurance premiums rose by an average of 7.9%/year. Since then, the rises have been about 5%/year.

Here's an argument that the promise has actually been met:

http://nymag.com/daily/intelligencer/2015/09/obamacare-haters-freaking-out-over-new-report.html#

Ultimately, we can only compare with projections of what the costs might have been in a parallel universe without the ACA, but we can't really be certain.

Obama didn't say that insurance premiums would be $2,500 lower than they would have been sans Obamacare. He said that the average family would save $2,500 compared to what they would have paid sans Obamacare. That almost certainly isn't true because premiums have been kept in check (relatively) only because of rising deductibles. A premium to premium comparison is not apples to apples.

The way to determine if Obamacare has created cost savings is to calculate what the total health care spending per capita has been in the US since the implementation of Obamacare, and compare that to what it would have been sans Obamacare. If total spending per capita turned out to be lower, either because the prices for medical services were lower or because there was less consumption of medical services (and the two probably go hand in hand), then you could reasonably claim that Obamacare has bent the cost curve. I suspect it hasn't.

ETA: Actually, I just looked at the Kaiser report that Jonathan Chait linked to in your article. It appears to me he has mischaracterized it, since nowhere does it say that the $2,500 putative cost savings that Obama promised have been realized. In fact, it says this (my emphasis added):

In 2015, the average annual premiums for employer-sponsored health insurance are $6,251 for single coverage and $17,545 for family coverage (Exhibit A). Each rose 4% over the 2014 average premiums. During the same period, workers’ wages increased 1.9% and inflation declined by 0.2%.2 Premiums for family coverage increased 27% during the last five years, the same rate they grew between 2005 and 2010 but significantly less than they did between 2000 to 2005 (69%) (Exhibit B).

 

[Ziggurat]

Here's an argument that the promise has actually been met:

The argument is wrong. Obama didn't simply say he would slow the growth of premiums. He explicitly promised to reduce premiums by $2,500. He used that exact word: "reduce". The plain meaning of the language he used is that premiums would be lower by $2,500 than they were at a fixed point in time, and that has never happened.

The most honest defense of Obama's claim is that it was so transparently a lie, so obvious that premiums wouldn't drop by that much (if at all), that you can only blame yourself if you believed it.

 

[Emily's Cat]

You define it away as not being necessary. And it can't be a monopoly because



Despite there being lots of evidence from history that this isn't the case.

I don't understand your response. The second quote isn't even me. Did you confuse me with a different poster perchance?

 

[Emily's Cat]

Try this search.

Commoditization of health care is a real thing, and it has been going on for decades. Maybe you can find examples where it's difficult to find substitutes for, say, a particularly skilled surgeon (I actually gave an example regarding a treatment for pancreatic cancer), but those would still represent a tiny percentage of health care spending. My guess is that north of 95% of spending is on completely commoditizable medical services.

sunmaster, you're not even wrong.

 

[Emily's Cat]

That's irrelevant. I'm talking about spending by the consumer. It matters little what percentage of the cost of the commodity service is in administrative costs. A large part of the cost of the gasoline I buy at the pump is probably administrative costs too. It's still a commodity.

Okay, let me set you straight on this, since you're clearly just pulling numbers out of... well someplace not particularly well illuminated.

In the commercial health care market (non-Medicare, non-Medicaid, non-Military)...

In any given year,

• Approximately 20% of all insured individuals have exactly zero claims.
• Approximately 35% of claims are for preventive and routine care. This attributes to just under 40% of insured individuals.
• The remainder are acute incidents (colds, short-term illnesses, injuries) and chronic care.
• The 20% most health-burdened insureds generate over 80% of the total cost of care for all insureds
• The 5% most health-burdened insureds generate about 5% of the total cost of care for all insureds

So, at the end of the day, 35% of the services provided *might* be able to be classed as commoditizable, if it weren't for the fact that there are no medical standards of practice. And that 35% of claims is only about 27% of the actual cost of care.

Your claim that 95% of the costs are on "commoditizable" services is so far wrong that it's nothing more than wishful thinking about a subject on which you are uninformed.

 

[Emily's Cat]

Let us know when premiums under the ACA are finally lower than where they would be had the ACA never been created.

How long do you have left to live?

 

[sunmaster14]

Okay, let me set you straight on this, since you're clearly just pulling numbers out of... well someplace not particularly well illuminated.

In the commercial health care market (non-Medicare, non-Medicaid, non-Military)...

In any given year,

• Approximately 20% of all insured individuals have exactly zero claims.
• Approximately 35% of claims are for preventive and routine care. This attributes to just under 40% of insured individuals.
• The remainder are acute incidents (colds, short-term illnesses, injuries) and chronic care.
• The 20% most health-burdened insureds generate over 80% of the total cost of care for all insureds
• The 5% most health-burdened insureds generate about 5% of the total cost of care for all insureds

So, at the end of the day, 35% of the services provided *might* be able to be classed as commoditizable, if it weren't for the fact that there are no medical standards of practice. And that 35% of claims is only about 27% of the actual cost of care.

Your claim that 95% of the costs are on "commoditizable" services is so far wrong that it's nothing more than wishful thinking about a subject on which you are uninformed.

And you seem to have a poor understanding of what the term "commoditizable" means. I don't see how the data you've presented is in any way relevant to my claim.