Monday, December 17, 2018

Judge Reed O'Connor's ruling on the "A"CA gives us the best opportunity in - well, my lifetime - to put health insurance on a normal-people footing

Braden H. Bousek's PJ Media essay about it is as insightful as you're going to find anywhere.

First, the ruling:

Many Americans checking the news for the first time following the weekend will learn that a federal judge in Texas, in a lawsuit that few were watching, declaredObamacare unconstitutional in its entirety. The question now becomes what happens next, legally and politically.
Judge Reed O’Connor, one of America’s most formidable legal minds, ruled (as predicted) that the individual mandate, originally justified as a tax, could no longer be since the penalty was set at zero. And by the words of Obamacare’s own architects, the individual mandate was essential to the law’s overall success. The whole thing came down along with the mandate.
And now, for some of the dang-I-wish-I'd-said-that insight:

Obamacare was intentionally made clunky and convoluted so as to disguise the true costs from Americans who the law’s author figured were too stupid to recognize the law for what it is – a tax and spend welfare program that would have looked quite at home during the New Deal but for its dishonest packaging.
Employers all across the country who have been hard hit by the "employer mandate" are finding it increasingly difficult to comply. With its hallmark leaden touch, Obamacare forced all large employers across the country and in different industries to provide the health insurance it mandated. As with any closed system, the market suffered.
The rate of the increasing cost of insurance will continue to accelerate as fewer healthy individuals purchase insurance, particularly if only part of the country needs to participate. With people waiting until they need care to buy insurance, the market will be less actuarially sound and the costs will increase further. 
And this insight: The notion that health care - and the means for covering it with insurance - is some kind of overwhelmingly complex web of interconnected factors is a lot of smoke and mirrors:

There’s probably less of a reason why health care isn’t more like the market for phones or cars than people commonly suspect. If you think "health care is just different" from other consumer goods, then check out what’s happened to laser vision eye care over the last decade. Unlike most health care products, it is generally severed from the third party-payer model. With consumers and doctors in charge, laser vision eye care has dramatically gone up in quality and down in cost. In other words, it has behaved unlike other health care products and exactly like a healthy market.
Now, Boucek says, it's time for those in a position to really move the needle to go get 'em:

Many states have incoming governors right now. They have fresh perspective to bring to bear into a debate that had gone stale. In a future when the health insurance market may, for the first time since WWII, not have to orbit around a federal dead star, state lawmakers will be free to innovate like never before. Innovation, consumer choice, and an open market may finally have the opportunity to flourish.
Those states that did not shackle themselves with Medicaid expansion have even greater freedom to experiment. And even those states that remain infatuated with central planning should have the chance to put their schemes into practice. Let us see the results of these competing philosophical models. 
Many thanks to the judge and to the impeccable policy-analysis chops - and ample common sense - of Mr. Boucek.
 

14 comments:

  1. Kinda like declaring the deer dead 6 months after it was shot, field dressed, butchered and frozen.

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  2. The opportunity to do it right is the exciting part.

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  3. Careful what you wish for because Dems are going to capitalize on the confusion and delay induced by this ruling your former party's quite questionably elected Chief Executive has tweeted his hearty approval of, as do you. Medicare for all will definitely be on the table now much sooner because of this edict and the outlook may now well be more favorable for it.

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  4. Good point about the laser eye surgery though.

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  5. This comment has been removed by the author.

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  6. Except, it's not. This is from my memory of a Bill Maher show a year or more ago so if you want to fact check my details, have at it. According to Neil Degrasse Tyson on that episode Rand Paul - a practicing ophthalmologist - used to make the same free-market claim about laser eye surgery but doesn't any more...because the story is wrong.

    The reason laser eye surgery got much better while costs dropped dramatically is because of our ability to apply technology developed with tax dollars by NASA. Seems the same tech that makes possible the docking of two space vehicles hurtling tens of thousands of miles per hours hundreds of miles above the earth is applicable to computer-driven laser eye surgery. Oops!

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  7. Advances occur all the tine with almost all of the medical technology so why doesn't the overall price of medical care drop commensurately? If you have ever been hospitalized, scrutinize your bill and you will find $25.00 aspirin, charges for occupational and recreational therapy you never had, and on and on. There is one price for insured patients and one for uninsured. The pricing and payment structures are gordian knots. This is why I raise a brow of eye over the free market solutions. Don't we all want a system that is forced to be honest? Perhaps that is where that invisible hand can come in handy.

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    1. The laser eye surgery example, unlike most medtech, was a lucky spinoff of the space station program, but was frequently trotted out - and apparently still is - as an example of free-market Valhalla...which it ain't.

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    2. You raise a good point, Rick. A lot more med tech than laser eye surgery has been birthed by NASA, a government agency.

      Here are a few of the many other medical advances that came at least in part from NASA:

      •Digital imaging breast biopsy system, developed from Hubble Space Telescope technology
      •Tiny transmitters to monitor the fetus inside the womb
      •Laser angioplasty, using fiber-optic catheters
      •Forceps with fiber optics that let doctors measure the pressure applied to a baby's head during delivery
      •Cool suit to lower body temperature in treatment of various conditions
      •Voice-controlled wheelchairs
      •Light-emitting diodes (LED) for help in brain cancer surgery
      •Foam used to insulate space shuttle external tanks for less expensive, better molds for artificial arms and legs
      •Programmable pacemakers
      •Tools for cataract surgery

      https://science.howstuffworks.com/innovation/nasa-inventions/nasa-breakthroughs-in-medicine.htm

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  8. Trump wants to supersize a program that spent almost a quarter of its funds on overhead.


    For years, conservatives have assailed the U.S. Department of Veterans Affairs as a dysfunctional bureaucracy. They said private enterprise would mean better, easier-to-access health care for veterans. President Donald Trump embraced that position, enthusiastically moving to expand the private sector’s role. Here’s what has actually happened in the four years since the government began sending more veterans to private care: longer waits for appointments and, a new analysis of VA claims data by ProPublica and PolitiFact shows, higher costs for taxpayers.

    Since 2014, 1.9 million former service members have received private medical care through a program called Veterans Choice. It was supposed to give veterans a way around long wait times in the VA. But their average waits using the Choice Program were still longer than allowed by law, according to examinations by the VA inspector general and the Government Accountability Office. The watchdogs also found widespread blunders, such as booking a veteran in Idaho with a doctor in New York and telling a Florida veteran to see a specialist in California. Once, the VA referred a veteran to the Choice Program to see a urologist, but instead he got an appointment with a neurologist.

    The winners have been two private companies hired to run the program, which began under the Obama administration and is poised to grow significantly under Trump. ProPublica and PolitiFact obtained VA data showing how much the agency has paid in medical claims and administrative fees for the Choice program. Since 2014, the two companies have been paid nearly $2 billion for overhead, including profit. That’s about 24 percent of the companies’ total program expenses — a rate that would exceed the federal cap that governs how much most insurance plans can spend on administration in the private sector."

    https://talkingpointsmemo.com/news/veterans-affairs-private-care-program?fbclid=IwAR3X-jyWu5bc99wwOaTOfhYUKs1dxBCE2Y6A_R5Aqnu2mMaQLEz-dWyEJ1s

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  9. But notice how the incompetencies happened under the auspices of a "program." In an actually free market, the government doesn't set up "programs." People just get what they're looking for at what they deem a fair price. In a truly competitive environment, anybody who sent a patient to an entirely wrong kind of doctor or had excessive overhead would not be in business long.
    Also, re: the innovations that originated at NASA: the ingenuity is in their application to other uses.

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  10. So you want to disband the VA now?

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  11. I'll bet there are far more effective ways to help our veterans.

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