Interesting People mailing list archives
Re What the Republican Health Plan Gets Right
From: "Dave Farber" <dave () farber net>
Date: Sat, 06 May 2017 22:56:34 +0000
---------- Forwarded message --------- From: Steve Papa <spapa1999 () gmail com> Date: Sat, May 6, 2017 at 4:47 PM Subject: Re: [IP] Re What the Republican Health Plan Gets Right To: <dave () farber net> As an engineer…..rather than first look at cost/benefit….I would first look at how do you cost-effectively deliver the basic benefit and build up from there. There is clear potential to deploy resources far more effectively than we do today but it’s a political problem versus an engineering problem. Here’s how to see one part of it clearly: The USA spends proportionally an EXTRA $100B/year on administration of healthcare relative to Canada (by using percentage of GDP). The AHCA is estimated by NPR to save $76.5B/yr in taxes. The incremental administrative costs in the US are GREATER than this AHCA tax cut. So if we are rationing benefits and want to drive down costs….it would seem the Canadian model gets you a basic foundation (that is arguably better than what AHCA is proposing) for much less than the US is spending AND those with means can still have tax cuts to spend on incremental care if they want. The political problem is that typically either party wants to tackle the revenue side (taxes) and its coverage implications without having the political strength or ideological flexibility to fully address the cost-effectiveness side where there are working models to inform a much better approach. I’m not advocating for the Canadian model….all I am saying is the engineers, if allowed to do their jobs, can improve this dramatically by providing more health care for all for less spend. Sources (this isn’t my day job – did 2 minutes of web searching – this is JUST the administrative side, the rest of the US healthcare spend relative to other countries has many other opportunities for improvement): *"Hospital administration costs ranged from 1.43 percent of gross domestic product (GDP) in the United States ($667 per capita) to 0.41 percent of GDP ($158 per capita) in Canada."* *The Bottom Line* Administrative costs accounted for 25 percent—or more than $200 billion—of total hospital spending in the United States. In the other nations included in this study, these costs accounted for between 12 percent of spending (Canada and Scotland) and 20 percent of spending (the Netherlands). http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs All told, the bill would cut taxes by about $765 billion over the next decade. http://www.npr.org/2017/05/04/526923181/gop-health-care-bill-would-cut-about-765-billion-in-taxes-over-10-years *From: *Dave Farber <dave () farber net> *Reply-To: *<dave () farber net> *Date: *Saturday, May 6, 2017 at 4:21 PM *To: *ip <ip () listbox com> *Subject: *[IP] Re What the Republican Health Plan Gets Right ---------- Forwarded message --------- From: Sidney Karin <skarin () ucsd edu> Date: Sat, May 6, 2017 at 4:17 PM Subject: Re: [IP] Re What the Republican Health Plan Gets Right To: dave () farber net <dave () farber net> Dave, For IP if you like. As an engineer I like to think in cost/benefit terms. To a first approximation Obamacare got the benefit right, but got the cost wrong. To a first approximation the AHCA gets the costs right, but gets the benefit wrong. I think that a good case could be made that we have already reached the point that we could spend the GDP on useful (extend life, improve quality of life) healthcare, not including all of the waste inherent in AHCA, Obamacare and what preceded it. If we haven’t reached that point we soon will and in the not too distant future we will be capable of delivering useful healthcare in significant multiples of the GDP. This begs the question of what basic health care should be made available to everyone? Obviously, not all conceivable health care. We will ration health care. Indeed, we already ration health care, witness such items as Lasik surgery. Those who get it pay out of their own pocket. Those who cannot afford it do not get it. We need a debate about what we think should be available to all and what will be available only to those with sufficient resources of their own. Some things seem obvious, including my Lasik example. On the other side of the ledger vaccines seem obvious. Real emergency care is another. The debates of recent years seem focussed on the costs and try, or at least pay lip service to, delivering all available health care to everyone. That isn’t going to work. It already doesn’t work. We need to refocus the debate. Who should pay how much is only part, albeit an important part, of the problem. Cheers, …….Sid On May 6, 2017, at 11:38 AM, Dave Farber <dave () farber net> wrote: ---------- Forwarded message --------- From: Mark Blacknell <mb () blacknell net> Date: Sat, May 6, 2017 at 2:37 PM Subject: Re: [IP] What the Republican Health Plan Gets Right To: Dave Farber <dave () farber net> Jesus. I was wondering who could come out to defend this plan, and . . . well. It's not the brightest and best. The doctor that wrote the op-ed complained about a patient that saw him too often for ailments she didn't have. And whose fault was that? Obama's, apparently. Not the patient's for making poor decisions, or even (especially) his for failing to educate his patient. Simple solution? He could have declined to see her. My kids' pediatrician refuses to see non-vaccinated children. He could have done the same. This reminds me a bit of my banker friends, who insisted that they only behaved so poorly in the run-up to the 2008 meltdown because the government let them. They were simply chasing profits, you see, and that's what they were supposed to do. It was the government's fault that they weren't restrained. (Also, could they have a bailout, please?) As to his pre-existing conditions claptrap, it strikes me as coming from someone who has never had job/economic insecurity. Aside from 22 year olds who haven't yet figured out that they're not, in fact, immortal, no one *chooses* to go without some sort of access to health care. The AHCA is a terrible failure of American government/politics/society. I can't imagine defending this particular piece of legislation. Mark Blacknell mb () blacknell net +1.202.270.5909 Washington, DC On Sat, May 6, 2017 at 1:20 PM, Dave Farber <farber () gmail com> wrote: Begin forwarded message: *From:* Dewayne Hendricks <dewayne () warpspeed com> *Date:* May 6, 2017 at 10:19:22 AM EDT *To:* Multiple recipients of Dewayne-Net <dewayne-net () warpspeed com> *Subject:* *[Dewayne-Net] What the Republican Health Plan Gets Right* *Reply-To:* dewayne-net () warpspeed com [Note: This item comes from friend Bob Frankston. Bob’s comment:'The author blithely offers a "let them eat cake" piece of advice by saying that people with preexisting conditions can just get a job and get coverage via their employer. Totally out of step with a gig and entrepreneurial economy. Or for that matter, any rational economy that doesn't try to hide the true costs of healthcare.’. DLH] What the Republican Health Plan Gets Right By MARC K. SIEGEL May 5 2017 < https://www.nytimes.com/2017/05/05/opinion/what-the-republican-health-plan-gets-right.html
Now that the Obamacare replacement bill has passed the House and is moving on to the more centrist Senate, the real debate begins. What is the true purpose of health insurance, and what is our government’s goal in ensuring we have it? I learn from my patients every day about the benefits, limitations and contradictions of their health insurance. One charming 60-year-old with severe seasonal allergies insists on seeing me every few weeks this time of year, even though I tell her she doesn’t need to — her antihistamines and nasal spray treatment rarely changes. But she worries that her allergies could be hiding an infection, so I investigate her sinuses, throat, lungs and ears. I reassure her, and her insurance (which she buys through New York’s Obamacare exchange) covers the bill. If she was responsible for more than a small co-payment for these visits, I’m sure I would see her less often. We pride ourselves on being a compassionate society, and insurance companies use this to manipulate us into sharing the costs of other people’s excessive health care. Meanwhile, 5 percent of Americans generate more than 50 percent of health care expenses. Why shouldn’t a patient who continues to see me unnecessarily pay more? The government’s job is to maintain public health and safety. It should ensure that insurance plans include mandatory benefits like emergency, epidemic, vaccine and addiction coverage. The Republican bill would let states apply for waivers to define these benefits differently; it would be a big mistake to drop such coverage entirely. But Obamacare went well beyond these essentials, by mandating an overstuffed prix fixe meal filled with benefits like maternity and mental health coverage that drove smaller insurers with fewer options out of the market. The few that remain often have a monopoly, and premiums rise. Speaking of compassion, how about some for the 20-something construction worker who can’t afford to pay his rent because his premiums help subsidize overusers like my allergy sufferer? Why shouldn’t a patient who is risk-averse pay more for coverage she might never need, while that construction worker be allowed to choose a cheaper insurance plan that might cover only the essentials? In addition to limiting the menu of essential benefits, the House bill would let states create high-risk pools for patients with pre-existing conditions who had let their insurance coverage lapse, and who could then be charged premiums more in keeping with their health care needs. This is the only way to make insurance affordable for most consumers; pre-existing conditions will continue to drive up premiums if everyone is compelled to pay the same price. These risk-pool premiums can and should be subsidized by the government. A recent report from the Kaiser Family Foundation found that high-risk pools can work, but have been historically underfunded. Trumpcare should change that — though it will cost more than the House bill’s $8 billion in additional funding. Drastic cuts to Medicaid should also be reversed, which could help the bill pass the Senate. [snip] Dewayne-Net RSS Feed: <http://dewaynenet.wordpress.com/feed/> ++++++++++++++++++++++++++++++++++++++++++++++++ Sidney Karin Ph.D., P.E. skarin () ucsd edu 858-534-5075 Professor Emeritus, Department of Computer Science and Engineering Director Emeritus, San Diego Supercomputer Center University of California, San Diego 9500 Gilman Drive La Jolla, CA 92093-0505 Archives <https://www.listbox.com/member/archive/247/=now> <https://www.listbox.com/member/archive/rss/247/126641-ae648579>| Modify <https://www.listbox.com/member/?&> Your Subscription | Unsubscribe Now <https://www.listbox.com/unsubscribe/?&&post_id=20170506162130:92CE227C-3299-11E7-8323-8A142EE0F2C1> <http://www.listbox.com> ------------------------------------------- Archives: https://www.listbox.com/member/archive/247/=now RSS Feed: https://www.listbox.com/member/archive/rss/247/18849915-ae8fa580 Modify Your Subscription: https://www.listbox.com/member/?member_id=18849915&id_secret=18849915-aa268125 Unsubscribe Now: https://www.listbox.com/unsubscribe/?member_id=18849915&id_secret=18849915-32545cb4&post_id=20170506185651:48C98912-32AF-11E7-B22D-A77D9619DF2F Powered by Listbox: http://www.listbox.com
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