@Larry Roth. "Financial failure"? No. Fiscal folly? Yes! Giving money to a for-profit insurance company, with a built-in guarantee of a return on investment, is exponentially more expensive that simply paying health care providers directly. See, e.g., Medicare, and every civilized social democracy in the world. Obamacare costs a bundle for the poor souls who try to file claims, as well as the lucky taxpayers who provide the premium subsidies. The difference between providing health care by paying for coverage, and planning for retirement by buying lottery tickets, is one of degree, not kind.
28
People who haven't had health insurance and now do so because of the ACA cause the health system to spend more money! Of course they do because before ACA they spent almost nothing because they could not afford it. People use health care because they are ill. duh! In the interest is to rein in cost, don't look at the people using the system as intended. Instead look at the American health care industry that costs twice as much as the systems in other industrial countries and rectify why our outcomes are considerably worse than average. American health is one of the biggest scams going,,,,my apologies to Wall street for putting them in an inferior position.
40
The reactions I see here are priceless. They're typical of the sort you'd expect when you find that a leg of one's argument has been knocked out from under them. You see it over on sites like the WSJ when they learn the stark truth about Gov. Sam Brownback's grand experiment in Kansas.
I can sense that many of you probably knew that providing more healthcare led to more healthcare spending - it simply makes sense on its face. But quite a few of you won't ever accept this, and will go on (I'm talking to you, Dr. Krugman) telling us all how we're saving money by spending it.
I do see arguments here touting the benefits of the single-payer system: That they spend less and "get more." Perhaps, but the economic formula to "spending less" in a market characterized by unlimited demand is simple: You ration supply. Republicans called this sort of thing "death panels," but don't confuse the shocking description with the reality of the arrangement - that is, when people have unlimited demand for a good and you have removed the price mechanism, the only limiting factor is supply. Not quite Econ 101, but not PhD level economics either.
Regardless, I don't expect much more from the posters here. Many of the comments are exactly what I've come to expect from NYT readers.
I can sense that many of you probably knew that providing more healthcare led to more healthcare spending - it simply makes sense on its face. But quite a few of you won't ever accept this, and will go on (I'm talking to you, Dr. Krugman) telling us all how we're saving money by spending it.
I do see arguments here touting the benefits of the single-payer system: That they spend less and "get more." Perhaps, but the economic formula to "spending less" in a market characterized by unlimited demand is simple: You ration supply. Republicans called this sort of thing "death panels," but don't confuse the shocking description with the reality of the arrangement - that is, when people have unlimited demand for a good and you have removed the price mechanism, the only limiting factor is supply. Not quite Econ 101, but not PhD level economics either.
Regardless, I don't expect much more from the posters here. Many of the comments are exactly what I've come to expect from NYT readers.
27
@Larry Roth. "Financial failure"? No. Fiscal folly? Yes! Giving money to a for-profit insurance company, with a built-in guarantee of a return on investment, is exponentially more expensive that simply paying health care providers directly. See, e.g., Medicare, and every civilized social democracy in the world. Obamacare costs a bundle for the poor souls who try to file claims, as well as the lucky taxpayers who provide the premium subsidies. The difference between providing health care by paying for coverage, and planning for retirement by buying lottery tickets, is one of degree, not kind.
6
To claim healthcare has elastic demand like Doritos is an absurd premise on it's face.
6
This article does not mention that the increased volume of patients are now getting the benefit of insurance (private and public) negotiated rates at healthcare providers. This is reducing costs.
This article also fails to mention how many jobs have been created because all the newly insured need to administered and cared for.
But sure...call it socialism. Great progress America!
This article also fails to mention how many jobs have been created because all the newly insured need to administered and cared for.
But sure...call it socialism. Great progress America!
9
Insurance still doesn't cover the things that keep us healthy. It pays for toxic meds & tests with dangerous side effects, operations that signal a failure of healthcare. We are paying for sick-care.
9
But that is the very definition of 'Insurance'! On average, all those that buy insurance of any kind will lose money. Else how could an insurance co. stay in business? News-Flash: more purchases of for-profit-product-X doesn't save money. Wow. What a revelation.
5
I am only a mathematician, not an economist, but I remember my father telling me to "look at the bottom line. The bottom line seems to be:
All other industrialized countries have some form of UNIVERSAL government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person on average. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
So how come if giving people insurance costs more, giving everyone insurance saves a bundle?
All other industrialized countries have some form of UNIVERSAL government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person on average. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
So how come if giving people insurance costs more, giving everyone insurance saves a bundle?
44
Finally, an unbiased opinion from the Ny Times. As a NY physician, I see our own Part time office staff who were previously staunch Obama supporters, complain about Obama care after enrolling in their bronze, silver or gold plans. As part timers, they don't qualify for insurance in our large practice. Those who pay for the lousy bronze plan, barely use it because the copayment so are high and the coverage for care is low. The higher paid PT staff pay much more for the gold plans and use their coverage like a free buffet on a cruise ship. Universally, they all complain about the high premiums and several opt for no coverage, simply paying cash for routine health visits and medications. That risky alternative is only tenable for the young and healthy with no chronic medical problems. Unfortunately, those highly sought insurance members who utilize little funds paid into the system, are not signing up in droves as the Obamacare architects had hoped.
Hence , even more financial reasons why Obama care fails from another false promise.
Hence , even more financial reasons why Obama care fails from another false promise.
11
The ACA is a done deal. Live with it.
Or, next time do some research about how to improve it and write about that.
Or, you can always vote for one of those clowns together with a veto proof Senate of other clowns. And wait and see how much money you can save and hope they don't in the meantime have a repeat of 1929 and 2008.
Or, next time do some research about how to improve it and write about that.
Or, you can always vote for one of those clowns together with a veto proof Senate of other clowns. And wait and see how much money you can save and hope they don't in the meantime have a repeat of 1929 and 2008.
14
Data is hard. There are lots of myths around ACA. It will have to change a lot in the future because our government is running out of other people's money.
8
Think how much money we could save if we let everyone suffer and die...
37
I find it odd that we measure the health of our people by the cost in terms of dollars . We spend more money on how to kill people then how to keep then healthy. Our defense expense-so mch of which is absolute waste; the unnecessary wars we fight have been the primary cause of our deficit-not health care spending. We would rather spend a few billions dollars building a new sub than a few billion on better health care that would benefit millions of people.
Crazy
Crazy
30
The bottom line argument seems to be that no one should have health insurance and no one should waste their money on disease treatment or prevention because we are all going to die anyway.
12
What is going on with the Times these past few weeks? The number of dangerously conservative-leaning articles is astounding. A lazy profile on the Kochs, a lazy headline about supposedly criminal investigations that took two days to correct, a headline about the president joking about a third term not labeled a joke until later in the day, no mention of the Kochs in an article about Kansas, passive aggressive digs at Joe Biden -someone who could steal the nomination with flying colors-through interviews with "friends," and now this headline without any detailed or objective, long-term analysis, including money saved for future generations. What is going on here?
23
Cost and efficiency are two different things. If all medical care and the practice of medicine were banned. imagine the savings! And we all eventually die anyway!
15
I was standing at the checkout counter after my checkup and was told that it would be $150 and my health insurance would cover it. The person at the next checkout counter was also paying for a checkup and was told "Since you don't have health insurance that will be $50." If my health insurance premium doesn't go down, I'll have to figure that the doctors will be charging everyone the higher rate.
2
To the author: "strong evidence from a variety of sources that people who have health insurance spend more on medical care than people who don’t"? You absolutely have to be kidding! The purpose of health care is not primarily to save money, it's to save people. It was never intended to be free.
17
Doesn't all insurance cost more than the damage it covers? If not, wouldn't insurance companies would regularly go bankrupt" But most of us carry at least some insurance and are better for it.
Perhaps this article points out some paradoxes in cost/benefit analysis when applied to health decisions.
Perhaps this article points out some paradoxes in cost/benefit analysis when applied to health decisions.
4
The cost of health care is going up because the US health care industry spits out outrageous bills. It does this because it can. Who is going to stop them, Congress? Congress is happy to make the average American give all of their hard-earned savings to the US health care industry. Congress does not care and Obama rolled over and rolled over and rolled over again booting Medicare-For-All out of the running.
There are still several things we can do to lower the cost of health care. The first is to eliminate the tax-payer subsidy for employer-based health insurance and ban group coverage. Place everyone on an equal footing in the health care market. The second is to publicly list the cost of every service and product of every health care provider. We do this for cans of soup, why is it so hard to do for a bag of saline or a pill? If your car dealer can provide an estimate for a repair in writing, why can't a hospital? Is a surgeon less competent than a mechanic in providing an estimate?
The US health care industry is a national disgrace. The NYTimes noted that insurance premiums in California are only going up a paltry 4% but, not only is that significant, they are going up much more (yet again) in other parts of the country.
Wake up my fellow Americans. The US health care industry will bury our economy before it buries us.
There are still several things we can do to lower the cost of health care. The first is to eliminate the tax-payer subsidy for employer-based health insurance and ban group coverage. Place everyone on an equal footing in the health care market. The second is to publicly list the cost of every service and product of every health care provider. We do this for cans of soup, why is it so hard to do for a bag of saline or a pill? If your car dealer can provide an estimate for a repair in writing, why can't a hospital? Is a surgeon less competent than a mechanic in providing an estimate?
The US health care industry is a national disgrace. The NYTimes noted that insurance premiums in California are only going up a paltry 4% but, not only is that significant, they are going up much more (yet again) in other parts of the country.
Wake up my fellow Americans. The US health care industry will bury our economy before it buries us.
18
The author seems to know the cost of everything and the value of nothing.
27
Thank you for letting us know just how beneficial "Obama" care is to so many, I had no idea how wonderful it was!
8
Our "Sick Care" system, which views patients as paying customers and works to keep them coming back (paying) by treating symptoms, leaves Americans spending twice as much for healthcare as other advanced nations, yet we still live sicker and die younger (per the World Health Organization). That's why arguments for repealing Obamacare and returning the status quo are so misguided. The ACA should be just the beginning of health reform, and it should be improved upon, not crippled, leading toward a single-payer system like Medicare-for-All.
Given our nation's technology & innovation, we "should" be able to cut costs in half or more while simultaneously improving care quality, outcomes, and satisfaction -- except for the corrupting power of big money in Congress. You see, the medical industrial complex is not thrilled with the idea of losing half of their revenue, or about $1.5 trillion/year, so they spend twice as much as the military industrial complex on lobbying to protect profits from their inefficient system. And our politicians depend on that money to be reelected, so they parrot the same arguments rather than acting on behalf of real citizens.
Apparently, not enough people are paying politicians to reduce the widening wealth gap or make infrastructure & wellness investments that fuel productivity, jobs, and GDP.
Given our nation's technology & innovation, we "should" be able to cut costs in half or more while simultaneously improving care quality, outcomes, and satisfaction -- except for the corrupting power of big money in Congress. You see, the medical industrial complex is not thrilled with the idea of losing half of their revenue, or about $1.5 trillion/year, so they spend twice as much as the military industrial complex on lobbying to protect profits from their inefficient system. And our politicians depend on that money to be reelected, so they parrot the same arguments rather than acting on behalf of real citizens.
Apparently, not enough people are paying politicians to reduce the widening wealth gap or make infrastructure & wellness investments that fuel productivity, jobs, and GDP.
16
Working in health care, I can tell you that the World Health Organization is incorrect in regards to live sicker die younger here in the US. The reality is that people in the US are living longer and as you age you have more issues. This is one of the many reasons social security is going broke, people are living longer in their retirement years and getting a greater return than what was invested.
The key issue is that Obamacare does nothing to address the fundamental problems in our system. All Obamacare does is grease the pockets of the insurance companies and increase costs, which this article acurately portrays. This is why big pharma, AARP and other big medical companies supported this legislation they knew this going in.
The key issue is that Obamacare does nothing to address the fundamental problems in our system. All Obamacare does is grease the pockets of the insurance companies and increase costs, which this article acurately portrays. This is why big pharma, AARP and other big medical companies supported this legislation they knew this going in.
6
This is a fairly biased way of looking at the problem. Obviously, more people in the healthcare system will bring up costs. What the author fails to convey, is that this cost increase is also accompanied by an invaluable resource for many people that they didn't have before, namely the peace of mind in having access to decent, more affordable healthcare instead of an empty vacuum with no affordable treatment options like before.
This peace of mind is even more valuable than any financial incentive, where one doesn't have to walk down the street and be afraid of stepping off the curb and ending up in the hospital with no health insurance.
All the author did was prove what many 1% and ultra conservatives already believe: that financial profits and control over a money-making system that exploit other people's misfortune is the most important matter when it comes to health care providers. This should not be the case, and is a sad reflection of the overwhelminggreed and profit driven attitude that exists at the top of the health care system.
Trickle down healthcare...how nice. Makes me feel so warm and cozy inside.
This peace of mind is even more valuable than any financial incentive, where one doesn't have to walk down the street and be afraid of stepping off the curb and ending up in the hospital with no health insurance.
All the author did was prove what many 1% and ultra conservatives already believe: that financial profits and control over a money-making system that exploit other people's misfortune is the most important matter when it comes to health care providers. This should not be the case, and is a sad reflection of the overwhelminggreed and profit driven attitude that exists at the top of the health care system.
Trickle down healthcare...how nice. Makes me feel so warm and cozy inside.
30
Of course insurance coverage of medical care doesn't cut the cost of the medical care -- it just (usually) cuts the share of cost the user has to pay. Market forces respond to what can be paid, and insurance coverage raises what can be paid and the market then has no need/incentive no to reduce costs.
It is the cost of healthcare, not the coverage by insurance, that needs to be addressed. How to do that is the problem. In fact, if insurance didn't pick a lot of the cost the cost would go be forced down.
It is the cost of healthcare, not the coverage by insurance, that needs to be addressed. How to do that is the problem. In fact, if insurance didn't pick a lot of the cost the cost would go be forced down.
3
Thinking bigger, however, what is the cost of a heart attack, not only to the healthcare system, but to society at large? How much does it cost a company when the heart attack victim, an employee, is in the hospital for weeks? How much does it costs the spouse to take off work to take care of the victim? If the victim is the primary bread winner and dies of a heart attack, what does it cost society as it tries to support the remaining family?
All these can be prevented with cholesterol testing.
All these can be prevented with cholesterol testing.
8
The problem with this article is it gathers together "evidence" of high costs from studies that weren't created to follow cost properly. For example, the Oregon Medicaid study, which was not properly fashioned by its authors to tracks costs, is cited as showing increased costs after one year. Of course costs will rise in one year, particularly because you can't change the ER-going habits of uninsured people in just one year.
Sure, screening tests may increase costs overall, but a huge problem is many of our current screening tests like mammograms and PSA are ineffective as screening tools and we administer them to groups of people who should not be getting them (like women with no family breast cancer history under the age of 50).
Overall, screening will bring down prices when we take politics out of medicine and use the proper screening tools on the proper groups of people.
Sure, screening tests may increase costs overall, but a huge problem is many of our current screening tests like mammograms and PSA are ineffective as screening tools and we administer them to groups of people who should not be getting them (like women with no family breast cancer history under the age of 50).
Overall, screening will bring down prices when we take politics out of medicine and use the proper screening tools on the proper groups of people.
5
I think this article is missing the point. It obviously makes perfect sense that someone who has health insurance would be more likely to consume healthcare. It also may be true that preventative care is not as cost-effective as people may wish to believe.
What the piece conflates is the difference between health spending and health care prices. It makes sense that giving more people insurance would increase health spending as more care is consumed. But what would be more interesting to know is whether consumers are getting more care for their dollar.
Insuring patients shifts costs from hospitals to insurance companies, which can negotiate prices with hospitals. Ultimately, this shift should drive prices down. Taken to its logical conclusion, a single-payer plan, the government would be able to drive prices as low as it wants by reimbursing providers at whatever rate it deems fair.
The ACA should arguably push towards this end goal. It's interesting that health spending is increasing, but it would be more interesting to know how and why.
What the piece conflates is the difference between health spending and health care prices. It makes sense that giving more people insurance would increase health spending as more care is consumed. But what would be more interesting to know is whether consumers are getting more care for their dollar.
Insuring patients shifts costs from hospitals to insurance companies, which can negotiate prices with hospitals. Ultimately, this shift should drive prices down. Taken to its logical conclusion, a single-payer plan, the government would be able to drive prices as low as it wants by reimbursing providers at whatever rate it deems fair.
The ACA should arguably push towards this end goal. It's interesting that health spending is increasing, but it would be more interesting to know how and why.
8
The point, my friend, is that the line that "this will reduce health care spending because people will use preventative services rather than expensive emergency services" was a very specific selling point for the ACA throughout the ongoing debate.
I find it interesting that the NYT won't let off Gov. Sam Brownback of Kansas after his clear failure in experimenting with trickle-down tax breaks and economics (I never see the NYT write "well lower taxes were a good idea anyways"), but you can see the pass being given here.
I'll keep searching for more two-sided reporting. When I want "Fair and balanced," I'll read Fox and the NYT.
I find it interesting that the NYT won't let off Gov. Sam Brownback of Kansas after his clear failure in experimenting with trickle-down tax breaks and economics (I never see the NYT write "well lower taxes were a good idea anyways"), but you can see the pass being given here.
I'll keep searching for more two-sided reporting. When I want "Fair and balanced," I'll read Fox and the NYT.
You have narrowed the healthcare problem down to one hot-button issue. I bet more people will read an article with a title such as this, rather than one that unravels the more complicated problems of mega-hospital consolidations, insurance industry lobbying, and that not-for-profit hospitals can take a loss on paper and still make billions. Oh, did I forget the outrageous salaries of those in administration and public relations vs. nurses, aides and doctors?
13
I'm wondering why this piece wasn't published under Op-Ed since it seems to me to be so slanted with cherry-picking facts and figures to fit the writer's idea. The article leaves out the part of the ACA that results in billions of dollars in savings through reductions in payments to hospitals. These savings are achieved in several ways. As more and more patients are covered under insurance, the federal charity payments made to hospitals through the Medicare Reimbursement Initiative GAP or Uncompensated Care Program are reduced by billions. Medicare payments to hospitals are also now adjusted for outcomes measured by the rate of re-admissions and the implementation of a Value-Based Purchasing Program that tracks quality of care metrics. The Electronic Health Care requirement of the ACA will now make it possible for health care professionals to review the history of a patient's medical record to reduce errors and improve care. Data will now be available in the future to evaluate and improve health care for decades to come.
5
Spoken like a true IT believer, one who's never received a beautiful digital record with the same clinical error duplicated in cut and paste fashion or watched a formerly brilliant diagnostician attempt to maintain a face to face encounter with a medically challenging patient while simultaneously entering data into a limited template designed to capture the expected rather than the complex.
4
It's much too soon to know if this is a valid conclusion. We'll only know if preventive care saves money in the long run with the potential reduction in chronic illnesses. It also doesn't take into account the secondary savings from reducing sick days, employee turnover, and other costs. I agree that a single-payer system would be preferable to one that keeps privately owned insurance corporations in the mix, but that's not very likely to happen in the U.S. in the foreseeable future. Other policy changes like a living wage requirement, paid sick days, etc. have been shown to have strongly positive economic effects in places where they've been instituted, but they're opposed with the same baseless arguments used against universal health care. It's time for this country to start taking into account the serious damage that income equality causes not only to quality of life of those living in poverty, but also to our economy as a whole.
8
A Modest Proposal
We are all so tired of paying for other people's needs, particularly health costs. It is just so expensive and wasteful. To save costs, the obvious solution is to deny health care to all the Takers, those who laziness keeps them out of the 1%. There are already too many without the skills and drive needed for today's economy. The dead wood should simply be allowed to perish rather than consume expensive heath care resources that by rights belong only to the successful.
We are all so tired of paying for other people's needs, particularly health costs. It is just so expensive and wasteful. To save costs, the obvious solution is to deny health care to all the Takers, those who laziness keeps them out of the 1%. There are already too many without the skills and drive needed for today's economy. The dead wood should simply be allowed to perish rather than consume expensive heath care resources that by rights belong only to the successful.
20
Everybody still gets one bad disease; it can be VERY expensive
I wonder if many readers will be familiar enough with the essay by Jonathan Swift from which you take your title to appreciate the intent of your comment. For those who aren't, look it up in Wikipedia.
This is op-ed is a negligible anti "Obamacare" rant, but it does help illustrate why a single-payer system for healthcare makes the most sense. Realistically, there was no way a single-payer system could be put in place at the time the Affordable Care Act was enacted. The health insurance industry was too entwined and important to our country's extremely fragile economy. Kill the parasite and the host would have perished as well.
The ACA was the best solution at the time, but shouldn't be assumed to be the end of the road. Because healthcare insurers can only attain a specified percentage of profit per dollar income there is no incentive to reel in costs. In fact, the higher the expenditures the more profit attainable. Also, right now profits for insurers are rising because of the increase in the numbers insured. However, once we reach saturation of those numbers, then what?
Now is the time to plan for that eventuality. Finding a way to single-payer seems the best and most proven solution, but our congress, the people we elect, must begin to be forward thinking and do what's best for this nation and not pander to ideologues.
The ACA was the best solution at the time, but shouldn't be assumed to be the end of the road. Because healthcare insurers can only attain a specified percentage of profit per dollar income there is no incentive to reel in costs. In fact, the higher the expenditures the more profit attainable. Also, right now profits for insurers are rising because of the increase in the numbers insured. However, once we reach saturation of those numbers, then what?
Now is the time to plan for that eventuality. Finding a way to single-payer seems the best and most proven solution, but our congress, the people we elect, must begin to be forward thinking and do what's best for this nation and not pander to ideologues.
18
Totally agree - the problem with a "government pays insurers" plan is, the government foots the bill but gives up its negotiating power. It's the worst of both worlds for the consumer, because the hospitals and big pharma will maximize profit on the government's dime.
Moving to single payer, the government can just set up sensible limits, like "we won't pay more than $100,000 to extend life by a year" and stick to them, reining in costs while also keeping people alive.
Moving to single payer, the government can just set up sensible limits, like "we won't pay more than $100,000 to extend life by a year" and stick to them, reining in costs while also keeping people alive.
1
Providing health insurance and health care to more people costs money. No surprise there. But it's the right thing to do.
The question always boils down to this: is healthcare a privilege or a right? For Republicans, it's a privilege - you can have it if you can afford it. For Democrats, it is (or should be) a right.
Unfortunately America, alone among advanced countries, does not believe in universal health care. Every other country does, and provides it. They start with the premise that everyone deserves health care; then they figure out how to provide it. Interestingly, they are able to provide universal health care for all, at lower cost than we provide healthcare for some.
Until we accept that most basic idea, we will endlessly debate whether the costs are worth it. Obviously they are: the Declaration of Independence says we are all entitled to "life, liberty and the pursuit of happiness." None of this matters if you basic needs aren't met, which (obviously) include having your health care needs met.
Republicans are happy to empty our national bank account on defense. They are happy to pass laws protecting embryos and fetuses. But they fail completely with the issue of universal health care.
Healthy people live longer, more productive lives. They contribute to society in many ways. Everyone deserves to be cared for when sick - not just wealthy Republicans.
That this is even a question goes to a serious failing of the social contract in America.
The question always boils down to this: is healthcare a privilege or a right? For Republicans, it's a privilege - you can have it if you can afford it. For Democrats, it is (or should be) a right.
Unfortunately America, alone among advanced countries, does not believe in universal health care. Every other country does, and provides it. They start with the premise that everyone deserves health care; then they figure out how to provide it. Interestingly, they are able to provide universal health care for all, at lower cost than we provide healthcare for some.
Until we accept that most basic idea, we will endlessly debate whether the costs are worth it. Obviously they are: the Declaration of Independence says we are all entitled to "life, liberty and the pursuit of happiness." None of this matters if you basic needs aren't met, which (obviously) include having your health care needs met.
Republicans are happy to empty our national bank account on defense. They are happy to pass laws protecting embryos and fetuses. But they fail completely with the issue of universal health care.
Healthy people live longer, more productive lives. They contribute to society in many ways. Everyone deserves to be cared for when sick - not just wealthy Republicans.
That this is even a question goes to a serious failing of the social contract in America.
12
Before the ACA we had two fundamental problems in healthcare.
The first was that people who were sick, unemployed, underemployed, or just plain old poor, could not get insurance, which limited or eliminated their access to any care outside of an emergency room. Some (remembering G.W. Bush's "Let them eat cake moment") felt the emergency room was just fine.
The other problem was that we as a nation spent more per capita, and more of our overall national output on healthcare.
The ACA made inroads into the first problem, but was not established - at least not as enacted by Congress - to address the second. Healthcare costs are Medical practice, pharmaceutical company, hospital, insurance company, medical supply company, TV ad company revenue. It is paying for a lot of jobs. Congress does not have the necessary spine to tell those industries that they must cut revenue and become efficient, or to tell Americans that they simply cannot have all the healthcare they want or believe they need. Reducing medical costs will at least for the near term, increase unemployment. So the will to do it is pretty low.
Reducing health cost is a hard change to entrenched interests - both corporate and medical business interests, and the interest of the American health care consumer, who have come to believe through years of third party payments, that they have a right to have everything possible provided to them as part of their work agreement.
The first was that people who were sick, unemployed, underemployed, or just plain old poor, could not get insurance, which limited or eliminated their access to any care outside of an emergency room. Some (remembering G.W. Bush's "Let them eat cake moment") felt the emergency room was just fine.
The other problem was that we as a nation spent more per capita, and more of our overall national output on healthcare.
The ACA made inroads into the first problem, but was not established - at least not as enacted by Congress - to address the second. Healthcare costs are Medical practice, pharmaceutical company, hospital, insurance company, medical supply company, TV ad company revenue. It is paying for a lot of jobs. Congress does not have the necessary spine to tell those industries that they must cut revenue and become efficient, or to tell Americans that they simply cannot have all the healthcare they want or believe they need. Reducing medical costs will at least for the near term, increase unemployment. So the will to do it is pretty low.
Reducing health cost is a hard change to entrenched interests - both corporate and medical business interests, and the interest of the American health care consumer, who have come to believe through years of third party payments, that they have a right to have everything possible provided to them as part of their work agreement.
4
The cost of not receiving timely health care is not only the cost of the health care itself! Preventable illnesses that occur because there was no prevention, or minor problems that escalate into major problems have extensive economic costs in lost work and income (and the taxes that would be paid on that income), family caregivers lost work and income, etc.
6
The implicit claim that all universal care approaches are the same is crazy, single payer systems are more cost effective than our ridiculous American universal/privatized approach.
Also what about all the money spent educating those people who die too soon? Where is that and their lost earnings entering into this author's grim savings calculation?
Also what about all the money spent educating those people who die too soon? Where is that and their lost earnings entering into this author's grim savings calculation?
9
What an odd premise. If course it's cheaper in terms of health care expenditure to have people die off rather than receive preventative treatment. If cost savings are due to worse outcomes and quality of life (or shorter length of life) for patients, how is this an acceptable metric?
19
You're missing the point: the "saving of money because people will use preventative care instead of emergency care" was a big selling point of this thing. That argument here appears to have been debunked.
The author cites this article as evidence and I have excerpt this statement."But by describing it as an easy win-win solution, the presidential candidates are gliding over an important part of the issue. Preventive care saves real money only when it replaces existing care that is expensive and doesn’t do much, if any, good. There are plenty of examples of such care — from induced labor to many lumbar surgeries and cardiac stent procedures." This is the gist of the rational argument she proposes with a lot of words surrounding it. Really Obamacare is on the right track but the system itself is fraught with its own issues. I suspect that the author got lost in the use of evidence to support the claim that preventive care doesn't love up to the political soundbite some use. I would question whether the overarching issue is more basic, if one has a physician who cares for you and creates a long term relationship with you, a productive life along with a community that supports you are you able to healthier?
2
The problem is our half measures that rely on private insurance. Progessive and prosperous European countries provide universal health care coverage at much lower cost.
14
The low cost is a result of a fundamental concept of economics: In a system characterized by unlimited demand, where the price mechanism does not exist, the limiting factor is supply.
Republicans called this "death panels," but don't confuse the shock-effect description with the technical term it represents: Rationing.
Republicans called this "death panels," but don't confuse the shock-effect description with the technical term it represents: Rationing.
2
Of course America has always rationed in its healthcare system. We chose the cruelest form of rationing: if you can't afford it, you can't get it.
The artilce says nothing about the increase in the cost of medical care,
drugs, physicians income/salaries, etc. This certainly has to be a serious
category of factors having a direct impact on the level of overall spending?
drugs, physicians income/salaries, etc. This certainly has to be a serious
category of factors having a direct impact on the level of overall spending?
4
Single payer make so much more sense than paying a parasitic industry to siphon off hard earned American money to collude with government for its profits. If we want to see serious reductions in health care costs, take the insurance industry out of the loop. That would be real savings and cost efficiency. The other would be to require a decent wage for workers. Those two changes, more than anything else, would give people an incentive to take care of themselves rather than stress over the bills - Xanax or scotch or comfort food in hand - when they get home.
26
Obama Care: A perfect example of how, in America, holding a private or publicly subsidized private health insurance card doesn't ensure access to safe, quality affordable health care, medications, diagnostics or treatments.
Psst: The health insurance industry lied, protected from all Federal Regulations by the McCarron Ferguson Act.
Psst: The health insurance industry lied, protected from all Federal Regulations by the McCarron Ferguson Act.
4
I wish they would stop characterizing testing as preventive health. It isn't. Doing yoga is preventive, eating good whole organic food is preventive, avoiding chemicals in one's daily life is preventive, acupuncture is preventive, meditation is preventive....
Testing for prostate cancer or breast cancer is not preventive health.
Stable affordable housing and good paying employment is also probably preventive health - as are safe neighborhoods. Colonoscopies, not so much.
We have an illness insurance system, I really look forward to the day when we have a genuine health assurance system instead.
Testing for prostate cancer or breast cancer is not preventive health.
Stable affordable housing and good paying employment is also probably preventive health - as are safe neighborhoods. Colonoscopies, not so much.
We have an illness insurance system, I really look forward to the day when we have a genuine health assurance system instead.
34
Yes, a good diet, exercise, and safe neighborhoods are preventative health.
Colonoscopies are preventative medicine.
Colonoscopies are preventative medicine.
Surely one of the things you are attempting with universal health care, is too improve the overall health of the population. So, yeah more cost on primary health care, and then less need for more hospital beds. So, money is saved not needing that new big hospital so soon.
And, given that so many uninured don't go to the doctor, I suspect that are ill more often and either off work or not as productive, which are both costs to them and us.
And, given that so many uninured don't go to the doctor, I suspect that are ill more often and either off work or not as productive, which are both costs to them and us.
4
I reluctantly accept the premise of the article, but am skeptical about the authors objectivity. Why only talk about the increased costs one year after formerly uninsured people get insurance, when pent up demand would clearly lead to increase utilization of the system. Costs 5 to 10 years after getting insurance would surely be a better, more informative statistic
13
There is also evidence that disease screening in healthy populations causes a far greater ratio of unneeded (and potentially dangerous) treatment to lives saved (a very small number I have read)
I had two minor but disfiguring surgeries and one major, life disrupting, and I imagine hugely expensive surgery. The later surgery was the result of a CA125 ovarian cancer screening and resultant CAT scan (deemed suspicious) a screening process I later learned was shown even at the time to be unhelpful. Thank God no cancer, but I was out of commission for months, still have lingering pain from the surgery and lost a good part time job, but still thank God no cancer.
I had two minor but disfiguring surgeries and one major, life disrupting, and I imagine hugely expensive surgery. The later surgery was the result of a CA125 ovarian cancer screening and resultant CAT scan (deemed suspicious) a screening process I later learned was shown even at the time to be unhelpful. Thank God no cancer, but I was out of commission for months, still have lingering pain from the surgery and lost a good part time job, but still thank God no cancer.
4
To save your health system money you'll have to cut the absurd administrative overheads of private insurance and hugely expensive costs of hospital care and drugs in the US. But the article is too narrow in looking at just the health system - people with health security save the overall economy much in terms of productivity and wellbeing. In the UK, the value of being able to see a doctor for no out of pocket cost, and on the same day if urgent, is surely pivotal to giving people the ability to focus on work, family etc. This may be hard to calculate but of course we also spend far less per capita on health in the first place so we get a win-win.
20
To decrease health care costs is simple: provide universally available and affordable family planning and contraception.
Every child costs a lot of money for prenatal, perinatal and postnatal care.
But further: every unwanted child is at greater risk for neglect and abuse. The reasons that a woman does not want a child increase the risk. Every neglected and/or abused child is at much higher risk of physical and mental health problems. Fewer unwanted babies means a healthier happier family and a healthier and happier cohort of citizens.
Every child costs a lot of money for prenatal, perinatal and postnatal care.
But further: every unwanted child is at greater risk for neglect and abuse. The reasons that a woman does not want a child increase the risk. Every neglected and/or abused child is at much higher risk of physical and mental health problems. Fewer unwanted babies means a healthier happier family and a healthier and happier cohort of citizens.
11
so quick to jump to conclusions on partisan lines, instead of acceepting some reality check on both sides. the least useful point of rigidity is from people worried about "Obama's legacy." it was an expensive decision that by definition had to be imperfect (there is no such thing as universal health care for all, in our country anyway; but maybe we thought it sounded like there would be.) it gave some people an option they didn't feel they had before. it forced others to narrow their options. it forced big business to look for clever ways to sneak in profits in stealth mode (insurers, providers). pluses and minuses on all sides of the experience. now comes the onerous task: gather the data and assess. why is america so reluctant to be analytical?
1
The article omits a comprehensive catalog of what comprises health care costs, thus making the analysis suspect. Non-direct costs are excluded. Just one example of non-direct health-care costs: if I don't have health insurance I may be partially or completely unable to hold down a job (missed work days due to illness, etc.). These lost wages are a direct result of lack of health care but are not actuarily counted in comparisons of health care/no health care costs. Further impacts in this scenario: an employer's staffing plans could very well be impacted by irregular workers attendance due to health issues, therefore creating more costs (both direct and opportunity costs). Another impact: commenters have noted impact on bankruptcies filed due to lack do health insurance. These are only a few examples. I would expect a more thorough analysis of this topic from this column.
11
Research? All one has to do is compare Canada's universal health care costing just below 10% of GDP to our less than universal health care costing just under 20% of GDP. Let's lower the risk and cost -- just copy the proven Canadian plan.
17
It is about "Giving More People Health Insurance", what is is about is acting in the best interest of citizens of a country being covered by taxpayer funded health insurance, cradle to grave. This creates a fully participating country where health is recognized for what it is, an attitude that addresses both mental and physical health, When we value all humans equally, we will, from beginning to end, recognize and treat all illnesses for the better.
And if you Margot Sanger-Katz do not understand the multiple cost of deliberately putting individuals and families in harms way, by barring them from receiving medical care, then perhaps you should step into any hospital in this country, work in any capacity, and see how so many, many individuals who have not received any health care in decades present with medical situations that are beyond the pale of normal.
And if you Margot Sanger-Katz do not understand the multiple cost of deliberately putting individuals and families in harms way, by barring them from receiving medical care, then perhaps you should step into any hospital in this country, work in any capacity, and see how so many, many individuals who have not received any health care in decades present with medical situations that are beyond the pale of normal.
8
Rising medical costs are caused by the profit-taking layers of the health system. We know this because we see on medical bills outlandish rates magically mitigated by having insurance. That phenomenon proves two things. 1. If people were paying out of their own pockets, the majority could not afford health care. 2. The provision of health care is dependent on collective monies bundled by private insurance. In order to achieve stability and savings, the profit-taking layer aggregating collective monies has to be streamlined and reduced. The US doesn't have the best health care system in the world. It does have one optimized for profit.
24
Does health insurance save money?
The World Health Organization says the average Canadian lives an average of five healthy productive years longer than the average American. The Americans I know are mostly insured but I don't see much difference in lifestyle and healthcare.
Five healthy productive years on average is a long time and I don't know how to put a price on it or how to calculate its savings in social cost.
The World Health Organization says the average Canadian lives an average of five healthy productive years longer than the average American. The Americans I know are mostly insured but I don't see much difference in lifestyle and healthcare.
Five healthy productive years on average is a long time and I don't know how to put a price on it or how to calculate its savings in social cost.
21
First point: it is by definition better to have people insured, and participating to at least some extent, in their own health.
Second point: what's left out here is that a) it's a matter of short-term costs, as millions who didn't get care get care; b) our real cost problem's with the aged baby-boomers, the exaordinary spending on drugs and tech that do little to extend a decent life, and our throwing money away on the unhelpable.
Second point: what's left out here is that a) it's a matter of short-term costs, as millions who didn't get care get care; b) our real cost problem's with the aged baby-boomers, the exaordinary spending on drugs and tech that do little to extend a decent life, and our throwing money away on the unhelpable.
4
By this argument, any and all maintenance is money wasted. For instance, to keep a major road repaired costs money causing more people to use the well maintained road making the road need more repair so it's all a big waste of money--so why bother?
By a similar construction, since everyone is going to die anyway they might as well never have any healthcare and let natural causes take it's toll, right? But this is not about absolute savings this is about making more health enjoyed by more people. It's also a class thing. By this argument of savings then only the wealthy are eligible to enjoy health promoting medical care--to live longer because it's a disposable expense they could afford that others can't. This argument makes health a luxury for only those with the cash to enable them to choose like a fancy car or expensive jewery. No. The "savings" is the health purchased not the money unspent.
Just as numbers like these would not calculate the cost to society of not having roads, these numbers fail to show the savings of not having healthcare. We'd never consider not building roads because people would only use them wasting all that money, or grow food because they'd just get hungry again tomorrow. The whole question of savings this way is just, well, stupidity.
By a similar construction, since everyone is going to die anyway they might as well never have any healthcare and let natural causes take it's toll, right? But this is not about absolute savings this is about making more health enjoyed by more people. It's also a class thing. By this argument of savings then only the wealthy are eligible to enjoy health promoting medical care--to live longer because it's a disposable expense they could afford that others can't. This argument makes health a luxury for only those with the cash to enable them to choose like a fancy car or expensive jewery. No. The "savings" is the health purchased not the money unspent.
Just as numbers like these would not calculate the cost to society of not having roads, these numbers fail to show the savings of not having healthcare. We'd never consider not building roads because people would only use them wasting all that money, or grow food because they'd just get hungry again tomorrow. The whole question of savings this way is just, well, stupidity.
56
I understand that the author is concerned that an estimated health spending "jumped by 5.5 percent" and looks for an explanation. It would be very useful also if she explained why "average increases in health spending for the 30 years before the recent Great Recession were 9 percent a year".
15
This article is asinine and the title misleading. In Europe, everyone has some form of insurance or is in the system and the amount they spend on health care is much lower than us. The author also takes a very very narrow perspective. What about the costs that come from the large number of medical bankruptcies (which we lead the world in)? What about the increased productivity of having healthy workers? What about the added administrative costs that come along with having a system as individualistic as ours? What about the collective bargaining leverage that insurance gains (this accounts for the biggest difference between our costs and Europe)?
25
I have a hard time stomaching the arguments in this article to the point it was difficult to read. Of course, prevention costs more if the preventive health care measures cost an outrageously absurd sum of money (my daughter had an MRI that cost 8,000$ - this same MRI in France would have cost about 400 Euros maximum (20X more) - and would have been fully covered by social security, whereas the one in the US was only 80% covered after a significant deductible was taken out....).
The so-called 'number needed to treat' is only relevant based on the real cost of the treatment/screening/medication. If those costs are unreasonably high (as most costs are in the US) then it is the costs that need to be reevaluated, not the use of those measures.
In the article you show a woman having her blood sugar tested thanks to Obamacare. This woman's blood sugar is outrageously high - she probably has had Type 2 Diabetes untreated for years with who knows what resulting long term health problems. Does this make sense at all? And, this type of screening should cost next to nothing - what is wrong with this picture?
Is health 'insurance' about health care or about someone making money? I think in the US it's the latter (including insurance companies, pharmaceutical companies, medical technology companies, hospitals and doctors). I don't think the US health 'care' industry has anything to do with taking care of people and keeping them healthy to the best of our ability.
The so-called 'number needed to treat' is only relevant based on the real cost of the treatment/screening/medication. If those costs are unreasonably high (as most costs are in the US) then it is the costs that need to be reevaluated, not the use of those measures.
In the article you show a woman having her blood sugar tested thanks to Obamacare. This woman's blood sugar is outrageously high - she probably has had Type 2 Diabetes untreated for years with who knows what resulting long term health problems. Does this make sense at all? And, this type of screening should cost next to nothing - what is wrong with this picture?
Is health 'insurance' about health care or about someone making money? I think in the US it's the latter (including insurance companies, pharmaceutical companies, medical technology companies, hospitals and doctors). I don't think the US health 'care' industry has anything to do with taking care of people and keeping them healthy to the best of our ability.
72
Honestly there are a tremendous number of problems with this "The Upshot", so many in fact that a detailed point by point critique would not be as effective as the piece itself which is self critiquing enough with its thin gruel of logic and facts. Seriously, a 1970 study from RAND, an estimate of an increase of 5.5 percent based on sparse data (compared to an average of 9 percent over the long term) from the "actuaries" and the Oregon Lottery study is a lot of predicting and not a lot of reality. Why don't we just wait a few more years and see how this plays out? No assessment of what the uninsured cost the insured versus the increase of 5.5 percent estimated now and what that amount possibly represents in savings to the insured. So much to challenge on, so much to critique, so much silly. But this finds its way into print and into the idea pool and into the debate and so it becomes "legitimized" and part of the "discussion" when really we and the debate would have been better off is some one had just said "You know what, dear, this is very nice, but let's wait another five years before we say these things. Okay?" and left this in a drawer.
19
Giving more people Health Insurance doesn't save money of insurance companies and citizen too. Costs grow. Insurance become less affordable. Obamacare is unprofitable for our government. I will tell you why.
67% of the purchased insurance policies are classified as "silver plan". It is the second by price but people who buy it are entitled to the maximum amount of medical services. So it turns out that the poorest part of the population receives a complete package of services and spends less money. Since the overall pot fails to complete, 97% of the cost of services according to insurance policy have to covered by the state.
67% of the purchased insurance policies are classified as "silver plan". It is the second by price but people who buy it are entitled to the maximum amount of medical services. So it turns out that the poorest part of the population receives a complete package of services and spends less money. Since the overall pot fails to complete, 97% of the cost of services according to insurance policy have to covered by the state.
2
Completely inaccurate; "Silver," palns, by defininition, don't cover as much as the pricier ones.
And why again is it cheaper and in the country's interest to have tens of millions of sick, elderly, and uninsured Americans?
And why again is it cheaper and in the country's interest to have tens of millions of sick, elderly, and uninsured Americans?
6
My way of thinking is healthy people lead to a healthy economy. So our expenditure on health care will have positive a positive impact on the growth of the economy. So enough of the rhetoric on the negative side of the ACA; think of it as a positive stimulus to the American economy.
9
There's a lot flawed with this logic:
(1) People who just got healthcare might have a backlog of preventive treatment or doctors visits they were putting off. We need to analyze spending over longer periods of times. Or spending for newly insured in years 5 and 10, compared to before they had insurance
(2) Of course pro-longing life will increase overall costs. What's a more interesting metric to measure is the cost of healthcare at every year of life. So look at three groups of 30 year olds. No insurance, just got insurance, has had insurance. Then look at those same 3 groups at age 40. What would be interesting to see is how their health care costs compared as time progressed.
(1) People who just got healthcare might have a backlog of preventive treatment or doctors visits they were putting off. We need to analyze spending over longer periods of times. Or spending for newly insured in years 5 and 10, compared to before they had insurance
(2) Of course pro-longing life will increase overall costs. What's a more interesting metric to measure is the cost of healthcare at every year of life. So look at three groups of 30 year olds. No insurance, just got insurance, has had insurance. Then look at those same 3 groups at age 40. What would be interesting to see is how their health care costs compared as time progressed.
21
Thanks Evan! I agree with your point on analyzing healthcare spending. There definitely needs to be more research done on the topic and not just related to cost, but metrics related to a persons quality of life and of course happiness. Compared to other developed countries the U.S. is so far behind when it comes to healthcare benefits.
3
an excellent point--most statisticians and actuaries split up populations into age cohorts when studying wide segments of the population
The implication of the article is that those fortunate enough to obtain health insurance, with no subsidy, would be better off, if the have not's did not have access to care. Quality of life is important. Making it more difficult for some people to access care might save money, while increasing misery or discomfort, commonly associated by dealing with illness and chronic conditions. Such cold objectivity might satisfy those bent on scuttling the Affordable Care Act. I find it objectionable, especially in an era when the common man seems to be losing ground, as a smaller number seem to be enjoying increased prosperity. We can no longer take medical insurance for granted, buy why shouldn't the government, in this country, follow the example of other nations who see improved health as an important priority, making health car accessible to all who need it?
7
What a surprise. Health policy wonks have finally discovered the realities of preventive care. Funny, while serving as "authoratative" advocates of Obamacare the point escaped them, although any practicing physician could have relayed the truth. But don't let reality prevent effective advocacy. Next they may even discover how the incredible regulatory and administrative overhead imposed on healthcare by the ACA and analagous efforts by the Center for Medicare and Medicaid Services has reduced time available from physicians and midlevel providers for actual delivery of care and how impactful the adverse effects have been. Good going, experts!
2
This article does not answer the key question: according to the government actuaries, how much would national spending on health care increase over the next ten years, if at all, if the economy stayed the same, the population did not age, and the population did not increase--as it does every ten years. Also not answered is the amount of non medical costs resulting from the medical problems of those who don't have insurance.
1
One commenter asks why American health care costs twice what better care costs everywhere else.
The answer, according to my health research colleagues at the University of California San Francisco, is that most American health procedures are either useless or actually harmful to patients. Other countries have government agencies that screen out these bad procedures, but in America the government does no such thing.
The idea of finding out which procedures actually work and paying only for the ones that are effective is called Evidence Based Medicine. President Obama decisively rejected it. The story is told in detail by the award winning former Wall Street Journal reporter Ron Suskind in his book Confidence Men.
To see some humorous suggestions, go to YouTube and watch Comedy Party Platform (2 min 9 sec). It's really no joke.
The answer, according to my health research colleagues at the University of California San Francisco, is that most American health procedures are either useless or actually harmful to patients. Other countries have government agencies that screen out these bad procedures, but in America the government does no such thing.
The idea of finding out which procedures actually work and paying only for the ones that are effective is called Evidence Based Medicine. President Obama decisively rejected it. The story is told in detail by the award winning former Wall Street Journal reporter Ron Suskind in his book Confidence Men.
To see some humorous suggestions, go to YouTube and watch Comedy Party Platform (2 min 9 sec). It's really no joke.
6
Does the book detail why President Obama rejected it (assuming that's true, no offense)? Was it part of a compromise? Considering how narrow the path through lobbying interests is (pharmaceuticals, AMA, med equip mfrs), it's a wonder it passed at all. Nominally, it does bring us in line with other industrialized first world nations, but the small print (as the numerous comments note) knocks us right back.
Your allegation of the exclusion, unfortunately, is tainted by the nasty political climate that has citizens' interest as it's last priority.
Your allegation of the exclusion, unfortunately, is tainted by the nasty political climate that has citizens' interest as it's last priority.
1
Although portions of this article are likely correct, some parts appear to be deliberately misleading or unclear. For example, the linked article showing that drug treatment for coronary artery disease is a net loser dates to when Lipitor was still patented. It's off patent and should be significantly cheaper. (It would have been cheaper before if Congress hadn't outlawed Medicare negotiating for lower prices, but that's not the focus of this article.) The claim that mammography is too expensive is fairly well-justified; it's at best only marginally justified even while ignoring costs. However, it's unclear what's meant by "screening for diabetes" costs more than it saves. The screen isn't very expensive, I imagine. If someone tests positive for diabetes, then I'm sure that treating it is more expensive than not treating it. Is not treating--because there was no diagnosis--what the author is advocating? If someone tests as "pre-diabetic," is the author suggesting that preventative treatment (often difficult to effect lifestyle changes) isn't worth it? Last, I notice that the article abruptly discontinues discussion of the Oregon study without saying that health outcomes were slightly improved for those in Medicaid, although the study lacked the statistical power to reach a conclusion about those improvements.
16
So why are costs lower in every other country? Canada's cost is about 40% of the US with better results (longer life expectancy, lower maternal death rate, lower infant mortality rate -- with or without abortion being counted). So what is going on here?
15
Half my family is Canadian living in Canada. Not all Canadians are enamored with their health care system. Long wait times to see a doctor, wait times for procedures, and quality of care are some of their concerns. Do they like the cost? Sure.
I have a family member who lost his vision in one eye because he wasn't seen quick enough. I recently had an MRI a day after an injury, while my Canadian cousin literally waited for a couple of weeks for an MRI.
As for the article, these are obvious points being made. Government by its very nature spends money. It doesn't make or save money. Of course spending on healthcare will go up.
However, as a society, enough voters decided that healthcare should be universal. That was the whole reason Obama was reelected. It was a referendum on universal healthcare. To be surprised that we aren't saving money is irrational.
I have a family member who lost his vision in one eye because he wasn't seen quick enough. I recently had an MRI a day after an injury, while my Canadian cousin literally waited for a couple of weeks for an MRI.
As for the article, these are obvious points being made. Government by its very nature spends money. It doesn't make or save money. Of course spending on healthcare will go up.
However, as a society, enough voters decided that healthcare should be universal. That was the whole reason Obama was reelected. It was a referendum on universal healthcare. To be surprised that we aren't saving money is irrational.
1
It's a different population with different characteristics; the global results noted are not comparable.
In 1986, Congress passed the Consolidated Omnibus Budget Reconciliation Act, which contained the Emergency Medical Treatment and Active Labor Act. The law requires hospitals to treat patients in need of emergency care regardless of their ability to pay, citizenship or even legal status. (Can you guess who was President and which party was the majority in Congress?) Since that day we have had universal coverage in the US. All you need to do is get to the emergency room of the hospital. Someone pays. Those who have insurance (that is insurance that actually pays before you go broke with co-pays, deductibles and "uncovered procedures) or can afford to pay have been paying for those who can't, or won't. With more people covered by some form of insurance, in a truly competitive system, the cost of care should go down. But in this country there is no such thing as too much profit, so why reduce prices? So if healthcare is a "for-profit" commodity (even "non-profits" have to make a profit), and insurance companies are exempt from anti-trust laws, why is anyone surprised that costs continue to go up, with or without the ACA. All other developed countries have universal coverage, but it's regulated. Ours is not. The others might wait for some elective procedures but receive prompt care in emergencies. In this country you just go broke, die or make someone else pay if you can get to the emergency room. In other countries everyone who pays taxes pays for healthcare. Not in the US.
11
For every uninsured patient who seeks care at Dallas County's public hospital, the Dallas County taxpayer picks up the tab. 'Nuff said?
8
Every person who gets an ACA tax subsidy is funded by all taxpayers. No difference and yes, the remaining uninsured are still getting their free care. In the end, there was some and mirrors on the payment stream but no real lasting change. The ACA is and always will be an insurance law not a healthcare law. It was crafted so the Dems and Obama can claim they did something historic. 'Nuff said!
Of course it costs more to insure additional people. Obama and his team knew that. It is the only reason they got they insurance companies to go along with what became known as Obamacare -- because it would pour a lot more money into the system and into their pockets.
This may come as a surprise to naive reporters who take at face value everything that comes out of the White House!
This may come as a surprise to naive reporters who take at face value everything that comes out of the White House!
2
Interestingly, universal healthcare in most countries costs less per capita than US healthcare did in 2008. Also, the US had the lowest life expectancy of several countries, and the highest per capita healthcare payments.
Why don't we just kill all babies at birth? That would save lots of money. After all, to quote John Maynard Keynes, we are all dead in the long run anyway, so why not take care of the problem immediately.
The problem with this economic argument is that the value of living a healthy life is left out of the accounting. Yeah, all those people who got their prescription drugs, who are treating their diabetes, watching their weight, getting exercise cost something, but the benefit to themselves and to society is huge.
The problem with this economic argument is that the value of living a healthy life is left out of the accounting. Yeah, all those people who got their prescription drugs, who are treating their diabetes, watching their weight, getting exercise cost something, but the benefit to themselves and to society is huge.
23
If you happen to live outside the US in a first-world, western country that happens to have had some version of universal health care for the past 50 or more years, you understand immediately how myopic this article is. UHC is not something that needs to be studied by model: it's not theoretical economics. There are decades of real-world examples all over the globe of how it works and how well it works. People in rich countries with UHC pay less per cap for health care than the US (by nearly a 2 to 1 gap) and have, ALL have, longer life expectancies than Americans. Chubby, poorly dieted, sedentary Australians, Canadians, Kiwis, French, Germans, Swedes - all live longer than Americans, and thats a few years longer.
If you're going to model the economics of UHC and study it, well, you need to encompass a lot more than is reported in this article.
But that's not necessary. If you want to know how fast a bear can run, I'm sure there are many complex formulas and biological studies that will give you a close approximation, but if theres a bear running by you every five minutes, just look at it and look at your watch.
If you're going to model the economics of UHC and study it, well, you need to encompass a lot more than is reported in this article.
But that's not necessary. If you want to know how fast a bear can run, I'm sure there are many complex formulas and biological studies that will give you a close approximation, but if theres a bear running by you every five minutes, just look at it and look at your watch.
29
Correlation does not prove causation; whether there is an effect of the type of health care organization a first world country has on overall mortality, etc., is not at all clear and there are large confounding variables in socioeconomic factors between countries. In fact, if one looks at certain specific outcomes (e.g., cancer, responsiveness of the healthcare system) the US ranks highly.
So, may I edit your headline, replacing your "No" etc (and say the same thing) with a positive "Yes" etc.? " Yes, Giving Less People Health Insurance Does Save Money " Now that that's been established,( The studies you cite say as much), there's also the" unavoidable fact," that due to less cholesterol screening, people are living shorter lives and therefore, less likely to develop Alzheimer's or some other costly illness. OK, it's not in jest I ask, is that really where you want us to go?
13
The surest way to save money in health care is to kill the health insurance companies once and for all. They sit athwart the revenue stream, siphoning off at least 20% of every dollar for executive salaries, gatekeepers, paper pushers and marketing. They are largely responsible for the ballooning clerical staff and fees of every doctor practicing today. And for that, they offer absolutely zero value added. Every dollar diverted to insurance company profits is a dollar that doesn't get spent on actual delivery of health care.
Medicare overhead is about 2%. It's time for Medicare for all!
Medicare overhead is about 2%. It's time for Medicare for all!
99
A typical general practitioner today handles about 2,000 patients. Did we create an additional 4,500 primary care doctors? That's on top of the doctors who have moved to concierge practices where they handle only 300 patients who pay $2-3k a year to actually get decent primary care.
5
Yeah, it all makes sense to me now.
If people could not afford food, then spending on food would go way down. And there could not be any other consequences of people not being able to afford to eat, could there?
Sure, if people can not afford to get health care they will not, and will die miserable, preventable deaths, or else bankrupt themselves and their families if they encounter a catastrophic health problem. But at least we would not be spending money on health care.
Geeze, what a refreshing analysis.
If people could not afford food, then spending on food would go way down. And there could not be any other consequences of people not being able to afford to eat, could there?
Sure, if people can not afford to get health care they will not, and will die miserable, preventable deaths, or else bankrupt themselves and their families if they encounter a catastrophic health problem. But at least we would not be spending money on health care.
Geeze, what a refreshing analysis.
41
There seems to be a flaw in this thinking. It may be true that people who don't have insurance spend less than those who do.
But - how much money is paid for by taxpayers for emergency room treatments for people without insurance? The hospitals are required to help those people, but no money changes hands. So how do the hospitals keep up their financing? Either taxpayers cough up the money, or else all the other patients with insurance do through higher hospital costs which they or insurance companies must pay. Let's see a study that shows how much money it takes for somebody to pay those hospital bills - clearly those using the ER without insurance aren't paying for it, but someone is. But it's not being counted in the expenses of either those who have it or those who don't, so not everything is being counted.
And if we had single payer, I'm betting costs would go way down. Medicare has proven that.
But - how much money is paid for by taxpayers for emergency room treatments for people without insurance? The hospitals are required to help those people, but no money changes hands. So how do the hospitals keep up their financing? Either taxpayers cough up the money, or else all the other patients with insurance do through higher hospital costs which they or insurance companies must pay. Let's see a study that shows how much money it takes for somebody to pay those hospital bills - clearly those using the ER without insurance aren't paying for it, but someone is. But it's not being counted in the expenses of either those who have it or those who don't, so not everything is being counted.
And if we had single payer, I'm betting costs would go way down. Medicare has proven that.
21
Medicare is subsidized by private insurance. If costs are go down with single payor, then it will be because, via coercion, less care is given per capita, and/or the quality of the care will suffer (all the time with propaganda that says otherwise). In fact, the latter is already happening, and there is a movement to accomplish the former-- talk to your doctor.
1
Not true! Medicare is not subsidized by private insurance. And, BTW, the administrative costs for Medicare are only around 3%, as opposed to private health insurance, which are about 30%!
Also, if you believe that the quality of health care health would go down if the US had single payer health insurance, why is it that all of the other countries that have universal health care have better results - healthier people who live longer lives?
Also, if you believe that the quality of health care health would go down if the US had single payer health insurance, why is it that all of the other countries that have universal health care have better results - healthier people who live longer lives?
3
If money were the only measure of the value of health care, this op-ed would make sense. Quality of life is and should be the primary measure of value. Life costs money; quality of life costs money, though not necessarily more money. And how one measures cost has a profound impact on the entire discussion - as long as costs to families and communities don't count, disease and death are cheaper. This is not the conversation we should be having as a society.
11
Medicare is not subsidized by any money
All FICA taxes go to the Treasury's general fund and pay for general government expenses
The fact that every dollar used from the so called trust fund increases the federal debt proves Medicare is unfunded
All FICA taxes go to the Treasury's general fund and pay for general government expenses
The fact that every dollar used from the so called trust fund increases the federal debt proves Medicare is unfunded
A missed point. The American people as a whole are more unhealthy than ever from poor diet and lack of physical movement. All of this causes record diabetes that is out of control, the same for arthritis, cancers and just wait for Alzheimer's.
True prevention is not catching a developing disease and then trying to fix it with drugs and surgery. Prevention is preventing it! Not getting sick in the first place. that means a healthy diet and physical movement.
True prevention is not catching a developing disease and then trying to fix it with drugs and surgery. Prevention is preventing it! Not getting sick in the first place. that means a healthy diet and physical movement.
8
Yes, in the long run UHC costs
could motivate the gov't to look into the "food" industry and other aspects of the American environment that lead to poor health
could motivate the gov't to look into the "food" industry and other aspects of the American environment that lead to poor health
Look at it this way. Many, many other countries provide health care for every citizen, and often for non citizens as well. Yet on a per capita basis they spend far less money than we do in the US to cover a fraction of our population and they get better health outcomes to boot. Its out system that is broken. Its not the goal of covering everyone that is the problem that is driving costs.
32
Nope, no free lunch, but a lot of cost shifting comes from increasing the insured population. The hospitals of choice for the uninsured are generally operating at a loss and subsidized by cities, counties and states, aka tax payers.
Other forms of recovery of roughly $100 billion in uncompensated care are from increased charge master prices which determine rates for employer insurance.
And longer living people do ultimately cost more in the Medicare system, same as in Europe, where total costs are less than half of the US.
Hmmmm...
The next frontier for cost compression is the employer insurance market. This now mandated benefit has become such a huge cost to employers that the nice folks in HR are about to be shoved aside by the flinty eyed financial types. This has already started. It's called "reference pricing", aka "this is what we pay for that procedure", initiated by a few major employers to date. Expect it to tear through the health care business, forcing the kind of tough decisions already made by a lot of other once fat and happy business sectors.
These things happen in the US. Take a look around.
Other forms of recovery of roughly $100 billion in uncompensated care are from increased charge master prices which determine rates for employer insurance.
And longer living people do ultimately cost more in the Medicare system, same as in Europe, where total costs are less than half of the US.
Hmmmm...
The next frontier for cost compression is the employer insurance market. This now mandated benefit has become such a huge cost to employers that the nice folks in HR are about to be shoved aside by the flinty eyed financial types. This has already started. It's called "reference pricing", aka "this is what we pay for that procedure", initiated by a few major employers to date. Expect it to tear through the health care business, forcing the kind of tough decisions already made by a lot of other once fat and happy business sectors.
These things happen in the US. Take a look around.
2
The fewer people, the lower the costs -- avoid a pregnancy and eliminate a person's expensive journey into existence; let early-onset disease go untreated and cull a few who might later, surviving, sprout financially disastrous tumours. "The dismal science" indeed.
7
Great title to this article. The improving economy has contributed to the increase in spending as well as the increased availability of health insurance (granted most do not cover beyond one or two doctor's visits with everything else out of pocket) due to the ACA. The ACA does not address cost of care and the out of pocket expenses incurred by the people who purchase the insurance. What I have seen is that the ACA has led to a windfall of profit for the commercial insurance companies, while medical debt remains a big problem for those chronically patients who need to see a specialist more than once a year.
In addition, the culture of how we practice medicine is also contributing. Fee for service practice really does need to go away with bundling of reimbursements and scientifically reasonable (not arbitrary and impossible like AV Fistula rates or readmission rates in dialysis patients..ahem) parameters for quality affecting that bundled payment for providers. This obsession of hospital administrators to buy and promote expensive and essentially useless technology to rake in more revenue and profits is the centerpiece of why the current system remains broken.
I sincerely hope that the next Presidential administration and the next generation of the Senate and House will realize that health care reform should not end with the ACA but continue toward a single payer system. We need a fairer way to fund this system and the ACA isn't cutting it.
In addition, the culture of how we practice medicine is also contributing. Fee for service practice really does need to go away with bundling of reimbursements and scientifically reasonable (not arbitrary and impossible like AV Fistula rates or readmission rates in dialysis patients..ahem) parameters for quality affecting that bundled payment for providers. This obsession of hospital administrators to buy and promote expensive and essentially useless technology to rake in more revenue and profits is the centerpiece of why the current system remains broken.
I sincerely hope that the next Presidential administration and the next generation of the Senate and House will realize that health care reform should not end with the ACA but continue toward a single payer system. We need a fairer way to fund this system and the ACA isn't cutting it.
4
As a country we are only seeing the beginning of the acceleration of health costs. We have a health care insurance industry that has a functional monopoly in over 70% of the country, large health care providers with monopoly power in many parts of the country, and the insane idea that this 'free market' competition will lower costs. These monopolies have a fiduciary responsibility to make as much money as they can and they are well on their way. Patients are now widgets in the economic machine of the medical-industrial complex rather than human beings and they are going to be promised the moon (life) while being squeezed like ripe tomatoes. Insane. The wailing and gnashing of teeth are not far behind.
10
All other rich western countries provide universal care at much much lower cost and with much much better life expectancies.
You are totally stupid.
You are totally stupid.
15
You are not working with the all of the facts. The US healthcare growth rates for the last 30 years have been in line with other OECD nations. In the 1970s the US had a large increase that outpaced countries in Europe. So the US had a growth problem in healthcare costs it no longer does. No country has ever managed to cut healthcare spending. Other countries aren't magic.
2
I've done some research on this issue, and I wish to point out that in 2010, the U.S. was spending $3000-$5000 more per citizen on health care than any other country in the world, while only insuring 85% of its citizens. That means that if we had swapped systems, sight unseen, with any other developed nation -- all of whom insure virtually 100% of their citizens -- it would have saved us $1-1.5 trillion per year. At the same time, of all those 'peer' nations -- nations at a comparable stage of affluence and social development -- we have the worst health outcomes. So it is clear that under the old system, we had the most wasteful, least inclusive, and least effective health care system in the developed world.
If this article is correct, and our extra trillion dollars a year was not being lost because of a lack of preventive care, then why was it being lost? That is not a rhetorical question -- I would really like to know. One advance warning: if you want to blame the malpractice lawyers, you should know that the best available study indicates that medical litigation and defensive medicine cost the economy about $55 billion per year. That leaves $945 billion unaccounted for.
If this article is correct, and our extra trillion dollars a year was not being lost because of a lack of preventive care, then why was it being lost? That is not a rhetorical question -- I would really like to know. One advance warning: if you want to blame the malpractice lawyers, you should know that the best available study indicates that medical litigation and defensive medicine cost the economy about $55 billion per year. That leaves $945 billion unaccounted for.
7
*Groan* Really. This article is just... Uneducated. Let's start very simply, by comparing healthcare spending as a percent of GDP in all first-world countries.
http://mercatus.org/sites/default/files/healthcare-costs-us-oecd-chart1.jpg
(This statistic is pre-ACA, BTW.) All of those countries offer Universal Healthcare with two exceptions: Switzerland and the US. In this graph, the US used a completely private system. Switzerland uses a system similar to Obamacare. You'll notice that US spending is higher than spending in every country, while Switzerland's is moderately high but still far below US spending. There are two other clusters: Canada, France, and Germany use semi-public systems, where the government provides basic health insurance but hospitals are privately-owned and people can get supplemental health insurance. Just below them you have the remarkably cost-effective systems of the UK, Japan, and others, where the government not only provides health insurance but also runs the hospitals. Notice a trend? *More government regulation reduces costs*. It's a bit of a paradox: Regulation tends to increase costs, as companies have to work to comply with them, yet healthcare is and always has been the exception.
http://mercatus.org/sites/default/files/healthcare-costs-us-oecd-chart1.jpg
(This statistic is pre-ACA, BTW.) All of those countries offer Universal Healthcare with two exceptions: Switzerland and the US. In this graph, the US used a completely private system. Switzerland uses a system similar to Obamacare. You'll notice that US spending is higher than spending in every country, while Switzerland's is moderately high but still far below US spending. There are two other clusters: Canada, France, and Germany use semi-public systems, where the government provides basic health insurance but hospitals are privately-owned and people can get supplemental health insurance. Just below them you have the remarkably cost-effective systems of the UK, Japan, and others, where the government not only provides health insurance but also runs the hospitals. Notice a trend? *More government regulation reduces costs*. It's a bit of a paradox: Regulation tends to increase costs, as companies have to work to comply with them, yet healthcare is and always has been the exception.
39
Once again you are not working with all the facts. For the last 30 years growth in US healthcare rates has been in line with the rest of the OECD including all the countries you mention. The US had a higher growth rate in the 70s so it was working from a higher base. No country has ever succeeded in cutting healthcare costs. Not a single one. All they have done is slow the rate of growth. But the US doesn't have a growth rate problem it had one 30 years ago. So moving to whatever system you fancy will not actually lower the costs.
1
This article is just plain stupid. Nothing more, maybe less. Of course people will suddenly be utilizing health care more when they can actually afford it. That is a no brainer. And of course any potential offset from prevention and reducing long term morbidity and mortality is not going to show up immediately. Those offsets are long term gains, not upfront. The only possible immediate gain would be reduced ER visits - I don't know what the data is on them.
Total dollars are not the appropriate way to judge health care to begin with. Measures like the numbers of years of life gained per dollar, and quality adjusted life years gained per year are more appropriate ways to determine whether we are seeing improvements in our health care costs. Unfortunately, some people only see total cost, and do not consider the benefits gained. Health care should never be about spending the least amount of money possible, if that was our measure we should just get rid of doctors and hospitals. It is about improving peoples lives. If we think only the wealth deserve a quality life, then lets keep the system we had. If we think health is a human right, lets ensure everybody, even better, lets pay for it all.
Total dollars are not the appropriate way to judge health care to begin with. Measures like the numbers of years of life gained per dollar, and quality adjusted life years gained per year are more appropriate ways to determine whether we are seeing improvements in our health care costs. Unfortunately, some people only see total cost, and do not consider the benefits gained. Health care should never be about spending the least amount of money possible, if that was our measure we should just get rid of doctors and hospitals. It is about improving peoples lives. If we think only the wealth deserve a quality life, then lets keep the system we had. If we think health is a human right, lets ensure everybody, even better, lets pay for it all.
51
I was unaware that the reason to expand access to heath insurance was to save money. How could it? The purpose, which I find compelling, is to allow our citizens to live healthier, more comfortable and more productive lives. If kindness and mercy are not important to you, then I suppose you would feel differently.
87
It was indeed supposed to lower costs. All that drivel about how other countries spend less and have better outcomes. Hogwash . Ms Sanger is correct and it disturbs the Obama deluded .
1
Wait a minute! I thought that progressive liberals were the evidence-based, mathematically-literate bunch in the room, and here you all are trying to refute or rebut Ms. Sanger-Katz. But you can't -- because what she says is empirically true! More health care services purchased means more money spent.
If she were talking about pieces of bubble gum, any six-year-old could tell you that the more gum you buy, the more you will have to spend.
Now, you may argue that spending more is a collective good, or that doctors and nurses should donate their services for free, or any number of other things on your progressive wishlist, but Ms. Sanger-Katz is correct -- Obamacare is not reducing health costs.
If she were talking about pieces of bubble gum, any six-year-old could tell you that the more gum you buy, the more you will have to spend.
Now, you may argue that spending more is a collective good, or that doctors and nurses should donate their services for free, or any number of other things on your progressive wishlist, but Ms. Sanger-Katz is correct -- Obamacare is not reducing health costs.
17
Nothing is reducing healthcare costs. NOTHING. Nothing has ever reduced healthcare costs. All that happens is the rate of growth slows.
1
Um, except it has? And I think any gum-chewing sixty year old could tell you the more you go to the dentist for checkups, the less likely you'll need an expensive root canal.
Wonkery and political debate focuses too much on $$$. It's important to debate the cost-benefit, but what about the sheer value of providing health and happiness to our fellow citizens? Rescuing our neighbors from health disasters and financial time bombs? Is it such a tragedy if our overall HC costs go up a smidgen, if we are making for a significantly healthier citizenry?
By the way, if we are to devote time to cost-benefit analysis - let's focus on end-of-life care that wastes tremendous national resources for a pittance in life extension (poor quality, to boot). We are being penny-wise and pound-foolish.
By the way, if we are to devote time to cost-benefit analysis - let's focus on end-of-life care that wastes tremendous national resources for a pittance in life extension (poor quality, to boot). We are being penny-wise and pound-foolish.
10
You're assuming that these neighbors who are near health and financial disasters will actually take their meds and follow the advice given them by their health providers. Many, many people have health problems due to poor lifestyle choices, and study after study has shown that most people are loathe to give up those poor choices. Those with Type 2 diabetes refuse to change their eating habits and lose weight. Those with heart disease refuse to quit smoking and/or lose weight. The list goes on and on...
What I have seen with people who work for me (house cleaners and yard help) is that they are now even more likely to call an ambulance and go to the ER. They also have learned that they need to actually be admitted and not held for "observation" in order to be covered, so they insist on this. They are signing up in droves to have their knees replaced (which most likely will have to be done again as they do not lose weight and are grossly obese).
I am NOT saying that these people should not have access to health care, but perhaps we ALL need to realize that our access might be denied if we don't do our part. No, losing weight is VERY hard, but good eating habits are not.
What I have seen with people who work for me (house cleaners and yard help) is that they are now even more likely to call an ambulance and go to the ER. They also have learned that they need to actually be admitted and not held for "observation" in order to be covered, so they insist on this. They are signing up in droves to have their knees replaced (which most likely will have to be done again as they do not lose weight and are grossly obese).
I am NOT saying that these people should not have access to health care, but perhaps we ALL need to realize that our access might be denied if we don't do our part. No, losing weight is VERY hard, but good eating habits are not.
2
Does healthy living actually reduce medical costs? Healthier people live longer, and therefore have more years to use healthcare. They exercise strenuously, which leads to expensive injuries. And no matter how healthy they are, they do eventually die, which is an expensive process in the U.S.
2
Exercise does not lead to more expensive injuries. Not exercising does.
This is cynicism at its best. I don't think that I ever thought that universal health care would be less expensive but rather that we would be a healthier, more productive nation. I heard a lot of "expects" and "available evidence" in this article that amounted to nothing but conjecture. I'll bet that if the heart attack that all of the testing prevents is Ms. Sanger-Katz's, or that the person whose disease is cured so that she will die from something else later in life was her mother she might have a different point of view. The facts ma'am. Please, nothing but the facts.
30
Of course; it's just math. The relevant question is: do you want to cover everybody with a reasonable standard of care? If so, do you want to do it efficiently? Every other industrialized culture manages to answer yes to these questions while spending less per capita than we do and achieving measurably healthier populations and better quality of life. It's time to quit rehashing these tired old arguments and move forward on health care.
150
Looks like the "ACA" needs to be stripped of its first "A".
6
I never thought the ACA was intended to save money. From the beginning it was clear to me that rationalizing health spending for insurance companies, drug and medical appliance companies, etc. would doom the legislation. Other things equal, though, ACA should now promote a healthier populace and better quality of life for many. Perhaps, now that ACA is in place, it is time to get serious about evidence based medicine, cutting back on dubious procedures and junk-meds.
14
So where was this brilliant analysis and reporting as the President, much of the NYT reporters and Op Ed writers and most commenters just kept repeating that
"oft-expressed view that getting all those people covered could actually save the health system money. The argument goes something like this: Once people have insurance, they’ll go to the doctor instead of an expensive emergency room. Or: Prevention costs far less than a serious illness down the road.
In selling the Affordable Care Act, President Obama was fond of making these sorts of arguments. "
So you all lied and costs have skyrocketed. Wonder why few believe Obama when it comes to TPP, Iran or his latest Energy Initiative? Cause, as GWB used to say, he spent all his political capital with the lies on ACA. Stick a fork in him, he's done, and so it the Times credibility.
"oft-expressed view that getting all those people covered could actually save the health system money. The argument goes something like this: Once people have insurance, they’ll go to the doctor instead of an expensive emergency room. Or: Prevention costs far less than a serious illness down the road.
In selling the Affordable Care Act, President Obama was fond of making these sorts of arguments. "
So you all lied and costs have skyrocketed. Wonder why few believe Obama when it comes to TPP, Iran or his latest Energy Initiative? Cause, as GWB used to say, he spent all his political capital with the lies on ACA. Stick a fork in him, he's done, and so it the Times credibility.
12
Costs have been skyrocketing for decades long before the ACA. Your argument does not hold a drop of water.
If the ACA had been, instead, Medicare For All then costs would be dropping down to what it is in other developed nations as a percentage of GDP. Our health care industry is a national disgrace. I blame the right wing whose only concern is padding the pockets of the 1% at the expense of everyone else.
If you are not part of the 1% then you have been had.
If the ACA had been, instead, Medicare For All then costs would be dropping down to what it is in other developed nations as a percentage of GDP. Our health care industry is a national disgrace. I blame the right wing whose only concern is padding the pockets of the 1% at the expense of everyone else.
If you are not part of the 1% then you have been had.
Let's just go back to having barbers do surgery.......think of all the money we would save. Money is not always the only determinate of good decisions.
12
The more important question is why should any of us care about this? The goal of expanding health insurance is to help society as a whole have higher WELFARE and HEALTH. Saving (or spending) money is a side effect / benefit from this outcome.
Do we, as a society, believe that the opportunity to live a healthy life (via health insurance) is a right all citizens should have? If so, then we, as a society, should agree to pay for that right. End. Of. Discussion.
If you wish to talk about healthcare inefficiencies and ways to save money generally, I'm all for that. There are numerous ways. But public provision of health insurance is a moral issue, not a matter of costs.
Do we, as a society, believe that the opportunity to live a healthy life (via health insurance) is a right all citizens should have? If so, then we, as a society, should agree to pay for that right. End. Of. Discussion.
If you wish to talk about healthcare inefficiencies and ways to save money generally, I'm all for that. There are numerous ways. But public provision of health insurance is a moral issue, not a matter of costs.
12
The more important question is why should any of us care about this?
Maybe because we are still not a dictatorship and the leadership of this country lied to it in order to pass legislation they knowingly would not do what they claimed. They even put "Affordable" into the title of the bill so don't claim that was not one of the key objectives or points used to sell it to the country. That's why we should care.
Maybe because we are still not a dictatorship and the leadership of this country lied to it in order to pass legislation they knowingly would not do what they claimed. They even put "Affordable" into the title of the bill so don't claim that was not one of the key objectives or points used to sell it to the country. That's why we should care.
7
Agree with others - this article is poorly written and the point is confusing. Should we or should we not offer preventative care? Should we - as a first-world country - deny health care to people because they can't afford a test, a pill or a treatment? Should insurance companies make it financially impossible for a sick person (fill in the blank with the disease of your choice, e.g., diabetes, high blood pressure, obesity, arthritis, cancer or something else) to be able to purchase insurance because they don't have a job or are self-employed?
17
Of course one serious problem is that insurance companies are still wagging the dog of government, despite the best intentions to keep "private enterprise" involved--they were to get rich off the broader customer base even if lower premiums.
There have been many positive serious studies on the results of ACA which I find only on the back pages. Why now as a lead story and why this specific study? Good grief, only 30% of the American public are positive on the ACA after 6 years of negative, irresponsible advertising by Republican billionaires?
Perspective please in this sort of article. Your presentation of the figures of health care costs over the years is distorted. You must compare to pre-ACA rip-off system which evidently you, following the GOP, think is the best in the world. And then mention how the rest of the world insures everyone at half the cost and better care than America.
There is a reason neither the GOP or health/economic reporters in the MSM can come up with a better alternative to ACA. There is none. There is nothing until we shift everyone onto a sane national Medicare insurance. That is what private companies would call "Better Practices".
There have been many positive serious studies on the results of ACA which I find only on the back pages. Why now as a lead story and why this specific study? Good grief, only 30% of the American public are positive on the ACA after 6 years of negative, irresponsible advertising by Republican billionaires?
Perspective please in this sort of article. Your presentation of the figures of health care costs over the years is distorted. You must compare to pre-ACA rip-off system which evidently you, following the GOP, think is the best in the world. And then mention how the rest of the world insures everyone at half the cost and better care than America.
There is a reason neither the GOP or health/economic reporters in the MSM can come up with a better alternative to ACA. There is none. There is nothing until we shift everyone onto a sane national Medicare insurance. That is what private companies would call "Better Practices".
23
"shift everyone onto a sane national Medicare insurance"
God forbid. Then we'll have the costs (or worse) of the ACA plus months-long waiting lists for many non-emergency procedures of single payer systems like in Canada and Great Britain. Better to go to a health care system like Germany or the Netherlands.
God forbid. Then we'll have the costs (or worse) of the ACA plus months-long waiting lists for many non-emergency procedures of single payer systems like in Canada and Great Britain. Better to go to a health care system like Germany or the Netherlands.
4
Of course giving more people access to healthcare would increase the overall cost of healthcare, whether the new coverage is through employer insurance, medicare or medicaid. That's a fact backed by actual figures; obviously, when it comes to people's health, the cost/benefit analysis should be more complex and take into consideration much more data than the mere healthcare expenses. The most appropriate question to ask is probably: with the additional coverage (and related costs) are people actually healthier? Unfortunately, we might never know the answer to this question, considering all the other factors influencing one's health other than the access to healthcare (lifestyle, pollution, eating habits etc.).
2
Public benefit analysis is the proper way to analyze overall health care costs. Do more people become more productive or do more people fall into are social safety nets. In other words, if it helps people to get work and/or keep working (and paying taxes) then it is probably good for us and the economy (and it can help boost the social safety nets to the sick and needy.)
1
The article is poorly written, lumping together diverse issues in a confusing way. The overall result is to make it appear that Obamacare is a financial failure, and the way it is phrased contributes to that impression.
"...every time you prevent people from dying from one disease, they are likely to live longer and incur future medical expenses. The patient who benefits from the cholesterol screening may go on to develop cancer, arthritis, Alzheimer’s or some other costly illness."
That helping people live longer means they may develop more expensive conditions later happens whenever people have access to health care. This almost sounds like an argument for death panels - people need to die from cheaper illnesses more quickly if our primary goal is containing costs. We are all going to die - the question is, what kind of life are we going to have in the meantime, and how much of it?
If preventive care does not lead to cost savings, that's a problem that is going to occur with any method of giving people health coverage, whether through Obamacare or some other mechanism.
The headline on this is deceptive. It should say preventive medicine does not save as much money as people expect - because that 's the obscured real point of the information in this article, not that expanded health care is the problem.
"...every time you prevent people from dying from one disease, they are likely to live longer and incur future medical expenses. The patient who benefits from the cholesterol screening may go on to develop cancer, arthritis, Alzheimer’s or some other costly illness."
That helping people live longer means they may develop more expensive conditions later happens whenever people have access to health care. This almost sounds like an argument for death panels - people need to die from cheaper illnesses more quickly if our primary goal is containing costs. We are all going to die - the question is, what kind of life are we going to have in the meantime, and how much of it?
If preventive care does not lead to cost savings, that's a problem that is going to occur with any method of giving people health coverage, whether through Obamacare or some other mechanism.
The headline on this is deceptive. It should say preventive medicine does not save as much money as people expect - because that 's the obscured real point of the information in this article, not that expanded health care is the problem.
101
I noticed that baloney too. If that was true, then insurance companies would charge less for smokers who presumably die younger and faster than non smokers.
9
When the rich pays for the poor, we call it communism.
When the rich pays for the poor, the number of poor people rises.
The minor becomes the major. Because the poor has no motivation to change his life
When the rich pays for the poor, the number of poor people rises.
The minor becomes the major. Because the poor has no motivation to change his life
1
There is no doubt that suddenly giving people access to medical care will increase costs in the short run; people are going to get chronic problems taken care of. That is what the data presented in this article primarily measures. However, it is not the question that the author asks. The author asks what is the long-term effect. To know that, we need to measure data on the long term and not make a guess after a year or two while in the midst of the initial wave.
However, as pointed out by other commenters, we can compare data with other countries where people have had medical care for a long time. Since ours is the most expensive system in the world (and even more expensive when outcomes are factored in), we can bet that costs will come down in the long run.
However, as pointed out by other commenters, we can compare data with other countries where people have had medical care for a long time. Since ours is the most expensive system in the world (and even more expensive when outcomes are factored in), we can bet that costs will come down in the long run.
19
The price of drugs is much higher in the States.Physicians and other health care personnel are more than twice as expensive when the average income per head is only 20 to 30% higher in States .A lot can be gained by a better organization but you cannot lower the costs without price control .
A less important factor is the cost of malpractice .It is practically impossible to sue a doctor in Europe ,so the medical profession has much lower insurance costs.
For those and other reasons I doubt that Americans will ever accept the societal changes that would be needed to get a decent medical system.
Just read the next comment (Albert Christie)!
A less important factor is the cost of malpractice .It is practically impossible to sue a doctor in Europe ,so the medical profession has much lower insurance costs.
For those and other reasons I doubt that Americans will ever accept the societal changes that would be needed to get a decent medical system.
Just read the next comment (Albert Christie)!
1
And why do you think costs will come down in the long run? Oddly enough, the biggest cost driver isn't the number of patients or even the type of care they're receiving. The cost driver is what the hospitals and doctors and pharmaceutical companies and medical device companies charge.
In this country, there is effectively no upper limit to what they can charge. I can rarely even find out in advance how much something is going to cost. "Oh, your insurance will cover it, why do you care?" I care, in part because I have huge co-insurance payments to make, and I care because some of the eventual bills are so absurd that I'm left in a state of shock and disbelief.
I, as an individual consumer, have precisely one way to keep down the cost: Don't get sick. And if I get sick, I shouldn't get treated.
In this country, there is effectively no upper limit to what they can charge. I can rarely even find out in advance how much something is going to cost. "Oh, your insurance will cover it, why do you care?" I care, in part because I have huge co-insurance payments to make, and I care because some of the eventual bills are so absurd that I'm left in a state of shock and disbelief.
I, as an individual consumer, have precisely one way to keep down the cost: Don't get sick. And if I get sick, I shouldn't get treated.
4
Correct. And what is still unstated anywhere is the extent to which insurance companies will go to game the new system. That's the market place. They got the lawyers and the lobbyists who write the Congressional legislation, I'm afraid.
3
There's a different kind of conclusion to be drawn from the few bits of data provided by the author: for profit medicine leads to overtreatment with expensive drugs of marginal effect. Look at cholesterol screening: "... to prevent one heart attack, the health care system has to test hundreds of healthy people - and give about a hundred of them cholesterol lowering drugs for at least five years ... prevention measures cost more than is saved on the heart attack treatment." This is a sign of for profit medicine run amok. There is evidence that statins are effective in reducing the chance of a second heart attack but the evidence for using statins to prevent a first heart attack is weak: five years of drugging "hundreds" to prevent a single heart attack? What about the side effects? Think about it! If you look at the data by sex, evidence for preventive use of statins by women is particularly weak.
The problem is the 21% "takeout" by insurance companies and the profit margin for drugs which are used off label without good supporting evidence. The problem is with American medicine, specifically. And it could be fixed.
The problem is the 21% "takeout" by insurance companies and the profit margin for drugs which are used off label without good supporting evidence. The problem is with American medicine, specifically. And it could be fixed.
10
I can wholeheartedly agree with you!
But personally I don't know how this situation could be fixed. The only way I see is sponsoring medical researches and hoping that finally the progress will happen
But personally I don't know how this situation could be fixed. The only way I see is sponsoring medical researches and hoping that finally the progress will happen
This piece is an exemplar of cherry-picking data without truly critical thinking.
29
I didn't see any mention of the variations among policies. To say, 'giving people health insurance means they use more health care', without noting that some plans have low co-pays and deductibles, some have very high ones, is disingenuous at best.
I agree with Karl - cherry picking data, big time.
I agree with Karl - cherry picking data, big time.
2
Yep, you can save a lot of healthcare dollars by just having folks die young, thereby avoiding the "expensive" older years.
22
Agree with Novak. Analysis of expenditures without recognized valuation of full benefits, e.g. days living quality lifestyle, predictably and unacceptably biases the outcome.
4
Her comparisons of alternative costs seem frequently flawed, as other commenters note in more detail. And even if some of her allegations are partially accurate, are not some cost increases linked to lack of hospital cost controls and limited power to negotiate drug prices? So, at best, these are arguments for universal health care. In that sense, the article grossly lacks comprehensiveness.
10
This makes no sense to me. "For the individual patient whose heart attack is prevented by a cholesterol screening, to give one example, that blood test is a cost-saver. But to prevent one heart attack, the health care system has to test hundreds of healthy people — and give about a hundred of them cholesterol-lowering drugs for at least five years. Added together, those prevention measures cost more than is saved on the one heart attack treatment." If we give a hundred at risk people a statin for 5 years, wouldn't we prevent more than one heart attack?
3
Not necessarily. The "decision rule" for determining who should take which medication is extremely non-specific. They -- the medical community -- can give a guess as to who's at risk, but they can't say for sure that if they treat person X, person X won't have the adverse event, whereas if they left X untreated, X would definitely have the adverse event. They *have* to treat a large number of people, almost all of whom would not have had the adverse outcome even if they'd never been treated. The drug is 'wasted' on virtually everyone who takes it, in order to prevent something terrible from happening to one person.
2
Probably not! That's what NNT means. Read dr. Barbara Roberts's book, The Truth About Statins.
This piece seems to be the equivalent of climate change denial pushed by the fossil fuel industry: these are super cheap sources of energy and alternatives aren't free but in fact have all sorts of costs that would make them inadequate choices for a free market. Yes, cheap ... so long as you ignore all of the consequence costs; if you don't, not so cheap.
Yet, the very same problem with that climate analysis also exists with this Upshot report. The key question is: compared with what? Does medical spend increase? Probably. But is that a greater expense than the alternative? Probably not.
For example, one key limitation of the Oregon study cited here was that the study used an absurdly low figure for the value of lives saved. I can't remember the figure, something like $125k per life. Of course, precious few people would think that this is a reasonable figure for a life (let alone our own life) and would insist that spending more than $125k is definitely good money at least if the result was a fair amount of continued life term at a reasonable quality of life. But the study doesn't make that kind of assumption, and therefore gives the result cited here: too much more money.
Yet, the very same problem with that climate analysis also exists with this Upshot report. The key question is: compared with what? Does medical spend increase? Probably. But is that a greater expense than the alternative? Probably not.
For example, one key limitation of the Oregon study cited here was that the study used an absurdly low figure for the value of lives saved. I can't remember the figure, something like $125k per life. Of course, precious few people would think that this is a reasonable figure for a life (let alone our own life) and would insist that spending more than $125k is definitely good money at least if the result was a fair amount of continued life term at a reasonable quality of life. But the study doesn't make that kind of assumption, and therefore gives the result cited here: too much more money.
6
It's quite interesting that most advanced industrial/electronic societies provide health care for all citizens but spend half as much per person for medical care than we do in the United States. The question is: Why does it cost so much to provide medical care in the United States of America????
43
The reason that medical care costs so much in the U.S. is because specialists get paid an enormous amount of money. Also, the cost of outpatient facilities, hospitals and pharmaceuticals in the U.S. are off the charts. The list goes on, but suffice it to say that medical care should be non-profit industry.
1
Expensive end of life care that may or may not provide any benefit.
Those services are much more managed in other countries, regardless of the anecdotal medical tourism stories.
Those services are much more managed in other countries, regardless of the anecdotal medical tourism stories.
1
"In 2014, an estimated nine million people became newly insured thanks to Obamacare. ... But, based on available information, the actuaries estimated that health spending that year jumped by 5.5 percent, a bigger rise than the country had experienced in five years."
That is a great deal, 5.5% increase in 2014 health care spending to take care of 9 additional million Americans. The extra bump in productivity we get from those 9 millions when quantified will be multiple of the 5.5% of 2014 health care spending.
That is a great deal, 5.5% increase in 2014 health care spending to take care of 9 additional million Americans. The extra bump in productivity we get from those 9 millions when quantified will be multiple of the 5.5% of 2014 health care spending.
3
And productivity from sick people without insurance is?
5
Sorry, but this article is little more than speculation. As the writer points out, the actuarial data is merely an estimate that may very well change as more information becomes available. Also, the writer fails to consider the effect of pent-up initial demand for health services due to years of being without coverage. Sorry, but this cherry-picked rant is meaningless.
65
Of course. The cheapest thing to do would be to immediately kill everyone who shows any signs of getting sick. Then, for the cost of one bullet, they are out of the way permanently.
By what crazy reasoning is this supposed to make sense?
By what crazy reasoning is this supposed to make sense?
181
You have great point. The cheapest health plan is 1) Don't Get Sick. 2) If You Do, Die Quickly. It also seems to be the only proposed alternative to the ACA.
I've got an idea. Let's charge people very high premiums for their policies, and then have huge deductibles. They won't have any money left after paying the premiums to pay for medical care, so costs will go down dramatically.
If this works out, I may qualify for a professorship at MIT.....
If this works out, I may qualify for a professorship at MIT.....
18
Why not increase the deductibles as participants earn 35 percent - guaranteed per year on their contributions
Paying $100 a
Month for 36 months provides $10,000 of coverage with a zero deductible
Bronze level premiums for a platinum
level plan
To learn more go to nationalprosperity.com
Don Levit
Paying $100 a
Month for 36 months provides $10,000 of coverage with a zero deductible
Bronze level premiums for a platinum
level plan
To learn more go to nationalprosperity.com
Don Levit
Probably, the same could be said of “efficiencies” or things that will “pay for themselves” at some ill-defined point in the future. Obviously, there’s a lot more at stake here than money, yet it never fails that someone has calculated that some other person’s medical problems are costing the country billions.
3
Morally, your insurance or financial status should not be available to the health provider. You either need the care or you don't. Several years ago, a friend was diagnosed with breast cancer. She was among the working poor with no insurance but too much income to qualify for public aid. She got minimum treatment and was sent on her way. Three years later there was a recurrence, but because she now had a job with insurance benefits, she was offered an extended hospital stay and follow-up treatments.
10
"It found that the less expensive you made it for people to obtain medical care, the more of it they used. That follows the pattern for nearly every other good in the economy, including food, clothing and electronics. The cheaper they are for people, the more they are likely to buy."
I find it offensive that you say the only value in universal healthcare is economic, and you compare my health to buying a flatscreen TV. Are we so obsessed with profit that we need a positive ROI in order to see the value in this?
You hardly have enough information here to make the claims you have.
I find it offensive that you say the only value in universal healthcare is economic, and you compare my health to buying a flatscreen TV. Are we so obsessed with profit that we need a positive ROI in order to see the value in this?
You hardly have enough information here to make the claims you have.
37
"his argument for the cost effectiveness of universal health coverage makes some intuitive sense, but it’s wrong. There’s strong evidence from a variety of sources that people who have health insurance spend more on medical care than people who don’t." - wait a second, this argument needs some support other then another NYT linked article with some opinions in it - by implicaiton vaccines don't save money? blood pressure pills to prevent heart disesase don't save money? is it really cheaper to have a productive worker dead at 40 from a heart attack then for them to live to 75? or let a treatable disease fester untile you end up in the ER...? the author needs some real evidence to back up her nonintuitive claims - oh and most other developed countries offer more health care at much lower cost...
9
Its actually pretty asinine to state that increased health insurance won't cut healthcare costs since it did not in the first year when the cost-saving would be through preventative care. If more people receive all types of care, including preventative in the first few years, then we should see costs going down after a few years when the preventative care has actually had a chance to prevent things.
8
The bill was sold to us as something that would save every family $2,500 per year on average. Maybe you forgot, but I certainly have not.
16
Nor have I, and if you just do the math you will see it is a fairly accurate calculation.
3
ANd it will
THat is roughly the amount that is what your premiums would have been without the ACA and are with the ACA
If your premiums were $15000 for a family in 2009, they were projected to be $25,000 in 2020. With the ACA they will only go up to around $22,500.
You will be saving that $2500 because your premiums will NOT GO up as much as they would have.
Honestly can the US public gt any dumber and simplistic than they are?
THat is roughly the amount that is what your premiums would have been without the ACA and are with the ACA
If your premiums were $15000 for a family in 2009, they were projected to be $25,000 in 2020. With the ACA they will only go up to around $22,500.
You will be saving that $2500 because your premiums will NOT GO up as much as they would have.
Honestly can the US public gt any dumber and simplistic than they are?
5
This is far too simplistic. Yes, some preventive care is not cost-effective. But some (like flu vaccination) is VERY cost effective. And health insurance covers more than prevention, since it can cover a host of other services. Studies that have looked at the cost-effectiveness of health insurance generally show it's a wise societal investment: http://www.ncbi.nlm.nih.gov/pubmed/15626556
9
Giving people socialized health care saves everyone money. Giving people subsidies to purchase for profit insurance products is incredibly expensive and wasteful.
181
Yes! Obamacare is the largest corporate giveaway ever.
His supporters close their eyes to his corporate side.
His supporters close their eyes to his corporate side.
1
A sick or worried person - or one tied to a job by health insurance - is not fully productive; surely business can realize that, even if corporations denounce any suggestion of responsibility to the community off of which they feed.
7
I am a family doctor and it is true that giving people health insurance doesn't save money. The picture that accompanies this article is of a fingerstick blood sugar on a woman who got insurance after 10 years - it reads 389. She has diabetes. If she had insurance all along it would have been diagnosed earlier and treated sooner - which would have cost money in pills, doctor visits and lab testing. She is more likely to go blind, need dialysis or have a foot amputated because of those years without medical care. Let's ask her what she thinks.
235
Mortality and Access to Care among Adults after State Medicaid Expansions
Benjamin D. Sommers, M.D., Ph.D., Katherine Baicker, Ph.D., and Arnold M. Epstein, M.D.
N Engl J Med 2012; 367:1025-1034
CONCLUSIONS
State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health.
Changes in Mortality After Massachusetts Health Care Reform: A Quasi-experimental Study
Benjamin D. Sommers, MD, PhD; Sharon K. Long, PhD; and Katherine Baicker, PhD
Ann Intern Med. 2014;160(9):585-593
Conclusion: Health reform (universal health insurance) in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.
Benjamin D. Sommers, M.D., Ph.D., Katherine Baicker, Ph.D., and Arnold M. Epstein, M.D.
N Engl J Med 2012; 367:1025-1034
CONCLUSIONS
State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health.
Changes in Mortality After Massachusetts Health Care Reform: A Quasi-experimental Study
Benjamin D. Sommers, MD, PhD; Sharon K. Long, PhD; and Katherine Baicker, PhD
Ann Intern Med. 2014;160(9):585-593
Conclusion: Health reform (universal health insurance) in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.
9
Of course it costs money to insure people and give them access to care. But I think that we can agree that people's lives improve when they get the care they need. The real question is whether the money being spent is cost-EFFECTIVE. Time will tell with Obamacare, but early signs are positive.
5
Parks can't pay for themselves but we all need them. Healthcare should be a right in a developed country like the US. It should have to be a cost/benefit analysis, but just the fact that it's the right thing to do.
Also, as one commentator posted, it's too early to say whether money has been "saved". Let's get the obesity crisis under control through preventive healthcare and see if we start "saving" any money!
Also, as one commentator posted, it's too early to say whether money has been "saved". Let's get the obesity crisis under control through preventive healthcare and see if we start "saving" any money!
7
I have insurance and I still hesitate to go for a check up, for care, or to use the our current wealth care system at all. The co-pays, co-insurance pays, deductibles, narrow networks, facility fees, etc., make budgeting for any sort of health care impossible. We have a wealth care system and we get the care we can afford, not the care we need. The only ones who are truly benefitting from the ACA are the health insurance companies, pharmaceutical companies, hospitals, labs, and so on. Patients and doctors do not benefit when we have to fight with the insurance companies for every treatment, medication, or recommendation made. We don't benefit when doctors we like or need to see leave or are kicked out of the network.
All the emphasis on cost containment overlooks the need for good consistent medical care for everyone. It also overlooks the need for the care we need rather than what we can afford. If we are a first world country we ought to have health care system rather than a wealth care system.
All the emphasis on cost containment overlooks the need for good consistent medical care for everyone. It also overlooks the need for the care we need rather than what we can afford. If we are a first world country we ought to have health care system rather than a wealth care system.
117
We have evidence that when patients don't share the cost of healthcare, they use it excessively. When given the choice, they chose the most expensive drugs and procedures, even if there is no proof that they are better, because they assume that more expensive is better. They demand procedures rather than waiting the 6 weeks proven to resolve 80% of back pain. Of course you don't like paying part of healthcare. I don't like paying for food and gas, either.
We also know that when people have too much responsibility they don't go because it's too expensive. I don't mind paying for food and gas but I do mind being nickel and dimed by the wealth care industry. And I never demand procedures. I hate them. I'd rather wait for something to resolve itself. It's the doctors that are pushing the prescriptions and procedures rather than spending time with us.
If you have to fight with your insurance company every time that you go to the doctor and every time that you get medication, then you should shop for another insurance company, and/or make sure that you healthcare providers did not make mistakes when billing for your care. I rarely have the problems that you mentioned; when I have those problems, it is usually because one of my healthcare providers made a mistake and billed the wrong procedure and/or diagnosis.
1
The real cost question, here, is cost per capita. Gross dollars spent is a meaningless number. If the authors ramblings are her beliefs then perhaps she should make her own funeral arrangements well in advance so that she could negotiate the very best price and then save all future medical expenses she might incur by having no medical care until she is dead. Think of how much money that might be!
16
This is the problem with allowing *only* the rich and businesses (and the lobbyists for them) to decide our government spending priorities.
If you elbow out other rational people from the debate, such as scientists, ethicists, people from charities, professors, religious leaders, who actually care about American society and care about actual human beings and who don't just measure every measure everything on the "if it costs money it can't be good" scale, then, of course, you are always going to hear politicians spewing out specious arguments about how every program will save us money.
And let's not forget the fact that extremist Republicans say, unless a program is directly related to policing or defense, the government shouldn't be spending money on it at all. (Including the VA and pensions.)
Until we pass a constitutional amendment that reforms campaign financing, the political agenda will continue to be framed around "How much tax money will this cost the rich?" and not "Will this program be good for America?"
If you elbow out other rational people from the debate, such as scientists, ethicists, people from charities, professors, religious leaders, who actually care about American society and care about actual human beings and who don't just measure every measure everything on the "if it costs money it can't be good" scale, then, of course, you are always going to hear politicians spewing out specious arguments about how every program will save us money.
And let's not forget the fact that extremist Republicans say, unless a program is directly related to policing or defense, the government shouldn't be spending money on it at all. (Including the VA and pensions.)
Until we pass a constitutional amendment that reforms campaign financing, the political agenda will continue to be framed around "How much tax money will this cost the rich?" and not "Will this program be good for America?"
49
"...those dollars spent may improve their health and financial security..."
Strike may, replace with will.
You cannot speak to this issue unless you've lived for at least several years without health insurance. Stand back until real life kicks in.
Life is not stats from a bounded pool of data. It's much more complicated than that. However, if you must cling to stats to test what life is about, please at least value the additional productivity and stable community life that comes from many individuals having better health and a sense of safety due to having health care.
Strike may, replace with will.
You cannot speak to this issue unless you've lived for at least several years without health insurance. Stand back until real life kicks in.
Life is not stats from a bounded pool of data. It's much more complicated than that. However, if you must cling to stats to test what life is about, please at least value the additional productivity and stable community life that comes from many individuals having better health and a sense of safety due to having health care.
45
I don't think the author is saying that you don't deserve health care. I think she's saying that we shouldn't be surprised that health spending is going up and that the argument used to pass healthcare, that it would save the government money, was, if not false, at least flawed.
Too bad the author didn't say something more forceful like, "Obama should have made the case that healthcare is a fundamental human right and a law should be passed for that reason alone."
Too bad the author didn't say something more forceful like, "Obama should have made the case that healthcare is a fundamental human right and a law should be passed for that reason alone."
9
I suppose this article is of value because it promotes discussion about our helathcare insurance system. But, it seems to me to be trying to explain something that has "duh" written all over it. The article argues that providing a product/service costs money and people shouldn't be surprised by that; just like food I guess. If only we could get people to stop eating we'd see a gradual decrease in the amount of money spent on farming. Now, if we could just get those sick people to die sooner....
6
How does The Upshot pretend to extrapolate any claims about the long term cost effectiveness of preventative care based on a couple years' worth of data? The oblique references to price/consumption studies aren't germane.
12
Expanded insurance coverage may not save money, but it does save lives. Shouldn't that be the bottom line?
18
Not in a discussion about dollars.
3
No, Giving More People Health Insurance Doesn’t Save Money - Uh Yes it does, look at every other developed country - they offer more health insurance for much less money than we do - This article is infurating becasue of its narrow and I would say ideological view point that intentionally fails to point out the obvious yet sounds like some sort of hard nosed data based article - and anybody who argues we all save money by letting people die from preventable conditions like heart disease without taking into account the added productity and taxes payed by longer life is quite frankly a sociopath.
200
That's because the actual costs of medical care are much lower in those countries. It is not the insurance system, it is what they actually spend on salaries, equipment, medicine and buildings.
2
Your argument is ridiculous: there are many other differences between the US and those other countries besides the percentage of people who are insured. You give no reason to think percentage insured is the difference that explains lower healthcare costs.
1
Very true, America's healthcare system is just economically inefficient compared to other nations. Other countries with single payer use monopsony to control the cost of healthcare. It is a kind of reverse monopoly where there is one large buyer and multiple sellers. Because only one entity purchases the products, medical companies in those nations try to make the best product for the cheapest price. In America, our system of insurance and lax government control over the costs of medicine are the reasons America pays more than any other nation per capita on healthcare, but many of us still struggle to pay for it.
4
Several assumptions need challenging here.
One, we are not currently measuring the total true costs of lack of health care to our nation and the toll poor health takes on families and our economy.
Two, the assumption that costs will inevitably rise as people age is not necessarily true. Now that insurance can't turn people away, there will be more incentives designed to help people keep healthy as they grow older. The top two predicators of poor health in the U.S. are smoking and obesity, both of which are possible to influence.
Finally, it will take a while for the numbers on chronic diseases like diabetes and cardiovascular to turn around. We need to continue to find ways to help people take responsibility for their own health. Those of us in health care know what keeps folks healthy: good nutrition, mobility, and sleep would take care of a lot of health issues. What we haven't yet figured out is how to help people keep themselves healthy without needing to see us.
One, we are not currently measuring the total true costs of lack of health care to our nation and the toll poor health takes on families and our economy.
Two, the assumption that costs will inevitably rise as people age is not necessarily true. Now that insurance can't turn people away, there will be more incentives designed to help people keep healthy as they grow older. The top two predicators of poor health in the U.S. are smoking and obesity, both of which are possible to influence.
Finally, it will take a while for the numbers on chronic diseases like diabetes and cardiovascular to turn around. We need to continue to find ways to help people take responsibility for their own health. Those of us in health care know what keeps folks healthy: good nutrition, mobility, and sleep would take care of a lot of health issues. What we haven't yet figured out is how to help people keep themselves healthy without needing to see us.
70
I agree completely about helping people form healthier habits. However, I think that this plays into assumption that if you are have some sort of disease, you've lived in a manner that caused your illness. This isn't always the case and it feeds into the "blame the victim" mentality we have against the sick in this country.
You see this idea all over readers comments posted on articles in the run-up to the passage of ACA. If people would just "live more healthy" they wouldn't need health insurance. And that's baloney.
Almost everyone, except those killed by suicide, accident, or violence will need a doctor at some point in their life. No matter how healthy you live, you are going to get a disease at some point and die from it.
And let's not forget, no one, no matter how "perfect" they try to be, no one knows exactly what "healthy" really means. Medical science is in its infancy. We don't do testing on the chemicals we spew out into the environment or on the cosmetics we smear on our bodies. We do very little research on vitamins we're taking and do even less regulation on vitamins sold to consumers.
Absolutely push healthier lifestyles. But also recognize that healthcare is a need that should be treated as a RIGHT, not "insurance" (pardon the pun) for an unhealthy lifestyle.
You see this idea all over readers comments posted on articles in the run-up to the passage of ACA. If people would just "live more healthy" they wouldn't need health insurance. And that's baloney.
Almost everyone, except those killed by suicide, accident, or violence will need a doctor at some point in their life. No matter how healthy you live, you are going to get a disease at some point and die from it.
And let's not forget, no one, no matter how "perfect" they try to be, no one knows exactly what "healthy" really means. Medical science is in its infancy. We don't do testing on the chemicals we spew out into the environment or on the cosmetics we smear on our bodies. We do very little research on vitamins we're taking and do even less regulation on vitamins sold to consumers.
Absolutely push healthier lifestyles. But also recognize that healthcare is a need that should be treated as a RIGHT, not "insurance" (pardon the pun) for an unhealthy lifestyle.
12
"Two, the assumption that costs will inevitably rise as people age is not necessarily true."
Yes it is. The majority of an individual's health care costs are incurred in their later years. While you are right in saying that there are incentives for keeping the elderly healthier, it does not controvert the obvious fact that the elderly need more care than when they were younger.
Yes it is. The majority of an individual's health care costs are incurred in their later years. While you are right in saying that there are incentives for keeping the elderly healthier, it does not controvert the obvious fact that the elderly need more care than when they were younger.
4
Absolutely on point, E. Nowak!
3
I believe there's flawed logic here.
The discussion on the cholesterol screening misses one key point -- that you don't know in advance -- that part is key -- which individual will benefit from that prevented heart attack.
It's exactly like buying insurance -- if I knew the future outcome, I would only purchase insurance if I knew I would be filing a claim, and that is not logical.
And, of course, the logic shown in this example also ignores the "cost" of that heart attack to the patient, in terms of lost income, quality of life, or even life itself.
If one totals up the total costs avoided, I believe the math might come out different, and that would be an Upshot I'd like to see.
The discussion on the cholesterol screening misses one key point -- that you don't know in advance -- that part is key -- which individual will benefit from that prevented heart attack.
It's exactly like buying insurance -- if I knew the future outcome, I would only purchase insurance if I knew I would be filing a claim, and that is not logical.
And, of course, the logic shown in this example also ignores the "cost" of that heart attack to the patient, in terms of lost income, quality of life, or even life itself.
If one totals up the total costs avoided, I believe the math might come out different, and that would be an Upshot I'd like to see.
20
Actually, this is an excellent point. Has anyone ever added up the cost of all the money spent on car insurance, home insurance, fire insurance, etc. - the types that are required to own a home/car/business? And then compared the total aggregate cost of what Americans spend on those (say, annually) with the total amount of money spent to cover the cost of claims on that type of insurance? Would we not find that we spend more money in toto on, say, home insurance as a society (paid by individual citizens) than the insurance companies pay out to cover claims? Because if that wasn't the outcome, those companies wouldn't exist/wouldn't insure people. (See, for reference, the home insurance crisis in Florida post-2005.) So the expectation that any kind of insurance will save money in the aggregate is flawed from the get-go. What it does save is individual people from having extremely negative outcomes, and the knock-on effects to society from a small but significant percentage of people having such outcomes, the cost of which is difficult to completely quantify but which surely exists. Thus the only way to reduce costs is not to insure more people, but in fact is to reduce costs - the actual costs of the service provided. Like the rest of the world does through careful regulation of their health care systems.
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Dr Reba
Of course insurers need to make profits
Through actuarial pooling we are able to differentiate those who have high infrequent claims from those who have low frequent claims
The power of the community for individuals is maximized by each participant having a segregated account
And we provide coverage in the most frequent cost corridor
55 percent of claims for individuals in a year are less than $25,000
Through pooling efficiently a person can accumulate a $10,000 paid up benefit - guaranteed - by paying $100 a month for 36 months
To learn more go to Nationalprosperity.com
Don Levit
Of course insurers need to make profits
Through actuarial pooling we are able to differentiate those who have high infrequent claims from those who have low frequent claims
The power of the community for individuals is maximized by each participant having a segregated account
And we provide coverage in the most frequent cost corridor
55 percent of claims for individuals in a year are less than $25,000
Through pooling efficiently a person can accumulate a $10,000 paid up benefit - guaranteed - by paying $100 a month for 36 months
To learn more go to Nationalprosperity.com
Don Levit
There are many ways to measure cost. and it would seem to me (though I have no objective evidence) that many of the cost savings that come from insuring people now would not be recognized until many years down the road (ie providing more care to diabetics, should decrease the amount of diabetic complications over time, even as it increases costs by keeping people alive longer). Certainly in the short term giving insurance ti people used to getting treated in ERS will at first lead to more ER visits until the paradigm for care in that person's life becomes to treat in advance of illness or before its complications are so great. But in the end, as long as giving insurance doesn't end up costing significantly more over time, you are saving money by hopefully increasing productivity of lives who were previously unable to get care.
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You are quite right, but the was Obamacare is set up the incentives don't work properly. If you are a patient of the UK NHS any money they spend now that will save money later can be looked at as an investment and properly evaluated. If you are, say, United Healthcare, the money you spend now may save Blue Cross money later, as the patient may change insurance. You are less inclined to spend the money now/authorise the care. Your incentives actually encourage you to withhold preventive care: a dissatisfied patient will change insurance, taking his costly problems with him, and probably will stay away from United.
The only clause in the ACA to deal with this is that companies must take you regardless of pre-existing conditions. They can still adjust premiums though.
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The only clause in the ACA to deal with this is that companies must take you regardless of pre-existing conditions. They can still adjust premiums though.
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Richard, what you say certainly used to be true. and I had my Medigap policy individually adjusted, but I thought that that was the only loophole, that the ACA required companies to change the cost to everyone in a plan. Thus if a company raised it premiums, it would be at a competitive disadvantage.