Health Care Transparency and CSPAN

[dcmdale]

That's interesting, thanks. It certainly isn't in the thumbnail description of Calvinism (eg: pre-destination to saved or preterite). This would be a good opportunity for a thread-drift. On that note: I visited the churches in Zurich. Rather austere in the decoration department!

Yes. The early reformation, particularly in the Reformed movement, was characterized by rather anti-popish architecture.

It is true. The 30+ significant volumes of Calvin are almost always condensed to TULIP, which only speaks to his soteriology (and which I don't agree with). And if they talk about anything else, it will be about his governmental style in Geneva (which as I mentioned before, is built off of the Roman legal doctrine of jus divinum which leads to belief in a state church, which I also disagree with). These tend to stand out, I think, precisely because they are the most controversial aspects of his doctrine. And both are the result of him not being able to get past some of the Greco-Roman baggage that became part of the church during the Middle Ages.

Once you get beyond these lightening rod issues, you find a brilliant thinker who is completely occupied with applying scripture to real world issues. Geneva was a major center of trade with a history of almost militant free market thinking. Calvin had to address this.

I don't think we're disagreeing as much as describing two different things.

if, from Day One, Obama had hammered on the theme that this would improve efficiency and save money (and made it stick) and addressed the fear you allude to it might have been more politically effective. I don't disagree with you on that at all. The problem is that rational political thought went right out the window with the crazy talk and fear mongering about death panels bumping off Grandma.

However, given where we are today, I think starting over would be tantamount to "nothing happening" because the Congress wouldn't have the stomach for it. Again, that agrees with the sentiment you expressed previously about the Congress' ability to solve problems.

I agree that the Democrats won't get another shot for a long time and the GOP is not interested in putting forth any real plan of their own. If you don't get this passed, it will be a long time before it is addressed by Congress again.

[Inquartata]

OK...where was I?

UHC, CIGNA, Aetna compete across state boundaries.

So a consumer in, say, Arizona can go to a physician in California and that provider will be 'in network' on his plan? Assuming that he is with a company that is in both states?

For that matter, can a consumer in Kansas City, Kansas go to a physician in Kansas City, Missouri---conceivably less than a mile across the state line---and have that provider be 'in network' on his plan?

I would prefer that all carriers compete in all markets. That would require removing industry exemption from anti-trust laws, so we're removing regulations on the one hand while adding regulations with the other.

Why would it require that, exactly?

I ask purely as an exercise, since in this case I think we would be exchanging bad regulation for ( relatively speaking ) less bad regulation if that were to happen.

However, this has nothing to do with the papers downunder linked. Why are we more expensive in administrative costs than countries that offer no competition at all?

I have already given my answer: Because of the demands of regulatory agencies.

Why would a state-run, controlled or directed system feel the need to impose regulations upon itself?

That's exactly what I want. A universal health care system detached from the employer. That's not what you are recommending, but you see we get that from my preferred solution just as with yours.

Unfortunately, that's not what we are going to get, either. None of the current bills seem to be interested in going in that direction.

And it's true, you are going quite a bit further than I. Personally I do not see why it should be thought so imperative to flunge straight to a government-directed system when a series of small advances might well get us to a better place without all the extra energy expenditure. Maybe this is the bias of an old fencer, though.

I am pro-competition, under a regulatory framework that protects consumers.

Great. So why not start there?

I oppose permitting unlimited competition if customers in State A are governed by rules in State B that lowers consumer protection to the least protective rules.

So...you oppose states rights, then?

Big Rule in debate and cross examination: never ask a question if you do not know the answer.

Well, but we are not in a formal debate setting, as I kept having to remind Fatfencer way back when.

One might hope occasionally to learn something one did not know, rather than only aiming to convince...

Hell no. Costs without benefits are a stacked deck, and one is worthless without the other.

You know, one day you are going to want to discuss some aspect of another question. Whereupon I am going to quote this passage back to you, and refuse to cooperate. Be warned.

Costs alone are useless. Stop me if I use too-advanced concepts

Sorry, but this is precisely the sort of thing microeconomics does: Consider narrow issues such as cost containment.

But I forgot: Economics is not a legitimate science...

I'm not letting you set the terms of discussion to let you stack the deck.

But that you should be able to do so, with your "hell, no" unbreakable linkage between cost and benefit, is OK? Tsk...

Also our system has costs that you would ignore if you only count regulatory costs.

Who advocated that?

Much of our costs are due to HMOs requiring providers and clients to preauthorize, reauthorize, and re-submit bills before they'll deign to pay.

Possibly. But how much? And how much of those result from the way regulations are written?

I take it that you do not reject the idea that laws and regulations can shape business practices?

To which of us are you referring?

Heh. "Big Rule in debate and cross examination: never ask a question if you do not know the answer". ( smily )

I'm doing nothing of the sort.

No? So you're answering all questions?

Hmm, I could have sworn that I was encountering...resistance. ( smily )

I'm asking you to justify your claim that health care administrative costs are higher in the US because of government regulations compared to countries with government programs!

Meh, which part of "take the difference between Medicare's admin costs and those in the private system and subtract profit" didn't you understand?

If our costs are big enough to be seen with the naked eye, you should be able to point to them.

I should?

You're saying that any layman should be able to rattle off a list without having any experience either of the insurance industry or of regulatory agencies?

Should I also know what brand of pencils Cigna uses in its corporate offices?

Come now!

If not, either they don't exist or they're too small to be significant.

Rather like atoms, I guess. ( smily! )

I know that there are regulatory costs. I don't think they are the main contributors to our higher costs (or "socialist programs" would cost yet more).

Why on earth would a socialized system bother regulating a government-owned or -run industry? It just decrees outcomes. There's none of that unrestrained profit motive to worry about, after all. After all, absent discretion by wicked private actors like ( brrr! ) CEOs, what's to worry about?

If it's regulatory cost then how do you explain that we cost more than countries with more regulation?

Maybe this is a semantic divide. In what way do you consider a government agency making a decision to be "regulation" of itself?

Where is your evidence that those overheads are due to regulatory requirements?

Do you have an alternate explanation of the difference? Moral turpitude, perhaps? What?

This is circular reasoning: "there are regulatory costs is because of higher administrative costs, and there are higher administrative costs because of regulatory burdens"

Nope. Just a simple "administrative costs result at least partly from regulatory burdens".

We can discuss what I believe are the reasons regulatory burdens get imposed if you like, but it's not because of high administrative costs...

I have studied economics and get it Just Fine. It's more heterogeneous in thought than you like to portray it. To disagree with you is not the same as being unschooled in economic principles.

Forgive me, but if you think for example that health care qualifies as a public good, what am I to conclude?

You completely mis-characterize what he said and what I said. Further, he's not just some guy, he's a Nobel Laureate, and he's not alone in rejecting free-market dogma.

Hey, if you get to pooh-pooh Friedman despite having the same impressive credential, then welcome to the other foot, shoe! ( smily )

I'm not saying a damned thing that Krugman hasn't said, and said better.

Change the name to "Friedman" and I could say the same. In fact I have given you direct quotes by him, and you have flatly rejected them. Why should I do otherwise? Goose, gander... ( smily )

He's pro-universal health care, pro-increased regulation on insurers to prevent them abusing consumers. He wanted a much bigger stimulus package than we got, and criticized Obama for being too timid there and wrt health care. He's pro-regulations to prevent future Enrons. He attacked Bush and the Republicans for trying to bankrupt Social Security, and for increasing economic inequality by cutting taxes on the rich. That's a hell of a lot more than "niggling little details".

Eh...not in the grand scheme of economics, it's not.

If Economist A believes there should be universal health care, people arguing about it should stop making the false statement that economists have a consensus against it.

Oh, aye? Now, to what other sciences shall we apply this rule? Climatology, perhaps? The rule seems awfully conveniently...situational to me.

You challenge using GDP as a metric, even though economists do, as do observers on both left on the right.

Nope. I just do not accept it as THE metric, perfect and unquestionable. It's measured by people, after all. Do you really trust implicitly that North Korea's GDP figures are absolutely accurate and comparable to those of, say, Great Britain? Or even those of South Korea? Really?

Oh, snap---no, what I really meant to say is that GDP is a production figure, and it just cannot be separated from costs. Stop me if the concept is too advanced for you! ( smily )

You challenged using metrics such as longevity and infant mortality, even though those are the fundamental metrics for health care quality.

I challenge that they are absolutely comparable from one nation to another, yes. And that conclusions can be drawn from them and extrapolated from one nation's situation to that of another...

[Philistine]

{snip}
For that matter, can a consumer in Kansas City, Kansas go to a physician in Kansas City, Missouri---conceivably less than a mile across the state line---and have that provider be 'in network' on his plan?{snip}

I think so.

I just looked online at my plan--which is Independence Blue Cross in Southeast Pa (I'm in Philadelphia). I plugged in "Cherry Hill, NJ" in looking for providers (Cherry Hill is just over the river and is actually closer to me than most places in Southeast Pennsylvania) and several hundred popped up. Unless I'm reading it wrong, I believe they're considered "in-network."

--Philistine

[jeff]

part 1

OK...where was I?

Well, we're not addressing posts 141, 143, 150, 151, and it looks like you're replying to a post (or at least paragraphs) you already replied to previously! Understandable with the passage of time...

So a consumer in, say, Arizona can go to a physician in California? (snip)

Yes, I can attest to this.

Why would it require that, exactly?

I ask purely as an exercise, since in this case I think we would be exchanging bad regulation for ( relatively speaking ) less bad regulation if that were to happen.

On the one hand we would remove anti-trust exemption hence permit more competition (yay) while on the other hand add regulations that (for example) require them to not exclude for "pre-existing conditions" und so weiter.

I have already given my answer: Because of the demands of regulatory agencies.

Why would a state-run, controlled or directed system feel the need to impose regulations upon itself?

The "because" does not follow. The countries to which we are comparing have "demands of regulatory agencies" that often exceed ours, yet cost far less.

The "Why?" should be obvious - to dictate policies and procedures. They are often imposed by one part of the "system" on another, such as Congress imposing rules on government agencies. It is a simple fact that governmental programs are subject to governmental regulation.

One thing that seems to be lost is the observation (already made in other threads) that not all the benchmark programs are UK-style National Health Systems. Look at successful health care systems and you'll also see single-payer with private providers and highly-regulated private insurers and private providers. So it's false to say that the alternative to our status quo is A Government Program.

Unfortunately, that's not what we are going to get, either. None of the current bills seem to be interested in going in that direction.

Agreed. I was stating what I prefer, not what I'm going to get.

And it's true, you are going quite a bit further than I. Personally I do not see why it should be thought so imperative to flunge straight to a government-directed system when a series of small advances might well get us to a better place without all the extra energy expenditure. Maybe this is the bias of an old fencer, though.

From my perspective of wanting a single-payer option that we're not going to get, what is on the table is a set of incremental changes that are more timid than I would prefer. Hey - I'm an older fencer than you are!

Great. So why not start there?

Because I think that after we "start" we'll be so exhausted that we won't continue, and that the most effective way to drive behavior is to have the single payer option to keep insurers honest... Also, let's keep in mind that a big part of the picture is to cover millions of individuals who are not currently covered by insurance, so regulatory protection for people-who-are-covered is but one part of the situation.

So...you oppose states rights, then?

Well, that's an open-ended question that we can take anywhere, can't we?

The risk is that State "A" could have rules that are attractive to insurers and damaging to consumers, and consumers in State "B" would be forced to abide by them. That's not about being against states rights, but states rights in opposition to one another. All an insurer would have to do is buy legislative relief in one state and they have an escape hatch for all 50...

Well, but we are not in a formal debate setting, as I kept having to remind Fatfencer way back when.

One might hope occasionally to learn something one did not know, rather than only aiming to convince...

I am fine with that.

You know, one day you are going to want to discuss some aspect of another question. Whereupon I am going to quote this passage back to you, and refuse to cooperate. Be warned.

If ever there is a topic where I favor or oppose something, and accordingly want to include only the benefits or costs in support of my preference and not the full ledger sheet, I want you to do exactly that. Seriously. I am in error (or at least incomplete) if I don't look at both sides of the ledger.

Sorry, but this is precisely the sort of thing microeconomics does: Consider narrow issues such as cost containment.

But I forgot: Economics is not a legitimate science...

Micro-economics states that we should only consider costs in the decision process, and not benefits? If so, then it's of limited value for decision making. Even so - this is not an insurmountable problem. As I stated in the thread with Bismarck, let the economists state how much something would cost, and that becomes a factor (but only a factor) in setting policy.

But that you should be able to do so, with your "hell, no" unbreakable linkage between cost and benefit, is OK? Tsk...

Why should it be illegitimate to say that any policy decision should never be evaluated without including both costs and benefits?

If only costs count, then the answer for any policy that costs anything is always "no" regardless of benefit. If only benefits count, then the answer for any policy that provides a benefit is always "yes" regardless of cost. Neither alternative is sensible.

Who advocated that?

I'm saying that a fair accounting must include costs we incur that are specific to our system. So far, I've seen nil on the pro-status quo argument side that addresses high costs that are unique to us and are NOT driven by government intervention.

Possibly. But how much? And how much of those result from the way regulations are written?

I take it that you do not reject the idea that laws and regulations can shape business practices?

Lots of those costs are HMO business-practice driven. The documents we previously talked about (downunder's cite) actually has a breakdown. Billing was a big component, and that's not government mandated at all.

To your second part: of course laws and regs can shape business practice. If not, there wouldn't be a billion dollar lobbyist business to shape them!

Heh. "Big Rule in debate and cross examination: never ask a question if you do not know the answer". ( smily

No? So you're answering all questions?

Hmm, I could have sworn that I was encountering...resistance. ( smily ) )

Nah - I was just resisting until we counted both sides of the ledger.

Meh, which part of "take the difference between Medicare's admin costs and those in the private system and subtract profit" didn't you understand?

That's simply not the case. See above for costs that are due to non-government-driven business practices. I have enumerated them at length before downunder's cite, too.

I should?

You're saying that any layman should be able to rattle off a list without having any experience either of the insurance industry or of regulatory agencies?

Should I also know what brand of pencils Cigna uses in its corporate offices?

Come now!

Tsk. You hypothesize at length of pernicious and substantial costs that are the reason for dramatically higher costs, but can't point to any of them. Perhaps they don't actually exist.

Rather like atoms, I guess. ( smily! )

Even before you could see individual atoms (you can now), you could measure the effect of forces on them and effects caused by them. If you hypothesize all sorts of costs but can't point to any of them....

I'll restate: I'm asking you to justify your claim that health care administrative costs are higher in the US because of government regulations compared to countries with government programs!. If our costs are big enough to be seen with the naked eye, you should be able to point to them. If not, either they don't exist or they're too small to be significant.

That's a completely fair request, and central to the argument.

Why on earth would a socialized system bother regulating a government-owned or -run industry? It just decrees outcomes. There's none of that unrestrained profit motive to worry about, after all. After all, absent discretion by wicked private actors like ( brrr! ) CEOs, what's to worry about?

Already answered.

Maybe this is a semantic divide. In what way do you consider a government agency making a decision to be "regulation" of itself?

Perhaps so.

First - many regulations are imposed by external organizations, such as may be imposed by legislative or court result. Look at Medicare rates being adjusted by Congress for example.

Secondly, a "regulation" that is self-imposed is nonetheless a regulation that employees and officials of an institution are obliged to follow. Every company I've ever worked for (all private sector) has had self-imposed "regulations" along with externally imposed ones. I don't see this as a meaningful distinction.

Third, we cost more than countries with single-payer with private providers and with highly-regulated private insurers and private providers.

Your claim is that we cost more because of government regulation, but countries with even more highly regulated private insurers and providers cost less than us while providing better care. That's why your claim doesn't stand up.

[jeff]

part 2. what a PITA

Do you have an alternate explanation of the difference? Moral turpitude, perhaps? What?

We've gone over this many times in the past 6 years, and downunder's cites include a refresh of the very same content. Plus, I've stated reasons in this very recent thread: billing, preauthorization, and appeal process is uniquely high in our private systems and adds great cost to both provider and insurer.

Nope. Just a simple "administrative costs result at least partly from regulatory burdens".

We can discuss what I believe are the reasons regulatory burdens get imposed if you like, but it's not because of high administrative costs...

Sure, HIPAA adds costs for filing disclosure statements, and regs that make insurers actually pay claims contribute to cost, but the former is small and the latter is a Good Thing. So?

Forgive me, but if you think for example that health care qualifies as a public good, what am I to conclude?

You can conclude that I consider the technical distinction irrelevant for policy decisions. Recall also the examples I gave you of rivalrous "public goods" that are accepted.

Hey, if you get to pooh-pooh Friedman despite having the same impressive credential, then welcome to the other foot, shoe! ( smily )

Change the name to "Friedman" and I could say the same. In fact I have given you direct quotes by him, and you have flatly rejected them. Why should I do otherwise? Goose, gander... ( smily )

Cool. As I've said previously in a post you lost in a different thread, I specifically invoke Dr. K in response to "Miltie said it and therefore it's irrefutably true". Now, neither of us can invoke our favorite guy as a way to squelch discussion.

Eh...not in the grand scheme of economics, it's not.

We must disagree here.

Oh, aye? Now, to what other sciences shall we apply this rule? Climatology, perhaps? The rule seems awfully conveniently...situational to me.

You've used that argument in the GW threads. Pick either one: either consensus rules (in which case GW is real) or not. In any case, you haven't established "free-market is consensus" in economics.

Nope. I just do not accept it as THE metric, perfect and unquestionable. It's measured by people, after all. Do you really trust implicitly that North Korea's GDP figures are absolutely accurate and comparable to those of, say, Great Britain? Or even those of South Korea? Really?

Oh, snap---no, what I really meant to say is that GDP is a production figure, and it just cannot be separated from costs. Stop me if the concept is too advanced for you! ( smily )

Nobody says GDP has to be "perfect". I've said that many times, and that you can attach error bounds to it if you like. Since we're 2x more expensive by GDP terms than comparable countries an error of 20 or 30% makes no difference to the fact we cost more. I also quoted you per-capita costs, which provide independent substantiation.

I'm not comparing health care costs to N. Korea. I don't care about inaccurate figures I'm not using.

I challenge that they are absolutely comparable from one nation to another, yes. And that conclusions can be drawn from them and extrapolated from one nation's situation to that of another...

Then I'm afraid you must stand alone, because that's what the professional economists working in the area do. "Absolutely" is a red herring.

It's not clear to me why you are spending so much energy on this sidebar. You seem to have agreed that our health care costs are higher than other first world nations even to the extent where you suggest reasons for it. Since that's the conclusion for which %GDP is cited (along with per capita costs ) so why struggle over the metric if we agree to the conclusion?

Are you saying that you don't think we have higher health care costs? If so, do you have any evidence to support that?

[MyrddinsPrecint]

So a consumer in, say, Arizona can go to a physician in California and that provider will be 'in network' on his plan? Assuming that he is with a company that is in both states?

For that matter, can a consumer in Kansas City, Kansas go to a physician in Kansas City, Missouri---conceivably less than a mile across the state line---and have that provider be 'in network' on his plan?

Under most commercial plans, yes. SOME budget plans do not include this feature. Full time college students in MA are required to have a minimum level of health coverage since before everyone else was required. Yours had to cover you *in MA where you'd be going to school* to count-- if it didn't, you had to buy into the (affordable) school supplemental or the (affordable) full plan, depending on what yours did cover.

Under most state Medicare/Medicaide plans, no, unless under dire circumstances and approved first.

[jeff]

Since this is the most recent health-care thread, I'll point to today's Krugman Op Ed here: http://www.nytimes.com/2010/03/19/op...19krugman.html

Inq may disregard the argument and facts in it because it's from the Nobelist he chooses to discount, but it's a good summary of why health care reform is needed, why the status quo is so bad, and why reform as currently proposed would be a big improvement. Inq - you're AWOL from this thread anyway, so maybe this will goad you into returning.

Highlighted story in Krugman's Op-Ed, how Fortis, a subsidiary of Assurant, illegally denied coverage to subscribers through a number of ploys; see the Reuters article at http://www.reuters.com/article/idUSTRE62G2DO20100317 The case is an instance of systematic exclusion from coverage by consumers who have purchased coverage. The insurer revoked coverage after a teenager was diagnosed with HIV, ignored him and his attorney, and off to court they went, with a $15M judgement against the defendant. In discovery they found that Fortis had programs to systematically cancel policies that were going to result in claims. The article also points out that Well Point's Anthem Blue Cross does the same thing and that a House committee "estimated that Assurant alone profited by more than $150 million between 2003 and 2007 from rescission." In other words, they made a lot more money by canceling coverage than they got fined in this instance - Cheating the public is extremely profitable, and the occasional fine merely a cost of doing business.

Krugman points out why "a tripartite policy: elimination of medical discrimination, mandated coverage, and premium subsidies", which would result in a plan "something like the health care plan Mitt Romney introduced in Massachusetts in 2006," and that "The United States is the only advanced nation without universal health care, and it also has by far the world’s highest health care costs."

[Inquartata]

I have a few spare minutes again.

Yes, I can attest to this.

And that will be treated as in-network? ( An insured from Arizona seeing a doc in California, that is. )

On the one hand we would remove anti-trust exemption hence permit more competition (yay) while on the other hand add regulations that (for example) require them to not exclude for "pre-existing conditions" und so weiter.

Why not just start with removing the former and see where it goes?

The "because" does not follow. The countries to which we are comparing have "demands of regulatory agencies" that often exceed ours, yet cost far less.

I think that we may still be having a semantic misunderstanding.

If a government runs, say, its national health care system, that is admistration, AFAICT, not regulation. I cannot see why on earth Britain's NHS, for example, would "regulate" itself. Does it write regulations which it then imposes upon itself? Or are you saying that there are other British government agencies which involve themselves with writing and enforcing regulations on the NHS?

Look at successful health care systems and you'll also see single-payer with private providers and highly-regulated private insurers and private providers. So it's false to say that the alternative to our status quo is A Government Program.

I don't think it is. There is a tipping point somewhere, at which a system becomes just a government-run operation---even if in some senses it still thinks of it as "private"...

Sort of the way North Korea calls itself the Democratic People's Republic of Korea but actually is neither democratic nor a republic.

From my perspective of wanting a single-payer option that we're not going to get, what is on the table is a set of incremental changes that are more timid than I would prefer. Hey - I'm an older fencer than you are!

Touche...

But you cannot possibly be a grumpier or more cynical one!

I think that after we "start" we'll be so exhausted that we won't continue,

I hope that that is true now...but I very much suspect that it isn't. I am afraid that the current law is going to "require" an awful lot of changes. That seems to be the way Congress thinks: Every policy either begins life as the thin end of a wedge, or gets turned into one when its sponsors find that it accomplished something they wanted but not quite all. Or else "needs an overhaul" when the law of unintended consequences bites too deeply.

and that the most effective way to drive behavior is to have the single payer option to keep insurers honest

Why is the insurance industry the only one where this applies?

And if it isn't---if this is in your view some sort of behavior inevitable from the nature of corporate private enterprise---then why restrict the "solution" to insurance? Why not take over all industries?

Also, let's keep in mind that a big part of the picture is to cover millions of individuals who are not currently covered by insurance, so regulatory protection for people-who-are-covered is but one part of the situation.

It's a big part of the picture as you see it. I still do not agree that this is a proper use of the power of government, or its natural province of control. Government should not short-circuit the workings of the market where it is not absolutely necessary, IMO.

Well, that's an open-ended question that we can take anywhere, can't we?

Probably.

The risk is that State "A" could have rules that are attractive to insurers and damaging to consumers, and consumers in State "B" would be forced to abide by them. That's not about being against states rights, but states rights in opposition to one another. All an insurer would have to do is buy legislative relief in one state and they have an escape hatch for all 50.

Again, though---where do you draw the line? At which point do we decree that the existence of state standards for anything are harmful to those living under the least restrictions, and therefore that we must substitute a national standard at least as stringent as the toughest state one? ( And still make the states pay for a large part of the costs of implementation, of course. )

Micro-economics states that we should only consider costs in the decision process, and not benefits?

No. But it does not demand that we cannot study one without simultaneously studying the other. It is possible and often desirable to compartmentalize them. That is, to examine costs and revenues separately.

Why should it be illegitimate to say that any policy decision should never be evaluated without including both costs and benefits?

That's not what I'm advocating. This was only about me asking you about costs, and you declining to answer unless I added something about benefits. In the context of an argument, not a study.

I mean, if person A is thinking of going to an NAC, I see no problem with him asking person B about the costs of travel and lodgings without also demanding to know about the relative "benefits" of each...

If only costs count, then the answer for any policy that costs anything is always "no" regardless of benefit. If only benefits count, then the answer for any policy that provides a benefit is always "yes" regardless of cost. Neither alternative is sensible.

It's not that only one or the other matters. It's that one can look at each separately...

I'm saying that a fair accounting must include costs we incur that are specific to our system. So far, I've seen nil on the pro-status quo argument side that addresses high costs that are unique to us and are NOT driven by government intervention.

I just caught a '60 Minutes' segment last weekend which perhaps provides some insight into one reason why our costs are so much higher.

Apparently, we permit the patenting of human genes. This in effect confers monopoly power over certain medical tests and treatments. The example the story used was the ownership of certain genes central to testing for predisposition to breast cancer by a biotech company, Myriad. The holding of this patent not only permits the company to charge a monopoly price for the test, it prevents anyone from developing a competing, or better, test. One expert interviewed estimated that the test, which runs about $3,200, could practically be done for under $300.

Now, I am all for letting a company which develops a test make a monopoly profit on it. That's what patent law is all about, after all. But in this case it's not the test which is patented, but genes. The company did not develop genes.

As if this were not bad enough, the company prohibits the use of those genes in other research, including medical research in academia.

I know that you have inveighed against the high prices of certain medical devices and procedures, but this is a case where the costs are inflated simply as the result of a bad legal policy which extends patent protection to pieces of the human being.

This IMO is an area which would be profitable to reform...not that anyone in power seems to be interested in reforming details which don't offer large PR payoffs for them personally or their Party collectively.

Lots of those costs are HMO business-practice driven.

I am sure.

But whence have come those business practices? I still argue that the answer is: From the industry environment, which is a direct function of historical federal policy and law, and of regulatory practices...

Billing was a big component, and that's not government mandated at all.

Government mandates restrictions on interstate trade which resemble those in no other industry I know. You cannot imagine that this could have any effect on routine business practices?

Just as one hypothetical, might there be economies of scale which would reduce billing costs if the sundry restrictions on competition were absent from the market?

See above for costs that are due to non-government-driven business practices.

I just do not find it as easy to sever them from government regulation. Most IMO can be traced back to roots therein, at least in part. Others are almost entirely traceable to government policies, as with allowing the patenting of genes.

Tsk. You hypothesize at length of pernicious and substantial costs that are the reason for dramatically higher costs, but can't point to any of them. Perhaps they don't actually exist.

It's possible. It's also unlikely, IMO.

I am simply not an expert in the trivia of federal regulation. I accept however that regulation can shape business practices, and that placing a requirement on a business to do something is not and cannot be costless...

I'll restate: [I]I'm asking you to justify your claim that health care administrative costs are higher in the US because of government regulations compared to countries with government programs!

Take the difference between...

Oh, never mind.

If our costs are big enough to be seen with the naked eye, you should be able to point to them. If not, either they don't exist or they're too small to be significant.

I reject the standard as too stringent. What you are saying is that if a non-expert cannot explain something in any given field, then that something cannot exist or be "significant".

That's a completely fair request

According to whom?

Look at Medicare rates being adjusted by Congress for example.

But this is not regulation. And Congress is not a regulatory agency. Neither are the courts, by the way.

[Inquartata]

part 2. what a PITA

Indeed.

billing, preauthorization, and appeal process is uniquely high in our private systems and adds great cost to both provider and insurer.

Aha!

And is it your contention that profit-maximizing businesses deliberately choose to use procedures which are more costly than alternatives they might use?

Why would they do that, if the option was wholly theirs? Why would ANY business do that?

Or is it perhaps only that these are the least costly procedures consonant with the structure of their industry and the constraints placed upon firms by regulatory requirements? Is that possible?

Sure, HIPAA adds costs for filing disclosure statements, and regs that make insurers actually pay claims contribute to cost, but the former is small and the latter is a Good Thing.

How do you know that "the former is small"? And I suspect that that is not the only law which imposes reporting requirements, either...

You can conclude that I consider the technical distinction irrelevant for policy decisions.

That's not really reassuring...

Pick either one: either consensus rules (in which case GW is real) or not.

Well, but in this case the question is which YOU pick, is it not?

In any case, you haven't established "free-market is consensus" in economics.

You really don't see why statements like that prompt me to dubiety?

Nobody says GDP has to be "perfect". I've said that many times, and that you can attach error bounds to it if you like.

That's problematic in itself, though: WHAT bounds? Even margins of error will vary depending on the comparisons. At the margins, Australia vs New Zealand will likely be more closely comparable than Cuba and the US, for example---or China vs. Ireland---or Britain vs. Haiti. Etc. This is all I am saying: That to say a simple GDP comparison proves something about whether a policy in A would be good or bad for B is overly simplistic. ( The same goes, BTW, for other measures like average longevity or infant mortality rate. )

Yardsticks are one thing, a Procrustean application of them another...

Then I'm afraid you must stand alone, because that's what the professional economists working in the area do.

They use them because they have nothing better, not because they believe them to be completely accurate or comparable.

It's not clear to me why you are spending so much energy on this sidebar.

"For want of a nail..."

[Inquartata]

Under most commercial plans, yes. SOME budget plans do not include this feature.

I'm not asking whether a plan will cover a medical expense incurred in another state ( or even abroad ). I'm asking if it will do so, CAN do so, "in network", that is, at the same rates as if the expense were incurred with a "participating provider" on your plan.

In my plan, for instance, services obtained from any out-of-network provider are both more restricted and much more costly than those obtained by an in-network provider---and ALL in-network providers are AFAIK in the state.

In fact, they may all be in my county of the state...

[Philistine]

{snip}
I just caught a '60 Minutes' segment last weekend which perhaps provides some insight into one reason why our costs are so much higher.

Apparently, we permit the patenting of human genes. This in effect confers monopoly power over certain medical tests and treatments. The example the story used was the ownership of certain genes central to testing for predisposition to breast cancer by a biotech company, Myriad. {snip}
This IMO is an area which would be profitable to reform...not that anyone in power seems to be interested in reforming details which don't offer large PR payoffs for them personally or their Party collectively.
{snip}

Not sure if the 60 Minutes segment was before or after, but last week, a court held Myriad's gene patents invalid.

Of course this will be appealed--but it was a thoughtful opinion which sets up a potential sea-change in gene patents (which are, IMHO, nuts).

I'm not asking whether a plan will cover a medical expense incurred in another state ( or even abroad ). I'm asking if it will do so, CAN do so, "in network", that is, at the same rates as if the expense were incurred with a "participating provider" on your plan.

In my plan, for instance, services obtained from any out-of-network provider are both more restricted and much more costly than those obtained by an in-network provider---and ALL in-network providers are AFAIK in the state.

In fact, they may all be in my county of the state...

Presumably, the closer you are to a state border, the more likely you are to be in-network across state lines. It's generally a distance thing, rather than a state thing (at least for geographically smallish states).

For instance, I have a ton of in-network providers in southern New Jersey and Northern Delaware, even though I live and work in Philadelphia. But none in Pittsburgh.

--Philistine

[MyrddinsPrecint]

Interestingly enough, the now overturned BRCA1 patent seems to have quite a bit more patented-- interesting article here.

I'm not asking whether a plan will cover a medical expense incurred in another state ( or even abroad ). I'm asking if it will do so, CAN do so, "in network", that is, at the same rates as if the expense were incurred with a "participating provider" on your plan.

In my plan, for instance, services obtained from any out-of-network provider are both more restricted and much more costly than those obtained by an in-network provider---and ALL in-network providers are AFAIK in the state.

In fact, they may all be in my county of the state...

It depends on the health plan. Very high quality health plans will have "in network" providers across the country. My father is a state employee, his health care plan doesn't just cover him in network in the state he works in, but every other state he's ever visited. This does, however, have something to do with the fact that the State bought into a very large national plan, and they pay quite a bit of money for it. But they live in a small state, and my family regularly receives care across state lines, in network.

Smaller plans, cheaper plans, may or may not cover across state lines. If a plan is set up for a geographic area, it's unlikely that that plan will have "in network" care across the country. State Medicare/Medicaid plans are the only ones I know of off the top of my head that definitionaly only cover medical emergencies that happen out of state lines (and even then, you're taking a big risk whether it will actually be approved). This isn't a big concern for someone who lives in the middle of a big state. It's a bigger concern for someone who lives near a state line.

[Inquartata]

This isn't a big concern for someone who lives in the middle of a big state. It's a bigger concern for someone who lives near a state line.

Define "big state".

Arizona is fairly large as states go, but I believe that my policy restricts my 'in-network' choices geographically even within it. I do know that premiums and co-pays are much higher for those who live outside of the Phoenix and Tucson metro areas.

This may not be the case in more densely populated states...

[MyrddinsPrecint]

Define "big state".

Arizona is fairly large as states go, but I believe that my policy restricts my 'in-network' choices geographically even within it. I do know that premiums and co-pays are much higher for those who live outside of the Phoenix and Tucson metro areas.

This may not be the case in more densely populated states...

I was talking very specifically about Medicaid/Medicare in the bit you quoted, which frequently covers not-one-single-cent of coverage outside of the state you live. With most health plans, even out of network coverage is covered to some degree, so while you may end up having to pay quite a bit more if you break your leg and the only nearby hospitals are out of network, you're not on the hook for all of it.

Being on Medicaid when you live on a state line can be terrifying-- If you're picking up a loaf of bread 10 minutes away from your house and break your leg, you might go from 'just making it' to 'bankrupt', even though you had health insurance, just because you were on the wrong side of the line.

Remember, I grew up in Rhode Island, went to college in Massachusetts, And I'm currently living in the area commonly referred to as the DMV Zone (DC, Maryland, Virginia). Crossing state lines is what you do if you want to buy fireworks, cheaper booze, or whatever else is easier over a state line. But for some, it means making sure they have enough medication before a vacation, because otherwise they're going to have to pay full cost.

[Inquartata]

Well, unless the border in question is the Canadian one. I hear that our 51st state offers free health care to all.

Meanwhile, my condolences for the Massachusetts captivity.

[jeff]

With misgivings, as I've enjoyed not being on f.net political arguments. Reslicing again for annoying 10,000 limits.

And that will be treated as in-network? ( An insured from Arizona seeing a doc in California, that is. )

Yes. As you know, I moved over 2000 miles not long ago, and had in-network coverage from providers here with the same plan. If I went to Brooklyn tomorrow, I could get in-network coverage there as well (I checked). If your policy doesn't provide that (I read ahead), it's because of the nature of your policy and who the insurer contracted with, not because of the government.

Why not just start with removing the former and see where it goes?

Because it's useless. It does nothing for providing health care coverage for all Americans and doesn't help Americans who have pre-existing conditions get coverage, nor prevent them from being dumped if they get sick.

I think that we may still be having a semantic misunderstanding. (snip)

That's the best kind to have.

I'm going to rewind this to the beginning of this particular rathole. You claimed last month that we have higher administrative costs than other countries because of the "demands of regulatory agencies".

You have yet to provide any evidence to support this, and a rhetorical question "Why would a state-run, controlled or directed system feel the need to impose regulations upon itself?" (which I answered) is not a substitute for evidence or logic. It does not matter whether you understand why and how a governmental agency might indeed regulate itself or be subject to rules imposed by another branch of government - that's simply the case. Whether you care to call it regulation, administration, law, rule, or banana, does not matter.

Also I've mentioned before other countries have higher regulatory demands yet lower cost than us - such as those imposed on private insurers and providers in countries mandating universal health care but without a UK-style NHS. I'll repeat that: Lower administrative costs, with higher governmental regulatory demands. Therefore regulation is not why we cost more than other countries. I'm tired of repeating this obvious point.

I don't think it is. There is a tipping point somewhere, at which a system becomes just a government-run operation---even if in some senses it still thinks of it as "private"...

Oh, how sad, if we had to suffer through a universal health care system that cost less and provided better health care, but - gasp! - only appeared to be private when it actually was government-run. We should be so lucky.

In a previous thread we agreed to call things what they were, not what they weren't. Regulated industries with private institutions providing insurance and health services are not "government run." Many industries are highly regulated: eg, aviation and banking, yet are very far from being "government run". Let's not indulge in hyperbole.

I'll use your clever remark: Ladies and gentlemen, meet the slippery slope fallacy. Fallacy, meet the folks of f.net.

Sort of the way North Korea calls itself the Democratic People's Republic of Korea but actually is neither democratic nor a republic.

And we say our states are "united", park on driveways and drive on parkways...

Touche...

But you cannot possibly be a grumpier or more cynical one!

I'll happily concede that (which proves the point, I suppose).

My conservative side comes up in fencing, where IMO the Powers That Be have terribly damaged foil by weakening the requirement that an action is considered an attack only if it continuously projects the blade towards the opponent and thereby puts it at risk of being parried. By eliminating that they've eliminated a vital part of what relates fencing to its origins and spirit, and broken the balance of risk between offense and defense.

But I digress.

I hope that that is true now...but I very much suspect that it isn't. I am afraid that the current law is going to "require" an awful lot of changes. That seems to be the way Congress thinks: Every policy either begins life as the thin end of a wedge, or gets turned into one when its sponsors find that it accomplished something they wanted but not quite all. Or else "needs an overhaul" when the law of unintended consequences bites too deeply.

Well, that's exactly what I hope happens: the original bill sets the course and subsequent fixes address problems that are discovered.

Why is the insurance industry the only one where this applies?

And if it isn't---if this is in your view some sort of behavior inevitable from the nature of corporate private enterprise---then why restrict the "solution" to insurance? Why not take over all industries?

The problem is that there is a misalignment of interest between insurer and insured. It is in the interest of an insurer to dump a policy holder whose expenses are expected to be high, or to reject a claim. A fair amount has been written on this problem.

Why not take over all industries? Isn't that the fallacy of bifurcation? FWIW, we have public schools, military, police, fire departments, water, and garbage collection, and about 1/2 of the US health care system is already in government, so it's hard for me to get worked up about the other half.

It's a big part of the picture as you see it. I still do not agree that this is a proper use of the power of government, or its natural province of control. Government should not short-circuit the workings of the market where it is not absolutely necessary, IMO.

In your opinion, as you say. Your stance is hardly news and isn't binding on anyone else. Unsurprisingly, I disagree with your opinion.

As far as the "workings of the market" - the market never evolved a solution to provide "health care for everyone" before the government got involved in the 1960s, so it's wrong to say it's been "short circuited." It didn't provide an answer before then or in the decades since, and it's pointless to hope despite the fact that it never happened before that at some unspecified time in the future it would.

Again, though---where do you draw the line? At which point do we decree that the existence of state standards for anything are harmful to those living under the least restrictions, and therefore that we must substitute a national standard at least as stringent as the toughest state one? ( And still make the states pay for a large part of the costs of implementation, of course. )

You did not respond to the point I made, that this would put states rights in conflict with one another.

To your question: should argue and decide on a case by case basis, I would hope, on the merits of each topic. But that's not even the situation: what you proposed would force states to abide by "least restrictions" in other states.

No. But it does not demand that we cannot study one without simultaneously studying the other. It is possible and often desirable to compartmentalize them. That is, to examine costs and revenues separately.

If we were on a project to work out costs or taking it as an academic exercise, that would be fine. But we've been arguing at a length of several years about whether a particular course of action is good or bad. In that context it is completely meaningless to discuss only costs or only benefits.

That's not what I'm advocating. This was only about me asking you about costs, and you declining to answer unless I added something about benefits. In the context of an argument, not a study.

I mean, if person A is thinking of going to an NAC, I see no problem with him asking person B about the costs of travel and lodgings without also demanding to know about the relative "benefits" of each...

Fine - if we're academically totting up one side of the ledger. If we're determining whether or not to do something is a different story (did you state the last sentence in the first paragraph above backwards?)

If going to a NAC, we've already decided that going to a NAC is a Good Thing - at least some of the benefits are implicit.

It's not that only one or the other matters. It's that one can look at each separately...

One can indeed - but that's not the conversation I thought we were having. Sorry if I misunderstood that.

I just caught a '60 Minutes' segment last weekend which perhaps provides some insight into one reason why our costs are so much higher. Apparently, we permit the patenting of human genes. (snip)

I agree that the patenting of human genes is completely dumb, but don't want to spend a lot of time on this because (a) MP already answered (b) it's an extremely new issue that hasn't had much chance to affect costs, and (c) the reason for the bulk of costs is well known, and this isn't it.

The problem is that our current system is set up to consume, consume, consume: patients are conditioned to believe (is this the American way?) that "More Is Better?" when it often isn't. Providers are paid for work done rather than results. The consequence is wide spread use of expensive procedures that have not been scientifically proved to improve health and are sometimes dangerous: repeated use of CTs now kown to shorten lives because of radiation. Stents, angioplasties, spinal fusions often used when there is no medical indication (but it makes $$$). Drugs to lengthen eyelashes... "Gimme an antibiotic" when there's no need for it. Don't get me wrong: administrative costs and defensive medicine contribute, but this is the core of the problem.

[jeff]

Part 1B

I am sure.

But whence have come those business practices? I still argue that the answer is: From the industry environment, which is a direct function of historical federal policy and law, and of regulatory practices...

A generic opinion for which you haven't offered the least shred of evidence or even pointed to specific causes and effects. That just won't do. Occam's Razor shows much more likely reasons, many of which have been described many times on f.net.

Government mandates restrictions on interstate trade which resemble those in no other industry I know. You cannot imagine that this could have any effect on routine business practices?

Just as one hypothetical, might there be economies of scale which would reduce billing costs if the sundry restrictions on competition were absent from the market?

(tears remaining hair slightly) Please, some evidence of this? Which restrictions?

The big insurers certainly have the critical mass that permits them to enjoy economies of scale in nationwide billing and claims processing. Even medium-sized ones like per-state Blues have that.

If you believe that economy of scale don't level off, then what you are calling for is a governmental single payer system, which would have higher scale than any private system. Are you sure that's what you recommend?

I just do not find it as easy to sever them from government regulation. Most IMO can be traced back to roots therein, at least in part. Others are almost entirely traceable to government policies, as with allowing the patenting of genes.

Again: which regulations? You claim the patient is bleeding - where's the blood, let alone the knife? This is merely evidence-free speculation.

If they're traceable - then trace them. (and let's leave the genes out of it - that only flies at all for the very rare cases in which somebody actually had that gene test.)

It's possible. It's also unlikely, IMO.

I am simply not an expert in the trivia of federal regulation. I accept however that regulation can shape business practices, and that placing a requirement on a business to do something is not and cannot be costless...

As you say, that's merely opinion, and you've sternly warned others that opinion is not probative. Regulations can add costs but other countries have more regulations yet cost less. The claim that regulation is the culprit in our higher costs simply doesn't make sense except as an ideological belief.

Take the difference between...

Oh, never mind.

No, Inq - because you're just making a claim that has no basis in evidence. If you troubled to actually study the topic in question - or even read the data that others have laid out here, you might have the expertise to know where costs actually come from.

It seems apparent to me that you have an ideological bias that makes it hard, if not impossible, to understand that a government institution can sometimes be lower cost than a private one, even when there is ample evidence.

I reject the standard as too stringent. What you are saying is that if a non-expert cannot explain something in any given field, then that something cannot exist or be "significant".

Then perhaps non-experts shouldn't opine on what they do not understand, hm?

And you mis-state what I said: I didn't say "explain" (which only an expert might be able to do), I merely said "point to them." You claim there is bleeding: show me the wound rather than claim without any basis that it exists and you know who wielded the knife.

According to whom?

Me. Do you really, really believe it's an unfair request? If so we have no basis for discussion since it exempts you from any obligation to show evidence for your side.

But this is not regulation. And Congress is not a regulatory agency. Neither are the courts, by the way.

So what? The etiology of government-imposed obligation isn't relevant.

[Captain America]

Part 1B



A generic opinion for which you haven't offered the least shred of evidence or even pointed to specific causes and effects. That just won't do. Occam's Razor shows much more likely reasons, many of which have been described many times on f.net.



(tears remaining hair slightly) Please, some evidence of this? Which restrictions?

The big insurers certainly have the critical mass that permits them to enjoy economies of scale in nationwide billing and claims processing. Even medium-sized ones like per-state Blues have that.



Again: which regulations? You claim the patient is bleeding - where's the blood, let alone the knife? This is merely evidence-free speculation.

If they're traceable - then trace them. (and let's leave the genes out of it - that only flies at all for the very rare cases in which somebody actually had that gene test.)



As you say, that's merely opinion, and you've sternly warned others that opinion is not probative. Regulations can add costs but other countries have more regulations yet cost less. The claim that regulation is the culprit in our higher costs simply doesn't make sense except as an ideological belief.




No, Inq - because you're just making a claim that has no basis in evidence. If you troubled to actually study the topic in question - or even read the data that others have laid out here, you might have the expertise to know where costs actually come from.



Then perhaps non-experts shouldn't opine on what they do not understand, hm?

And you mis-state what I said: I didn't say "explain" (which only an expert might be able to do), I merely said "point to them." You claim there is bleeding: show me the wound rather than claim without any basis that it exists and you know who wielded the knife.



Me. Do you really, really believe it's an unfair request? If so we have no basis for discussion since it exempts you from any obligation to show evidence for your side.



So what? The etiology of government-imposed obligation isn't relevant.

Holy S##T! do you really think anyone is going to read all that crap you typed? You really are a self-important fool, huh?

Try to get your arguements under the size of The Tale of Two Cities and someone might read them.

"It was the best of posts, it was the worst of posts.....Madame Jeffy knitted blah blah blah"

[jeff]

Indeed.

Yup. This is the previous part 2. Sigh.

Aha!

And is it your contention that profit-maximizing businesses deliberately choose to use procedures which are more costly than alternatives they might use?

Why would they do that, if the option was wholly theirs? Why would ANY business do that?

Hold onto your "Aha" - you haven't reached the "Eureka!" yet.

No. I do not contend they do that deliberately but sometimes businesses really do more costly things than they ought. They may not have thought of a better way. They might be clueless that they're wasting money. The individuals involved might not give a damn (A brokerage I used to work in had people sending same-building interoffice mail via Federal Express. New York to Kansas City to New York, at incredible cost). Managers often spend their entire budget to make sure they get a bigger budget next year. Happens all the time. Have you spent much time in business? Businesses do dumb things all the time - haven't you read Dilbert? - and you can't blame government for it.

But that's generic, not the health-care specific reason: one of the reasons that the administrative costs are so high is that many of the costs imposed by the HMO are not borne by the HMO: they are inflicted on patients and especially providers. Go read the doc downunder linked from way back - if you miss this you're missing the point. When an insurer demands pre-certs, demands repeat documentation, denies claims that have to be resubmitted that's a cost to the provider. When a provider takes 50 different insurers, he or she has increased costs in order to comply with conflicting mazes of claim precert and filing rules. No government involvement here to blame.

Or is it perhaps only that these are the least costly procedures consonant with the structure of their industry and the constraints placed upon firms by regulatory requirements? Is that possible?

There are regulatory costs, but if you read the documentation that has been provided in past discussions you will see that the processes I just list above (and frequently in the past) did not originate with the government.

"Is that possible?" is the wrong question. Lots of things are "possible" at least hypothetically - but turn out to not be the reason. The right question is "Is that the reason?"

You have yet to give any evidence at all that the reason you suggest is the actual reason. It's all been hypothetical and evidence-free.

How do you know that "the former is small"? And I suspect that that is not the only law which imposes reporting requirements, either...

Sarbanes-Oxley is expensive, because of the data that has to be collected. Boy oh boy. HIPAA - not so much. Frankly, HIPAA mostly applies to providers rather than insurers and - pay note - applies just as much to government payers like Medicare as it does private insurers. Therefore it is not the reason that private insurers have higher costs. A factor in common cannot be the difference....

That's not really reassuring...

Alas, reassuring you is not my intention or concern. Hmph, you already doubt my judgment, not much I can do about that anyway.

Well, but in this case the question is which YOU pick, is it not?

Uh, no - it is not.

You really don't see why statements like that prompt me to dubiety?

No, I do not. Economists opinions on the sanctity of the free market varies all over the map - I am expressing a simple fact which you surely must know. Nobelists Joe Stiglitz and Paul Krugman differ sharply from Nobelist Milton Friedman. (Two Nobelists to one for my side! I win! ) Tell the truth, it's statements like yours that inspire doubt in me about how well you understand the big picture.

That's problematic in itself, though: WHAT bounds? Even margins of error will vary depending on the comparisons. At the margins, Australia vs New Zealand will likely be more closely comparable than Cuba and the US, for example---or China vs. Ireland---or Britain vs. Haiti. Etc. This is all I am saying: That to say a simple GDP comparison proves something about whether a policy in A would be good or bad for B is overly simplistic. ( The same goes, BTW, for other measures like average longevity or infant mortality rate. )

Yardsticks are one thing, a Procrustean application of them another...

The good news is that all that is nicely factored in, and in particular in every case I've mentioned on this board we've been talking about the kind of first world countries whose figures are indeed directly comparable.

For cryin' out loud. Today's NYT OpEd by Paul Krugman on debt uses GDP over and over (topic is debt) discussing the US and Greece.

Real economists see no problem using GDP for such comparisons and do it all the time. Public health care professionals use those mortality statistics. That's what the pros do, and there's nothing wrong with it at all Let's move on.

If I were cynical, I might think you were trying to cast doubt on widely accepted information that was harmful to your argument...

They use them because they have nothing better, not because they believe them to be completely accurate or comparable.

Do they? Really? All economists? Most? Who did you ask? Can you name any who feel uneasy about using GDP? Can you provide citations to support that claim?

Here's the bottom line: as you say in your own words. "They use them"

(Let's take out the "completely" - nobody has ever claimed that in the many arguments on this board that use GDP, and the arguments in question don't require "completely." I have specifically on several occasions said "I don't claim complete accuracy". In the very thread you're replying to I say "perfectly" is not needed. Stop putting that back in)

Can you point to articles where economists express such deep reservations about this metric that they feel it should not be used.

Specifically (since this is the entire context of why we've discussed GDP ad nauseum): can you provide evidence that economists feel that GDP is so inaccurate that one cannot use it to substantiate the statement that "US health care is more expensive than other first world countries"?

If not, then this entire subtopic is a waste of time. If I were a cynic, I would say it was a red herring meant to distract from the substantive issues...

"For want of a nail..."

Inapt aphorisms aren't a substitute for evidence....

What is really weird about this, and the reason why I cannot fathom why you spend so much energy on it, is that you haven't denied (or agreed, as far as I remember) that US health care is more expensive than other countries.

If you agree that it's more expensive, then why go to all the effort to dispute comparisons that lead to that conclusion? That would be a pointless waste of effort.

If you disagree, and think we don't have more expensive health care, then come out and say so. That will come as a big surprise.


Oh, I see we have a new board idiot again. Well, that will really provide incentive to come back here. Shrug.

[Captain America]

Yup. This is the previous part 2. Sigh.



Hold onto your "Aha" - you haven't reached the "Eureka!" yet.

No. I do not contend they do that deliberately but sometimes businesses really do more costly things than they ought. They may not have thought of a better way. They might be clueless that they're wasting money. The individuals involved might not give a damn (A brokerage I used to work in had people sending same-building interoffice mail via Federal Express. New York to Kansas City to New York, at incredible cost). Managers often spend their entire budget to make sure they get a bigger budget next year. Happens all the time. Have you spent much time in business? Businesses do dumb things all the time - haven't you read Dilbert? - and you can't blame government for it.

But that's generic, not the health-care specific reason: one of the reasons that the administrative costs are so high is that many of the costs imposed by the HMO are not borne by the HMO: they are inflicted on patients and especially providers. Go read the doc downunder linked from way back - if you miss this you're missing the point. When an insurer demands pre-certs, demands repeat documentation, denies claims that have to be resubmitted that's a cost to the provider. When a provider takes 50 different insurers, he or she has increased costs in order to comply with conflicting mazes of claim precert and filing rules. No government involvement here to blame.



There are regulatory costs, but if you read the documentation that has been provided in past discussions you will see that the processes I just list above (and frequently in the past) did not originate with the government.

"Is that possible?" is the wrong question. Lots of things are "possible" at least hypothetically - but turn out to not be the reason. The right question is "Is that the reason?"

You have yet to give any evidence at all that the reason you suggest is the actual reason. It's all been hypothetical and evidence-free.



Sarbanes-Oxley is expensive, because of the data that has to be collected. Boy oh boy. HIPAA - not so much. Frankly, HIPAA mostly applies to providers rather than insurers and - pay note - applies just as much to government payers like Medicare as it does private insurers. Therefore it is not the reason that private insurers have higher costs. A factor in common cannot be the difference....



Alas, reassuring you is not my intention or concern. Hmph, you already doubt my judgment, not much I can do about that anyway.



Uh, no - it is not.



No, I do not. Economists opinions on the sanctity of the free market varies all over the map - I am expressing a simple fact which you surely must know. Nobelists Joe Stiglitz and Paul Krugman differ sharply from Nobelist Milton Friedman. (Two Nobelists to one for my side! I win! ) Tell the truth, it's statements like yours that inspire doubt in me about how well you understand the big picture.



The good news is that all that is nicely factored in, and in particular in every case I've mentioned on this board we've been talking about the kind of first world countries whose figures are indeed directly comparable.

For cryin' out loud. Today's NYT OpEd by Paul Krugman on debt uses GDP over and over (topic is debt) discussing the US and Greece.

Real economists see no problem using GDP for such comparisons and do it all the time. Public health care professionals use those mortality statistics. That's what the pros do, and there's nothing wrong with it at all Let's move on.

If I were cynical, I might think you were trying to cast doubt on widely accepted information that was harmful to your argument...



Do they? Really? All economists? Most? Who did you ask? Can you name any who feel uneasy about using GDP? Can you provide citations to support that claim?

Here's the bottom line: as you say in your own words. "They use them"

(Let's take out the "completely" - nobody has ever claimed that in the many arguments on this board that use GDP, and the arguments in question don't require "completely." I have specifically on several occasions said "I don't claim complete accuracy". In the very thread you're replying to I say "perfectly" is not needed. Stop putting that back in)

Can you point to articles where economists express such deep reservations about this metric that they feel it should not be used.

Specifically (since this is the entire context of why we've discussed GDP ad nauseum): can you provide evidence that economists feel that GDP is so inaccurate that one cannot use it to substantiate the statement that "US health care is more expensive than other first world countries"?

If not, then this entire subtopic is a waste of time. If I were a cynic, I would say it was a red herring meant to distract from the substantive issues...



Inapt aphorisms aren't a substitute for evidence....

What is really weird about this, and the reason why I cannot fathom why you spend so much energy on it, is that you haven't denied (or agreed, as far as I remember) that US health care is more expensive than other countries.

If you agree that it's more expensive, then why go to all the effort to dispute comparisons that lead to that conclusion? That would be a pointless waste of effort.

If you disagree, and think we don't have more expensive health care, then come out and say so. That will come as a big surprise.


Oh, I see we have a new board idiot again. Well, that will really provide incentive to come back here. Shrug.

Way to go, Tolstoy!