An economics, investment, trading and policy blog with a focus on Modern Monetary Theory (MMT). We seek the truth, avoid the mainstream and are virulently anti-neoliberalism.
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Monday, July 24, 2017
David Dayen — Single Payer, Meet All Payer: The Surprising State That Is Quietly Revolutionizing Health Care
@Matt, it sounds like the rate increase is due to only sick people signing up for O-Care. The Dayen article is about controlling provider costs.
... five countries — France, Germany, Japan, Switzerland, and The Netherlands — use all-payer rate setting
Yes, and health care in those countries is more expensive than single payer countries, which is in turn more expensive than zero payer countries.
Most Americans seem to realize our health care system is dysfunctional and we've begun to have a national discussion on what to do about it. That's good.
More than one system has been proven to work reasonably well. Zero payer, single payer, and Euro-Romney-Care all work when managed decently. The problem with O-Care is that it was designed to fail. Political gridlock and lack of leadership have prevented those design failures from being addressed.
As much as I despise O-Care, I believe it is possible to fix it. It needs a mandate with teeth, and it needs premiums to be subsidized such that every single American could afford to have insurance. Various schemes to control provider costs, like "all-payer," would be icing on the cake.
We need to stop claiming that there is only one path to universal health care and instead acknowledge that most systems can be made to work if properly designed and managed.
Kaiser Permanente (HMO) is proposing only a 9% increase for the same "individual group"...
Math training: formula for premium has group size in the denominator.... ie make denominator larger to get premiums down... this is how the large employers can get much better premiums for their employees...
I havent had time to look at this new thing here in Maryland but seems to ring hollow as state will have hard time being "payer" when state govt has no numismatic authority, federal govt does...
Might be interesting to look at this scheme here in Maryland with Trumpcare's $4k annual tax credit available as "single's payer"...
Seems to me Trump is trying to convert from a present insurance type scheme to HMO scheme by giving everybody $4k monthly-annual in an HSA and then this would incentivize the providers to form networks to go after the munnie debiting the HSAs on the first of the month and then just doing whatever they need to do for any member who walks in with an ailment for the rest of the month...
Article says: "Maryland has a relatively low number of uninsured, about 6.7 percent of the population as of 2015. "
Population is about 6 million so this is about 400k people (probably not including illegals of which there are GOBS of illegals in this state which that has to eventually be addressed...)
So Trump's $4k annual times 400k people is $1.6B... Can you take care of 400k people for $1.6B up front and guaranteed?
This is the ONLY question that should be being asked... the rest is moron bibble babble blather....
", it sounds like the rate increase is due to only sick people signing up for O-Care"
well if you have a chronic condition youre gonna have a hard time holding down a full time job lol ... you end up in and out of the workforce... so you end up in the moron "individual group!" insurance scheme, denominator goes to 1 and premiums skyrocket in an insurance type scheme...
Its interesting that the "uninsured" here is 6.7% which imo is not a very high %... we could easily have 6.7% of our fellow man that have a chronic condition that renders them unable to hold down what is typically considered a "full time job"...
Its not that many people on a % basis... the rest of us could EASILY take care of them... some of them may WANT to work when they are able... some probably cannot/should not be working at all...
@Matt, the REAL cost of providing health care to everyone -- real cost being doctors, nurses, meds, etc. -- is the same in any universal system. This debate about insurance and deductibles and copays is merely about the fiat cost and the fiat distribution, not the real cost. It's insane when you think about it.
Give everyone 100% free health care and let's debate the best way to produce more doctors instead of debating how to move fiat tokens around.
Math training: formula for premium has group size in the denominator.... ie make denominator larger to get premiums down... this is how the large employers can get much better premiums for their employees...
I have a friend who has been in insurance all his life as was father. He specialized in health insurance. He told me that one of the tactics of insurance companies is to decrease the size of the pool. The way it works is they give a low rate to join. A person is put in a pool that decreases over time as premiums rise and better deals are available elsewhere for those that have not developed pre-existing conditions. Those that have are left in the pool. Guess what happens then? Right. As pool expenses rise, so do premiums and those that are trapped either have to pay or drop out. If they drop out, then the premium goes higher, since the pool is smaller.
Everybody else has to do it... providers shouldnt get a pass imo...
This means that there should be a single administered price across the board, similar to a price control.
Right now the health care market is a negotiated market with different providers negotiating prices with payers (mostly insurance cos) that are not transparent to the market.
Largest insurer in the state (which is a Dem associated non-profit btw) wants a 50% increase in the moron "individual group"...
ReplyDeletehttp://www.baltimoresun.com/health/blog/bs-hs-rate-increases-20170504-story.html
Big problems on the horizon...
@Matt, it sounds like the rate increase is due to only sick people signing up for O-Care. The Dayen article is about controlling provider costs.
ReplyDelete... five countries — France, Germany, Japan, Switzerland, and The Netherlands — use all-payer rate setting
Yes, and health care in those countries is more expensive than single payer countries, which is in turn more expensive than zero payer countries.
Most Americans seem to realize our health care system is dysfunctional and we've begun to have a national discussion on what to do about it. That's good.
More than one system has been proven to work reasonably well. Zero payer, single payer, and Euro-Romney-Care all work when managed decently. The problem with O-Care is that it was designed to fail. Political gridlock and lack of leadership have prevented those design failures from being addressed.
As much as I despise O-Care, I believe it is possible to fix it. It needs a mandate with teeth, and it needs premiums to be subsidized such that every single American could afford to have insurance. Various schemes to control provider costs, like "all-payer," would be icing on the cake.
We need to stop claiming that there is only one path to universal health care and instead acknowledge that most systems can be made to work if properly designed and managed.
Dan,
ReplyDeleteKaiser Permanente (HMO) is proposing only a 9% increase for the same "individual group"...
Math training: formula for premium has group size in the denominator.... ie make denominator larger to get premiums down... this is how the large employers can get much better premiums for their employees...
I havent had time to look at this new thing here in Maryland but seems to ring hollow as state will have hard time being "payer" when state govt has no numismatic authority, federal govt does...
Might be interesting to look at this scheme here in Maryland with Trumpcare's $4k annual tax credit available as "single's payer"...
Seems to me Trump is trying to convert from a present insurance type scheme to HMO scheme by giving everybody $4k monthly-annual in an HSA and then this would incentivize the providers to form networks to go after the munnie debiting the HSAs on the first of the month and then just doing whatever they need to do for any member who walks in with an ailment for the rest of the month...
Article says: "Maryland has a relatively low number of uninsured, about 6.7 percent of the population as of 2015. "
ReplyDeletePopulation is about 6 million so this is about 400k people (probably not including illegals of which there are GOBS of illegals in this state which that has to eventually be addressed...)
So Trump's $4k annual times 400k people is $1.6B... Can you take care of 400k people for $1.6B up front and guaranteed?
This is the ONLY question that should be being asked... the rest is moron bibble babble blather....
", it sounds like the rate increase is due to only sick people signing up for O-Care"
ReplyDeletewell if you have a chronic condition youre gonna have a hard time holding down a full time job
lol ... you end up in and out of the workforce... so you end up in the moron "individual group!" insurance scheme, denominator goes to 1 and premiums skyrocket in an insurance type scheme...
this is not rocket science...
Its interesting that the "uninsured" here is 6.7% which imo is not a very high %... we could easily have 6.7% of our fellow man that have a chronic condition that renders them unable to hold down what is typically considered a "full time job"...
ReplyDeleteIts not that many people on a % basis... the rest of us could EASILY take care of them... some of them may WANT to work when they are able... some probably cannot/should not be working at all...
@Matt, the REAL cost of providing health care to everyone -- real cost being doctors, nurses, meds, etc. -- is the same in any universal system. This debate about insurance and deductibles and copays is merely about the fiat cost and the fiat distribution, not the real cost. It's insane when you think about it.
ReplyDeleteGive everyone 100% free health care and let's debate the best way to produce more doctors instead of debating how to move fiat tokens around.
Math training: formula for premium has group size in the denominator.... ie make denominator larger to get premiums down... this is how the large employers can get much better premiums for their employees...
ReplyDeleteI have a friend who has been in insurance all his life as was father. He specialized in health insurance. He told me that one of the tactics of insurance companies is to decrease the size of the pool. The way it works is they give a low rate to join. A person is put in a pool that decreases over time as premiums rise and better deals are available elsewhere for those that have not developed pre-existing conditions. Those that have are left in the pool. Guess what happens then? Right. As pool expenses rise, so do premiums and those that are trapped either have to pay or drop out. If they drop out, then the premium goes higher, since the pool is smaller.
Well one way to do that Dan is to get those people to write an number down on a piece of paper and slide it across the table...
ReplyDeletethis is the "business" type of approach and Trump is a business person so we can see him going this way...
He wants the providers to commit to a price and he will provide them scale and a guaranty of payment in return...
Everybody else has to do it... providers shouldnt get a pass imo...
Pays to re-shop your insurance Tom every couple of years...
ReplyDeleteEverybody else has to do it... providers shouldnt get a pass imo...
ReplyDeleteThis means that there should be a single administered price across the board, similar to a price control.
Right now the health care market is a negotiated market with different providers negotiating prices with payers (mostly insurance cos) that are not transparent to the market.
Its a negotiated market on a individual band-aid and tongue depressor level...
ReplyDelete"how much for a tongue depressor?!?"
Its stupid...