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Thread: I have seen the future, and it is Medicaid - by Nobel prize winning economist Paul Kr

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    Default I have seen the future, and it is Medicaid - by Nobel prize winning economist Paul Kr

    I Have Seen The Future, And It Is Medicaid

    One of the papers at Brookings was an attempt at prognosticating the future of health care costs — for what it’s worth, their best guess was slightly below CBO’s, so it was consistent with CBO’s relatively not-scary long-term fiscal forecasts. But what struck me most was this chart, showing cost growth in different forms of health insurance:


    That flat red line at the bottom is Medicaid.

    Everyone who’s serious about the budget realizes that to the extent we do have a long-run fiscal problem — which we do, although it’s far from apocalyptic — it’s mainly about health care costs. And then there’s much wringing of hands about how nobody knows how to control health costs, so maybe we should just give people vouchers, and if they still can’t afford insurance, too bad.

    Meanwhile, we have ample evidence that we do know how to control health costs. Every other advanced country does it better than we do — and Medicaid does it far better than private insurance, and better than Medicare too. It does it by being willing to say no, which lets it extract lower prices and refuse some low-payoff medical procedures.
    Ah, but you say, Medicaid patients have trouble finding doctors who’ll take them. Yes, sometimes, although it’s a greatly exaggerated issue. Also, middle-class patients would surely be unhappy if transferred from the open-handedness of Medicare to the penny-pinching of Medicaid.

    But the problems of access, such as they are, would largely go away if most of the health insurance system were run like Medicaid, since doctors wouldn’t have so many patients able and willing to pay more. And as for complaints about reduced choice, let’s think about this for a moment. First you say that our health cost problems are so severe that we must abandon any notion that Americans are entitled to necessary care, and go over to a voucher system that would leave many Americans out in the cold. Then, informed that we can actually control costs pretty well, while maintaining a universal guarantee, by slightly reducing choice and convenience, you declare this an unconscionable horror.

    So, I’m not proposing that we turn the whole system into Medicaid any time soon. But what I take from the data is that if and when we feel the need to make tough choices — really, really make tough choices, not use the rhetoric of tough choices to justify what conservatives wanted to do in any case, namely privatize everything in sight — health cost control won’t turn out to be that hard after all.
    "Do not think that I came to bring peace... I did not come to bring peace, but a sword." - Matthew 10:34

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    Hitomi has a couple of really outstanding points.

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    Interesting. I assume the cabal that sets Medicare reimbursement rates does not also set Medicaid rates. So, anyone know how Medicaid rates are established?

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    Quote Originally Posted by Hitomi's Tanakas View Post
    I Have Seen The Future, And It Is Medicaid

    One of the papers at Brookings was an attempt at prognosticating the future of health care costs — for what it’s worth, their best guess was slightly below CBO’s, so it was consistent with CBO’s relatively not-scary long-term fiscal forecasts. But what struck me most was this chart, showing cost growth in different forms of health insurance:


    That flat red line at the bottom is Medicaid.

    Everyone who’s serious about the budget realizes that to the extent we do have a long-run fiscal problem — which we do, although it’s far from apocalyptic — it’s mainly about health care costs. And then there’s much wringing of hands about how nobody knows how to control health costs, so maybe we should just give people vouchers, and if they still can’t afford insurance, too bad.

    Meanwhile, we have ample evidence that we do know how to control health costs. Every other advanced country does it better than we do — and Medicaid does it far better than private insurance, and better than Medicare too. It does it by being willing to say no, which lets it extract lower prices and refuse some low-payoff medical procedures.
    Ah, but you say, Medicaid patients have trouble finding doctors who’ll take them. Yes, sometimes, although it’s a greatly exaggerated issue. Also, middle-class patients would surely be unhappy if transferred from the open-handedness of Medicare to the penny-pinching of Medicaid.

    But the problems of access, such as they are, would largely go away if most of the health insurance system were run like Medicaid, since doctors wouldn’t have so many patients able and willing to pay more. And as for complaints about reduced choice, let’s think about this for a moment. First you say that our health cost problems are so severe that we must abandon any notion that Americans are entitled to necessary care, and go over to a voucher system that would leave many Americans out in the cold. Then, informed that we can actually control costs pretty well, while maintaining a universal guarantee, by slightly reducing choice and convenience, you declare this an unconscionable horror.

    So, I’m not proposing that we turn the whole system into Medicaid any time soon. But what I take from the data is that if and when we feel the need to make tough choices — really, really make tough choices, not use the rhetoric of tough choices to justify what conservatives wanted to do in any case, namely privatize everything in sight — health cost control won’t turn out to be that hard after all.
    See therein lies the rub. Of course healthcare decisions involve tough choices. No sentient being denies that. But the question is WHO makes those choices. Statists prefer a scenario where THEY control what gets paid for and for whom (always themselves and their buddies).

    I prefer freedom where people make their own choices. Unfortunately, I am losing the argument because freedom is a much harder proposition than the promise of "something for free" paid for "by the rich"

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    Quote Originally Posted by I Love America View Post
    See therein lies the rub. Of course healthcare decisions involve tough choices. No sentient being denies that. But the question is WHO makes those choices. Statists prefer a scenario where THEY control what gets paid for and for whom (always themselves and their buddies).

    I prefer freedom where people make their own choices. Unfortunately, I am losing the argument because freedom is a much harder proposition than the promise of "something for free" paid for "by the rich"

    The freedom to have coverage denied by your insurer (if you're lucky enough to have one) doesn't really strike me as that hot of a freedom.

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    Quote Originally Posted by Dungheap View Post
    The freedom to have coverage denied by your insurer (if you're lucky enough to have one) doesn't really strike me as that hot of a freedom.
    Your statement presumes that you have a right to have an insurer cover you. You do not

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    Quote Originally Posted by Dungheap View Post
    The freedom to have coverage denied by your insurer (if you're lucky enough to have one) doesn't really strike me as that hot of a freedom.
    Yeah. Freedom to get sick and die... Rah.

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    Quote Originally Posted by Dungheap View Post
    The freedom to have coverage denied by your insurer (if you're lucky enough to have one) doesn't really strike me as that hot of a freedom.
    What does "luck" have to do with it?

    Pay your premiums.

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    Quote Originally Posted by Big money View Post
    What does "luck" have to do with it?

    Pay your premiums.

    . . . and if you have a pre-existing condition, tough shit.

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    Quote Originally Posted by Dungheap View Post
    . . . and if you have a pre-existing condition, tough shit.
    or if you hit the limit for the policy...also tough shit

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    Healthcare rationing based on who has money - perfectly acceptable
    Healthcare rationing based on need - evil
    "Do not think that I came to bring peace... I did not come to bring peace, but a sword." - Matthew 10:34

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