California’s Malpractice Reforms


In 1975 on his first tour as Governor, Jerry Brown signed legislation limiting attorney fees and non-economic damages on medical malpractice claims to $250,000.

A 2004 article in the Archives of Internal Medicine reported that California malpractice premiums have increased by less than 3% annually, or one-third of the rate nationally, and have fallen by 40% in constant dollars since 1975.

The Berkeley Research Group estimated that raising the cap on damages to $1 million would increase malpractice premiums by between 16% and 38%…California’s annual health costs would rise by $9.9 billion, or $1,000 for a family of four. (WSJ)

Headlines I Wish I Hadn’t Seen


Why thretirement-crackede disabled on Medicaid can’t afford to retire. Here’s how Chile solved that problem.

ObamaCare pushes doctors and hospitals to consolidate; then the FTC and the DOJ claim they’ve violated anti-trust law.

30 percent fewer “young invincibles” enrolled in ObamaCare than expected; administration gets two Pinocchios.

More than 1,100 IRS employees who owe back taxes received more than $1 million in bonuses and more than 10,000 hours in time-off awards.

When Working-Age People Consume Less Medical Care, Medicare Beneficiaries Consume More — but They Get Little, If Any Benefit


There has been a lot of discussion recently about how people who lost health insurance as a result of the post-2008 recession reduced their use of medical services. But when working-age people consume fewer medical services, Medicare patients take up the slack:

Reductions in the demand for medical services among adults below age 65 are not associated with reductions in the total quantity of physician services supplied. The increased Medicare utilization that accompanies lower demand among those under 65 has few, if any, benefits for Medicare patients.

(Sherry Glied, National Bureau of Economic Research)

What If Premiums in the Exchange Go Down Next Year?


Everyone’s expecting them to go up. But what if they go down? Many families could be worse off.

money-crossroadsIf a family of four headed by two adults in their mid-30s is making $59,625 per year, then the ObamaCare subsidies will make it so the second-lowest cost silver plan costs no more than 8.15 percent of its income, or $4,860.

In Marion County, the two cheapest silver plans are sold by Anthem Blue Cross and Blue Shield. The cheapest plan costs $7,700 a year and the second-cheapest costs $8,040.

To make that second-cheapest plan cost only $4,860, ObamaCare applies a tax credit of $3,180. So that is the subsidy available for any family of four making $59,625 — NO MATTER WHICH HEALTH PLAN that family purchases in the ObamaCare exchange. It can be a bronze plan or a gold plan. It can be more or less expensive. No matter, that family will receive a subsidy equal to $3,180.

But what happens if another insurer — such as UnitedHealthcare, which sat on the sidelines this year, or MDwise Inc., offers a silver plan in 2015 that’s just a little bit cheaper than the cheapest Anthem plan, say, for $7,500 per year?

Can Anything Be Trusted in This Administration?


The new announcement that the Census Bureau is completely changing its Current Population Survey (CPS) questions about health insurance coverage (see previous post here) is devastating for those of us who do health research.

We have all known for years — decades — that the CPS count of the insured isn’t especially accurate. The questions it asks are about full-year coverage but people tend to answer based on their current status. It chronically under-reports Medicaid enrollment — the actual head count from Medicaid programs is always higher than indicated in the survey. The same is probably true for employment-based coverage. It has often been criticized for being weak on foreign language questions. Massachusetts, for example, has a significant population of people who speak Portuguese and that state thought the CPS failed to capture those people.

The Census Bureau recently (in 2007) revised its numbers because the software was misallocating people who reported that everyone in their family was covered. More on this below.

Hits and Misses


Smiling NurseThree more states — Connecticut, Nebraska and New York — are in the process of allowing nurse practitioners to work without oversight from a doctor, in an effort to alleviate physician shortages.

Tom Sargent summarizes economics in 335 words. Or is it 297 words?

eHealth, Inc., an online insurance broker, is ObamaCare’s biggest winner.

If we had a drug to delay Alzheimer’s by five years, annual treatment costs would drop by almost half a trillion dollars a year.

Why Sweden is Privatizing Health Care


people-in-waiting-room…[T]he average wait time (from referral to start of treatment) for “intermediary and high risk” prostate cancer is 220 days. In the case of lung cancer, the wait between an appointment with a specialist and a treatment decision is 37 days.

Stories of people in Sweden suffering stroke, heart failure and other serious medical conditions who were denied or unable to receive urgent care are frequently reported in Swedish media. Recent examples include a one-month-old infant with cerebral hemorrhage for whom no ambulance was made available, and an 80-year-old woman with suspected stroke who had to wait four hours for an ambulance. (WSJ)

Headlines I Wish I Hadn’t Seen


prescription-drugsPrices for a dozen generic drugs jumped 2,000 percent in one year: FDA to blame.

Users report better experience on broken state ObamaCare exchanges than federal exchange.

Did Kathleen Sebelius request kickbacks from H&R block for enrolling ObamaCare applicants?

Man covered by ObamaCare owes half the cost of a $54,000 helicopter ambulance bill.

The Heartbleed virus infected ObamaCare exchange enrollees advised to change passwords.

What Difference Does Drug Insurance Make?


Results indicate that obtaining prescription drug insurance through Medicare Part D was associated with an 8% decrease in the number of hospital admissions, a 7% decrease in Medicare expenditures, and a 12% decrease in total resource use. Gaining prescription drug insurance through Medicare Part D was not significantly associated with mortality.

Robert Kaester, Cuiping Long, G. Caleb Alexander, National Bureau of Economic Research.

How Well Do We Match Medical Student’s with Residencies?


Amy Ho at Forbes writes:

StethoscopeThis year, 5.6% of US allopathic (MD) seniors did not match, and 22.3% of U.S. osteopathic (DO) seniors did not match. On the whole, 25.0% of applicants in the NRMP Match did not match — with a 25% unemployment rate, how successful is the Match, really?

This system is highly wasteful. It incurs massive costs for hospitals and students through the interview process, precludes contract negotiations that could optimize value for both parties and results in depressed wages for young physicians. Additionally, it incurs significant opportunity cost in trading interviews for educational senior year curricula, causes undue duress for applicants and their families and contributes to decreased quality of care in physicians unsatisfied with results of the Match.

Full piece worth reading.