Prostate Cancer Screening: Can the Government Get It Right?


Senior Man ThinkingProstate Specific Antigen (PSA) tests are back in the news, as they are one entry point for the government to start micromanaging how it pays doctors in Medicare. To set the stage:

  • Currently, Medicare pays for an annual PSA test for men 50 and older as “preventive care.”
  • However, Obamacare does not consider an annual PSA test for men 50 and over as “preventive care.”
  • The U.S. Preventive Services Task Force’s current guidelines (updated in 2012), recommend against PSA tests.
  • PSA testing has declined significantly since the 2012 guidelines were updated.
  • The American Cancer Society favors PSA tests for men over 50, and as early as 40 for men with more than one first-degree relative diagnosed with prostate cancer.

GDP: Health Services Accounts for 30 Percent of Services Spending Growth


BEAToday’s second estimate of Gross Domestic Product for the third quarter indicates growth in health services spending is maintaining a disproportionate share of still slow GDP growth.

Spending on health services grew faster (5.0 percent, annualized, in current dollars) than spending on non-health services (3.9 percent) or non-health personal consumption expenditure (3.0 percent) from the second quarter (Table I). The growth in health services spending ($25.1 billion, annualized) accounted for 17 percent of all GDP growth ($151.0 billion), one fifth of personal consumption expenditure ($130.2 billion), and 30 percent of all services spending ($85.5 billion).

Broad Coalition Calls For Congress Not To Hand Health Insurers’ Losses To Taxpayers


JRGrahamUnitedHealth Group’s proposal (threat? promise?) to withdraw from Obamacare’s health insurance exchanges, and the failure of Obamacare’s COOPs are both events which NCPA has been predicting for a long time (see here and here).

Two years ago, we identified Obamacare’s “risk corridors” as a vehicle through which the Administration would expose taxpayers to unlimited liability for insurers’ losses in Obamacare. Due to our research and testimony, Congress prevented this exposure last December.

What with the exchanges unravelling so quickly, we are not surprised to learn that lobbyists are pressuring Congress to restore unlimited liability. We joined a broad-based coalition to write a letter to Congress urging the current policy be maintained.

Obamacare must be completely renegotiated from root to branch. Just handing taxpayers’ money to insurers for losses they incur will not solve the problem.

Read the entire letter here.

Work & Employment Down, Sleep & Socializing Up: Obamacare’s “Slacker Mandate”


sleeping-womanWhat with Obamacare’s health insurance exchanges unraveling pretty quickly, Americans might be excused for having forgotten one of Obamacare’s first intrusions: The “slacker mandate.” This was the provision that requires employer-based health plans to cover “children” on their parents’ plans until they are 26.

It took effect in 2010. The results are in, according to a new study published by the National Bureau of Economic Research:

If, as suggested by prior work, the provision reduced the amount of time young adults work, the question arises, what have these adults done with the extra time?

The extra time has gone into socializing, and to a lesser extent, into education and job search. Availability of insurance and change in work time appear to have increased young adults’ subjective well-being, enabling them to spend time on activities they view as more meaningful than those they did before insurance became available.

(Gregory Dolman & Dhaval Dave, “It’s About Time: Effects of the Affordable Care Act Coverage Mandate on Time Use,” NBER Working Paper No. 21725, November 2015.)

Here’s an Example of Why Obamacare is a Job-Killer


A recent New York Times article illustrates what a job killer Obamacare really is. That comes as no surprise to economists who tried to warn Obamacare proponents six years ago. But an “I told you so!” hardly makes workers out of a job feel any better.  As Obama advisor Jonathan Gruber found more than 20 years ago, employer mandates raise the cost of employing workers. In the process, employer mandates depress wages and reduce employment. Gruber also found employer mandates tend to harm the very people they were intended to help.

Hospital Ownership of Physicians Drives Up Costs


New research published in the JAMA Internal Medicine journal supports, with rigorous data analysis, that hospital ownership of medical practices drives up costs:

Among the 240 Metropolitan Statistical Areas, physician-hospital integration increased from 2008 to 2012 by a mean of 3.3 percentage points, with considerable variation in increases across MSAs. For our study sample of 7,391,335 nonelderly enrollees, an increase in physician-hospital integration equivalent to the 75th percentile of changes experienced by MSAs was associated with a mean increase of $75 per enrollee in annual outpatient spending from 2008 to 2012, a 3.1% increase relative to mean outpatient spending in 2012). This increase in outpatient spending was driven almost entirely by price increases because associated changes in utilization were minimal (corresponding change in price-standardized spending, $14). Changes in physician-hospital integration were not associated with significant changes in inpatient spending ($22 per enrollee) or utilization ($10 per enrollee).

(Note: I have edited out the measures of statistical significance from the abstract, for ease of reading.)

Large Insurer May Exit Exchange: The Exchange System is Collapsing Under its Own Weight


I reported earlier this week that the Obamacare Marketplace is slowly failing. Three days later the largest health insurer in America, UnitedHealth Group, announced it expects to lose $500 million on exchange plans next year and may exit the market in 2017.

Connected Care: Moving (And Keeping) Patients Out Of Hospitals


Doctors Rushing Patient down Hall(Part one of a two-part series. A version of this Health Alert was published by Forbes.)

One of the greatest frustrations in health care is that technology tends to drive up costs. In pretty much every other area of our lives, technology reduces costs. Increased health spending is associated with better health outcomes (as recently summarized by Cynthia Cox of the Kaiser Family Foundation). Nevertheless, we would like to get these benefits at less cost.

The opportunity to achieve this is at hand. A host of technologies promises to significantly reduce costs by eliminating friction in the flow of clinical data between providers and patients, making sense of data from different sources, and allowing patients and providers to interact in new, cost-effective ways. This will allow patients to get more care where they want it, and not where the system demands they show up.

CPI: Medical Prices Rose Three Times Faster Than Other Prices; Hospitals Stand Out


BLSOctober’s Consumer Price Index (CPI) confirms medical prices continue to spring ahead of prices for other goods and services. Overall CPI increased 0.2 percent on the month and also 0.2 percent, year on year. Medical prices, on the other hand, increased 0.7 percent on the month and 3.0 percent, year on year (Table I).

20151117 CPI

Research Explains Why the Obamacare Marketplace is Slowly Failing


With great fanfare, the U.S. Department of Health and Human Services issued a press release in mid-October estimating enrollment in the Obamacare Marketplace (i.e. the exchange) at 10 million by the end of 2016. HHS Secretary Burwell said, “We believe 10 million is a strong and realistic goal.”

Before you burst out with excitement, keep in mind enrollment for 2015 is estimated at 9.1 million. As recently as March 2015, estimates by the Congressional Budget Office (CBO) projected 21 million would sign up in 2016. Enrollment is only about half what the CBO originally estimated and is likely to gradually decline into what actuaries sometimes refer to as an adverse selection death spiral.