Medigap added to Medicare means more spending:
[E]mployer-sponsored and self-purchased supplemental coverage were associated with annual spending growth rates of 7.17 percent and 7.18 percent, respectively, compared to 6.08 percent for beneficiaries without supplemental coverage. In the first empirical study of the topic, the researchers found significantly higher rates of spending growth in all supplemental insurance categories compared to the category without supplemental insurance, even while controlling for sociodemographic, disease, disability, and health behavior characteristics. Golberstein and his colleagues suggest that policy efforts to restrict the generosity of Medicare supplemental insurance plans, and the anticipated lower levels and lower generosity of employer-sponsored supplemental Medicare coverage for future retirees, could slow the rate of spending growth for Medicare beneficiaries. (Health Affairs)
Why has the topic of “inequality” been getting so much attention in recent years? I have a theory, which I’ll advance in a future piece. But first things first.
What do the writers who are obsessing about it mean by “inequality”? They basically mean inequality of income. That would make sense if we all agree that the most important way in which people are unequal is differences in income. But what if that isn’t the case? Almost all of the people who are doing the complaining have chosen professions that earn less income than they could have had. That is, all these professors and editorial writers could have gone to law school or gotten an MBA or done something else that would have earned them more money. Obviously, money isn’t the most important thing in their lives.
The list below shows some other ways in which people are unequal. These things basically can’t be purchased. But if we were really concerned about life’s unfairness, we could compensate those who have less of these attributes and tax those who have more.
Life is unfair.
This is from my column today in The Wall Street Journal.
The Obama administration wants something the federal government has never done before: a computer system that connects HHS, the Internal Revenue Service, the Social Security Administration, Homeland Security and perhaps other departments as well. This is a herculean task with unclear benefits. For perspective, consider that the Veterans Administration converted to electronic medical records in 1998 and the VA and the Department of Defense have been unsuccessfully trying to share records ever since. Even though they have spent millions of dollars on the effort, it now appears that the two agencies are abandoning the goal altogether.
They cover minimal requirements such as preventive services, but often little more. Some of the plans wouldn’t cover surgery, X-rays or prenatal care at all. Others will be paired with limited packages to cover additional services, for instance, $100 a day for a hospital visit. Federal officials say this type of plan, in concept, would appear to qualify as acceptable minimum coverage under the law, and let most employers avoid an across-the-workforce $2,000-per-worker penalty for firms that offer nothing.
Larger employers, generally with more than 50 workers, need cover only preventive services, without a lifetime or annual dollar-value limit, in order to avoid the across-the-workforce penalty…Such policies would generally cost far less to provide than paying the penalty or providing more comprehensive benefits, say benefit-services firms. Some low-benefit plans would cost employers between $40 and $100 monthly per employee, according to benefit firms’ estimates.
Source: The Wall Street Journal.
Buried in the more than 800 pages of the bipartisan legislation (pdf) is language mandating the creation of the innocuously-named “photo tool,” a massive federal database administered by the Department of Homeland Security and containing names, ages, Social Security numbers and photographs of everyone in the country with a driver’s license or other state-issued photo ID.
Employers would be obliged to look up every new hire in the database to verify that they match their photo.
David Kravets from Wired.
The information allows drug makers to know which drugs a doctor is prescribing and how that compares to a colleague across town. They know whether patients are filling their prescriptions — and refilling them on time. They know details of patients’ medical conditions and lab tests, and sometimes even their age, income and ethnic backgrounds. (NYT)
I was completely surprised that nobody was funding some of these vaccines. When I first looked at this I thought, well, all the good stuff will have been done. It was mind-blowing me to find things like Rotavirus vaccine were going unfunded. One hundred percent of rich kids were getting it and no poor kids were. So over a quarter million kids a year were dying of Rotavirus-caused diarrhea. You could save those lives for $800 per life. That’s like $20 or $30 per year of life. It’s just ridiculous that an intervention like that isn’t funded.
And I’m really surprised at the variance. Some very poor countries run great vaccination systems and some richer ones run terrible programs. The north of Nigeria has about 30 percent vaccination coverage, and they’re above average in terms of wealth within Africa. You compare that to, say, Somalia, which has absolutely no government at all, and they get about 60 percent vaccine coverage of children. So you have a place literally with no government getting a better vaccine coverage than a place that’s above average wealth.
This is from an interview with Ezra Klein.
The folks at Harvard really, really hate cost sharing (i.e., deductibles, coinsurance and co-pays) in health care. They are much less concerned about high premiums or taxes. At least that is the conclusion one might draw from a new article in Health Affairs.
The authors examined the fate of 393 families enrolled in high-deductible plans through Massachusetts’ Commonwealth Connector. The families were well off enough to be unsubsidized and enrolled in a Harvard Pilgrim health plan. These were compared to similar families in plans with no deductible. They were looking for –
…respondents’ reports of any financial burden, higher-than-expected out-of-pocket costs, or discussions of costs with doctors. To measure financial burden, we asked enrollees whether, in the prior twelve months in the Connector plan, they or a family member had had problems paying or had been unable to pay medical bills; had had to set up a payment plan with a hospital or doctor’s office; or had had trouble paying for other basic needs such as food, heat, and rent because of medical costs. An affirmative answer to any of these three questions was considered an indication of financial burden.