A defense of narrow networks. (A weak defense in my opinion.)
Here is the latest Barrack Obama statement fact checked by the Washington Post:
“We believe we’re a better country than a country where we allow, every day, 14,000 Americans to lose their health coverage; or where every year, tens of thousands of Americans died because they didn’t have health care; or where out-of-pocket costs drove millions of citizens into poverty in the wealthiest nation on Earth.”
The Post gives the president a pass on the first claim, citing previous fact checking, but awards 1½ Pinocchios for the next two.
Even the first claim is false, however. The 14,000 figure was an estimate of the number losing health insurance because they lost a job and it was made during the recession, when there was rising unemployment. But the president, remember, has pledged to reverse the jobs picture. If he is successful, we should have 14,000 a day gaining insurance ― unless of course the private insurance industry is in turmoil because of ObamaCare.
Claim number two, the Post reports is cherry picking the data. And claim number three is refuted by a study by an economist who is actually working for the Obama administration! The original claim that lack of insurance kills was based on a thoroughly discredited study by the Institute of Medicine. Richard Kronick, now working for HHS, concluded that if the study were done correctly,
the IOM study “would almost certainly have found no difference in survival between the uninsured and similar insured respondents.” As part of his study, Kronick took a sample of more than 600,000 people, interviewed from 1986 to 2002, with follow-ups, and then controlled for a variety of factors, including how long they went without insurance. He consistently found no difference in the [mortality] outcome.
More recent research has produced mixed results, but see this study by former Congressional Budget Office director, June O’Neill.
About the time that Nelson Mandela became South Africa’s president, there was wholesale deregulation of the country’s market for health insurance. As a result, virtually every major form of insurance that existed in the United States at the time competed on a level playing field in the South African market: PPOs, HMOs, MSA plans, etc. In fact, U.S. companies were involved in many of these ventures.
In a short period of time, Medical Savings Account plans became the most popular, capturing more than 50 percent of the market. However, as Shaun Matisonn explained in an NCPA study, there were no restrictions on the design of MSA plans like there were in the U.S. Whereas our plans are required to have an across-the-board deductible, in South Africa insurers were free to creatively use the accounts to create special programs for the chronically ill and to create economic incentives only in those areas and for those services where patience choice is appropriate and desirable.
This market, by the way, directly affects only about 20 percent of the population ― since everyone else tends to rely on free health care system. Like similar systems in other countries, government-provided care is characterized by limited resources and rationing by waiting.
In the new approach — called phenome-wide association studies — scientists start with a gene variant and then search among thousands of conditions for a match…
The new study was carried out by scientists from a consortium of medical research institutions. Known as the Electronic Medical Records and Genomics Network — eMERGE for short — it was founded in 2007 and includes institutions like the Mayo Clinic and Vanderbilt University School of Medicine…
The eMERGE team has now taken the database out for a test run. Looking at previously published genome-wide association studies, they identified 77 gene variants with strongly supported links to diseases. The scientists then tried to replicate the results.
In 51 out of 77 cases, Dr. Denny and his colleagues ended up with the same link. With 1,358 different conditions to choose from in the electronic medical records, it was practically impossible for them to do so well simply by chance. (NYT)
Yale law professor Stephen Carter reports:
The U.K. may soon approve a regulatory proposal that would allow scientists to create a human embryo using the DNA of three individuals. The idea is to remove damaged maternal DNA and replace it with genetic material from another woman, in order to reduce the risk of transmitting a mitochondrial disorder.
And here’s the rub:
This all sounds on the surface very clean and high-tech and altruistic. Yet it turns out that lots of people oppose it, including members of the Parliamentary Assembly of the Council of Europe and members of the European Parliament involved in its Bioethics Intergroup. What’s striking is how the opponents span the political spectrum. The open letter from the Bioethics Intergroup, for example, was signed by representatives of both the Conservative and Green parties.
Full piece is worth reading. Then tell us what you think in the comments.
The exchanges are based on a laudable idea: that competition, transparency and consumer choice will lead to higher-quality, more affordable products. The decisions consumers make will thus have significant implications for their own personal and financial health, as well as the overall sustainability of the exchanges. But despite the good intentions behind the website, behavioral science research suggests that many consumers may be ill equipped to make good decisions in the insurance marketplaces.
The government has approved several privately-run websites including eHeathInsurance.com, GetInsured.com and GoHealth.com, “to sell coverage under the ACA, including granting permission to connect to HealthCare.gov itself ― once it works right.” The sites, which are run by for-profit companies, “can sell policies that comply with the ACA’s individual mandate in the 36 states served by HealthCare.gov.” While not all of the technology “is in place to let the sites process the ACA’s tax subsidies for moderate-income insurance buyers,” most people “who don’t need subsidies can buy now.” (USA Today)
Everybody that I’ve led through a CoveredCA application stumbles when they get to the subsidy section. The problem lies in the estimation of next year’s income. The law asks you to predict the future and that’s not possible to any degree of accuracy. California addresses the issue by requiring enrollees to login and update their information every time their income change…a requirement that’ll be forgotten (or ignored) by most people. I assume other states have a similar requirement.
And a suggestion:
Change the law to base next year’s subsidy on the current year’s income. If someone is signing up in the October through December enrollment period, they should be able to estimate year end income far more accurately than next year’s income. And if you’re signing up after January 1, the books are already closed.