Employer-Based Coverage Does Not Equalize Workers’ Access to Health Care

InsFormSmallOne reason public policy favors employer-based health benefits instead of individually owned health insurance is the former is supposed to equalize access to health care among workers of all income levels. Insurers usually demand 75 percent of workers be covered, which leads to benefit design that attracts almost all workers to be covered.

Employers do this by charging the same premium for all workers but only having workers pay a small share of the premium through payroll deduction. Most is paid by the firm. Last year, the average total premium for a single worker in an employer-based plan was $6,435, but the worker only paid $1,129 directly while the employer paid $5,306.

Although this suppresses workers’ wages, workers cannot go to their employers and demand money instead of the employers’ share of premium. The tax code also encourages this, by exempting employer-based benefits from taxable income.

Does this equal access to care? Not at all, according to new research:

When demographics and other characteristics were controlled for, employees in the lowest-wage group had half the usage of preventive care (19 percent versus 38 percent), nearly twice the hospital admission rate (31 individuals per 1,000 versus 17 per 1,000), more than four times the rate of avoidable admissions (4.3 individuals per 1,000 versus 0.9 per 1,000), and more than three times the rate of emergency department visits (370 individuals per 1,000 versus 120 per 1,000) relative to top-wage-group earners.

(Bruce W. Sherman, et al., “Health Care Use and Spending Patterns Vary by Wage Level in Employer-Sponsored Plans,” Health Affairs, vol. 26, no. 2 (February 2017): 250-257.)

The reasons are not fully explained. Nevertheless, this research suggests employer-based benefits are not a good equalizer of access to health care, and the tax code’s prejudice in favor of those benefits and against individual health insurance should be revisited.

Comments (55)

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  1. Lee Benham says:

    Nice try, but why perpetuate the lie? As an economist you know very well that employees are paying 100% of the cost of their benefits because it’s part of their compensation package. In reality employees are renting benefits from their employer that they are paying the entire cost of ownership, yet they own nothing. It’s this insanity that is perpetuated by the insurance industry and policy wonks that has led to the general public and our politicians to not having a clue what they are getting for what they are paying for.

    Next time change the name to Renting Employer Based Benefits could be the death of you.
    Now that would be an article with some punch!

    Like I said not all bad nice try. keep up the hard work.

    • Ron Greiner says:

      Lee, I called Alachua County Public Schools and talked to the HR Director who is named Allison. I said, “Allison is my daughter’s name and she worked her way through college, at the turn of the Century, enrolling tax-free HSAs.” Then I asked her, “Are you licensed to sell insurance?” She said, “Yes I am.” I thought – really. Then I asked, “Allison, if a teacher becomes too sick to work, can they keep their insurance?” Allison blew my mind with her honesty, she said, “The teacher would lose both their health and the voluntary life insurance that they have purchased.”

      Lee, I know you know this but I guess nobody else in America knows how simple this is. If a young female employee pays $70 a month, out of her check, to purchase $300,000 worth of life insurance and she gets ovarian cancer, loses her hair, becomes too sick too work, she has her $300,000 worth of life insurance STOLEN from her and her family. There isn’t even a short-term COBRA on Life insurance.

      They don’t do research on what percentage of employees lose their insurance when they don’t meet their magic ELIGIBILITY requirement.

    • Or you could read the whole article, namely: “Although this suppresses workers’ wages,…”. I cannot go through an entire lecture on labor economics in each blog post.

  2. Allan says:

    “…to equalize access to health care among workers of all income levels”

    Can we call the above policy (ESI) a Faustian policy? It has the same results. It has led to a group of expensive uninsured, healthcare inflation, skimming, gaming and a whole host of other problems while not providing the healthcare that was assumed to be provided. We barked up the wrong tree and are afraid to climb down.

  3. Henry GrosJean says:

    I agree with Mr. Benham. This article is pretty worthless, especially since they comment that the reasons for the inequity of care “are not fully explained.” Really? They know the reason, but don’t want to admit them.
    And, if the new Administration has their way and implement the rumored cap of the employer exclusion of health insurance based on 90% of the plans actuarial value we’re talking about more taxable events on the employer and employee. It will be less of a benefit to offer.

  4. Jimbino says:

    Wrong. Workers can definitely refuse to participate in the company’s group health insurance by arranging with a compliant employer to convert their employee W-2 status into that of a 1099 contract worker or of a consultant. Another option is to arrange a corp-to-corp contract, some of which I’ve been doing for years. You lose the illicit tax benefits, but you gain a 50% hourly rate premium. Even better, you can fly uninsured, pay cash for your health care and enjoy a worldwide open network for any treatment and not pay for perinatal care if a man or prostate surgery if a woman. Only a fool participates in health insurance of any kind, unless of course he has overwhelming pre-existing conditions.

    Of course, these options are most rational for healthy, single, young, high-tech STEM males who are the ones most screwed by Obamacare and group insurance in general.

    • Ron Greiner says:

      Jimbino, you write, “fly uninsured, pay cash for your health care.” I insured a 7-Eleven owner in Chicago and immediately she was diagnosed with ovarian cancer and after 4 long years she died. Her husband Charlie is still a friend of mine and I’m sure he is glad his wife didn’t take you advise and fly naked. Jimbino, they had a home and assets and insurance was required for her treatment.

      Just a thought Jimbino why some roll their eyes when they read your comments.

      • Jimbino says:

        Yeah, I’m libertarian, atheist, physicist, attorney, multilingual and skeptical, of course, concerning religion, superstition and any and all of your anecdotes presented as some kind of evidence. I disdain all those who “roll their eyes” in the face of facts.

        Insurance is NEVER required for treatment!

        • Ron Greiner says:

          Jimbino, only you have the facts? I asked my son if he wanted to cancel his insurance because you said, “Insurance is NEVER required for treatment!”

          He did not “roll his eyes” but they did get pretty big when he said, “NO!”

          His medication costs $100,000 a year. How would you tell him to get his Rx if he did cancel his insurance as you suggest? I bet this is one of those questions that Jimbino doesn’t answer.

          • Jimbino says:

            Wrong again, Greiner. A person always has the option to pay cash, to finance the treatment, or to seek treatment in Cuba, Mexico or Costa Rica.

            Insurance generally provides your son the option of paying a 25% premium over the value of whatever treatment rendered. That’s the idea behind the 80% “loss-ratio” of Obamacare.

            Did you read where I wrote “Only a fool participates in health insurance of any kind, unless of course he has overwhelming pre-existing conditions,” which appears to be the very case of your son?

            • Ron Greiner says:

              He got his insurance before he got sick. So then you think he should keep it now that his $100K bill on Rx is payable.

              On the 7-Eleven owner who took 4 years to die you just blew that off as, “anecdotes presented as some kind of evidence.”

              Really Jimbino, if you are as bad an attorney as you debated here – I know exactly who not to call when I have a legal question — YOU!

              • Jimbino says:

                I would be overjoyed to take the opposing side from yours in a courtroom or poker table. You appear not to have mastered the concept or the math of probability and statistics, essential to the study of risk and insurance. You are probably one of those fools who buy “insurance” when playing Blackjack.

                see:
                http://blackjacklife.com/blackjack-insurance-a-bad-bet/

                All insurance is a bad bet. Take Obamacare, for example. It requires that participating insurers maintain a “loss-ratio” of 80%, which means that the insured pays a premium of 25% over the value received on every dollar’s worth of health care. I read that the loss-ratio of title insurance is around 2%.

                Added to that severe Obamacare penalty is the fact that single, childfree, young, healthy males are subsidizing the health care of the old and sick and of the married breeders.

                If you remain one of the those so exploited, you’ve got to be an idiot ignorant of simple math.

                • Lee Benham says:

                  Jimbino.
                  You my friend seem to not understand the concept of Insurance. Where you might life in utopia, us living in the states have to deal with the realities of where we live. I buy insurance to transfer risk. Same as any other person that buys any kind of insurance. What you are saying is there is no risk therefore there is no need. Personally I don’t want to lose everything I have worked for over the last 50 years if I have an unforeseen illness or injury. So I buy insurance to transfer that risk to a company willing to accept that risk and hopefully make a profit.
                  Is it a bad bet? Hell yes, the only way I come out financially ahead is I have to get sick. That sucks. Is it worth the bet to me, hell yes. Dental insurance or blackjack insurance? Hell no, losing at blackjack or needing a tooth pulled will not cost me everything I have ever worked for but a cancer might.

                  • John Fembup says:

                    “What [Jimbino is] saying is there is no risk therefore there is no need.”

                    Well, Lee, to be fair, what Jimbino actually said about medical insurance was “the insured pays a premium of 25% over the value received on every dollar’s worth of health care.”

                    And it seems to me what Jimbino actually said reveals an even more fundamental misunderstanding of insurance. He observes there is no risk in the aggregate level; he concludes there is no risk at the individual level. Which is nonsense on stilts.

                    Insurance companies make money precisely because risks in aggregate are predictable using the very types of mathematics Jimbino claims to understand. Yet individuaks often find the purchase of insurance to be worthwhile because they cannot bear the consequence of a risk that becomes an actual fact. Which, annoyingly, risks sometimes do.

                    Comparisons of medical insurance to other types of insurance are not persuasive. Blackjack cards don’t succumb to diabetes; property titles aren’t injured in auto accidents. Cards and property titles do not behave in ways that can affect the risk of insuring them. People can – and do.

                    Or – – ya think maybe it’s all different in Brazil? 😎

                    • Lee Benham says:

                      I’m sure it’s different in Brazil. Its probably cheaper just to euthanize the sick.
                      I’m glad that I bet on insurance. Having sold insurance for the last 20 some years I have seen first hand the financial devastation illness can bring to families. I’ve seen clients lose everything even being insured. What I never understood until recently is the emotional stress families go through. With my wife’s cancer I have never been worried about the financial risks. We are more than adequately covered.
                      However waking up to a wife that is crying in the shower because large clumps of her hair are clogging the drain is not something I was prepared to see. Apparently women are emotional about that sort of thing.

    • dennis byron says:

      Sorry but the IRS employs a lot of people to monitor companies moving employees to 1099 contractor status. Conversely if you file a 1099, you have to show multiple 1099s (in other words, you have to demonstrate that you are truly a self-employed contractor with multiple contracts)

      • Jimbino says:

        Wrong, having multiple contracts is only one item in a multi-part test. I have worked for a year plus a month’s renewal as a 1099 contractor. What the IRS thinks can in any case be contested.

        • Allan says:

          While Jimbino is essentially correct one has to meet certain criteria for that status to be considered valid. The question that arises if one tried to be hired as an independent contractor is whether it is worth the hassel or risk for the employer. We have to remember that if the IRS ruled otherwise the employer could be held responsible for taxes not paid by the employee. There are other problems as well.

          Jimbino apparently is in a position that he is a valid independent contractor which is good for him, but not necessarily good for others.

          • Jimbino says:

            You’re right. Just notice that most Uber and Lyft drivers are independent contractors, too, with no BA or BS needed. If they were to become employees, they’d lose a lot of freedom and income.

            • Allan says:

              Many Uber drivers have regular jobs or are semi retired. Many use Uber so that they can take a write off on their car and make some money at the same time.

              I don’t believe that one necessarily needs a college degree. In fact one young individual started a company called Praxis (look it up on the net). This company takes young people without college degrees and trains them in a short period of time for jobs in high tech. I don’t know for sure, but it sounds as if many of those, if not all going to Praxis, get tech jobs.

              We have a lot of openings and we have a lot of unemployed. What we don’t have are those willing and able to work at these jobs. That is what happens when government gets too involved in education and our personal lives.

  5. Ron Greiner says:

    Alan Colmes and Brenda Buttner died last week of cancer so these FOX News people are dropping like flies. I asked FOX News reporter Evan Axelbank at my Congressman Gus Bilirakis’s Obamacare town hall last week, “If you get too sick to work can you keep your FOX News health insurance?” Evan said, “YES, of course.” So there you go a stupid reporter covering Obamacare.

    I said to Evan, “Are you saying you can keep employer-based heath insurance if you get a head full of brain tumors and get too sick to work?” Evan, said, “I know what you are trying to do.” I said, “What?” He said, “I know what you are trying to do.”

    Brenda Buttner of FOX News Bulls and Bears might be able to keep her insurance but this nobody Evan would be slammed on a short-term COBRA for insurance termination and nobody at FOX News would blink an eye.

  6. Bob Hertz says:

    Having spent some time helping administer employer groups, I would endorse the results that are referenced in this post.

    Low wage employees tend to smoke more, have more accidents, have worse compliance with medications, and skip more doctor visits.

    I am going from memory here, but I think I read that something like this also exists in England despite the universal NHS.

    Some would blame this on the low wages, others would take a more Darwinistic view on the human material. Either way, tax incentives never produce equality by themselves. About all I would venture to say is the health of low wage employees in corporate plans is better than it would be without these plans.

    • Chaz says:

      I have wasted five precious minutes reading this inane article and the even more inane comments but I feel I must comment on one thing.

      Low wage workers do seem to use the health care system less (e.g., miss appointments and when they do use it they are more likely to visit the emergency room for one simple reason: They are most likely hourly paid employees who will lose some of their already measly pay by going to appointments during the work day. Salaried and higher paid workers (which I presume make up the majority of the readership of this blog) are more likely to be able to do so without losing any pay (or in any event a lower percentage of pay).

      • Lee Benham says:

        I would disagree,
        Self employed use the medical services the least. they have a choice. make money or go to the doctor. let me assure you they will go to the doctor only when they absolutely have to.

        I have been self employed for over 25 years. guess how many sick days or vacation or FML days I have built up over the years? ZERO.

        Lets see go make money or go sit in a Doctors office for a few hours. tuff choice.

        • Ron Greiner says:

          Exactly, Lee you beat me to the punch. But I don’t think it is money as much as a personality. You see a farmer with 1000 acres and he tells you that when he cut off the tip of his finger he put it back on himself with black electrical tape. Of course he has no feelings with that finger anymore.

          Multiple times I have heard that they did not go see a doctor when they had that heart attack. They thought they had a cold or something.

    • Jimbino says:

      Right, but you have to admit that the child education, housing, cars and food of low wage employees in corporate plans is worse than it would be without these plans.

  7. Lee Benham says:

    Bob,

    Low wage employees tend to smoke more, have more accidents, have worse compliance with medications, and skip more doctor visits. – See more at: http://healthblog.ncpa.org/employer-based-coverage-does-not-equalize-workers-access-to-health-care/#comments

    So does Charlie Sheen what’s the relevance ?

  8. Ron Greiner says:

    Lee, President Trump was way too weak in that speech last night. I would fire those speech writers in a second. The very best part was when President Trump said we are going to Repeal and Replace the nightmare of Obamacare because EXACTLY like the TITANIC it can’t be saved. Did you see the look on those Democratic SOCIALISTS faces? Then President Trump said, “We will replace with tax credits and EXPANDED Health Savings Accounts (HSA).” I almost cried. I swear I knew more about tax-free HSAs in 1996 before I enrolled America’s very 1st one than anybody knows yet today.

    President Trump should have said, “We now know that Hillary worships at the alter of SATAN. I want to heal this country BIGLY and even EMPOWER you SLIMY DEMOCRAT SOCIALIST losers to save premium, ELIMINATE TAXES and build wealth! Learn more at http://www.DonaldTrumpHSA.com

  9. Allan says:

    “Insurance is NEVER required for treatment!”

    That is absolutely correct. It is also correct that insurance isn’t required to cover risk.

    A requirement isn’t the question and you are right, the insured only get a portion of their money back. However, what treatment one gets is dependent upon resources and insurance can extend those resources (though perhaps not through ObamaCare). You can take the lesser level of care and you are still getting treatment. No, Cuba is not the place where one can get the best medical care. It is one of the worst unless you have some relationship to the Castro regime. Brazil also doesn’t have the best medical care, but it is fine for a lot of people. Mexico also doesn’t have top notch medical care though in all countries there are vast differences in quality. Generally when the very rich get sick and leave their country for treatment they come to the US.

    The nature of risk is greatly determined by the individual. However, if one has significant assets in the US one is stupid not to offset the risk of losing all those assets. If one is a bit hedonistic and doesn’t save for the future they might have to be placed on the dole. That is not the type of person I am attracted to. I have no problem with the way you manage your life and like your independence as long as I am never involved in paying for it.

    • Jimbino says:

      The trouble with your idea of having to pay for treatment of the uninsured or underinsured is that everyone who walks into an emergency room, insured or otherwise, has already paid over half the costs in the form of federal funding of medical research, treatment and other types of socialized medicine in the USSA. Only a fraction of the costs are paid by anyone at the point of actual treatment.

      • John Fembup says:

        Jimbino hypothesizes “everyone who walks into an emergency room, insured or otherwise, has already paid over half the costs in the form of federal funding of medical research treatment and other types of socialized medicine”

        C’mon. That’s nonsense on stilts.

        The federales are a conduit – they take from some, give to others, and keep a share for themselves. But productive workers pay for everything. The federales pay for nothing – even in Brazil.

        Fact is, about half of Americans pay more than 97% of all federal income taxes, and therefore fund nearly all of the social welfare burden; the other half of Americans pay less than 3% of all federal income taxes and therefore fund very little of that burden. In the real world that does not average out to your claim that everyone already paid over 50%.

        https://taxfoundation.org/summary-latest-federal-income-tax-data-2015-update/

        You understand mathematics? This is just arithmetic.

        • Jimbino says:

          What you don’t seem to understand, Fembup, is that in a socialist society like we have here in the USSA, the major preoccupation of the gummint is to steal from the producers to give to the indolent.

          See Ayn Rand for a good explanation that doesn’t reference arithmetic that you might not understand.

          Now that USSA socialism is firmly established, we don’t require at the schoolhouse door, entrance to Yosemite, or the ER that a person show that he has paid in taxes to cover his entrance privilege. That would happen in a free-market economy that we haven’t had for decades.

          In other words, your calculations of who’s paid what don’t mean a shit.

          • John Fembup says:

            What you don’t wish to admit Jimbino is that I do understand all that stuff – better than you’ve shown you understand it.

            So you respond to my comments with inarticulate rage? Normally that’s a flashing red light that one has liost the argument.

            On the other hand, if you can respond with substance, you are free to begin any time.

            • Allan says:

              Jimbino, you are right. Our government has turned in a socialistic direction, but you don’t think Cuba is better do you? How about Brazil? We need to move to a more free market environment which would satisfy some of your concerns, but at present there are a lot of socialistically inclined folk running our government.

              However, all of that doesn’t abrogate the need of many to offset risk and/ or expand the power of their dollars should they develop a costly illness they cannot afford.

              I understand your anger at the system, but I wonder if you can clarify what makes you angry over what is being said.

              • Jimbino says:

                @Allan: you don’t think Cuba is better do you? How about Brazil?

                I shop at Harbor Freight and Walmart, both of which offer bargains. When I shop for medical care, I don’t join the Saudis in paying a fortune for stateside care.

                Here is a current list of prices for exams and treament in my town in Brazil. I wager I pay less cash than what the insured Amerikan pays in co-pay (prices are in Reais, now trading at 3.11 to the dollar):

                http://www.abmedconvenio.com.br/?id=tabela

                • Allan says:

                  I looked at the normal pricing and probably on average the prices are lower. However, I am not sure of the value or if the same tests are being done on the same quality of machine.

                  I took one blood test that I believe is done the same way everywhere. TSH $R74 Brazil roughly $24.66 USD. I compared that with Quest $26.74. Medicare’s allowance was $22.93 Using TSH as a metric tells us alot. Remember the labor to do such testing and the quality requirements are much higher in the US.

                  As far as the scans go, cash paying patients can find a radiologist who takes cash and does those tests for around $400. It will vary with the test, the requirements and the machine. At least in the past I understand we sent lot of our old equipment to South America.

                  We have to remember that one gets healthcare not to see who charges the least rather to obtain a favorable outcome. The best international study that is peer reviewed and well respected throughout the world is the CONCORD study. Let’s see how Brazil and the US rank as far as outcomes go. This involves survival rates for common cancers. I leave out Cuba because they are not credible reporters.

                  Breast cancer: USA #1 Brazil # 28(out of 30)
                  Prostate cancer: USA #1 Brazil # 22(out of 30)

                  Brazil’s best performance was in:
                  Cancer of the rectum (men): USA #2 Brazil #12 (out of 29)

                  However for:
                  Cancer of the rectum for women Brazil fell to #24.

                  You can continue to say that prices in America are high. They is due our government’s involvement in insurance, but, none the less the comparison for outpatient testing that can be done in the US for cash is relatively close to that done in Brazil. Outcomes for the common cancers studies are #1 or #2 for the US while Brazil is in the bottom half of the heap. I’ll choose better outcomes of less expensive prices. You can do as you want.

              • Jimbino says:

                OK, let’s talk about Cuba. Wikipedia lists the life expectancy of Amerikans as roughly equal to that of Cubans.

                https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

                Yes, Cuba is better since it doesn’t impoverish a family as much per year of life as does the USSA.

                Explain yourself.

                • Ron Greiner says:

                  the USA has more crack whores. They die young.

                • Allan says:

                  It is well known that Cuba registry statistics are not credible.

                  I take note that in scientific discourse you use Wikipedia instead of legitimate journals. It is true that many people use lifespan as the only data point to conclude a lot of things including how good a healthcare system is.

                  For those that understand the science they realize that those conclusions are ideologicial. The lifespan of a nation is dependent on many variables including what Ron said and including a whole host of other things such as infant mortality. What we call infant mortality in many other countries is not listed as infant mortality so those deaths don’t enter into their lifespan statisitics Then again personal habits and genetics play a major part as well. So do war and auto accidents. Don’t forget the differences in registering deaths or infant mortality.

                  As an example of the problems with the statistics that you seem to like I used to shock people by telling them that I lived in a city with the highest per capita death rate in the nation. They came up with all sorts of questions, but forgot a variable. The city was quite small and the hospital within the city was quite large. You would have swallowed that hook, line and sinker. (For those a bit slow, there are a lot of deaths in large hospitals.)

            • Jimbino says:

              It would be nice if you gave a link to your CONCORD study. Otherwise, the best we can do is to consider it fake news.

      • Allan says:

        Jimbino, I am not quite sure what direction you are taking or how your argument pertains to what I said above.

        John F. has wreaked havoc over your new argument so I won’t add to his response.

        It is true that we pool some of our resources in many different areas and in many different ways. Are you trying to promote more pooling of the forced variety? You have brought up Cuba’s excellence in the past so perhaps force is what you are looking for.

        • Jimbino says:

          What kind of “pooling of resources of the forced variety” is involved in my access to cheap medical care in Cuba or Brazil?

          It seems to me that most all commenters on this blog are either insurance salesmen or hospital shills.

          • Ron Greiner says:

            You independent contract lawyers are sure full of opinions Jimbino. What is your problem with insurance salespeople?

            • Jimbino says:

              My problem with insurance salespeople is that they are either ignorant of game theory or, in the alternative, willing to use their knowledge to exploit those who are ignorant.

              Still, I hate to pick on them, since those who lack intelligence, education and erudition still have a right to earn a living and, I guess, it’s better to sell insurance that pays the victim 80 cents on the dollar than to become a priest or minister who has nothing of value to offer.

              • Ron Greiner says:

                Thanks Jimbino. I have sold a ton of lawyers and I have to tell you they are an easy bunch to manipulate because of their massive egos.

                I justify to myself that it is OK to use my sneaky selling tricks on them because I know what is best for them and I don’t want to spend all day with those schnitzels.

                • Jimbino says:

                  I sold Christmas cards starting at 8 on Chicago’s South Side, my home and that of your deposed socialist spiritual leader. As a teenager, I sold Fuller Brushes door-to-door. I could sell anything to anybody, and if I’d had no morals, I could have become rich selling insurance.

                  After physics at the U of Chicago, I did lots of magic in the USSA, Germany and Italy, where I hypnotized hundreds of folks, some of whom were cops or insurance agents.

                  The cops, who were armed,”killed” Godzilla, King Kong and the Beast from 20,000 Fathoms without harming anyone, but the insurance agents couldn’t of course be prodded to act with any sense of morality or ethics.

                  By the way, don’t call me a lawyer, since there’s no way I’ll sit to be certified by some State, five of the most backward of which, like Texas in its constitution, still require that a lawyer believe in god, for chrissake.

              • Allan says:

                I use insurance sales people, but I restrict myself to the good ones. As a sideline I am also an entrepreneur so I want to protect my assets and therefore I buy insurance of many types.

                I also sometimes need the services of engineers, There too I try to restrict myself to good ones.

          • Allan says:

            In Cuba, the government owns everything so that is probably the largest pool possible.

            I believe that Brazil has some type of national health plan and that involves pooling.

            But, that is beside the point. In my case I don’t believe the federal government should be involved in any large measure with regard to healthcare. It isn’t in the Constitution. You seem to be arguing with yourself.

            I am not a hospital shill and I think you insult a lot of good people. I am a private physician that has fought for individual liberty and marketbased healthcare based upon the studies, not Wikipedia. You could learn a lot from the insurance salesmen and those that understand how hospitals in America function.

            You have something to offer, I believe. I think I recognize your name from the incidental economist blog. You would have encountered me under more than one name (thrown off multiple times) because the authors of that blog have thin skin and don’t like it when solid evidence from the experts contradicts what they are saying. Lately I have been wondering what it is that you stand for, not for yourself, rather for an entire nation.

            • Jimbino says:

              Brazil has some kind of socialized medcine, but those who have some money can choose to go private. A colonoscopy here costs R$1500, only some $500, on the private market. Probably less than a co-pay under Obamacare, once you figure in the “facility fee” and the extra charges for anesthetist.

              • Allan says:

                Jimbino, I have looked a few things up, but that doesn’t necessarily mean these figures are correct. We don’t have the appropriate information to be sure of prices or much of anything else.

                $1209.5 – Average cost for Diagnostic Colonoscopy in Brazil.

                http://spotlighthealth.com/c/in/brazil/gastroenterologist/diagnostic_colonoscopy

                On THCB http://thehealthcareblog.com/blog/2014/08/27/how-much-is-my-colonoscopy-going-to-cost/

                “If you’re uninsured, this is a big question. We’ve learned that cash or self-pay prices can range from $600 to over $5,400, so it pays to ask.” …

                What we do know is that in the US prices vary considerably and those that search for less expensive cash prices can see tremendous reductions in price and frequently can find some procedures for free.

                Prices can vary considerably all over the world and so can quality. I don’t know what you are trying to prove. A lot of differences in pricing involve regulations and staffing, something that is quite high in the US. But, look at income differentials (IMF per capita income) US $59,407 Brazil $15,496. Of course anything that is labor intensive will cost more in the US. Then again look at the difference in price for a test that is comparable. Medicare pays almost $2 less for the TSH than one pays in Brazil according to your price sheet.

                Then there is quality. You wanted to call the CONCORD study “fake news” and complained there was no citation for it. You now have it available, but I haven’t heard a retraction of the “fake news” argument. There is quality in colonoscopies as well. Not everyone has the skills to do everything that can be done with the colonoscope. Not everyone has the same educational level or experience to administer the medications which affects the procedure’s quality, not everyone is as effective in sterility practices and the care of the colonoscopes. These differences are quality related and outcome related as well.

                I hope along your way in this discussion you learned a bit about how to use healthcare statistics along with the problems in their present use. We all agree prices are too high and many of us believe that the federal government should not be as involved in healthcare as the federal government is.

            • Jimbino says:

              I agree that the feds should not be involved in those things the Constitution doesn’t provide for, like marriage, education, health care and social security insurance.

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