There is More Income Mobility than You Think

 

It turns out that 12 percent of the population will find themselves in the top 1 percent of the income distribution for at least one year. What’s more, 39 percent of Americans will spend a year in the top 5 percent of the income distribution, 56 percent will find themselves in the top 10 percent, and a whopping 73 percent will spend a year in the top 20 percent of the income distribution…

Likewise, data analyzed by the I.R.S. showed similar findings with respect to the top 400 taxpayers between 1992 and 2009. While 73 percent of people who made the list did so once during this period, only 2 percent of them were on the list for 10 or more years. These analyses further demonstrate the sizable amount of turnover and movement within the top levels of the income distribution. (NYT)

What are the Financial Risks of Being Uninsured?

 

Previously, Chris Conover showed that the medical risk of being uninsured is small:

…[T]he evidence that having health insurance will reduce mortality risk by any significant amount is pretty thin…even if we assume that having coverage reduces the chance of early death by 22 percent, this is comparable to a half dozen other risks that people face. For the same amount as we are spending to expand coverage under ObamaCare, we could save eight times as many lives by focusing on other causes of death such as smoking.

See also his analysis of the claim that failure to expand Medicaid kills people and Linda Gorman on the same subject at this blog.

In his latest post, Conover shows that the financial risks are small as well:

I have calculated the medical bankruptcy risk facing those with continuous coverage at 1.25 per 1,000. Eliminating this difference would evaporate the risk of medical bankruptcy for 1.89 people out of every 1,000 uninsured Americans every year.

…[I]f having coverage could reduce bankruptcy risk by 1.89/1,000, what would that mean? First, the overall difference in bankruptcy risk (inclusive of medical and non-medical causes) between those with health insurance and those without is 10.7 per 1,000, so eliminating the “excess” risk of medical bankruptcy that we are assuming can be attributed to lack of health insurance coverage would shrink this difference by less than 20%. Perhaps more astonishing, such a reduction would shrink an uninsured person’s overall bankruptcy risk by a mere 11% (from 17.9 to 16.1 per 1,000).

Headlines I Wish I Hadn’t Seen

 

nutrition-labelAre serving sizes on food packages intentional attempts to mislead us? No, they are dictated by the government.

Medicare kept paying dozens of doctors after they were suspended or terminated from state Medicaid programs or were indicted or charged with fraud.

Terminal cancer patients in Russia are sent home to die; can’t get pain medication; some are committing suicide. (HT: Jason Shafrin)

Patients at risk: More than 100,000 doctors, nurses, medical technicians, and healthcare aides abuse prescription drugs.

We’re Looking More and More like Canada

 

doctor-mom-and-sonPatients — and physicians — say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements. It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes. And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems.  (KHN)

How Dirty Is Your Money?

 

money_1By analyzing genetic material on $1 bills, the NYU researchers identified 3,000 types of bacteria in all — many times more than in previous studies that examined samples under a microscope. Even so, they could identify only about 20% of the non-human DNA they found because so many microorganisms haven’t yet been cataloged in genetic data banks.

Easily the most abundant species they found is one that causes acne. Others were linked to gastric ulcers, pneumonia, food poisoning and staph infections, the scientists said. Some carried genes responsible for antibiotic resistance. (WSJ)

Lying With Statistics?

 

Scot Winship reviews Thomas Piketty’s book, Capital in Twenty-First Century:

The Piketty and Saez data for the U.S. indicate that between 1979 and 2012, the bottom 90 percent’s income dropped by over $3,000.

But this ignores transfer income, such as Social Security. It ignores employer benefits, such as health insurance. And it ignores charges in household size over time.

When I incorporate these improvements using the Census Bureau data, I find that median post-tax and -transfer income rose by nearly $26,000 for a household of four ($13,000 for a household of one) between 1979 and 2012.

Does Failure To Expand Medicaid Kill People?

 

Who’s killing whom?

Writing in The New York Times the other day, Paul Krugman had this to say:

And while supposed ObamaCare horror stories keep on turning out to be false, it’s already quite easy to find examples of people who died because their states refused to expand Medicaid. According to one recent study, the death toll from Medicaid rejection is likely to run between 7,000 and 17,000 Americans each year.

Really? 17,000 deaths per year? This outrageous claim flies in the face of years of careful study by real economists — who have concluded that there is almost no relationship between health insurance and mortality in the general population. As we previously reported:

In independent empirical papers, Richard Kronick and David Card and his colleagues find little evidence that health insurance coverage significantly reduces mortality. Former Director of the Congressional Budget Office June O’Neill and her husband Dave also conclude that lack of insurance has little or no impact on mortality. See the discussion at this blog here, here and here.

So where does Krugman’s claim come from? Not from economists, it turns out, but from a Health Affairs blog post  by Sam Dickman, David Himmelstein, Danny McCormick and Steffie Woolhandler. And notably, they do not do what serious scholarly papers do — acknowledge the work of other scholars who have addressed this same topic.

Their numbers rely on surveys known to overestimate the uninsured and on results from papers with methodological problems that are both serious and widely known. Their claim that failing to expand Medicaid in conformance with ObamaCare dictates will kill somewhere between 7,115 and 17,104 people a year confuses ideological posturing with scholarship.

Knock, knock, knockin’ on heaven’s door

ObamaCare in the Granite State

 

The only exchange option afforded to consumers comes from Anthem Blue Cross and Blue Shield, a unit of WellPoint. The insurer built a narrow network that lowered premiums by 25% or 30% while still complying with ObamaCare’s other mandates…

…Of the 26 in-state acute care hospitals, 10 were booted from Anthem’s network (not counting emergency services). Even the state capital of Concord was shut out, and the coverage gaps are wider because so many primary care and specialist practices are now owned by health systems.

The Granite State didn’t lack for insurers before. Anthem dominated with 40.7% of all private policies, but strong rivals included Harvard Pilgrim (20.4%), Cigna (18.7%) and Aetna (7.8%). Anthem did have a 76% share of the individual market, but aren’t the exchanges supposed to increase competition? (WSJ)

Are We Winning the War Against Diabetes?

 

Federal researchers on Wednesday reported the first broad national picture of progress against some of the most devastating complications of diabetes, which affects millions of Americans, finding that rates of heart attacks, strokes, kidney failure and amputations fell sharply over the past two decades.

The biggest declines were in the rates of heart attacks and deaths from high blood sugar, which dropped by more than 60 percent from 1990 to 2010…

Beyond the declines in the rates of heart attacks and deaths from high blood sugar, the study found that the rates of strokes and lower extremity amputations — including upper and lower legs, ankles, feet, and toes — fell by about half. Rates for end-stage kidney failure dropped by about 30 percent.

Unfortunately, diagnoses continue to increase: “The number of Americans with diabetes more than tripled over the period of the study and is now nearly 26 million.”

(Sabrina Tavernise & Denise Grady, New York Times)

Why We Spend So Much on Drugs

 

The editors at Bloomberg explain:

prescription-bottleHere’s how the system works: When a doctor administers a drug in his or her office, Medicare pays 106 percent of its average selling price. The doctor keeps the extra as compensation for administering the injection.

What has this got to do with eye doctors? The drug Lucentis, used to treat macular degeneration, cost Medicare almost $2,000 a shot in 2012. Another drug, Avastin, which works just as well, costs about $50. If you were the doctor, faced with a system that pays you 6 percent of the drug’s cost, which would you choose? That Medicare spent a total of about $1 billion on Lucentis in 2012 suggests most ophthalmologists went with the more expensive one.

It gets worse:

This problem goes beyond a single drug. Of the $20 billion Medicare spent on drugs administered by doctors in 2010, 85 percent went to the 55 most expensive ones. In what seems unlikely to be a coincidence, 42 of those drugs also showed an increase in use from 2008 to 2010.