For ex-Yazuka members: prosthetics to replace severed fingers. HT: Tyler Cowen
Henderson on Keynes. Unusual and interesting.
Let’s see if I have this right. People who answer to Barack Obama have the ability to detect all of the phone calls to and from Mitt Romney and all of the phone calls those people make. So, in the blink of an eye, they could know basically who is important to the Romney campaign — as employee, as financial backer or as supportive in some other way. And without asking for any court order or going before any judge, they would be able to tell whether a call was made to a mistress, a call girl service, a gay bar, etc. The monitors would know who is vulnerable, who could potentially be bribed, who could potentially be smeared. But of course, no one at the NSA would actually do this because that wouldn’t be fair, wouldn’t be gentlemanly and…hmmm…maybe wouldn’t even be constitutional.
I’m not the first to think of this. See David Friedman.
In a classic article, Stanford University professor Kenneth Arrow argued that the market for medical care is inherently flawed because of asymmetric information. In what follows, I am going to embellish on the argument, making it even more forceful than it was in the original text.
The doctor knows more than the patient. As a result, doctors can recommend unnecessary care that enhances their incomes, even though it may be of no benefit to the patients. Doctors might also recommend one drug over another or one medical device over another because of their financial relations with the producers. Because of their limited knowledge, patients have no reliable way of evaluating the quality of the advice they are getting ― especially when they get different advice from different doctors.
About the only check on the system is third-party payer utilization review. But this is crude and highly imperfect activity engaged in by another party that has a financial interest in the outcome.
Arrow said this flaw in the market justifies occupational licensing and other government restrictions on doctor behavior. Health economics textbooks have generally accepted Arrow’s critique, holding that the free market for medical care has no answer to the problem.
In recent years, hospitals have become increasingly open with patients: over 80 percent of hospitals in my study have a policy of apologizing to patients when errors occur. And hospitals are more willing to discuss and learn from errors with hospital staff.
Here is more.
This is from Avik Roy:
The law requires that every employer with 50 or more “full-time employees” offer “minimum essential coverage” in an “affordable” manner…
The penalty is triggered if at least one employee seeks federal exchange subsidies instead of gaining insurance form his employer. In that case, the employer will have to pay a non-tax-deductible fine of the lesser of $2,000 times the number of full-time employees ― 30.
If the employer does offer a health plan, but it isn’t “affordable” to all workers or fails to meet the “minimum essential coverage” requirements, then the employer pays the lesser of the fine described above, or $3,000 times the number of full-time employees receiving exchange subsidies.
What does this mean in reality? It means that employers have an incentive to offer coverage that is either “unaffordable” according to ObamaCare or that fails to meet the law’s “minimum essential requirements.” That way, the employer pays a penalty only for those workers who gain subsidized coverage on the exchanges. So the best way for employers to “dump” coverage onto the exchanges is not by offering no coverage at all, but by offering coverage that doesn’t meet ObamaCare’s requirements.
“We saw it happen almost overnight,” [State Senator Diane J. Savino] said, describing programs that sprang up in sites like former auto-shops and part-time banquet halls in neighborhoods like Brighton Beach and Manhattan’s Chinatown, siphoning off low-income immigrant seniors from regular senior centers, “and basically stealing Medicaid dollars to do it.”
“We’re dealing with the unintended consequences of a very good initiative,” she added, referring to the Cuomo administration’s Medicaid redesign, which has rapidly transferred tens of thousands of elderly and disabled people from a fee-for-service system to managed care, in an attempt to reduce Medicaid spending and nursing home use.
Under the new system, managed care plans get roughly $3,800 a month for each eligible person they enroll in New York City, regardless of what services are provided. The plans contract with the social adult day care centers to provide services to their members. But advocates for the elderly and for people with disabilities have warned state officials that some plans were “cherry-picking” healthy seniors by using the new day care centers as marketing tools, while shunning the people who needed hours of costlier home care.
Joan Pastore, director of Amico, a city senior center in Dyker Heights, Brooklyn, said members of the center told her that they were not only signed up by new centers with enticements like $100 in cash and $50 for bringing a friend, but “coached on how to lie to qualify for home care.” (NYT)
Bloomberg is reporting that states hungry for revenue and flush with the power to requisition individual medical records are moving to capitalize on the value of that information by selling the information in them to all comers. Unlike private companies, states and their agents are exempt from HIPAA requirements and therefore do not have to take data privacy especially seriously.
In an experiment, researchers were able to match several dozen people with their supposedly de-identified medical records by combining public record searchers and the information in a sample group of records purchased for $50 from Washington State. Among other things, “an executive treated for assault was found to have a painkiller addiction,” and a “retiree who crashed his motorcycle was described as arthritic and morbidly obese.”
Bloomberg reports notes that states that exclude zip codes, and admission and discharge dates are less vulnerable to records identification. But even “de-identified” data sets contain significant personal information that could be used to identify individuals, especially in rural areas with small populations.