Over at Signal Health Tom Hilliard has been having an entertaining time with Mark Pauly and the boys from Cato. Go over there and take a look at the latest round of back and forth. Suffice it to say that if Mark Pauly had to buy his insurance in the individual market rather than receiving from the Ivy League Ivory Tower he sits in, I suspect that he would be rather more concerned about the way the individual market works, particularly the 20% he acknowledges doesn’t work well.

Meanwhile, Eric Novack and I are both reading Cato’s Michaels Cannon and Tanner’s latest work which is out today. (I had planned on a pre-publication review but then again…) We’ll be discussing it in another podcast sooner or later, but you’ll get the basic idea from the SignalHealth discussion.

Meanwhile, Health Affairs has some numbers out about the rise of the HDHP and the HSA.  You can see the full article here. But here’s the abstract pull:

Almost 4 percent of employers that offer health benefits offer one of these arrangements in 2005, covering about 2.4 million workers. Deductibles, as expected, are relatively high, averaging $1,870 for single coverage and $3,686 for family coverage in high-deductible health plans with an HRA and $1,901 for single coverage and $4,070 for family coverage in HSA-qualified high-deductible health plans. One in three employers offering a high-deductible health plan that is HSA-qualified do not contribute to HSAs established by their workers.

The last line is by far the most significant (hence my bolding it).  Even though the HSA is supposed to be the employees benefit, in fact in a third of the cases setting up a HDHP is straight cost-shifting to the employee. You were getting something and now you’re getting nothing to deal with the first chunk of medical expenses. So at least those employers have figured out how not to screw over their own risk pools (assuming that they keep some of that money that would have ended up in the HSAs in reserve to cover the expensive cases). You know that the rest of them will go down that path too — in fact a survey that was covered in this THCB article confirmed it a while back. Oh, the joys of a "jobless recovery".

And of course employers are getting out of the game of providing insurance anyway.  Another Kaiser Foundation survey this morning confirms that the percentage of employers offering insurance has gone from 69% in 2000 to 60% in 2005. In effect the HDHP over time offers the employer a way to get out of the game without having to bear the shame of leaving the field completely.

This of course continues to boil the frog….

Finally, it does make me chuckle that in the comments to this post about Medicare Part D, Eric Novack is apparently appalled that a combination of lobbying from drug companies, PBMs, health plans and providers mixed in with the endemic scratch my back corruption of the current Administration and its leaders in Congress ended up with a welfare plan for them all called Medicare Drug Coverage. But it’s a little weird that he thinks that the water-carriers for the Administration over at Heritage are actually surprised. The guys from Cato might be forgiven for being true believers, but Heritage, AEI and the rest sold their souls long ago, and know exactly how they’re dealing with.

CODA: I hate to link to Tech Central Station given how dishonest it is in its lack of transparency, but if the funny Cato boys will insist on writing there, then this one from Randy Balko is worth a chuckle.

With all the BSing that’s gone on from the Administration about what went wrong and finger pointing, there is clearly much blame to go around. I’m impressed that New Orleans mayor Ray Nagin went ballistic when nothing was happening last Thursday night, but there are reasonable questions being asked of him by the right wing bloggers about why he didn’t or couldn’t use the city’s municipal and school buses to evacuate people in advance of the Hurricane or after it (I assume that after it he didn’t have anyone to drive the buses). Not that of course those questions are being asked in a particularly nice way, but I won’t discuss my last post or Nagin’s ethnicity.

However, even if there is local and state blame, that doesn’t absolve the Bush Administration for two reasons.  The first one is that there is a clear line of command in these situations, and this comes straight from Bush’s mouth on August 28, the Thursday before the storm.

THE PRESIDENT: This morning I spoke with FEMA Undersecretary Mike Brown and emergency management teams not only at the federal level but at the state level about the — Hurricane Katrina. I’ve also spoken to Governor Blanco of Louisiana, Governor Barbour of Mississippi, Governor Bush of Florida, and Governor Riley of Alabama. I want to thank all the folks at the federal level and the state level and the local level who have taken this storm seriously. I appreciate the efforts of the governors to prepare their citizenry for this upcoming storm. 

Yesterday, I signed a disaster declaration for the state of Louisiana, and this morning I signed a disaster declaration for the state of Mississippi. These declarations will allow federal agencies to coordinate all disaster relief efforts with state and local officials. We will do everything in our power to help the people in the communities affected by this storm.

In addition here’s an article which basically shows that even within all the bureaucratic BS going on, the Federal government is in charge in a disaster situation, and FEMA has the ability to do basically what it likes–which those of you hooked on The X-Files know has always been the case (although alien takeovers weren’t the issue last week)

But the main point is that, whatever the bureaucratic BS, a real leader would have got those buses into New Orleans and got the people out by Wednesday at least. That would have to be a Federal effort rounding up a few hundred buses in neighboring cities and getting them into New Orleans, while setting up tent cities to deal with the volunteers. It was this lack of action after the flood between Tuesday night and Friday morning that is the really criminal part, and even if the locals had screwed up, that does not mean that the Federal government is absolved of blame. We needed Presidential leadership, and we got little boy lost — again.

And as for health care, that goes for the evacuation of the hospitals too. It’s clear that that ended up being largely a private effort (and well down to HCA’s management which really stepped up in the crisis when it realized that the Feds weren’t helping.  Perhaps we should have completely for-profit private health care organizations so that all rescue efforts can be run out of Nashville! But if that’s not going to happen, and if every victim isn’t going to be in a hospital — as is clearly the case — then we have to depend on the Federal government.  After all this is the same Federal government that’ll move heaven and earth to make sure the sick people don’t smoke pot.

UPDATE: Brown was basically fired this afternoon–one week after Bush said "Brownie, you’re doing a hell of a job".  Odd.  Usually these incompetents get awarded the Presidential Medal of Freedom.