Arnold Kling’s response to Holt, Havighurst, and Cohn is up at Cato Unbound. You know that I and Jon Cohn are going to largely find fault with Arnold Kling, while Clark Havighurst is a fellow traveler who actually says very sensible (but probably unrealistic) things about the tax treatment of health benefits.
In his response Kling agrees with my premises but doesn’t agree with my conclusions. Fancy that! Still go over there and read all the essays, because it’s good stuff!
Well worth a read — a NY Times op-ed from a Jamaican academic called The Other Losing War and this column from a Scottish Labour Party MP about prohibition in Scotland, which is causing a little fuss there.
#1 health care blogger, well actually #1 patient blogger, but probably the most important one in the whole medical blogosphere, Amy Tenderich has written a book called called Know Your Numbers, Outlive Your Diabetes about (obviously) how to manage diabetes. We don’t deal much with actual medical care over here at THCB, but for your holiday Monday I thought that an introduction to her book would be a great start. And of course who better to introduce it than Amy herself!
Forget any inkling you may have had that the media is sensationalizing the "diabetes epidemic" story. It’s real folks. In fact, the American Diabetes Association just launched a campaign called "Every 21 Seconds" as in that’s how often another American is diagnosed. Diabetes now affects the lives of 20.8 million children and adults in this country, and at the going rate, could rise to 50 million by the year 2025.
With the medications and tools available here in the US, the devastating effects of this disease are largely preventable.
Bart Mongoven is an analyst with Austin-based Stratfor.com and the author of the Stratfor Public Policy Intelligence Report. In this piece he examines the obstacles facing the Schwarzenegger health care plan on the national and local levels and reaches a contrarian conclusion — the proposal is likely to succeed after a major fight with special interests. Mongroven predicts "a victory within the year" for Schwarzenegger, a bold claim that if true will clearly have major national implications. If you’re unfamiliar with their work, Stratfor is the private corporate intelligence firm founded by political scientist Dr. George Friedman. While most of the firm’s work focuses on national security and foreign policy issues, its analysts also track domestic policy issues — as in this case. You may not agree with Mongoven’s conclusions, but his analysis is insightful and his arguments well worth noting. The piece remains copyright Stratfor.com of course. — John Irvine
California Gov. Arnold Schwarzenegger outlined
a proposal Jan. 8 for a massive overhaul of California’s healthcare system.
In his State of the State speech, the Republican governor only lightly
touched on the core elements of the ambitious plan. But as even a few details
of his proposal have become known, controversy has begun to roil.
At
present, just about no one in California seems happy with the proposal. The
California Chamber of Commerce has called it a tax on employers. The
California Nurses Association condemned it as a gift to big business.
Conservatives call it socialized medicine. Liberals say the
pro-health-insurer GOP has co-opted the proposal.
National interest
groups, meanwhile, have been silent. The voices of business — the U.S.
Chamber of Commerce and the National Federation of Independent Businesses —
have not issued press releases either supporting or criticizing the proposal.
National labor organizations are not issuing press releases, and neither are
healthcare advocacy organizations, like the AARP or Families USA. On the
surface, a number of reasons explain why the national organizations have left
this battle to state lobbyists in Sacramento.
Up at Spot-on I’m discussing Arnie’s plan — Sacramento, We Have A Problem. As ever, return here to comment.
When looking at the Golden State’s governor, Arnold Schwarzenegger, and
his attempt to fix health care, I am reminded of a movie. Not one of
his, rather the scene in Apollo 13
when the crew on the ground had to figure out some wacky mechanical fix
that would enable the guys out in space to filter their oxygen without
using more than the two amps of power they had available. It seems that
we have a similar situation. The prognosis is grim, but the political
reality is that, like the Apollo crew, we need to use the limited
resources at hand.
Schwarzenegger taken on a big job and, it seems, entering his final
four years as governor – a political career that began on a whim – he
doesn’t much care who he takes on. Given that California is roughly 10%
of the nation, with a higher than 10% share of the nation’s uninsured,
most people were expecting that Schwarzenegger would identify covering
all children as the extent of his health-care ambition. Children are
politically palatable – when it comes to health and medicine. But
Schwarzenegger didn’t stop with the children. Instead he actually
believed all the stuff he was saying about all options being on the
table to cure the system and has acted accordingly.
In an address on Monday he introduced a plan
that actually went further towards universal coverage than the one
State Senator Pro Tem Don Perata introduced late last year.
Schwarzenegger called for full universal coverage, and promised to get
there by a mix of what’s known as pay or play – a mandate that
employers must cover their employees or pay a tax – and an individual
mandate compelling citizens to buy health insurance. The details of the
plan are very complex but understandable. Continue Post …
Meanwhile as you might expect, two of the more sensible editorials about the Schwarzenegger plan have been written by Leif Wellington Haase (Century Foundation) and Jonathan Cohn (New Republic). They’re both somewhat more optimistic than I am that a) something will happen, and that b) the rest of the country will pay attention.
California’s single payer-proponent Sheila Keuhl, as you’d expect, doesn’t think that Arnie’s plan will work. Don McCanne from PNHP has some details on why not
As I said over at Cato, I am rapidly coming to the conclusion that we’ll screw around for a while and then in a decade or so the whole thing will implode into a bare-bones single payer system. But I hope all this commotion proves me wrong.
UPDATE: If you missed Thursday’s press conference, you can
watch a webcast of the whole thing
here. If so inclined, you can also read the full text of the proposal
here.
(Achtung! pdf)
SEE ALSO:
SPOT-ON : Fashion and Fads in Health Care Legislation POLICY: It’s all the illegal Austrian socialist’s faultPOLICY/POLITICS: I love the guy’s moxie
Not exactly but I am up at Cato Unbound with a piece replying to Arnold Kling’s fascinating essay "Insulation v Insurance." Read his first, then read mine. It’s called Abundance Is Insulated from a Crisis–For Now.
In his insightful book and in this interesting essay, Arnold Kling
has made several leaps forward from the pack of “America-first free
marketeers." If you want to see them in action, take a look at the comments page
of any blogger who dares to suggest that spending nearly double what
its economic competitors are spending on health care—primarily because
it is paying its providers more for more or less the same volume of
services—may mean that the U.S. is not getting too good a deal.It’s
apparent to any serious student of health care that the impact of
medical care on overall raw measures of health is not sufficiently
important that differences in spending here or there makes too much
difference to health. The somewhat pedantic arguments over life
expectancy and infant mortality, and the slightly more real ones over
the appropriate treatment of predominantly elderly people with serious
diseases, are all massively less important than the political and
medical culture in which the health care system exists. So there is
broad agreement, I believe, among most rational observers that the
activities Kling describes as "premium medicine" are far more in the
interests of providers and suppliers (including those middlemen who
mark up the price without taking on much risk) then they are in the
interest of patients&mdash, and certainly of society as a whole. Continue.
BTW before the brickbats start flying; “loony libertarian” is a term of affection. Actually most of the Cato guys are very sensible libertarians whom I agree with on almost all social & civil liberties issues.
Last year LifeMasters pulled out of one of the Medical Health Support DM pilots in rural Oklahoma because they found that adhering to the proper standards of care made the cost of care go up for those patients they enrolled, not down.
Now Healthways, the largest DM for-profit company, which has the greatest number of the Medicare Health Support pilots, appears to be seeing some big problems too.
MHS Pilots Based on the receipt of essentially complete first-year data which revealed smaller separation from the control group than reflected in previous reports, the Company’s net per share costs in the MHS pilots for the first fiscal quarter of 2007 totaled $0.10 per diluted share, $0.04 more than previously estimated. For the first 15 months of the pilots, per member per month (PMPM) beneficiary costs, including inflation, have been held flat, which the Company believes reflects meaningful impact resulting from program interventions. To date, however, the control group costs as reflected in the most recent report released by CMS’ third party actuarial firm are also unchanged, and do not reflect anticipated increases provided by CMS nor the results of historical national and regionally-specific trends identified by third-party actuarial analysis of the Standard Analytical File (better known as the Medicare 5% Sample). The Company has brought this issue to CMS’ attention and has received the Agency’s commitment to pursue understanding and resolution of this anomaly in a timely manner.
While the Company has no direct control over the timing of this review by CMS, it will communicate progress toward resolution. Based on the strength of the Company’s performance with the intervention group, particularly as compared to the Medicare 5% Sample data, as well as the questions raised by the unanticipated trend of control group costs, the Company is maintaining its fiscal 2007 guidance related to the MHS pilots until this issue can be resolved to the satisfaction of all parties.
In other words either Medicare has got the data wrong about its control group, or the control group is healthier than average, or (gulp) DM doesn’t save money for the sick Medicare recipients group. And so the DM companies, which have promised CMS that they’re going to pay them 5% savings for the sick group (and make their money on the reduction from there!), are going to be losing money.
Healthways stock is down around 15% over the last week as this news seems to have seeped out. But it’s PE ratio is in the 40s, and the stock price went up more than five fold 2003–6, suggesting that the market is expecting it to continue its quick growth. If MHS is deemed a failure, there may not be any growth. Watch this space.
(Thanks to Fred Goldstein for this tip).
Say what you like about Arnold, but you got to give him credit for being a proper flip-flopper with real moxie. While Bush drowns in his stay-the-course quagmire, Arnold has repudiated basically everything he claimed to care about when he first came into office, and is now running like the unaligned centrist everyone thought they were voting for back in 2003.
Today he called for universal coverage based on a comprehensive pay or play, surrounded by an individual mandate. He even brought back the notion of provider taxes, a beast last seen in the wild in the pre-HillaryCare years, but thought to be extinct having been shot by the AMA and AHA back then.
But my favorite of all is the fact that the pay-or-play employer mandate he’s calling for includes all employers with more than 10 employees. In November 2004, just 26 months ago, he told people to veto Prop 72, which had a pay-or-play system for employers with more than 20 employees. Boy, times and people change, don’t they!
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