Category Archives: Health Care

Mortality Rate vs Survival Rate

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Aaron Carroll, Zombie arguments defending the US healthcare system:

There’s a new Commonwealth Study that ranks the US [healthcare system] pretty poorly. Nothing new there. Nothing new to some of ways that people defend the US. So let’s dispense with them in rapid fashion…

He makes three points, one of which is that when evaluating the effectiveness of a country’s healthcare system mortality rates (mortality rate = deaths per year per 100,000 people for a specified illness) are a better measure than N-year survival rates (survival rate = the probability that you’ll be alive N years after diagnosis).  It’s not that survival rates are irrelevant in the grand scheme of things, just that they’re not a good measure of how effective a healthcare system is.   Here’s his explanation for why mortality rates are more relevant than survival rates:

Dylan Scott, The Toughest Questions The GOP Should Have To Answer On Obamacare

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Brad DeLong sends us to Dylan Scott, The Toughest Questions The GOP Should Have To Answer On Obamacare.  Scott’s questions follow below.  Read his post for related comments:

Three Questions For Republicans Who Want To Repeal The Affordable Care Act

  1. How would any alternative policy account for the millions of previously uninsured people who have gotten health coverage under Obamacare?
  2. Do you think covering the uninsured should be the goal of federal policy? If so, how would your alternative policy achieve that and keep insurance costs stable without an individual mandate?
  3. You have criticized President Obama for canceled policies under Obamacare. If your alternative policy is intended to expand health coverage, how would it achieve that without causing the same kind of disruption in the market?

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Lydon is back!

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Christopher Lydon will be back on WBUR Thursday nights starting tonight!   Years ago he hosted a morning program on BUR, The Connection, which was the best radio show I’ve ever listened to.  The show covered just about every topic you could imagine and Lydon was a great host – got good guests and actually did his homework before the show so that he and his guest could have an intelligent on-air conversation.  He took the job very seriously.  The Connection started off as a local program then went national after a few years – still had a Boston focus though.  Anyhow, Lydon was let go after he and the station couldn’t negotiate a new contract.  The new host was decent but the show wasn’t nearly as good as when Lydon was host.  Lydon went off to create Radio Open Source, which is what BUR will be broadcasting on Thursday nights.  I listened to a number of episodes when it was internet only – all good – but tuning in required I go a bit “off the beaten path” so I didn’t listen often.  In contrast, BUR is my default station.  I’ll be glad to hear Lydon and I’m glad he’ll be getting a wider audience again.   He’s an excellent journalist.

Archive of The Connection broadcasts here.  (I think Lydon’s last broadcast was March 9, 2001.)

Henry Aaron and Harold Pollack, Now’s Not the Time for Liberals to Say “I Told You So” About Obamacare

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Henry Aaron and Harold Pollack in The New Republic (emphasis mine):

The U.S. health-care system is far and away the most complex in the world, one that includes employer-sponsored coverage, Medicare, Medicaid, Tricare, the Indian Health Service, and small-group and individual insurance coverage—and that’s before Obamacare was implemented.  Given that complexity, some on the left say, life would be simpler if only Congress had been willing—which it was not—to scrap all current arrangements and replace them with a single, federally administered health insurance plan…

We wish ACA had gone farther. It could have provided more generous premium assistance and cost-sharing for working families. It could have allowed people near retirement to buy into Medicare. Alas, senators such as Joe Lieberman—not Obama—scuttled these possibilities. The ACA is only the first step in a long journey of needed health reforms.

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Picking a health insurance plan

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Like 55% of the population, our family has employment-based health insurance.  The open enrollment period for 2014 ended a couple weeks ago.  We had the option of continuing with the “traditional” plan we had this year or changing to one of three “High Deductible Health Plans”  (HDHP).  Ordinarily we would have simply continued on with the plan we had but the premium on the traditional plan is going up by $150/month next so we evaluated our other options.  Summary characteristics of our current plan and the plans offered for 2014:

Monthly Annual
Year Plan ID premium Premium Deductible Max o.o.p. Worst Case
2013 Health Plan $327 $3,920 $1,500 $5,000 $10,420
2014 Health Plan $477 $5,724 $1,650 $3,800 $11,174
2014 HDHP Option 1 $394 $4,728 $2,800 $3,700 $11,228
2014 HDHP Option 2 $235 $2,820 $4,500 $5,250 $12,570
2014 HDHP Option 3 $84 $1,008 $6,250 $6,450 $13,708

The plans cover the employee, his/her spouse, and all children.  The columns show monthly premium, annual premium, the deductible below which you pay 100% of your medical bills (with the exception annual your annual check-up and some other basic services which are covered in part or in full by the plan).  Once you hit the deductible then you pay 20% of the bill if you get your services in-network (and 40% if the provider is out-of-network).  For in-network you have the 20% co-pay until you hit the “maximum out-of-pocket”, at which point the plan pays 100% of your bills.  (NB:  If you go out of network then you pay 40% and there is no maximum out of pocket.  You get a significant discount but the sky’s the limit in terms of your liability.)  The “Worst Case” is the sum of the three columns to the left and is the maximum amount we’d pay for medical care for the year.   If you need a heart transplant, spend six months in the ICU after a bad accident, need brain surgery, etc. then you’d probably hit the “Worst Case” number.   For just routine doctor visits you probably won’t be out much over the premium payments.  “Worst case” is a chunk of change but it’s not so much that it would bankrupt most middle/upper-middle class people in this neck of the woods.  And that’s the point, it’s an insurance plan.  If it didn’t limit your worst case expenses it wouldn’t be insurance.

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Charlie Pierce: The Surrender Is Not Abject, So There’s That

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UPDATE:  Robert Reich addresses minimum standards for health insurance in language less colorful than Pierce’s.  (Read him if you’re not in the mood for Pierce.)

Pierce:

So the president, in the interest of finding a “middle ground” on his health-care that is approximately as real as are the Elvish lands, has decided to allow people to keep their moth-eaten, useless — but cheap! — health-care coverage for a year. This, of course, is meant to “head off” a general stampede by the Democratic chickenshit caucus…

Obama delivered a message to Americans who have complained about receiving cancellation notices: “I heard you loud and clear.” He continued: “Already people who have plans that predate the Affordable Care Act can keep those plans if they haven’t changed. That was already in the law. Today we’re going to extend that principle both to people whose plans have changed since the law took effect and people who bought plans since the law took effect.”

Translation From The Presidential Weaselspeak: OK, keep that lemon of a plan you’re so fond of, but please, shut yer gob about it now. Also, pray that you don’t need any medical procedure more complicated than a Band Aid for the next year, because that’s all you’re covered for. But… cheap! [Note:  See here for more on “junk insurance”.]

There are two fundamental dynamics at play here. Continue reading →

HealthCare.gov needs to work

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Busy couple weeks so no time for my own thoughts but here’s a bibliography of posts about the problems with HealthCare.gov and some suggestions on how to fix them.