Monday, June 12, 2017

More wind-spitting (health insurance take whatever)

Today's call to John Faso's office was to confirm that he still hasn't found the spine to have an opinion about the Congressional Budget Office's analysis of the bill Faso voted for, the trillion-dollar tax cut dressed up as a health-insurance bill.

And no, he doesn't have an opinion that he's willing to share.

It seems like there are three reasonable choices:
  1. Accept the CBO’s findings
  2. Put forward your own findings, with an equal level of transparency as to how you made your estimates
  3. Admit you really don’t care what effects the law will actually have.
If Faso’s not willing to say what effect he thinks the law will have on people’s ability to get health insurance, it’s hard to avoid the conclusion that that’s absolutely unimportant to him.

The staffers always want to have a message to pass along. So I asked the Congressman to be honest with his constituents about how you think the AHCA will affect their health insurance, or stop pretending to care about our well-being.


  1. Hi Karl, thank you for your efforts. I am wondering if you--as an economist interested in healthcare--would have any take on what I consider a bizarre editorial that just came out in the Washington Post: Single-payer health care would have an astonishingly high price tag. I also find it astonishing that this is endorsed by the Washington Post editorial board. I put up a quick comment about what I think is bad math and crazy assumptions. But would be grateful for any thoughts!

    1. Your comment at WaPo hit the highlights (a related case could also be made for VA spending).

      The figure of 32 trillion over 10 years is essentially dishonest. As you observe, that's spending that would be moved to the government from other sources, like individuals and corporations. But more precisely, it's spending that would be moved to the _federal_ government from all other players, including from state and local governments (see p. 6 of the report). Total _government_ spending would go up a lot less than 32 trillion.

      A more meaningful number is earlier on p. 6, when they say national health expenditure would increase 6.6 trillion over 10 years. That's still pretty large, but it's a lot less than 32 trillion.

      I've only skimmed the report, but I didn't see where they accounted for the cost reductions of people having continuous insurance and therefore getting moderate-cost treatment for conditions before they become high-cost problems for Medicare to deal with. It's bad logic to simply extrapolate out the cost of treating people who've been denied preventive care over many years and treat that as representative of the long-run cost of the system.

      The WaPo adds to the Urban Institute report by pointing to the real political obstacles to lowering costs: you can't keep down drug prices because Pharma is powerful; you can't control doctors' compensation because the AMA is powerful.

      The problems they point to are real, but it's a cop-out to use those an excuse to do nothing. As Atul Gawande documented about 10 years ago, medical costs can vary by at least a factor of 2 between locales without making health outcomes worse, just based on structures of payment and ownership. If our society doesn't want to adopt effective structures of payment and ownership, that's a choice we can make (it's a choice we have been making), but it's a lame excuse to avoid universality.

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