John Cole takes me to task for not knowing that health insurance premia have tripled in New York State. Indeed, he's right--I should have checked.
But this is not the "gotcha" the left believes. I erred so low because I was trying to be charitable to the cause of national health care. You see, the reason that insurance premia are so high in New York State is that New York State enjoys community rating, guaranteed issue, and a very generous bevy of mandatory services. The result is that the cost of insurance is very, very high. What I failed to realize was just how radically out of line New York's rules had pushed its health care costs. The average premium across the United States has increased about 25% since 2004. In New York, the rate of inflation has apparently been about 16 times that. I wasn't "aware" that insurance premiums have doubled and tripled over the last seven years, because for the country as a whole, this isn't true.
So yes, John, the Atlantic's economics expert didn't realize just how much the kind of regulations Democrats are now pushing had managed to screw up New York's health insurance market. In trying, while writing a blog post on the fly, to err on the side of charity towards my ideological opponents, I grossly misled my readers. Massive state interference in the insurance market is clearly much, much worse than I--the eternal pessimist!--managed to imagine. Thanks for calling that oversight to my attention.
Copyright © 2010 by The Atlantic Monthly Group. All rights reserved.
Megan, this is a gotcha not because of any flaw in your reasoning, but because you constantly talk as if you're an expert on things about which you're not really informed. If you were, you'd know the basic facts about them.
You make sweeping, unsubstantiated claims like "the government screwed up NY's private health insurance" but you don't know jack crap about NY's private health insurance. How are we supposed to think anything other than that you're an ideologue? You admit to being ignorant yet you have an opinion anyway! Then you tell us that your ignorance doesn't matter! Seriously, examine yourself for one damn second, woman.
Any chance you'll stop thinking that "premia" is a word? Seriously, you're like one of those kids that learns the "rules" for past tense and starts saying "runned" all over.
I'm a little confused. Did you have a little problem understanding her post. The corrected numbers made her point even stronger. I'm sorry but she knows what she is talking about.
did you have a problem understanding my post, because I explain my criticism clearly in it. See, if you make an argument while being ignorant of all basic facts regarding the subject on which you're arguing, it doesn't really matter if you're right or wrong. You can pull the correct answer out of your ass.
I don't concede nor address the veracity of her argument, merely the fact that she is ill equipped to argue on the topic at all, which is, to my interpretation, John Cole's point.
See, in reading comprehension, it's a good thing to focus on what the author does discuss. If the author makes not attempt to address an issue, it's safe to say he's not arguing about it. I did not address the issue of Megan's right or wrongness vis-a-vis NY health care because it seems irrelevant in the face of Megan's ignorance of NY health care.
Spelled out clearly enough, Mr Waterman? She doesn't know what she's talking about illustrated clearly enough by the fact that one of the few "facts" she cites is in fact, wrong.
Well, we could start with the idea that what you have here is not a "post" but a "comment." These are frequently confused in the blogosphere, but the definitions are really pretty clear cut.
So the rightness or wrongness of your genre identification might not matter - but it certainly bothers me.
Just for completeness.
Also, premia is a word.
Examine yourself for one damn second, man!
http://dictionary.reference.com/browse/premia
http://dictionary.reference.com/browse/premium
and the red underline in spellcheck is another clue.
God you people are stupid.
Just for completeness.
(replying to Nutella on Toast @7:55 here as comments only nest finitely)
http://en.wiktionary.org/wiki/premia
Also, it's antiproper to depermit the pleasurette of verbongeny to profoundular thinkerizers like our Megan.
(apologies to Peter da Silva).
Nutella, you are wrong. Google "definition premia" and follow some of the links, or go to a physical library and check an unabridged dictionary.
Webster's online concedes that it's a word, but it's one of the extra-high-quality words that you have buy a subscription to Webster's unabridged online to read about.
http://www.merriam-webster.com/dictionary/premia
I assume you concede that if a word is in unabridged english dictionaries, it is, in fact "a word", even if it's not in the abridged dictionary you favor.
http://en.wiktionary.org/wiki/premia
Heh. This comment has it all: an ad hominem slur against Megan, another against the rest of us, and embarassingly wrong factual assertion.
Definitions of premia on the Web:
Premia is a comune (municipality) in the Province of Verbano-Cusio-Ossola in the Italian region Piedmont, located about 140 km northeast of Turin ...
en.wikipedia.org/wiki/Premia
plural of premium. (see also premiums)
en.wiktionary.org/wiki/premia
God, Nutella is stupid.
Hmmm...according to the history data this so called word "premia" was entered into Wiktionary by someone named Megan McCardle on Aug07,2009 at 0945EST.
I kid.
The "word" was first entered by someone named TheDaveBot back in October 2006.
Personally, I'll wait until it appears in the OED or the Urban Dictionary before I give it any credenceness.
Not to mention that it didn't take an Ezra Klein post: I flagged the issue and linked to the NY state insurance commissioner's web site with county-by-county HMO rates within minutes of Meagan's initial post.
She noted my comment but didn't correct her post, which would have been easy to do since I'd handed her the data.
^ John Cole, not Klein.
I hate to pick on someone who is so obviously mentally retarded but....
Its premia or premiums. Latin-origin words like premium (originally praemium) can use the Latin-style -um or anglicized -s endings.
The more you know! :D
http://en.wiktionary.org/wiki/premium
Your original was back to 2001.
http://www.abc.org/Newsroom2/News_Letters/6/38/Newsline_New_Survey_Finds_87_Percent_Increase_in_Health_Care_Premiums_Since_2000.aspx
"Premiums for health care coverage in the United States have increased 87 percent since 2000, according to a survey released Sept. 26 by the Kaiser Family Foundation and Health Research and Educational Trust.
The “2006 Employer Health Benefits Survey” also determined that health care premiums increased 7.7 percent in 2006, which is more than twice the rate of increase for workers’ wages (3.8 percent) and overall inflation (3.5 percent). "
Pretty graph:
http://www.hsafinder.com/Employer-Healthcare-Premiums-Up
Any chance you'll stop thinking that "premia" is a word? Seriously, you're like one of those kids that learns the "rules" for past tense and starts saying "runned" all over.
It actually is a word. "Premiums" is also acceptable, but that does not mean "premia" is wrong. Look it up in a dictionary.
So maybe you want to stop "talk(ing) as if you're an expert on things about which you're not really informed"
http://dictionary.reference.com/browse/premia
http://dictionary.reference.com/browse/premium
and the red underline in spellcheck is another clue.
God you people are stupid.
Sir, I know this may shock you and force you to confront the inherent flaws in your entire worldview, but dictionary.reference.com is not an exhaustive compendium of English words. You might want to do a Google search and see how many other online dictionaries list the word as the plural of premium. You might want to also see hundreds of other webpages that use premia as the plural of premium, for example "risk premia".
Her argument lacks the ad hominem attacks that your argument contain.
Now that you succeeded in insulting McArdle and "you people" in the comments section, you win.
"this is a gotcha not because of any flaw in your reasoning"
So you agree with her point?
God you people are stupid.
RACIST!
FYI, the red underline also appears under floccinaucinihilipilification, which is clearly a word with a honorificabilitudinitatibus pedigree, so I wouldn't put too much faith in that.
Speaking as a professional copy editor (that is, someone who gets paid to practice prescriptive grammar) who has edited hundreds of economics journal articles and several scholarly books, I have a couple of things to say about this:
1. No one professionally competent in copy editing takes the results of a spell check as conclusive. My personal spell checker contains hundreds of words and phrases that I have added since I acquired it . . . and still I add new ones every week, some because I have verified them in other ways, and others because I have a better vocabulary than the people who program spell checkers.
2. In English usage, Latin plurals and English plurals have slightly different functions. One uses the English plural for a word that has become assimilated into the English vernacular; one uses the Latin plural for a word that is still thought of as being of Latin origin. Similarly for plural forms from other non-English languages. Some words have both plural forms!
3. In the economic papers I have copy edited, "premia" seems to be marginally more common than "premiums," marking it as a scholarly or technical term. The difference may be that one refers to "premia" when analyzing, technically, why a price is higher than expected, but "premiums" in talking about things that stores offer to their customers, or payments that people make for insurance policies . . . everyday commercial transactions of various sorts.
4. The mark of an incompetent copy editor is heavily handily laying down rules for proper usage and applying them indiscriminately in all contexts.
One of the things that makes reading Megan's column enjoyable to me is that her prose usually strikes me as literate and linguistically sensitive. I would not have paused for a moment at her use of "premia," if I had been hired to copy edit her column.
You must be a Juan Cole kind of guy:
datum/data premium/premia
I guess you never took any Latin.
Also:
http://www.stanford.edu/~wfsharpe/mia/prb/mia_prb2.htm
"Risk Premia
The difference between the expected return on a security or portfolio and the "riskless rate of interest" (the certain return on a riskless security) is often termed its risk premium. Underlying the terminology is the notion that there should be a premium (higher expected return) for bearing risk. As we will see, however, there is no reason why such premia should be associated with all types of risk.
An equivalent definition of a risk premium is: the expected excess return on a security or portfolio, where excess return is the difference between an actual return and that of a riskless security. "
Finally, it is particularly stupid to claim spell check is an authority on valid words. (Notice, my spell checker claims "riskless" is misspelled. Maybe that means it is not a valid word. Ya' think?).
Rick
And, as usual, your math is off. From 2004 to 2008 is 4 years. 27% (12680/9950=1.274. Were you too tired even to do the division?)in 4 years is about 6% a year.
A 7 year run on the Kaiser numbers is 80%. And if you look at page 7 of the report, that's not comparing the same plans. There's been a major trending towards higher deductibles and co-pays, which has kept costs down. As well, of course,as the increasingly ruthless practices of recission and denial that make insurance a crapshoot.
Plus, um, your last post was talking about individual rates, and this is about groups. Not the same thing (or were you really basing your idea of what an individual would pay on what you paid in a group plan?). Any more than New York has a 96% annual inflation rate in group policies. (Were you too tired to multiply 6*16?)
I'm always curious about what industry does behind the scenes when state mandates kick in.
I gotta wonder, what was the insurance industry saying in the hearings that would have proceeded those mandates on service?
But I'm cynical because I've sat through too many hearings where the only members of the public attending were me in my role as a reporter and the insurance industry's lawyers. And usually, the press isn't there, it's too expensive.
Did those 'mandatory' services turn into a honey pot for industry? (Medicare Part D, anyone?) The guarantee of regulatory capture through both legislation and rule making is my biggest concern about health care reform.
People, please don't feed Nutella. Check firemeganmcardle.blogspot.com if you really want more of his brand of utter douche.
Someone that disagrees with you is a douche? Stay classy!!
Someone who calls everyone who comments here on an issue where she's clearly wrong (premia is a word) is a douche.
Nice try, but disagreement wasn't the issue at stake in Nutella's performance art. It is at least possible to disagree with someone and, to borrow your turn of phrase, "stay classy" about it.
However, I think it is impossible have class and use any version of the word "class".
My dear girl, why are you wasting your life arguing the toss with the sort of dimwit who thinks that "premia" is not a word?
And WHO in their right mind puts Nutella on toast?
Well, despite my problems with his/her arguments, I do. Premade golden toast when in Italy, plain ol' toast when at home.
Me too!
I love Nutella on toast.
The comestible, not the commenter (not that I have anything against the commenter).
Um, here we go again. Sigh.
Megan, community rating does not generally lead to increased prices. It *can* lead to increased prices, but only if 1) individuals are free to opt out of the risk pool and 2) they are not incentivized to stay in. Condition #1 gets to why universal coverage is an important aspect of decreasing health care costs. Condition #2 explains the original logic behind giving preferential tax treatment to health coverage and why that system worked pretty well for a while.
I am a little bit at a loss for words when I read posts that contain such basic errors in price theory. A couple of weeks ago, there was a post about IPhone-ITunes "bundling" (it wasn't really) that was full of fundamental errors in basic price theory. Megan, in response to my comments, you said you were talking about "supply side," not demand-side. But your posts frequently make such mistakes.
This blog has a lot of interesting material. It would be much improved, however, if you would read a couple of price theory textbooks.
"Condition #1 gets to why universal coverage is an important aspect of decreasing health care costs."
Decreasing *costs*? That doesn't make sense. Requiring insurance coverage doesn't make the goods or services cheaper.
It may make insurance premia (point and laugh at Nutella. pwned!) cheaper for some people who otherwise would pay more because healthy people opt out of the pool if possible. But medical services do not become cheaper because more people have insurance.
So muzzybelly, your explanation 2) is really that community rating doesn't lead to increased prices if there's a level of subsidy that helps pay for the increased prices that would occur otherwise?
You're still ignoring that it creates bad incentives for individuals. "No matter what sort of risks you take, your premiums won't go up." So you also have to postulate that your ideal community rating allows exemptions for higher premiums for smokers, motorcycle riders, etc., and other chosen behaviors that might lead to higher costs.
Spartee, you're right, it doesn't decrease health care costs. I meant health insurance costs.
John Thacker, the reason that community rating can lead to higher prices is adverse selection. That happens when healthy people decide paying an "average" cost isn't worth it for them. So then the health of the risk pool erods, and the average cost goes up.
If everyone stays in the pool, there is no adverse selection. On average, prices stay low.
As for incentives, you have a point, but only in a very limited sense and over the long term. The degree of individualized rating only makes a difference for observable traits or behaviors. Smoking is a good example, but it is really the only good one. Most others are either not observable or are things that would constitute unfair discrimination. Obesity possibly is like smoking but it is a much, much more complex issue and not really suited for discriminatory cost pricing. And these lifestyle choices rarely affect things in the short term.
As a matter of personal opinion, I don't buy the moral hazard argument for health insurance. Major health care, even is paid for, is generally terrible and life disruptive. Lung cancer is a really bad and risky thing. I don't know anyone who smokes because they don't risk much since after all they have good health care. They smoke because they don't care about the future and/or are addicted.
John Thacker, the reason that community rating can lead to higher prices is adverse selection.
That's ONE reason. Another is the problem all socialist systems have: they disincentivize rational economic behavior, driving up costs.
Most others are either not observable or are things that would constitute unfair discrimination.
Matching costs to benefits cannot be discrimination; you cannot "discriminate" against the likelihood of someone's insurable event. You can, however, try to force other people to pay for it -- but this obviously is a violation of those other's people rights, which constitutes actual discrimination.
So you can either price fairly or discriminate against healthy people. This is a pretty obvious moral hazard.
Lung cancer is a really bad and risky thing. I don't know anyone who smokes because they don't risk much since after all they have good health care.
It's not even just obvious things like smoking. For instance, increasing one's intake of green tea has an enormous array of well-documented benefits. But it has a cost, too: most people aren't used to consuming it in drinkable or supplement form. If you don't incentivize that behavior, you'll get less of it.
Health is to some extent its own reward, but if you incentivize/subsidize poor health, you will get more of it just like anything else.
I think we're very likely to the point that someone should start a McCardle Job Deathwatch.
Even David Bradley has his limits, and I suspect we're nearing them.
Huh?
"Even David Bradley has his limits,"
Surely you jest sir - one of his bloggers has had his head jammed up Sarah Palin's cooch for the last 10 months while he desperately tries to learn where babies come from, and he is still rather securely employed.
Coffee sprayed out of my nose when I read that. Thank you for the best laugh I've had in days. You win the thread.
What is really sad is how inordinately proud I am of that. Thank you for making my day.
It that's the best laugh you've had in days, you must lead a rather dreary life. Hell, one out of every 2 demotivational posters are funnier than that.
Is was such a nice series on obesity... Oh well. Already then. John Cole is now "the left".
Megan, when people attack your posts the complaint is almost always the same - you can't resist making a lot of assertions, and some turn out to be false. So, instead of childishly saying that you were trying to be "charitable to the cause of national health care" (I wonder if a single person bought that), it would be nice if you would listen for a change. Credibility is a lot easier to lose than to get back.
By the way:
Medicare costs per beneficiary have risen at an annual rate of 8.8% — but insurance premiums have risen at an annual rate of 9.9%.
if insurance premiums had risen “only” as much as Medicare spending, they’d be 1/3 lower than they are.
Your attempts to be charitable are really not necessary.
By the way:
Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.
You too can save lots of money by not paying.
My Massachusetts premiums just went up 30% :(
Then you should become a Muslim.
In Massachusetts, only Jews have to pay the health care tax (and Christians).
Muslims don't have to pay.
Athiests? Hindus? Zoroastrians? What's the deal with them?
Great post Megan, once again the lefties embarass themselves. It's certainly fun watching them shoot themselves in the foot like this.
You see, the reason that insurance premia are so high in New York State is that New York State enjoys community rating, guaranteed issue, and a very generous bevy of mandatory services.
Exactly, this is why some people are just opting out of the system. By law, I am not only not allowed to purchase the insurance I want, I am also forced to subsidize other people's higher premiums. So why buy it at all?
I think the worst part of this is the coercive aspect: we are all forced to either socialize those costs or accept the possibility of a massive financial hit. Most people won't take that chance.
And when that level of ceoercion is insufficient, then Obama says "Oh look, you're uninsured. Let me help you by essentially making avoiding insurance illegal with massive fines." It's Orwellian.
Re: . By law, I am not only not allowed to purchase the insurance I want
This is true of a whole lot of products or and services. You can't purchase a car that lacks various mandatory safety features. You can't buy a house without indoor plumbing. This list could go on and on.
Re: I think the worst part of this is the coercive aspect: we are all forced to either socialize those costs or accept the possibility of a massive financial hit.
That's just reality. Yes, it really is either/or there. Insurance, of any kind, only works because it socializes the losses across a large pool of subscribers. No alternatives are possible. Might as well wish for 2+2=5 or the repeal of the Second Law of Thermodynamics.
This is true of a whole lot of products or and services. You can't purchase a car that lacks various mandatory safety features. You can't buy a house without indoor plumbing. This list could go on and on.
Those are for reasons of safety. Insurance cannot harm me.
Insurance, of any kind, only works because it socializes the losses across a large pool of subscribers.
No, no, no, no, no. That is not how most other kinds of insurance works. You are confusing socialization of costs with spreading of risk.
For instance, if car insurance worked this way, perfect drivers would be forced to pay similar rates as a teenager with 10 DWIs, 20 moving citations, and several totalled cars. You would also be forced to buy every kind of insurance offered (theft, collision, even the need for an oil change).
"Those are for reasons of safety. Insurance cannot harm me."
In the case of infectious disease, yes, your lack of insurance could harm me, and my lack of insurance could harm you. Bacteria and viruses don't care whether or not you've been paying your fair share. If someone doesn't go to the doctor to get it taken care of, for whatever reason, they're putting the rest of society at risk. The harm might be something as minor as a cold, or it might be something as major as a Spanish Flu epidemic, but the potential for harm is there.
our lack of insurance could harm me, and my lack of insurance could harm you
BS. Most infectious diseases are prevented or treated on the cheap (or, of course, not treated at all). You can afford antibiotics or a dose of flu vaccine without any health insurance whatsoever, unless you're literally living in the gutter.
Heart attacks, cancer and Alzheimer are not catching.
Tel, if you wanted to make insurance against treating infectious diseases mandatory, I'd accept that. It'd be thew same as liability insurance for drivers. Insurance for other stuff shouldn't be forced, however.
In the case of infectious disease, yes, your lack of insurance could harm me
That's lack of treatment, not lack of insurance. Also, we're talking about the characteristics of the insurance I am allowed to buy, not the lack of insurance.
For instance, it would be dangerous to operate a car without proper brakes and headlights, so one could reasonably prohibit such operation. But buying insurance that, say, only covers cancer, (i.e. doesn't cover infectious disease) doesn't make me any more dangerous than if I have no insurance at all.
TallDave:
>You should be allowed to insure against that before being screened.
I guess I'm unclear on how this would work. Ditto with your comment above that you can insure against chronic conditions and don't need to socialize them.
What, I buy a policy at age 18 that insures me against all chronic disease expenses for my entire life? How much do you expect
Or on the genetic screening insurance, I would buy a policy that would cover all the expenses of anything the screening might find? Of course, to get that insurance they'd probably want my parents/grandparents medical histories which means I'm probably still screwed by the genetic lottery.
Not to mention the cases of someone born with a condition that will require significant lifelong expenses. You can't insure against that since there is no "risk"; the insurer knows from day 1 that they'll be paying out. So is the solution that before getting pregnant parents should have to buy a policy that covers lifetime chornic illness expenses for their potential offspring??
I honestly don't get what you're suggesting, though I'm guessing a lot of it comes down to your "life is tragic" comment and that you're willing to say some people are just screwed. That's a valid philosophical position, I guess, but again, it won't sell politically so you might as well figure out what your second-best is.
Re: You are confusing socialization of costs with spreading of risk.
You're simply obfuscating the situation. Above you stated that you don't like the fact that your money would be used by insurers to pay other people's claims, and I pointed out that this is inevitable under insurance, otherwise we wouldn't have insurance. Even if Person A is charge more than Person B, Person A may well run a claim much larger than their summed premiums-- again, that's the whole point of insurance, to amortize the cost of things no one (or very few people) could afford to pay on their own no matter how carefilly they might save. Here's an example: when I was 19 I had a new car-- for all of five weeks. Another driver ran a stop light and slammed into me, totaling my car. My insurance company paid out c 8K on that. While I can't recall what my premiums were, I assume they were what was typical for a 19 year old male, which is to say, rather on the high side. Yet no way had I paid 8K in premiums at that point: every other person insured by Auto Owners in Michigan at that point contributed to my 8K payout. Why do you object to this? Or why do you object to it in healthcare if not not in auto insurance?
You're simply obfuscating the situation.
No, you simply don't understand how insurance works.
Above you stated that you don't like the fact that your money would be used by insurers to pay other people's claims, and I pointed out that this is inevitable under insurance, otherwise we wouldn't have insurance.
Paying claims has nothing to do with it, it's the difference in premiums.
Most kinds of insurance have no socialization of costs. They try to figure out what your policy is likely to cost them in claims and charge you accordingly. In this case we are deliberately setting premiums lower or higher than your expected costs to even them out across populations of different health.
Again, this is like asking good drivers to subsidize poor ones. The result in either case is that for people expecting lower costs, insurance is a losing proposition.
Anirprof,
Excellent, now you're starting to really think in terms of risk management.
Yes, all those things are insurable events, just like a home catching fire or an earthquake or a flood.
It's really pretty simple: if there is a low-probability, high-cost event you want to hedge against, you insure against it.
TallDave:
I appreciate the compliment, but you didn't answer the questions I posed.
Again, tell me what an insurance policy looks like for someone with Type I (i.e., juvenille onset) diabetes? When they first take out a policy on themselves when they reach adulthood, there is no "risk", there is already a 100% chance that they have the disease.
Is your answer, "Well, there is no insurance for them, you can't insure against something that already happened" and they just pay out of pocket for all of their care? If so, what happens when that young adult can't afford the cost of their care -- "life is tragic" and they die?
Again, tell me what an insurance policy looks like for someone with Type I (i.e., juvenille onset) diabetes?
It looks like just like any other insurance policy.
Essentially the policy would cover the costs of having diabetes for the rest of your life, and would cost what such treatment is expected to cost, discounted to the future, multiplied by the likelihood of such an outcome. This is what a rational market looks like: costs matched to benefits.
You can't purchase a car that lacks various mandatory safety features. You can't buy a house without indoor plumbing. This list could go on and on.
Said list is also missing the fact that in the real world, you still have choices. For example you can buy a motorcycle, which lacks every one of those safety feature except possibly (if you crash it at just the right angle) the ability to disintegrate before you do. And then you can park it in front of your unimproved cabin in the hills.
Under the Obamacare vision, you will first be required to buy the government's one-size-crams-all Yugo no matter where you go or what your actual needs are.
Actually, you CAN purchase a car without mandatory safety features. You cannot then drive it on public roads, but you can DAMN WELL BUY IT. Now unless you are prepared to make an utterly specious post about how the government owns our bodies and can therefore demand what type of vehicle by which we obtain insurance, a post which the sane among us would no doubt floccinaucinihilipilificate, your comparison fails UTTERLY.
TallDave:
Thanks for the generic response and avoiding the real issue.
As a baseline, someone with Type I diabetes is probably running up to $10,000/year in expenses (insulin, tests, specialists. That's 100% certainty every year, forever, so the premium starts at $10,000 for a year.
Add in the high likelihoods of complications that require treatments ranging from kidney transplants to laser treatment of the eyes to heart bypasses to limb amputation and then all the complications those surgeries might have, etc., and you are very quickly talking big money. Even a 1% chance of needing a kidney transplant and/or dialysis isn't small.
Then of course add in all the risks unrelated to diabetes that anyone has.
You pretty quickly get to premiums like $30,000 per year making sense. For someone further along who already has kidney or heart trouble, $100,000/year and up could make sense.
So, for the 90% of Americans for whom $100,000/yr exceeds their gross income and who can't even afford $30,000/year after tax, housing, etc., what happens to them?
Pretty quickly, you
One good answer to this is to keep medical research profitable so that seriously innovative research could possibly address this in the future. Medical knowledge isn't static and it isn't "pie in the sky" to say that future discoveries could make serious improvements for the lives of diabetics.
re "socializing costs":
It is excellent for you that you don't have any conditions or genetic predispositions or age or whatever that would cause you to either be uninsurable or to face astronomical premiums.
I assume that if you personally ever end up in that situation you'll happily go w/o care once you've exhausted your personal saving rather than expect the cost to be socialized to the rest of us.
Is that really your solution, though? Strictly individual underwriting, and back luck to you if you develop something expensive? What's your proposal for the people with cancer, diabetes, MS, or other conditions?
Personally, I'd support a reasonable program that would address the plight of the uninsurable minority, leaving the insurable majority largely alone. There isn't one on the table.
I'd second that. Heck I'm a mean son of a bitch. I'd say if you have a pre-existing condition and can still afford to pay what the insurance companies want to charge then you should pay it. If you can't afford then Uncle Sugar should kick in anything over some percent of your income.
As an aside, isn't that something like what the Swiss do? I have some memory of them saying that they'll pay whatever's over 10% to get a person insurance.
Max and coreilly:
First question of course is what "afford to pay" means. If your Swiss comment means 10% of gross income, then for say a middle-aged diabetic or cancer survivor you're probably looking at subsidizing anyone who makes less than $150,000 to $250,000 per year, for an individual policy alone.
Second, you'll certainly need a lot more regulation than a simple subsidy rule. Under your proposal, what do you do when insurance companies say they'll charge everyone with a pre-exisiting condition $1,000,000. And to declare that "had a nosebleed or sprained ankle in the last 5 years" is a pre-existing condition worthy of that penalty rate.
Third, it's just not politically sellable. The vast middle class is terrified by a policy where if you got unlucky in the genetic lottery and develop an expensive condition, you're screwed. That will be even more true as genetic screening gets better and you get scewed merely for latent conditions. Sticking with "Sorry, you lose!" approaches is the best way to get single-payer socialized medicine someday when the anger gets too strong.
anirprof,
The vast middle class is terrified by a policy where if you got unlucky in the genetic lottery and develop an expensive condition, you're screwed.
You can insure against that. That's not a socialized cost.
That will be even more true as genetic screening gets better and you get scewed merely for latent conditions
You should be allowed to insure against that before being screened. This is how risk management works.
Re: I'd support a reasonable program that would address the plight of the uninsurable minority, leaving the insurable majority largely alone.
The insurable majority will end up paying for the unisurable minority one way or another. Community Rating simply does this via the market rather via taxation, which, arguably, introduces a second layer of bureaucracy and frictional loss. Isn't that preferrable?
We have Medicaid for those who can't ever pay for the healthcare goods and services they consume. The rest can generally afford to borrow and pay it back over time.
Life is sometimes tragic. I don't bow to the superior morality of using the state's monopoly on violence to enslave everyone else to the needs of the afflicted.
I'll also note in passing that education costs seem to also be rising very quickly (three times inflation since 1972), even faster than medical care, yet we aren't hearing much about "greedy" educrats or the need to control costs, nor does the large amount of government control seem to be doing anything to keep costs from rising.
http://www.nytimes.com/2008/12/03/education/03college.html
What I will note is that inflation seems to be rising faster than "inflation," and has been for some time. Education, health care, food, fuel, rents, fees, all seem to be rising faster than inflation. I remember that the inflation rate is calculated by samples of prices of a "basket of goods," which is a guarded secret. I think that's a problem, because with so many government outlays indexed to rise with inflation, there is a strong financial motivation on the part of the government to understate the actual inflation rate. Say, for example, half a dozen of the items which make up the basket, which used to fairly reflect inflation thirty years ago, are no longer made in America and have been replaced by cheap imports available to consumers. If that were the case, the basket would underrepresent actual inflation, and the bureau would have a disincentive to remedy the situation by substituting alternative items. As we are focused on health care costs, a question should be: to what extent does the inflation in prices in that area reflect general inflation over and above the nominal rate of inflation?
Re: Education, health care, food, fuel, rents, fees, all seem to be rising faster than inflation.
There's currently downward pressure on rents (Lots of rentals are flooding the market due to the housing bust), food prices have been declining, gasoline has gone up this year, but is still well off its previous spike. Not everything is going up, by any means.
Incomes are also keeping inflation down.
On the flip side, interest is going back up. This ought to keep deflation away. Yay.
Don't know about food prices. I haven't noticed a drop.
Things are going to get much uglier.
I've heard plenty about greedy educrats - the teachers unions are really pretty easy to make fun of if you're so inclined. Difference is, because it's government-controlled, the flak comes from the right, not the left.
Mickey Kaus had a hilarious throw away line about reducing the cost of Education - part of his ongoing railing against Peter Orzag. It was basically use the McCallen (sp?) Texas Gawande article idea but with Education. Find the most cost effective per pupil districts and then force the expensive poor outcome districts to emulate them.
The market does that, gov't is very poor at it.
The level of viciousness of these comments and the number of ad-hominem insults have risen precipitously. People, can't we keep things civil? If you don't like what Megan says, mention the points where you think she's wrong, and argue against those points. Mentioning how stupid or ignorant you think she is, at the very least, doesn't add to your argument. Treating grammar errors like they're war crimes does not, in my opinion, cause readers to hold the person making the corrections in high esteem.
Anyway, my experience highlights elements that fit into some ideas of both Megan and her critics. When I moved from New Jersey back to NY, my health insurance premium rose by 400%, and I even bumped down to a bare bones plan that basically only covered catastrophic events. Megan is right that it can be a lot more expensive for some people, but she may be incorrect that it was more expensive for everyone, overall. I was one of the young chumps who was risk-averse enough to stay in the pool, so perhaps my inclusion in the "community" ended up lowering rates for relatively sick people. And even the enormous cost of health insurance wasn't enough of an impetus for me to move out of the city. However, I was in my early 20s, and didn't mind the fact that none of my pay check went into savings. So neither the cost of health insurance nor $14 martinis was particularly motivating. I don't know if I'd make the same decision today, but if I ever move back to NY, by then I may be part of the population that stands to benefit from community ratings.
Regarding
The level of viciousness of these comments and the number of ad-hominem insults have risen precipitously. People, can't we keep things civil? If you don't like what Megan says, mention the points where you think she's wrong, and argue against those points. Mentioning how stupid or ignorant you think she is, at the very least, doesn't add to your argument. Treating grammar errors like they're war crimes does not, in my opinion, cause readers to hold the person making the corrections in high esteem.
Thank you, maam!
"Treating grammar errors like they're war crimes does not, in my opinion, cause readers to hold the person making the corrections in high esteem."
True, but she makes her living as a writer. It's as if Tiger Woods showed up to tee off using a wiffle ball bat. Sure it sorta gets the job done but when you are being paid to be a professional (at whatever industry you're in) you should, at a minimum, use the correct tools - in Megan's case, things like grammar and words. Blog posting is srs bzns.
Sean, Tiger Woods may be the best golf player in the world, and even he makes plenty of errors. His very good, but not quite as excellent colleagues, make even more errors. I have never heard anybody going up to any of these golfers, following such an error, and make a disparaging, vicious, sarcastic rant directed toward them.
Unless you can claim that you never made a mistake in your line of work, your argument about perfect or even excellent grammar doesn't make sense. Some people will make a LOT of mistakes, and their work will still be worthwhile, in the aggregate. Even if you indeed never made a mistake in your line of work, this still wouldn't, by a long shot, justify being rude to those who do. Especially if it's not about administering the wrong medication, but about whether or not you used "premia" as a plural noun.
The obvious explanations of high prices in New York would be all the mandatory services, plus adverse selection.
The mandatory services is a danger for a national health policy, but I don't think an overwhelming one. People have been able to get private insurers to pay for all sorts of things through the courts, and if done right (a big if) a national policy could bring some rationality.
The adverse selection problem is why universal coverage is necessary.
The real debate is between people who think that medical costs should be socialized to some extent - either like education, or like food, where it is available as a last resort - and people like TallDave, who apparently think everyone should either pay for their own care or do without.
Re: The real debate is between people who think that medical costs should be socialized to some extent - either like education, or like food, where it is available as a last resort - and people like TallDave, who apparently think everyone should either pay for their own care or do without.
That debate is meaningless. Medical costs WILL be socialized (to some extent) because there's no such thing as an unpaid bill. That's just the way the world works. If anyone imagines otherwise they need ro accept reality and deal with it. You can't change human nature (or basic arithmetic), after all. Libertarianism has the same flaw that Communism had: it dreams up a supposed utopia into which wants to shoehorn humankind it when we just don't fit.
That debate is meaningless. Medical costs WILL be socialized (to some extent) because there's no such thing as an unpaid bill.
As I pointed out above, you're a bit confused as to how inurance works.
Libertarianism has the same flaw that Communism had: it dreams up a supposed utopia into which wants to shoehorn humankind it when we just don't fit.
Except libertarian principles are designed precisely to fit human nature and have thereby given us an incredibly wealthy and free society, whereas Communism assumed altruism and thereby killed 100 million and impoverished billions. Other than that, very similar.
whereas Communism assumed altruism and thereby killed 100 million and impoverished billions. Other than that, very similar.
Because we have numerous examples of sociopolitical implementations of libertarian ideas that operated on a similar scale, I can see how this comparison is justified.
Because we have numerous examples of sociopolitical implementations of libertarian ideas that operated on a similar scale
We do. It is generally referred to as "the free world" and is the best place to live by any reasonable standard.
I'll grant you one thing: because libertaianism is based on a profound suspicion of government power, libertarians will never come to power, and if they do they will be unwilling (at least I hope) to use that power to enact their utopian vision coercively. Thankfully, this is one ideology that will remain in the world of academic speculation, blog posts and late night beer and bull sessions.
Medical costs WILL be socialized (to some extent)
Then there ought to be nothing wrong with reducing the extent rather than increasing it, n'est-ce pas?
"Libertarianism has the same flaw that Communism had: it dreams up a supposed utopia into which wants to shoehorn humankind it when we just don't fit."
Libertarianism promises no utopia. It just prefers that people see the true costs of their actions and are allowed to behave accordingly.
The real debate is between people who think that medical costs should be socialized to some extent - either like education, or like food, where it is available as a last resort - and people like TallDave, who apparently think everyone should either pay for their own care or do without.
I'd be happy if people would just pay premiums related to their likely costs, like we do with most kinds of insurance. Why penalize people for being healthy?
BTW, this is not only disincentivizing healthy behavior (yes, health is its own reward too), it is also very regressive and something any real progressive should oppose.
People's health care costs rise with age -- as do their incomes and savings. The practice of socializing costs thus amounts to a giant wealth transfer from the younger and poorer to the older and richer.
Pretty much like most government programs, you are saying?
In New York one also has to deal with the costing of 'uncompensated care',otherwise known as the unpaid patient bills of the New York voluntary hospitals. Most of these costs are passed on to those covered by private insurance schemes through surcharges and assessments. For a typical construction worker in a multi-employer plan that cost of' uncompensated care' amounts to $ 1 per hour worked. It appears that the public sector plans, for state and local workers, are not similarly burdened.
One of the big questions to asked about the proposed 'public plan' is how it will participate in covering the costs of the residual uninsureds ( including the illegals).
By the way, to the people calling for Megan to lose her job- if there were nationwide protests against Megan, that still probably wouldn't impress the editor. Although he may be impressed by how much traffic's being directed to the site.
The online magazine business cares about the number of page views, not about how enamored you are with the staff. If you really want Megan to be fired, I suggest you stop reading her posts, avoid emailing them to others, refrain from complaining about them on your blogs, and to pretend that Megan doesn't exist. If you really want her to be fired, then your only solution is to try to decrease her web traffic (or otherwise decrease ad revenue...buy shares in Visa? Take over safecount.net?...I'm basing this on what's featured on Atlantic's home page this hour...) Anyway, raising an angry ruckus can only help the woman whom you seem to wish were unemployed.
Sorry, Megan for giving "hints" on how to get you fired, but I figured this would help, not only the anti-Megan brigade, but also the people who are sick of constantly hearing their personal opinions about your character and moral aptitude.
These numbers actually make me grateful to my employer, for while my personal premiums have certainly gone up, it looks like my employer has been sucking up an even greater portion. I imagine that employers in high cost places like NY and MA would be the first to dump their workers into the Obamacare "option" out of sheer necessity.
Re: I imagine that employers in high cost places like NY and MA would be the first to dump their workers into the Obamacare "option" out of sheer necessity.
Some might, but most will not. Employers do not offer health benefits out of altruism. They do so because they compete to attract good workers, and workers demand these benefits, or they will go to work for the other guy down the street who does provide them. Unless this hypothetical "public option" is really good, workers will still prefer workplace health plans instead, and employers will continue to offer them.
That's a good point. The more mandates you have, the more incentive for employers to dump them.
The primary reason employers offer health insurance has almost nothing to do with attracting workers (they could, after all, offer them cash instead, and let them buy their own insurance). The main reason we get insurance through employers is that the government has created a gigantic tax incentive to do so (were you to buy your own insurance, you would have to pay tax on the income first).
The primary reason employers offer health insurance has almost nothing to do with attracting workers (they could, after all, offer them cash instead, and let them buy their own insurance).
Speaking as an employer who actually tried that approach, not so. We surveyed a straight salary increase, high-deductible insurance plus HSA, and a traditional health plan with a medium-sized deductible.
To say that there was a bias towards the last doesn't cover it - it more like revulsion towards the first two. Could that be handled with education? Maybe, but in a competitive employment environment, it's just something else you need to get past when trying to attract top talent - especially when said talent is very often older and has a family.
Of course there is, but that's because of the tax incentive structure.
@TallDave
No. The costs and benefits were adjusted to be roughly equivalent on an after-tax basis.
This illustrates my point above on the non-sellability of the "you're on your own" approach where risks are merely insured on an individualized basis vs socialized across groups. People -- other than some of the young, single, and healthy -- are simply not willing to run those sorts of risks and when given free choice will go for the risk-reducing indemnity plans.
The costs and benefits were adjusted to be roughly equivalent on an after-tax basis.
Huh? Why would you, as an employer, deliberately avoid a tax incentive? You're increasing your costs at no benefit. You're going to make your CPA cry.
@talldave
Huh? Why would you, as an employer, deliberately avoid a tax incentive? You're increasing your costs at no benefit.
As I said, we have a need to attract and retain skilled workers. Finding them can be hard; replacing them even harder - we require an average of three months of on the job training.
All of that costs money. It's a very competitive industry.
The notion was that, on a fully loaded basis, it would be cheaper to pay the benefit as salary, and that this would be also be a boon to recruiting. Made a lot of sense, and so did the numbers.
Our finance people were actually pretty pleased with the math.
Our employees weren't.
Hmmm, I think I see the fly in the ointment: health care costs rise faster than wages. So your employees probably thought "Aha, I will do better with the insurance" and your finance people similarly saw long-term savings.
Also, people don't have much experience buying healthcare insurance and probably find it somewhat intimidating.
I suggest you work the numbers. What's corporate tax rate. I admit I don't know off the top of my head. But I'm pretty sure it isn't 100%. Let's say it's 30%. So on an annual premium of $10,000 the employer saves $3,000. OK, not peanuts, but if the employer dropped the healthplan altogether he'd save the whole 10K instead. So no it isn't the tax break that motivates employers to provide benefits. In oure dollars and cents it would still be cheaper not to. Obviously the employer gets something else worthwhile that makes that 7,000$ insurance expense that the tax break doesn't cover worth it.
/facepalm. No. It has nothing to do with the corporate tax rate.
Here is how the actual numbers work. You are employer X. You offer $70K salary, $10K worth of insurance. Employer Y offers $80K. In a world with no employer health care tax incentive, Y's offer would be equal (technically slightly better, because cash always has greater utility than the noncash equivalent, but let's ignore that).
Let's say the marginal individual tax rate from 70K to 80K is 30%. Now the benefit of that last $10,000 to employees is only $7,000 -- but since health insurance benefits aren't taxed, your insurance is still worth $10K. That means Y's offer is only worth $77,000 and all else being equal rational employees will sign with you over at X.
This is why employers offer health insurance -- it's something they can offer more cheaply than the person can buy it. It's a somewhat perverse incentive.
@talldave
And it would be much better to offer at $80K, all things considered, since people tend to look at the take home more than the benefits, especially if they have some notion of self-insuring. Pretty smart thing to do, too, since it probably effects their future earnings.
But, no so fast, as I've seen.
It would seem to me that they are wising up, and it will be very interesting to watch what happens as people become more aware of rescission and guaranteed issue. That may actually start to create a flow of skilled labor towards states that have these laws. People are worried.
Something else to consider is that I, as an employer, am not at all sure I'm happy with an employee self-insuring, for entirely selfish reasons. I have enough issues with people asking for "small" bonuses to cover car breakdowns and so on. For lots of employees, that's an easy "no", but for a key employee, it gets really, really dicey. I know for damn sure that a self-insurer who, say, breaks his arm and incurs a $10K bill is going to do one of two things: hit me up for a raise, or a bonus...or start looking. If my replacement cost for that employee is high enough, I'm probably covering part of that "self-insurer's" out-of-pocket expenses out of mine.
State mandates generally do not add very much to the cost of health care. I'm not counting things that are sometimes "mandated" but really constitute an important part of comprehensive insurance, such as mental health benefits, chiropractic care and prescription drugs.
The only mandate that has a significant effect on cost is in vitro, which really should not be a part of health insurance. But according to CAHI (a group that advocates reducing mandates) that adds only 1-3% to the cost.
Plus, it's worth realizing that some types of mandates add to the cost of health insurance but save money on other services. Family therapy provided by social workers may cost money, but it also prevents a lot of things that cost a lot more money, like domestic violence, child abuse, divorce, etc.
You can read more at CAHI.org, if you care about facts.
Um, that doesn't make sense.
If you want to criticize state mandates for raising health care costs, that only makes sense if the state mandates are for things that wouldn't normally be provided.
If state A required insurance coverage to include emergency room costs, and state B did not, I would expect A and B to have very similar insurance costs, because all policies in B will also have emergency room coverage. Yet a dishonest commentator could cite the fact that mandated services comprised 20% of state A's costs to imply, misleadingly, implying that mandates were raising prices.
Of course mandates raise costs.
What if I decide there's no chance I'm going to see a shrink every week for 10 years, and don't want to pay extra to insure against that?
Oops, no, can't. Mandated.
And no, preventing your divorce does not save me money. Sorry.
Megan's post raises an issue that I haven't really seen addressed anywhere. One of the ideas being floated in Washington is a tax on so-called "gold-plated" or "cadillac" health plans. The use of these terms is obviously meant to imply that people who receive these plans from their employers are the beneficiaries of some sort of luxury, and it's only fair that they be made to pay.
This post is the latest of a number of references I've seen on the web to lengthy lists of state mandates that range from debatable (fertility treatments) to absurd (baldness treatments). Since Congress apparently hasn't decided yet exactly what constitutes an evil gold-plated health plan, I'm wondering how many of the people who will be branded as greedy bastards who, by all that is holy, must be made to pay for their wanton indulgence, actually have the minimum coverage that their states will allow them to have.
Can it really be that bad? Such prices are nigh incomprehensible.
I live in Colorado. I pay $124 a month for pretty decent health insurance, and another $39 for dental, for a family of 2 (plus an equal amount from my employer and yes I know what incidence is). I think it's gone up maybe 10% in 4 years. Frankly I find even that much barely tolerable, not in an I-can-barely-afford-it sense but in a I-don't-feel-I'm-getting-value-for-my-money sense, since my modal medical expenditure per year is $0 (the dental however works out great). And people are paying double, or triple that?
And we're suggesting the regulations that produce those prices should be extended nationally?
You New Yorkers will truly be the death of us all.
You're lucky. I'm a Colorado government employee, and I pay $250 for a high deductible plan (the state purportedly pays roughly $750 more). The difference in premiums between a more traditional plan is more than the $200/month I'm out-of-pocket after tax once I write off the $3000 deductible.
But seriously, it's a really crappy feeling when your kid grabs a hot stove (2007), or your wife's little red spot turns out to be carcinoma (2008), or you start shitting blood for a couple of weeks (2009), and you know that that each little health problem just cost you $3000 minimum.
I take it you have no "in-network" coverage that doesn't go against the deductible? At $12K/yr this doesn't sounds like a great bargain to me (CO should not be that different from TX) but I've never been anywhere near government employment. Yet, adding those $3K to the cost (pre-tax if you have FSA), the result is still far from outrageous.
Now, it would hardly take more than a glitch in tax rate to add those $3K to my tax burden...
I take it you have no "in-network" coverage that doesn't go against the deductible? At $12K/yr this doesn't sounds like a great bargain to me (CO should not be that different from TX) but I've never been anywhere near government employment. Yet, adding those $3K to the cost (pre-tax if you have FSA), the result is still far from outrageous.
No, that's the point of a high deductible plan. We're lucky that we have adequate savings from when I was an overpriced private attorney to just keep on ponying up the annual $3k into perpetuity -- but it still hurts every time we do. Personally, I'd prefer to do the slightly cheaper Kaiser HMO option, but my wife refuses to have anything to do with managed care.
Now, it would hardly take more than a glitch in tax rate to add those $3K to my tax burden...
I remember those days fondly. Now I'm enjoying doing interesting work and working half as many hours for a third as much money.
All it will take is one of you to get a burst appendix or badly broken ankle or something and you'll feel like you've done pretty well having that covered by having spent several years paying $1,500 per year -- pre tax! -- when you see what those hospital bills add up to...
Well, most HSA's have a high deductible followed on by a decent cap - 2500 deductible, 5000 cap so that's your exposure for the year.
A few healthy years dropping 3000 into the account should cover you for a few rough ones, especially since you'd still be putting in the 3000.
Also, Megan, New York's per capita Medicaid expeditures are over twice the national average. Medicare expenditures in the last two years of life are nearly 20% more. Don't you think that the fact that medical care in NY is a lot more expensive than the national average might have something to do woth the higher insurance premiums.
(And I should add that despite all of this, NY insurance premiums are only a few percent over the national average.)
New York's per-capita Medicaid expenditures are high because a) it makes the cities contribute so that it can b) get more money from the Feds and c) give it to Denny Rivera's absurdly powerful healthcare union while d) also providing more generous benefits than almost any other state. High cost of living has something to do with it, but most of the healthcare wound is self-inflicted.
This doesn't explain the Medicare phenomenon.
Nor is it wholly satisfying in and of itself. Regardless of whether New York gets money from the cities, CMS isn't going to authorize FFP for anything that isn't medically necessary (setting aside waiver services, which I know a lot about, but not in New York).
My strong hunch is that health care costs a lot more in New York, regardless of insurance or government subsidization. If so, that would go a long way in explaining the (small) average price increase over the median.
(I also note that this increase is reflected in both private and group plans. The latter are regulated by ERISA, so state mandates shouldn't affect them.)
You are wrong on state mandates. They do apply and are one of the reasons that our rates are through the roof.
You are correct about the costs. Hospitalization is high because there are too many hospitals, with to few customers. Insurance companies are forced to subsidize these via a hefty tax which is passed on to policyholders. Doctors cost too much because their malpractice premiums are higher. That is because NY is the shyster capital of the world. NY laws are set to heavily favor the shyster industry - whether in malpractice or other areas. This is seem in my county - Nassau - population 1.2 million. The courts need almost 1000 potential jurors PER DAY for all the lawsuits.
You are wrong on state mandates. They do apply and are one of the reasons that our rates are through the roof.
Um, no, they don't apply to ERISA plans. Once again, the point is that health care costs are high across the board in NY -- including many costs that are not paid for by private insurance plans. To me, this implies that the problem with the high premiums lies on the cost side, not the coverage side.
As far as the malpractice argument goes, this doesn't deserve a response. Yes, malpractice premiums are onerous in certain specialties (OB/GYN being the most notorious). But they're virtually non-existent in others (oncology comes to mind). Yet costs have increased similarly among virtually every specialty. This leads me to believe that malpractice premiums are not the answer.
Joe, that causality can flow in both directions. New Yorkers may be consuming more (or more expensive) health care because it is available or expected, not because it is needed. They may be, as you suggest, have expensive-to-treat conditions more often -- but New York State has a large enough population that the null hypothesis should be that it is statistically similar to the country as a whole in terms of health conditions. A study could validate your hypothesis about costs, but I am not familiar with any that do so.
That's the point. If New Yorkers are consuming more or more expensive healthcare, then their premiums are going to be higher for reasons wholly unrelated to state mandates.
But Michael's point is that they probably aren't, and that the expense is legislative in nature, not based on actual health differences.
But Michael's point is that they probably aren't, and that the expense is legislative in nature, not based on actual health differences.
???
How could state insurance regulation affect health costs paid for by the government? My point was that Medicaid (and Medicare, and ERISA) spending implies that there is something going on in NY to drive the cost of health care up, and it is THIS -- and not insurance regulation -- that is the primary culprit for the higher premiums in the state.
Michael was suggesting reasons why health care costs might be more expensive. I agree that he probably identifies the correct one (more treatment, and more expensive treatment, regardless of necessity), but this has nothing to do with what Megan identifies as the cost drivers.
Whoops, misread your post - I was addressing an argument you didn't make. Sorry.
If lots of its retirees head south, shouldn't one expect NY to be cheap and Florida expensive?
Florida healthcare also up 88% since 2000.
http://www.healthreform.gov/reports/statehealthreform/florida.html
Florida's average age is higher, so you would expect their health insurance costs to be higher.
Except they have more people covered by medicare.
One of the things I'm sure most of you don't know is that health insurance is heavily TAXED in NY.
No, you don't see a tax item on the bill. It's in the premium. The insurance companies pay it on every hospital bill. I forget the name, but it's something like "discharge fee".
The tax was passed years ago by whores for the hospital workers union - especially in New York City. NYC has too many hospitals and most are large. Capacity far exceeds demand. If unnecessary hospitals were to close, the union monkeys would lose jobs.
Of course, this tax was not presented as a way to preserve unnecessary jobs for union monkeys. It was presented as a way to subsidize the unnecessary hospitals because they're teaching hospitals which serve a "vital need". Hence, health insurance companies pay hospitals the equivalent of a sales tax and pass the on to customers.
Every time there is ANY mention of trying to reign in runaway costs, you'll hear ads on the radio and on TV sponsored by the unlikely combination of union AND hospital management, because the unnecessary hospitals not only employ many unnecessary union monkeys, but also a large number of unnecessary administrators.
By the way, there are so many unnecessary hospitals in NY that they piss away millions and millions on advertising, trying to attract customers (patients). They pay for the ads by raising fees that the insurance companies must, by NYS law, pay.
All of this is on top of much mandated coverage (a pimple can be described as a "lesion" and require popping by a doctor -as shown on WNBC news a few years ago.
Bush's attempt to make health insurance a national market was a rational attempt to stop this type of insanity. The Dems shot it down because the Dems want to preserve al those unnecessary jobs for their union monkey masters.
because the unnecessary hospitals not only employ many unnecessary union monkeys, but also a large number of unnecessary administrators.
Heh. The jackals and the lions don't always like each other, but they both eat the zebras.
Jesus Megan! Do you do any research before you make a fool of yourself? You are linking to on your own post, information that proves you wrong. How can anyone believe what you say now?
Yet another kind liberal doesn't resort to ad hominem attacks! Next your kind will be saying McArdle isn't a "real American" or a "political terrorist".
It doesn't matter anyway. According to that genius, Paul Krugman, if you are opposed to Obama's healthcare reform, it is because you are racist.
Truly, it has been amazing watching the left go completely bonkers at the first serious opposition to their policies.
One more thing on New York insurance cost. If you need an ambulance, even a NYC Fire Dep't. one, and have insurance carrier will be billed - a lot.
If you don't have insurance, or are poor, you won't be expected t pay anything.
Megan, you point is correct. However, you should also look at incomes over the same time period and also maybe rents and taxes.
A rather pernicious claim. What would it take to convince you that a given person didn't know what they were talking about, but opining on it anyway? Let's look at something else Megan has written about, Elizabeth Warren and the Terrible, Horrible, No Good, Very Bad, Utterly Misleading Bankruptcy Study:
Now, this was a six-page study. From page 5 of the pdf file under the heading Changes in the Law:
Note that in this series of posts, Megan said that Warren was not only wrong, but being dishonest. My question here is: do you think Megan knew what she was talking about? Or was she merely offering up a provocative and unschooled opinion? On a related note: Going towards the issue of credibility, I have yet to see Megan acknowledge that she was wrong on this one, nor make any apology for her libel of Warren. When I see someone who is not only wrong, not only glaringly, blindly wrong, not only glaringly, blindly wrong, but making serious accusations, who then never acknowledges it, or apologizes for it, well, I think they have a rather severe credibility deficiency.
Is this example also dismissable as 'just a post' or whatever? Don't you think there has to be some sort of standard for this sort of thing?
Doesn't it make you feel "special" that you can criticize the author, yet TOTALLY IGNORE just WHY those insurance premiums would be so high in a state completely controlled by liberal Democrats who's primary constituency is public employee unions and others that "drink form the government trough".
Then again their other constituency is shysters - who force up all medical costs so doctors and hospitals can pay their insurance premiums. NY is the shyster capital of teh world. The "esteemed" Speaker of the Assembly is even "of council" to one of the biggest shyster firms.
But you get to make yourself feel good by criticizing the author.
I'm guessing that Alaska, whose family coverage costs are slightly higher than New York is also a shyster capital?
Or Maine? New Hampshire?
Wyoming?
http://www.statehealthfacts.org/comparetable.jsp?typ=4&ind=271&cat=5&sub=67&sortc=3&o=a
I see more of the tired old blame it on the lawyers drivel. To cut to the chase, medical costs in El Paso County, Texas are approxmately 30% lower than in McAllen County, Texas. When asked the reason for the difference, the doctors in McAllen County initially blamed the lawyers - until it was pointed out that Texas has "tort reform" that caps damages at $250,000. Just one more red herring to confuse and distort the health care problems this country faces.
As for the comment about Dems panicking over opposition to health care reform, I simply have to shake my head. Republicans and their wingnut talk show flying monkeys are filling the airwaves with gross distortions about what is in plans being considered by Congress, prompting riled up and ignorant people to "attend" town hall meetings with nothing to contribute but yelling and disruptive behavior, and its the Dems who are panicking? I know reality has a liberal bias, but this is mind boggling.
gross distortions about what is in plans being considered by Congress,
Congress is helping to create that problem by writing a bill so convoluted and circuitous they themselves say they cannot read it.
I know reality has a liberal bias,
Uh huh. Back in the real world, they're running out of toilet paper in Cuba. The reality is governments don't do well running economies.