Re What the Republican Health Plan Gets Right

["Dave Farber" <dave () farber net>]

---------- Forwarded message ---------
From: Steve Papa <spapa1999 () gmail com>
Date: Sat, May 6, 2017 at 4:47 PM
Subject: Re: [IP] Re What the Republican Health Plan Gets Right
To: <dave () farber net>


As an engineer…..rather than first look at cost/benefit….I would first look
at how do you cost-effectively deliver the basic benefit and build up from
there.  There is clear potential to deploy resources far more effectively
than we do today but it’s a political problem versus an engineering
problem. Here’s how to see one part of it clearly: The USA spends
proportionally an EXTRA $100B/year on administration of healthcare relative
to Canada (by using percentage of GDP). The AHCA is estimated by NPR to
save $76.5B/yr in taxes. The incremental administrative costs in the US are
GREATER than this AHCA tax cut. So if we are rationing benefits and want to
drive down costs….it would seem the Canadian model gets you a basic
foundation (that is arguably better than what AHCA is proposing) for much
less than the US is spending AND those with means can still have tax cuts
to spend on incremental care if they want. The political problem is that
typically either party wants to tackle the revenue side (taxes) and its
coverage implications without having the political strength or ideological
flexibility to fully address the cost-effectiveness side where there are
working models to inform a much better approach. I’m not advocating for the
Canadian model….all I am saying is the engineers, if allowed to do their
jobs, can improve this dramatically by providing more health care for all
for less spend.





Sources (this isn’t my day job – did 2 minutes of web searching – this is
JUST the administrative side, the rest of the US healthcare spend relative
to other countries has many other opportunities for improvement):



*"Hospital administration costs ranged from 1.43 percent of gross domestic
product (GDP) in the United States ($667 per capita) to 0.41 percent of GDP
($158 per capita) in Canada."*



*The Bottom Line*

Administrative costs accounted for 25 percent—or more than $200 billion—of
total hospital spending in the United States. In the other nations included
in this study, these costs accounted for between 12 percent of spending
(Canada and Scotland) and 20 percent of spending (the Netherlands).



http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs



All told, the bill would cut taxes by about $765 billion over the next
decade.



http://www.npr.org/2017/05/04/526923181/gop-health-care-bill-would-cut-about-765-billion-in-taxes-over-10-years







*From: *Dave Farber <dave () farber net>
*Reply-To: *<dave () farber net>
*Date: *Saturday, May 6, 2017 at 4:21 PM
*To: *ip <ip () listbox com>
*Subject: *[IP] Re What the Republican Health Plan Gets Right





---------- Forwarded message ---------
From: Sidney Karin <skarin () ucsd edu>
Date: Sat, May 6, 2017 at 4:17 PM
Subject: Re: [IP] Re What the Republican Health Plan Gets Right
To: dave () farber net <dave () farber net>



Dave,



For IP if you like.



As an engineer I like to think in cost/benefit terms.  To a first
approximation

Obamacare got the benefit right, but got the cost wrong.  To a first
approximation

the AHCA gets the costs right, but gets the benefit wrong.



I think that a good case could be made that we have already reached the

point that we could spend the GDP on useful (extend life, improve quality
of

life) healthcare,  not including all of the waste inherent in AHCA,
Obamacare

and what preceded it.



If we haven’t reached that point we soon will and in the not too distant
future

we will be capable of delivering useful healthcare in significant multiples
of

the GDP.   This begs the question of what basic health care should be made

available to everyone?  Obviously, not all conceivable health care.  We will

ration health care.  Indeed, we already ration health care, witness such
items

as Lasik surgery.  Those who get it pay out of their own pocket.  Those who

cannot afford it do not get it.



We need a debate about what we think should be available to all and what

will be available only to those with sufficient resources of their own.
Some

things seem obvious, including my Lasik example.  On the other side of the

ledger vaccines seem obvious.  Real emergency care is another.



The debates of recent years seem focussed on the costs and try, or at least

pay lip service to, delivering all available health care to everyone.  That
isn’t

going to work.  It already doesn’t work.  We need to refocus the debate.
Who

should pay how much is only part, albeit an important part, of the problem.



Cheers,



…….Sid







On May 6, 2017, at 11:38 AM, Dave Farber <dave () farber net> wrote:



---------- Forwarded message ---------
From: Mark Blacknell <mb () blacknell net>
Date: Sat, May 6, 2017 at 2:37 PM
Subject: Re: [IP] What the Republican Health Plan Gets Right
To: Dave Farber <dave () farber net>



Jesus.  I was wondering who could come out to defend this plan, and . . .
well.  It's not the brightest and best.

The doctor that wrote the op-ed complained about a patient that saw him too
often for ailments she didn't have.  And whose fault was that?  Obama's,
apparently.  Not the patient's for making poor decisions, or even
(especially) his for failing to educate his patient.  Simple solution?  He
could have declined to see her.  My kids' pediatrician refuses to see
non-vaccinated children.  He could have done the same.



This reminds me a bit of my banker friends, who insisted that they only
behaved so poorly in the run-up to the 2008 meltdown because the government
let them.  They were simply chasing profits, you see, and that's what they
were supposed to do.  It was the government's fault that they weren't
restrained.  (Also, could they have a bailout, please?)

As to his pre-existing conditions claptrap, it strikes me as coming from
someone who has never had job/economic insecurity.  Aside from 22 year olds
who haven't yet figured out that they're not, in fact, immortal, no one
*chooses* to go without some sort of access to health care.

The AHCA is a terrible failure of American government/politics/society.  I
can't imagine defending this particular piece of legislation.



Mark Blacknell








mb () blacknell net

+1.202.270.5909

Washington, DC



On Sat, May 6, 2017 at 1:20 PM, Dave Farber <farber () gmail com> wrote:




Begin forwarded message:

*From:* Dewayne Hendricks <dewayne () warpspeed com>
*Date:* May 6, 2017 at 10:19:22 AM EDT
*To:* Multiple recipients of Dewayne-Net <dewayne-net () warpspeed com>
*Subject:* *[Dewayne-Net] What the Republican Health Plan Gets Right*
*Reply-To:* dewayne-net () warpspeed com

[Note:  This item comes from friend Bob Frankston.  Bob’s comment:'The
author blithely offers a "let them eat cake" piece of advice by saying that
people with preexisting conditions can just get a job and get coverage via
their employer. Totally out of step with a gig and entrepreneurial economy.
Or for that matter, any rational economy that doesn't try to hide the true
costs of healthcare.’.  DLH]

What the Republican Health Plan Gets Right
By MARC K. SIEGEL
May 5 2017
<
https://www.nytimes.com/2017/05/05/opinion/what-the-republican-health-plan-gets-right.html
>

Now that the Obamacare replacement bill has passed the House and is moving
on to the more centrist Senate, the real debate begins. What is the true
purpose of health insurance, and what is our government’s goal in ensuring
we have it?

I learn from my patients every day about the benefits, limitations and
contradictions of their health insurance. One charming 60-year-old with
severe seasonal allergies insists on seeing me every few weeks this time of
year, even though I tell her she doesn’t need to — her antihistamines and
nasal spray treatment rarely changes. But she worries that her allergies
could be hiding an infection, so I investigate her sinuses, throat, lungs
and ears. I reassure her, and her insurance (which she buys through New
York’s Obamacare exchange) covers the bill.

If she was responsible for more than a small co-payment for these visits,
I’m sure I would see her less often.

We pride ourselves on being a compassionate society, and insurance
companies use this to manipulate us into sharing the costs of other
people’s excessive health care. Meanwhile, 5 percent of Americans generate
more than 50 percent of health care expenses. Why shouldn’t a patient who
continues to see me unnecessarily pay more?

The government’s job is to maintain public health and safety. It should
ensure that insurance plans include mandatory benefits like emergency,
epidemic, vaccine and addiction coverage. The Republican bill would let
states apply for waivers to define these benefits differently; it would be
a big mistake to drop such coverage entirely. But Obamacare went well
beyond these essentials, by mandating an overstuffed prix fixe meal filled
with benefits like maternity and mental health coverage that drove smaller
insurers with fewer options out of the market. The few that remain often
have a monopoly, and premiums rise.

Speaking of compassion, how about some for the 20-something construction
worker who can’t afford to pay his rent because his premiums help subsidize
overusers like my allergy sufferer? Why shouldn’t a patient who is
risk-averse pay more for coverage she might never need, while that
construction worker be allowed to choose a cheaper insurance plan that
might cover only the essentials?

In addition to limiting the menu of essential benefits, the House bill
would let states create high-risk pools for patients with pre-existing
conditions who had let their insurance coverage lapse, and who could then
be charged premiums more in keeping with their health care needs. This is
the only way to make insurance affordable for most consumers; pre-existing
conditions will continue to drive up premiums if everyone is compelled to
pay the same price.

These risk-pool premiums can and should be subsidized by the government. A
recent report from the Kaiser Family Foundation found that high-risk pools
can work, but have been historically underfunded. Trumpcare should change
that — though it will cost more than the House bill’s $8 billion in
additional funding. Drastic cuts to Medicaid should also be reversed, which
could help the bill pass the Senate.

[snip]

Dewayne-Net RSS Feed: <http://dewaynenet.wordpress.com/feed/>





++++++++++++++++++++++++++++++++++++++++++++++++


     Sidney Karin Ph.D., P.E.                  skarin () ucsd edu
                                                              858-534-5075
     Professor Emeritus,
     Department of Computer Science and Engineering
     Director Emeritus,
     San Diego Supercomputer Center
     University of California, San Diego
     9500 Gilman Drive
     La Jolla,  CA  92093-0505

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