Health Care Plans Compared

Brad DeLong co-authors a comparison of the candidates health care plans in the WSJ and provides the talking points here.

I find this comment to be cryptic:

- Pooling. The Obama plan would give individuals and small firms the option of joining large insurance pools. With large patient pools, a few people incurring high medical costs will not topple the entire system, so insurers would no longer need to waste time, money and resources weeding out the healthy from the sick, and businesses and individuals would no longer have to subject themselves to that costly and stressful process.

My thought - if insurers can only drop "pools" from their coverage and not individuals, then I can see that large pools would discourage a lot of this patient evaluation.

However, large insurers are not going to "topple" based on a few people getting sick.  And if individuals can be disqualified without dropping the entire pool, I see no obvious difference to a large insurer's bottom line between covering 100 small pools and weeding (awful metaphor) each of them for sick individuals and covering 1 large pool formed by the 100 small ones and weeding that large pool for patients likely to produce high coverage costs.  (Sorry, people with medical issues are not "weeds" but the metaphor is clear - they are the people an insurer does not want in an otherwise appealing pool.)

Clearly I need to research this point.

Developing...

Comments

[jpe]

Perhaps it's in the pricing. One could isolate a sicker pool pretty quickly and jack up the price, which defeats the purpose of pooling in the first place.

[bacaangel]

If McCain can so easily and readily lie to you without blinking, how can you believe him when he tells you ANYTHING! You can't. A man's word is his bond. You just can't trust McCain to be honest, nor his running mate Sarah Palin; they lie about their lying!

John McCain -- "he walked the anti-regulatory party line, with only occasional exceptions...and tried to lay down a smokescreen of righteousness by campaigning against small potato[e!]s like legislative earmarks--money to study the mating habits of, uh, crabs, in, uh, Alaska (proposed by Governor Honorable)." Joe Klein

[bad]

I'm definitely into pools-and pool boys.

[bad]

...so insurers would no longer need to waste time, money and resources weeding out the healthy from the sick...

Obama sounds so solicitous of the big, bad, insurance company. He's going to help them. Surely there is a campaign slogan here.

[Paul Zrimsek]

Perhaps it's in the pricing. One could isolate a sicker pool pretty quickly and jack up the price, which defeats the purpose of pooling in the first place.

The plan apparently avoids this threat by making it impossible to "isolate" any pool in the relevant sense; if they jack up the price of a pool that's been identified as high-risk, everyone will desert in in favor of lower-priced pools (which will not be allowed to deny them entry). The clear intent is to smuggle community rating in through the back door; it's not clear how they intend to deal with the resulting mass exodus of young, low-risk people from the system. Some may recall that the issue of mandated coverage was a fairly heated one during the primaries.

[Bob]

If you need to see the difference between McCain and Obama, just watch this performance!
Obama splains it to ya!

[Paul Zrimsek]

Incidentally, looking at the plan on the Obama campaign website, I can't tell which part of it DeLong and Cutler's section on "pooling" is supposed to correspond to. The closest match was this:
-----
Guaranteed eligibility. No American will be turned away FROM ANY INSURANCE PLAN because of illness or pre-existing conditions.
-----
However, this paragraph is embedded in the section describing the FEHB-like public plan intended for people who can't get private insurance. DeL&C may be referring instead to the "National Health Insurance Exchange" described a little later on, but I can't tell whether insurers are even required to take part in that.

[Sue]

All I remember is Hillary's and Obama's healthcare plan was similar except one forced you into it and the other didn't. I'm not sure I want a healthcare plan that is similar to one Hillary would have created.

[bio mom]

I do not believe that, whomever is president, we will see any vast new spending programs in this economic climate. That is the silver lining in our current dark cloud.

[Paul Zrimsek]

Arnold Kling observes that DeLong was against deductibility before he was for it.

[steve sturm]

These 'solutions' will not work for the same reason no other solution has worked: the problem is not 'health insurance' per se, the real problem is (1) the cost of medical care and (2) the argument over who pays for medical care for those unable and/or unwilling to pay for the care they want/need... and all these proposals do is shift the costs from one group to another.

And for all you bleeding hearts who b***h and moan about mean insurance companies denying coverage to this or that poor sick person, if they don't 'weed out' sick folks and limit reimbursements to the letter of the policy, YOU (yes, YOU) will have to pay higher insurance premiums (what, you thought insurance companies pay for coverage out of the goodness of their heart? Silly fools.) Maybe a lot, maybe not so much, but I haven't seen a rush of people offering to pay any more each month in insurance premiums in order to provide coverage to those without; in fact, what I see is people complaining that they're already paying too much.

As for pooling, all it does is spread the cost for including high usage customers over a larger group, making the per-person increase slightly less than would be the case in a smaller group, but make no mistake, there is no way to provide coverage to everyone without a significant increase in the rates paid by those who currently have coverage.

[kim]

Government involvement in our education worked at first and has now disintegrated. Government involvement in our health has always been counterproductive. Where's the Right to Privacy about our own well-being?
========================

[kim]

It's the nature of the beast that the healthy, those presently selected to have cheap insurance policies, eventually become sick? What then? Get out, you now not at ease, beyond the pale, so we healthy ones can still get cheap rates? Howsoever you treat the least among you, blah, blah, blah.
=====================================

[clarice]

Just as some smart person noted (Friedman I think) that you cannot have open borders with a welfare state, you cannot have govt health care with our present personal injury litigation structure.
Aside from everything else--i.e., rising cots--the notion of public health depends on a rationing of care and a cost/benefit analysis for medicines and treamtnet which cannot exist in America with its expansive notion of right to best care.

[clarice]

**medicianes and TREATMENT***

[ben]

"I do not believe that, whomever is president, we will see any vast new spending programs in this economic climate. That is the silver lining in our current dark cloud."

I think that is wishful thinking, bio mom. The interest groups supporting Obama aren't doing it for nothing. With a Democratic congress they will get a return on their investment and that will be higher taxes and more entitlements, even if its "hidden" in the form of "windfall" taxes and fees and expensive regulations for businesses, and "soak the rich" gimmicks, all of which end up being paid by consumers. Do you think Obama would be able to avoid "health care reform"? Global warming programs? The bill for consumers if Obama wins will be horrendous.

[ben]

Bacaangel was not at the top of the troll gene pool, obviously. Quoting Joe Klein to attack McCain, wow. Who is next? Paul Krugman? Barbra Streisand?

[Pagar]

Bio Mon,
I don't have the latest info on this Bill but I'm going to try to find it. I'm pretty sure it is scheduled for a vote soon, and I'm also thinking that the House has already passed it.
As I understand the bill, the American taxpayer will take over the responsibility for taking care of all the poor in the world.

"Obama’s Global Tax Proposal Up for Senate Vote

AIM Column | By Cliff Kincaid | February 12, 2008

It appears the Senate version is being pushed not only by Biden and Obama, a member of the committee, but Lugar, the ranking Republican member.

A nice-sounding bill called the "Global Poverty Act," sponsored by Democratic presidential candidate and Senator Barack Obama, is up for a Senate vote on Thursday and could result in the imposition of a global tax on the United States. The bill, which has the support of many liberal religious groups, makes levels of U.S. foreign aid spending subservient to the dictates of the United Nations.

Senator Joe Biden, chairman of the Senate Foreign Relations Committee, has not endorsed either Senator Barack Obama or Hillary Clinton in the presidential race. But on Thursday, February 14, he is trying to rush Obama's "Global Poverty Act" (S.2433) through his committee. The legislation would commit the U.S. to spending 0.7 percent of gross national product on foreign aid, which amounts to a phenomenal 13-year total of $845 billion over and above what the U.S. already spends.

[JohnW]

I thought McCain's plan had an element in it (unobtainium?) to make a national insurance market instead of 50 indiviual state markets? Thereby increasing competition and bringing down costs?

IMHO, they need to do
1) That ^
2) Lower mandatory minimum coverages
3) Cap malpractice awards
4) Secure the southern border
5) Do something about Medicare and Medicaid not covering the full costs of procedures.

[Eric Blair]

Two words: Demographic Rating. It used to be 'community rating' where indeed it was one big pool(s). Then some private insurers came up with the idea that you could rate by demographics and therefore cut out expensive people like cancer patients and pregnant women. (ok, that's a bit glib, but you should get the point.) and bribed enough legislators to let them get away with it.

Karma is a bitch, AIG.

[clarice]

WE need to change expectations about insurance--it should be for catastrophic situations. Your car insurance doesn't cover fill ups or tune ups, does it?
For those to poor to cover out of their own pockets ordinary care, we might consider expanding the now shrunk public health service and using public facilities like schools for clinics in off hours as WE USED TO DO not so many decades ago.

[clarice]

**those TOO poor**

[Molon Labe]

Hmmm...pooling risk. Sort of like a collateralized debt obligation. And we know how well that worked out.

[narciso]

Could have been worse, could have quote Cottle or Wieserltier, who went full Steinem on Palin, or Cohn, who went Sullivan
on McCain's economic plans. The New Republic
has gone slightly less insane than the New Yorker's pathetic attempt, or the NY Times
derangement last fully seen against Guiliani; where they interviewed crack dealers on how the situation in their neighborhood had deteriorated in the 90s;
well from their prospective.

[Neo]

At last ... something that smells like an "issue".

I always wonder if these folks have missed the obvious.

A funeral director once told me that he doesn't "see all those 50's heart attack deaths anymore", like he did in the 1950's and 1960's. Instead, they all die now in their 70s' and 80's of cancer.

Bottomline .. medical success breeds more future costs.

Anyone who believes that medical coverage for all will reduce the load on the system is fooling themselves. It will require more.

The only solution to really lower the load and costs of the medical system is to let more people die, younger. I doubt anybody will be signing up for that plan.

[Charlie (Colorado)]

Um, *cough*, I wrote on this a while ago....

Clarice is just right: we're calling this "insurance" when it doesn't fit the insurance model, because it includes things that happen with probability ~ 1, like kids' colds. You can't spread the risk of something in that case; all you can do is transfer wealth from the healthy to the sick.

[glasater]

What really gets to me is that folks who don't pay any insurance at all expect the same kind of health care as those of us who faithfully pay our insurance premiums and have the largest deductibles possible.

[glasnost]

This liberal often-described-as troll is impressed that Tom is willing to empirically investigate actual proposed policies on issues of general concern to the American electorate. Even describing the policy at all, in any detail, is a victory for non-hysteria and nonpropaganda. With this information, it's practically possible to have a debate - "which policy is better for Americans or some subset therein?", rather than simply invoking the boogeyman of socialism and thus ending the 'debate' without even bothering to investigate the alternative plan.

The point is, people everywhere who like information thank you.

[Pagar]

I haven't found the Senate schedule on S2433, Global Proverty Act yet. but this statement makes me believe that it is still slated to be pushed before the Senate in this session.

"The Congressional Budget Office estimates that the cost of implementing the GPA would be less than $1 million, a small sum to pay to increase the effectiveness of several billions of dollars in development aid. The GPA passed the House in 2007 and is currently pending in the Senate.

Bread for the World commends Sen. Debbie Stabenow, who is a co-sponsor of the Senate bill. Readers are asked to urge Sen. Carl Levin to also give the GPA (S. 2433) his full support. We must act quickly, as Congress intends to complete the current session later this month."

Article

In my first post on this subject today I for got to post the link.
LUN

[aogen]

Global poverty and the food bill problems go back to Bill declaring no one should be poor or starving or without medical care for AIDS. Obama is just going to say Bill. Biden is just going to say Obama. If the foreign aid money is checked, including Biden's 'loans' at Treasury, you'll find the US can't give away free money in five year 'emergency sustainable budgets' and programs that are entitlements over a long period of time. So, the US is losing it's loans and going into recession. It's the free aid money. Poverty and food.

The British taxed their GDP. The Canadians taxed their GDP. Both countries threw those PMs out of office.

The medical care is medication too? Canada is debating free medication, but major cities already do this on social programs. So, you might not want to insure Chicago, but the city programs should take care of that. Guaranteed eligibility.

[Neo]

Obama also sponsored S.2433:110th 'Global Poverty Act of 2007' which is out of Foreign Relations and is on the "Senate calendar".

This bill faces a certain Presidential veto as it expands US foreign aid by a phenomenal 13-year total of $845 Billion over and above what the U.S. already spends" to reduce global poverty. The amount of new aid is based on a percentage of GDP, with many expecting this to be funded through "carbon" taxes or "carbon offsets".

I assumed the actual date of the vote is being coordinated with Team Obama since this would then be the first piece of legislation that could possibly pass with Obama as the chief sponsor.

[bad]

Neo

That is not the sort of legislation the bitter clingers are going to be in favor of. I hope it is trumpeted far and wide.

[Pagar]

Neo, Did you notice the co-sponsors?

Bad, once the bitter clingers have cast their ballots, their ability to affect bills are pretty limited. The house has already passed the bill, according to what I hear. If this bill is passed and vetoed by Pres Bush, but Obama is elected, I'd be willing to bet a small amount that it will be back on the agenda in Jan. Once the Global Proverty Act is passed, my guess is America can say goodby to its's first world status.

This election is getting more critical every day and noone is telling the voters anything.
but garbage

[cathyf]

The legislation would commit the U.S. to spending 0.7 percent of gross national product on foreign aid, which amounts to a phenomenal 13-year total of $845 billion over and above what the U.S. already spends.

Unless Obama gets elected, implements his campaign promises, and throws us into another Great Depression. If you shrink GNP small enough 0.7% of GNP would end up being less than the foreign aid we give out now.

(How's that for a cheerful thought?)

[PeterUK]

This one is teetering.

[Pagar]

Here's the House Bill 1302, the link shows it has 84 sponsors. It passed on a voice vote which means (as I understand it) that there is no roll call to determine who voted for it.
Does anyone think any of these sponsors or co-sponsors will lose their job because their name was on this bill?

No wonder Obama isn't worried about his brother who lives on $12 a year (Or whatever),
he's sitting it up so that you're going to take care of him and everyone else in the world.

Cathyf, as I read the bill, the additional funds would be an add on to what we are spending now on foreign aid.

[Aaron]

Let's "pool" everyone's mortgages together and make the banks them in big groups. It will save them time and money not to have to spend time "weeding" out the bad risk mortgages.

How well did that work?