Shifting Tides?

by publius

One reason I'm suddenly feeling better about the chances of reform is that the incentives seem to be aligning in a more constructive way.  And the pressure from the left for both a public option and reconciliation is helping make this happen.

Consider the world from the perspective of insurance companies.  Understandably, they're very opposed to the public option.  And I'm sure they'd be quite content to kill the whole bill.  However, the more it looks like Dems will use reconciliation, the more the insurers' calculus changes.  As Brian Beutler reported, reconciliation could result in an even stronger public option.  And that's scary for them.

The upshot is that insurers now have ever-increasing incentives to start pressuring their legislative subsidiaries to pass a non-public option bill with 60 Senate votes.  The more credible the reconciliation threat becomes (and it's very credible now), the more incentives insurers will have to start lobbying affirmatively for passage.

These changed incentives won't help, of course, with legislators who are frightened of GOP primary voters.  But it should help a lot with people like Nelson and some of the rich-people-first Blue Dogs.

Comments

[cursorial]

Was just watching Anthony Weiner talk about medicare on the Rachel Maddow show, and it struck me for the first time how ridiculous - not just self-interested - the insurance industry's position is.

They play in a market where the most expensive recipients, the elderly, are covered by Medicare and those unable to pay are covered by Medicaid. So the industry risk pool is richer and healthier - more profitable - than the population as a whole because the government absorbs the unprofitable segments.

Doesn't that represent a massive indirect subsidy to the health insurance industry? (Honest question, maybe I'm thinking about it wrong.)

I'm generally pro-free market, and wasn't that worked up about the absence of a public option before. Now I want to throw things at the TV every time one of these flacks starts blathering on about the sanctity of the market.

[ChrisJ]

Cursorial -- exactly. The insurance industry gets to play in a very sheltered workshop indeed. It's astonishing that the hard kernel of their argument against the public option is that they'd be unable to compete with programs like Medicare on a level playing field.

[publius]

And that leads to a more general point that frustrates me -- the benefits of government tend to blend invisibly into the background. People forget that free education and Medicare didn't appear out of the ether, but were fought for.

You see the same thing in telecom law. Government has provided decades of subsidies, etc. - hell, it practically built the American telecommunications system (or at least heavily subsidized it). But all we hear about is how we can't interfere with the market, etc.

[(The Original) Francis]

Privatize the gains; socialize the losses.

That's about as good a motto for the modern Republican party as you get in six words.

[Fledermaus]

Yes. I'm utterly surprised that i surance companies are backing a bill that requires every american citizen to buy thier product.

My publius is a bad, bad publius

[tomtom]

"Privatize the gains; socialize the losses."

Nice.

My optimistic take on health care reform is that the other side has given their all to kill it.

And it isn't dead.

Compare and contrast with Social Security "reform", 2004.

[GoodOleBoy]

'They play in a market where the most expensive recipients, the elderly, are covered by Medicare and those unable to pay are covered by Medicaid.'

'Doesn't that represent a massive indirect subsidy to the health insurance industry?'

If the insurance companies covered these classes of people, the premiums required to stay in business would be higher (maybe much higher) across the board, looking much like an tax increase to all those insureds whose premiums increase. The actual real taxes required would (should) go down to reflect any premiums actually paid by those classes of insureds, but would not if the premiums were subsidized by government where the insureds could not actually afford to pay their own premiums.

How is this a massive indirect subsidy to the insurance companies? Its a subsidy to those who cannot afford their own coverage. And, of course, medical practitioners and facilities also provide a subsidy for these classes since government often pays less than would be charged a patient paying for their own services received.

[GoodOleBoy]

Often, the discussion and treatment of the costs of healthcare is puzzling or even dumbfounding here.

Where government is 'in charge' there are the basic costs including administration, costs attributable to inefficiencies, mismanagement, fraud, etc.

Where the private insurance industry is 'in charge' there are basic costs including administration, costs attributable to inefficiencies, mismanagement, fraud, etc., and profits.

The bottom line between these two approaches will be determined by how well the provider can manage these factors that affect costs.

Some think government will do this better and some think private insurance will. A fair debate can occur here.

Where the debate sours for me is when I lose any ability to have choice and this means there is essentially no appeal process over which I have any control. Since my personal conclusion is that the private insurance option will be more cost-effective than the government option and I get to retain some control over where I do business, and the government can participate in any appeal process, I vote for private insurance.

[Brett Bellmore]

"And that leads to a more general point that frustrates me -- the benefits of government tend to blend invisibly into the background."

So do the costs, thanks to withholding. Let's see how popular government would be if we abolished withholding, and handed everybody a bill for their taxes... Ideally on the first Monday in November.

[Nate]

I'm really not sure how people can say stuff like "private insurance will be more cost-effective than the government option", given our experience, and how the US pays many times more per person than any other country, especially those with government provided insurance.

Insurance companies have had 80 years to show how their magical free market practices can be so much more efficient, and all they've done is do their best to not cover anybody who's going to cost them money.

[russell]

my personal conclusion is that the private insurance option will be more cost-effective than the government option

I appreciate your desire to have choices.

Regarding the relative efficiencies of private vs public providers, my understanding is that the public providers -- Medicare, Medicaid -- are significantly more efficient than the private ones.

In other words, even after factoring out profit and commissions, their administrative costs -- the dollars not spent on health care -- are lower than for their private counterparts. I believe the CBO puts administrative costs for private carriers at about 11-12%, Medicare/Medicaid is 2-5%.

Do you have any evidence that this is not so? Can you explain why you believe private providers are, or would be, more efficient than public ones?

[russell]

Privatize the gains; socialize the losses.

That's about as good a motto for the modern Republican party as you get in six words.

I actually make that as the motto of American corporate governance.

The Republican perspective was, IMO, best expressed by Allen Raymond, RNC employee and convicted phone jammer:

"America is about self-interest within the rule of law"

That phrase will either make excellent sense to you, or strike you as a piece of toxic amorality. In my experience, your political affiliation and your vote will follow suit.

[Nombrilisme Vide]

Where government is 'in charge' there are the basic costs including administration, costs attributable to inefficiencies, mismanagement, fraud, etc.

Where the private insurance industry is 'in charge' there are basic costs including administration, costs attributable to inefficiencies, mismanagement, fraud, etc., and profits.

In both cases there are also basic costs including benefits paid which you fail to mention - no, wait, there it is, plain as day on the private list: "inefficiencies".

This comparison strikes me as a fine opportunity to see the hoary old "private industry is better because it can deliver (inferior) service for (theoretically) cheaper than some socialist monstrosity" chestnut. If we assume that the service is just as good (and therefore in this case, just as expensive) and in fact cheaper, just about the only place left to squeeze out the insurance industry's colossal profits (plus that presumed price difference) would be significantly lower administrative costs. If, as Russell suggests, the administrative costs are in fact higher, something in that rosy pro-free-market narrative's gotta give. Right?

[GoodOleBoy]

'In other words, even after factoring out profit and commissions, their administrative costs -- the dollars not spent on health care -- are lower than for their private counterparts. I believe the CBO puts administrative costs for private carriers at about 11-12%, Medicare/Medicaid is 2-5%'

Are costs of fraud in this comparison? I don't have any evidence for my personal conclusion, just theory. There is no reason to believe government has any inherent advantage to achieve efficiencies. Theoretically it should be the contrary. Two things one gets with government that can reduce administrative costs are scale and the ability to make the rules, neither of which appeals to me. Competition, one of the most significant forces in reducing business costs, is missing. One way monopolies reduce costs is through arbitrary behaviors and rule-making over which service recipients and providers have no influence. This is one of the detriments of not having choice.

[russell]

There is no reason to believe government has any inherent advantage to achieve efficiencies. Theoretically it should be the contrary.

I understand the theory. I'm asking if you can demonstrate it from the real cases.

We have both public and private health insurance providers in this country. The evidence appears to be that the public providers are significantly more efficient.

Since you claim that that is not, or would not, or should not be so, I'm asking you if you can explain the discrepancy.

Reality doesn't appear to conform to your theory. You'd like public health policy in this country to reflect your theory, rather than what our actual experience appears to be.

You need to put something stronger on the table than "theoretically it should be the contrary".

As far as I can see, it's not the contrary.

Why do you believe private providers would be more efficient?

How do you explain the fact that, at present, they are not?

[Nate]

GoodOleBoy: In what way do most people have choice in their insurance plans these days? Most have, at best, a choice of a couple of plans from one company, or maybe a couple of companies, through their work. The individual market is borked, and the insurance companies often rescind their coverage when somebody actually runs into something that'll cost money. And most of the time on insurance plans, your choice of doctors/hospitals/etc is all limited, which seems like a more important reduction of choice than having the government pay for insurance but let people pick any doctor they want.

[liberal japonicus]

Scale doesn't appeal to you? I guess you hate Amazon, Google, McDonalds... In fact, it is hard to imagine any major business that doesn't utilize scale. If it works for all those companies, what's the problem with the government using it?

[KCinDC]

Privatize the gains; socialize the losses.

Ambrose Bierce had that right a hundred years ago:

CORPORATION, n. An ingenious device for obtaining individual profit without individual responsibility.

[Nombrilisme Vide]

There is no reason to believe government has any inherent advantage to achieve efficiencies. Theoretically it should be the contrary. [...] Competition, one of the most significant forces in reducing business costs, is missing.

Um. Right. GOB, competition doesn't reduce "costs" in the abstract. Those reductions have to come from somewhere. So, if the private entities are inspired by competition to reduce costs, where are they getting that money? Is it from more rigorous fraud elimination? That should be an easy enough case to make if it is. If not... where? Russell suggests the CBO is showing that it's not administrative. So where would that magical competitive cost advantage that can overcome less efficient administration plus profits come from? Hmm?

As a side note, why exactly are you ruling out economies of scale as a legitimate means of cutting costs, especially in insurance, of all domains? Insurance is all about economies of scale. If that's not legitimate...

[GoodOleBoy]

The scale the government would have that is unappealing is monopolistic scale.

The present private insurance market is not competitive and one major cause is government involvement, federal and state, in areas like requiring mandates. So we get a choice of insurance provider without getting the choice of insurance product. Wherever the hand of government touches it has an effect. Lobbying, to preserve an existing advantage or to gain a new one, increases costs of doing business, and this is a direct result of government involvement. There is no dearth of explanations for why this system is not working. The primary responsibility rests with our elected officials, federal and state.

[someotherdude]

Just because....

myth frivolous lawsuits medical

[John Thullen]

Brett:

"Let's see how popular government would be if we abolished withholding, and handed everybody a bill for their taxes .."

Let's see how popular health insurance would be if we handed everybody a bill for their annual premiums, ideally on the first day they got cancer.

Let's see how how popular mortgages would be if we handed everybody a bill for just the interest portion of their mortgage, ideally on the same day the health insurance premium was due.

Let's see how popular food would be if we handed everybody a bill for their annual grocery bill, ideally just before breakfast.

Let's see how popular salaries and wages would be if we handed our employers a bill for our annual wages and salaries, ideally just before the employers' bonuses were paid.

Let's see how popular driving would be if we handed people a bill for their car payments and fuel expenses, ideally just before their doctor's appointments.

Let's see how popular children would be if we just handed their parents a bill for the first 18 years of expenses, ideally just after foreplay.

Let's see how popular guns would be if we just handed everybody a bill for their annual bullet wastage.

Let's see how popular commenting on internet sites would be if we handed everybody a bill for bullsh--.

I'd certainly have to find something else to do.

[Nate]

So it's government's fault that health insurance companies turn down people as often as possible and rescind coverage regularly when a claim is made? It's government's fault most people's insurance is tied to their employment? Or is this just a handy handwave "Oh, any problems with the market's results are the fault of government interference, because the free market can never be less than perfect."?

Seriously, do you think that without government existing, companies would never try and preserve existing advantages and gain new ones, using whatever methods they have at hand?

You're not addressing any of the questions people asked you, you're just saying "government is bad" and blaming the bad actions of private companies on unspecified "government interference".

[cursorial]

How is this a massive indirect subsidy to the insurance companies? Its a subsidy to those who cannot afford their own coverage.

I'm picturing the health insurance industry absent Medicare. The effect would be, as you say, a shift from tax-funded health care to premium-funded health care; my health insurance would suddenly look much more expensive with that slice of medicare tax added into it.

I don't object to insurance company profits; but the pro-free market argument implies that what we have today is a free market, when in fact it's highly distorted by medicare.

Put another way, if I'm an insurance company executive looking to maximize profits, the customers I want least are those most likely to file major claims - demographically, that's the over-65 contingent. Conveniently, the government takes them off my hands at that point.

So we have a public option now - but it's only available to a group that the insurance industry would rather not cover.

There may be a better term for that than "indirect subsidy", but the effect is the private health insurance business is much more appealing as a business with Medicare in existence than without.

"Privatize the gains, subsidize the losses" sums it up pretty well and I'd like to hear one of the free market proponents on CNN explain why that's not what we're doing. But since we're at the "keep the government out of my Medicare" level of debate in the media, I'm not holding my breath.

[GoodOleBoy]

'Put another way, if I'm an insurance company executive looking to maximize profits, the customers I want least are those most likely to file major claims - demographically, that's the over-65 contingent. Conveniently, the government takes them off my hands at that point.'

This is not true when premiums across all the insured population are adjusted to reflect the costs of all claims across that population. Of course, the premium adjustment will be painful, but the insurance company executive should be indifferent once it is in place since the bottom line for the company will be maintained.

[Nate]

In a truly free market, without the corrupting hand of government, the insurance companies would just not cover anybody who made a claim or might get sick, but they'd go ahead and raise the premiums for everyone else, because hey, they've got to pay more to cover those old people who get sick and cost more. Then once those old people get sick, it's on to market priced ice floes for them while the executives laugh all the way to the bank.

[Nombrilisme Vide]

The primary responsibility rests with our elected officials, federal and state.

This is so true. I can't believe that e.g. the government mandate to maximize profits via institutionalizing rescission didn't get those bastards thrown out of office en masse. I tell ya, we wouldn't be seeing crap like this happening if we had no government regulation getting in the way of insurance companies' ceaseless efforts to serve the public good.

[sanbikinoraion]

Nombrilisme Vide just won the internets.

[ChrisJ]

It seems to me we're back at the starting point: Healthcare -- public good or just another private commodity. If you think it is a public good, the question is how best to provide it, and we're just arguing about the details. If you think it's a product, a commodity like any other, then all those market-based arguments apply.

I spend my days awash in healthcare anecdotes, one-after-another examples of why healthcare is a public good, not some kind of widget, and should be organized as such. All that free marketeering stuff is a bunch of crap.

[hairshirthedonist]

Let me start off by making it clear that I support the public option, and, further, would support a public, single-payer health-insurance system.

But: One aspect of the argument that Medicare/Medicaid is more efficiant than private insurance that bothers me is that it seems to ignore that those covered are more expensive per capita in terms of dollars spent on actual care, effectively growing the denominator when calculating efficiency as a ratio of admin costs to health care expenditures. So it's not (or may not be) so much that Medicare/Medicaid is good at keeping admin costs down so much as they simply have to provide more care given the nature of those insured. I find that compelling, but I'd love to hear why I shouldn't.

[russell]

The present private insurance market is not competitive and one major cause is government involvement, federal and state, in areas like requiring mandates. So we get a choice of insurance provider without getting the choice of insurance product.

This is completely true. We do not have a purely competitive free market health care system. And the reason we don't is because of government regulation.

The reason we have the government regulation is to help ensure that, at least for the folks who actually have health insurance, that their insurance covers a useful level of service.

There are people who are simply uneconomic to insure. There is nothing whatsoever that can be done to change that fact.

In a purely private, competitive model, those folks would not get health insurance. Because there is no, absolutely no, economic motivation to sell it to them. At least not for a price that the vast majority of people could afford.

The price of a free market approach would be that health insurance would, very simply, not be available to a lot of people.

I'm with ChrisJ. Health care cannot be made to fit the definition of commodity, and should not be treated as a commodity. There is a broad and readily justifiable public interest in making access to health care available to as close to 100% of the population as we can possibly achieve.

I have no problem with private insurers being in the game, but the game overall is not a good fit for a free market solution.

Some things are, and some things aren't. This is not.

[mutt]

Has the invisible hand drawn the roadmap showing the benchmark metrics are yet?
what a load of crap. Stick a fork in it. Draw the chalk outline, and move along. The general population has been sold out, business as usual. Funny part of it is a good portion of said genpop will heave a sigh of relief: they've been spared communist inspired forced suicide. Whew! THAT was close!

[ChrisJ]

Hairshirt:

I'm less familiar with Medicare than I am with Medicaid, but the majority of Medicaid patients are actually children, who are not very expensive to take care of individually. Most of the Medicaid money (about 75%) goes for the care of the disabled and elderly (because Medicare does not cover chronic care, such as nursing home care), who actually are a minority of the patients in the program.

A major difference between Medicare and Medicaid is that reimbursement differences are stark: the very same procedure is reimbursed at a much higher rate for a Medicare patient than it is for a Medicaid patient. There are interesting (and distressing) historical reasons for this, but that's something for another discussion.

[elm]

hairshirthedonist: Administrative overhead almost certainly has some per-person component, some per-treatment component, and some per-dollar component.

There is good reason to believe that baseline per-person costs are very low. Consider a completely healthy person who receives no treatment (0 treatments and $0). Administrative costs for this person are limited to a few database entries, a few bills, a few statements, and a few other mailings.

If you have evidence that the per-person component is significant or dominant, then I'd like to see it, but it seems unlikely.

Canada also has lower per-capita "insurance overhead" ($259 vs. $47 in 1999), according to this study: Costs of Health Care Administration in the United States and Canada.

[KCinDC]

Hairshirt, it's not clear to me why the numerator wouldn't be increasing as well. Why would you expect administrative costs to increase with the number of people covered rather than with the cost of care, or number of procedures/prescriptions/visits, or something?

[elm]

Krugman on administrative costs.

He notes that Canada's large-population Medicare program has low per-capita administrative costs.

Also, Medicare Advantage plans -- private insurance for elderly in the U.S. -- cover a population similar to Medicare. Their per-dollar administrative overheads are higher than Medicare and similar to those of the rest of the private insurance industry.

[hairshirthedonist]

elm: hairshirthedonist: Administrative overhead almost certainly has some per-person component, some per-treatment component, and some per-dollar component.

There is good reason to believe that baseline per-person costs are very low. Consider a completely healthy person who receives no treatment (0 treatments and $0). Administrative costs for this person are limited to a few database entries, a few bills, a few statements, and a few other mailings.

and KCinDC: Hairshirt, it's not clear to me why the numerator wouldn't be increasing as well. Why would you expect administrative costs to increase with the number of people covered rather than with the cost of care, or number of procedures/prescriptions/visits, or something?

To answer you both, it's not that I don't think there would be some overhead increase for those who receive more care. I just don't think it would be on the scale of the increase in the costs of the care itself. (In thinking about that, I wonder how the Prescription Drug Benefit comes into play, if at all, in the numbers russell quoted.) I would think that, for example, the administrative costs associated with a $100 doctor's visit would be far greater than 1/200th of those for a $20,000 surgery.

elm: If you have evidence that the per-person component is significant or dominant, then I'd like to see it, but it seems unlikely.

I don't, but, to me, it seems likely. So I guess I'm blegging for info rather than bringing it. (And I'm certainly not married to a position that doesn't support my preferences.)

[hairshirthedonist]

elm: Consider a completely healthy person who receives no treatment (0 treatments and $0). Administrative costs for this person are limited to a few database entries, a few bills, a few statements, and a few other mailings.

Thinking about this particular example a bit more, it's really very supportive of my intuitive sense of things. While the admin costs for someone receiving no care at all would be very low, the efficiency would be zero, given a zero numerator and a finite denominator. Or, presented as in russell's comment, admin costs would be 100% of overall spending. That looks as bad as it possibly can mathematically.

[Brett Bellmore]

"Let's see how popular health insurance would be if we handed everybody a bill for their annual premiums, ideally on the first day they got cancer."

Yeah, withholding tends to hide all sorts of costs, not just taxes. Ideal transparency would involve having to write a check by hand for everything, just so you notice it.

Anyway, I'll be writing a check shortly for a good part of my savings, to pay for some major surgery; Just got diagnosed with prostate cancer.

[russell]

crap. sorry to hear that, Brett.

[hairshirthedonist]

elm: Krugman on administrative costs.

Thanks for the link, elm. I don't make a habit of arguing against empiricism, despite my initial intuitions. The commenters on Krugman's post make some good points about the extra costs in private insurance that government-provided insurance doesn't (wouldn't) have, too.

[Hogan]

Best of luck, Brett.

[hairshirthedonist]

Anyway, I'll be writing a check shortly for a good part of my savings, to pay for some major surgery; Just got diagnosed with prostate cancer.

Good luck with that, Brett. (Seriously - no sarcasm) My dad was diagnosed several year ago and is doing fine after being treated. He did have to go back for roto-rootering of sorts a little while after his initial teatment, but that's about all. (Thanks to the VA, if I might throw that in.)

[John Thullen]

Brett Bellmore:

I trust the cancer was caught in time and I wish you a speedy recovery with no lasting side effects.

I've had several friends who have had prostate cancer surgery in the last year or so, and all of them report success, knock on wood, so to speak.

I also trust we'll have a public option for those without health insurance and that private insurance will be barred from denying coverage to those with pre-existing conditions.

Get well soon and come back here and give everyone hell.

[Eric Martin]

Good luck, get better and be well Brett. Having gone back and forth with you for the better part of 6 years dating back to legal fiction days, I'm confident in your tenacity and your fight. You can and will beat this, I'm convinced.

[Catsy]

Sorry to hear that, Brett. I'm not being snarky when I say that I hope your situation doesn't turn into yet another health care horror story statistic.

[Johnny Pez]

You're not addressing any of the questions people asked you, you're just saying "government is bad" and blaming the bad actions of private companies on unspecified "government interference".

I hope this doesn't come as a surprise to you. I have yet to encounter a libertarian who argues any other way.

[Jay Jerome]

Sincere best wishes for a speedy recovery, Brett...

[cleek]

sorry to hear it Brett.
best of luck.

[Nate]

Good luck, Brett.

[Jay Jerome]

Brett
..
a quick online look at recovery rates for early detection and treatment are very encouraging:

100% after five years...
91% after ten years...

And if you were diagnosed this year, your outlook is likely to be better than the numbers reported above.

[Slartibartfast]

knock on wood, so to speak

Thullen makes me laugh when I least expect it. Probably no one expects...oh, that's something else.

Oh, and best wishes for a successful procedure and speedy recovery, Brett.

[Marty]

Brett
Best of luck. Hope things go perfect.

[jonnybutter]

Hope it was caught very early, and glad it's not a more difficult cancer, Brett (not that prostate is FUN!). Good luck.

[Jacob Davies]

Brett: "So do the costs, thanks to withholding. Let's see how popular government would be if we abolished withholding, and handed everybody a bill for their taxes... Ideally on the first Monday in November."

I don't disagree with this, actually. But those costs aren't hidden to me. They're on every payslip and I have to type them into my tax returns once a year. I'm pretty well aware how much I pay in taxes and even where it goes, thanks to the splitting out of payroll taxes from income taxes.

What I do wish they would do is put the full amount of payroll taxes - including the employer portion - on payslips. The whole division into "employer" and "employee" payments is meaningless. What is important is the the cost to the employer of each employee.

Ditto for the cost of medical insurance and other employer-provided benefits. I certainly don't want people to feel guilty over what they get, but I do want people to be able to compare coverage costs and benefits more easily. If you have a quote-unquote gold-plated plan, I'd like you to know that it amounts to a boost in income a lot larger than someone with bare-bones coverage, or someone else with a middle-of-the-road HMO plan. Information is good.

And: good luck with the treatment.

[Jacob Davies]

As for shifting tides, the AMA (broadly) endorsed the Obama plan: http://prescriptions.blogs.nytimes.com/2009/09/09/ama-endorses-a-health-care-overhaul/

Mixed feelings about that, along the lines of, "If the AMA likes it I'm not going to", but on the other hand their endorsement is a sign that powerful groups out there are recognizing that something is going to pass one way or another, so they'd better get on board their favored option.

[Brett Bellmore]

Low Gleason score, moderately low PSA, cancer only showed up in one of 14 biopsy samples; They say I'll probably (90% plus) be completely cured. Joke is, the treatment is going to be worse than the cancer would have been for at least 6-8 years; If I die from an auto accident 5 years from now, I am going to be SO pissed about having gotten the surgery. ;)

[liberal japonicus]

Sorry to hear that Brett, though, (and this isn't be being sarcastic), you are in the best country in the world to have prostate cancer. The infrastructure for detection and treatment much more extensive than other countries.

Because my dad had it, I've been worried about getting it, but the level of screening here is minimal, because, apparently, levels of prostate cancer here in Japan are very low. So, a PSA isn't part of my normal checkup, and knowledge of the cancer and treatment options are much more limited. However, I'm safe on stomach cancer, which has a higher incidence here so a check is included yearly. Too bad this kind of stuff isn't fungible.

[CharlesWT]

1. Medicare Administrative Costs Are Higher, Not Lower, Than for Private Insurance

2. Medicare’s Hidden Administrative Costs: A Comparison of Medicare and the Private Sector (.pdf)

3. Does Medicare actually have higher administrative costs than private insurers?

[CharlesWT]

4. Comment on 3.

5 . Administrative costs (Paul Krugman's response to 1. above)

6. Author of 1. response to 5.

[hairshirthedonist]

Low Gleason score, moderately low PSA, cancer only showed up in one of 14 biopsy samples; They say I'll probably (90% plus) be completely cured. Joke is, the treatment is going to be worse than the cancer would have been for at least 6-8 years; If I die from an auto accident 5 years from now, I am going to be SO pissed about having gotten the surgery. ;)

I just recently heard an interview on NPR (was it Atul Gawande? he was on recently) with a doctor discussing a recent study on outcomes for those diagnosed with prostate cancer who went through "watchful waiting" versus those who went through aggressive treatment immediately after diagnosis. For those with certain types of slow-growing prostate cancers, there was no significant difference in outcome. The ones who waited until it was clearly necessary to have it treated, if ever, did virtually just as well as those who treated immediately after initial diagnosis. It's hard to imagine being that risk tolerant, though, even if it turns out that the risk isn't really significantly different.

[Nell]

Privatize the gains; socialize the losses.

That's about as good a motto for the modern Republican party as you get in six words.

If it were only Republicans who acted on the motto, life would be good. But the corporate grip on our politics goes much, much further than that.

[Hartmut]

Good luck, Brett.

Prostate cancer seems to be quite an interesting medical phenomenon. I read that the probability of getting it is approaching 1 with age, i.e. any man living long enough will get it in the end. But because of usually slow growth and benign hyperplasy being almost universal as well, many will not even notice it and die of something else before it is even detected.

[bedtimeforbonzo]

What Thullen said.

[Brett Bellmore]

Hairshirt, as far as "watchful waiting" is concerned, it's of little consolation that it would take the cancer most of a decade to kill you, when you're only 50. I've got a 11 month old son, I'd kind of like to be around while he grows up. Well, 98% around, or so.

[sanbikinoraion]

Good luck and hope all goes well, Brett!

/me goes back to lurking

[hairshirthedonist]

Hairshirt, as far as "watchful waiting" is concerned, it's of little consolation that it would take the cancer most of a decade to kill you, when you're only 50. I've got a 11 month old son, I'd kind of like to be around while he grows up. Well, 98% around, or so.

I can understand that sentiment, thus my finishing sentence. But the point the doctor was making was that the cancer, in certain types of cases, was not significanly more likely to be fatal after any number of years than if treated immediately. Watchful waiting doesn't mean watching and waiting for it to kill you. It means watching and waiting until treatment is clearly necessary, before it kills you.

I only write this to be clear about what I was describing and not to urge you to change your course of action. I'd do the same thing were I in your shoes. I'd guess I'm pretty likely to be in your shoes at some point, given my dad's history.

[JanieM]

Brett --

I don't know if you have older children too, but if not, you're still within the time period with your son when for me, after I had my kids, I was gradually realizing how everything, just everything I felt about risks of all kinds (for any of us) had changed because I wanted us all to be around together for many many years. I have to say that for me it has never changed. My son is almost 24 and is starting his second year in China and he just wrote to me about guidelines they've given him for monitoring swine flu. He's more afraid of their medical system than of the flu, but I'm not sure that's justified. I'm just afraid, period, and to be honest, wishing there was someone to pray to.

Gee, did I just agree with you about two things in one comment? :)

Best of luck with an uneventful surgery and a speedy recovery.

[magistra]

Brett,

Let me add my hopes that your treatment is successful (and doesn't break the bank).