« The Wheels of Justice – Weekend Open Thread | Main | dead-heading »

June 22, 2017

Comments

A point of interest in the NY Magazine article that cleek cites is the difference in the actuarial value of what we have now, vs what the Senate bill would deliver. The only person I see talking about that is David Anderson over on Balloon Juice.

Also noted by Anderson is what appears to be a relaxing or removal of the maximum loss ratio - the percentage of revenues that insurers are required to spend on actually funding health care for the insureds.

I really don't see how this ends up anyplace other than people being worse off.

That, and a tax cut.

No, the 22m is the difference in today and then if it's enacted. It is not a comparison to then under the current plan.

i'm not sure what you're trying to say here. the article is clear about what it's comparing:

And on March 13, CBO issued another, much-anticipated projection of the Obamacare repeal bill being considered by the Republican-controlled House. CBO estimated that under the GOP’s American Health Care Act, 14 million fewer people would have health insurance next year than under current law, and that number would rise to 24 million in 2026.

“In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law,” CBO said.

the numbers change slightly for the Senate plan.

The budget office projects that by 2026, 49 million people would be uninsured, compared with 28 million people if the current law remained in effect. (The total increase is 22 million due to rounding.)

there's a pretty graph on the NYT page, so you can see what they're talking about.

A discussion of actuarial value.

The ACA has a benchmark of federal support up to 70% of actuarial value.

The (R) Senate bill has a benchmark of 58%.

Subtract that number from 100, and that's the percentage of total cost of care that the insured pays.

More discussion from the commies at Business Insider.

Marty:

Lemme see if I can embed this image (from 538):

This is what we're talking about. The Obamacare baseline is 28M uninsured, which Dems agree is too high. Most of that is due to states refusing to expand Medicaid, and other forms of GOP sabotage.

Under the Senate bill, the uninsurance rate would go back to approximately the pre-ACA status quo. Approximately 20M people would lose their insurance, 15M of them in a single year.

Is this clear to you now?

Have your news sources been telling you this, but you haven't understood them? Or have they not been saying this clearly?

If the news sources you follow haven't given you this information, you need better news sources. If they've been contradicting this, you need to examine your choices and think about why you're believing people who are lying to you.

If the news sources you follow haven't given you this information, you need better news sources. If they've been contradicting this, you need to examine your choices and think about why you're believing people who are lying to you.

Thank you Doctor Science. I'm afraid that this needs to be said to people over and over. It's really the basis of our problem.

"Under the Senate bill, the uninsurance rate would go back to approximately the pre-ACA status quo. Approximately 20M people would lose their insurance, 15M of them in a single year."

It has always been clear to me. But the CBO has to assume that the current law continues to work the way it is today. Which it is clearly not and wont. The CBO doesn't assess what the impact of doing nothing is.

They also cant assume any change in policy at the state level, so they have to assume the dollars that are capped automatically cap signups. How two faced would it be if the Governors of all those states that complain about this just did nothing and didn't get the money to cover their state.

The point is that the CBO is NOT analyzing whether the current assumptions under current law are correct or not, they are REQUIRED to assume they are. Thus a flat line on the graph for Obamacare. The second most unrealistic part of the assessment.

This doesn't seem to be the same argument you were making earlier, Marty.

instead of the CBO, who should we use to assess the impact of a policy that reaches far and deep into 18% of the US economy?

if you have a better estimate, show your work.

"instead of the CBO, who should we use to assess the impact of a policy that reaches far and deep into 18% of the US economy?"

The National Football League?

http://talkingpointsmemo.com/dc/senate-bill-medicaid-funding-roads-bridges-stadiums

I wonder if potholes are considered pre-existing conditions?

Marty:

CBO has to assume that the current law continues to work the way it is today. Which it is clearly not and wont. The CBO doesn't assess what the impact of doing nothing is.

Do you mean because "Obamacare is collapsing"? I can find no graph from anyone projecting that this so-called collapse will lead to an increase in the number of uninsured (which is the metric we're discussing). Link or take it back.

Also: Obamacare is not "collapsing". Where it is running into trouble, it's because the GOP is undermining it.

Again, if people are telling you that Obamacare is "collapsing" or "imploding", they are ignorant and/or lying to you.

hsh, It is, hopefully just more clearly. It is comparing what will happen with essentially today, because it doesn't assume any change in results from todays policies.

That is always a CBO scoring issue, both sides don't like it when it is their change it is analyzing. It is a good place to start in assessing changes, but it is rarely a good ending point.

It is comparing what will happen with essentially today, because it doesn't assume any change in results from todays policies.

the CBO says that the Senate bill will cause 15M people will lose insurance in 2018.

are you expecting the GOP to put out another health care law (which the CBO doesn't know about) to fix this, in the next 6 months?

"Link or take it back."

Really? Is that an order?

Where it is running into trouble is where the current legislature doesn't continue to subsidize the insurance companies beyond what the original law specified. It is collapsing because, without the government subsidies eventually there will be no insurance company willing to insure everyone at the defined required levels.

Yes, all we have to do is guarantee a profit for all the insurance companies and pay 100% of Medicaid adds for all the states forever and Obamacare would be fixed. Well, financially anyway.

That would make it not the ACA, which didn't anticipate either of those things. It ended the insurance company subsidies in 2015 and never adequately anticipated the cost of Medicaid expansion.

Or perhaps the people who are telling you it isn't are ignorant or lying to you. Because I intimately know how it has degraded over the last 3 years, cost of policies, size of deductibles and copays, number of options and all of that was before this Congress.

Just out of curiosity, do you have an estimate (and I realize it will be only an estimate) of what the change will be if the current law goes forward? Just so we can at least see what you think the proper comparison is.

Thanks

It's going to be very difficult to reduce the cost of healthcare if nothing is done on the supply side.

Healthcare is the most heavily regulated sector of the economy. Not just public regulators, but private regulators like the AMA and other professional organizations.

Many medical procedures and treatments that are reserved to MDs could be done by nurse practitioners at a lower cost.

Why must women see a doctor and pay for an office visit just to legally purchase birth control pills?

State level Certificates of Need limit the availability of medical care and increase costs.

I suspect that there are surgeries that are now so by the numbers that they could be done by surgical technicians without a medical degree.

Each state having its own medical license requirements limits mobility and availability of practitioners.

An inclusive list would be many times longer than this.

Marty, I re-read your earlier comments, and they are at least consistent with what you're saying now. The only thing I don't get is that we all know the CBO doesn't have a crystal ball and has to make certain assumptions. The question isn't whether or not they are assuming things will change with the ACA, but whether or not they are making comparable assumptions about the two laws in making projections.

What makes you think the assumptions they are making about each law are somehow biased against what's being proposed in the senate bill? What makes you think the senate bill will/would go exactly as they're predicting while the ACA will/would go far worse than predicted?

Why isn't it just as likely that their projections about the senate bill's implementation are overly rosy?

The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law

https://www.cbo.gov/publication/52849

wj,

I suspect that the numbers of uninsured would go up something less than the 15M projected for next year but probably all of that by 2026. This is based on the numbers of people that they say wont buy insurance because they cant afford to go to the doctor anyway, which is already happening, even in employer provided health insurance. In essence whatever part of that increase is due to choice it will happen anyway.

That leaves between 6 and 7 million people not getting Medicaid. While, based on the 50% overages between 2014 estimates and 2016 actuals I am really not sure how much the Medicaid costs will accelerate, it is certainly well beyond a flat line and at some point "something will have to be done". It is not an infinite resource.

Not insuring this 6-7M is completely stupid of course, but it can be done more efficiently. I do think to solve the problem permanently we should push it back to the states, in block grants so eventually the leverage exists to make them cover everyone.

I appreciate Charles' comment here because he is addressing *cost*.

Most of the discussion on the topic of health care is around who gets stuck paying the bill. If it wasn't so expensive in the first place, that would be less of a problem.

Regardless of what the cost is, there will always be the issue of providing care for folks who just don't have a lot of money.

But the issues we are dealing with now extend well beyond that. Among other things, the rise in health care costs is one of the reasons real wages have been flat for so long.

It's starving other sectors of the economy.

Charles at 2:37
Yes to pretty much all of that. (Of course, parts of the economy which are regulated as health care, e.g. hair and beauty salons, are so only because it limits competition more effectively.)

But do you see any realistic prospect for changing that in the foreseeable future?

I am really not sure how much the Medicaid costs will accelerate, it is certainly well beyond a flat line and at some point "something will have to be done".

I agree with this. But, it's not due to "Medicaid costs", it's due to costs, full stop.

If Medicaid doesn't pay, somebody else has to. Or, no-one pays, and care is not delivered. And that's not free, either, because folks either go to the ER, or whatever they may have contributed to overall prosperity (in whatever form) is lost.

It's actually a kind of dead loss to all of us if thousands or millions of people die before their time, or live significantly limited lives due to preventable or treatable illness.

To me, the Senate bill is basically the feds responding to "something has to be done" by saying "somebody else do it". Which is, on its face, attractive to people who just hate the freaking federal government, but the states are kind of a crap shoot.

You seem to believe that pushing it on to the states is going to inspire them to rise to the occasion and fill in the gaps. I suspect that belief is naive.

Where it is running into trouble is where the current legislature doesn't continue to subsidize the insurance companies beyond what the original law specified. It is collapsing because, without the government subsidies eventually there will be no insurance company willing to insure everyone at the defined required levels.

Correct me if I'm wrong here, but it appears you are claiming that we (the federal government?) are currently giving the insurance companies more that originally authorized by statute? Wouldn't this be breaking the law? Tell me how this took place.

But do you see any realistic prospect for changing that in the foreseeable future?

I'm doing my part. I haven't seen my primary care physician in probably 8 or 10 years.

It's all NP's in my guy's practice now.

Why must women see a doctor and pay for an office visit just to legally purchase birth control pills?

because BC is not risk-free.

ex. my wife's arm started swelling up and getting sore last year. allergy? bug bite? lymph node? it took all of her doctors a couple of weeks to figure out that it was a blood clot. luckily it was in her arm where it effects were visible (if hard to diagnose at first). if it had been internal, or larger, or in a different place... well. she's off BC now. and some people should never start.

I haven't seen my primary care physician in probably 8 or 10 years. It's all NP's in my guy's practice now.

ditto.

it works. so i guess it's OK. but people ask me who my doctor is and i say "Dr Torey. i don't know if he's still at the practice there or not. he was nice, but i don't remember when i last saw him."

But do you see any realistic prospect for changing that in the foreseeable future?

There are some approaches that are evolving. Practitioners offering medical care in exchange for flat, monthly fees. Surgical clinics providing services for upfront cash payments.

Here's a whitepaper on medical reform. You may not agree with a lot of it.

The American Health Care System: Principles for Successful Reform

I haven't seen my primary care physician in awhile either. It's nurse practitioners.

I guess somehow the cost curve is getting bent but, help me out here, my copays, deductibles, and premiums continue to increase despite the cheaper labor attending to me.

So I assume my primary care doctor is still raking it in, to the extent that Kaiser Permanente doctors can be said to rake, while others do the work.

Why am I not seeing some discounts and rebates for cheaper service?

Or does EVERYTHING have to be bullshit in America?

He's an asshole bullshitter even to Mickey Mouse:

https://www.balloon-juice.com/2017/06/27/pardon-our-motherfucking-dust/

Why am I not seeing some discounts and rebates for cheaper service?

One reason may be that it's difficult for anyone, including service providers, to know what the price for various services should be.

Ram this thing through now or we might have to observe the rules of Democracy and make the bill better:

http://www.politico.com/story/2017/06/27/republican-health-care-bill-mitch-mcconnell-trump-239998

"One reason may be that it's difficult for anyone, including service providers, to know what the price for various services should be."

If anyone would know how to determine those costs and prices and bend the cost curve, it would be Kaiser Permanante.

They've spent tens of millions of dollars studying processes and practices.

If next time I go in and the $10.00 per hour receptionist tells me to look to the left and cough for the $30 copay, first, I'm going to demand some of the 200 percent markup back, and second, I'm going to set up a quickie-lube surgical center out of a van in their parking next to the taco truck.

Political proctologists try to insert their invisible hands up our wazoos:

https://www.dailykos.com/stories/2017/6/27/1675736/-Far-right-groups-push-Senate-hard-liners-to-oppose-Trumpcare

Guns. Lots of them.

Charles at 2:37
Yes to pretty much all of that.

Yes, sure. But Charles would go on to claim that is the fault of "the government" as if the government were some kind of sentient being and not a social institution that all too often reflects the desires of a bunch of powerful rent seeking constituencies.

Dean Baker has done yeoman work on the many rent seeking restrictions on the supply of health care. These outcomes are due to political choices.

Political choices can be revised.

PS: I see mcconnell does not have the votes and pulled the plug today on holding a vote prior to the holiday.

Hope remains.

"Hope remains."

No, it doesn't. It will be easy peasy to make the bill more brutal and kill even more Americans, and thus pick up the required remaining votes from the hardliners like Ted Cruz, who, amazingly, remains free of bullet wounds.

By the way, my apartment rent goes up year after year regardless of supply and demand and despite hundreds of new units going up in the immediate area.

I've never met my landlord, but he or she has plenty of low paid practitioners on hand to collect.

Like my invisible doctor, what exactly does my landlord do for his annual pay raises?

I ought to get a free colonoscopy from my landlord as a perk.

Especially since I'm already bending over.

One reason may be that it's difficult for anyone, including service providers, to know what the price for various services should be.

Maybe providers could offer their services on ebay, and just let folks bid at auction for their medical care.

Can't get much more market-price-setting than that.

"If Medicaid doesn't pay, somebody else has to."

I don't really disagree with this. However,
right now no one has to do the work. The Governors don't have to justify the cost to their constituents because it is buried in the manna from heaven.

Republican or Democrat, they get to just be shocked, shocked I say, that anyone would think their constituents aren't worth unlimited funding.

At least in a block grant system there is some element of accountability for creating the best possible system at the state level. Right now it's just that money tree my Dad told me didn't exist.

single payer, yadayadayada.

we need to quit screwing around and just do it.

For 80% of Americans single payer will be a rude awakening to what rationed healthcare looks like.

But then we will be as good as all those other countries, we will have health care as good as Bosnia.

But then we will be as good as all those other countries, we will have health care as good as Bosnia.

I have some friends from Bosnia (who are now American citizens). They have doctors here, but when they visit their family once a year, they see doctors there because the healthcare is excellent. I think your xenophobia is showing.

The citizens of Bosnia who are our age went through a terrible war, so I'm sure it had an effect on their public health. But their doctors are excellent.

It will be hilarious (no, actually tragic) when, in a few years, people from other countries will be comparing their excellent healthcare to our huge maternal mortality rate. Kind of like Texas now.

Thanks to decent people like McKinney and you, lots of women die.

For 80% of Americans single payer will be a rude awakening to what rationed healthcare looks like.

health care is already rationed.

ask your insurance company if they'll pay for anything you want.

"But then we will be as good as all those other countries, we will have health care as good as Bosnia."

It's one thing to step IN it.

But try not to jump up and down in it.

You were right on Bosnia. But not "all those other countries". That's OK, they have funny names.

http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

sapient, the high maternal mortality rate in Texas, especially among black women, is a metric that is believed by republicans to prove that freedom reigns supreme.

They see a corpse, especially a black or female one, and they believe things are going precisely as the founders and God intended.

Fake news, indeed!

https://www.balloon-juice.com/2017/06/27/mister-richard-smoker/

I got no idea how good Bosnia healthcare is, I know a few people that live there, a good friend of the family goes back every other year to visit her family. It was a random European country that I was sure we would get compared to.

I'm not sure what "you were right about (them)" means.


"I got no idea how good Bosnia healthcare is, I know a few people that live there, a good friend of the family goes back every other year to visit her family. It was a random European country that I was sure we would get compared to."

Marty, if you are going to drink while blogging, give us a heads up so we can be on an even footing. ;)

Though I'm in favor of some form of single payer, I'm increasingly skeptical that it could work in America, given the class of people we have to work with.

Generally speaking, government-haters, tax-haters, hellbent on the ruination of a government because it might do something right, half-drowned in a bathtub, made to be incompetent to prove its incompetence.

We couldn't organize D-Day today either. Nor the moon landing.

We are an incompetent bunch of self-righteous losers in dime store Davy Crockett hats, repeatedly grabbing our balls every few minutes to make sure we have balls.

Ingrates.

Shitheads who worship shitheaded real estate tycoons who stole everything they have and just hit the motherload.

America is fucked up irrevocably without a radical game-ending makeover for the filth among us.

Though I'm in favor of some form of single payer, I'm increasingly skeptical that it could work in America, given the class of people we have to work with.

Generally speaking, government-haters, tax-haters, hellbent on the ruination of a government because it might do something right, half-drowned in a bathtub, made to be incompetent to prove its incompetence.

We couldn't organize D-Day today either. Nor the moon landing.

I agree. The acknowledgment of that truth is causing me a whole lot of problems. But then, let's just talk about me.

Thanks to decent people like McKinney and you, lots of women die.

So, they're personally responsible for people's lifestyle choices and the variations in how the data on maternal mortality is collected and analyzed?

Based on death certificates, the task force also determined that cardiac events, drug overdoses and hypertensive disorders like pre-eclampsia (formerly called toxemia) were the leading reasons for the maternal deaths recorded, and that the majority of the deaths didn’t occur in the delivery room or shortly thereafter, but more than 42 days after delivery.
Maternal Mortality in Texas: Unpacking the truth behind the state’s spike in pregnancy-related deaths

So, they're personally responsible for people's lifestyle choices and the variations in how the data on maternal mortality is collected and analyzed?

Hope you're eating the right probiotics, CharlesWT, and doing exactly the right aerobics and lifting. Don't forget perfect alcohol consumption, and stay away from Advil! And genetics. And such ...

Oh, and science discovers new things. So if you weren't eating eggs, hope you're eating them now! And fish twice a week? Or not?

Many 90-year-olds have defied the odds. The stats for women's health are pretty convincing. Pregnant women with prenatal care do well. Those without don't. Check out the headstones.

Or not.

From your link, charlesWT:

"Sean Blackwell, M.D., explained that the primary issue isn’t that medical care in Texas hospitals is worsening or below par, but rather that too many women are not receiving care."

Hmmm.

For 80% of Americans single payer will be a rude awakening to what rationed healthcare looks like.

I have employer-provided health insurance.

I already know what rationed healthcare looks like

I already know what high deductibles look like

I already know what high co-pays look like

maybe your OCare plan has you spoiled.

as far as Bosnia, for most measures of basic public health go, our outcomes and general quality and availability of care are inferior to other OECD countries. and we pay more, by far. not a little more, a lot more.

if what you really, really need is access to a piece of absolutely cutting edge, state of the art high tech gear, you may be at an advantage to be in the US system.

otherwise, not.

all of that is beyond well known, it's a commonplace. it's a given.

any argument that proceeds from an assumption that having US health care turn into what any other OECD nation has is a step down is a losing argument.

we're just stupid. that is the problem.

CharlesWT, I want to ask you something: do you actually believe this stuff, or are you just playing about and rattling our cages for the fun of seeing where the conversation goes?

Believe which stuff?

Believe which stuff?

Which which stuff.

https://finance.yahoo.com/news/republicans-better-off-living-obamacare-203045751.html

http://www.msn.com/en-us/money/markets/gop-lawmaker-loses-dollar17-million-as-favorite-stock-plunges/ar-BBDmtjz

I wonder if trump asked her to do a little spin during her interview with him?

http://www.thedailybeast.com/trumps-abstinence-queen-has-a-tarnished-record?via=newsletter&source=Weekend

So,they're personally responsible for people's lifestyle choices and the variations in how the data on maternal mortality is collected and analyzed?

CharlesWT: to give just the latest example (and not arguing about Marty's and McKinney's personal responsibility, because as you know I prefer not to take part in this kind of personalisation) your characterising of the increase in Texan maternal mortality largely, or even partly, as "lifestyle choices".

But GftNC, isn't pregnancy a "lifestyle choice"? ;-)

Who knew.

(But then, there seem to be those, although I don't think Charles is among them, who think being raped counts as a "lifestyle choice.")

From the count's link:

If Congress were interested in fixing what’s wrong with it, they’d focus first on making all healthcare more affordable.

Sounds good.

The solution is a complicated one, involving gradual change that improves efficiency and transparency, slowly shifting more responsibility onto patients, so they make more cost-effective choices.

This makes absolutely no sense to me.

The market theory model of patients as consumers of some commodity called "health care" is not just nutty, it's harmful.

Market dynamics will find reasonable prices for things to the exact degree that the conditions for an efficient market exist.

Virtually none of the conditions for an efficient market exist in the domain of health care. None.

Markets are a great thing. Thinking that markets are the appropriate mechanism for resolving every issue in life is more than wrong-headed, it's a kind of monomania.

You wake up in the morning, have a pee, and see blood in your urine. Urinary tract infection? Kidney stone? Cancer? Make an informed and cost-effective choice.

You find it increasingly difficult to swallow. GERD? Hypertrophy of the swallowing muscles? Incipient Parkinsons? Make an informed and cost-effective choice.

Your kid spikes a fever of 104F. It's 2 AM on Sunday morning. Take them to the ER? Give them a cool shower? Give them lots of fluids and an aspirin and see what happens? Make an informed and cost-effective choice.

Everybody's got a brain, I guess, but some folks seem determined not to use theirs.

What's the market-clearing price for angioplasty, I wonder? It would be nice if the number of patients and available doctors would be exactly equal.

Market-based solutions all rely on "informed consumers/purchasers". So if we are going to have market-based health care solutions, we need to create (because we definitely don't have them now) informed consumers. That means providing everybody with education in medicine at least equivalent to that of an EMT or nurse. Possibly higher -- not having that kind of education myself, I'm not sure exactly how much would be required.

Getting that kind of detailed and wide-spread education funded would be a stretch. Not to mention the challenge of getting it by those who already oppose the very narrow and limited provision of sex education and information about contraception that the schools (mostly) provide. But it's a prerequisite for a market-based health care solution.

your characterising of the increase in Texan maternal mortality largely, or even partly, as "lifestyle choices".

For the sake of clarity, I should have said:

your characterising of the increase in Texan maternal mortality largely, or even partly, as being a result of "lifestyle choices".

GftNC: ... your characterising of the increase in Texan maternal mortality largely, or even partly, as "lifestyle choices".

Based on death certificates, the task force also determined that cardiac events, drug overdoses and hypertensive disorders like pre-eclampsia (formerly called toxemia) were the leading reasons for the maternal deaths recorded, and that the majority of the deaths didn’t occur in the delivery room or shortly thereafter, but more than 42 days after delivery.

My link seems to indicate that most of the deaths are due to illnesses from lifestyle choices, genetic predispositions, and complications that even otherwise healthy women with good health care might encounter after a pregnancy. Probably a good percentage of the deaths could have been avoided with adequate medical care.

When a metric doubles in a single year, most of the change is likely due to a change in methodology rather than such a large change in what is being measured.

For the Texas task force’s analysis, a pregnancy-associated death was defined as any woman who died within 365 days of birth or fetal death from any cause; the analysis examined all maternal deaths during the 2011-2012 time period, excluding motor accidents and non-pregnancy related cancers.

By contrast, the national Obstetrics & Gynecology report relied on death certificate questions related to pregnancy, which changed during the time period measured, 2000 to 2014. A so-called “pregnancy question” was added to the 2003 revision of the U.S. standard death certificate and included checkboxes for whether an individual was pregnant within the past year, pregnant at the time of death, not pregnant but pregnant within 42 days of death, not pregnant but pregnant 43 days to one year before death (considered later maternal death), or if she was unknown to be pregnant within the last year.

When I encounter the term, Maternal Mortality, I, as I suspect a lot of people do, think of deaths occuring leading up to, during and in the immediate aftermath of childbirth. I don't think of deaths for almost any reason for up to a year after childbirth. Do other countries use anything close to the above methodologies to count maternal deaths?

That means providing everybody with education in medicine at least equivalent to that of an EMT or nurse.

To introduce another controversial point, not everyone has to conceal carry for conceal carry to have an impact. :)

That means providing everybody with education in medicine at least equivalent to that of an EMT or nurse.

what would likely happen in this case is that a new service industry would spring up: the medical financial analyst. instead of having to know medicine yourself, you would hire these people to analyze your diagnosis and treatment options vs. your bank account balance and how much credit you cost expect to get in the time allotted before treatment becomes moot. they would determine the best solution for you, for a small fee. rush orders would be available, for a larger fee.

someone would eventually start calling them "death panels".

:s/cost/could/g
:wq

Probably a good percentage of the deaths could have been avoided with adequate medical care.

This seems to me the nub of it, and to the extent that medical care for poorer women has been compromised in Texas, it's hard to see how this is not a major cause.

I have never heard of pre-eclampsia being described as anything other than a complication of pregnancy, and therefore any death where it is indicated as a cause as being a case of maternal mortality. It so happens that 2 of my (white, healthy, non-obese) friends suffered from pre-eclampsia, and both were immediately hospitalised until the birth, which in one case was brought forward somewhat.

I cannot answer your question about the methodologies used in other countries' compiling of maternal mortality statistics, but I thank you for your answer to me. Your statement with which I head this reply at least convinces me that you are not a raving lunatic, or someone just messing with us for the hell of it.

Market-based solutions all rely on "informed consumers/purchasers"

That's only one of the requirements for an efficient market.

Low barrier to entry, fungibility of the goods or services, no single provider dominates the market.

It's not a domain that affords efficient market dynamics.

If you're talking about band-aids, or OTC cold remedies, Ace bandages, yes.

Almost anything else, no.

"This makes absolutely no sense to me."

Me neither.

Kidney stone got you doubled over in pain and near passing out?

Put it out for bids. Take a few days to haggle.

When you find your practitioner, do what market-based shoppers do in third-world open-air markets over pig's feet: Get the price down until the seller says that's his or her final offer, and then turn on your heel and walk (in this case, hobble, trying not to give away the extent of the pain because at that point the cost curve is going to bend the wrong way again) away. Invariably, the seller will stop you just as you seem unlikely to return and take another few centavos off the price.

Be sure to ask "What's with the $12 dollar tab of aspirin?" ahead of time.

If you don't like the price, go without. Go shoe shopping to pass the time since that's exactly like shopping for kidney stone removal.

If kidney stone removal is precisely like selling shoes, how come if I go shoe shopping while writhing and screaming in pain, the shoe seller doesn't (1) jack the price of shoes up because obviously this person really needs some shoes, or 2) hand you the shoes for free, go ahead, get outta here, out of sheer empathy.

So, if I'm shopping for shoes, why can't I buy just one shoe without paying for two. Maybe I'm a hopper. Maybe I'll hop back next week to purchase the other shoe? I don't know. Why the iron rule?

You say, well, to whom am I going sell the left-over shoe? To which I ask, am I wearing a sign as a consumer of your goods that says "Hi! I'm here to solve your problems."

I want, I want.

Imelda Marcos wanted. Did a single shoe seller on the face of the Earth say "Sorry, you bought 40 pair yesterday, you don't need any more shoes because we're trying to bend the cost curve over here."

No. You know why? Neither do I!

Or, how about this? Why can't I buy one style of shoe, that is, just one shoe, for one foot and a completely different style of shoe, again, one shoe, for the other .. without paying for four shoes? Hanh?

Why can't I get two colonoscopies for the price of one? Say, on Thursdays. Say, I have a friend who needs one, so I share the coupon with him?

Why, I ask you, can't the hospitals do what the bar down the street does. They have six bottles of various spirits, each with the label covered up and for a dollar off you get to choose your poison. They don't say about three of them, that you don't need that even though you are willing to pay.

It could be fun. The hospitals each day could advertise six mystery procedures and you go in and guess which one you want on that day. it could be six different ones each day or week.

Do some merchandising here.

Why don't hospitals and doctors have "used MRI machine lots" in the same vein that automobile sellers have used car lots. They work, why can't we use them for less price.

See, by market forces, what Americans mean is that we'll explain to you how it works in a perfectly reasonable "it's very simple" Milton Friedman PBS tone of voice, kindofa down in the throat serious business voice, but what we really mean is how the fuck should I know how this works, I'm just doing what everyone else does, living off the vig and if you don't like it, go fuck yourself.

Has it ever occurred to anyone that hospitals are the only buildings that contain both gift shops and morgues on the premises?

I just want to know how "making more cost-effective choices" differs in practical terms from that boogeyman "rationing." Are you supposed to feel better about going without because you decided on your own to forego (probably ignorantly and unwisely) this or that medical procedure or service?

Now you tell us, shitheads. As if we didn't know already. America is a fucking disgrace. Who knew what would happen by purging all of the professional lawmakers? Plenty is us and you can eat me:

http://talkingpointsmemo.com/livewire/steve-womack-gop-we-dont-know-how-to-govern

"making more cost-effective choices" is lunacy.

our health care system is based on a small number of huge and powerful companies whose entire business model is based on taking people's money and then paying health care providers as little of that money as they can. they aren't in the business of overpaying. if there were a lot of low-hanging "cost-effective choices" out there, insurance companies would be all over that shit.

how are unorganized individuals supposed to work the system better than monster like BCBSs and UHC ?

As mentioned over and over here and elsewhere, the concept of a "market" for "healthcare" has severe theoretical problems. Conservatives never acknowledge this essential fact, and plow right on with specious "skin in the game" proposals that actually reduce the number of folks with coverage (aka, "taking skin out of the game").

In addition....

rates are (to a large degree) set by doctors.
the supply of doctors is artificially constrained.
We give out patents for drugs and medical devices like free candy at the 4th of July parade.

There are practically millions of prices out there with wild variances that have no earthly connection to "actual cost", and there is no effective way for a consumer to make an "informed judgement".

I'd like to see Charles describe the typical healthcare v. no healthcare indifference curve.

I'd wager it has a rather unusual shape.

We have a system totally infested with rent seekers, and a set of public policies that encourages them.

But when common sense solutions are put forth, all we get is spittle flecked screaming about "the market" because as you know, the market is God.

When I encounter the term, Maternal Mortality, I, as I suspect a lot of people do, think of deaths occuring leading up to, during and in the immediate aftermath of childbirth.

Similarly, when we see data regarding death from alcoholism, we should only count those who drop dead in the taverns and cocktail lounges, and being in the restroom at the time doesn't count.

GFNC...that study had some high powered critics. If you get a moment, you should research further.

Thanks.

Why does the GOP want to kill people by cutting back the availability of Medicaid?

Tax cuts for the wealthy.

It's pretty darned simple.

bobbyp, if I gave the impression I was convinced by Charles's linked study, that was a wrong impression. What I was glad to see was a further gloss on his original, ridiculous remark that the increase in maternal deaths was down to "people's lifestyle choices and the variations in how the data on maternal mortality is collected and analysed". At least he agreed that "with adequate medical care a good percentage of the deaths could have been avoided". But FYI, I agree completely with your first paragraph above.

i'd like to know if the data for other countries counts deaths up to a year after childbirth, too. not that there can't be childbirth-related deaths a year after the event, but just to know if we're comparing apples to apples.

unless there's an international standard for this (ISO 12936?), i suspect different studies will have a different cut-off.

Want something long to read on health care? Of course you do.

So check out this report from the folks that the Economist's Intelligence Unit. Among the findings:

  • Political will and a social compact are prerequisites for both access and sustainable health systems.
  • Good primary care is a vital building block for good access.
And finally this:
"Universal coverage does not mean universal access, but extending universal health coverage (UHC) can be a crucial part of improving access. There is an important distinction to be made between the ability to access healthcare services and its successful delivery to a wide population. A right to healthcare may be guaranteed in law but not actually available in reality, especially in remote or underdeveloped regions. It may be accessible but not affordable."
That last is something that has (deliberately?) contributed to a lot of confusion in American discussions of the latest proposals on the subject.

our health care system is based on a small number of huge and powerful companies whose entire business model is based on taking people's money and then paying health care providers as little of that money as they can. they aren't in the business of overpaying. if there were a lot of low-hanging "cost-effective choices" out there, insurance companies would be all over that shit. (cleek)

and

We have a system totally infested with rent seekers, and a set of public policies that encourages them. (bobbyp)

That's it in a nutshell.

https://www.vox.com/the-big-idea/2017/6/28/15881720/deaths-senate-health-care-bcra

bobbyp, if I gave the impression I was convinced by Charles's linked study, that was a wrong impression.

That thought never crossed my mind.

Regards,

Why did McConnell make sure Putin received copies of the AHCA printed in Cyrillic script before Democrats and even republicans got a look:

http://washingtonmonthly.com/2017/06/28/mitch-mcconnells-sinister-role-in-the-russian-hacks/

Why are Russian hackers about to attack the U.S. federal government's Social Security, Medicare, and Medicaid accounts and zero them out?

Who gave the orders?

We have a system national culture totally infested with rent seekers, and a set of public policies that encourages abets coddles protects enables idolizes and kowtows to them. -- bobbyp quoted by hsh, enhanced by me

Oh my God, have you all seen this (I'm not on FB, but someone sent me the link)? It's pretty much a call for a civil war:

https://www.facebook.com/NRA/videos/1605896562755373/?autoplay_reason=all_page_organic_allowed&video_container_type=0&video_creator_product_type=2&app_id=119211728144504&live_video_guests=0

"clenched fist of truth" was cute.

i'm sticking with neutron bomb of kindly thoughts.

Jackhammer of compassion.

i'm pretty sure that violent rhetoric from armed extremists is only cause for concern if they aren't white. otherwise, it's fine.

The first thing that popped into my mind (you'll never guess) was Catholic radio, which I sometimes happen upon while channel surfing in the car on the drive between home and Portland. (This is a bit of a different beast from the more generic "Christian" radio that I hear on my trips to Ohio.)

The commonality is an extremely targeted emotional loading of the message. As with advertising, I am flummoxed that anyone can take this seriously instead of as an attempt to play them.

Sad to say, I'm flummoxed a lot. But as to this specific instance, since I don't follow the NRA I don't know whether this is an escalation of the level of incitement or business as usual.

Meanwhile, today I learned that one of my co-workers was leaving the company. He's Armenian, his wife's visa is expiring, and they are unable to get a renewal.

Things were proceeding nicely, it seems, until Trump took office.

Great guy, great work ethic, accomplished entrepreneur, doing a great job transforming the culture of my workplace to a more functional and effective style. Amazingly savvy for a guy his age, he's probably about 30.

Nice knowing ya!

But now I must break away, because I have to arrange primary care referrals for two procedures I have coming up in the next month. I called my primary's office this AM to get that done, they told me I first had to call back the specialist's offices to get some magic ID number, then call them again with that number to get the referral.

My primary is the guy who sent me to the specialist, and provided me with their contact information. They all participate in the same network of practices. I'm pretty sure they have whatever ID number they need on file.

But, as the patient, it's my job to track all of this bullshit down so that they can provide a referral for services that they recommended for me, otherwise I will have to pay for them myself.

Too much bullshit for one day.

Home-made strawberry jam on my PBJ though, so it ain't all bad.

otherwise, it's fine.

It's all fun and games until somebody gets hurt.

OnT:

McConnell is still trying to get his health care abomination passed by Friday.

Does anyone else get the feeling there's some other universe they belong in?

maybe Kang really is president.

cleek...??? article says he is trying to get it passed prior to August recess?

Don't Correct Me!

/scurries away

I don't know whether this is an escalation of the level of incitement or business as usual.

I see it as the further spreading of a dangerous stain into the commonly accepted level of discourse inhabiting the public sphere. It typifies a level of right wing extreme rhetoric not seen since the KKK's heyday in the 1920's if you ask me.

Don't Correct Me!

lol!

The comments to this entry are closed.

Blog powered by Typepad