Aetna’s ObamaCare Shock
Government economists thought Obamacare would be a boon for insurers, so did the Keynesian economists in the industry. It is not a boon, but a bust. This seemed obvious at the outset, but Keynesian's look at the world through a fantasy lens. The industry thought that Obamacare was a no lose proposition since the government stood to help out if things went awry. But it has proven to be the disaster the Austrian economists forecast.
Tick tock Obamacare, tick tock.
Blue Cross Blue Shield losing money on Obamacare exchanges across the country - Hot Air
Will the last insurer leaving Obamacare, please, turn out the lights.
Low-fat diets and exercise are pointless for losing weight, warns surgical expert
Solve this problem by exercising your push back gene, and push back from the table sooner.
More below the fold, including how to fix the health care insurance system.
Tougher Medicare Overpayment Rules: What Must You Do Now?
. . . are of keen interest to the medical providers over at the Medscape site.
Transparent Prices Fail to Lower Health Spending, Study Shows
. . . these researchers evaluate the wrong cohort for the wrong issue.
Are Robots Job Creators?
. . . as usual.
"Automation, driven by technological progress, has been increasing inexorably for the past several decades. Two schools of economic thinking have for many years been engaged in a debate about the potential effects of automation on jobs, employment and human activity: Will new technology spawn mass unemployment, as the robots take jobs away from humans? Or will the jobs robots take over release or unveil—or even create—demand for new human jobs?
The debate has flared up again recently because of technological achievements such as deep learning, which recently enabled a Google software program called AlphaGo to beat Go world champion Lee Sedol, a task considered even harder than beating the world’s chess champions."
Mass jobs are a relatively new phenomenon. Prior to the industrial period there was little need for employees, and so there were few. Most of these jobs were performed by slaves, or people who would not be confused as an employee. Today, mass jobs are common, plentiful, and essential to the economy. So, people like the author, and the people arguing about this issue seem to fail to understand that if this is a phase shift, it will likely do away with jobs as the mechanism by which the new economic model distributes wealth through society.
I am unsure whether the outcome of the massive shift we are now undergoing will necessitate a phase shift including the elimination of jobs, but if it does it will result in a fairer, wealthier, more prosperous, and more inclusive economy, not an economy which will see more segregation, and wealth inequality. Although just as the shift from the agricultural phase to the industrial phase brought some temporary wealth inequality, so it is likely will any phase shift in the economy. This happens simply because some see the way to the new economy, and this brings great wealth, while other attempt to conserve the old economy, and this destroys wealth. In this divide tech is bringing wealth, while the blue model, unions, and the like are destroying wealth.
"Ultimately the question boils down to this: are today’s modern technological innovations like those of the past, which made obsolete the job of buggy maker, but created the job of automobile manufacturer? Or is there something about today that is markedly different?"
This is the wrong question. The question is will these innovations change jobs to better jobs, or will it eliminate jobs? That I cannot answer.
"It may seem easy to dismiss today’s concerns as unfounded in reality. But economists Jeffrey Sachs of Columbia University and Laurence Kotlikoff of Boston University argue, “What if machines are getting so smart, thanks to their microprocessor brains, that they no longer need unskilled labor to operate?'"
These people are worrywarts fretting about things they do not understand, and likely cannot understand. They need to follow Niebuhr's prayer. "God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. Reinhold Niebuhr Quotes at BrainyQuote.com" The do not, and instead they fret, stew and harumph over issues they cannot change.
"As the decoupling data show, the U.S. economy has been performing quite poorly for the bottom 90 percent of Americans for the past 40 years. Technology is driving productivity improvements, which grow the economy. But the rising tide is not lifting all boats, and most people are not seeing any benefit from this growth. While the U.S. economy is still creating jobs, it is not creating enough of them. The labor force participation rate, which measures the active portion of the labor force, has been dropping since the late 1990s."
This is unadulterated bullshit, or evidence that the people saying this have no understanding of what life was like in the 1970s, 1980s, or 1990s. The authors statements demand substantial proofs not mere hot air and blather.
The unemployment rate today is at a national average below 5%.
Labor force participation prior to 1970 averages about 58%, it was only after the equal rights, and the women's movements demanded their inclusion in the workforce in great numbers that we saw the labor force participation rate skyrocket to absurdly high levels. There is no evidence that Americans actually wanted this level of labor force participation. We know they did not historically. Now that we are far wealthier than we were in the 1940s, -1980s it seems likely that the LFP rate shift is due to the desires of fewer family members to work, and participate more deeply with family needs, children's needs, old age adult needs, and the like. Statements like the ones made here need extensive proof. They have none, and the author clearly has no understanding of LPF rate changes over time. Yet another piece of detritus to ignore.
The poor today live all but infinitely better than the middle class of the 1950s, 1960s, and likely even the 1970s.
Air Conditioning, Cable TV, and an Xbox: What is Poverty in the United States Today?
The poor and the average of today have a similar spectrum of amenities, although the poor do have fewer.
How Poor Are America's Poor? Examining the "Plague" of Poverty in America
"The typical American defined as "poor" by the government has a car, air conditioning, a refrigerator, a stove, a clothes washer and dryer, and a microwave. He has two color televisions, cable or satellite TV reception, a VCR or DVD player, and a stereo. He is able to obtain medical care. His home is in good repair and is not overcrowded. By his own report, his family is not hungry and he had sufficient funds in the past year to meet his family's essential needs. While this individual's life is not opulent, it is equally far from the popular images of dire poverty conveyed by the press, liberal activists, and politicians.
But the living conditions of the average poor person should not be taken to mean that all poor Americans live without hardship. There is a wide range of living conditions among the poor. Roughly a third of poor households do face material hardships such as overcrowding, intermittent food shortages, or difficulty obtaining medical care. However, even these households would be judged to have high living standards in comparison to most other people in the world."
If you scroll to the bottom there is an instructive chart on US versus international housing conditions of which only three countries even compare with the US poor's housing conditions, based on Floor Area per Person:
Country (City) Floor Area per Person Persons per Room
US Poor 439 .54
Australia (Melbourne) 545.73 .69
Norway (Oslo) 452.09 .50
Canada (Toronto) 442 .50
After this all of the entries are below the US Poor
Sweden (Stockholm) 430.56 .56
Remember this compares the US POOR with these other nations (cities). If one takes the time to compare the amenities the US poor have to the amenities the average person in Europe has it is shocking how much better the lives of even poor Americans are than the average European. This includes medicine.
CDC - Cancer Survival: The Start of Global Surveillance
The CONCORD-2 study is well worth your read. Remember that the figures for the US include our uninsured. It is impossible to believe that the European countries do not beat the US in every category since pretty much everyone in these countries is covered by a national health care plan. But they commonly do not, and even more surprisingly the US commonly beats many of these countries for the majority of the cancers, especially the more esoteric, even with our uninsured cohort.
Five-Year Survival Rates for Patients Diagnosed with Five Common Cancers in Seven Countries, 2005–2009
Country Female Breast Colon Lung Prostate Childhood Leukemia
Canada* 85.8 62.8 17.3 91.7 90.6
France** 86.9 59.8 13.6 90.5 89.2
Germany 85.3 64.6 16.2 91.2 91.8
Italy 86.2 63.2 14.7 89.7 87.7
Japan 84.7 64.4 30.1 86.8 81.1
Kingdom* 81.1 53.8 9.6 83.2 89.1
States 88.6 64.7 18.7 97.2 87.7
Comparing the amenities the poor have today with the past is eye opening, but I will leave that mostly to you. I don't remember most Americans in 1970 having a cell phone, a computer, internet, air conditioning, a microwave, color television (at all), cable or satellite TV reception, a VCR or DVD player, or a stereo. Food issues were rampant among the poor, as was hunger, and medical care was a problem as well, both in availability and the care available. Medical care today is far advanced from that of 1970.
No, the average poor person today lives better than the average person of 1970, and of everyone living in 1920 or before.
The New Republic should be ashamed of itself for publishing this tripe.
"While manufacturing output is at an all-time high, manufacturing employment is today lower than it was in the later 1940s. Wages for private nonsupervisory employees have stagnated since the late 1960s, and the wages-to-GDP ratio has been declining since 1970. Long-term unemployment is trending upwards, and inequality has become a global discussion topic, following the publication of Thomas Piety’s 2014 book, Capital in the Twenty-First Century."
This is bullshit, and nonsense. It is not the actual wage which matters but what the wage can purchase, and wages today, stagnant or not purchase more than they did in the past, and they purchase higher quality goods. Plus, non-wage benefits have risen, and when accounted for, this answers the wage stagnation "riddle" nicely. Failing to evaluate all the evidence, and misunderstanding that product price deflation, and quality improvement also answer much of the question.
Stagnating Middle-Class? - Cafe Hayek
Dead Wrong with Johan Norberg - Stagnant Middle Class
The New Republic has attempted here to pull off the difficult Triple Lindy of squaring the progressive economic canard. It cannot be done, or if it is, it requires advanced forms of pretzel logic to pull off, because the facts simply do not support the progressive theories.
Big Insurer Flees Obamacare
. . . and if others follow, that could spell disaster.
"As the FT notes, UnitedHealth’s decision does not come as a surprise (we wrote about the company’s ACA woes last year), and—unless other big insurers follow suit—it doesn’t herald the imminent collapse of the law. But the fact that even major insurers like UnitedHealth are hemorrhaging cash on the Obamacare exchanges highlights the fact that for all the ACA’s technocratic tinkering, it did not and will not fix the fundamental problem facing the U.S. healthcare system: That it’s too expensive, and that costs are growing too quickly.
The architects of the ACA took aim at access, rather than affordability, achieving a coverage expansion mostly by putting more Americans on the Medicaid rolls. They left the underlying issues plaguing the healthcare system in place (and in many cases exacerbated them), so middle class families are still seeing a growing share of their paychecks consumed by rising premiums and deductibles. And they failed to realize that in the long run, affordability is access, and that attacking the factors that inflate the cost of healthcare in the private market should be a higher priority than expanding subsidies. The departure of UnitedHealth from the exchanges is a devastating illustration of Obamacare’s failure to bring down costs, and clear evidence that, no matter what the White House says, the debate over health reform isn’t going away."
Perhaps this is nothing, and all the other insurers are doing fine. Then again that seems unlikely. The ACA is faring poorly in its goals, and it seems to be consuming both insurers, and insureds at a disturbingly high rate. If it is to survive it will need to do more to lower insurance premium costs, while at the same time it increases coverage. This is likely an impossible goal for a program run by government, but the likely outcome of a free market program.
Perhaps it is time to introduce the ACA to the free market.
A Swede Quickly Corrects Misperceptions of Sweden - Cafe Hayek
. . . among other things.
He has another good video here:
This follows on to my earlier post: whenever I travel in Europe, I am always amazed . . .
Sweden, and the US provide a good starting place, here at the End of History, to refine, and fine tune the welfare state. One point Norberg makes is that much of the medical, and pharmaceutical advancement comes out of the American free(er) medical markets. This is absolutely true. I am optimistic that the European blue model which is slowly strangling Europe will be reformed, and one of the reforms will be the reintroduction of more free market reforms. If this happens, the European medical community will begin to create more medical advancements. This would be a very positive outcome for the entire world.
We only find the less deadly cancers.
"A new report raises fresh questions about the value of mammograms. The rate of cancers that have already spread far beyond the breast when they are discovered has stayed stable for decades, suggesting that screening and early detection are not preventing the most dangerous forms of the disease.
The report, in Thursday's New England Journal of Medicine, is by three prominent cancer specialists and is based on federal statistics going back to the 1970s.
It comes a week after the American Cancer Society scaled back its mammography advice, saying most women should start annual screening at age 45, not 40, and switch to every other year at 55. A government task force recommends even less -- every other year starting at 50.
"We're undergoing what I think for the public is a very confusing debate" about screening, but it's really "a course correction" prompted by more awareness of its risks and benefits to various groups of women, said Dr. H. Gilbert Welch, a health policy expert at Dartmouth Medical School. "All they heard for years was, 'there are only benefits.' "
He is the lead author of the report, co-written with Dr. David Gorski of Wayne State University School of Medicine in Detroit and Dr. Peter Albertsen of the University of Connecticut Health Center in Farmington.
"Screening offers hope that cancer can be detected in an early, localized phase when it's more amenable to treatment," they write, but that assumes that cancer starts in one place, grows and then spreads. If that was always true, screening would reduce the rate of advanced cancers.
And that has not happened. The rate of breast cancers detected at an advanced stage has been stable since 1975, despite wide use of mammography since the 1980s. The average age of women diagnosed with cancer also has remained around 63, another sign cancers are not being found sooner.
The trends suggest that some breast cancers are already "systemic" or widely spread from the start, and that finding them sooner has limited impact.
"Screening mammography has been unable to identify those bad cancers, destined to become metastatic, at an earlier stage. That doesn't say mammography doesn't help less aggressive cancers," but those are less likely to prove deadly, Welch said."
The rate of cancers that have already spread far beyond the breast when they are discovered has stayed stable for decades – Lowell Tech Air - Albany Daily Star Gazette
This is true for many cancers. We need to seriously rethink the hype we are hearing surrounding preventative medicine, and testing. Much of this is little more than cross selling for doctors who own shares in the lab.
Nearly every doctor to whom I speak with has a litany of anecdotes of people helped by their pet procedure, whether mammography, PSA, colonoscopy, or something else. But when I ask about problems, negative outcomes, and the like, its is as if they have never heard of such a thing. Yet as a litigator handling medical cases, I saw these, commonly.
If we allow government to infringe on our medical payments we will see a significant reduction in quality of care. Instead of careful analysis of whether colonoscopy, sigmoidoscopy, FIT or some other non-invasive test is better, we will see the wizened mandarines simply making a decision and then subjecting us to their dictate. Are their good quality comparative studies in the medical literature about the long term efficacy of these testing procedures, have they been studied comparatively? No.
The colonoscopy became the gold standard because Medicare agreed to pay for the procedure even without high quality comparative studies, because it looks at more, and thus, must be better. So, they dictated this outcome without evidence. The insurance companies all but had to go along since every gastroenterologist bought a colonoscopy machine. Why not, it pays the doctor far more than the competitor machine.
Europe has been doing some minor comparative studies which seem to show the colonoscopy is no better than the sigmoidoscopy but does have higher incidence of complications.
Whether cancer, or other medical treatment, these issues need to be much more front and center in our debate.
To get a baseline grasp on this problem I suggest reading:
Overdiagnosed: Making People Sick in the Pursuit of Health 1st Edition by H. Gilbert Welch
Should I Be Tested for Cancer?: Maybe Not and Here's Why Paperback – March 6, 2006 by H. Gilbert Welch
Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care 1st Edition by Gilbert Welch
Know Your Chances: Understanding Health Statistics Paperback – November 30, 2008 by Steven Woloshin M.D.M.S.