Medicare, the free market, and a drug that doesn’t work

This story will make you discouraged about BOTH the government AND the free market when it comes to healthcare.  Peter Whoriskey reports:

The U.S. health-care system is vastly overspending for a single anemia drug because Medicare overestimates its use by hundreds of millions of dollars a year, according to an analysis of federal data. The overpayment to hospitals and clinics arises because Medicare reimburses them based on estimates rather than the actual use of the drug.

The government for years has tried to rein in spending on the prescription drug, Epogen, which had ranked some years as the most expensive drug to taxpayers through the Medicare system.

Medicare’s current estimates are based on Epogen usage in 2007 for dialysis treatments. But since then, use of the drug has fallen 25 percent or more, partly because of Food and Drug Administration warnings about its perils and partly because Congress removed the financial incentives for clinics and hospitals to prescribe the drug. Because Medicare continues to reimburse health-care providers as if the dosing levels haven’t changed, the significant savings in doses has not translated into savings for the U.S. Treasury.

The amount of the overspending is more than $400 million annually, according to calculations done separately by The Washington Post and experts.

“I think we probably left money on the table,” said Rep. Pete Stark (D-Calif.), a critic of the way the drug had been used who helped shepherd through legislation that removed the financial incentives for bigger doses beginning in 2011.

The overpayment for Epogen reflects both the promise and difficulty of large-scale government reform of health-care spending.

For years, Epogen was one of a trio of anemia drugs — all manufactured by Amgen, a California biotech firm — that cost Medicare as much as $3 billion annually. Overall U.S. sales of the drugs exceeded $8 billion.

Nearly two decades after the drugs were first approved in 1989, their purported benefits were found to be overstated, and the FDA issued a series of stern warnings about their potentially deadly side effects, such as cancer and heart attacks.

At least some of their popularity stemmed from the fact that hospitals and clinics made lots of money using them: The spread between what they paid for a dose and what Medicare paid them to administer one reached as high as 30 percent, according to the Medicare Payment Advisory Commission.

The incentives drove up usage. By 2007, about 80 percent of dialysis patients were getting the drugs at levels beyond what the FDA now targets as safe.

Congress pushed Medicare to revise its payment system to remove the incentives for larger doses. Under the new system for dialysis patients, Medicare pays a set fee for a bundle of dialysis services and drugs.

via Medicare overspending on anemia drug – The Washington Post.

So Medicare reimbursed based on ESTIMATES rather than actual usage?  And hospitals and doctors prescribed the drugs so much in part because “they could make so much money using them”?

Of course, the reason the drugs were so lucrative is because Medicare paid so much for them, so it’s the unholy alliance between the government and the private sector–which is at the heart of Obamacare– that is to blame.  Still, this dashes further the assumption that our medical treatment is always based on objective considerations of patient care.

Are business practices that work in other profit-making enterprises fitting for health care?  For example, why are all of these prescription drugs being advertised on television?  Are patients now “consumers” who are expected to demand certain medicines from their physicians, in which case, what happens to objective determinations in the practice of medicine?  Or are the physicians the target of these marketing campaigns, in which case, again, what happens to objective determinations in the practice of medicine?

About Gene Veith

Professor of Literature at Patrick Henry College, the Director of the Cranach Institute at Concordia Theological Seminary, a columnist for World Magazine and TableTalk, and the author of 18 books on different facets of Christianity & Culture.

  • SKPeterson

    Within a truly free medical and pharmaceutical market, people would be free to choose from a wide variety of medications, treatments and healthcare providers including various types of medical practitioners and pharmacists. I read nothing in the passage quoted above that resembles that in any way; this is an outcome that is directly the result of multiple layers of government regulation, subsidy, and intervention. Somehow blaming the “free market” when it isn’t even in the healthcare conversation except as a favorite whipping boy and bogeyman used to divert attention away from the true causes of our healthcare “crisis” is missing the point. Our healthcare crisis has been created, expanded, perpetuated and deeply insinuated into so many government policies at both the federal and state levels over a period of decades that any cost overruns, any lack in the provision of healthcare, or any adverse health outcomes, are the direct fault of such continued interventionism and almost complete crowding out of the free market from the healthcare sector.

    Name one single aspect of the healthcare market that isn’t extraordinarily subject to regulation and oversight from numerous federal and state regulatory agencies, or subject to narrowed choices in line with distortionary provisions of the tax code. Insurance regulations and subsidies. Medical licensing of doctors expressly for the purpose of limiting competition. Pharmaceutical research subsidies. Pharmaceutical approvals. Just to name a very few of the categories of intervention in, interference against, and outright banishment of the free market in healthcare.

  • SKPeterson

    Within a truly free medical and pharmaceutical market, people would be free to choose from a wide variety of medications, treatments and healthcare providers including various types of medical practitioners and pharmacists. I read nothing in the passage quoted above that resembles that in any way; this is an outcome that is directly the result of multiple layers of government regulation, subsidy, and intervention. Somehow blaming the “free market” when it isn’t even in the healthcare conversation except as a favorite whipping boy and bogeyman used to divert attention away from the true causes of our healthcare “crisis” is missing the point. Our healthcare crisis has been created, expanded, perpetuated and deeply insinuated into so many government policies at both the federal and state levels over a period of decades that any cost overruns, any lack in the provision of healthcare, or any adverse health outcomes, are the direct fault of such continued interventionism and almost complete crowding out of the free market from the healthcare sector.

    Name one single aspect of the healthcare market that isn’t extraordinarily subject to regulation and oversight from numerous federal and state regulatory agencies, or subject to narrowed choices in line with distortionary provisions of the tax code. Insurance regulations and subsidies. Medical licensing of doctors expressly for the purpose of limiting competition. Pharmaceutical research subsidies. Pharmaceutical approvals. Just to name a very few of the categories of intervention in, interference against, and outright banishment of the free market in healthcare.

  • Steve Billingsley

    Obamacare is nothing more than a $2 trillion big wet, sloppy kiss to health insurers and pharma companies (at least the ones who played ball). It only increases coverage by expanding Medicaid, which is the lowest common denominator of health coverage. And it drives up costs on most other types of plans (excepting the “Cadillac” health plans for the unions that got sweetheart deals and the states, such as Louisiana and Nebraska that got paid off for their Senator’s votes).

    It is the worst of almost all possible worlds. And that is the signature legislative achievement of the Obama administration.

    It is unpopular and the only reason it isn’t more unpopular is that more people don’t understand what it actually is. Straightforward single-payer would have been more honest (and likely a better alternative for about 2/3 of the population).

  • Steve Billingsley

    Obamacare is nothing more than a $2 trillion big wet, sloppy kiss to health insurers and pharma companies (at least the ones who played ball). It only increases coverage by expanding Medicaid, which is the lowest common denominator of health coverage. And it drives up costs on most other types of plans (excepting the “Cadillac” health plans for the unions that got sweetheart deals and the states, such as Louisiana and Nebraska that got paid off for their Senator’s votes).

    It is the worst of almost all possible worlds. And that is the signature legislative achievement of the Obama administration.

    It is unpopular and the only reason it isn’t more unpopular is that more people don’t understand what it actually is. Straightforward single-payer would have been more honest (and likely a better alternative for about 2/3 of the population).

  • fjsteve

    Still, this dashes further the assumption that our medical treatment is always based on objective considerations of patient care.

    I’m sorry, who makes this assumption?

    For the record, what Medicare is planning by fixing the price for a bundle of services makes as little sense as overpaying based on usage. In one instance, the hospital has incentive to prescribe more in the other they have incentive to provide less (note, the cost of the drug isn’t going down). And it makes no sense what they’re doing now by providing a different level of reimbursement based on whether the patient has end-stage renal failure. It’s all just a sophisticated guessing game, really.

  • fjsteve

    Still, this dashes further the assumption that our medical treatment is always based on objective considerations of patient care.

    I’m sorry, who makes this assumption?

    For the record, what Medicare is planning by fixing the price for a bundle of services makes as little sense as overpaying based on usage. In one instance, the hospital has incentive to prescribe more in the other they have incentive to provide less (note, the cost of the drug isn’t going down). And it makes no sense what they’re doing now by providing a different level of reimbursement based on whether the patient has end-stage renal failure. It’s all just a sophisticated guessing game, really.

  • Other Gary

    SKP @1 : “Somehow blaming the “free market” when it isn’t even in the healthcare conversation except as a favorite whipping boy and bogeyman used to divert attention away from the true causes of our healthcare “crisis” is missing the point.”

    A healthcare system that is truly based on the free market leaves the poorest Americans unable to afford modern medicines, surgeries, tests, etc. Supply and demand will set the price, and there will be no free market reason to provide services to the people who can’t afford them. What would you say to those folks?

    Steve @2: “Obamacare is nothing more than a $2 trillion big wet, sloppy kiss to health insurers and pharma companies”

    Your’s is a criticism that hits the target. Even though I’m in favor of Obamacare over the mess we have now, it just looks like the main players to benefit are the one’s you’ve pointed out. Why should taxpayers make Big Insurance rich? But if the Republicans are so smart, why, when they held both houses and the White House, didn’t they even _try_ to work up a better solution? Republicans (yourself included, I imagine) are just playing politics with this issue.

  • Other Gary

    SKP @1 : “Somehow blaming the “free market” when it isn’t even in the healthcare conversation except as a favorite whipping boy and bogeyman used to divert attention away from the true causes of our healthcare “crisis” is missing the point.”

    A healthcare system that is truly based on the free market leaves the poorest Americans unable to afford modern medicines, surgeries, tests, etc. Supply and demand will set the price, and there will be no free market reason to provide services to the people who can’t afford them. What would you say to those folks?

    Steve @2: “Obamacare is nothing more than a $2 trillion big wet, sloppy kiss to health insurers and pharma companies”

    Your’s is a criticism that hits the target. Even though I’m in favor of Obamacare over the mess we have now, it just looks like the main players to benefit are the one’s you’ve pointed out. Why should taxpayers make Big Insurance rich? But if the Republicans are so smart, why, when they held both houses and the White House, didn’t they even _try_ to work up a better solution? Republicans (yourself included, I imagine) are just playing politics with this issue.

  • Steve Billingsley

    Other Gary @ 4
    “But if the Republicans are so smart, why, when they held both houses and the White House, didn’t they even _try_ to work up a better solution?”

    First, who said Republicans are all that smart? Second, your correct, the reason the Democratic Party has had traditionally a political advantage with the healthcare issue is that Republicans have not given nearly enough attention to the issue, other than opposing “socialized medicine”. I think that opposition to universal healthcare is a conservative shibboleth (and I am conservative). There are ways to achieve universal healthcare in ways that involve and prefer the private sector. Australia and Switzerland employ these kinds of systems. The devil is always in the details, but I think that when Republicans and conservatives picture universal healthcare, they picture a British style National Health Service.

    Achieving universal coverage in a way that enables lower income people to have a high quality of health care is a worthy goal that conservatives should embrace. But Obamacare doesn’t really accomplish that. For that matter, the pre-Obamacare status-quo didn’t either.

  • Steve Billingsley

    Other Gary @ 4
    “But if the Republicans are so smart, why, when they held both houses and the White House, didn’t they even _try_ to work up a better solution?”

    First, who said Republicans are all that smart? Second, your correct, the reason the Democratic Party has had traditionally a political advantage with the healthcare issue is that Republicans have not given nearly enough attention to the issue, other than opposing “socialized medicine”. I think that opposition to universal healthcare is a conservative shibboleth (and I am conservative). There are ways to achieve universal healthcare in ways that involve and prefer the private sector. Australia and Switzerland employ these kinds of systems. The devil is always in the details, but I think that when Republicans and conservatives picture universal healthcare, they picture a British style National Health Service.

    Achieving universal coverage in a way that enables lower income people to have a high quality of health care is a worthy goal that conservatives should embrace. But Obamacare doesn’t really accomplish that. For that matter, the pre-Obamacare status-quo didn’t either.

  • Other Gary

    Wow, Steve, thank you! God bless you! If more people like you were in the movement, I might be persuaded to rejoin the ranks of the social/fiscal conservatives. I’m being totally serious.

  • Other Gary

    Wow, Steve, thank you! God bless you! If more people like you were in the movement, I might be persuaded to rejoin the ranks of the social/fiscal conservatives. I’m being totally serious.

  • Mary

    re: #6 Other Gary
    From my perspective out here in fly over country there are a great deal of people that hold to similar if not completely the same positions as Steve at #5. We just don’t get the airtime that the hair flaming wacky conservatives receive. Not good copy I guess. Won’t sell papers.

  • Mary

    re: #6 Other Gary
    From my perspective out here in fly over country there are a great deal of people that hold to similar if not completely the same positions as Steve at #5. We just don’t get the airtime that the hair flaming wacky conservatives receive. Not good copy I guess. Won’t sell papers.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “There are ways to achieve universal healthcare in ways that involve and prefer the private sector. Australia and Switzerland employ these kinds of systems.”

    If we had their populations, we could do it, too.

    Why is health care expensive?

    -It requires a lot of people to do the actual work.

    -Those people require a whole lot of expensive training.

    -Only some people can be trained to do it and are willing to do it.

    -Demand for treatment is nearly infinite because the better job you do, the more demand you create.

    -The focus is on treatment not cure. This probably can’t truly be changed.

    - More treatment => older population => more demand => proportionally fewer providers

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “There are ways to achieve universal healthcare in ways that involve and prefer the private sector. Australia and Switzerland employ these kinds of systems.”

    If we had their populations, we could do it, too.

    Why is health care expensive?

    -It requires a lot of people to do the actual work.

    -Those people require a whole lot of expensive training.

    -Only some people can be trained to do it and are willing to do it.

    -Demand for treatment is nearly infinite because the better job you do, the more demand you create.

    -The focus is on treatment not cure. This probably can’t truly be changed.

    - More treatment => older population => more demand => proportionally fewer providers

  • Other Gary

    sg @8: “More treatment => older population => more demand => proportionally fewer providers”

    I find no flaw in your logic. But what can be done to work through this issue? I refuse to throw up my hands and say it’s impossible. I have some vague ideas of my own, but this isn’t my area of expertise by any means, and in any case, the majority of folks wouldn’t care for my proposals.

  • Other Gary

    sg @8: “More treatment => older population => more demand => proportionally fewer providers”

    I find no flaw in your logic. But what can be done to work through this issue? I refuse to throw up my hands and say it’s impossible. I have some vague ideas of my own, but this isn’t my area of expertise by any means, and in any case, the majority of folks wouldn’t care for my proposals.

  • Steve Billingsley

    sg,

    I don’t think it would be easy to transition our system to something that resembles Switzerland or Australia, but I don’t think our population is the issue.

    I think the issue is that our system has been incredibly distorted for a long time. The linking of health coverage to employment compensation during WWII started a distortion of our health care delivery system that has been doubled down upon again and again. Costs are driven up because most consumers have almost no incentive to understand and manage their costs. Most consumers own auto, life and/or home insurance policies that they understand, comparison shop and use with discretion.

    Then add Medicare (with all of it’s wonderful iterations) Medicaid and now Obamacare and it’s a ridiculous mess of misaligned incentives, overlapping bureaucracies and bass-ackward economics (increasing demand, decreasing supply)

    The best answer now would not be to add layers, but to simplify things (transition away from employer-based health care, insurance across state lines, etc.) and focus on increasing supply. But I still think the end game should be high quality coverage for everyone.

  • Steve Billingsley

    sg,

    I don’t think it would be easy to transition our system to something that resembles Switzerland or Australia, but I don’t think our population is the issue.

    I think the issue is that our system has been incredibly distorted for a long time. The linking of health coverage to employment compensation during WWII started a distortion of our health care delivery system that has been doubled down upon again and again. Costs are driven up because most consumers have almost no incentive to understand and manage their costs. Most consumers own auto, life and/or home insurance policies that they understand, comparison shop and use with discretion.

    Then add Medicare (with all of it’s wonderful iterations) Medicaid and now Obamacare and it’s a ridiculous mess of misaligned incentives, overlapping bureaucracies and bass-ackward economics (increasing demand, decreasing supply)

    The best answer now would not be to add layers, but to simplify things (transition away from employer-based health care, insurance across state lines, etc.) and focus on increasing supply. But I still think the end game should be high quality coverage for everyone.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “I don’t think it would be easy to transition our system to something that resembles Switzerland or Australia, but I don’t think our population is the issue.”

    Why? Consider China. They don’t have an awesome health care system yet have pretty good health. Populations are not identical. Western diet has huge impact on populations not adapted to it. We have huge numbers of these folks in the US. That impact is very expensive. They don’t have that in Switzerland and Australia.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “I don’t think it would be easy to transition our system to something that resembles Switzerland or Australia, but I don’t think our population is the issue.”

    Why? Consider China. They don’t have an awesome health care system yet have pretty good health. Populations are not identical. Western diet has huge impact on populations not adapted to it. We have huge numbers of these folks in the US. That impact is very expensive. They don’t have that in Switzerland and Australia.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “But I still think the end game should be high quality coverage for everyone.”

    Sounds great. Who is going to deliver it?

    Medical care has to be supplied by actual workers. Without $$ as an incentive, why would people go through the long expensive training?

    We could have more training programs and depress health care worker salaries. We could change college funding schemes that make all health care training free and not give much financial help to go into any other fields. That would motivate some students to go into health care. Any other ideas?

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “But I still think the end game should be high quality coverage for everyone.”

    Sounds great. Who is going to deliver it?

    Medical care has to be supplied by actual workers. Without $$ as an incentive, why would people go through the long expensive training?

    We could have more training programs and depress health care worker salaries. We could change college funding schemes that make all health care training free and not give much financial help to go into any other fields. That would motivate some students to go into health care. Any other ideas?

  • Steve Billingsley

    Switzerland and Australia don’t have monolithic populations. There is ethnic diversity there, just like there is here. And Australia, in particular, has a diet very similar to the US. (We’ve exported a whole lot of our diet to them).

    Western diet certainly impacts the cost of health care, but it isn’t a reason to reform our system.

    I wouldn’t consider China to be the exemplar of good health, so I don’t know where you are getting that claim.

  • Steve Billingsley

    Switzerland and Australia don’t have monolithic populations. There is ethnic diversity there, just like there is here. And Australia, in particular, has a diet very similar to the US. (We’ve exported a whole lot of our diet to them).

    Western diet certainly impacts the cost of health care, but it isn’t a reason to reform our system.

    I wouldn’t consider China to be the exemplar of good health, so I don’t know where you are getting that claim.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    We need to consider how many actual doctors, nurses, and allied health professionals we need to deliver the care. Then we need to provide training programs that will produce that number of providers. We don’t do that. In fact we import health care workers from countries that have much worse provider to population ratios than we have. That is a pretty serious moral problem right there.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    We need to consider how many actual doctors, nurses, and allied health professionals we need to deliver the care. Then we need to provide training programs that will produce that number of providers. We don’t do that. In fact we import health care workers from countries that have much worse provider to population ratios than we have. That is a pretty serious moral problem right there.

  • Steve Billingsley

    sg @ 14
    I think that the quality (or lack thereof) of our educational system (particularly K-12) is a factor. There a lots of other factors, but I do think that is one to consider.

  • Steve Billingsley

    sg @ 14
    I think that the quality (or lack thereof) of our educational system (particularly K-12) is a factor. There a lots of other factors, but I do think that is one to consider.

  • L. H. Kevil

    I agree strongly with SKPeterson. There is no free market in medicine and there hasn’t been one for a very long time. The title merely reframes left-wing talking points.

  • L. H. Kevil

    I agree strongly with SKPeterson. There is no free market in medicine and there hasn’t been one for a very long time. The title merely reframes left-wing talking points.

  • DonS

    This problem has nothing to do with the “free market”, other than that private providers and insurers are involved in the administration and receipt of government benefits, which is how our system tends to work.

    In a truly free market, there would be no incentives for the kinds of abuses that occurred in this instance.

    The best way to provide universal healthcare is to incentivize the purchase of catastrophic coverage, and to subsidize that coverage for the poor. This coverage would be supplemented by HSA tax-free accounts to cover deductibles and out-of-pocket expenses, which again would be subsidized for the poor. This kind of approach would be the best way to preserve free market choices for the elderly, through Medicare, as well, and would reduce clogging paperwork in the system by 70 or 80%.

  • DonS

    This problem has nothing to do with the “free market”, other than that private providers and insurers are involved in the administration and receipt of government benefits, which is how our system tends to work.

    In a truly free market, there would be no incentives for the kinds of abuses that occurred in this instance.

    The best way to provide universal healthcare is to incentivize the purchase of catastrophic coverage, and to subsidize that coverage for the poor. This coverage would be supplemented by HSA tax-free accounts to cover deductibles and out-of-pocket expenses, which again would be subsidized for the poor. This kind of approach would be the best way to preserve free market choices for the elderly, through Medicare, as well, and would reduce clogging paperwork in the system by 70 or 80%.

  • Steve Billingsley

    DonS @ 17
    That is basically the way the auto and homeowner’s insurance markets work. Treating health insurance, like, actual insurance would be huge.

  • Steve Billingsley

    DonS @ 17
    That is basically the way the auto and homeowner’s insurance markets work. Treating health insurance, like, actual insurance would be huge.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “I wouldn’t consider China to be the exemplar of good health, so I don’t know where you are getting that claim.”

    It is relative to their health care, not absolute.

    Life expectancy in China is higher than you would expect.
    http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

    Would you expect people on average to live longer in India or in Ukraine? Which do you figure has better health care on average? My point is that there is more to health outcomes than just health care provision. In order for the USA to have numbers that we think are “good” we have to spend a ton of money. Whereas countries with different populations can get by spending less because they have people who are different and live differently. Japan doesn’t have the highest life expectancy because they spend the most money. They have it because they are the healthiest people. So, when you start comparing apples to oranges you frustrate yourself. You have to use appropriate metrics and comparing ourselves to other countries is generally not appropriate. We don’t have the same people, food, or lifestyles and those matter, a lot.

    All I was saying is that general comparisons with other countries have too many uncontrolled variables. You have to look at actual criteria and context. If we had the Japanese people, food and lifestyle, we could get their numbers, too. We don’t, so we can’t. Everything is not necessarily possible. Yes, we need to improve, but we need honest metrics and not blame healthcare for what may more appropriately be attributed to diet, lifestyle, or even genetics.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “I wouldn’t consider China to be the exemplar of good health, so I don’t know where you are getting that claim.”

    It is relative to their health care, not absolute.

    Life expectancy in China is higher than you would expect.
    http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

    Would you expect people on average to live longer in India or in Ukraine? Which do you figure has better health care on average? My point is that there is more to health outcomes than just health care provision. In order for the USA to have numbers that we think are “good” we have to spend a ton of money. Whereas countries with different populations can get by spending less because they have people who are different and live differently. Japan doesn’t have the highest life expectancy because they spend the most money. They have it because they are the healthiest people. So, when you start comparing apples to oranges you frustrate yourself. You have to use appropriate metrics and comparing ourselves to other countries is generally not appropriate. We don’t have the same people, food, or lifestyles and those matter, a lot.

    All I was saying is that general comparisons with other countries have too many uncontrolled variables. You have to look at actual criteria and context. If we had the Japanese people, food and lifestyle, we could get their numbers, too. We don’t, so we can’t. Everything is not necessarily possible. Yes, we need to improve, but we need honest metrics and not blame healthcare for what may more appropriately be attributed to diet, lifestyle, or even genetics.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “The best way to provide universal healthcare is to incentivize the purchase of catastrophic coverage, and to subsidize that coverage for the poor.”

    That works well when 5% of your people meet the definition of poor. It doesn’t work so well when 70% of the people meet the definition of poor. More than 10% of all Texans are both poor and under 18. That doesn’t count the elderly and working age poor. When you count them, you are pushing 45%. And Texas is really cheap. You have to be below the poverty line to even qualify.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “The best way to provide universal healthcare is to incentivize the purchase of catastrophic coverage, and to subsidize that coverage for the poor.”

    That works well when 5% of your people meet the definition of poor. It doesn’t work so well when 70% of the people meet the definition of poor. More than 10% of all Texans are both poor and under 18. That doesn’t count the elderly and working age poor. When you count them, you are pushing 45%. And Texas is really cheap. You have to be below the poverty line to even qualify.

  • Steve Billingsley

    And your definition of poor is?

  • Steve Billingsley

    And your definition of poor is?

  • Steve Billingsley

    45% of Texans aren’t below the poverty line.

  • Steve Billingsley

    45% of Texans aren’t below the poverty line.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “I think that the quality (or lack thereof) of our educational system (particularly K-12) is a factor.”

    No, no, no.

    We have the highest performing system/students in the world.

    The only countries that beat us are either almost 100% European population or Asian population. Similar students do as well or better here. Our black students beat the scores of black students of every other country in the world. Mexican kids in US schools way way outperform Mexican kids in Mexico on the PISA tests. There are even companies that get Chinese people visas to deliver their babies in the US so their kids can go to US schools as citizens.

    We constantly and continually import poor uneducated people and they go straight into our schools. Then we lump their scores in with all of the rest. Other countries are not doing that. So, sure, by the aggregate data, our schools look low performing compared to the highest performing Asian and European countries. Disaggregated data is where you see the real deal.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “I think that the quality (or lack thereof) of our educational system (particularly K-12) is a factor.”

    No, no, no.

    We have the highest performing system/students in the world.

    The only countries that beat us are either almost 100% European population or Asian population. Similar students do as well or better here. Our black students beat the scores of black students of every other country in the world. Mexican kids in US schools way way outperform Mexican kids in Mexico on the PISA tests. There are even companies that get Chinese people visas to deliver their babies in the US so their kids can go to US schools as citizens.

    We constantly and continually import poor uneducated people and they go straight into our schools. Then we lump their scores in with all of the rest. Other countries are not doing that. So, sure, by the aggregate data, our schools look low performing compared to the highest performing Asian and European countries. Disaggregated data is where you see the real deal.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    @21,22

    Yeah, that is the point. What is poverty? Well, how does a poor person afford $8000 a year for health insurance? Texas official poverty rate is like 17% but does that mean that everyone above that line can really afford $8k for health insurance. 17% is not the rate of folks getting subsidized care. The elderly are subsidized as are folks who just never pay their medical bill because they didn’t have the money, then they died. That is where I am saying 45% are not paying for their own health care, aka de facto subsidized poor.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    @21,22

    Yeah, that is the point. What is poverty? Well, how does a poor person afford $8000 a year for health insurance? Texas official poverty rate is like 17% but does that mean that everyone above that line can really afford $8k for health insurance. 17% is not the rate of folks getting subsidized care. The elderly are subsidized as are folks who just never pay their medical bill because they didn’t have the money, then they died. That is where I am saying 45% are not paying for their own health care, aka de facto subsidized poor.

  • BW

    sg @23,

    Not to further push this thread down the education trail, but could you provide a link to that disaggregated data? I’d like to see it. I just heard today that the US spends more, per capita, on education than any other country except for Switzerland, but our test scores, amongst the industralized world, rank in the bottom half.

    I do think we could learn from those high performing European countries about the variety of public and private school choices they have in their nation to create choice and competition among schools.

  • BW

    sg @23,

    Not to further push this thread down the education trail, but could you provide a link to that disaggregated data? I’d like to see it. I just heard today that the US spends more, per capita, on education than any other country except for Switzerland, but our test scores, amongst the industralized world, rank in the bottom half.

    I do think we could learn from those high performing European countries about the variety of public and private school choices they have in their nation to create choice and competition among schools.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “I do think we could learn from those high performing European countries about the variety of public and private school choices they have in their nation to create choice and competition among schools.”

    Why? We are beating most of them now. The only students who aren’t beating their scores are black and hispanic students. And our black and hispanic students are far outperforming similar students elsewhere. When European schools can beat us teaching non European students, then they will have something to teach us.

    Data links:

    http://nces.ed.gov/surveys/pisa/

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    “I do think we could learn from those high performing European countries about the variety of public and private school choices they have in their nation to create choice and competition among schools.”

    Why? We are beating most of them now. The only students who aren’t beating their scores are black and hispanic students. And our black and hispanic students are far outperforming similar students elsewhere. When European schools can beat us teaching non European students, then they will have something to teach us.

    Data links:

    http://nces.ed.gov/surveys/pisa/

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg
  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg
  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg
  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg
  • SKPeterson

    Other Gary @ 4 – You are assuming that under a free market in healthcare that prices will remain static or go up and that this will unfairly penalize the poor. I would agree, if degregulation was a half-hearted and haphazard undertaking akin to the “deregulation” of California’s energy market. Yet, many of the public healthcare policies implemented over the past 4 decades have been designed expressly to alleviate the condition of the poor vis-a-vis healthcare and insurance, but costs have still gone up and the poor have still been unfairly penalized with substandard or nonexistent care. Doubling down on a regulatory state who’s greatest contribution to the health of Americans is to make healthcare more expensive to obtain doesn’t exactly sound like a rational or reasonable option, no matter how emotional and melodramatic the soundbites may be.

    However, in many cutting edge, technologically intense industries (electronics, computing, telecommunications, and software for example), costs have stayed stable or decreased as competition has increased. Services have expanded across the board to the extent that even many of the poor have cell phones, pc’s, and flat panel tv’s. Where the market is freed up, the poor generally are made better off by having access to higher quality goods, a wider range of choices, and lower prices than they face under restricted and over-regulated (non)market conditions.

  • SKPeterson

    Other Gary @ 4 – You are assuming that under a free market in healthcare that prices will remain static or go up and that this will unfairly penalize the poor. I would agree, if degregulation was a half-hearted and haphazard undertaking akin to the “deregulation” of California’s energy market. Yet, many of the public healthcare policies implemented over the past 4 decades have been designed expressly to alleviate the condition of the poor vis-a-vis healthcare and insurance, but costs have still gone up and the poor have still been unfairly penalized with substandard or nonexistent care. Doubling down on a regulatory state who’s greatest contribution to the health of Americans is to make healthcare more expensive to obtain doesn’t exactly sound like a rational or reasonable option, no matter how emotional and melodramatic the soundbites may be.

    However, in many cutting edge, technologically intense industries (electronics, computing, telecommunications, and software for example), costs have stayed stable or decreased as competition has increased. Services have expanded across the board to the extent that even many of the poor have cell phones, pc’s, and flat panel tv’s. Where the market is freed up, the poor generally are made better off by having access to higher quality goods, a wider range of choices, and lower prices than they face under restricted and over-regulated (non)market conditions.

  • Steve Billingsley

    Re: US Education performance.
    A better shade of bad isn’t the same as good.

    Re: the ethnic homogeniety hobby horse.
    Wow, we are riding that one hard today.

  • Steve Billingsley

    Re: US Education performance.
    A better shade of bad isn’t the same as good.

    Re: the ethnic homogeniety hobby horse.
    Wow, we are riding that one hard today.

  • SKPeterson

    Steve @ 30 – Ethnic homogeneity has been put forth as a rationale for the extensive welfare state apparati that exist in the Scandinavian countries. Most of the evidence for the argument is recent – as immigration has increased into those nations, there are more incidents that might be described as purely racially or ethnically motivated against foreigners. This is not universal, but the evidence does point to limits on the willingness of people to provide for those they perceive as “other” or outside the extended family that is the dominant homogeneous ethnic group, and to the notion of unlimited social tolerance in the Scandinavian countries. Some evidence has come as well from recent elections in Sweden that saw the Sweden Democrats gain seats, and the True Finns in Finland.

  • SKPeterson

    Steve @ 30 – Ethnic homogeneity has been put forth as a rationale for the extensive welfare state apparati that exist in the Scandinavian countries. Most of the evidence for the argument is recent – as immigration has increased into those nations, there are more incidents that might be described as purely racially or ethnically motivated against foreigners. This is not universal, but the evidence does point to limits on the willingness of people to provide for those they perceive as “other” or outside the extended family that is the dominant homogeneous ethnic group, and to the notion of unlimited social tolerance in the Scandinavian countries. Some evidence has come as well from recent elections in Sweden that saw the Sweden Democrats gain seats, and the True Finns in Finland.

  • BW

    sg,

    Let me try and give a better response later today. For now, I’ll say I don’t think increased competition from more private schools would hurt a thing. I think the fact remains that since the US does spend a lot on education and may not be getting its money’s worth, would be reason to evaluate the public school system. I would love to hear from others on the subject as well though.

  • BW

    sg,

    Let me try and give a better response later today. For now, I’ll say I don’t think increased competition from more private schools would hurt a thing. I think the fact remains that since the US does spend a lot on education and may not be getting its money’s worth, would be reason to evaluate the public school system. I would love to hear from others on the subject as well though.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    How about subsidizing medical education for doctors and health providers? Increase the number of seats in medical schools and programs. That is an area where government could help people get education, employment and serve the real needs of people for healthcare. Instead of having more government employees administering health care, we could have more private sector providing health care. Government needs to be honest about the fact that subsidies incentivize the behaviors they reward.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    How about subsidizing medical education for doctors and health providers? Increase the number of seats in medical schools and programs. That is an area where government could help people get education, employment and serve the real needs of people for healthcare. Instead of having more government employees administering health care, we could have more private sector providing health care. Government needs to be honest about the fact that subsidies incentivize the behaviors they reward.

  • Grace

    The situation doesn’t call for more physicians, or more seats for wannabe doctors, in med school. Doctors are discouraging their children from becoming physicians. Socialized medicine is not a viable alternative.

    Obama’s health care bill is a catastrophe.

    Report: 83 percent of doctors have considered quitting over Obamacare

    07/09/2012
    By Sally Nelson

    Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.

    The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court.

    http://dailycaller.com/2012/07/09/report-83-percent-of-doctors-have-considered-quitting-over-obamacare/

  • Grace

    The situation doesn’t call for more physicians, or more seats for wannabe doctors, in med school. Doctors are discouraging their children from becoming physicians. Socialized medicine is not a viable alternative.

    Obama’s health care bill is a catastrophe.

    Report: 83 percent of doctors have considered quitting over Obamacare

    07/09/2012
    By Sally Nelson

    Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.

    The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court.

    http://dailycaller.com/2012/07/09/report-83-percent-of-doctors-have-considered-quitting-over-obamacare/

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    Well if 83% quit, we will definitely need to train some new ones. Anyway, many doctors are retiring just as many people are retiring. When a higher fraction of the population are older, demand for health care goes up. So living longer means we need more doctors, etc.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    Well if 83% quit, we will definitely need to train some new ones. Anyway, many doctors are retiring just as many people are retiring. When a higher fraction of the population are older, demand for health care goes up. So living longer means we need more doctors, etc.

  • Grace

    sg,

    You simply don’t get it. If the standards are lowered to make more seats for med students, it won’t have the cream of our youth. It’s just that simple. We will have sub-standard care.

    You get what you pay for. People don’t want to buy their OWN insurance, instead they look to the government to pay their way.

  • Grace

    sg,

    You simply don’t get it. If the standards are lowered to make more seats for med students, it won’t have the cream of our youth. It’s just that simple. We will have sub-standard care.

    You get what you pay for. People don’t want to buy their OWN insurance, instead they look to the government to pay their way.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    No need to lower standards. Medical schools don’t take all of the qualified students because they don’t have space. There are plenty of qualified people out there.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    No need to lower standards. Medical schools don’t take all of the qualified students because they don’t have space. There are plenty of qualified people out there.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    Medical student scores and acceptance rates according to
    Association of American Medical Colleges

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    Medical student scores and acceptance rates according to
    Association of American Medical Colleges

  • http://steadfastlutherans.org/ SAL

    With Obamacare coming soon I’ve been working hard to lose weight (my wife and I have both lost 40-50lbs) and exercise.

    I’m expecting the influx of uninsured to overwhelm and destroy the quality of care. So my main effort is to avoid needing a doctor. If I have anything that’s less than life threatening I’m going to wait as long as possible before I deal with the new lower quality and more bureaucratic healthcare system.

  • http://steadfastlutherans.org/ SAL

    With Obamacare coming soon I’ve been working hard to lose weight (my wife and I have both lost 40-50lbs) and exercise.

    I’m expecting the influx of uninsured to overwhelm and destroy the quality of care. So my main effort is to avoid needing a doctor. If I have anything that’s less than life threatening I’m going to wait as long as possible before I deal with the new lower quality and more bureaucratic healthcare system.

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    I’m expecting the influx of uninsured to overwhelm and destroy the quality of care. So my main effort is to avoid needing a doctor. If I have anything that’s less than life threatening I’m going to wait as long as possible before I deal with the new lower quality and more bureaucratic healthcare system.

    What a thing of beauty! Even the suggestion of the new health care law can induce better behavior and better health. Those Dems may be on to something!! Assuming SAL represents some fraction of Americans, we may soon be on our way to healthier America!!

  • http://www.biblegateway.com/versions/Contemporary-English-Version-CEV-Bible/ sg

    I’m expecting the influx of uninsured to overwhelm and destroy the quality of care. So my main effort is to avoid needing a doctor. If I have anything that’s less than life threatening I’m going to wait as long as possible before I deal with the new lower quality and more bureaucratic healthcare system.

    What a thing of beauty! Even the suggestion of the new health care law can induce better behavior and better health. Those Dems may be on to something!! Assuming SAL represents some fraction of Americans, we may soon be on our way to healthier America!!

  • DonS

    sg@24:

    Yeah, that is the point. What is poverty? Well, how does a poor person afford $8000 a year for health insurance?

    The whole problem with our current system is that health insurance COSTS $8,000 (or more!!!) a year. But the reason for these high costs is that government mandates so many coverages, including free preventive care, free contraception, etc. Catastrophic coverage would cost FAR less, making health insurance affordable for a much greater proportion of the population. So then we are talking mostly about covering the out-of-pocket costs for those who can’t afford them. Sure, health care would still be an expensive prospect for government, but far less so than it is now, with people over-using care because it is free, and with providers having to file claims for every procedure and visit, choking the system with paperwork.

    It’s a no-brainer.

  • DonS

    sg@24:

    Yeah, that is the point. What is poverty? Well, how does a poor person afford $8000 a year for health insurance?

    The whole problem with our current system is that health insurance COSTS $8,000 (or more!!!) a year. But the reason for these high costs is that government mandates so many coverages, including free preventive care, free contraception, etc. Catastrophic coverage would cost FAR less, making health insurance affordable for a much greater proportion of the population. So then we are talking mostly about covering the out-of-pocket costs for those who can’t afford them. Sure, health care would still be an expensive prospect for government, but far less so than it is now, with people over-using care because it is free, and with providers having to file claims for every procedure and visit, choking the system with paperwork.

    It’s a no-brainer.


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