The copay assumes the 99% treat healthcare like spiteful buffet gorgers


#82

So I think we are probably broadly in agreement. Probably. My first post noted that I didnt think of co-pays as a priority to get rid of compared to say, selective coverage. My first priority would always be universal coverage, and my best suggestion for a solution would be Medicare for all. Me personally, I would probably suggest that the UK model was fine - i.e you do have some co-pays on prescriptions etc, unless you are in receipt of certain means tested benefits in which case it gets picked up by a central government fund.

Is it socially beneficial for co-pays to be zero? I struggle to believe that but my mind is not closed. How would you demonstrate that zero is the optimal level for a co-pay? It isnt how the system operates now in the UK, and I dont know other systems (apart from the US) well enough. However I would agree that the current co-pay structure in the US might well be a disincentive to treatment in the US for some. Co-pays may well be too high.

I doubt mainstream economics is an ally. I cant imagine Greg Mankiw (for example) doing anything other than advocating for the rich. Its what economics is primarily for - explaining why its good and proper that you are poor and the rich are rich.

Here is a question for you. Which goods and services should have zero prices on them? Fresh air ? Clean water? Health care? Enough food to survive? I can make the case that all of the above should have a zero cost.

And now, which ones do have a zero prices? Absurdly not even fresh air has a zero price. You do not currently have a right to air which has not been polluted by others.


#83

I would think number one (or rather a?!) should be that insurance is intended to mitigate potential loss, but health is a guaranteed loss. For profit insurance markets don’t belong in health care.


#84

Knowing one of those people, if we had a functioning health care system, they wouldn’t be in the ER, because they might have been able to get to the bottom of their issues, instead of turning up at the ER for care or pain management now and then. Studies have been done, yes, fix your frequent fliers issues, and save money. But, we can’t just give people free stuff!!!


#85

And this is another way in which people are funneled through the insurance billing cycle with little benefit for themselves, but that in a way that keeps the feedback loop going.

If you have no family history or symptoms, it should be entirely uncontroversial for you to skip the colonscopy or a mammogram. If you do have a family history and no symptoms, it should be just as uncontroversial for you to be screened often.


#86

I have no problem with the rich buying themselves nicer rooms or food when they get sick. I can even make a case for why they should be able to buy ridiculously expensive treatments of dubious effectiveness. What I cant do is make a case why poor people should die unnecessarily in rich countries.

I have never understood it.


#87

Thanks for the link, interesting article. It makes the very valid point that a lot of preventive health care that definitively has a benefit is via programs that are outside the typical medical arena:

It also requires a more expansive definition of preventive medicine. The Trust suggests such steps as extending bus lines to parks so people without cars can go someplace pleasant for physical activity and other “community-based” efforts. These strategies save more money in healthcare spending than they cost.

This taps straightly into a hobby horse (heh) of mine:

A decent cycling infrastructure is not cheap to build, but it basically pays itself through the massive health gains.


#88

I have employer provided insurance, but we are small company with employees spread across multiple states. Our insurance sucks - in the 7 years I have had it, it has never paid a penny for anything. The only benefit I get from it is the reduced cost of visits based on their negotiated rates. When the ACA came in we did get slightly lower deductibles and more coverage but I expect those improvements to disappear over time.

I’ve taken with our president and CFO about this and it’s not that they are being mean, it’s just that there is literally nothing else available in the marketplace for a company with less than 50 employees in 6 states. The system is fundamentally broken


#89

Disagree completely. You require economics to understand how inequality appears in a system, you require economics to even define what rich and poor even mean. You can pick out people like Mankiw for individual bad opinions usually out of their areas of expertise (Mankiw advocates for a carbon tax for example), but you need to look at the current broad thrust of economic opinion - generally in favour of more redistributive taxes, more universal healthcare, so on and so forth.

Zero price? Specifically? How would it be implemented? And as an alternative to what? I think you are proceeding too far by gut instinct. There are many points you are failing to address.

To talk about zero prices implies these things are available to buy. Take clean water as an example. If you can obtain as much clean water as you want at price 0, then I could load up all the water I want straight from the supply into my truck and leave you with none. If we want clean water to actually to be available to people we need therefore to make careful rules about how much water you should get. Some classes of consumer should get free water and some just shouldn’t.

For the food example, is it actually a smart idea to offer ‘enough food to survive’ as a free service, when we could just give people enough money to buy food? This is not a trivial question.

For the fresh air example, what does it mean to “have a right to air which has not been polluted by others”? Clearly any optimal economic policy has to balance the needs. It would be absurd for someone to shut down an entire city because one person within it protests the cars around them are violating their right to free fresh air.

If you want to talk about price-0 goods, you need to balance the costs. You need goods that people can’t really overconsume, that don’t produce externalities, where the administrative costs of delivering pricing is significant, where (ideally) the free market is bad at delivering, where offering the service produces positive benefits e.g. in terms of trust and encouraging the use of the service. Free healthcare seems pretty reasonable, education seems good too, policing/fire service, public transport…


#90

Generally speaking, if you really need meds for episodic pain, you will hoard them and ration them - because using them unnecessarily decreases their effectiveness.

Addicts are usually trying to stave off withdrawal symptoms, which generally leads to completely different behaviors.

Currently, the economically motivated “opioid epidemic” moral panic is increasingly denying safer, legal painkillers to patients with documented history of avoiding addiction, thus driving those patients to illegal drugs whose varying purity and effectiveness makes it harder for them to avoid addiction and/or overdose.


#91

Well, for one thing these aren’t questions. They are statements of reality that need to be addressed without economic concern because they strongly relate to humans being able to live without suffering, and it’s only economists think everything is “logically” quantifiable and that there needs to be debate over whether or not people should have clean air, and just how clean it should be since we don’t want to inconvenience auto manufacturers with pesky regulations too much, or just how free should food be, we wouldn’t want to accidentally feed any undesirables.

While you may think this is a pointed attack, it’s really not. It’s simply how these arguments play out in the real world outside of a peer reviewed paper. What you dismiss as “gut instinct” others feel are a human right. That economists choose to debate the economic costs of human rights is why there’s such a backlash against them.


#92

I cannot speak to how hard it is for insurance companies to make that determination. However, I’m not in favor of making screenings so expensive and/or difficult to request that consumers must skip them for that reason. I’m sure that there’s a great deal of anxiety and uncertainty associated with having no routine exams at all, but who is studying that would take more research than I have time to do at the moment.

I do not agree with the argument that only people with a family history of a specific condition should be screened, either. What if you are the first? Those of us who want preventative care know the risks of false positives but would rather be proactive than be a victim of undetected and untreated conditions.


#93

No “gut” involved at all. First of all, when I use the term “zero price” I refer to the point on the demand curve where price=0. In some cases the demand function will be asymptotic approaching p=0. In some cases not. If we remove co-pays we can think of that as setting the marginal price of healthcare at p=0. p=0 is a special case or boundary condition. If the copay was non-zero that would be off the boundary condition. Im not clear why a 1c or $1 copay would really disincentivize more people than it would persuade to not be wasteful of resources. But that is the nature of the discussion. In the UK, some things - like prescriptions - do involve charges unless you are in a special means-tested category. I dont see why that kind of thing would be so bad in the US. Even after the UK has defunded its healthcare system its still way better for ordinary people than the US system.

In the following - where there is invective it is not directed at you but at economics.

Disagree completely. The broad thrust of neclassical economics is just peddling neoliberal thinking. There are other branches of economics - its not obvious to me why neoclassical economics is so popular when it has explained pretty close to nothing that has happened over the last 40 years. Take for example the dot.com crash - nope no prediction. Or the banking collapse in 2008 - absolutely nothing, no one operating in the conventional paradigm say it coming. In the conventional neoclassical paradigm the whole thing shouldn’t have happened. Indeed there is not even a viable theory of money in the standard neoclassical model. As we say in the UK its just a load of bollox which has two really useful characteristics

  1. It justifies then status quo.

  2. It explains that rich people are rich because they have contributed more (justifying the status quo).

You dont require economics to define inequality - thats some trivial arithmetic or mathematics. Corrado Gini of the eponymous coefficient wasnt an economist but a statistician and sociologist - no need to define a whole new subject. Its true that the study of economics is, at least in part, the study of inequality. However whats striking to me is how its also the way the agenda gets set and the rationalization for policies which created much of the inequality in the first place.

David Ricardo is my favorite example of economics as nothing more than advocacy. Ricardo argument against the corn laws was entirely in service of the new industrialists. I like the way he constructed his argument but it clear that the argument for free trade came after the development of a substantial class of people who would benefit from free trade. The joy of the Ricardo example is economics as advocacy has clearly been going on a long time.

So lets look at the neoclassicals like that fucktard Samuelson or Dornbush etc. Name any you want pretty much. These guys told us about the primacy of money supply which was the justification for the first wave of mass unemployment in the 70s. They also told us (in micro) about the importance of aligning incentives which is what justified the use of options as a means of rewarding CEOs and other C-suite thieves. Before their pernicious writing, CEOs might earn 5-10 times what the average employees earned. Now its 300x.
Do you really think companies are better managed today?

Keynes said that “practical men who believe themselves to be quite exempt from any intellectual influence, are usually the slaves of some defunct economist. Madmen in authority, who hear voices in the air, are distilling their frenzy from some academic scribbler of a few years back”. You could take this as proof of the efficacy of economics as a discipline. I take it the other way - its proof that there is no absolute truth in economics - just rhetoric which is used to serve some slimeball’s interests, and usually the rich cos they are the guys with the money. These arguments come in and out of fashion and are simply mercenary - deployed to achieve a goal.

There is a case for studying economics - which is that regardless of whether we study the subject there will still be governments and they will conduct their policies. So we might as well understand what views have been held about various policies down the ages. However to think there is an absolute truth to be derived from the study of economics is I think obviously wrong. The best case I can construct is you get to highlight the fraud and cupidity of those claiming they are working for the public good. “Trickle down” my arse, for example.

As for needing economics to define rich or poor, I just cant accept that argument. I dont think I would trust economists with that kind of question. They have already disqualified themselves by being so useless for so long. I would leave it to pure mathematicians or just laymen.

Forgive the length.


#94

I think it should be up to each individual to make informed choices about cancer screenings. You should be able to have the tests you would like, but others should not be compelled (for example, doctors requiring patients to comply with a pap smear in order to recieve birth control) to have tests if they do not want or need them.


#95

As I said, I have had a lot of interaction of late with opioid users. The second point is definitely true. Where people get “sick” they will do what it takes to get what they need. If thats blowing strangers in a parking lot or breaking into their next door neighbors apartment then so be it.

I dont know what you mean by the economically motivated “opioid epidemic” moral panic. Is it the epidemic which is economically motivated or the moral panic or both? I agree that legal painkillers are probably safer than illegal painkillers and its a shame to push people towards the illegal. However I have been surprised at how hard it is dealing with people in the grips of this kind of addiction. I had met opioid users in the past and I have used them myself. Truth is I have been shocked by how much of this kind of addiction there is out there. In one particular context I have found 20% of a particular population has received naloxone in the last 6 months. Its true that it is a poorer demographic, but still.


#96

For decades, now, it’s been increasingly difficult for people with episodic pain (I get migraines, personally) to get safe legal medication.

But when the research data came out that showed placing legal restrictions on doctors’ ability to prescribe always causes a sharp uptick in illegal drug trade and the attendant associated crime and suffering, efforts to restrict prescription seemed to go into overdrive. This seemed very strange to me, especially during a period when marijuana prohibition was being overturned, and hi-test beer was a popular fad. We knew that preventing doctors from using their best medical judgement drove up crime and addiction and overdose - it’s a clearly demonstrated relationship - so why the sudden doubling-down on prohibition, in the name of an “opioid epidemic” which is surely a medical and not a legal problem? It turns out that for-profit prisons are spending millions of dollars on this issue.

“Private prisons are in the business of filling beds, and they make millions by incarcerating nonviolent drug offenders along with violent offenders and white-collar criminals.” –Open Secrets

There really are far too many people suffering from avoidable addictions and I don’t mean to deny that, in any way. But the moral panic is being cynically used by private prison owners to fatten their pockets, with no other benefit to anyone.


#97

I don’t know how you define “free things”, but I pay over $1600/mo for my health insurance. Plus A $25 deductible for office visits.


#98

I wasn’t thinking of an insurer’s perspective when writing this, more from a public health perspective, like from the CDC or similar. You are absolutely right that screening should not come with ludicrous copays or be difficult to request. And it should be an individual’s choice whether to take part in a screening or not, because in the end, one can do the trade-off only for oneself, like @Magdalene said.


#99

Economics is a social science rooted in the humanities, and thus open to wide interpretation. Couple that with a discussion of health care administration, which is the epitome of distorted markets and perverse incentives, and whatever “laws” of economics could normally be applied to other industries become worse than useless.


#100

Unfortunately there were more than a few doctors who were using their licenses to basically supply millions of pills to “patients” who were conduits to the illegal opioid market.

And as usual, our governmental solution is to make life a couple of orders of magnitude more difficult for the overwhelming majority of doctors who have always used their prescription pads in a perfectly legal and appropriate way. This reminds me of another thread I’ve posted to here recently, but I won’t go there…


#101

This was learned in the 60s, when the government in the uk made it harder for doctors to prescribe to addicts. Only, of course, no one learned from it…