03/28/2010
Aaron Carroll - RA ArchivesHealth policy expert Dr. Aaron Carroll sits down with Gerry Dick to discuss the immediate impact of health care reform on Indiana businesses, including pharmaceutical giant Eli Lilly, insurance giant WellPoint and Indiana’s orthopedics capital in Warsaw.
Go watch it!
03/28/2010 Austin FraktThe universe according to a blogger (or Facebook user, or child, or politician, or …).
03/27/2010 Austin Frakt 03/26/2010 Aaron Carroll - RA ArchivesMany, many readers ask:
How are they paying for this?
Where is the money coming from?
There’s no way they can pay for this. What’s the deal?
You know there’s not way they can possible raise a trillion dollars. When will you admit they lie?
Deficit reducing? Come on.
I tried going through the CBO report. But it’s almost impossible to break the revenues apart from everything else. Then The Tax Foundation did the heavy lifting for me. Here’s how it breaks out:
Add that up and you get $1.085 trillion dollars. Since the bill is projected to cost $938 billion, that’s how you get a deficit reduction of $142.5 billion.
UPDATE: Sigh. I missed the nice graph they put together. You can go see it at Austin’s site.
03/26/2010 Austin FraktIt’s clear to everyone that the Affordable Care Act (ACA) is what we’re calling health reform now, right? Good.
Anyway, Ezra Klein pointed readers to a handy pie chart from The Tax Foundation that shows where the money will come from to pay for ACA goodies. I agree with Klein that it would have been terrific if the creators had broken out the Medicare savings.
Taking a peek at the CBO scoring document it looks like about 43% of the Medicare cuts are in reductions in updates to fee for service rates, mostly for hospital payments I believe. About 30% is cuts in Medicare Advantage payments. The rest is a grab bag of other stuff each piece of which is small.
03/26/2010 Austin FraktUniversity of Minnesota professor Roger Feldman, with whom I’ve co-authored several papers, has written an opinion piece for the Minneapolis/St. Paul Star Tribune. He takes the Obama Administration to task for rhetorically double counting health reform’s Medicare cuts, once to shore up Medicare and once again to pay for expansion of health insurance. However, he notes CBO made no such error.
The CBO did not make a mistake in its arithmetic. By law, it must estimate the effect of proposed legislation on the federal deficit, and … [not on] other federal programs [that] must be cut.
The president, however, does not have to follow the same rules as the CBO. He could have told us that Medicare spending cuts can be used to fix Medicare or to pay for health insurance expansion, but not both. Instead, he chose to maintain the fiction that Medicare savings can be counted twice.
… Congress should address Medicare reform and health insurance reform separately in future legislation. … However, the CBO should not change its method of scoring proposed legislation. The CBO is not responsible for maintaining the fiscal soundness of Medicare. But another federal agency, the Office of Management and Budget, should publish a budget that shows the future liabilities for all entitlement programs and these should be included in the president’s annual budget.
Until we meet this challenge, we will continue to use bad arithmetic and budgetary tricks to hide the cost of health care reform.
I would also prefer to see policy debates conducted in a climate of candor. Unfortunately one can’t count on everyone to behave that way. And neither side has an incentive to be fully open and honest. The proper penalty is to point it out, as Roger has. None of this changes the fundamental truth that the budget deficit problem is a health care spending problem. I don’t think anyone who follows the debate is under the illusion that that problem will be fixed with this reform alone. Obama may have tried to make the hole appear shallower than it is. But even half a deep hole is a deep hole.
03/26/2010 Austin FraktGoogle Wave is a relatively new Google product that claims to be a “real-time communication and collaboration. A wave can be both a conversation and a document where people can discuss and work together using richly formatted text, photos, videos, maps, and more.” One obtains a Google Wave account by invitation only. I received my invitation late in 2009 and fiddled around with Wave a little. (If you want an invitation, send me your e-mail address.)
It didn’t take me very long to decide how to use Google Wave. The answer is: not at all. I haven’t found a single thing that makes Google Wave a good alternative to other ways of communicating and sharing. That’s not to say that I don’t believe it is possible it is better. It’s just not there yet.
Part of the trouble is that it is not intuitive. I watched as a half-dozen other Wave users edited a blog post of mine for possible use on the Bogleheads Wiki (*). It was pretty hard for me to follow the editing process because it wasn’t clear to me what the master document was. All the edits and communication appear in one long window, very little of which is visible at any one time. I think it’d be far better if the document could be viewed in a full-screen mode with some sort of mark-up or linking convention that indicated who did what to which part and when. (I see that some of my requests may be possible, but as I said it isn’t intuitive.)
I recognize that my impression of Google Wave is based on very little use and on a beta version of the product. I also recognize that Google has produce an 80-minute video on Wave’s features. But I’m not going to watch a long video to learn how to use a communication/document sharing product. It should be intuitive. If Google has any hopes of making a splash with Wave they’d better make it so, and fast. If they don’t, my prediction is that this will not be the only bad review.
Perhaps I’ll be wooed by subsequent versions of Wave. I’ll try to keep an open mind. I think the burden of proof that Google Wave has value is on Google. Build something obviously good and users will come.
(*) About 2.5 months ago I asked these Wave users and others for feedback on their experience. I did so in Wave itself. None responded. I take that as an indication that either (a) they’re not using Wave and didn’t see my query or (b) they don’t have a strong opinion of Wave (positive or negative). Either way, it does not seem Wave is a wild success with this crowd.
03/25/2010 Aaron Carroll - RA ArchivesA reader asks:
One item that I cannot find and would like to know is: When a person applies for health insurance after the reform takes place, will companies be able to ask health questions on the application? Also, does this reform prevent rating policies up for health problems? These are two very important questions. If companies can do this..the reform is not reform. Thought you might have access to this information.
Nope. No health questions. No rating policies up for health problems. That’s one of the reasons reform is reform. From the Kaiser Family Foundation (italics mine):
How do premiums vary by age and health status? Under the status quo, people buying coverage on their own generally face medical underwriting, meaning that they can be turned down for coverage or charged a higher premium based on their health status. That is prohibited under the Congressional proposals. Premiums today also vary by the age of the policy holder, with the premium for a single 64 year old typically being five times or more the premium for a 19 year old. For families the variation in premiums by age is generally less pronounced. The House bill caps the amount that an insurer can vary premiums by age at two to one, meaning that premiums for older people would be lower than under the status quo while premiums for younger people would be higher. The Senate bill and the President’s proposal cap the variation for age at three to one.
03/25/2010 Aaron Carroll - RA ArchivesA reader asks:
Just curious. Why don’t you permit comments/questions to your blog posts? That seems odd.
My question is what does the word “affordable” mean in the context of health care reform? I hear it over and over in this messy debate, but no one says what it means. Does affordable insurance for someone “high risk” with a pre-existing condition means a premium of $4,000 per year or $40,000?
As to comments, I have a policy (and reasons)*. In compensation, I try to answer a ton of email. Like this one.
“Affordable” is – as the reader notes – a subjective term. But, to get a concrete answer as to what insurance would cost for you (if you’re not getting it from your job), go to one of the many calculators. There will be no rate difference because of your condition. That’s one of the key pieces of reform.
*If people are curious, my recent request for suggestions on whether to change the comment policy was overwhelmingly for leaving it in place.
03/25/2010 Austin Frakt
The Finance Buff (TFB) has just published a truly wonderful little book called Explore TIPS: A Practical Guide to Investing in Treasury Inflation-Protected Securities. Nearly everyone should include TIPS in their portfolio. If you’re familiar with TIPS but don’t own any or if you’ve never heard of them, this book is for you.
I read a draft copy of TFB’s book and found it to be an excellent guide to TIPS, covering all important elements efficiently and clearly.
