• Back to basics

    I’m putting together some slides for a talk, and I thought it might be worth posting this:

    That’s the data on uninsurance from the last CBO report on PPACA.  The blue bars represent forecasts about the next decade without reform.  The green bars represent what is expected under PPACA.

    Note that no one is really disputing this.  No one is claiming that PPACA will not lower the rate of uninsurance.  People don’t like the mandate, they don’t like the “government over-reach”, and they don’t like the taxes.  But I’m not hearing many Republicans saying the bill needs to be repealed because it won’t get many more people insurance.

    I grant you that it doesn’t get us to universal coverage (which is one of my problems with it).  I also grant you that it doesn’t do as much to improve quality and costs as much as I’d like.  But this bill was always about access, and dropping the numbers of the uninsured this much is no small feat.  I’m not seeing any other proposals being floated around Congress these days which will do better than this.

    As cries for repeal heat up, some should stop and consider if those blue bars are really worth fighting for.

    • I think that your end goal is health, is insurance the most cost efficient way to increase health? Clearly more than half of the people lose by having insurance. Should we be telling people to save more for their healthcare later in life and perhaps to reduce insurance by opting for a higher deductible (I an scared to encourage people go without insurance all together, though Arnold Kling once said that is what he would do if his employer did not provide it for him.)

      Should millionaires be encouraged to not carry health insurance? There be some positive externalities if most rich people did not carry insurance.

      I try to question ideas that most people just take as givens.

    • Addendum to my comment above:

      I was shocked to read that the median persons lifetime health care spending was under $400,000. Many middle class spend more than that on housing it seems like an expense that could be covered without insurance. It might even be better if people paid for expensive interventions like surgery and cancer treatment after the fact because it might would discourage quixotic attempts that on net cost life. I think that sometimes hospitals will do treatments that are more likely to shorten life and keep the patient in more pain in order so that they and family can feel good about not holding back doing everything possible. If they needed collect after the fact they might more realistically assess 5 year survival rates.

      Not having insurance could get people to try things like Apollo healthcare which is healthcare offered in India by USA qualified Doctors.

    • And he insists on calling it “insurance”, which it obviously isn’t.

    • The numbers look daunting when you fail to exclude from the ranks of the “uninsured” those who are already eligible for programs like Medicaid but didn’t sign up, illegal immigrants, those who could afford coverage but choose to spend their money elsewhere, and those who are temporarily between plans. Including them has hyped the size of the problem all along. That inflation more than doubles the numbers over a more appropriate focus on those Americans who have been locked out by cost or medical condition. If you continue to include non-Americans and those who won’t participate, you are making the situation look worse than it is, both pre- and post-PPACA. You can’t help but be disappointed when you unnecessarily frame the glass as half empty.

    • “(I an scared to encourage people go without insurance all together, though Arnold Kling once said that is what he would do if his employer did not provide it for him.)”

      I would love to see people who claim that actually go without. They could model their own theories for the rest of us.


    • Steve, I do have a $10,000 per person annual deductible and I have paid $10,000 out of pocket one year and $30,000 another year (the disease that afflicted my wife was not covered by the police that I had and so $30,000 bill on a 10,000 deductible). Mine is an individual policy. So I am taking the risk that I recommend.