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Healthcare Weirdness
Ezra Klein says he's "baffled" by Michael Kinsley's column 
on healthcare reform in the Post today. He's being way too kind. I read it last night and Kinsley's column isn't even coherent.
Do we need a root-and-branch reform of healthcare in America? "The answer is probably yes," Kinsley affirms. But then, without warning, he pulls a high-speed U-turn out of his hip pocket and declares that we shouldn't bother right now regardless. Why? Because healthcare reform gets its urgency "merely from [its] association with truly urgent measures like the stimulus package." Because it will cost $100 billion per year or so and it really ought to be free. Because it will be politically difficult.
Huh? Healthcare reform was viewed as urgent long before the banking crisis. Its cost is no surprise at all. And everyone knew it would be politically difficult from the get go. None of this is news and none of it makes any sense.
And what makes even less sense is the "low hanging fruit" that Kinsley suggests we implement in place of broad change: malpractice reform, electronic recordkeeping, and comparative effectiveness research. That's not low hanging fruit. It's low hanging gnats. They're all good ideas, but they'd have only a tiny impact on costs and essentially no impact at all on broadening coverage. It's like telling GM to spend more time designing prettier hubcaps. Very strange.
Kinsley
Kinsley is the original liberal contrarian. He begat all those TNR and Slate writers. Ultimately, I blame Kinsley for Mickey Kaus.
What Kinsley wants to write,
What Kinsley wants to write, but can't get past his liberal editors, is this: the government can't afford to enact health care reform while trying to spend its way (unsucccessfully so far) out of these economic downtimes. Polls show a mounting dissastifaction with Obama's econmic plans and his policies.
It seems as if only liberals think the government can spend and spend and spend its way to economic and financial salvation, all the while providing more entitlement programs and ridding the world of so-called global warming. You have to pay for these programs, one way or another. Heap a large tax bill on the electorate and they can't spend or invest in the economy. Borrow to pay for these bills and eventually, your creditors in Beijing and Riyadh will start demanding better terms for the loans.
Kinsley realizes this New-New Deal won't work because the old New Deal didn't work. He, unlike most liberals, is a student of history. He, like most people, doesn't want the government to run head-first into economic disaster with the only lifeline being a world war that claimed millions of lives.
No sense
We pay *twice* as much per capita on health care than the rest of the civilized world.
So why do they need more money?
No, Tort Deform Is Not a Good Idea
It's a corporatist lie. Eliminating the right to recover from those seriously injured by medical malpractice shifts the burden of malpractice from the doctors and their insureds to the victims of malpractice. And, what's worse, the shift is from those most harmed.
Stop spreading this lie.
Lowering Costs
Changing medical malpractice rules would have a tiny impact on costs (if it had one at all). But actually comparative effectiveness research and health IT can bring down costs quite substantially -- there are credible estimates that health IT could save hundreds of billions of dollars over ten years (the Commonwealth Fund has some good estimates on this); and CER could get you to around half a trillion if you also implement evidence-based protocols and make sure docs know about it.
The rub is that just throwing money at computers and research isn't going to have much impact -- if they're part of a more systematic reform that shifts incentives for insurers and providers, brings everybody into the system, and does a lot of back-end modification to the delivery and payment systems, you really can get huge savings. but just kicking in a couple more billion dollars for studies isn't going to do much on its own. This really is a place where virtuous cycles and synergies between different policies is the only way to realize substantial savings -- a piecemeal approach centered on these policies isn't likely to accomplish very much.
too much over cooked synthetic heroin
Kinsley took too much synthetic heroin in the Seventies and is now dependent on dopamine, which the insurance and pharma companies will only give him when he writes what they tell him. They told him no health care reform now.
Who'd a thunk it?
Wow, an incoherent column penned by Michael Kinsley. Next thing you know, there'll be gambling going on at Rick's.
Thinking Inside The Box
Kinsley only seems incoherent if you're not Kinsley. Imagine, he gets paid big bucks for this, and even calls himself a liberal (but a special refined type of liberal, not like those common versions), and all he has to do is write up a few talking points from the Chamber of Commerce- nice work, if you can get it.
you gotta be kiddin Kevin
Implementing CER would drive down costs tremendously. We could adopt the VA's record keepingsystem and it too would cut costs and medical mistakes. Get a public option for Medical malpractice insurance which is a monopoly scam too and watch 90% of doctors instead just 59% now jump on board.
If you really think the only savings is going to come out of insurance you should support single payer.
Not gnats
Comparative effectiveness research is how we wring expensive, unnecessary procedures out of the system. It is low hanging fruit that can save many billions per year.
The macro cost-saver, by far
The macro cost-saver, by far the biggest of all, will be eliminating uncertainty for doctors and hospitals whether they will be paid and by whom when they take on a new patient, especially for very large claims. The next biggest savers will be (1) eliminating the fudge factor that prudent insurance companies must charge in their premiums to cover the possibility of huge claims from an unpredictable risk pool; and (2) private-entity profit on that necessary fudge factor. The Federal government needs no such fudge factor for universal insurance against the catastrophic layer of payouts because it covers the entire pool of risks. Of course, there is no need for profit on the premium charged for such risks.
To a person, it seems, all the progressive reformers and pundits are failing to grasp the significance of distinguishing between a catastrophic layer of risks and smaller claims in amounts below that. It is the really big claims, the ones nobody is immune to and almost anyone can be financially destroyed by, that most need to be socialized. The net tax revenue cost resulting from shifting that liability from private companies to the government will be enormously reduced compared to the aggregate premiums we pay. Moreover, eliminating payment uncertainty will generate the possibility (and pressure) for large reductions in fees for healthcare services, and, accordingly, reductions in the premiums insurers of those services need to charge for the layer of claims they would continue to cover.
I have also seen nobody connect the dots between creating certainty for all Americans that they will never be financially destroyed by a health problem even if they lose a job through which they get health insurance coverage, and the level of confidence in the economic future that is essential for a thriving economy. Destruction of the safety net is a critical factor in causing the fix we are in by undermining national confidence, and the possibility of financial destruction due to a health problem is the biggest hole in the safety net.
Why are these dots so hard for the so-called "experts" to connect? Is it an NIH syndrome?
So-called "Malpractice Reform"
Restricting injured patients' rights to be compensated and hold those who harmed them accountable is not the kind of "reform" America needs. Moreover, everyone from the Congressional Budget Office to insurance experts themselves have consistently shown that malpractice premiums and claims are each a tiny percentage (1-2 percent) of overall health care costs. If we really want to bring down health care costs, let’s stop talking about trying to solve health care problems on the backs of patients, and let's start talking about how we stop medical malpractice. http://tinyurl.com/l7czhv