Ezra Klein: Link of the Day: Me Edition

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January 23, 2006

Link of the Day: Me Edition

One frustrating thing about a large group blog is that you can work hard on a post only to watch it get buried as the day progresses. So today, I'm going to self-promote. Check out my State of the Union primer over at Tapped -- I think it's an important contextualizer for all the cautiously worded previews currently swirling through the media.

January 23, 2006 | Permalink

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Comments

We've talked about this a bit before, but I just don't see how anything Bush proposes can change anything. Those companies that are going to offer health insurance are still going to offer it, and those who don't or who are going to get rid of it still won't offer it and still will try to get rid of it. Unless Bush proposes a law that abolishes insurance companies, we're still going to have insurance.

Posted by: Stephen | Jan 23, 2006 11:37:16 AM

Nice post Ezra.

Do you know if the HSA plans envision a yearly $10,000 deductible? Many chronic diseases would have over $10,000 in yearly expenses for many years in a row. In fact, one of the major goals in some diseases (e.g. advanced breast or colon cancer) is to convert acute, rapidly fatal illness into chronic illnesses (likely demanding ongoing, expensive treatment) which could make the out-of-pocket lifetime payments $100,000 or so.

Posted by: Ted | Jan 23, 2006 12:30:17 PM

It's an annual deductible, Ted. Some plans have lifetime maximums, but others do not. It's the kind of fine print that people with breast cancer will read, but people without breast cancer won't read.

One huge problem with these accounts is that they won't control spending, even if people become smarter shoppers b/c they're spending their own money.

There's somehting called the 80/20 rule of healthcare spending: 20% of people generate about 80% of the costs. This is because healthcare spending mostly isn't for cheap stuff like doctors' appointments, it's for expensive stuff like open heart surgery, chemotherapy, hip replacements, and preemie babies who weigh 2 pounds.

Big ticket items like these are waaaaay over the $10k deductible, which means people don't care what they cost because insurance is footing the bill. So much for the power of smart shopping.

And the idea that people will take better care of themselves if they have to pay to go to the doctor is a funny one. Um, if getting my feet cut off isn't enough to make me take better care of my diabetes, why will being forced to pay for the doctor's visit in which he tells me I'm going to have to go get my feet cut off make a huge difference in my attitude? I'm just saying that I think people are overestimating the power of money, here.

I'm trying to think of an analogy. I think it's like a company trying to save money by charging its employees a nickel every time they turn on a light, but charging them nothing if they leave the light on all night long. Don't be surprised when people fall asleep in dark meetings but your electrical bill still goes up because the lights in offices are on all night long.

Posted by: theorajones | Jan 23, 2006 1:41:15 PM

theorajones,

your comment was awesome. perfectly put. Love the getting my feet cut off example as a disincentive. It's funny, but really not..

the best part is no one knows when they're going to get breast cancer. You might have an HSA because you're perfectly healthy. Next thing you know, you've got a 10,000 a year illness (that's just your out of pocket!) for the rest of your life.

Why on earth anyone ever thought this is the way to "fix" health insurance is beyond me.

Posted by: Kate | Jan 23, 2006 5:14:04 PM

Get some facts. 10k is not the min. deductible. It can be as low as 1k (single) or 2k (multiple people).

Posted by: David Andersen | Jan 24, 2006 4:46:23 PM

These proposals wrongly assume that utilizing health care services is just like buying any other consumer product. You're buying a car - you check Consumer Reports, talk with your friends, haggle (or not) with the dealer.
How do you "shop" for medical services? How does an individual determine which diagnostic tests they should have or how much they should pay for them?

Posted by: CParis | Jan 24, 2006 5:20:34 PM

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