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Author Topic: Obamacare Predictions for May 2015
Greg Davidson
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Customer satisfaction, doctor shortages, growth in medical paperwork - Part 6

This is a grab bag of predictions and data that I have group together in the belief that some of these questions are related, but I acknowledge that linkage could be arguable. We don't have direct information on paperwork growth. There is some limited information on doctor shortages (there is a widely publicized May 2015 story on ER use going up and driving doctor shortages, but when you dig into the details, it's based on an internet poll with no stratification of the data). Finally, there are measures of customer satisfaction by users of policies from the exchanges, and this not only addresses my prediction, but arguably might be a measure whether something else (such as excessive paperwork or inability to get doctors) is affecting those who got insurance through the exchanges.

Now to the predictions

quote:
The minority of the population directly affected by the exchanges (ie; those without health insurance from their employer) will generally be satisfied (Greg Davidson 11/28/2013)
quote:
60% of doctors are refusing to take new medicaid patients, and 33% of doctors reject all medicaid period. With the new large medicaid expansion this will not end well. (Seneca 4/1/2014)
quote:
30%+ of all docs CURRENTLY refuse medicaid, 66%+ CURRENTLY don't accept new medicaid patients. That is huge and happening NOW. What will happen is that it will get WORSE. (Seneca 5/5/2014)
quote:
9. Medical staff directly related to patient contact and care will continue to see cuts. Paper pushers associated with medical staffing will increase. (RedVW on laptop 11/29/2013).
quote:
Lyrhawn: That mountain of paperwork, by the way, is as much a problem from private insurance as from government sources, possibly more so

noel c.: That balance is about to change decisively.

Lyrhawn: I don't really see why it would. Everyone signing up for Obamacare is still signing up for private insurance. Why would doctors need to call the government about a patient's private insurance plan? (3/26/2014)

And what does the evidence look like?

JD Power (a private sector company known for consumer surveys, not political views) reports that those using the exchanges have a slightly higher average level of satisfaction than those who got their insurance through their employers:
quote:
People who had coverage through Obamacare had an average satisfaction score of 696 (out of 1,000) in 2014, thinking back to their last year of coverage. During that same year, people in mostly employer-based plans had a satisfaction rating of 679—17 points lower.
link

Here's a Kaiser/PBS study which is only for California, but it covers both satisfaction and doctor access (and California accounted for ~15% of national sign-ups).
quote:
Among Covered California members, 74% rated their coverage as excellent or good. It was 88% among people with other private coverage.

Ninety-one percent of exchange customers said it was easy to get to their usual source of medical care, matching the response among people with other types of private coverage.

Many consumers have complained about a shortage of participating doctors in narrower Covered California networks and problems getting accurate information from insurers' provider directories.

link

This data is consistent with a study I posted a few months ago
quote:
The Commonwealth Fund Affordable Care Act Tracking Survey, April–June 2014, was conducted by SSRS from April 9 to June 2. The survey consisted of 17-minute telephone interviews in English or Spanish, and was conducted among a random, nationally representative sample of 4,425 adults, ages 19–64, living in the United States.
________________________________________
78 percent of all Americans said they were very or somewhat satisfied with their new coverage
74 percent of Republicans said they were very or somewhat satisfied with their new coverage
75% of people with new insurance found it somewhat easy or very easy to get a new primary care doctor
67% were able to get an appointment in 2 weeks or less
30% with new coverage needed to see a specialist; of those 58% got an appointment within 2 weeks
58% said that they were better off now than they were before
9% said they were worse off

Finally, here's the result of a study of 9 large states

quote:
most of the health centers and large physician groups contacted said they were prepared for new patients because they had added space and providers. A few cautioned that the full impact could be bigger because of the late surge of enrollees buying private plans in late March and April, whose coverage would just be taking effect in May, and the large numbers still awaiting Medicaid cards. Besides Colorado, Kentucky and Washington state, other sampled states were California, Connecticut. New York, Florida, Texas and Pennsylvania...

And while Medicaid saw a net growth of 4.8 million people since October, more than a million who signed up are waiting to get the cards that are their admission tickets to free or low-cost doctors’ visits.

Many of the concerns about people experiencing delays grew out the experience in Massachusetts after that state adopted near-universal coverage in 2006. Wait times for a doctor’s appointment rose to an average of 50 days with some as long as 100 days, according to a Massachusetts Medical Society report in 2008.

But Glied notes that Massachusetts’ residents historically had long waits for primary care visits so their experience is not a good indicator.

And unlike the Massachusetts law, the Affordable Care Act gave health providers more than three years to prepare. In that time, the federal government has spent billions expanding community health centers while private practices have added nurse practitioners and physician assistants and adopted electronic health records.

Kaiser Health News - PBS
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Greg Davidson
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Enrollment #'s including premium nonpayment #'s- Part 7

quote:
there is a net zero gain in people covered by "private" insurance when those being kicked off of their plans are factored in, and roughly 1\3 of new UCA "enrollees" have been placed on the Medicaid roll. (noel c 3/26/2014)

quote:
Barry's enrollment count is encrypted buy their own incompetence (unless they are simply lying), but actual enrollment is a net negative at best if unpaid policies, and termination of private policies are factored in. Medicaid accounts for nearly 1/3 of the "six million" number.(Noel c. 3/29/2014)
quote:
Kathleen Sabelius claims that she does not know what the actual enrollment numbers are, nor does she know who how many included in her estimate have paid their first premium. I don't really believe her (given the veracity of her past reports to congress, why should we?), but why are you confident in your sources numbers? They look thoroughly cooked to me, by at least a factor of five. (noel c 3/29/2014)
quote:
Noel c.: Of the 48 million total uninsured that the UCA was supposed to take a chunk out of, I suspect we will still end up with 45-46 million uninsured as of the close of enrollment... (noel c. 4/1/2014)
Greg: Excellent - thank you for your prediction. We shall document either your victorious prognostication, or your significant level of error

quote:
By the time all individuals who had existing health care coverage are factored in, it is quite possible "2 million" will be the correct number. This ridiculous "20 million newly insured" is a patent lie promoted by surrogates who the administration can disclaim at the end of the day. I think it is reasonable to double the Rand number... (allow ambiguity the benefit of a doubt). The UCA is still an unmitigated disaster, and not primarily because it failed, but because it dismantled some highly valuable health-care delivery infrastructure. (noel c. 4/1/2014)
quote:
With 317,000,000 Americans I'll predict 13,000,000 plus or minus 2,000,000 newly insured Americans. And that is only counting the number who got insurance this year, i.e. it excludes the 23-26 crowd who was already covered on their parents insurance. It also is excluding the large number who signed up yesterday. I am very comfortable with 11,000,000 as the lower bound for insured people as a result of the law. Yossarian22c 4/2/2014
quote:
There is only so long people can delay paying before their policy would be canceled. I'm sure there are plenty of people who will wait til the 11th hour to pay but I'm betting on most of them paying. So I don't think that failing to pay will put a significant dent <=500,000 in the numbers. Yossarian22c 4/2/2014
quote:
21 coverage rates among the uninsured will still have 40,000,000 uncovered RedVW on laptop 11/29/2013.
quote:
Greg: noel, of those who have not yet paid their first premiums, how many do you think won't pay? "...

noel c.: I believe that the only ones who will pay are those that find themselves in need of insurance at sometime within the next year. In that event, they will claim "a place in line", and Barry's current HHS secretary (probably not Sebelius), will be more than happy to "complete" their enrollment processing. noel c 4/2/2014

quote:
(responding to a premise that there would be substantial non-payment of premiums) Doctors will essentially be blackmailed into paying their own patients' health insurance premiums or risk being stuck with even larger expenses if those patients stop paying for their insurance. (Seneca 3/20/2014)
Gallup shows the percentage of respondents who were uninsured fell from 17.1% from around the time this thread started down to 12.9% by the end of December 2014 Gallup

Another study shows the level of uninsured was already down to 37.2 million as of September 2014 (link) and the 2015 sign-ups according to the calculations of Charles Gaba are 12 million through the exchanges in addition to the ~12 million through the Medicaid expansion that was part of the ACA, which also includes an 88% premium payment rate. link. And I cite Gaba's work not as just an edition of he said/she said, but because he goes into significant detail about all of his sources and the methodology used to verify information. And the results have been consistent with other analytically rigorous studies.

Here's the conclusion of a RAND study
quote:
Researchers estimate that from September 2013 to February 2015, 22.8 million Americans became newly insured and 5.9 million lost coverage, for a net of 16.9 million newly insured Americans.

Among those newly gaining coverage, 9.6 million people enrolled in employer-sponsored health plans, followed by Medicaid (6.5 million), the individual marketplaces (4.1 million), non-marketplace individual plans (1.2 million) and other insurance sources (1.5 million).

link

Totaling the current number of uninsured people in the US is actually a little complicated. A few measures track people who have lacked insurance the entire year, vs. other measurements that track whether people have insurance coverage as of the moment that they are surveyed. The Kaiser tally for the number of uninsured in 2013 was 41 million. link

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Seneca
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Where are the numbers for doctors accepting Medicaid and new Medicaid patients in there? I did not see them.
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Greg Davidson
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Seneca, you are right, I could not yet find a quality analysis of that prediction one way or the other. If you have some time, I'd appreciate if you took on that part of the search.
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Greg Davidson
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Political effects of Obamacare (and political support) - Part 8

Here was where I had my wrongest prediction.

quote:
When the dust settles, one of the interesting pieces of data is going to be how many people get insurance in states that tried to make this succeed vs. how many people get insurance in states where the elected leadership tried to make Obamacare fail. It's possible that some people will notice, and remember it was Democrats who tried to bring them health care, and Republicans who tried to stop it. ( Greg Davidson 4/2/2014)

quote:
If they hold both houses of Congress you better believe we are headed for another impasse (Seneca 4/29/2015)
quote:
noel c.: Implementation of ObamaCare is not popular, and there are some red state democrats who are not going to be rehired because of the presence of that "achievement" on their resume (noel c 3/26/2014).

Greg response: There may be some politicians for whom Obamacare is a negative, but there may also be some reverse cases as well (for example, people in West Virginia are seeing how ACA provisions help with treatment for Black Lung disease, the politics are not panning out as crisply as you might think)

quote:
2 advertisement for healthcare by third party groups closely associated with democrat interests will have increased dramatically. (RedVW on laptop 11/29/2013).
quote:
5. Carve outs/set asides for democrat leaning groups and industries will increase. Resulting in unions getting favorable tax and regulatory treatment. While industries with political alliances with Democrats such as GM or unionized teachers will see passes made on regulatory and tax application of self insured policies. (RedVW on laptop 11/29/2013)
quote:
6. Medicare and Medicaid annual funding will be further cut. (RedVW on laptop 11/29/2013)
quote:
7. States that took the Medicare Medicaid prebate funds will beg Washington to make federal direct funding permanent. (RedVW on laptop 11/29/2013).
quote:
I predict that as more people get onto medicaid and the problem gets more attention that the government will increase the medicaid/medicare reimbursement rate. (Yossarian22c 5/5/2014)
quote:
And Republicans will still be benghazi'ing some weird aspect of Obamacare that motivates their base but that the majority of Americans just don't care about. (Greg Davidson 11/28/2013)
This language is also slightly ambiguous. As of May 2015, I’d say that the basis of the King v. Burwell case constitutes a weird Benghazi-like argument that motivates the Republican base but the majority of Americans don’t care about, and thus I would call this prediction as true, but “benghazi’ing” is not a precisely defined term, and “weird” is a judgmental term, so I don’t have a basis for convincing anyone who disagrees
quote:
Political support for Obamacare
The number is inherent in my prediction. "More unpopular then ever"= Whatever was maximum % of Americans with an "unfavorable" view of Obamacare, at any time, will be eclipsed by the % of Americans with an "unfavorable" view of Obamacare, on 1 May, 2015, 1200 hrs zulu time. (Grant 4/19/2014)

The Kaiser Family Foundation poll showed Obamacare with its highest level of favorability as of April 2015 link

quote:
Polling will indicate that more Americans will favor continuing the law than repealing it. (Greg Davidson 11/28/2013)
Recent Kaiser Family Fund polling indicates favorability continues to increase. 46 percent combined say either improve it (24 percent) or leave it alone (22 percent) versus 41 percent who want it scaled back (12 percent) or repealed (29 percent) link

The wording of my prediction is not iron-clad here – while my intent was to count those who wanted to keep Obamacare in some form as compared to those who want to repeal it, it is possible to read my words and say 29% want to repeal and only 22% want to leave it the same. The outcome as of May 2015 is as I believed it would be, but my words can’t rule out an opposite interpretation

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Greg Davidson
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Hacking and a few other predictions - Part 9

quote:
So another prediction is that there will be serious talk about salary caps for insurance executives and broad support from Americans especially if the insurance companies get a bailout but even if they don’t because why should we be forced by law to pay for some big wig insurance company executive’s multimillion dollar salary? (Cherrypoptart 11/28/2013)
quote:
Emergency room access will increase as the primary access point.
Unclear – there’s a slew of articles in early May 2015 that assert an increase, but when you dig through multiple layers it turns out that the data comes from an email solicitation for ER doctors to respond in a survey with no attempt to ensure the 9.1% of those who responded are representative of all ER doctors or that their estimates are accurate) link

quote:
web portal will still be scaling badly despite now being hosted by HP enterprise division (RedVW on a Laptop 11/28/2013)
quote:
Security concerns will improve to a “d” level – hard to measure what “d” level security literally means, there have been no significant security breaches that I am aware of (RedVW on a Laptop 11/28/2013)
quote:
healthcare.gov will be hacked (if it hasn’t been already) and the personal information of most, if not all (G3 12/3/2014)
quote:
My next prediction, the hacking will be covered up and not reported. It will come out as some type of leak (G3 12/3/2014)

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Greg Davidson
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Reasonable questions where we don't yet have data or information to answer- Part 10

quote:
The most likely result even if you sign everyone up on the new plans is not millions of people receiving better health care. The deductibles and costs on these plans mean for practical purposes those who could not afford plans in the old model are still not going to be flocking to doctors, and when they do it’ll largely be paid out of pocket. Plus they’ll have less money in pocket because of higher premiums, which even for those receiving subsidies will be a concern if they ever increase their income and exist from subsidies. (Seriati 12/26/2013)
quote:
I predict that if you get the fully loaded expenditures, federal, state, and private on healthcare you won’t see a decline in costs or savings, absent a reduction in quality of care (personally, I think we’ll end up with both a higher cost and a reduction in care) (Seriati 12/26/2013)
quote:
4. Small business will still be unable to utilize portal for employee insurance. (RedVW on laptop 11/29/2013).
quote:
8. Medical device manufacturing will see continued offshore flight. (RedVW on laptop 11/29/2013).
quote:
15. Fraudulent or non paid healthcare access by illegal aliens will show no change. (RedVW on laptop 11/29/2013).
quote:
16. Doctor shortages will speed up and calls for H1B visa carve outs will be required . (RedVW on laptop 11/29/2013).
quote:
17. New classification of nurses created with far less training compared to RN or PA levels, yet wil have pharmacy rights. (RedVW on laptop 11/29/2013).
quote:
18. Wait times to see primary care physician for scheduled appointments will increase by three days and actual examination time will drop by four minutes. (RedVW on laptop 11/29/2013).
quote:
19. Physician consultation time will decrease by 4%.(RedVW on laptop 11/29/2013).
quote:
20. Medicaid and Medicare acceptance rates for new patients will decline 1%. Payouts on reimbursements will suffer a real decline of coverage by 1%.(RedVW on laptop 11/29/2013).
quote:
22. Private insurance with private closed health systems will see an increase in market share of 3%. Trend towards concierge doctor access for wealthy individuals increase. (RedVW on laptop 11/29/2013).
quote:
24. Co-pays increase 4% on average. (RedVW on laptop 11/29/2013).
quote:
25. Deductibles increase 2% on average. (RedVW on laptop 11/29/2013).
quote:
26. Bed access and availibility issues force delays in elective surgery. (RedVW on laptop 11/29/2013).
quote:
27. Pharmaceutical spectrum of available and approved by insurer drugs will shrink for most people. Out of pocket costs to individuals will increase as wellness programs are dropped for fiscal reasons.
quote:
31. Health outcome and care issues either show slowed improvement, or a cessation of improvement. (RedVW on laptop 11/29/2013).
quote:
32. Life expectancies slow. (RedVW on laptop 11/29/2013).
quote:
33. Infant mortality increases. (RedVW on laptop 11/29/2013).
quote:
34. Prescription rate per capita increases. (RedVW on laptop 11/29/2013).
quote:
35. Surgery hours increase while surgerys per capita decrease. (RedVW on laptop 11/29/2013).
quote:
36. Recovery days will be reduced. (RedVW on laptop 11/29/2013).
quote:
38. Healthcare as a component of GNP will increase 1%. (RedVW on laptop 11/29/2013).

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Greg Davidson
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Easy true statements - Part 11

Either no one disagreed with these, or the claim was made in a way that is virtually inarguable (for example, "IRS will accept fraudulent self reporting" - since a single instance proves the point, and since our whole tax system relies in a number of ways on self-reporting, it's a sure thing as predicted)

quote:
Obamacare remains the law of the land (Greg Davidson 11/28/2013)
quote:
Obamacare remains the law (RedVW on a laptop 11/28/2013)
quote:
Rich people will see higher taxes (G3 12/03/2013).
True – some taxes increased
quote:
Some young professionals will see a big increases in their premiums (G3 12/03/2013).
quote:
Insufficient subsidies combined with a bad employer mandate could leave some people in a no man’s land where they can’t really afford insurance but are forced to pay the individual mandate (G3 12/03/2013)..
True – given a broad and diverse marketplace for insurance and the important caveat “some”.
quote:
The Cadillac tax will also cause people with good insurance to see their benefits cut and deductibles increased (G3 12/03/2013)..
Again with the wording – if the intent is to describe what happens to “some” people it is very likely to be true, but unclear how significant a fraction that is
quote:
37. Healthcare as a budget outlay at the federal level will increase 3% (RedVW on laptop 11/29/2013).
Probably true, but I suspect this is true as healthcare costs have been rising 5%-10% for decades so 3% is quite reasonable as a prediction
quote:
13. IRS will accept fraudulent self reporting. (RedVW on laptop 11/29/2013).
Whew, got everything posted before midnight of the last day of May, 2015.

I'll follow with some additional thoughts. Any comments from anyone else? Either about the specifics, or the nature of this exercise?

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Seriati
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quote:
Originally posted by Greg Davidson:
It could go either way. Normally, when you attempt to get more output out of a system (as in more health care services to people), it requires an increase in inputs. That is consistent with your position, and it is a very reasonable one. I have some optimism we might cut the rate of cost growth compared to the status quo with this particular system (American health care) because we are starting out from an unusually inefficient equilibrium (the US spends twice as much per patient as the next most expensive country and considerably more that twice as much as the average for developed economies that achieve similar or better health care results).

You have looked back on what I wrote, so you know, I've never disagreed that we could control the rate of cost growth, but I was very specific about what that would in fact entail.

Specifically, the government can reduce what it pays for the services (which is price suppression, and doesn't actually impact costs) or we can receive a lower quality of service than we had previously. The only other option to achieve the result is for the system to operate with greater efficiency. There is no example, that I'm aware of, where increased government involvement has lead to greater efficiency.
quote:
On the other hand, we still retain our reliance on a for-profit healthcare model, and maybe that will wind up dominating the outcome.
Oddly, this would be the one thing that could save Obamacare's cost problem.

In the end, I suspect we get more people treated, at an enormously higher overall cost but we have trumpeted at us partial cost figures heavily influenced by price citations (ie premiums and/or government payment reductions) and still end up with worse overall care.

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TomDavidson
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quote:
I suspect we get more people treated, at an enormously higher overall cost but we have trumpeted at us partial cost figures heavily influenced by price citations (ie premiums and/or government payment reductions) and still end up with worse overall care.
When you get a chance, let's talk about what metrics you're going to use to measure the quality of care. [Smile]
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Seriati
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Totally fair question. Baseline metrics to me have to do with access level and availability of treatments.
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Greg Davidson
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I'd also say that mortality statistics and people's perceptions regarding the quality of their care in one time period as compared to responses to the same question in another time.

Sorry I haven't been participating more - work has been on overload. I have more to say on this whole exercise, but it will have to wait until there is time.

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Seriati
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quote:
Originally posted by Greg Davidson:
I'd also say that mortality statistics and people's perceptions regarding the quality of their care in one time period as compared to responses to the same question in another time.

I would disagree with those metrics. Perception regarding quality is too easy to manipulate, and mortality is too swayed by the inclusion or exclusion of people from the pool (I'd suspect by the way that mortality would increase for Obamacare b/c of the increase in coverage).
quote:
Sorry I haven't been participating more - work has been on overload. I have more to say on this whole exercise, but it will have to wait until there is time.
I know the feeling.
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Greg Davidson
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quote:
There is no example, that I'm aware of, where increased government involvement has lead to greater efficiency.
How about the legal system? Contract enforcement? Roads? Public schools? There's a whole class of scenarios in which government sets a standard of some kind which can be more efficient than free market actions. There are also counter-examples, and I would even agree that in the majority of cases government actions reduce rather than increase economic efficiency, but if you are aware of no examples, you really should examine the matter more thoroughly.
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Seriati
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Look I love the law Greg, but are you really arguing that years for satisfaction is an exercise in efficiency? Honestly, do you know anyone who was satisfied with the speed of a legal remedy? If someone breaches a contract how long till you get a remedy?

Roads? Which gets built faster a public road or a toll road?

I love the public schools, but you could relabel them as union job factories and not be too far from the truth.

You're not making an argument for actual efficient. You're making an argument for the only real solution.

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TomDavidson
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quote:
I love the public schools, but you could relabel them as union job factories and not be too far from the truth.
I'm curious what sort of "efficiency" you think a school should have, precisely. What is the best measure of an "efficient" school? The idea that a school is a "job factory" is remarkable to me, especially when compared to, say, the financial services industry, which is only "efficient" insofar as it encourages predation. But in that sense, efficiency is hardly virtuous.

quote:
Baseline metrics to me have to do with access level and availability of treatments.
No. Access to care and availability of treatment is actually one of the great flaws in the American system, which throws expensive treatments at people without any indicator of actual value. Frequent check-up visits with a regular doctor, for example, are very effective at addressing many long-term health problems, but our culture of care and our insurance plans tend to reward expensive procedures following a health crisis instead of brief, regular preventative visits. I think looking at healthcare outcomes as a function of total cost and population is really the only metric that makes sense.
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Seriati
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quote:
Originally posted by TomDavidson:
quote:
Baseline metrics to me have to do with access level and availability of treatments.
No. Access to care and availability of treatment is actually one of the great flaws in the American system, which throws expensive treatments at people without any indicator of actual value. Frequent check-up visits with a regular doctor, for example, are very effective at addressing many long-term health problems, but our culture of care and our insurance plans tend to reward expensive procedures following a health crisis instead of brief, regular preventative visits.
It's always interesting to me when someone starts by rejecting something and then proceeds to provide an example of the rejected item. Frequent check-up visits is a measure of access level.

And my measure with respect to the availability of treatments has no connection with your concern about the abuse of certain treatments. In fact the abuse of certain treatments is almost completely the result of current government interference in health policy. It's a combination of broken compensation models that incentivize over testing by paying for it better, and an overly litigious overall health practice that forces defensive medicine practices.

In any event, the measure I proposed is whether treatments are available when medically called for, not when not justified (and yes that's mushy, this IS medicine and individual patient needs have to govern within reason). It is in fact a common failing of socialized medicine that treatments, particularly expensive ones, are not available when medically called for.
quote:
I think looking at healthcare outcomes as a function of total cost and population is really the only metric that makes sense.
I do think a measure of outcome quality makes sense.

We do need to be aware that any of these measures are manipulable though. One only has to look at the VA's records about wait times, and how they were manipulated by not entering patients into the system in a timely way to see the dangers here.

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Greg Davidson
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quote:
Greg, but are you really arguing that years for satisfaction is an exercise in efficiency? Honestly, do you know anyone who was satisfied with the speed of a legal remedy? If someone breaches a contract how long till you get a remedy?

Roads? Which gets built faster a public road or a toll road?

I love the public schools, but you could relabel them as union job factories and not be too far from the truth.

My points were a bit more basic - people may not be pleased with the average speed of a legal remedy, but imagine there is no government at all and then attempt to get redress for a wrong. Look at the efficiency of building roads in a hypothetical universe where there had never been a government to build the first 99.9%+ of a road system that your toll-road plugs into.

Again, all I was doing is questioning your claim that you had never seen government be more efficient than the private sector - it is the extremity of the claim of "never" I am questioning, not the general trend.

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NobleHunter
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quote:
It is in fact a common failing of socialized medicine that treatments, particularly expensive ones, are not available when medically called for.
The reverse is that in private systems treatments, particularly expensive ones, are inaccessible when medically called for. While they can become available in socialized system whether by waiting list (problematic) or by prioritization (better but still problematic), the more straightforward means of improving accessibility will just run into the availability problem anyways. So why not just skip the accessibility problem? I mean aside from philosophy of government stuff.
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TomDavidson
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quote:
Frequent check-up visits is a measure of access level.
Not in the way it's usually meant when people talk about "access." Most other countries do frequent wellness visits with nurses or corner clinics, which provides an equivalent quality of care for much cheaper. America's one of the few countries that expects a MD for a checkup.
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Greg Davidson
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Change of pace here - how do people feel about the predictions that they made (or about the ones that you saw being made)? Again, it's been a very late night for me in meetings etc. so I haven't gone through the full analysis, but there seem to be some consistent trends in the predictions.

How many people were surprised? Does anyone have any different thoughts about the effectiveness of Obamacare as a policy in light of how things have progressed in the 18 months since the initial predictions that many of us made?

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Greg Davidson
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I want to note with appreciation the people who acknowledged at least one prediction they made that did not come out as they had expected: Grant, Yossarian22c, D.W. and Seriati. I did so as well (and please forgive me if I missed a name and/or prediction; there were a lot of pages to go through!).

We have not yet heard an acknowledgement of errors in predictions from G3, Cherrypoptart, noel c., RedVW on a laptop, or Seneca. In all but one case, this may be because they just haven't visited Ornery or seen this thread in the last week or two. However, based on comments made, we do know that Seneca has seen the results part of this thread. In addition to his silence on his predictions, I found this passage particularly noteworthy:

quote:
Tell us what you are willing to agree can't have been known by this time due to Obama's delays. I'd prefer to find out if you are unwilling to acknowledge that before I put time into this. (Seneca 5/29/2015, italics mine)
I did then answer that specific question, but I also found I agreed with his concern (about putting in a lot of time when others in the discussion will be unwilling to acknowledge where they may have been wrong).
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Greg Davidson
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Another aspect of this exercise that I have been thinking about is the power of time. I am curious about how dialog and persuasion function in on-line debates. I believe that the lack of face-to-face human contact eliminates some impedances on extremist or intolerant communication. I believe that anonymity has a mix of positives and negatives (it may free some who have legitimate concerns about the implications of speaking their mind under their own name, but it also further removes personal accountability from what a person communicates).

Time is an interesting additional dimension to this conversation that I had not previously considered. I not only just finished this exercise on Ornery, but also after 5 years I sent back a correspondence from 2010 with one of the smartest men I know (more left-wing than right-wing) who had written sincerely about an apocalyptic scenario of running out of oil, environmental catastrophe, debt collapse, gold standard survivalism destroying the world in less than 20 years.

I wonder if the use of expanded timelines in these discussions can get us ultimately closer to a meeting ofthe minds. On-line debates lack direct interpersonal contact, but they do have the virtue of recording in time the entire transcript of discussion. By directing the discussion to embed belief systems into predictions, we elicit more truth in two ways.

(1) Framing the expression of ideas as predictions seemed to have a limiting influence on at least some of us. I found that there were fewer really extreme statements made when we were focusing on something that would be demonstrated within a finite timeframe.

(2) After-the-fact reflection on predictions may either shed light on any preconceptions that led to errant predictions, or it may reveal an unwillingness for self-examination even after the real world refuses to fit into a preconceived model.

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Greg Davidson
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Speaking of thoroughly debunked assertions that have never been acknowledged as false by those who spouted them:
quote:
Medicare to Pay Doctors for End-of-Life Counseling; Idea Sparked 'Death Panels'Uproar
link
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Greg Davidson
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Oh, and the uninsured rate is down to 11.4% according to Gallup

link

Now why was it that there was such an intensity of posting on this topic a year ago, while so little now?

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stilesbn
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Everyone is suffocating in smug.
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JoshCrow
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It's no fun to be proven wrong, but the wise at least try to make it an educational moment.

I am appreciative of Greg's efforts here and I hope to see more threads like it. It is easy to have convictions, hard to have the courage to back them up, and far harder to have the humility to change them.

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Seriati
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quote:
Originally posted by NobleHunter:
quote:
It is in fact a common failing of socialized medicine that treatments, particularly expensive ones, are not available when medically called for.
The reverse is that in private systems treatments, particularly expensive ones, are inaccessible when medically called for. While they can become available in socialized system whether by waiting list (problematic) or by prioritization (better but still problematic), the more straightforward means of improving accessibility will just run into the availability problem anyways. So why not just skip the accessibility problem? I mean aside from philosophy of government stuff.
Because what you stated is not an accurate summation of the difference. Private treatment systems have a history of bringing the price down on treatments that are medically too expensive initially over time. That's fundamentally different from the socialist default. The risk with capitalist systems is of overallocation of resources to expensive process not of underallocation. Any expensive and thus profitable treatment will always become more available overtime in the private system, and only might do so in the socialist system.

Of course the inverse can be true as well, with socialist systems widely distributing less profitable/expensive treatments that the private system ignores.
quote:
Originally posted by TomDavidson:
quote:
Frequent check-up visits is a measure of access level.
Not in the way it's usually meant when people talk about "access."
I can't help it if you want to argue about illogical thought.
quote:
Most other countries do frequent wellness visits with nurses or corner clinics, which provides an equivalent quality of care for much cheaper. America's one of the few countries that expects a MD for a checkup.
Which is fair enough, but it goes directly to the original claim I made that the quality level would have to reduce or the price increase. I'm not going to debate it again, but there is no real question that check-ups with doctors are superior, there's only a reasonable question about whether they are enough superior to justify the cost.
quote:
Originally posted by GregDavidson:
Change of pace here - how do people feel about the predictions that they made (or about the ones that you saw being made)?

I still think it was silly for anyone to make specific predictions other than as a lark.
quote:
How many people were surprised? Does anyone have any different thoughts about the effectiveness of Obamacare as a policy in light of how things have progressed in the 18 months since the initial predictions that many of us made?
Not surprised. The only surprising thing to me was the level of unconcern as the timing of the implementation was deliberately manipulated.

Nothing so far has changed my view that this policy is going to cost way more than advertised (both in real cost, but also in price); that it fundamentally reduces our civil rights that we can now be forced to buy commercial products; and that ultimately its going to lower treatment levels. I think it's also evident that the medical record consolidation requirements expose health records to real risks of misappropriation and misuse.

It's also shown (not alone grant you) that we need a new process for the approval of regulations. Congresses role in passing and implementing law has been completely subverted by expansionist regulatory actions by unelected bureaucrats. Basically, Congress is now barred from setting the terms of our laws, unless they can get a supra-majority and either override the President or get executive consent. In such a circumstance it was intended there would be no law, not that a bureaucrat could implement whatever the courts don't prevent them from doing.

I think no regulation should become valid, unless it receives an affirmative vote in Congress, but I don't mind them doing it in bulk if they choose.
quote:
Oh, and the uninsured rate is down to 11.4% according to Gallup
You might ask in a country where it's a violation to not have insurance its still that high.
quote:
Now why was it that there was such an intensity of posting on this topic a year ago, while so little now?
No one listens anymore. The sides are set and no longer convincible. So what is there to be intense about?

I mean honestly, we're reading some of the same reports, but you're concluding the half empty glass proves the law is working, and I'm concluding it's a demonstration of it failing. And everyone is being intentionally manipulated by misleading statistics, which makes it trivially easy to "validate" your own beliefs and thereafter to ignore contrary evidence.

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Greg Davidson
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Welcome back Noel C,

While you were gone, we took a comprehensive look at the predictions we all made on Obamacare. Care to see how accurate your predictions were? More importantly, will you change your world view in any way to address the significant differences between what you thought would happen and what did happen?

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noel c.
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Please quote my prediction.
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noel c.
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Ah, I see that you listed a few at the top of this page.

This is the year we begin to see the IRS lay into non-participating tax payers in a serious way. "General satisfaction" levels should begin coming in at that point, along with the increases in premium, or reduction in services, under employment plans.

I can speak anecdotally on the latter. A liberal friend was utterly exasperated by his increased coverage costs, and wished he had signed up under Utah's exchange. He raved that an unemployed acquaintance paid only $30/month for far better coverage. Like most liberals he seems to believe lunches are free.

Last year I personally had $58,000 worth of knee, and shoulder surgery that I have put off for more than 30 years. For me, Obama care was the supreme motivator as I hate hospitals, knives, and needles. It took a piece of legislation like the UCA to persuade me to finally bite the bullet before my health care became more "affordable".

I am glad I did. It is surprising how accustomed to low grade pain we can become. I give Barry credit for that.

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Greg Davidson
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Noel, if you look at May 26 you can see my first of ten posts regarding the 700 pages of material in this thread. Using a common standard for what is a prediction, you made 7 predictions and were wrong on 6 (all about how Obamacare would function), I judged your political prediction that Obamacare would hurt red state democrats to be true.

But you were clearly wrong about how it worked. Do you ever ask yourself if your worldview is true, why did things turn out so vastly differently from your predictions?

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noel c.
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Greg,

"It", whatever it may ultimately be, has not been fully implemented. Justice Roberts only recently cleared the path for comprehensive federal subsidy.

Now the show begins, and "it" will not proceed unapposed, or unmodified as has been the pattern since its inglorious christening under Sabellius. "It" came into being through non-bipartisan maneuvering, but it will likely die a death of a thousand cuts through bi-partisan action beginning with the medical device tax. :

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/52274

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Greg Davidson
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Noel, I asked very specifically for predictions as of a finite time (May 2015). You offered your predictions with what appeared to be a great deal of certainty. For example, you scoffed at government reporting and asserted only an additional 2-3 million people would be covered. You were wrong.

Have you learned anything that will make your analyses and predictions more accurate in the future, or is your position and worldview independent of what actually happens in the real world?

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noel c.
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"For example, you scoffed at government reporting and asserted only an additional 2-3 million people would be covered. You were wrong. "...

I still scoff at government reporting, and the nature of paid "coverage". Show me evidence of added efficiency. If you cannot, this is just another liberal give-away destined to collide with economic reality... unless, of course, your opinion is "independent of" economic reality.

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Greg Davidson
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Noel, it appears that your ideology blinds you so much that you cannot even recognize or acknowledge that you made wildy wrong claims. Do the other arguments you make similarly suffer from an inability to recognize or acknowledge error?

And you errors are not just an assertion on my part - they are clearly documented in your own words:

quote:
there is a net zero gain in people covered by "private" insurance when those being kicked off of their plans are factored in, and roughly 1\3 of new UCA "enrollees" have been placed on the Medicaid roll. (noel c 3/26/2014)

quote:
Barry's enrollment count is encrypted buy their own incompetence (unless they are simply lying), but actual enrollment is a net negative at best if unpaid policies, and termination of private policies are factored in. Medicaid accounts for nearly 1/3 of the "six million" number.(Noel c. 3/29/2014)
quote:
Kathleen Sabelius claims that she does not know what the actual enrollment numbers are, nor does she know who how many included in her estimate have paid their first premium. I don't really believe her (given the veracity of her past reports to congress, why should we?), but why are you confident in your sources numbers? They look thoroughly cooked to me, by at least a factor of five. (noel c 3/29/2014)
quote:
Noel c.: Of the 48 million total uninsured that the UCA was supposed to take a chunk out of, I suspect we will still end up with 45-46 million uninsured as of the close of enrollment... (noel c. 4/1/2014)
Greg: Excellent - thank you for your prediction. We shall document either your victorious prognostication, or your significant level of error

quote:
By the time all individuals who had existing health care coverage are factored in, it is quite possible "2 million" will be the correct number. This ridiculous "20 million newly insured" is a patent lie promoted by surrogates who the administration can disclaim at the end of the day. I think it is reasonable to double the Rand number... (allow ambiguity the benefit of a doubt). The UCA is still an unmitigated disaster, and not primarily because it failed, but because it dismantled some highly valuable health-care delivery infrastructure. (noel c. 4/1/2014)

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Greg Davidson
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The latest Kaiser Family Foundation indicates that average 2016 Obamacare premium increases were 3.1% (in 13 major cities in different states where all premium information was available)

link

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Rafi
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Here's one to check

quote:
"We will start," Obama said back in 2008, "by reducing premiums by as much as $2,500 per family."
The result:
quote:
Since 2008, average family premiums have climbed a total of $4,865.
[Exploding]
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D.W.
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But Rafi, he did say "by as much as" not "on average". [Wink] As long as SOME family got that reduction, he was spot on...
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Wayward Son
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Besides, based on history, what would have been the average premium rise in the last 7 years (since 2008)?

$7,365? [Smile]

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