KRUGMAN optimistic on even private based health insurance partial-reform

[yurbud]

Krugman says that even partial reform is popular, solves some problems, and increases public support for further refinement.

He mostly uses Massachusetts Romneycare as the model for his predictions, and says a public option would keep the companies honest, but one line really stuck craw: when he said Massachusetts is going to cut costs by reducing incentives for excessive care.

Why not control costs by regulating how much insurance companies can spend on overhead like profits, executive compensation, and those armies of phone operators who deny care?

Give them some modest multiple of what Medicare spends on overhead--Sen. Dianne Feinstein has proposed this. It ain't rocket science. Or better yet, cut that overhead even further by making them operate as non-profits like the post office.

The problem isn't that people are too stupid or reckless to buy insurance but that they are priced out of the market or that they correctly estimate that once you add up all the premiums and co-pays, they are better off taking their chances and paying for medical expenses out of pocket.

I don't want a system that leaves insurance companies in the driver's seat, forces us to be their customers, and let's them decide how much to charge us.

We should be legislating ways to castrate insurance companies not corralling their victims for serial rape.

And reform remains popular. Earlier this year, many conservatives, citing misleading poll results, claimed that public support for the Massachusetts reform had plunged. Newer, more careful polling paints a very different picture. The key finding: an overwhelming 79 percent of the public think the reform should be continued, while only 11 percent think it should be repealed.

Interestingly, another recent poll shows similar support among the state’s physicians: 75 percent want to continue the policies; only 7 percent want to see them reversed.

There are, of course, major problems remaining in Massachusetts. In particular, while employers are required to provide a minimum standard of coverage, in a number of cases this standard seems to be too low, with lower-income workers still unable to afford necessary care. And the Massachusetts plan hasn’t yet done anything significant to contain costs.

But just as reform advocates predicted, the move to more or less universal care seems to have helped prepare the ground for further reform, with a special state commission recommending changes in the payment system that could contain costs by reducing the incentives for excessive care. And it should be noted that Hawaii, which doesn’t have universal coverage but does have a long-standing employer mandate, has been far more successful than the rest of the nation at cost control.

http://www.nytimes.com/2009/10/26/opinion/26krugman.html">full text

[JohnWxy]

1. IF you stop "pre-existing conditions" as a condition for denying care this will

reduce some overhead because man-power spent researching patient records to find a "reason" to deny care will go away. But you have to have a public option to keep insurance companies from moving what once was an operating cost into fatter profits. The competing Public Option would be more effective at this than auditing insurance company books as businesses are brilliant at inflating costs to hide profits under new and different cost categories. But with the Public Option competing with the insurance they would be forced to remove these unnecessary costs to stay competitive.

Something Krugman may be referring to here is excessive diagnostic testing. In the last decade or so there are more doctors setting up their own diagnostic testing facilities and when they prescribe a test ... of course, the patient goes to his doctor's testing facilty. There has been a large growth in for-profit diagnostic clinics selling MRIs and other diagnostic tests to people.

Recommended.



The dramatic expansion in the number of MRI and CT scans since 1995 has not led to better health care or reduced mortality, a new national study has found.

Eric Haberichter, owner of Smart Choice MRI in West Milwaukee, said the greatest growth in scanning occurs when a group of doctors purchase the technology as a way to make extra money
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The most interesting thing about the findings is that demand is created after the supply is increased, said Paul Danao, vice president of business development for American Imaging Management (AIM), Chicago.

AIM is owned by WellPoint Inc.

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However, not all of the growth is clinically appropriate, Danao said.

“Physicians who own their own machines are four to seven times more likely to order tests as opposed to physicians who do not,” he said. “One reason is this is a profit-generating opportunity. Studies have shown about 30 percent of imaging done in the United States is unnecessary from a clinical prospective.”