Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[Larry]

Since the introduction of ACA, the rate at which healthcare spending (so that includes deductables) is increasing has also declined (though how much of that is due to the ACA is unclear).

I've seen the theory (perhaps by you) that it's possible that healthcare spending is down, (well, more accurately, "not increasing as fast as it was") primarily because the economy went south.

Makes sense, to me. Healthcare certainly isn't the most elastic commodity in the economy but nothing is completely inelastic.

 

----------

 

I figure that a lot of things that have happened, since Obama took over, have been driven more by the economy than by Obama. 

 

(Mainly because I can't really see that Obama has accomplished much that could have affected many things.) 

Edited October 30, 2014 by Larry

[PeterMP]

I've seen the theory (perhaps by you) that it's possible that healthcare spending is down, (well, more accurately, "not increasing as fast as it was") primarily because the economy went south.

Makes sense, to me. Healthcare certainly isn't the most elastic commodity in the economy but nothing is completely inelastic.

 

The economic slow down is part of it and so is/was the patent cliff.

 

http://www.fiercepharma.com/story/big-pharmas-patent-cliff-losses-spawn-239b-savings-2013-drug-spending/2014-09-10

 

But a lot of people I read say the ACA is probably contributing some too.

Edited October 30, 2014 by PeterMP

[twa]

We're using less health care—but it's costing more

http://www.cnbc.com/id/102128108#.

 

 

 

wait, what?

[PeterMP]

We're using less health care—but it's costing more

http://www.cnbc.com/id/102128108#.

 

 

 

wait, what?

 

 

The healthcare we are using is costing more, but we are using less so real costs are going down (or at least the rate at which they are going up has declined).

 

Again, our costs have been going up faster than inflation for decades now.  That fact that the trend is continuing isn't surprising.

 

No more than it is surprising that health care premiums are still going up as they have been for decades now.

 

There's never been any doubt that one of the reasons our health care costs have been too large is because we use too much health care.

 

There's nobody that talks about reducing health care costs that doesn't at least partly doesn't talk about us using less health care.

 

**EDIT**

Here's a good story about over usage driving costs.

 

http://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum

 

It is older now, but it is a real eye opener.

Edited October 30, 2014 by PeterMP

[chipwhich]

Actually, I was going to ask you to support your claim that healthcare costs don't get computed into healthcare costs.

 

But you're perfectly correct.  I do not have the ability to prove that someone you haven't named is not either completely dishonest or an absolute idiot. 

 

Unfortunately I don't know how to "prove" it to you.  Why don't you stand by an opinion for once, put your flag the sand and stand up for something YOU believe in.  If you are claiming deductibles are included, you prove it.  I deal with health insurance year round, I don't know how to google the answer.

[twa]

is that short for we cannot afford ins and paying the dr?

[chipwhich]

2.  Since the introduction of ACA, the rate at which healthcare spending (so that includes deductables) is increasing has also declined (though how much of that is due to the ACA is unclear).  I actually made this point in my post so my post actually actually deal with all costs and not just deductibles and premiums, but all costs.

 

Got a link for that?  I know you made the point, but I haven't seen where it says anywhere.

[PeterMP]

Got a link for that?  I know you made the point, but I haven't seen where it says anywhere.

 

You mean other than the link I gave?

 

http://www.nytimes.com/interactive/2014/10/27/us/is-the-affordable-care-act-working.html?_r=0#/

 

"But it is hard to make a case that the Affordable Care Act deserves substantial credit for the recent trend — though it may be helping to nudge it along. The spending slowdown began before the law was even written. The major provisions of the law intended to slow down spending growth have mostly come in the form of small-scale experiments, and studies of those programs have shown mixed results."

 

"Health economists have been alternately celebrating the slowdown and puzzling over it. A series of studies have tried to examine what factors have caused it, with an eye to determining whether the trend is here to stay. The typical answer includes the recession (individuals and hospitals, facing financial stresses, reduced their health care spending); the rise of high-deductible health insurance plans;the loss of patent protection for many blockbuster drugs, leading to the use of more low-cost generics; and changes in the way medical care is being delivered."

 

"Optimists about the Affordable Care Act tend to point to hospital readmissions — when a patient leaves the hospital only to bounce back within a month — as an example of how policy is helping medical care become cheaper and better. Historically, hospitals had little financial incentive to prevent readmissions since they got paid for both visits. The Affordable Care Act began imposing penalties on hospitals with a lot of readmissions, and in just a few years the number declined. But readmissions represented only a tiny fraction of medical spending, so they cannot explain too much of the overall slowdown."

 

I'm not sure that the ACA has much of anything to do with the slow down, but maybe it is a part of it.

 

But if we can insure more people without affecting prices, is that a bad thing?

[chipwhich]

Where is the quote that says health care spending includes deductible costs paid by the patient?  I get reports from my health care provider, they do no reporting of my employees deductibles costs unless they exceed my high deductible plans and the insurance company needs to pay.

[Larry]

Why don't you stand by an opinion for once, put your flag the sand and stand up for something YOU believe in.

I believe that there are 22 posts, on this page, as I type this.

(Edit. Two posts were made, while I was typing).

I believe that 7 of them were by me.

And, while I'll certainly agree that what does or does not count as "an opinion" is probably rather subjective, I think I count six opinions I've stated, just on this page.

In fact, at least once, you've quoted me, and edited out some opinions I stated, so you could complain about something else.

I assume it's because you agree with all of them.

Edited October 30, 2014 by Larry

[chipwhich]

I assume it's because you agree with all of them.

 

Please provide the post number so I can agree or disagree with each item.

[PeterMP]

Where is the quote that says health care spending includes deductible costs paid by the patient?  I get reports from my health care provider, they do no reporting of my employees deductibles costs unless they exceed my high deductible plans and the insurance company needs to pay.

 

So you don't think health care costs include deductible costs by the patient?

 

http://www.healthcostinstitute.org/files/IB%209%2010-28-14.pdf

 

"Between 2012 and 2013, out-of-pocket ex-penditures per capita rose from $660 to $800 (Table 1).  This 4.0% increase was the lowest growth in the out-of-pocket spending during the study period."

[Wrong Direction]

Re: premiums - I'd expect some instability this year simply because Plans had to guess about their enrollment mix much more last year than this year. There's a lot more market reaction happening this year. This is part of the process of the market setting itself. 

 

Re: health spending - the rates supposedly include all money spent, including patient cost sharing. I'm not sure if I understand what issue you're debating, so I may be off on this point. If you're talking about overall health spending (Peter's links), I'm right. If you're talking about how ACA premiums are set, that's not true.

 

Generally, I expect this to be a year with a lot of changes just from the markets. I just saw a headline saying 200,000 doctors have opted out of the ACA. I have no idea if that number is credible, but this is the type of turmoil people can expect as everything shakes itself out. Provider networks will change. Drug formularies will change. Premiums will change. The non-political question is whether these changes affect satisfaction and cost enough to significantly disrupt the markets. If so, the bill could fall under its own weight (unlikely). If not, the markets will become more stable over the next 1-2 years. 

[chipwhich]

So you don't think health care costs include deductible costs by the patient?

 

http://www.healthcostinstitute.org/files/IB%209%2010-28-14.pdf

 

"Between 2012 and 2013, out-of-pocket ex-penditures per capita rose from $660 to $800 (Table 1).  This 4.0% increase was the lowest growth in the out-of-pocket spending during the study period."

 

No, I don't.  I have yet to see a government estimate, or report, or anything that covers anything but premiums.

 

Re: premiums - I'd expect some instability this year simply because Plans had to guess about their enrollment mix much more last year than this year. There's a lot more market reaction happening this year. This is part of the process of the market setting itself. 

 

Re: health spending - the rates supposedly include all money spent, including patient cost sharing. I'm not sure if I understand what issue you're debating, so I may be off on this point. If you're talking about overall health spending (Peter's links), I'm right. If you're talking about how ACA premiums are set, that's not true.

 

Generally, I expect this to be a year with a lot of changes just from the markets. I just saw a headline saying 200,000 doctors have opted out of the ACA. I have no idea if that number is credible, but this is the type of turmoil people can expect as everything shakes itself out. Provider networks will change. Drug formularies will change. Premiums will change. The non-political question is whether these changes affect satisfaction and cost enough to significantly disrupt the markets. If so, the bill could fall under its own weight (unlikely). If not, the markets will become more stable over the next 1-2 years. 

 

I am simply saying I haven't seen an unbiased report on spending that includes deductibles as a part of health care costs and applying that historically.  Typically the stats used are based on premiums.  If there is a historical report that compares costs to include premiums and deductibles, I have never seen one.  But if you have a link....

In my own company, my health care provider (Cigna) gives me extensive reports with regards to health care costs for my employees.  None of the reports include any information on bills paid by employees prior to hitting their deducitble.

[Wrong Direction]

 

No, I don't.  I have yet to see a government estimate, or report, or anything that covers anything but premiums.

 

 

I am simply saying I haven't seen an unbiased report on spending that includes deductibles as a part of health care costs and applying that historically.  Typically the stats used are based on premiums.  If there is a historical report that compares costs to include premiums and deductibles, I have never seen one.  But if you have a link....

In my own company, my health care provider (Cigna) gives me extensive reports with regards to health care costs for my employees.  None of the reports include any information on bills paid by employees prior to hitting their deducitble.

 

 

This is why I was confused about the discussion. As I understand it, there are two issues being discussed:

 

1. ACA premium changes

2. National Healthcare Expenditures

 

#1 is about premiums, often unweighted for enrollment, so potentially misleading. I think this is what you're referring to.

#2 is about total healthcare spending. This is ACA, Medicare, private insurance, etc. This includes patient cost sharing. I think this is what Peter's referring to. 

[PeterMP]

 

No, I don't.  I have yet to see a government estimate, or report, or anything that covers anything but premiums.

 

 

I just gave you a link to a report on out of pocket costs.

 

"Out-of-pocket expenditures are payments made by insureds directly to medical professionals, facilities, pharmacies, and other providers and suppliers, and are among the most visible health care costs to consumers"

 

from the same link.

This is why I was confused about the discussion. As I understand it, there are two issues being discussed:

 

1. ACA premium changes

2. National Healthcare Expenditures

 

#1 is about premiums, often unweighted for enrollment, so potentially misleading. I think this is what you're referring to.

#2 is about total healthcare spending. This is ACA, Medicare, private insurance, etc. This includes patient cost sharing. I think this is what Peter's referring to. 

 

I started by talking about premiums primarily.  chipwhich criticized that post because it was about premiums primarily so I started talking about total spending/costs.

Edited October 30, 2014 by PeterMP

[chipwhich]

Sorry, I will try and clarify.

I am trying to see a report that covers total health care expenditures for a historical perspective (as in every year for however long) which includes premiums, deductibles, and copays.

[Wrong Direction]

Sorry, I will try and clarify.

I am trying to see a report that covers total health care expenditures for a historical perspective (as in every year for however long) which includes premiums, deductibles, and copays.

 

That's the National Healthcare Expenditures report. 

[PeterMP]

I love when people say I've never seen X number as if they actually have ever bothered to look for it or even bother to read much of anything on the topic and the fact that they've never seen it has any significance at all.

[chipwhich]

I love when people say I've never seen X number as if they actually have ever bothered to look for it or even bother to read much of anything on the topic and the fact that they've never seen it has any significance at all.

 

Got a link?

 

I love when people refer to something they aren't willing to post.  Given that I have been buying health care insurance for a decade for my company and play with numbers to keep costs down, also given all the political nonsense that ignores all of the facts about total health care costs including deductibles and copays, etc. I don't think it's love.

 

 

That's the National Healthcare Expenditures report. 

 

Where do I get that.

[PeterMP]

Got a link?

 

I love when people refer to something they aren't willing to post.  Given that I have been buying health care insurance for a decade for my company and play with numbers to keep costs down, also given all the political nonsense that ignores all of the facts about total health care costs including deductibles and copays, etc. I don't think it's love.

 

 

 

Where do I get that.

 

The CMS reports, including the NHE report are the go to source for the information on health care spending in the US.

 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/index.html

 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

 

And are regularly cited in scholarly work about health care spending in the US and how to control it.

 

(They also do estimates into the future.)

Edited October 30, 2014 by PeterMP

[chipwhich]

The CMS reports, including the NHE report are the go to source for the information on health care spending in the US.

 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/index.html

 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

 

And are regularly cited in scholarly work about health care spending in the US and how to control it.

 

(They also do estimates into the future.)

 

Not trying to be difficult, really

 

I want to see a historical chart that covers all health care costs including premiums, deductibles, and copays and compare changes historically in health care spending.  There are a TON of these reports that show premium costs throughout history and how premiums increase, I haven't seen one that includes all costs from a historical perspective.

 

And BTW, those links don't have it....as far as I can tell.

Edited October 30, 2014 by chipwhich

[JMS]

The CMS reports, including the NHE report are the go to source for the information on health care spending in the US.

 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/index.html

 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

 

And are regularly cited in scholarly work about health care spending in the US and how to control it.

 

(They also do estimates into the future.)

Good links... the problem with the NHE historical links you published is the data only goes up to 2012 so it doesn't assist in a discussion of Obamacare.

[PeterMP]

 

Not trying to be difficult, really

 

I want to see a historical chart that covers all health care costs including premiums, deductibles, and copays and compare changes historically in health care spending.  There are a TON of these reports that show premium costs throughout history and how premiums increase, I haven't seen one that includes all costs from a historical perspective.

 

And BTW, those links don't have it....as far as I can tell.

 

 

The link at the NYT that I posted before includes a graph based on the CMS data.

 

The link includes a link to the zip file that includes an excel and a cvs file that includes all costs from 1960-2012, and then is broken down into categories, including out of pocket costs, insurance costs, and government costs.

 

Then it breaks it down further into other categories (e.g. hospital spending).

I've posted links that include analysis on total health care costs, and out of pocket costs in this thread.

 

In each cases, the rate at which costs are growing is decreasing.

 

If you have a significant question that is worth any discussion at this point in time, I don't see it.

[PeterMP]

Good links... the problem with the NHE historical links you published is the data only goes up to 2012 so it doesn't assist in a discussion of Obamacare.

 

Which is why I mentioned estimates into the future above.

 

They've done projections for 2013 based on available data, which you can also get and is related to the ACA.