Monday Links

Posted on by John C. Goodman

AI is better than Dear Abby. HT: Tyler

Commonwealth Fund:  having insurance doesn’t mean health care is affordable. Missing: the observation that Obamacare has made the problem worse.

The meaning of the Cigna settlement with the government: Medicare Advantage plans should be held accountable for submitting accurate risk adjustment data.

Which is better: for-profit or nonprofit? All the evidence, much of which Effective Altruists helped to compile, shows that nonprofits are much more likely to be fraudulent, or to simply fail to achieve their goals. 

Stanford University neurobiologist Robert Sapolsky makes two claims: one possibly true (there is no free will) and one very wrong (it is unfair to reward good behavior and punish bad behavior). The first claim is irrelevant because we experience the world as though we have free will, and we have no alternative to that. And, the reason to reward good behavior and punish bad behavior is the utilitarian desire to get more of the former and less of the latter.

[This is also an example of the fallacy of the stolen concept. If you claim there is no good or bad behavior because there is no free will, you can’t turn around and use ethics to condemn the rewarding and the punishing.]

3 thoughts on “Monday Links”

  1. The Commonwealth Fund doesn’t seem to distinguish between out-of-pocket issues arising from high cost versus less-comprehensive coverage relative to non-US countries. Although I’m sure it’s both; the former is a contributor to the latter, after all.

    Reply

  2. I don’t see the connection between cost-access problems and Obamacare, as Dr. Goodman’s byline suggests.

    Obamacare recipients under 200% of poverty have in general never had it so good.
    The cost-sharing-reductions bring their deductibles down to about $750 in many cases, even $0 in some situations. Even the more expensive Obamacare plans sometimes include three free office visits or nominal fees for primary care.

    There are people who delay getting a $1200 dental procedure because they just don’t have $1200 — even if they have perfectly adequate insurance for everything else. Commonwealth does not catch this at all.

    There was a bloc of people who clearly did not benefit from Obamacare. Generally they were middle class or above, and had inexpensive insurance because they were healthy and willing to take a few risks. Dr. Goodman and other conservatives tend to pull out this group at every opportunity, which they have the right to do.

    But it ain’t the whole story.

    Reply

  3. Bob, I read Goodman’s intro sentence as referring to the medical cost problem in the U.S. Obamacare has not solved that problem. Evidence is the continuing substantial yearly growth in total U.S. per capita medical costs, which accelerated after Obamacare took full effect in 2014:

    https://www.statista.com/statistics/184955/us-national-health-expenditures-per-capita-since-1960/

    I wonder if you’re reading the sentence in terms of the reduced net premium cost to participants – after the very substantial federal subsidies for ACA. Here is how CBO measured the subsidies for 2022, and forecasts their increase for 2023

    https://www.cbo.gov/publication/57962

    So it seems to me there is no disconnect in Goodman’s comment. ACA has managed to hold down net premium to participants only because of the massive taxpayer subsidy of the program cost. Of course citing “premiums” is an insurance distraction.

    That’s because without subsidy, ACA premiums would be much higher and rising. And that’s because the underlying medical costs are high, and rising. The problem of medical costs simply cannot be solved by some insurance scheme (I.e., subsidizing the cost for some, by making others pony up subsidies). That is why Obamacare has not and cannot solve the medical cost problem. Sooner or later this unpleasant fact will become clear to the taxpayers.

    Then what?

    Reply

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