Posts I liked this year:
A small minority of people drive the vast majority of costs and utilizations. Conversely, most people are minimal users of healthcare services in any given year. This means there are two very distinct strategies that should promote good outcomes.
Under my plan, the Medicaid beneficiary would receive a bonus check for a good choice. The check would be a portion of the difference between the bundled reference price and the regional average price
Deductible plans favor the sickest people as the low utilizers pay for almost all of their care via deductible cash. That means a comparatively high proportion of the pool’s individual responsibility amount is borne by healthy people.
the desire to use Medicare as the basic structure of a national single payer system as it is a pre-exisiting program whose skeleton is strong enough to build on. However that skeleton has some odd deformities to it, and a lot of trade-offs have been built into Medicare that would need to be re-examined if we were to massively expand Medicare’s scope…. as Medicare E is not a matter of simply printing up new ID cards and mailing them to everyone in the country with a start date three months from the mail date
If the Finance and Accounting folks want Mayhew Insurance to increase profit margins by $5 PMPM (which is a massive increase for an increasingly low margin business), premium price increases are a low priority solution because they have significant costs. Instead we’ll see if we can craft a special narrow network which will be very attractive to people with very low utilization but we can charge a couple of extra bucks PMPM while still holding our relative Silver position, we’ll see if we can reduce mail expenses again by a dime PMPM, we’ll see if switching our preferred Hep-C cure to Harvoni instead of Solvadi reduces costs by a quarter PMPM, we’ll see if we really need a VP for Employee Morale (hookers and blow section),
If we assume that the net federal spend per person who is Medicaid eligible is roughly the same plus or minus a reasonable amount, the net economic loss to a rejection state is “only” the amount of Medicaid spending that is available to cover people who make under 100% FPL as well as those people over 100% FPL but under 138% who would have signed up for Medicaid but did not sign up nor continue to pay their premiums for an Exchange policy.
That number is significantly smaller than Brad Delong’s .7% GDP, probably closer to 0.5% GDP.
A wonky post on how provider networks are built
a symptom of the extremely dysfunctional nature of the individual insurance market before PPACA. It was a vampire that drank blood in quarts and very rarely paid benefits as it specialized in very high deductible policies with significant coverage limitations and short term contracts. The old business model was based on churn, it was based on cherry picking, and it was based on very low medical expense ratios
A summary of an NBER paper examining care costs after a switch to an HDHP. There were no big explosions of costs three years out. This is making rethink HDHP to some degree.
Currently, CSR is only attached to Silver plans. What if states decided to change their subsidy attachment point as part of the Wyden Waiver?
If a state decided to look at the total cost of providing the second lowest Silver in determining subsidy levels instead of just looking at the second lowest premium for Silver, average actuarial value would increase as choice space increases. The change in subsidy formula would be the sum of premium plus CSR subsidy cost minus the individual contribution = subsidy.
On the health insurance side, margins are already fairly low, and there is some fat left to cut, but not much. On the provider side of the equation, there is plenty of fat left to cut on the basis of international comparisons. The major areas where the Democratic Party can get a lot of money out of the US healthcare system is on high end provider payments, drug costs and hospital payments while also expanding the lower levels of basic but very valuable care. Right now the US health system has numerous guilds and other anti-competetive practices in place which protect small, concentrated and powerful groups’ incomes while screwing the broader society by ringing up much higher healthcare costs without delivering amazing value in return.