Our path breaking insurance companies

Looks like I got a check in the mail and didn't even notice it. Good thing, because I'd be in real trouble now.

Annals of Derp: The Infinite-Deductible Plan

Updated in tribute to the late Kenneth Arrow

Image from 25 Cognitive Biases.

Shorter Bret Stephens, "A Price for the G.O.P.'s Health Care Insanity", June 30 2017:

A colonoscopy will cost you $372 in Australia and $3,059 in the US, so obviously the problem in America is insurance, as Kenneth Arrow crisply explained in 1963, because nobody's going to shop around for the best price on their hip replacement if the Blue Cross is going to be paying for it anyway. Thus the Affordable Care Act is a colossal failure, so the Republicans should stop trying to repeal and replace it and instead double the limits on health savings accounts. I am not a crank.

No, that problem isn't insurance, because Australians don't shop around for the best deal on a colonoscopy either. They can't, because the government controls prices for medical services, as part of the operation of its publicly owned and funded Medicare system of universal health insurance, as do the other cheaper countries Stephens references, Spain, UK, and New Zealand. Thanks to these and other countries, we know a lot more about this now than Kenneth Arrow did in 1963, although Arrow knew a whole lot more than Stephens does, see below. Controlling health costs requires an active government effort, which is why the US is always dead last in doing it even as it provides mediocre care.

Update: Kenneth Arrow, who died last February, was the Nobel-winning economist who demonstrated from the model-theoretical standpoint in his 1963 paper that health care is a special case for which a laissez-faire market approach is "intolerable", and that government is obliged to step in, most likely acting as insurer, to make up for this. Krugman cited him in 2009 to warn against making the Obama plan too market-oriented. For Stephens to be quoting the work in defense of a system where everybody pays cash is like quoting Galileo to prove the Sun revolves around the Earth. I can't imagine what he thought he was accomplishing.

Stephens really does make that psychotic break from denouncing the death-spiraling Obamacare in the usual distorted terms to saying the Republicans should stop trying to do anything about it:

Annals of Derp: The Map of Doom

the map

According to the Center for Medicare and Medicaid Services, 47 counties in 4 states could have no online marketplace insurance provider in 2018—the red ones here. The 47 counties are underpopulated farm country, and currently have a total of 35,000 active Exchange enrollees, out of a nationwide total of some 9.2 million Exchange enrollees, or 0.038%. And 320 million or so total health insurance purchasers in the United States.

According to Republicans, this shows that the Affordable Care Act is "imploding", or in a "death spiral". To save those 35,000 folks from Missouri, Nevada, Ohio, and Washington from going without health insurance, they tell us, we need to adopt a new law that will take health insurance away from 23 million or so (mostly Medicaid patients, of course, but something close to 9 million from other places, very much including the exchanges) over the next ten years.

Not an expression I often use, but "Let that sink in."

Required Reading

Rafflesia in Sabah, East Malaysia.

Why I Hate the New York Times, the Rafflesia of media-criticism blogging as I call it, after the Southeast Asian jungle flower that produces its huge and spectacular single bloom once every ten years or so, has just shown up with four months of material, and just as the Rafflesia smells like a corpse, the piece is as funny as hell, if you read it with attention: "How to Resist Trump" as the writers of the Times conceive it.

For instance, by not marching too much, the way the women did at the beginning of the regime:

Those ladies meant well, but they didn’t know what they were doing. “This movement focuses on the wrong issues…. Marchers…were marching under the conventional structure in which the central issues were clear.” That was their first mistake, according to known marching tactics expert David Brooks: Never march in a framework in which the central issues are clear. 

Or by being civil:

Bad enough to fail

Victorian children. Via.

Dr. Krugman:

Given the rhetoric Republicans have used over the past seven years to attack health reform, you might have expected them to do away with the whole structure of the Affordable Care Act — deregulate, de-subsidize and let the magic of the free market do its thing. This would have been devastating for the 20 million Americans who gained coverage thanks to the act, but at least it would have been ideologically consistent.

But Republican leaders weren’t willing to bite that bullet. What they came up with instead was a dog’s breakfast that conservatives are, with some justice, calling Obamacare 2.0. But a better designation would be Obamacare 0.5, because it’s a half-baked plan that accepts the logic and broad outline of the Affordable Care Act while catastrophically weakening key provisions. If enacted, the bill would almost surely lead to a death spiral of soaring premiums and collapsing coverage. Which makes you wonder, what’s the point?

Hey, maybe that's the point! To furnish us with what they call a teachable moment—to demonstrate the truth of the sacred conservative axiom that government interference with the provision of health care is bound to lead to disaster.