Tuesday, October 29, 2013

Three From McArdle

Megan McArdle has written three good analyses of ObamaCare at Bloomberg lately.

"Is Obamacare in a Death Spiral?" (10/21/2013)
The exchanges were also broadly understood to be needed to get young, healthy people into the system. Somewhat naturally, almost every story you’ve seen about a new enrollee -- including those told by the president this morning -- has focused on someone who couldn’t buy insurance before, or who had very expensive insurance. But it’s not surprising that those people are fighting through the system to get coverage; they would pull themselves to the top of Mount Rushmore using only their teeth if that’s what it took to get a cheap insurance policy. What we need to know is what is happening among the people who didn’t need Obamacare to help them buy insurance, because insurers would be perfectly happy to sell them a policy without it. Those are the folks whose premiums will cover treatment for the rest.
"Obamacare Fiasco Isn't a Single-Payer Conspiracy" (10/24/2013)

In response to the current ObamaCare launch difficulties, she notes:
The interesting thing is that people on both ends of the political spectrum seem to believe that the answer is the same: single payer. What Walter Russell Mead dubbed the “pivot" to single payer has begun as various folks point out that if we only had a total government takeover, these issues wouldn’t put the whole system in danger. I’ve seen more than a few progressive commenters suggest that maybe an epic fail will finally open the way to the single-payer system we should have had in the first place.

In private, and occasionally in public, conservatives are expressing the same fear. There’s a pretty popular conspiracy theory running around to the effect that this was the Barack Obama administration’s intent all along: Design this big Rube Goldberg apparatus that couldn’t possibly work, and when it fails, sweep in and “fix” things by enacting the single-payer scheme you wanted all along.

Perhaps they did want single payer all along, in their secret heart of hearts, but it’s ludicrous to think that they were capable of designing and pulling off a conspiracy of that magnitude...
(I do think that many on the political Left will use this as a "justification" to promote the single-payer system, regardless of the intentions of the initial legislators who passed the law.)

"Stopping Overtreatment Sounds Easy, Until It's Your Heart Attack" (10/25/2013)

I recommend reading the whole thing.  McArdle notes:
Is this to say that there is no way to save money in health care without hurting patients? Of course not. But we should be wary of asserting that it will be easy to save money without hurting patients as long as we simply follow the best evidence. Studies are, of course, the foundation of science. But they also have limits. The questions they can answer are often much narrower than the questions we would like to answer -- and often other studies give different answers. There’s a decent amount of evidence that hospitals which do more intensive interventions get better outcomes.
One point -- it's very easy for central planners to opine from their armchair about "best practices" for doctors and patients.  Yet such plans often run into trouble with real-life patients.