Krugman: I Have Seen The Future, And It Is Medicaid

[dkf]

One of the papers at Brookings was an attempt at prognosticating the future of health care costs — for what it’s worth, their best guess was slightly below CBO’s, so it was consistent with CBO’s relatively not-scary long-term fiscal forecasts. But what struck me most was this chart, showing cost growth in different forms of health insurance:


That flat red line at the bottom is Medicaid.

Everyone who’s serious about the budget realizes that to the extent we do have a long-run fiscal problem — which we do, although it’s far from apocalyptic — it’s mainly about health care costs. And then there’s much wringing of hands about how nobody knows how to control health costs, so maybe we should just give people vouchers, and if they still can’t afford insurance, too bad.

Meanwhile, we have ample evidence that we do know how to control health costs. Every other advanced country does it better than we do — and Medicaid does it far better than private insurance, and better than Medicare too. It does it by being willing to say no, which lets it extract lower prices and refuse some low-payoff medical procedures.

Ah, but you say, Medicaid patients have trouble finding doctors who’ll take them. Yes, sometimes, although it’s a greatly exaggerated issue. Also, middle-class patients would surely be unhappy if transferred from the open-handedness of Medicare to the penny-pinching of Medicaid.

But the problems of access, such as they are, would largely go away if most of the health insurance system were run like Medicaid, since doctors wouldn’t have so many patients able and willing to pay more. And as for complaints about reduced choice, let’s think about this for a moment. First you say that our health cost problems are so severe that we must abandon any notion that Americans are entitled to necessary care, and go over to a voucher system that would leave many Americans out in the cold. Then, informed that we can actually control costs pretty well, while maintaining a universal guarantee, by slightly reducing choice and convenience, you declare this an unconscionable horror.

http://krugman.blogs.nytimes.com/2013/09/21/i-have-seen-the-future-and-it-is-medicaid/?smid=tw-NytimesKrugman&seid=auto&_r=0

[libdem4life]

1. Health costs have not gone up as much as health charges and health executive profit.

For profits can loot far more efficiently than public option. They have sticky fingers in both the profit and the government side. Example: Rick Scott of Florida.

[russspeakeasy]

2. Thanks for posting this. An excellent read.

[Laelth]

3. k&r for exposure. n/t

-Laelth

[Hoyt]

4. Whew. I tend to agree, but a lot of folks would gripe if provider choice were limited,

allowed drugs were on a formulary, certain high cost - low efficacy - procedures were limited, etc. People seem to be OK with someone else having less choice, jyst not themselves.

If Obama suggested Medicaid for all, he'd be impeached on some trumped up charge.

[GreenPartyVoter]

6. Having been on Medicaid I prefer it to private insurance, and especially to

not being insured at all.

When the ACA was being debated I had hoped Medicaid for all would be dconsidered, but it wasn't really.

[Hoyt]

7. I used to work for my state's Medicaid Agency. I think it does a world of good.

But physicians raised hell, people got mad because their doc didn't accept Medicaid, etc.

I'd be fine with Medicaid, but I've seen too many people, even on DU, complaining about health plans that limit providers, drugs, certain care, etc., to think a lot of people would not complain. For universal healthcare to work, we are going to have to accept some compromises. I don't think most are ready to do that.

[GreenPartyVoter]

8. I think it will go state-by-state. The ones more open to it will get there first.

[Hoyt]

10. Good point. There are states thst are cleary "advanced" in such respects.

The state gubmit where I live is actively trying to undermine Obamacare, and has not so far elected to expand Medicaid, no matter how many people might get hurt by leaving them uninsured.

[GreenPartyVoter]

11. Same problem here. Darn you, LePage!

[dkf]

12. What is the difference in doctor payments?

[Hoyt]

13. Usually Medicaid is about the lowest of all payers. A doc who saw nothing but

Medicaid, has to work hard and won't have salary any where near what they can make seeing other patients. But, they can make a decent living, and help some folks.

Some see Medicaid because they feel they should (I think a few states require them to take some Medicaid), some take only a few, others take them because they need patients, but a lot avoid Medicaid. I think ACA raises rate for an office visit to Medicare rates, which will help.

[jsr]

5. Recommend

[Hekate]

9. KnR, Krugman