Cardiff Garcia on the AEA meetings, and the health care cost slowdown

Here is one bit of many:

The embedded papers by Louise Sheiner of Brookings, Chapin White of the Rand Corporation, and Thomas Getzen of Temple University are recommended. To be simplistic, there was agreement that much of the slowdown was likely the result of the recession and sluggish recovery, as slow economic growth translated into less health spending and also slower wage growth for health care workers. But not all of it.

Sheiner finds that outside of spending on prescription drugs — which has been flat since 2008 because of the patent cliff — there actually hasn’t been any unexplained slowdown in health spending relative to the fifteen years before the recession. In this context, “unexplained” means a change in health spending that can’t be attributed to the business cycle. She also adds the intriguing observation that in a downturn, more health workers join the labour force, often because their spouses have lost their own jobs — but wages for health workers fall. The shortage of registered nurses mostly evaporated after the recession of 2008, she said.

White looked more closely at the Medicare slowdown and believes that the Affordable Care Act’s price cuts did have an impact, as did a recent crackdown on fraud by the Centers for Medicare & Medicaid Services.

I hope the rest is not “too gated” for you, hat tip goes to Claudia Sahm.  And Philip Greenspun reports on the meetings.


Many were saying that the ACA would lead to higher costs and wouldn't reduce the number of uninsured. Have we now switched to debating whether or not it's the cause of the slowdown in costs?

It would be more accurate to say that the arguments about the ACA were all over the spectrum, and as more data comes in, the range of arguments shrinks. It seems to be closing in on "small or no effect on spending"and" modest effect on uninsured ", but much of the hard stuff of the ACA was delayed and may have a much greater effect when it is implemented.

The "hard stuff" was not delayed but merely takes a long time to be implemented.

The law promotes new models for billing for services in multiple ways.
The law promotes quality metrics as a priority a la Deming.

When the auto industry of the 60s started being forced to implement the same changes based on the focus on bundling for billing and the focus on quality, the time required to see major changes was measured in decades.

I remember when a high percentage of cars were built to order - you went to the dealer and selected dozens of options, each billed individually, giving the dealer the opportunity to add hundreds to the bill for the car you started buying at the bargain $800, until you added wheels and tires, seats, mirrors, radio, paid to have it painted, etc.

For imports, ordering from the factory would require lead times of 8-10 months. So, the imports offered only a few options that could be installed by the dealer. But the bills were written just like the cars from Detroit. Everything was listed:
wheels: no charge
tires: no charge
seats: no charge
paint: no charge

US dealers started inventing options. The three times of rust proofing used by the Japanese, plating, primer, paint, were not enough so you needed to buy undercoating, which often damaged the paint and primer and led to rusting.

Same for quality. In the factory, the complex orders led to parts being dropped in the car instead of being installed and the dealers had to rebuild the car. That's why dealers were so critical.

But when the Japanese automakers responded to the attacks on Japanese quality, the factories produced cars with low defects and now car dealers were not part of the process of building cars. Cars could be sold mail order (pre-Internet) but the laws were changed to protect the dealer by making sure the Japanese cars were not sold without local dealers which would have ultimately killed off the Detroit dealer system.

Radios and TVs required dealers to maintain them. Like cars did. But today we have no dealers of electronics because few need maintenance.

Costs and quality are a never ending struggle that impact society in lots of ways whether electronics, cars, health care. The systems do not change rapidly.

I'm really at a loss. I get "the point" of your lengthy analogy, but it does not prove anything. I could similarly trace the evolution of military strategy from Christ's Birth through the formation of pike-and-shot, but it does not indicate improvement: a well-led 2nd Century Imperial Legion will trounce anything up to Agincourt, except another Imperial Legion or Genghis Khan. We have a little sound idea what these currently-marginal trends are going to bring in the future. Ultimately that depends on how future Congresses act at important milestones. This can just as easily grow to eat the whole budget.

As a Roman history major, I want to like this comment - because the Roman legions were badass - but my suspicion is that the significant improvements in saddles, stirrups and harnesses made medieval cavalry much more effective than the Roman version. Anyone know of literature on this point?

In addition to the improvements in saddles, stirrups, and harnesses, there were improvements in bow and arrow technology, which made the Mongolian horse archers the tanks of their day: high firepower combined with high mobility. Researchers estimate that the Mongol bows had the hitting power of the English longbow, but were considerably easier to use while on horseback.

The Parthians were less dangerous militarily, but still annihilated a Roman army at Carrhae.

But Beta Guy still has a point. The Romans at Carrhae were badly led, and the Romans were masters at learning from the technology of their opponents. They had no navy, but eventually built one and beat the Carthaginians. They adopted the Spanish short sword and it became known as the gladius. Even though they never became natively good at cavalry, they pried Hannibal's Numidian allies away from his army and thus gained the dangerous Numidian light cavalry.

So a technologically static Roman legion would have trouble facing the improved cavalry and missile troops of the following millenium. But realistically the Romans wouldn't have remained technologically static; they would've learned how to emulate or neutralize the new technologies.

The point of that long digression was to get everyone to forget the laughable premise in the first paragraph. We are to believe that ACA implementation delays were not influenced by political considerations.

"We are to believe that ACA implementation delays were not influenced by political considerations."

Well maybe that was the point, but no informed, rational person would believe it. The delays were quite deliberately implemented to take effect after the election cycle, for two different elections.

The 'hard stuff was delayed'....yet a few days ago we were told Harvard was making its generous health plan a bit less generous because of those onerous, costly, requirements of the ACA?

"Many were saying that the ACA would lead to higher costs..."

Really, because I remember a rather prominent person saying that the ACA would lead to drastically lower costs. Not a slowdown in increases, but an actual drop in the cost.

Barack Obama - ""I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family's premium by up to $2,500 a year."

That comment was about the ACA? Strange as it was clearly made long before the ACA was even drafted. Or was that an aspirational campaign promise? Sort of like Bush paying off the debt or ending Clinton's 'racial profiling' of Muslim Americans (yes he promised that, look it up).

So now we excuse the lies of politicians as "aspirations"? Too cute.
Or I guess making s**t up is okay when it's for a good cause?

I wish I could call any unrealistic guarantee I failed to deliver" aspirational " and have people defending me.

In the law there is a concept that it isn't just the words you use but what is reasonable to expect. For example, if you alleged that you loaned $10,000 to a 75 year old man who had no income and was very sick, you'd have a hard time convincing a court you had a contract for him to pay you back with interest since there'd be no reasonable way you'd expect that to happen.

If a quarterback at the start of the season says he is going to take it all the way to the Superbowl, it is assumed that is at least partially aspirational. Since we all know a President can only propose laws and then sign or veto the ones that pass, it is understood that there is a limit to how far any promise can go unless you are talking about a power that is purely with the President. Likewise I have even less patience for those who like to scream about his failure to close Gitmo while applauding Congress literally making it impossible to close it.

For example, a promise to nominate only pro-life or pro-choice SC judges would be quite different.

It's the combination of the economy and increased deductibles and co-pays, the latter (and, according to some cynics, the former) supported by conservatives. As the economy recovers and insureds adjust to the higher co-pays and deductibles, I would expect health care expenditures to increase, not so much because of the economy and adjustment but because of consolidation and integration in the health care industry. The problem with studies like the one cited is that they are ancient history by the time they are published; health care, if nothing else, is the pac-man industry.

So the ZMP worker being fired had a good effect in dampening runaway heathcare costs? Hat's off to the ZMP worker then!

Firing factory and construction workers cut health care costs?

... ah by those workers qualifying for disability and after two years becoming qualified for Medicare...

Single payer cuts costs!

Pesonally, I find non-Americans who are not employed by free market policy institutes to be a much better source for commentary - 'So, as the New Year hangovers finally, gently, fade away, why don't we consider what it is that we really do want in a healthcare system. And even, well, who manages to do this quite well?

Do not fear, we are not about to find that the answer is the US. That really is God's Own Clusterfuck of a system. All the problems of a market system and almost none of the benefits. Quite how any nation can manage that is beyond belief.'

When the Bitish are mocking you for a failed health care system, it is truly a sad state of affairs.

Much like the Daily Mail mocking Fox News - 'But Kooiman continued to ask Brenner if the difference in measurements were to blame, and if that makes international travel riskier.

'It's not just a difference in the way that we measure things?' Kooiman asked. 'Is it not as safe in that part of the world? Because our viewers may be thinking, "International travel, is it safe? Is it not safe?"''

After all, everywhere else in the industrial world uses the metric system, and also has a cheaper and more effective health care system.

Sometimes you seem smart, here you seem like a mash up of tired progressive nonsense. Maybe, since you so often remind us of your residence outside the US, you just haven't heard anything more nuanced than "US primitive free market brutes vs Enlightened Euro socialists". Who knows? You are a fascinating creature, however tiresome your arguments are.

I'm a non-American, or rather a dual citizen of both the USA and Canada, and I've received treatment, including surgery for serious cardiovascular problems in both countries. My diagnostic and treatment experience in Canada can only be described as a cross between something imagined by Kafka and Monty Python. My experience here in Virginia was prompt, efficient, and first rate. I spent far less time in a Virginia hospital for a quintuple bypass than I did in an Alberta hospital waiting for an angioplasty. Had I chosen to wait at home for the plasty it would have been a 6 month wait instead of the 2 weeks I did spend warehoused in one hospital, only to be twice transported by ambulance to another hospital, once for the angiogram and another time for the angioplasty (this sort of thing requires a one night stay in an American hospital and the two procedures are done at the same time). It also took me 4 months from the first time I saw a PCP, complaining of severe chest pain, to get a referral for something as simple as a tread mill stress test. I kept getting told that I had probably pulled a muscle in my chest. There are many problems with American health care, but I would rather have serious heath problems in this country than in Canada or Britain. To claim otherwise is to display either an appalling ignorance or an appalling dishonesty about American health care. I also made use of French health care (not for anything serious) when I lived in France and I was quite impressed by the experience, particularly the pharmacies.

ガラガラガラ ガッシャーン!だから メンズファッション
コーディネート ユニクロ なんか一人でファビョってるけど
これからは男性にとっての理想像も「さわやか正社員」系になるのかもしれない。える あれは売れてるらしいからね。
今から20年前。ミュータントと人類の平和的な共存を望み、ミュータントを正上女気 型にもよると思いますが…

かえって免疫がつく。だがしかしちょと待って欲しい。こんな まだファー付きダウンが流行ってると思ってる。
レディースの秋冬、ラバー厚底シューズのほうがメンズよりかっこいい....立つ メンズファッション
秋 コーディネート 顔見たらむかつくからテレビでニュースとかワイドショー全然見なかったけど

Domo arigato, Mr. Roboto.

Prescription drug costs are about to shoot up. The patent cliff was a temporary phenomenon. Drug makers have figured out astronomically priced specialty drugs is the way to go.

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