Are caterpillar ovaries just as good as chicken eggs for growing the flu shot vaccine? Apparently.

Number of people living on a dollar a day has plummeted from almost 1 billion to about one-third that number. The reason: the spread of capitalism.

Physicians find more polyps in early-morning colonoscopies: Hour by hour, the results get worse as the day goes on.

Source: Robert B. Helms, “Medicaid: The Forgotten Issue in Health Reform.”

You call it a welfare program masquerading as health care reform.

In a November 2, 2009 letter to Representative Rangel, the Congressional Budget Office calculates what estimated payments will be for the health insurance “reference plan” at various levels of income in 2016. The lavish plan that the bill defines as basic, combined with the massive web of subsidies and taxes, ensures that individuals who make more than $20,000 a year are going to be paying quite a bit more for health insurance than they do now.

Here’s what the CBO estimates that single people and families will be paying by income level:

Source: Congressional Budget Office. Letter to Representative Charles B. Rangel, November 2, 2009. http://www.cbo.gov/ftpdocs/106xx/doc10691/hr3962SubsidiesRangelLtr.pdf

According to the Census Bureau, in 2008, there were 127 million Americans under the age of 65 living in households with incomes between 100 and 400 percent of the federal poverty line. The House and Senate health-care bills would essentially promise all of them either free insurance through Medicaid or caps on their insurance premiums based on their incomes. This would constitute the single largest entitlement spending expansion since the Great Society programs of the 1960s. CBO expects the federal spending associated with these new open-ended health entitlement commitments to reach about $200 billion annually by 2019 and escalate at about 8 percent annually thereafter.

Fasten your seatbelts, it’s going to be a bumpy [ride]…

Sen. Lieberman: “The wonderful thing of being an independent: You have options.”

Should people pay up to $250,000 in fines and spend up to five years in jail if they don’t buy health insurance? Pelosi dodges question (video).

Goodies for labor tucked away in health bill.

• Spending: The cost of the bill is $2.5 trillion over 10 years of full implementation (2014-2023).
• Taxes Increases: Taxes will go up $493.6 billion — nearly half a trillion dollars.
• Medicare Cuts: Medicare will be cut $464.6 billion — another half a trillion dollars.
• Government Plan: The bill includes a government run plan and provides states with the possibility of opting out of participating in that plan. According to CBO, the government run plan “would typically have premiums that were somewhat higher than the average premiums for the private plans in the exchanges.”
• Employer Mandate: The bill will impose $28 billion in new taxes on employers that do not provide government approved health plans.  

Additional CBO Background:

• The bill would bend the federal cost-curve up. 
• 24 million people would be left without insurance.
• States will have to spend an additional $25 billion in Medicaid expenditures
• Taxes on uninsured individuals will total $8 billion.
• Taxes on employers from the “free-rider” penalty would total $28 billion.
• 5 million Americans would lose their employer coverage.
• Only 19 million people will get a subsidy to help them buy health insurance. None of the 162 million people with employer-based care will even be eligible for a subsidy.
• The costs of the subsidies in the exchange would grow at 8 percent a year.
• The tax on high value plans will quickly be applied to almost all plans. CBO expects the revenues from the Cadillac plan tax to grow at 10-15 percent per year outside the budget window.

Full text

First year benefits

CBO score

New taxes (ATR)

Many a tear has to fall

Federal and state regulations have created such a mess in the small group market that in many cases it is less expensive for employees to buy their own health insurance than to pay the employee’s share of the premium for insurance purchased by their employer. This small business dropped its small group coverage when small group prices went up so much that employees, who had to pay 50 percent of premiums, could buy individual policies for the same amount of money.

As the company is in a state with a functioning high risk pool that offers insurance to people who are uninsurable, everyone can purchase an individual policy if he so desires.

This company has found that making people responsible for their own health insurance has substantially reduced management costs. For a small business in which management has neither the time nor the expertise to explain benefits, deal with conflicts over the plan, field complaints about an insurer, or help employees file claims, this is no small matter.

Direct purchase has also let employees pick both exactly the kind of plan they want and the amount of coverage they need. People who prefer HMOs get them. People who prefer large deductibles and health savings accounts get them. People who want low deductibles and are willing to pay higher premiums get what they want, too. Plus, employees continue to have health insurance if their small employer folds, if they change jobs, get laid off, or want to start their own business.

And because individuals own their own health insurance, their health history is none of their employer’s business.

One of the enduring myths in US health care policy circles is that large group insurance costs less than individual insurance. The problem is that the people making this claim compare premiums for individual insurance with premiums for employer provided group insurance. They ignore the fact that employer group plans also need human resources departments to administer them, and that those costs should be included in the premium comparisons.

In contrast, individual health insurance premiums include all of the costs for the brokers who educate customers, help them choose plans, and help them navigate the claims process. It also includes all the costs for record keeping, underwriting, and negotiations.

 For more information on how effective direct purchase health insurance is at spreading risk while keeping costs down, and on why guaranteed issue for pre-existing conditions and the price controls that go with them will likely raise health insurance costs for everyone, see my article for the Library of Economics and Liberty.

The task force recommended against screening because it concluded that there was “moderate evidence that the net benefit [of screening mammograms] is small for women aged 40 to 49 years.” The documents supporting its decision review selected literature on mammography and breast cancer survival. They show that mammography reduces the risk that women aged 40 to 49 will die from breast cancer about as much as it reduces the risk that women aged 50 to 59 will die from breast cancer. According to one of the supporting papers, screening produces a 15% reduction in breast cancer mortality in both groups.

What are the costs that the Task Force measured against the benefit of a 15% reduction in mortality in order to come up with its “small net benefit?”  No one knows because they don’t say.

Radiation risks are said to be very low and the pain and anxiety associated with the procedure are manageable for most people. Overall, the Task Force’s supporting papers say that  adequate evidence suggests that the overall harms associated with mammography are moderate for every age group considered, but that “false-positive results are more common for women aged 40 to 49 years.” How much do the false positives cost? It doesn’t say.

Nonetheless, one can infer that the false positives are the real reason for the Task Force recommendations. One of its references, a paper in the Annuals of Internal Medicine,  reports on the results of 6 models that estimate the outcomes of breast cancer using various assumptions. That paper states that:

If the goal of a national screening program is to reduce mortality in the most efficient manner, then programs that screen biennially from age 50 years to age 69, 74, or 79 years are among the most efficient on the basis of the ratio of benefits to the number of screening examinations. If the goal of a screening program is to efficiently maximize the number of life-years gained, then the preferred strategy would be to screen biennially starting at age 40 years. Decisions about the best starting and stopping ages also depend on tolerance for false-positive results and rates of overdiagnosis.

In other words, to save the most lives, you screen the 40 to 49 year olds. To save money by getting rid of pesky false-positives that require follow-up visits, you don’t. Medical researchers have long known that the cost of screening per life saved is lower for women in their 50s than for women in their 40s. But should money be the determining factor?

The main difference between U.S. health care and health care of other developed countries is that the U.S. is concerned with saving lives. Other countries are more likely to balance medical benefits against economic costs. That is why U.S. women get more Pap smears and more mammograms, and have better cancer survival rates.

As health reform legislation wends its way through Congress, two things are worth keeping in mind: (1) The federal government will determine what kind of health insurance everyone must have, including such screening benefits as mammograms and Pap smears, and (2) 15 years ago what helped kill health reform was Hillary Clinton’s decision to mandate from the White House which women would be eligible for such tests and at what age and how often.