Good news everybody

National healthcare spending is significantly (~10%) below 2010 projections:

And people are less stressed about being able to pay for a medical bill:

Why I was told that was Unpossible

Open thread

Late Night Low-Hanging Fruit Open Thread


(In reference to one strand of conspiracy theory about Scalia’s death, of course.)

For old-persons-mocking-the-youths…

It’s nice they’ll have something to keep their hands busy, she said sweetly.

Been searching for so long

I normally hate big data wankery, but I find this shit fascinating: the share of google searches for a GOP candidate in NH on election day closely mirrored that candidate’s share of the vote.


Strangely enough, Jeb is doing very (second place to Trump — EDIT: hopefully this new link is not paywalled) in google searches in South Carolina right now.

The establishment is the kiddie table

Via Political Wire:


new Morning Consult poll finds Donald Trump with a huge national lead over his GOP rivals at 44%, followed by Ted Cruz at 17%, Ben Carson at 10%, Marco Rubio at 10%, Jeb Bush at 8% and John Kasich at 4%.

The consolidated establishment lane of “responsible” Republicans pull in 22%.  That is a faction less than the Cruz/Carson faction.  The Republican Establishment is the kiddie table in that party.

I am having a harder time seeing how Trump is not the nominee for the GOP as he controls the terms of debate, the media loves him, and plausible unified opponents can’t unify.  His non-Cruz/non-unadulterated grifter opponents are locked in a single shot, non-iterative game with a single winner takes all prize.  Coordinating so one of the opponents in this category is the proffered opponent leaves the withdrawing opponents only soft agreement enforcement mechanisms to get any promised goodies.  Throw in that there is personal loathing among some of the Establishment candidates , it makes a non-Cruz anti-Trump consolidation behind a single candidate improbable in the next week or two.

And even if there is a consolidation with universal support transfer, the anti-anti-Establishment non-obvious grifting wing of the GOP is a minority faction.

How does Trump not get the nomination?


Centrist Dalek Horror Theater Presents: The Schoening

As the New Hampshire primaries get underway today, former NYC Mayor Michael Bloomberg confirms this week that he is considering entering the 2016 presidential race as an independent, something that made the rounds as a trial balloon two weeks ago.  Now however Bloomberg himself is saying he’s considering making the jump.

The billionaire media mogul and three-time former New York mayor told Financial Times in an interview published Monday that he is “looking at all the options.”

Fellow New York billionaire Donald Trump has been leading polls on the Republican side for months, and Hillary Clinton only narrowly escaped Iowa with a victory over a self-described “democratic socialist.” Bloomberg, who is considering running as an independent, said Americans deserve “a lot better.”

Bloomberg has set a March deadline to determine whether he will run, and should he decide yes, he told the FT he would have to begin getting his name on ballots next month. He has signaled he could spend at least a billion dollars of his own money to sustain a campaign, according to a New York Times report citing anonymous sources briefed on his deliberations.

That’s not the funny part.  The funny part is who’s advising him.

Bloomberg’s pollster, Douglas Schoen, outlined the case for his boss’s potential White House bid in an op-ed last week for the Wall Street Journal.

Pundits are missing a large group of centrist voters who opt out of partisan primaries, Schoen argued, pointing to the low turnout in Iowa.

“That’s the new silent majority: the millions of Americans who don’t participate in Democratic or Republican primaries. They are equally as fed up with the status quo, but they have a different approach to problem-solving and different policy prescriptions than those on the ideological extremes,” Schoen wrote.

That has created an opportunity for someone to mount an independent run, he argued:

“Who fits the bill? Michael Bloomberg, a centrist with a clear (and arguably unique) record in business as an entrepreneur and in politics as a three-term mayor of New York. Mr. Bloomberg is a fiscally prudent conciliator who advances pro-growth policies and takes tough stands.”

That’s right, the guy running Bloomberg’s numbers is none other than our old friend pollster Doug Schoen, who along with his partner in crime Pat Caddell is the obnoxious No Labels/Americans Elect centrist grifter that warned Obama could never win re-election in 2012 and that Hillary had to primary him, that Obama had to champion the Simpson/Bowles Catfood Commission, that the Democrats were the real extremists, that Obama had to become a right-wing Democrat in order to attract Tea Party votes, that Trump should have gotten into the race in 2012 as in independent, and my personal favorite, that Barack Obama should have dropped out of the 2012 race completely for the good of America.

It looks like Doug has found his Trojan Horse to sink the Democrats and get his massive austerity cuts by splitting votes in favor of the GOP in Bloomberg, so if there was any doubt that a Bloomberg run is more Nader than Perot, the fact that Doug Schoen is involved should have you running for the exits.

The Centrist Daleks are back to TRIANGULAAAAAAAATE it seems, and should Bloomberg actually run, keep in mind it only takes ruining one swing state with a third party bid to throw the presidency.

What’s a couple trillion among friends

The Committee for a Responsible Federal Budget ran the numbers on the Sanders’ healthcare plan and its financing and depending on the assumptions, the Sanders plan is either $3 trillion dollars short over 10 years or $14 trillion dollars short over ten years compared to what the campaign is claiming.

That Sen. Sanders has shown a commitment to paying for his new initiatives and has proposed specific concrete changes to do so is quite encouraging. However, by our rough estimates, his proposed offsets would cover only three-quarters of his claimed cost, leaving a $3 trillion shortfall over ten years. Even that discrepancy, though, assumes that the campaign’s estimate of the cost of their single-payer plan is correct. An alternateanalysis by respected health economist Kenneth Thorpe of Emory University finds a substantially higher cost, which would leave Sanders’s plan $14 trillion short. The plan would also increase the top tax rate beyond the point where most economists believe it could continue generating more revenue and thus could result in even larger deficits as a result of slowed economic growth.

Sanders is not running in the Republican primary where the ability to propose programs with multi-trillion dollar piles of bullshit is an asset.  His campaign should respond to CRFB and Thorpe’s cost estimates on a non-ad-hominem basis to explain why their estimate that single payer is a net neutral fiscal move instead of a massive budget buster.

Pareto proportions in healthcare

Health care finance and utilization is a Pareto curve.  A small minority of people drive the vast majority of costs and utilizations.  Conversely, most people are minimal users of healthcare services in any given year.  This means there are two very distinct strategies that should promote good outcomes.  But first, let’s look at a great graph via Martin Gaynor:


For people on the left hand side of the graph, they are relatively healthy and relatively low users. They’ll be using primary care providers, urgent cares, low end prescription drugs, the occasional specialist, the occasional low end surgery and hospitalization. There may be spikes in cost such as a year in which a woman gives birth, but over the medium run, costs and utilization are fairly low because need is fairly low.

Here, consumer driven healthcare could make a decent amount of sense. A co-pay of $50 for an urgent care visit instead of a $25 co-pay for a PCP visit could lead people to make better choices. Reference pricing for simple, straightforward elective surgery could drive people to choose low cost providers. Deductibles may force people to defer care that is not particularly valuable. High deductible health plans paired with health savings accounts are not inherently crazy nor malicious.

However any cost savings here don’t matter all that much because the base level of spending is so low to begin with.

The other side of the Pareto curve is where the real money is.

And there, consumer driven decision making runs into the brick wall of reality.  People don’t have $50,000 or $100,000 lying around to fix a blown shoulder that happened while mopping in various states of undress.   People don’t have the ability to continually pay $300,000 per year for preventative hemophilia treatments in the hope that they can avoid a $5 million crisis claim.  A deductible will be hit no matter what.  Coinsurance and co-pay limits will be hit no matter what.

If we were to fully embrace consumerism for the most expensive 10% to 15% of the population, what we will be telling the chronically ill to do is to buy an ounce or two of morphine, a syringe and a blanket so they can die quickly and quietly in the corner.

We’re not going to do that as a society.  Instead, we have to do a few different things.  The first is the 50 year policy of segregating the group of people who are most likely to have very large claims away from the rest of the population in the form of Medicare and dual eligibility for Medicaid-Medicare.  The Federal government picks up a good proportion of the shock claim risk.

But that does not do everything.   We put people into the market and hope it works well enough.  But that fails.   There is no market within a half day drive of the Major Academic Medical Center that can effectively treat certain types of pediatric cancers, so market forces don’t work.  Administrative forces need to work instead.  And that is where things like Accountable Care Organizations, gain-sharing, risk-sharing, population health management, preventative nursing visits and focus chronic disease management programs come into play. The systems, hopefully, are built so that everyone benefits in that the patient gets better quality of life, and the resources devoted to that goal are used effectively and efficiently.