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Wednesday, April 15, 2015

Oh, look! The uninsured rate fell again!

As any conservative can tell you, Obamacare is a job-killing "train wreck." Not only is it a job killer, there is no way that it could possibly work. Except, of course, it does.

When I last visited this issue, the percentage of adults without health insurance had fallen from its peak of 18.0% in the third quarter of 2013 to 13.4% in the second quarter of 2014. Now, as Gallup (via Matt Yglesias) shows us, it continues to fall, dropping to 11.9% in the first quarter of 2015, based on over 43,000 interviews throughout the quarter. This is a drop of exactly one percentage point from the fourth quarter of 2014, or about 2.4 million adults.

The gains that we have seen now through two enrollment cycles (Q4 2013 through Q1 2015) affect every major demographic group, as the following table from Gallup shows.

Percentage of Uninsured Americans, by Subgroup

Especially notable are the gains for minorities (8.3 percentage points for Hispanics and 7.3 for African-Americans), those with income below $36,000 per year (8.7 points) and adults from 26-34 (7.4 points). But notice that even Americans making over $90,000 annually have seen their uninsured rate fall by 2.3 points, meaning that 40% of this group is no longer uninsured. This is actually the biggest percentage gain among any of the demographics Gallup surveyed.

As Gallup and Yglesias both point out, part of the reason for the improvement is the declining unemployment rate. But Yglesias is right on the money that this undermines the "job-killer" meme. In fact, as he shows, 2014 was "the best year of job creation since 1999."

This is one argument conservatives aren't going to win. In fact, it looks like they've already lost the vote of one Tea Partier who was able to retire early because of Obamacare.

Cross-posted at Angry Bear.

11 comments:

  1. Why is 'more insured' a good thing? Does that automatically translate into more health care delivered to those needing it? Or even to less expenditure on medical treatments.

    I'd think the most likely result of 'more insured' is more people using other people's money to chase an essentially (in the short run, anyway) fixed capacity of medical care.

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    1. Yes, more insured does in fact translate into more health care to those who need it. If you disagree with this basic fact then you are willfully disregarding all the studies that have been posted over the past several years.

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  2. Every ER visit that is replaced with an office visit saves costs while consuming no additional medical resources. The savings can then be used to fund more medical care. So, I wouldn't say it's automatic, but in the long run more insurance would equal more care for those who need it.

    Did you notice in my linked article from last June that hospitals in states which expanded Medicaid saw noticeable drops in both the uninsured and in the amount of charity care they had to provide, but that didn't happen in non-expansion states? Or that Medicare 30-day readmission rates have fallen?

    The medical sector continues to add 200,000+ jobs per year (http://www.forbes.com/sites/dandiamond/2014/06/06/since-obamacare-passed-50-months-ago-healthcare-has-gained-almost-1-million-jobs/), so it hardly seems correct to say capacity is fixed.

    And I don't understand your moral reasoning: What have you got against people getting health care they need? That's only fine as long as it doesn't inconvenience you? It's not like you aren't already paying for ER visits through higher insurance premiums, state budget appropriations, federal reimbursements to hospitals that provide a lot of charity care, and of course the tax code (for-profit hospitals have their profits, and hence taxes, reduced by the cost of charity care).

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  3. 'Every ER visit that is replaced with an office visit saves costs while consuming no additional medical resources.'

    That's a theory, not a fact.

    '...hospitals in states which expanded Medicaid saw noticeable drops in both the uninsured and in the amount of charity care they had to provide....'

    Excuse me, but Medicaid IS charitable care. It just substitutes government charity for private. You need to show that that substitution was beneficial to the system as a whole.

    'And I don't understand your moral reasoning: What have you got against people getting health care they need?'

    Nothing. I object to wasting money on theories that are illogical on their face. BECAUSE that's likely to result in fewer resources being available to the truly needy. Say, what happened in this article;

    http://www.theatlantic.com/health/archive/2015/04/the-problem-with-satisfied-patients/390684/

    'When Department of Health and Human Services administrators decided to base 30 percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they likely figured that transparency and accountability would improve healthcare. The Centers for Medicare and Medicaid Services (CMS) officials wrote, rather reasonably, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.” They probably had no idea that their methods could end up indirectly harming patients.'

    Why they had 'no idea' is rather amazing since it's commonplace for such ideas to have unintended consequences. Especially when one party provides a good or service, a second party consumes, and yet a third pays for it. A recipe for inefficiency, I'd say.

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    1. Excuse you is right. Charity care yields zero revenue, whereas Medicaid provides revenue to hospitals. Which is why non-expansion states are seeing hospitals close.

      And it's a little funny for you to invoke efficiency when the U.S. spends more per capita on health care than any other industrialized nation, by a very large margin, and generates no more health care products than they do -- not to mention that it doesn't have the best health outcomes. The most marketized healthcare system in the world is the most expensive. Markets improve efficiency for lots of things, but healthcare clearly isn't one of them.

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    2. 'Charity care yields zero revenue, whereas Medicaid provides revenue to hospitals.'

      Only if you ignore the hidden sources of the revenues that hospitals receive to cover charity care. They can't continue to operate at a loss for long. They charge SOMEONE for their free care.

      Btw, hospitals have been closing for decades, as have doctor's offices.

      '...the U.S. spends more per capita on health care than any other industrialized nation, by a very large margin, and generates no more health care products than they do....'

      Again, you have to cherry pick statistics to 'prove' that. I have Canadian friends who tell me that if they really find themselves with a serious medical situation, they don't waste their time with Canada's system and its waiting lists, they go to the Mayo Clinic in Minnesota and pay out of pocket.

      As one of those friends said, about his country's system. 'They tell you it's free, but, you know what, you get what you pay for.' In his case, it was his life.

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    3. You accuse me of cherry-picking statistics, and then you cherry-pick mere anecdotes.

      For your information, according to McKinsey, the U.S. receives 60-85,000 medical tourists per year. By contrast, 750,000 Americans go abroad for health care. http://en.wikipedia.org/wiki/Medical_tourism

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  4. 'The medical sector continues to add 200,000+ jobs per year (http://www.forbes.com/sites/dandiamond/2014/06/06/since-obamacare-passed-50-months-ago-healthcare-has-gained-almost-1-million-jobs/), so it hardly seems correct to say capacity is fixed.'

    Ignoring the obvious post hoc,propter hoc, fallacy that Obamacare had anything to do with the 'new jobs', you mean. Health care has been expanding as a fraction of the economy for decades.

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    1. I didn't say anything about the cause of the new jobs; I just said the increasing employment in health care undermines your assumption that capacity is fixed. It's right there in what you quoted.

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    2. ' Markets improve efficiency for lots of things, but healthcare clearly isn't one of them.'

      How could you know that to be true? In the USA government pays for about half of all health care through the VA, Medicare and Medicaid. It heavily subsidizes private insurance through the tax code.

      It retards innovation with occupational licensing that allows a cartel to limit competition in the provision of health care, as well as in the market for drugs. Government has been much better at inhibiting market competition in health care than allowing it.

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    3. Well, we know that efficiency involves getting the most output for the least input. Then we look at the data; that's how we know it to be true. The VA, Medicare, and Medicaid all have much lower overhead costs than private insurance, giving them a leg up in being more efficient. Medicare would be even more efficient if the government allowed it to negotiate drug prices like private insurance companies do.

      And you want to tell me there are all these imperfections in the U.S. medical market, but the U.K. is pretty close to pure socialized medicine, with the providers being government employees. So the U.S. system is far more market-oriented than the U.K. system -- yet the U.S. system is more than twice as expensive. You want to compare imaginary market outcomes rather than look at what really happens in medical markets.

      This is your last post in this thread. You have your own blog; criticize me there if you want to. I don't have any obligation to give you free traffic if you're not doing the same. You are still free to comment on other posts.

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