Wednesday, October 21, 2009
Is it just me
On my way up to Montreal on Friday I was treated to the first of This American Life's two-part series on health insurance in America. Today, I've been blazing through the second, and I must say that I'm taken aback at how conservative it is. It sounds as if it was sponsored by Blue Cross for how tender it is to the insurance industry. In fact, both shows make a mighty effort to convince their audience that everything is wrong in American healthcare but insurance companies. The bottom line, apparently, is that premiums only go up because of hypochondriac patients, overcautious or smug doctors, mincing, greedy drug manufacturers and bird-brained public policy. At point the show even baldfacedly contends that insurance companies couldn't really deny that many people payment for their services because then they'd lose customers, but provides no evidence that this is in any way true except to ask an insurance executive's opinion. Another commentator then claims that insurance companies should deny payment more often, as they did when HMO's ruled in the 90's, because to do so would better contain costs, and mocks those instances when such denial was fatal as "anecdotal horror stories." I always have had beef with Planet Money for being such a shill of business and economic orthodoxy, but to add This American Life to the casualty list weighs heavily on my heart. The decade and a half that NPR has spent relying almost entirely on corporate largesse has certainly decayed its progressive roots.
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Well hopefully next week they can go back to interviewing people about the sandwich that changed their lives.
ReplyDeleteSol's still pissed cause I made him listen to a whole episode about the classified section of the Chicago Tribune.
ReplyDeleteI definitely looked forward to both the episodes, and while they were both interesting you're right that they work pretty dang hard to make the insurance companies look like helpless damsels tried to a train track. It was also the first time I'd ever heard anyone speak fondly of the HMO days, which was a little confusing. But you have to keep in mind that the Planet Money team is on the right in most cases; remember the hour-long Watchmen episode they did, which spent the first 30 minutes working you into a rage over Moodys and rating agencies and deregulation, only to tell you that Moodys was really only acting under systemic pressure, and so how can you blame them anyway, and also regulation ain't so hot? That was infuriating, for reals.
I think that their main point, though, was that American health care is structured around manipulating the fears and shortcomings of ordinary people to circumvent the desires of their doctors, and that the pressure to keep the system working like that comes from a whole bunch of places. Insurance companies are imhumane leeches, to be sure, but just cause you can recite the hippocratic oath doesn't make you a saint either. And more importantly, the healthcare recipients being discussed here are American consumers, a group of people notorious for their poor purchasing abilities.
I had no real problem with the coverage they did of hospitals. I thought that it was quite clever of them to dig up the dirt on that sector of healthcare, one which, as far as I know, has been AWOL since the beginning of the reform debate. Doctors are the best paid professionals in the United States, and are not well-known, at least here, for upholding the health of their patients over the health of their portfolios. My only complaint really is that it seemed completely unnecessary to try and fight tooth-and-nail for insurance companies. They're still trying to make a profit, and a good one, and that's why they raise premiums so dramatically when outside pressures force costs up. That's not some automatic price-stabilizing supply-and-demand-esque action; it's a conscious decision to keep margins between 5 and 10% no matter the price their clients have to pay. And, though they were entirely dismissive of the public option, they seem to have missed the point. If the public option doesn't have to make a profit and it has enormous bargaining clout, then it is doubly resistant to the pressures that insurance companies seem so bad at facing.
ReplyDeleteMoreover, that little section at the end with Uwe Reinhardt was just disgusting. Why did they bring him on to tell us that insurance executives are all really nice guys who are just doing their (unfortunately evil) jobs? I thought Hannah Arendt turnbuckled that line of reasoning when she wrote about Eichmann. All in all, a real disappointment. Bring back the sandwiches.
Oh, and what is it with people in economics and constantly flogging the 'well, even if you don't like things now, back then they were so much easier only because they were horrible' trope? Adam Davidson did not need to condescend to us by talking about how miserable healthcare was in 1900 in order to illustrate that it got expensive when it started to work. What does that prove, that the only way to bring costs down is to revert to lichen tonics and gambling oil? I wish he would get swallowed by a python.
ReplyDeleteI actually found the Uwe Reinhardt segment the most interesting. Not so much the bit about insurance companies being nice folks (whether or not they are--and as you point out Lion, anyone who enriches him or herself within a system that is itself immoral is probably a shithead--is really pretty irrelevant to anything), but about his general claim that it is a lack of competition among providers, and not insurers, that drives up the cost of care.
ReplyDeleteI had never heard that argument before. And given the fact that, as was pointed out in the part 1 of the story, providers are even more profitable than insurers, it doesn't strike me as an unreasonable conclusion. I've been looking around for studies, or even blogged commentary, on that claim, but I haven't found anything. If any of you see something to that effect, post it.
What doesn't make as much sense to me is the Reinhardt, who I've always heard was a pretty upstanding guy on these issues, uses this argument to bludgeon the public option. As he sees it, diluting market power within the insurance market will by definition increase the bargaining power of providers, the latter effect being the source of health care inflation. But, as Lion mentioned, if the public option was strong enough and, oh say, set its prices along side those of Medicare, government provided/sponsored care in the form of medicare, medicaid, and the public option, would (maybe) be able to effectively set prices for a huge segment of the market. Which is, after all, the solution Reinhardt advocates.
Yeah, but, sandwiches.
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