Some Weekend Research Summaries

A few miscellaneous items.

First, I have written recently about the damage consolidation among health care providers and health plans is doing to costs, access and quality in the United States.  A recent article in the Journal of the American Medical Association points out how ill-advised government regulation (is there any “well-advised” government regulation?) has contributed to our spending woes.  Laws restricting the development of new facilities and prohibiting physician ownership of facilities has led to the shortage of capacity which contributes to higher prices as well as making access to needed services difficult.  (JAMA Article)

For several decades in health care there has been a belief that if you just intensively manage certain conditions or certain people’s health, you can lower total spending and improve quality outcomes.  The research, in general, has not supported these claims.  Another recent study of an program for those with serious kidney disease comes to similar conclusions.  A large health system used a team approach and electronic health records to try to slow progression and improve adherence to care guidelines.  While more drugs were used, there was no difference in progression to more serious kidney disease.  And likely there was higher total spending when the cost of the program was included.  (JAMA Article)

This study looked at whether being in a Medicare Advantage plan lowered out-of-pocket spending for enrollees.  The research found small differences in such spending, somewhat lower for MA members, which varied by income level.    (Annals Article)

The Congressional Budget Office regularly estimates how much of the population has some form of health care coverage, what percent is uninsured, and makes future projections regarding coverage.  The percent uninsured is always fodder for the single-payer nuts, but the fact is that most uninsured people choose that status because they are usually young and have low health expenses.  According to CBO, the population will grow from 342 million in 2024 to 360 million in 2034. (they must think Biden won’t be re-elected).  The percent uninsured will rise from 7.7% now to 8.9% during that period, with almost all the growth in people aged 19 to 44, consistent with my statement above.  The rise in uninsured is due to expiration of the epidemic Medicaid expansion, the potential expiration of the completely misnamed Affordable Care Act subsidies and illegal immigration.   The following numbers show why we are so screwed in a country full of slackers and grifters.  Employer plans will only go from covering 164 million people to 169 million, Medicare will rise from 60 million to 72 million, Medicaid will drop from 92 million to 79 million (that epidemic expansion was incredibly costly), and individual coverage, mostly subsidized ACA plans, will increase from 19 million to 20 million. (note that some people have two forms of coverage, for example, Medicare and Medicaid)  So basically 171 million Americans getting their health care largely paid for by the government at mammoth cost.  Not sustainable.  That Medicaid number is the biggest problem, and a bunch of Medicare is supposedly disabled people, who are largely people disinterested in working.   (HA Article)