Author Topic: Munger Says We Will Have Single Payer  (Read 10885 times)

Schwab711

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Re: Munger Says We Will Have Single Payer
« Reply #30 on: June 04, 2018, 11:33:07 AM »

health care in the US........

any thoughts on this?

I am worried because I am invested in the MCOs
\

If the government were to institute a universal coverage system it would most likely be outsourced to MCOs. MCOs run most Medicaid plans today and are taking share quickly and close to half share in Medicare. Government run fee for service plans are not the way forward.

Word. The term 'single payer' is probably misleading for the broad population.

Aside from that, if you zoom out and look at the next century, I believe significantly more lives will be lost to reduced innovation than gained by single payer.

We can show that this this is unlikely to be true. In 2017, approximately 10% of the population didn't have health insurance. It was ~20% prior to ACA. This statement assumes that the remaining 10% are not worth insuring because we could 'save the lives' of 11.1% of the 90% insured (10% of the population). The 90% insured is generally composed of working folks (private [employer] insurance), elderly (Medicare), and the disable/poor (Medicaid). Most likely, the 11.1% we would be saving would come from the Medicaid population since you can't prevent aging and the working class is generally much healthier than any other group (since there's some Bayes Theorem in the sense that if you are healthy, you are able to work).

Pre-ACA, we'd have 20% of the population uninsured and the majority of insured Americans would be on private insurance or Medicare. It would be impossible to find 25% of the 80% on private insurance/Medicare that have inadequate coverage to the degree that those additional Medicaid subsidies would be better spent 'saving' them as opposed to providing basic treatment/services to uninsured. Obviously incremental gains are largest when you have no care (uninsured) relative to at least some care (the presently insured).

I can understand arguments along the lines of 'moral hazard' and they probably have a lot of validity (it's a subjective topic so I'm not sure how we can be any more generous than 'probably'). However, to say that incremental care of insured persons could provide greater healthcare outcomes relative to the gap between no care and basic care doesn't make sense to me. Especially in the numbers you are talking about.


Greater than 50% of lives saved from innovation in the last century are not a result of infant and children's death's.

Where does this stat come from? What metric are you using (or quoting) to determine 'lives saved'? I've never seen any study that even hints at anything other than infant mortality as the primary reason for increasing longevity.

Again, a simple thought experiment will show why.

Say we have 10 people in the country and 20% infant mortality. There lifetimes last (in years):
1
1
60
60
65
65
70
70
75
75

This implies a longevity of 54.2 years.

Let's say we decrease infant mortality to 10% and one of those babies lives to 60. The longevity would increase to 60.1 years.

Now instead, let's leave infant mortality at 20% and increase the life of surviving individuals by 5 years (that's huge innovation!). The longevity would increase to just 58.2 years.

Having more people live a full life is the easiest way to increase national longevity. It's really not even close. The properties of an average/mean dictate this. If the argument is more based on 'standard of living' then there is a lot of subjectivity and it's hard to rigorously conclude anything.


If you invest in biotech you'll know that 'innovation' in healthcare really isn't as impressive as marketing would make you think. Most leading cancer drugs barely provide statistically significant improvements over placebos or the current standard of treatment. The best treatments extend life expectancy of someone with terminal illness by 10% or so on average. The intended patient populations for these drugs are measured in the thousands. Obviously individual experiences may make folks think it's a miracle drug but it just doesn't move the needle for a nation's health. If anything, these types of innovations are the cause of our escalating healthcare costs.

The biggest healthcare innovations over the last 200 years are probably washing our hands, vaccine/inoculations, and penicillin. Simple stuff with mass application goes a long way.


Cigarbutt

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Re: Munger Says We Will Have Single Payer
« Reply #31 on: June 04, 2018, 01:57:04 PM »
If you invest in biotech you'll know that 'innovation' in healthcare really isn't as impressive as marketing would make you think. Most leading cancer drugs barely provide statistically significant improvements over placebos or the current standard of treatment. The best treatments extend life expectancy of someone with terminal illness by 10% or so on average. The intended patient populations for these drugs are measured in the thousands. Obviously individual experiences may make folks think it's a miracle drug but it just doesn't move the needle for a nation's health. If anything, these types of innovations are the cause of our escalating healthcare costs.

The biggest healthcare innovations over the last 200 years are probably washing our hands, vaccine/inoculations, and penicillin. Simple stuff with mass application goes a long way.

1+ from my perspective also.
From the what is provided point of view, perhaps we're in a diminishing return temporary plateau but, apart from some breakthroughs, progress at that level has been slow for quite some time.

The quality/cost curve has been unfavorable and whatever the reason (too little or too much government, distorted private incentives or a combination of both), innovation should not be limited to what is provided but also to how it is provided.

longinvestor

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Re: Munger Says We Will Have Single Payer
« Reply #32 on: June 04, 2018, 03:28:08 PM »
https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

There are about 30 nations who have longer life expectancy stats than the US. One interesting stat is the Health Adjusted Life Expectancy (HALE) (Healthy Years  + Disability Years), which for the US is 69. Full LE is 79. That delta of 10 is in the same ballpark as the 30 higher ranking nations.

The purported healthcare innovation is akin to throwing money at the problem.

Cigarbutt

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Re: Munger Says We Will Have Single Payer
« Reply #33 on: June 04, 2018, 04:50:32 PM »
https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

There are about 30 nations who have longer life expectancy stats than the US. One interesting stat is the Health Adjusted Life Expectancy (HALE) (Healthy Years  + Disability Years), which for the US is 69. Full LE is 79. That delta of 10 is in the same ballpark as the 30 higher ranking nations.

The purported healthcare innovation is akin to throwing money at the problem.

Complementary info:
https://www.ncbi.nlm.nih.gov/books/NBK62584/

The first two paragraphs summarize well.
Basically, at the individual or "mutual level", it boils down to an NPV decision to see if potential useful life lost is worth the investment.
The Constitution mentioned that all are created equal and can have a free and happy life (duration not mentioned).
Life expectancy, when the document was written, was estimated in the mid 30's but recently, after incredible progress, in the aggregate, has been dropping for two years in a row.
Multi-dimensional problem but America's best days lie ahead (ref: Warren Buffett).

KJP

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Re: Munger Says We Will Have Single Payer
« Reply #34 on: June 05, 2018, 08:04:12 AM »
https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

There are about 30 nations who have longer life expectancy stats than the US. One interesting stat is the Health Adjusted Life Expectancy (HALE) (Healthy Years  + Disability Years), which for the US is 69. Full LE is 79. That delta of 10 is in the same ballpark as the 30 higher ranking nations.

The purported healthcare innovation is akin to throwing money at the problem.

Complementary info:
https://www.ncbi.nlm.nih.gov/books/NBK62584/

The first two paragraphs summarize well.
Basically, at the individual or "mutual level", it boils down to an NPV decision to see if potential useful life lost is worth the investment.
The Constitution mentioned that all are created equal and can have a free and happy life (duration not mentioned).
Life expectancy, when the document was written, was estimated in the mid 30's but recently, after incredible progress, in the aggregate, has been dropping for two years in a row.
Multi-dimensional problem but America's best days lie ahead (ref: Warren Buffett).

"In the aggregate" there's been a dip recently, but under the hood there's a more disturbing longer-term picture for some:

https://www.vox.com/science-and-health/2018/1/9/16860994/life-expectancy-us-income-inequality

Of course, there's more than just less access to healthcare driving the growing disparity in outcomes.

frommi

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Re: Munger Says We Will Have Single Payer
« Reply #35 on: June 05, 2018, 08:49:06 AM »
"In the aggregate" there's been a dip recently, but under the hood there's a more disturbing longer-term picture for some:

https://www.vox.com/science-and-health/2018/1/9/16860994/life-expectancy-us-income-inequality

Of course, there's more than just less access to healthcare driving the growing disparity in outcomes.

Based on what i know longevity has nothing to do with healthcare costs, its much more a factor of what you eat, drink, smoke and how much you use your body. No drug in the world will deliver what not smoking and drinking, eating healthy and running/weightlifting 2-3 times a week does for you. And the richer you are the more you know and care about that, its not even about the money directly.

jmp8822

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Re: Munger Says We Will Have Single Payer
« Reply #36 on: June 05, 2018, 09:14:44 AM »
"In the aggregate" there's been a dip recently, but under the hood there's a more disturbing longer-term picture for some:

https://www.vox.com/science-and-health/2018/1/9/16860994/life-expectancy-us-income-inequality

Of course, there's more than just less access to healthcare driving the growing disparity in outcomes.

Based on what i know longevity has nothing to do with healthcare costs, its much more a factor of what you eat, drink, smoke and how much you use your body. No drug in the world will deliver what not smoking and drinking, eating healthy and running/weightlifting 2-3 times a week does for you. And the richer you are the more you know and care about that, its not even about the money directly.

+1

Also, to be rich you need self-discipline.  To eat healthy you need self-discipline.  To limit smoking/drinking you need self-discipline.  Poor people would be extremely unlikely to start eating kale and flax seeds if you gave them an extra $5,000 per year.  Junk food and poverty are a mindset, not an income.

sleepydragon

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Re: Munger Says We Will Have Single Payer
« Reply #37 on: June 05, 2018, 09:50:10 AM »
Speaking of flax seed, I gave my chicken that stuff. Lol
According to my wife, flax seed has long chain omega 3 which is very hard for human to digest. But chicken can digest it and turn them into short chain omega 3 in their eggs which is better for human

KJP

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Re: Munger Says We Will Have Single Payer
« Reply #38 on: June 05, 2018, 10:48:33 AM »
"In the aggregate" there's been a dip recently, but under the hood there's a more disturbing longer-term picture for some:

https://www.vox.com/science-and-health/2018/1/9/16860994/life-expectancy-us-income-inequality

Of course, there's more than just less access to healthcare driving the growing disparity in outcomes.

Based on what i know longevity has nothing to do with healthcare costs, its much more a factor of what you eat, drink, smoke and how much you use your body. No drug in the world will deliver what not smoking and drinking, eating healthy and running/weightlifting 2-3 times a week does for you. And the richer you are the more you know and care about that, its not even about the money directly.

It's quite difficult to tease out the effects of lack of health care access on mortality versus other factors, but to my knowledge the existing data suggests there is a relationship.  See, e.g.,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775760/   
If you are aware of contrary studies that suggest no link in the US between access to healthcare and mortality, I'd be interested in seeing it.  More anecdotally, do you really believe that poverty has nothing to do with, for example, having hookworm, or that having hookworm has no impact on overall outcomes:  https://www.theguardian.com/us-news/2017/sep/05/hookworm-lowndes-county-alabama-water-waste-treatment-poverty

You also didn't mention a few other factors associated with poverty that likely increase mortality:  (i) more environmental pollution; (ii) more dangerous jobs; and (iii) more overall stress.

Regarding the "self-discipline" argument, I think it's easy (and perhaps comforting) to say that the poor die sooner because they are lazy, impulsive and stupid.  I personally doubt that account and the policies based upon (or justified by) it.
« Last Edit: June 05, 2018, 10:53:07 AM by KJP »

jmp8822

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Re: Munger Says We Will Have Single Payer
« Reply #39 on: June 05, 2018, 11:14:33 AM »
"In the aggregate" there's been a dip recently, but under the hood there's a more disturbing longer-term picture for some:

https://www.vox.com/science-and-health/2018/1/9/16860994/life-expectancy-us-income-inequality

Of course, there's more than just less access to healthcare driving the growing disparity in outcomes.

Based on what i know longevity has nothing to do with healthcare costs, its much more a factor of what you eat, drink, smoke and how much you use your body. No drug in the world will deliver what not smoking and drinking, eating healthy and running/weightlifting 2-3 times a week does for you. And the richer you are the more you know and care about that, its not even about the money directly.

It's quite difficult to tease out the effects of lack of health care access on mortality versus other factors, but to my knowledge the existing data suggests there is a relationship.  See, e.g.,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775760/   
If you are aware of contrary studies that suggest no link in the US between access to healthcare and mortality, I'd be interested in seeing it.  More anecdotally, do you really believe that poverty has nothing to do with, for example, having hookworm, or that having hookworm has no impact on overall outcomes:  https://www.theguardian.com/us-news/2017/sep/05/hookworm-lowndes-county-alabama-water-waste-treatment-poverty

You also didn't mention a few other factors associated with poverty that likely increase mortality:  (i) more environmental pollution; (ii) more dangerous jobs; and (iii) more overall stress.

Regarding the "self-discipline" argument, I think it's easy (and perhaps comforting) to say that the poor die sooner because they are lazy, impulsive and stupid.  I personally doubt that account and the policies based upon (or justified by) it.

Here is what I know about my Midwest city: I grocery shop in the rich part of town every Wednesday and almost everyone is buying healthy food. I then grocery shop in the poor part of town every Sunday and almost everyone is buying junk food.  And the junk food is not cheaper - if anything, it is more expensive. I'm talking brand name everything junk food.  Why are those poorer people buying junk food that will kill them sooner? I'll let you solve that.  But, it is an undeniable, extremely strong correlation and if your answer is 'policies' good luck with that.