Monday, May 17, 2010

A Bizarre Paper, But With An Important Point

Private-Payer Profits Can Induce Negative Medicare Margins

Jeffrey Stensland, Zachary Gaumer & Mark Miller
Health Affairs, May 2010, Pages 1045-1051

Abstract: A common assumption is that hospitals have little control over their costs and must charge high rates to private health insurers when Medicare rates are lower than hospital costs. We present evidence that contradicts that common assumption. Hospitals with strong market power and higher private-payer and other revenues appear to have less pressure to constrain their costs. Thus, these hospitals have higher costs per unit of service, which can lead to losses on Medicare patients. Hospitals under more financial pressure-with less market share and less ability to charge higher private rates-often constrain costs and can generate profits on Medicare patients.

Good lord. The problem is not "profits," but rather that costs are increasing without bound. The point is that in the absence of any kind of competition, the very idea of "cost" is poorly defined. Every step along the line can charge higher prices, because the costs are passed on. You can call that profit if you want, but it's really just a transfer based on the monopoly protections afforded to health care by government restrictions on advertising, and the creation of insuperable entry barriers.

Two things you should read, if you think the article above makes sense (hint: it doesn't)

1. My little piece on insurance, at REASON
2. Nick G's cool piece on eye surgery, at ReasonTV

Cost can come down in a hurry, with competition. But the Obamacare program will, if anything, make the problem worse by focusing on insurance and bureaucratic price-fixing. In any case, blaming "profits" is the sort of idiocy you learn in public health schools, where as far as I can tell they would save time if they could just lobotomizing students. A lobotomy and an MPH are only distinguished by the size of the scar they leave; the effects are identical.

(Nod to KL for the article)

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