What Was Wrong With My Last Video
July 31, 2009
After I posted my last video on wait times for getting a doctor’s appointment in Atlanta, Georgia vs. wait times in Boston, Massachusetts despite the fact that insurance premiums are drastically more expensive in Boston, I received a more mixed response than to any of my other videos.
Fortunately, I have commenters who are much smarter than I am. So I want to take the time to make note of what was wrong with that video.
Things that were wrong:
- While I didn’t say this, I left the impression that the universal health coverage program in Mass was solely responsible for the expensive premiums. That is not the case. In the study I referenced, premiums were extremely high in Mass, but that was done before universal health coverage (UHC) was implemented. There has not (to my knowledge) been a similarly comprehensive study done since the implementation of UHC, so I cannot say that UHC inevitably leads to higher premiums.
- Instead of comparing Boston to all the places that don’t have UHC, I picked one place that I liked (I used to live in Atlanta). Atlanta is particularly good on wait times, but it isn’t average. It would have been far better to compare Boston to the rest of the country as a whole.
Things that weren’t wrong, but that people complained about anyway:
- “The cost of living is higher in Boston. That is what drives the insurance premiums higher”
This statement was done by people who haven’t actually run the numbers. No one has yet explained to me how a 14% increase in cost of living between Atlanta and Boston explains a 300% increase in health insurance premiums. More importantly, no one has pointed out that doctors in Boston make significantly more than doctors in Atlanta (which would be a far more important data point for investigation).
Also, it doesn’t explain the difference between Boston and Los Angeles. The Los Angeles cost of living is 22% higher than Boston, but they still have cheaper insurance. And they still have wait times that are half of Boston’s.
To me, the most important point of all of this is the fact that we may not have enough data to say that UHC has actually caused Boston to get a lot worse than it already was, but we do have enough data to say that it certainly hasn’t made things better.
Some people would point out such statistics as “Well, nearly everyone in Massachusetts has health insurance now! It’s been a success!” (In fact, that’s exactly what Mitt Romney does when he says we should, like, totally copy the Massachusetts model.)
But this isn’t a single variable issue, it’s a trade-off issue. If we gave everyone in the country health insurance, but it cost $1 trillion per year, everyone would be against it because the benefit outweighs the cost. Similarly, if we provided everyone with health insurance and kept the cost the same as before, but it took five times as long to get a treatment, most people would still be against it.
It is not self-evident to me that 100% health insurance coverage is a good thing because it depends so heavily on the trade-offs. You could have “100% health insurance coverage” as a matter of statistics, but if that means that it takes three years on a waiting list to get a hip replacement, I’ll stick with the 85% we have today.
And I’ve only mentioned three variables here (cost, insurance coverage and wait times). There is a balance between hundreds of variables that has to be maintained. If you ever listen to the President’s speeches on this issue, you come away with the impression that there will be no trade offs and that it will be cheap premiums, universal coverage and no wait times! And the government will make drugs cheaper.
Also, there will be rainbows and ponies.
Call me a cynic, but that kind of thinking about in the UHC plan strikes me as somewhat naive.
What I would like to see is a comprehensive study of the effects on the Massachusetts plan on the health care system. I don’t know that there are really that many positive effects other than “Look, everyone has health insurance!”