Map of life expectancy at birth from Global Education Project.

Thursday, March 31, 2016

Did I ever mention that we need universal, comprehensive, single payer national health care?

I may have noted that once or twice.

Anyway, as I have also noted, Obamacare is an improvement on what we had before. In fact it's worked better than expected! But it's a very kludgy fix.

The consulting firm Avalere Health, which for some reason sends me free excellent analysis every couple of days, finds a lot of "churn" in the exchanges from year to year. Specifically, only 1/3 of people who were enrolled in 2015 kept the same plan in 2016. They figure this is because most people who buy insurance through the exchanges are low income, and very sensitive to price. That means they are always shopping for a cheaper deal.

On the one hand, that doesn't sound like such a bad thing. In fact, if you're a conservative free market ideologue, you should be super duper happy. Consumer choice! Competition! Adam Smith!

The bad news is, however, that this likely means for many of them that they end up changing providers. Continuity of care is very beneficial. You know your doctor, your doctor knows you. You don't have to tell your story all over again, get records transferred, navigate unfamiliar systems. You get better outcomes. Even if your doctor retires or moves to Borneo, she can manage a smooth transfer to a colleague.

There isn't actually any benefit in this phony choice among insurance companies. If we had universal, comprehensive, single payer national health care then you could pick any doctor who had an opening and stay with him or her if you liked the relationship, or move on if you didn't. The single payer would get a single, fair price from everybody, and could pay for results, not volume. And the insurance companies wouldn't be skimming off profits, marketing and administrative costs. We'd all be better off.

But you know, soshulism.

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