He writes,

no one has collected the information I consider most important. The literature review underlying the USPSTF’s updated recommendations concludes “there is no accepted risk-assessment tool to help tailor colorectal screening” to patients with above-average risk; we still do not know the significance of small polyps; and, most stunning, “no [colorectal cancer] screening modality has been shown to reduce all-cause mortality.”

Because of my medical history (Crohn’s disease), a family friend who is probably the best gastroenterologist I know recommended that I get a colonoscopy screening every year! I have not done so, but I have gone for screening, which I probably would not have done at all if I had no history.

In order to prevent death, a colonoscopy must detect and remove polyps that will evolve into cancer that worsens rapidly enough to kill you before something else does. What we know is that a doctor can use colonoscopy to detect and remove polyps. The rest is much harder to pin down.

Most colonoscopies do not detect polyps, presumably because many people do not have them. These “clean” colonoscopies are a relief to patients, but they greatly increase the cost per life saved from routine colonoscopy screening. And if “all-cause mortality” is unaffected by the procedure, then the cost per life saved is infinite.

Summarized here. Twelve points, including

Health Status Insurance: For the first time, people with pre-existing conditions will have real protection against discrimination and against the “race to the bottom,” reflected in narrow networks and high drug costs for the chronically ill. Risk adjustment between health plans (similar to Medicare Advantage) will insure each plan receives an actuarially fair premium when receiving an enrollee from another plan. (Plans will not benefit by seeking the healthy or avoiding the sick.) Plans are free to voluntarily agree to better risk adjustments, so there will eventually be free market risk adjustment. We expect plans to eventually specialize, with some plans becoming focused on cancer care, others on heart care, etc.

…Grandfathering. To minimize potential disruption, self-insured employer plans and labor union plans may elect to remain in the current tax system. Individuals with insurance obtained from an (ObamaCare) exchange may elect to remain in that system.

The latter is this proposal’s version of “if you like your plan, you can keep your plan.”

I happened to run into John last week, and he was very enthusiastic about the plan. I expressed my doubts about something like this getting anywhere with a Trump candidacy, and he said that he was actually optimistic. But when I pressed him, John admitted that “Trump is hard to get to see.”

In a comment, Spencer wrote,

You just can not resist claiming that firms were required to provide health insurance.

It may not matter whether you think of firms as obligated to provide health insurance or as incentivized to provide it. The trend toward reducing the number of full-time workers would be affected by rising health care spending nonetheless.

Workers differ in their preferences for employer-provided health insurance and take-home pay. This leads to clientele effects. That is, workers who place a high value on employer-provided health insurance will seek to be full-time employees. Workers who would rather receive more take-home pay and deal with health insurance some other way will instead prefer to be hired as contractors.

As health care spending rises, these clientele effects get stronger. One would expect to see more workers noticing that they can get higher take-home pay as contractors, and one would expect to see firms notice that their compensation costs for hiring contractors are coming down relative to the cost of hiring full-time workers.

On Tuesday, there was a full page ad in the WaPo signed by various economists about the issue of chronic diseases, including Douglas Holtz-Eakin of the center-right and David Cutler of the center-left. The ad did not say much, and it referred the reader to this page.

Our health care system needs reforms that align incentives to encourage payers, providers, employers, and individuals to better prevent, detect, treat, and manage chronic diseases – both physical and mental – before they become an acute problem. Special attention should be paid to patients with multiple chronic conditions who consume the majority of the nation’s health care spending.

Read the whole page. I am afraid that all I could take away from it is that a few chronic conditions generate a lot of health care spending, and public policy should deal with this. When I see a phrase like “special attention should be paid,” I note two things.

1. It is in passive voice.

2. It seems to say, “We know there is a problem, but we have no idea what to do about it.”

The cynic in me thinks that what these economists want is more funding for their research into the impact of these diseases on health care spending.

Timothy Taylor writes,

Health care prices aren’t being set in a well-functioning competitive market. Some geographic markets just lack competition in health care. But in many others, prices for hospital services are being negotiated in ways that result in big variations between geographic areas–like prices for a given service in one place being a multiple of what it costs in other places. In turn, these different prices being charged are linked to big differences in spending across geographic areas. Moreover, all of this is happening in a setting with potentially large cross-subsidies–potentially running in either direction–between private health insurance and public health insurance programs like Medicare. It’s all part of the reason why designing policies to slow the rise in health care spending is so difficult.

What you will hear is that the problem is with our free-market health care system. For many people, “free-market”
serves as an all-purpose boo-word. Of course, my own view is that health care regulations are what are most heavily implicated in the high, opaque pricing of medical services.

In a comment, he writes,

As bad as it may presently be, the whole domain between the current equilibrium and a more genuinely market-like equilibrium is a vast no-man’s-land of even more dysfunctional instability. This type of circumstance is usually a big factor when bad systems are surprisingly stable.

Again, anyone that proposes a reform that relies on nudging the system towards the market-equilibrium from where we are now by taking one little step is being very naive. One has to accept the possibility that we might have to pair pro-market moves with non-Libertarian coercive regulatory actions, at least in the short-term.

These are provocative statements, with which I am inclined to agree. For a long time, I have been saying that he basic problem we face is that in the United States we undertake many medical procedures that have high costs and low benefits. There are two directions that we can turn in order to change this. The “left turn” is toward government rationing. The “right run” is toward the price mechanism, with market forces turned loose and health insurance providing only catastrophic coverage, so that consumers must confront the true marginal cost of what I call “gray area medicine,” where the benefits are low and uncertain.

Obamacare is a weak left turn, that neither solves the basic problem (high-cost, low-benefit medical procedures) nor satisfies the goals of those on the left to equalize access to health care services. My reading of Handle’s comment is that what is likely to happen if Republicans win in 2016 is a weak right turn, which will not solve the basic problem and not satisfy the goals of the right to foster a flexible, innovative health care system.

I will repeat my mantra that what individuals want is unlimited access to medical services without having to pay for them. To the extent that politicians attempt to satisfy this, they create incentives for ever-increasing spending. That describes the status quo, which Obamacare did not change.

From where we are now, it is hard to move either left or right. Households and businesses are basically satisfied, despite grumbling about higher health insurance premiums and higher deductibles. Health insurance companies are basically satisfied, despite grumbling about regulation. Health care providers are basically satisfied, despite grumbling about insurance company practices. So the politically winning approach is to tell everyone “you can keep your ___.”